Globalisation and the Obesity Epidemic

Although many initiatives on preventing obesity aim to change individual behaviour, the reasons driving these behaviours (insofar that these are not directly attributable to biological or psychological issues) can no doubt be found in the ‘obesogenic’ environment that surounds us. How this obesogenic environment is, in part, attributable to ‘globalization’ and how approaches that go well beyond educating or targeting individuals will need to be considered to improve population health (rather than just obesity), is the topic of an editorial by Kim Raine, University of Alberta (and Chair of the Canadian Obesity Network’s Science Committee), published in the International Journal of Public Health. Given the rising obesity rates in emerging economies around the globe, Raine asks, “Are emerging epidemics inevitable, or have we learned lessons that may help prevent developing countries from suffering our fate?“ As Raine points out, the determinants of obesity include individual behavioral determinants (diet and physical inactivity), environmental determinants (e.g., economic access to healthy food and physical activity opportunities) as the context for behavior and social determinants (cultural, economic and political) that function at societal levels. Yet, the first line of defense in public health often emphasizes educating individuals on the importance of maintaining a health lifestyle, when in fact the experience for from industrialized nations actually suggests that a focus on individual behavior change is insufficient to stem the rising tide of obesity. Rather, it appears essential to address the “upstream” environmental and social determinants of diet and activity behaviours. Thus, instead of focusing on changing peoples behaviours through education, it is perhaps important to note that (as stated by Swinburn) “Obesity is the result of people responding normally to the obesogenic environments they find themselves in. Support for individuals to counteract obesogenic environments will continue to be important, but the priority should be for policies to reverse the obesogenic nature of these environments”. Thus, an ‘ecological perspective’ on the obesity crisis suggests that efforts must influence policy to create opportunities for social and cultural change and address the social, economic and cultural determinants of obesity. As Raine writes: “The urgency of shifting the intervention focus upstream to reverse the obesity epidemic poses a significant public health challenge to local, national and global organizations. Addressing the root causes, or drivers, of obesity means confronting and regulating a globalized economic system that promotes growth and consumption, including a food system that profits from expanding markets and… Read More »

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Why Preventing Childhood Obesity Should Not Be About Preventing Childhood Obesity

Conventional wisdom of public health ‘gurus’ dictates that the solution to the obesity epidemic is to start early – particularly to target ‘prevention’ measures at kids – the younger the better. A thoughtful and provocative commentary by Robert C. Whitaker, from the Departments of Public Health and Pediatrics, Temple University, Philadelphia, published in the latest issue of Archives of Pediatric and Adolescent Medicine, suggests that it may be time to focus on societal norms and the values underlying those norms rather than focusing on the ‘symptom’ (childhood obesity). Thus, Whitaker reminds us that: “The childhood obesity epidemic is just one symptom of our way of living. Reversing the epidemic may require that we apply a new approach to improving child health in the 21st century. One approach is to make societal changes to enhance human well-being rather than to prevent a particular symptom, such as childhood obesity. In the process, we may address obesity and other socially determined health conditions while preventing new ones from emerging.” The discussion about ‘diet and exercise’ recommendations or targeting advertising to children is ‘misguided’ because it distracts from the broader societal discussion of how much value we place on creating a healthy and nurturing environment for our children. As I have pointed out before – the questions (and answers) should focus on the ‘whys’ and not the ‘whats’ that determine our childrens’ health and well-being – in fact, obesity is only one of many problems attributable to the same ‘whys’. Or, in Whitaker’s words: “Many of the other “new morbidities,” such as depression, substance use, attention-deficit disorder, and bullying, are likely to share causes rooted in our way of living. To address those root causes, we must ask not only how our way of living has changed but why.” Ignoring the ‘why’, Whitaker warns, may actually make things worse – not better: “It is plausible that we could reverse the obesity epidemic by changing children’s environments in ways that make children less well than they are now, especially if we do not recognize that obesity may reflect how children are coping with multiple stresses induced by our current way of living. For example, protecting children from food marketing or removing televisions from their bedrooms may leave children lean, but not well, if we fail to address the questions of whether we should market anything to young children or have more than 1 working television in a household.” It is these… Read More »

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