News Release

Tackling the obesity epidemic: governments must lead

Peer-Reviewed Publication

The Lancet_DELETED

The final paper in The Lancet Obesity Series looks at the interventions needed to halt and reverse the epidemic. The paper—by Professor Steven L Gortmaker, Harvard School of Public Health, Boston, MA, USA, and colleagues—says the changes needed are likely to require many sustained interventions at several levels, but that national governments should lead them.

The authors say: "Many parties—such as governments, international organisations, the private sector, and civil society—need to contribute complementary actions in a coordinated approach. Priority actions include policies to improve the food and built environments, cross-cutting actions (such as leadership, healthy public policies, and monitoring), and much greater funding for prevention programmes. Increased investment in population obesity monitoring would improve the accuracy of forecasts and evaluations."

The authors identify several effective and cost saving policies that governments should prioritise for implementation. These include taxes on unhealthy food and drink (such as sugar sweetened beverages) and restrictions on food and beverage TV advertising to children. Cost effectiveness studies indicate the importance of such policy approaches and their potential to reduce long term health-care costs. The authors note that policies such as taxation and limiting marketing to children were effective in tobacco control.

They state that decision makers should also consider implementation issues including feasibility, sustainability, and effects on equity. Policy makers need to weigh the relative benefits of high-impact interventions reaching a modest number of people against lower-impact interventions reaching wider populations.

Much better monitoring of obesity trends and physical activity is needed across all countries, including high-income countries that are far behind where they could be. Most countries still need basic data: only a third of European Union nations have representative data on children's weight and height. Even fewer countries have set targets for rates of obesity or for changes in determinants such as dietary intake and physical activity. Political leadership for action is low in many countries; the interest of the US First Lady, Michelle Obama, in the issue of obesity shows the value of such attention.

As pointed out in a previous paper in the Series, steep reductions in calorie intake are needed for US adults to attain their 1978 BMI levels; around 240 calories per day for the average person, but double this reduction is needed for obese adults of BMI 35 or higher. Countries must focus on prevention in new birth cohorts, so that children of normal size do not become overweight or obese in adulthood (since reversal of obesity trends become more difficult as excess weight accumulates).

UN Member States will soon gather in New York in September, for the first High-Level Meeting of the UN General Assembly focused on non-communicable diseases. The global obesity epidemic, described as a "wicked problem" because of its complex and intractable nature, will be a huge challenge for Member States.

A wide-ranging effort from many sectors of society will be needed to tackle this obesity epidemic. The authors say the national governments are the most important players and should lead obesity prevention efforts, since they have the ability to regulate at a population level and introduce interventions such as junk food taxes. A more systems-based approach is needed where greater investments are made in the core, structural support systems for obesity prevention, such as workforce development, healthy public policies, leadership and cross-sectoral platforms for action. In addition, international agencies, the private sector (through self-regulation), civil society, health professionals, and individuals must all play their part.

The authors conclude: "The UN meeting provides a key opportunity to strengthen international leadership from the UN and its agencies, and to stimulate other agencies and states to begin to seriously address the continuing global epidemic of obesity. Beyond that meeting, the test will be how well Member States match their declarations with supportive funding and policies to support global actions."

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Professor Steven L Gortmaker, Harvard School of Public Health, Boston, MA, USA. (in UK Tues 23rd-Sat 27th Aug) T) +44 (0) 7808 799161 E) sgortmak@hsph.harvard.edu Alternative contact: Todd Datz, Media Relations. T) +1 617-432-8413 E) TDATZ@hsph.harvard.edu


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