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 promoting energy-dense products.”

Unfortunately, as I have noted before, changing such social and environmental drivers of obesity at a policy level may have to go well beyond simply making this a matter of ‘diet and exercise’.

Thus, simply calling for populistic ‘quick-fix’ policies, which focus on making us “eat less and move more”, an approach that has proven so ineffective at the individual level, is likely to remain as ineffective at the population level, unless we address the key societal values and norms that lead to such policies.

As I have previously declared, ‘shame, blame, ban and tax’ approaches, that may have worked well for tobacco, are very unlikely to work for obesity (how exactly would you tax someone into feeling better about themselves, getting more restorative sleep or lowering their emotional stress levels?).

Indeed, such a policy discussion would likely need to be prefaced by a fundamental societal discourse on what we value as individuals and as social beings – everything from how we make and spend our money, raise our kids, build and nurture relationships, and find spiritual meaning, purpose and balance in our lives would likely have to be ‘open game’ for discussion.

Are we really ready for that?

AMS
Toronto, Ontario

Raine KD (2011). Obesity epidemics: inevitable outcome of globalization or preventable public health challenge? International journal of public health PMID: 22075687