Combating Obesity

By Arvind M. Dhople, Ph.D., Professor Emeritus, Florida Tech

Before the COVID-19 pandemic in 2020, there already exists a pandemic related to excess body adiposity.  In 2016, the World Health Organization (WHO) estimated that 1.9 billion adults and over 340 million children and adolescents aged 5-19 years were living with overweight or obesity.  With the prevalence of obesity rising unabated, the WHO has projected that one billion globally, including one in five women and one in seven men, will be living with obesity by 2030.

                March 4 will mark World Obesity Day, an opportunity to reflect and support actions that can help people achieve and maintain a healthy weight.  This year’s theme “Changing perspectives: Let’s talk about obesity” aims to address misconceptions, end stigmas, and shift norms.  Simplistic views of weight as a personal choice still remain and drive stigmatization – affecting confidence, creating barriers to accessing health care, and harming mental and physical health; whereas obesity is complex, multifactorial, with contributing factors embedded in the wider determinants of health.

                Obesity is a serious public health challenge globally and a major determinant of disability and death.  According to WHO, overweight and obesity have reached epidemic proportions in the European region, affecting almost 60% of adults and one in three school-aged children.  In the US, 14 million children and adolescents live with obesity.  Acknowledging such a challenge, in March 2023, the American Academy of Pediatrics published a comprehensive guideline on evaluating and treating children and adolescents with obesity.  The guideline recommends early and intensive treatment approaches, including motivational interviewing, intensive health behavior and lifestyle treatment, and pharmacotherapy and bariatric surgery if indicated.  However, the dearth of supportive behavioral programmes nationwide and the substantial time and financial commitments required, could well impede progress.

                Obesity develops across the life course.  Vulnerability to unhealthy body weight can develop in early life, and therefore preventive measures must start early.  The Food Foundation’s (London, UK) recent report puts prevention at the heart and urges policy makers to include preconception and pregnancy in policies related to diet and obesity, as these are crucial times for a child’s healthy growth trajectory.  Children with obesity are five times more likely to be obese in adulthood.  However, it is essential to take a life-course approach and continue supporting a healthy diet and physical activity later in life.  70% of adults with obesity were not obese in childhood, and obesity prevalence increases with age, with more than half of middle-aged adults being overweight or obese in many countries, including US.

                Importantly, beyond applying a life-course approach, policy interventions must target the fundamental environmental and commercial determinants of poor diet, address dietary inequalities, and achieve sustainable food systems.  A so-called obesogenic environment, in which energy-dense foods of low nutritional quality remain the cheapest option and are disproportionately promoted, drives the obesity epidemic.  Nowadays, the obesogenic environment is also digital, with for example digital marketing of unhealthy food products to children.

                Commercial determinants remain a crucial barrier to progress.  Breastfeeding reduces the risk of obesity but fewer than half of infants globally are breastfed as recommended by WHO, while the consumption of commercial milk formula does not offer the same health benefits as breastfeeding.  The sales of commercial milk formula have skyrocketed due to marketing tactics undermining breastfeeding and exploiting parents’ emotions. 

                There is an imperative to grasp obesity with its complexities and to change perspectives.  This includes tackling blame, weight stigma, and discrimination that too often stain the narrative used around obesity; creating an environment that supports individuals in developing and sustaining healthy eating and physical activity through the life course; and challenging, wholeheartedly and unambiguously, the commercial determinants that influence food production and availability, but also transport or work patterns.  Addressing obesity is much more than a challenge for public health, it is also a political challenge.  The goal should be ensuring healthy lives and promoting wellbeing for all people at all ages.