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Should Obesity Prevention Efforts Focus Less On Individuals?



Obesity is now increasingly recognised as the “natural” consequence of societal changes that have occurred over the past decades to foster an increasingly obesogenic environment.

Yet, rather than focus on the root causes of these societal drivers of obesity, governments apparently prefer to make obesity prevention a personal matter, with a strong emphasis on trying to get individuals to change their lifestyles.

It is clearly far easier to simply tell people to eat more fruits and vegetables and to walk 10,000 steps than it is to provide them with the means or the environment that would actually allow them to do so.

A paper by Celeste Alvaro and colleagues from Dalhousie University, Halifax, Nova Scotia, Canada, published in the latest issue of Health Promotion International, explores why Canadian government policies, particularly those related to obesity, appear to be ‘stuck’ at promoting individual lifestyle change.

The paper uses key concepts within complexity and critical theories as a basis for trying to understand the continued emphasis on attempting to change individual lifestyle factors despite strong evidence showing that a change in the environment and conditions of poverty is truly what is needed to tackle obesity at the population level.

As the authors note, not just in Canada have health promotion programmes and policies had a ‘lopsided’ emphasis on individual lifestyles, with limited attention given to addressing the broader social, economic and political factors that create and produce obesogenic environments in the first place.

As the authors point out, “Individuals are continuously blamed for unsuccessful modifications to their lifestyle, even though living in an obesogenic environment makes achieving a healthy lifestyle close to impossible.”

Despite some attempts to change ‘environments’ (such as schools and workplaces), as recently undertaken in programs such as ActNow BC, they often fail to comprehensively address key economic issues underlying obesity, but rather focus on encouraging individual behavioural change.

The paper calls on both complexity theory to conceptualize governments as ‘systems’ with a history that shapes their current decisions and actions as well as critical theory to draw attention to power struggles within the policy implementation process, and to the role of dominant interests and ideologies in maintaining particular policies.

The authors provide several illustrative policy examples that highlight key concepts explaining why governments prefer to perpetuate and appear to be ‘locked’ into a focus on these largely ineffective lifestyle policies.

Although the paper may help better understand why governments are so reluctant to address the true underlying drivers of obesity, the authors admit that the path to actually and substantially moving government policies in the direction of fundamentally altering the obesogenic environment is far from clear.

Whether or not their suggestion that health promoters and others inside and outside the health field must develop collective action to catalyse the required changes across government and political sectors, will in the end move government in the right direction remains to be seen and may well prove overly optimistic.

Given that many ministries have a say in the drivers of the obesogenic environment but have left it largely to the seemingly powerless Ministries of Health to deal with the issue of obesity, the authors suggest that it may be time for a critical debate about how to promote the active, sustained and collective involvement of multiple sectors and groups to address obesity.

Clearly, as long a governments continue ignoring the real factors at play in the obesity epidemic, and remain focused on ‘reactive’ solutions that target individuals rather than society as a whole, prevention efforts are unlikely to translate into a meaningful decrease in the incidence and prevalence of obesity anytime soon.

AMS
Lincolnshire, IL

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Alvaro C, Jackson LA, Kirk S, McHugh TL, Hughes J, Chircop A, & Lyons RF (2010). Moving governmental policies beyond a focus on individual lifestyle: some insights from complexity and critical theories. Health promotion international PMID: 20709791

2 Comments

  1. You have hit the nail on the head Dr. Sharma and very eloquently put. We continue to ask people to swim upstream in a raging current that is sweeping them away and then we blame them for drowning! The obese are simply the most vulnerable in our food infested society where nearly half of the food grown is thrown away. If only they could learn to swim better (nutrition/exercise “education”), become stronger swimmers (have more willpower), get on a life raft (adopt a diet that works in the long run(as if there is such a thing). We as a society clearly need to focus on upstream drivers of obesity versus downstream behaviours A systemic change in the system is in order, but what do do?- where to start? A system changes by each one of us changing a bit and influencing others and it will rub off.

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  2. Combination of gov’t and individual effort:

    Include CALORIE understanding in the CANADA FOOD GUIDE.

    It is very deceiving to put forth a GOVT food guide with practically no reference to calories when weight control depends on calorie control and obesity is epidemic.

    Talk about “drivers of an obesogenic environment”!!!

    The gov’t food guide ignores the nutritional factor which is the cause of the worst food related disease today, obesity.

    Omitting calorie control from the OFFICIAL food guide advice is the equivalent of saying calories don’t matter.

    That’s like being back in the bad old days when people didn’t know about bacteria and viruses. They tried all kinds of remedies which didn’t deal with the root causes of diseases like cholera and smallpox and measles, etc. Now we have vaccinations and sanitation. Even a simple thing like handwashing works because it attacks root causes.

    Obesity is caused by eating too many calories. We should have public service ads telling people to count calories to balance their input and output just like we have public service ads telling people to wash their hands to prevent the spread of bacteria and viruses.

    You can go to a wonderful, free, sports facility, but if you come home and eat a meal which has more calories than you need, you will gain weight. You can follow the Canada food guide to be healthy, but without calorie control, you can make guide-approved meals and still gain weight. If you’re not aware of calorie counts, it’s easy to burn hundreds of calories exercising and then eat 4 times that much at a fast food place.

    The Canada food guide should fight the current worst food caused disease, and that’s obesity. Canadians are more at risk of obesity than scurvy, ricketts, pellagra, or other nutrient deficiency diseases.

    The FIRST THING on the food guide for the public should be “MANAGE YOUR CALORIES”.

    “MANAGE YOUR CALORIES” should get just a much PR and advertising as “Wash your hands” or “Wear your seatbelt” or “Don’t text while driving” or “Vaccinate your children”.

    Will people object? I dare say they will – nobody likes to be told to do things like stop smoking or wear a seatbelt. But it’s up to the Canada food guide to make sure people know the truth about what they are doing to themselves – give people the knowledge and the motivation to choose the right food, and that means the right number of calories.

    In the era of home-made food, calories were more obvious – you knew the cake was “fattening” because you made it with lots of butter and sugar. Today restaurant and prepared foods can have huge numbers of calories that aren’t obvious.

    Gaining weight because of ignoring calories can lead to a downward spiral of weight gain, feeling bad and eating more, crash dieting and regaining, and eventually developing psychological problems because of the weight problem.

    The main factor in this obesogenic culture, in my opinion, is ingesting way too many calories, and the Canada food guide should make countering that trend its priority.

    Canada Health and food guide slogan: MANAGE YOUR CALORIES!!

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