Unprecedented obesity rates are a “time bomb” of future burdens on health care systems but global efforts to reverse the epidemic are failing, according to a major new series in the Lancet, one of the world’s top medical journals.
An estimated 2.1 billion people are now overweight and even modest targets set by the World Health Organization — to maintain zero growth in obesity rates between 2010 and 2025 — are at risk of being missed.
Turning this tide will require strong government policies, as well as engagement from the food industry, civic society and health practitioners, according to the Lancet series, published Wednesday.
But the world also needs to shift how it currently thinks about obesity, said Christina Roberto, who led one of the six studies in the series.
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Obesity, she said, is a multi-faceted health problem — caused by everything from genes and globalization to predatory food marketing aimed at children — that demands an equally complex solution.
“An individual is responsible for his or her food choices but it’s often true that the environment shapes what we eat,” said Roberto, an assistant professor with the Harvard T.H. Chan School of Public Health.
“The discourse has traditionally been focused on ‘oh, it’s either the individual or it’s the food environment.’ What we’re trying to say is both are true.”
The Lancet series explores a wide-ranging approach to tackling obesity, which can lead to chronic ailments like diabetes, cardiovascular diseases and cancer. As of 2010, a high body mass index (which calculates body fat based on height and weight) accounted for roughly 2.8 million deaths per year.
While everybody is vulnerable to eating too much unhealthy food, modern environments have been “designed to exploit that biological vulnerability,” Roberto said.
The risk is particularly high for children, who are heavily targeted by the food industry, according to Dr. Tim Lobstein with the World Obesity Federation, another study author.
“Not only can the companies influence children’s immediate dietary preferences, but they also benefit from building taste preferences and brand loyalty early in life, which last into adulthood,” Lobstein’s paper states.
In 2010, Roberto discovered just how powerful simple marketing decisions can be in shaping a child’s food preferences. In a study published in the journal Pediatrics, she gave 40 children the same snack in different packages — one plain and the other decorated with Shrek, Scooby Doo or Dora the Explorer stickers. Not only did the kids overwhelmingly choose the decorated snacks, they actually believed the food tasted better.
“Companies have an interest in children overeating,” Lobstein wrote in an email. “Why? Because a fatter child eats more and will continue to eat more for their lifetime.”
Lobstein said the average American kid is now 11 pounds heavier than three decades ago, consuming an extra 200 kilocalories a day. This extra food costs about $400 (U.S.) per year for each child — translating to roughly $20 billion in additional business for the food industry.
But unhealthy foods are also making inroads in the developing world, where some countries are now battling the “double burden” of both undernutrition and obesity. One study cited in Lobstein’s paper found that in Vietnam, 5 per cent of overweight children had stunted growth due to poor nutrition, which can lead to developmental problems and a greater risk of infectious disease.
The authors behind the Lancet series argue that governments around the world must play a greater role in regulating the food industry, perhaps by taxing unhealthy ingredients or restricting how junk food is marketed to children.
But truly long-lasting change can only come by involving everyone, not just the food industry but also the general public — which can demand stronger policies on health food — and the health care sector, which is poorly prepared to tackle the problem.
“We are already seeing a significant increase in the diseases caused by obesity,” Lobstein said.
“The costs for health care are escalating and the costs in terms of lost earnings, the need for extra family care, even the costs in extra fuel to transport a fatter population — all these are mounting.”
A new approach to tackling obesity
How can the world reverse the obesity epidemic? The Lancet researchers have eight suggestions:
Recognize obesity as a complex problem, where everyone has a biological, psychological, social or economic vulnerability to becoming overweight that is readily exploited by the food industry.
For both children and countries not yet dominated by multinational food corporations, governments should create policies to protect them from market forces that will steer them towards unhealthy eating.
Enable good choices through nutrition labelling on packages and by creating access to healthy food choices. Dissuade unhealthy eating by taxing junk food and using other point-of-sale initiatives.
Agencies and researchers tackling malnutrition currently operate in silos, concentrating on either undernutrition or overnutrition. But both conditions now coexist in developing countries and often require the same solutions.
“Governments are allowing a proliferation of sophisticated marketing of unhealthy foods to children to continue in the midst of a childhood obesity epidemic,” the Lancet series states. “Governments need to regulate to prevent this unethical exploitation of children’s vulnerabilities.”
Areas in need of improvement: services for people with obesity. Education and innovations on obesity management. Biases that stigmatize obesity and discourage early treatment. Systematic support for both weight loss and weight maintenance.
Traditional efforts to fight obesity have been top down. “Grassroots, public demand for policy actions is needed now more than ever.”
Focusing on who (or what) is responsible for obesity tends to result in finger pointing and blame games. Shifting toward an accountability-based approach will “involve multiple actors with various degrees of power over one another to ensure each other’s performance.”
