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The obesity pandemic: can more be done?

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In 2022 over two thirds of adults in the WHO European Region are classified as obese or overweight. The effects of obesity aren’t restricted to the individual but can be recognised across every aspect of our society.

Excess fat leads to an increased risk of non-communicable diseases such as type 2 diabetes and 13 types of cancer. The rise in preventable health problems has put a persistent strain on public health resources because of higher medical costs to treat diseases and accompanying mental health support.

Obesity also impacts a person’s quality of life, missing out on opportunities and facing performance loss at work due to absenteeism.

Over nine years ago the Member States of the World Health Assembly agreed to a set of WHO targets to stop the rise of obesity by 2025, but all 194 members have failed to stay on track toward this goal, especially in the aftermath of the COVID-19 pandemic.

Professor Donna Ryan, President of the World Obesity Federation, stated:

“There is no excuse for this inaction. People with obesity require respectful and equitable access to treatment or opportunities for prevention. This requires action from policymakers around the world to address the underlying roots of obesity.”

More alarming still is the prevalence of obesity among children.

The NHS reported 14.4 per cent of children in Reception class (4-5 years old) as obese in 2021 as compared to 9.9 per cent the year before.

Obese children are more likely to maintain their weight into adulthood and continue an intergenerational cycle of obesity.

How can obesity be measured and tracked?

Obesity is measured using Body Mass Index (BMI) to divide a person’s weight by their height. Though experts acknowledge that BMI doesn’t provide a direct measure of excess fat it is the most practical approach for the majority of people and has the benefit of being non-invasive.

WHO also has a dedicated European Childhood Obesity Surveillance Initiative (COSI) that has operated for the last 10 years, measuring trends in obesity among primary school children.

COSI records the BMI from over 300,000 children every 3 years to determine trends in obesity.

What determines obesity?

Simplifying the discussion: obesity is a consequence of excessive energy consumption compared to energy expended.

However, this is much too simple an explanation for obesity. Biological, behavioural, environmental and economics factors all impact a person’s energy intake and cause obesity.

There are studies showing associations between obesity and socioeconomic status, namely parental education, parental employment status and family-perceived wealth.

However not every country or even city faces the same determinants and so preventing obesity isn’t a one-size-fits-all approach.

How can obesity be prevented?

Obesity is a systemic issue, it requires us to look further than an individual’s physiology at the broader societal perspective toward food, analysing how attitudes, behaviours and choices are influenced by our social backgrounds.

Furthermore, the surge of technology and social media in our lives has made it difficult to escape constant nudges to purchase food and instantly indulge in our cravings.

Nudges are powerful tools that exploit subconscious decision-making by appealing to cognitive biases. Eating, in particular, is one area in which people’s decisions are largely guided by irrational cognitive biases and environmental cues.

These nudges are so subtle that unless a person is educated on their uses, they may believe they are making free, informed choices as opposed to being manipulated into impulsive ones.

The UK government has funded public campaigns to educate people about eating their five a day or cutting down on their sugar consumption, but little information has been released to the public to inform them about these online and in store nudges, which I believe is a missed opportunity.

In the effort to prevent obesity, bans are also being imposed on junk food advertisements and many companies are undergoing product reformulation to ensure healthier ingredients.

Though these appear to be steps in the right direction, it would be more useful to shift advertisements toward healthier products and position these in the public eye, replacing the unhealthy alternatives.

With the right education and the marketing of healthy products, the public health system would have a better chance of reducing and preventing obesity.

Ludovica De Pieri is a public health nutritionist and the founder of Reveal My Food.

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