Tackling obesity: an ecological public health approach

Geof Rayner, PhDAssociate Professor of Public Health, Brunel University UKVisiting Research Fellow, City University UKDirector, GRAssociates consultancyMail@rayner.uk.com

18th Consumers International World Congress, Sydney

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Questions to address Is there a policy consensus on what

causes obesity? Is obesity a ‘medical’ issue or just a ‘lifestyle’ issue?

Why can’t the individual just act alone and change their behaviour?

What would an ‘ecological’ approach to obesity look like?

What policy interventions would be necessary if this approach was taken?

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A simple model for weight gain

Eat more + do less = gain weight

Political response: “It’s their own fat fault” (Boris Johnson, MP, The Times)

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This presentation

1 Background What’s the problem? Where is the problem? Who

is the problem?2 Science, evidence and policy Obesity science – very simple or very

complicated? Lessons from UK’s Foresight review

Societal transitions in diet, environment and culture

3 Rethinking public health and consumerism Why are current approaches failing? What is an ‘ecological public health’ approach? What can the consumer movement do?

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1. Background

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USA: 2 out of 3 overweight, 1 out of 3 obese

“among adults aged at least 20 years in 1999-2002, 65.1% were overweight or obese, 30.4% were obese, and 4.9% were extremely obese”Hedley, AA, Ogden, CL, Johnson, CL, Carroll, MD, Curtin, LR, Flegal, KM. Overweight and obesity among US children, adolescents, and

adults, 1999-2002. JAMA 291:2847-50. 2004

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Variation by ethnic group (US)

Hedley, AA, Ogden, CL, Johnson, CL, Carroll, MD, Curtin, LR, Flegal, KM. Overweight and obesity among US children,

adolescents, and adults, 1999-2002. JAMA 291:2847-50. 2004

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Projections - England

Klim McPherson Martin Brown & Tim Marsh Quantitative Modelling, Source: Foresight, Tackling Obesities: Future Choices –Project Report UK Government Office for Science 2007

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Projections - England

Klim McPherson Martin Brown & Tim Marsh Quantitative Modelling, Source: Foresight, Tackling Obesities: Future Choices –Project Report UK Government Office for Science 2007

10The cover of "The Economist", Dec. 13-19, 2003.

Emerging global epidemic

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WHO (2005) Preventing Chronic Diseases: a vital investment. Overview. Geneva: WHO p.4

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Diet and Risk of NCDs Population-based prevention is the most

cost-effective and the only affordable option for major public health improvement in NCD rates

Up to 80 % of coronary heart disease and up to 90 % of type 2 diabetes could be avoided through changing life habits.

About one third of cancers could be prevented by eating healthily, maintaining normal weight and being physically active throughout the life span.

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-75%

-82%

CHD mortality in all Finland and in North Karelia35-64 year old men

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200

300

400

500

600

700

69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 200020012002

Year

North Karelia

All Finland

start of the North Karelia Project

extension of the Project nationally

Source: Pekka Pushka, National Public Health Institute, Finland

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2 Science and policy

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Foresight obesity map: a picture of complexity!

Source: Foresight, Tackling Obesities: Future Choices –Project Report UK Government Office for Science 2007

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What theoretical models are used to explain obesity?

Adapted from: Tim Lang, Geof Rayner, Obesity: a growing issue for European policy? Journal of European Social Policy, Nov 01, 2005; 15: 301-327.

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What historical/societal factors can help explain ‘passive obesity’*?

DIET TRANSITION: Shift from simple to processed foods Rise of fat production and consumption Rise of soft drinks

PHYSICAL ACTIVITY TRANSITION: Rise of cars Decline in walking – and everyday work/nonwork

‘activity’ CULTURAL TRANSITION:

Supermarkets, new food culture ‘Sport by proxy’ - screen based culture Commodity consumerism as way of life

* Foresight, Tackling Obesities: Future Choices –Project Report UK Government Office for Science 2007

18Source: Pepsico

Example of dietary transition: soft drinks – following USA?

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Example of dietary transition: fat overproduced and consumed

WHO/FAO (2003) Diet, Nutrition and the Prevention of Chronic Diseases. WHO TR 916 p.18

20Source: Euromonitor, 2003 http://www.euromonitor.com

Example of dietary transition: packaged food

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Physical activity transition: motorised transport 1930-2000

Michael P Walsh, Motor Vehicle Pollution Control, Paper to China Fuel Economy Workshop, Hong Kong, December 13, 2004, http://www.walshcarlines.com/china/Applying%20The%20Lessons%20To%20China%20-%20MOVE%20.pdf

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Drivers of diet and culture: ‘supermarketisation’

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New supermarket culture: Tesco (Bangkok)

24Yum! Brands: World's largest restaurant company: 34,000 restaurants, 100 countries

New food culture: KFC (Bangkok)

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3. Rethinking public health and consumerism

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There are world-wide actions underway to counter child obesity

Source: Foresight, Tackling Obesities: Future Choices –Project Report UK Government Office for Science 2007

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Auditing national policies to counter obesity (Europe)

Policies to reduce and prevent excess body weight and obesity in children and adolescents, WHO Europe, Factsheet 2.7, May 2007

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Common national responses

Countries vary in responses but most stress ‘The informed consumer in marketplace’ National cultural traditions (e.g. Mediterranean

diet) Reliance on ‘soft’ or partial responses

Social marketing – eat less, do more Labelling, information Transfat bans School soft drink bans Community projects in healthy living The WHO Global Strategy on Diet, Physical

Activity and Health is the beginning of the global response - but as yet no society has developed a ‘whole society (‘North Karelia’)response to obesity

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Noting that short term initiatives have limited results Foresight says obesity represents the ‘Climate Change of Public Health’ *

Failure to act at an early stage leads to immense and undesirable consequences.

Awareness not matched by requisite change by governments, markets and society.

Obesity ‘normalised’, even as the trends accelerate and the evidence grows.

Environmental determinants misunderstood and under-researched, while policy drifts towards individualised responsibility and treatment.

Danger that the political moment to act will be missed and historical point of reversal lost

* Foresight, Tackling Obesities: Future Choices –Project Report UK Government Office for Science 2007

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Simplifying complexity: The Ecological Public Health perspective suggests filtering policy reviews through ‘four domains’ *

The physical world (the built environment, the nature of urbanisation, the extractive relationship with nature)

The physiological world (the body) – with obesity focus on energy use (thermodynamic) components

The social world (societal institutions, power - multi-layered and complex)

The cognitive world (the life world - interpretive structures which are individual yet based on shared meanings)

Lang, T. and G. Rayner, Overcoming Policy Cacophany on Obesity: an Ecological Public Health Framework for Politicians. Obesity Reviews, 2007 8(1): p. 165-181.

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Obesity and the consumer movement: developing a fresh approach

There are no easy ‘consumer’ solutions; no (as yet) magic pill for obesity – and what would be the result?

Dealing with obesity means about asking questions about the society in which we all wish to live and inserting health into the framework of commerce and every life

Maintaining civil society pressure on politicians & companies, using parenting as a ‘pressure focus’

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Obesity and the consumer movement: developing a fresh approach

Engage criticism of ‘choice’ ideology and food industry view that healthy products are a ‘niche market’

Consumer NGOs can adapt their experience for health audits (e.g.UK National Consumer Council yearly health audits of top 10 retailers) - not just of food and supermarkets - but of public and private policy and action (food, transport, town planning, employment policies, etc.)

Build new alliances between public health movement, consumer movement and environmental movement.

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Thank you!

Mail@rayner.uk.com