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Rethinking and reframing obesity

2015; Elsevier BV; Volume: 385; Issue: 9985 Linguagem: Inglês

10.1016/s0140-6736(15)60163-5

1474-547X

Sabine Kleinert, Richard Horton,

Diet and metabolism studies

In 2011, we published The Lancet's first Series on obesity, which summarised the then available knowledge about its origins, economic and health burden (with projections for the future), and the physiology of weight control and maintenance. The Series concluded with science-based recommendations for action. 1 Swinburn BA Sacks G Hall KD et al. The global obesity pandemic: shaped by global drivers and local environments. Lancet. 2011; 378: 804-814 Summary Full Text Full Text PDF PubMed Scopus (2895) Google Scholar , 2 Wang YC McPherson K Marsh T Gortmaker SL Brwon M Health and economic burden of the projected obesity trends in the USA and UK. Lancet. 2011; 378: 815-825 Summary Full Text Full Text PDF PubMed Scopus (1863) Google Scholar , 3 Hall KD Sacks G Chandramohan D et al. Quantification of the effect of energy imbalance on bodyweight. Lancet. 2011; 378: 826-837 Summary Full Text Full Text PDF PubMed Scopus (732) Google Scholar , 4 Gortmaker SL Swinburn BA Levy D et al. Changing the future of obesity: science, policy, and action. Lancet. 2011; 378: 838-847 Summary Full Text Full Text PDF PubMed Scopus (666) Google Scholar In an accompanying Editorial, we called for a concerted response with five urgent messages (panel). 5 The LancetUrgently needed: a framework convention for obesity control. Lancet. 2011; 378: 741 Summary Full Text Full Text PDF PubMed Scopus (47) Google Scholar PanelThe Lancet's five messages on obesity in 2011 •The obesity epidemic will not be reversed without government leadership •Business as usual would be costly in terms of population health, health-care expenses, and loss of productivity •Assumptions about speed and sustainability of weight loss are wrong •We need to accurately monitor and evaluate basic population weight data and intervention outcomes •A systems approach is needed with multiple sectors involved •The obesity epidemic will not be reversed without government leadership •Business as usual would be costly in terms of population health, health-care expenses, and loss of productivity •Assumptions about speed and sustainability of weight loss are wrong •We need to accurately monitor and evaluate basic population weight data and intervention outcomes •A systems approach is needed with multiple sectors involved Patchy progress on obesity prevention: emerging examples, entrenched barriers, and new thinkingDespite isolated areas of improvement, no country to date has reversed its obesity epidemic. Governments, together with a broad range of stakeholders, need to act urgently to decrease the prevalence of obesity. In this Series paper, we review several regulatory and non-regulatory actions taken around the world to address obesity and discuss some of the reasons for the scarce and fitful progress. Additionally, we preview the papers in this Lancet Series, which each identify high-priority actions on key obesity issues and challenge some of the entrenched dichotomies that dominate the thinking about obesity and its solutions. Full-Text PDF Smart food policies for obesity preventionPrevention of obesity requires policies that work. In this Series paper, we propose a new way to understand how food policies could be made to work more effectively for obesity prevention. Our approach draws on evidence from a range of disciplines (psychology, economics, and public health nutrition) to develop a theory of change to understand how food policies work. We focus on one of the key determinants of obesity: diet. The evidence we review suggests that the interaction between human food preferences and the environment in which those preferences are learned, expressed, and reassessed has a central role. Full-Text PDF Mobilisation of public support for policy actions to prevent obesityPublic mobilisation is needed to enact obesity-prevention policies and to mitigate reaction against their implementation. However, approaches in public health focus mainly on dialogue between public health professionals and political leaders. Strategies to increase popular demand for obesity-prevention policies include refinement and streamlining of public information, identification of effective obesity frames for each population, strengthening of media advocacy, building of citizen protest and engagement, and development of a receptive political environment with change agents embedded across organisations and sectors. Full-Text PDF Child and adolescent obesity: part of a bigger pictureThe prevalence of childhood overweight and obesity has risen substantially worldwide in less than one generation. In the USA, the average weight of a child has risen by more than 5 kg within three decades, to a point where a third of the country's children are overweight or obese. Some low-income and middle-income countries have reported similar or more rapid rises in child obesity, despite continuing high levels of undernutrition. Nutrition policies to tackle child obesity need to promote healthy growth and household nutrition security and protect children from inducements to be inactive or to overconsume foods of poor nutritional quality. Full-Text PDF Management of obesity: improvement of health-care training and systems for prevention and careAlthough the caloric deficits achieved by increased awareness, policy, and environmental approaches have begun to achieve reductions in the prevalence of obesity in some countries, these approaches are insufficient to achieve weight loss in patients with severe obesity. Because the prevalence of obesity poses an enormous clinical burden, innovative treatment and care-delivery strategies are needed. Nonetheless, health professionals are poorly prepared to address obesity. In addition to biases and unfounded assumptions about patients with obesity, absence of training in behaviour-change strategies and scarce experience working within interprofessional teams impairs care of patients with obesity. Full-Text PDF Strengthening of accountability systems to create healthy food environments and reduce global obesityTo achieve WHO's target to halt the rise in obesity and diabetes, dramatic actions are needed to improve the healthiness of food environments. Substantial debate surrounds who is responsible for delivering effective actions and what, specifically, these actions should entail. Arguments are often reduced to a debate between individual and collective responsibilities, and between hard regulatory or fiscal interventions and soft voluntary, education-based approaches. Genuine progress lies beyond the impasse of these entrenched dichotomies. Full-Text PDF Strategic science with policy impactEvidence-based policy making is an important aspirational goal, but only a small proportion of research has the policy impact it might have. Most researchers are not trained to create policy impact from their work, engagement with policy makers is not encouraged or rewarded in most settings, and the communication of scientific findings occurs within the academic community but rarely outside it. There are exceptions, but little is done to systematically link scholarship to policy. Full-Text PDF