SocialSciencesandHumanitiescontributiontotackletheObesityEpidemicChallenges&PotentialsinObesityResearchtowardsHorizon2020

ConcludingReport

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SOCIALSCIENCESANDHUMANITIESCONTRIBUTIONTOTACKLETHEOBESITYEPIDEMICCHALLENGES&POTENTIALSINOBESITYRESEARCHTOWARDSHORIZON2020WritingCommitteeProfessorLotteHolm,UniversityofCopenhagenProfessorPeterSandøe,UniversityofCopenhagenAssociateProfessorMortenEbbeJuulNielsen,UniversityofCopenhagenProfessorThorkildI.A.Sørensen,UniversityofCopenhagenandInstituteofPreventiveMedicine,RegionHPeterBørkerNielsen,projectmanager,UniversityofCopenhagenAnneMeidahlPetersen,EUadviser,creoDKCamillaVerdich,researchcoordinator,UniversityofCopenhagenScientificAdvisoryCommitteeProfessorLotteHolm,UniversityofCopenhagenProfessorGemaFrühbeck,UniversityofNavarra,EASOProfessorPeterSandøe,UniversityofCopenhagenProfessorJean‐MichelOppert,UniversityPierre‐et‐MarieCurie,EASOProfessorThorkildI.A.Sørensen,UniversityofCopenhagenandInstituteofPreventiveMedicine,RegionHProfessorJohnBlundell,UniversityofLondon,EASOAssociateProfessorMortenEbbeJuulNielsen,UniversityofCopenhagenStrategyandOrganisingCommitteePeterBørkerNielsen,projectmanager,UniversityofCopenhagenAnneMeidahlPetersen,EUadviser,creoDKCamillaVerdich,researchcoordinator,UniversityofCopenhagenEuanWoodward,executivedirector,EASOAcknowledgementsWewouldliketothankourEASOcolleaguesandalltheparticipantsattheworkshopforhelpingusputtogetherthisreportbygivingvirtualinputpriortoandfollowingtheworkshop.ForfurtherinformationonthefullprocessandtheparticipantsattheworkshoponSSHobesityresearch,pleasevisitwww.foodfitnesspharma.ku.dk/SSHCopyrightAllrightsreservedEditorialOfficeUniversityofCopenhagenUNIK‘Food,Fitness&Pharma’NørreAllé20,Room33.5.65DK‐2200Copenhagen

PREFACE

OnbehalfofrepresentativesfromresearchfieldsinthesocialsciencesandhumanitiesacrossEurope,wearepleased topresent the concluding report of theworkshoponSocial sciencesandHumanitiescontributiontotackletheObesityepidemic–Challenges&PotentialsinObesityResearchtowardsHori‐zon2020.

Theworkshopwas initiated by representatives of the Danish social sciences and humanities (SSH)researchcommunityintheareaofobesityresearchandorganisedwiththeEuropeanAssociationfortheStudyofObesity(EASO).Itbuildsuponamovementofon‐goingEuropeanandnationalinitiativesinDenmark,France,andGermanywiththecommonobjectiveofoutliningnationalresearchprioritiesandroadmapsrelatedtothechallengesofobesity.

After the conference ‘FromBiology toSociety ‐WhatMessageCanObesityResearchDeliver toPolicy‐makers?’, organisedbyEASO inFebruary2012, itwas clear that, in order to tackle the challengeofobesity,thereisaneedtoinvolvemultipledisciplinesrangingfrombiomedicineandthenaturalsci‐encestothesocialsciencesandhumanities.OnlythroughacombinedeffortwithaparticularemphasisonSSHresearch,wewillbeabletounleashthefullpotentialofobesityresearch,whichisalsoakeyissueinthenextEuropeanFrameworkProgrammeforResearchandInnovation,Horizon2020,begin‐ninginearly2014.

OnecurrentchallengeforresearchinEuropeistoidentifythekeyissuesonourscientificfrontierthatwillhavethegreatestsocial,economic,andsocietalimpactforcitizens.

Toaddresstheobesityepidemic,Europeanresearchersneedtocometogetherto findthebestsolu‐tionsandusetheircombinedknowledgetoprovidethemostinnovativeresearchideas.Bygatheringmorethan50researchersandstakeholdersfromaroundEurope,wetookanimportantsteptowardsestablishing strongnetworks andbuilding bridgesbetween thenatural sciences and social sciencesandhumanities that can addressobesityasa complex societal challenge andhelpminimise thegapbetweenresearch,markets,andcitizens.

Theobjectivesoftheworkshopweretocreateacross‐Europeanforumforidentifying,describing,anddiscussingfuturepotentialinobesityresearch,toestablishnewandtonurtureexistingnetworksandcollaborationsbetweenresearchersacrossthesocialsciencesandhumanitiesandthenaturalscienceswithaninterestinobesityresearch,andtherebytomobilisesignificantEuropeanresearchcapacitiesandpotentialinpreparingforHorizon2020.

Thisreport,whichsummarisestheworkshop,shouldbeseenasaplatformillustratingthepotentialinSSHobesityresearchfortruetransdisciplinaryeffortstoaddressobesityasacomplexphenomenon.

ScientificAdvisoryCommittee&

StrategyandOrganisingCommittee

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TABLEOFCONTENTS

Preface 3 

Tableofcontents 4 

Introduction 5 

Theworkshop:what,whyandhow? 5 

Obesityasacomplexchallenge 8 

Whatarethesocialsciencesandhumanities? 9 

Socialsciences&Humanitiesandobesity 10 

Whatanswerscansocialsciencesandhumanitiesprovide? 10 

Outliningthepresentationsfromtheworkshop 12 

Resultsfromtheworkshop:societalchallenges&demands,futureresearchpotential,andpossibleimpact 22 

Concludingremarks 39 

Bibliography 41 

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INTRODUCTION

Thisreportwillguideyouthroughtheagendaandresultsof theworkshop.First,wewillshowwhyobesityisastrongexampleofaresearchchallengethatcallsforacollectiveeffortbydifferentscien‐tificdisciplines.Second,wewillprovidesomeinsightintothedisciplinesofsocialsciencesandhuman‐itiesandwhichresearchquestionsthedisciplinesareabletoidentifyandaddress.Third,wewillgiveashortsummaryofthepresentationsattheworkshop,highlightingtheperspectivesandchallengesthatdifferentstakeholdersandresearchershaveidentifiedashavingimportance.Lastbutnotleast,wewillpresentresearchpotentialidentifiedforeachoftheseventhemesattheworkshopbydescribingthesocietalchallenge,thefutureresearchpotential,andtheimpactoftheresearch,togetherwithpossibleresearchcollaboration,stakeholders,androadblocks.THEWORKSHOP:WHAT,WHYANDHOW?

Obesityisarapidlygrowingpublichealthchallenge,anditisbecomingoneofthemainhealthprob‐lemsintheworldwithhighsocietalandindividualcosts(21).Moreover,severeobesityisagatewaytomanyotherchronicdiseases,suchastype‐2diabetes,cardiovascularandheartdiseases,andcancer,aswell as a multitude of adverse social and psychological conditions affecting quality of life, mentalhealth,physicalhealth,andhealthcarecostsaswellastheefficiencyoftheworkforce.Wealreadyknowthattounravelthechallengeoftheobesityepidemicfully,wemusttakeintoaccounttheobesogenicenvironment,theobesethemselves,andthewaysocietyandindividualsaddressobesi‐ty.InsightsfromSSHwillradicallybroadentheperspectiveontheobesityepidemic.Theyallowustoincludethepointofviewoftheobeseindividuals,theirrightsandstatusascitizens,theirlifestories,andtheirpersonalnarratives,andthiswillalsoopenupquestionsontheimpactofobesitydiscourseonthenon‐obesepopulationandothersocietalissuespertainingtohistory,socialconditions,morali‐ty,law,aesthetics,andpsychology.Inotherwords,toaddressobesityasacomplexphenomenon,thereisaneedtointegrateandmobiliseallrelevantscientificdisciplinestobuildtruetransdisciplinaryresearch,whichrequiresdeterminationfrom all sides.We need to change and broaden our view of obesity by looking at the role of socialstructures,thesocialinequalityandstigmaassociatedwithobesity,andthecost‐effectivenessofinitia‐tives and interventions and by critically evaluating the potential in choice architecture, behaviourchange,andvarious formsofpolicydevelopmentandpoliticalregulation.At thesametime,wealsoneedtoheightenawarenessofsocietaleffectsandtheconsequencesoftheobesityepidemic.In organising theworkshoponSocial sciencesandHumanitiescontribution to tackle theObesityEpi‐demic – Challenges& Potentials inObesityResearch towardsHorizon 2020 (13), the ambitionwas tobring together disciplines such as economics, anthropology, sociology, psychology, political science,architectureandurbanplanning,ethnology,epidemiology,philosophy,history,geography,communi‐cationandinformationsciences,scienceandtechnologystudies,andmanymorewithinthesocialsci‐encesandhumanities,astheyallholdapieceofthishighlycomplexpuzzle.Bycombiningthesefieldswithclinicalresearch,physicalactivity,nutrition,biomedicalsciences,andepidemiology,wewereabletoanswernewquestionsandtherebysecurenewfindings,solutions,andagreaterimpactonobesity

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research. Thus, the future potential of obesity research aims at adding to our understanding of thecomplexsystemofmechanismsrelatedtoobesity.Themainsessionattheworkshopconsistedofround‐tablediscussions,whichtooktheirstartingpointinsevenpre‐definedthemesandaconsultationprocesswherealltheinviteeshadtheopportunitytoprovideonlineinputtothethemespriortotheworkshop.Thethemesbuiltonexpectationsandpoten‐tialforfutureobesityresearch,aspreviouslyidentifiedbypoliticalstakeholdersandresearchers.Thethemeswere: Theobesityepidemic:costs,effects,andconsequences Rethinkingpolicyandinterventions Valuesandnorms–blameandstigmafromthecitizens’perspective Disseminationofinformation:Power,knowledge,andthecitizen Socialstructures,urbanenvironment,andchoicearchitecture Socialinequality,thelife‐courseperspective,andvulnerablegroups SSHwithinmedicalsciences:Towardscross‐disciplinaryresearch

Theparticipantswere asked to identify the future researchpotential for each of the themes and todiscusswhatimpactsuchresearchwouldhaveforaddressingtheobesityepidemic.Furthermore,nec‐essaryscientificcollaborators,stakeholders,androadblockswereidentified.In the round‐table discussions, it became clear that, ifwe combine the SSHdisciplines in battling asocietalchallengesuchasobesity,wewillbeabletotapintopromisingpossibilitiesthatcanhelpiden‐tifypotentialareasofactionstoimprovethewaywetackleobesity.

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OBESITYASACOMPLEXCHALLENGE

Obesityisfrequent,serious,complex,andchronic.ThisistheconclusionfromtheexecutivesummaryoftheEuropeanObesityResearchConferenceheld inBrussels, February2012 (13).Obesity imposesanincreasinglyheavyburdenonoverweightandobesecitizens,healthcaresystems,theefficiencyoftheworkforce,andsocietyatlarge.Inbiomedicine,obesityisrecognisedasaseriousriskfactorformanyotherdiseases,includingbutnotlimitedtodiabetes,heartdisease,cancers,respiratoryproblems,andjointproblems.Ifobesityisprevented,amajorsupplyrouteforthesediseaseswillbeblocked(13).

Significant investments have been made to tackle obesity from a biomedical perspective and eventhough there are small indicationsof stagnation in theprevalenceof obesity in somecountries, theobesityepidemicshouldstillbetakenveryseriouslyandtackledstrategicallybyaunitedEurope.

TheEASOconferencecalledforresearchtoanalyseobesityfromamorecomplexandsystem‐orientedperspective, highlighting the need for transdisciplinary approaches that combine social sciencesandhumanitieswithbiomedicalresearch,usebothquantitativeandqualitativemethods,anddevelopsystemsthinkingand,possibly,newparadigmsthatrecognisethatobesityistheoutputofacomplexsystemand,thus,cannotbelimitedtoanunderstandingofhumanphysiology(13).

Obesityfollowsfromandaffectswhatpeopledo,howtheythinkandfeel,howtheyperceivetheworld,andthesituationsinwhichtheyfindthemselves.Thesethemesareaddressedbythesocialsciencesandthehumanities.Howpeoplethink,act,andfunctionisintertwinedwithsocietalstructures,socialinstitutionsandconventions,politicalregulation,andthestrategies,policiesandactionsofpublicandprivate actors. Themeaninghumanbeings ascribe to their experiences relate to theirwider frame‐workofvaluesandwaysofseeingtheworld.Inotherwords,themeaningandimportanceofobesityareatleastpartiallyembeddedinsocialandculturalcontextsandvaluesthatmightbeverydifferentfromnationtonation,classtoclass,andindividualtoindividual.Assoonasoneremembersthatobesi‐tyconcernspeople,thechallengestandsoutasahighlycomplexandcontext‐dependentphenomenon.

Toillustrate:atitsbiomedicalroots,obesityconcernsanexcessofenergyintakeinrelationtoenergyexpenditure–arelativelysimplephenomenon.However,evidently,sincemostpeoplewanttostayorbecomeslim,whydowestillseegrowingratesofobesityinanumberofcountries?Andwhyisthereasocialgradientinobesityinwhichthelesswell‐offtendtobemoreobesethanthosewhoarebetteroff?Inotherwords,obesityhasimportantsocial(culturalandeconomic)dimensions,andcannotbereducedtoabiomedicalissue.

Thismeansthatthenecessaryknowledgebaseforaddressingtheobesitychallengemustincludesev‐eraldisciplinaryperspectives.Itmustbebasedonarangeofmethodologicalapproachestocaptureallthelayersofthephenomenon.Here,thesocialsciencesandhumanitieshaveacrucialroletoplay.

SSHcan,amongotherthings,contributeuniquelyinthefollowingways: Theycananalysesocialandculturalcausesofobesity. Theycanaddresstheissueofwhyandhowobesityisaprobleminthefirstplace. Theycananalyseandenlighten thesocial, cultural,andmoralnormsandpredicaments,etc.,

thatimpactobesity. In doing so, SSH can help address the challenges produced by obesity for individuals,

healthcaresystems,andsocieties.

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WHATARETHESOCIALSCIENCESANDHUMANITIES?

Thesocialsciencesandhumanitiesrepresenttwowide‐rangingacademicfieldsembracingamultitudeofdisciplines.There isnoestablishedconsensuson thedefinitionofor thedifferencesbetween thesocialsciencesandthehumanities,andthepreciseprofileofthesedisciplinesandthedistributionoffacultiesvariessomewhatamongcountriesandinstitutionsandovertime.Thelinkbetweenthemisthatbothstudyhumans incultural,historical,social,ethical,andeconomiccontextsand,indoingso,theytrytodeepenourunderstandingofthewayshumanbeingsact,think,andvaluevariousphenom‐ena.

Thesocialsciencesstudysocietiesandhumanbeingsatthemacro‐andmicro‐levelsand,typically,in‐cludeacademicdisciplinessuchaslaw,economics,politicalscience,sociology,criminology,anthropol‐ogy, ethnology, communication studies, information studies, human geography, and psychology.Throughsocial sciencedisciplines,weareable toexplore theextent towhicheconomicevaluationsguide or should guide obesity policy actions, the psychological and social underpinnings of obesitywitha focuson individualexperience,orthe interplayamongobesogenicenvironments,cultureandethnicity,andsocio‐economicstatus.

Thehumanitiesstudythehumanconditionand,typically,includetheacademicdisciplinesofphiloso‐phy,history,ethics,archaeology,religion,languages,linguistics,literature,visualandperformingarts,andthelike.Throughhumanisticdisciplines,wecananalysehowpublicconceptionsofpublichealthandtheacceptanceofgoverningpeople’sliveshasdevelopedthroughhistory,howdiscourseonobesi‐ty hasdevelopedor howandwhy individuals, organisations, andmember statesperceive and rankvaluessuchasliberty,health,equity,andresponsibilityinpublichealthpolicies.

Theboundariesbetweenthesocialsciencesandthehumanities intheexamplesaboveare,ofcourse,stereotypical.Dependingonhoweachdisciplinedefinesthedetailsoftheresearchquestions,boththesocialsciencesandthehumanitiescanhelpaddresstheresearchquestionsabove.

Methodologically,theSSHdisciplinesincluderesearchandanalysisthatmaybemoreorlesstheoreti‐cally‐ or empirically‐based. Theymay address human life on the individual or the supra‐individuallevel.Somedisciplinesfocusoninterpretation(e.g.anthropology,artsstudies);whereasothersfocuson interventions and change (e.g. economics, business studies, and law.). Methods range from thequantitativestatisticalanalysisofnumericaldataandmathematicalmodellingtoqualitativein‐depthinquiry,formallogic,interpretation,andmuchmore.

Asshouldbeclear,SSHisnotauniformresearcharea,butrather,arangeoffieldsofresearchinclud‐ingmultipledisciplines thatvarywith respect to thequestions theyaddress, themethods theyuse,andthetypesofanswerstheyproduce.Obesityresearchwillbenefitfromthevarietyofapproachesinaddressingthecauses,cures,andconstraintsofobesityviewedasasocietalproblembutalsofromthebroadersenseoftheimpactofobesityonsocietyinmarkets,civilsociety,andpoliticalauthorities.

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SOCIALSCIENCES&HUMANITIESANDOBESITY

Inobesityresearch,SSHcancontributebydeepeningourunderstandingofthecausesandimpactofobesityon the individualandsocietal levelandbyhelping toprovideknowledgeabouthowobesitycanbestbeaddressedbyvariousactors:intheclinic,incommunities,insociety,andbytheindividual.SSHcanaddlayersofreflectionandcriticaldistancetomorereductionistunderstandingsofobesity,anditcanhelprefineanddevelopnovelconceptsandframeworksforamorecomplexunderstanding.

Obesityalsohasanimpactonsocietyandhumanlifethatgoesbeyondthosedirectlyinvolved.Obesitydiscoursewith a focusonbodyweight andbody shape influences the thinkingand the values, con‐cerns,andidealsofthebroaderpopulation–leading,e.g.,tohealthierandmorephysicallyactivelivinghabits,ontheonehand,and,ontheother,tosocialstigma,exclusion,anddiscrimination.Theobesityproblemalsoraisesissuestobeaddressedandopportunitiestobeutilisedbymarketactors,civilsoci‐ety,politicalauthorities,andsocialmovements.SSHcancontributetoourunderstandingofsuchwideraspectsofthemodernobesityepidemicand,thus,informpoliciesandactions,helpmaximiselegitima‐cy,acceptance,andtheethicsofintervention,andminimiseunintended,negativeconsequences.

WHATANSWERSCANSOCIALSCIENCESANDHUMANITIESPROVIDE?

SSHresearchaddressesobesity inadifferentwaythanthenaturalandhealthsciences. Itaddressesobesityfromtheperspectiveofthehumanworld–consistingofculturally‐formedindividuals,popula‐tions,societies,nations,communities,socialgroups,andorganisations.Humanbeingspossessagency;theyattributemeaningtotheiractions;theycreateideasabouttheworldthatguidetheiractions,andtheyproduceandreacttotheenvironmentsinwhichtheylive.Thisproducescontingency–notnatu‐rallaws.

SSHmost often produce results that are contextually specific. This can help provide amore preciseunderstanding of obesity in relation to population groups, communities, cultures, or social classes.Findingsonthecausesofobesityorhowobesitycanbestbeaddressedwillalwaysvaryaccordingtothespecificcontext.

Thedailyhabitsandconcernsorpracticalunderstandingsandorientationsassociatedwiththedevel‐opmentofobesitymayvaryconsiderablybetweenmenandwomen,childrenandadults,socialclasses,andmemberstates,whichmeansthatpoliciesandservicesthatprovedeffectiveinonenational,re‐gional,orsocio‐economicsettingmaynotworkinsettingswhereinstitutionalframeworksoreconom‐icconditionsaredifferent.Socialsciencesandhumanitiescanhelpproducevalidevidenceofthespe‐cificconditionsforcauses,problems,and“cures”invariouscontexts.

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OUTLININGTHEPRESENTATIONSFROMTHEWORKSHOP

WELCOMEANDINTRODUCTIONTOTHEWORKSHOP

Professor Lotte Holm, University of Copenhagen, Denmark, and Professor Jean‐Michel Oppert, pastpresidentofEASO,gaveajointintroductiontothebackgroundandobjectivesoftheworkshop.ProfessorHolm introducedobesityasa societal challenge thatneeds tobeaddressed throughbio‐

medicalresearchand,toamuchhigherextent than has been the case untilnow,bythesocialsciencesandhuman‐ities.Themessagewasthatthecauses,the consequences, and the potentialcuresforobesityarenotonlybiomedi‐cal. They are also social, political, eco‐nomic, ethical, and cultural matters.Stakeholders such as EU institutions,public authorities, and the obesity re‐search community increasingly recog‐nise the need for social sciences and

humanitiestoanalyse,conceptualise,andunderstandobesity.ProfessorHolmoutlinedtheobjectivesoftheworkshop: To prepare the European obesity research community for the forthcoming EU framework pro‐

grammeHorizon2020,whichwilladdresssocietalchallengesthroughresearch. To establish and strengthen the network of researchers in social sciences and humanitieswith

interest,capacity,andexperienceinobesityresearch. Tocreateaforumfordiscussionthataimstoshapefutureobesityresearch. TofacilitatethecreationofnewtransdisciplinarycollaborationsinobesityresearchacrossEurope.ProfessorHolmbrieflypresentedthebroadspectrumofparticipantsintheworkshop,whichincludedscientistsfromanumberofdifferentSSHdisciplines–forexample,anthropology,sociology,psychol‐ogy, political science, philosophy, history, geography, communication, and science and technologystudies.Moreover, biomedical researchers and nutritionists with specific interest and experience in cross‐disciplinary collaborationswere representedalongwith staff fromEU institutionsand internationalorganisations.

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ProfessorOppert explained thebackgroundof theworkshop, introducingEASOas thevoiceof theEuropeanobesityresearchcommunity.ProfessorOppertsummarisedEASO’s2‐yearconsultationpro‐cessfrom2010‐2012.Thisprocesshaschallengedthecurrentthinkingandparadigmsinobesityre‐searchand identifiedkey issues topush the scientific frontier in the field.ProfessorOppert empha‐sised the results from the EuropeanObesity Research Conference “FromBiologytoSociety”,whichwasconvenedbyEASOinFebruary2012.The recommendations included devel‐oping a transdisciplinary approach toobesity research by integrating socialand biomedical sciences, developing alife‐course perspective on obesity, anddeveloping a deeper understanding ofthe societal impact of obesity. The pre‐sentworkshopwaspresentedasadirectfollow‐uponthepriorresearchconferencewiththeclearaimofstrengtheningexistingandestablishingnewnetworksthatcutacrossbiomedicalandsocialscienc‐es.Itshouldbeseenasanimportantstepinbreakingdownbarriersbetweendifferentacademicdisci‐plines and helping to nurture the development of a common transdisciplinary approach to obesityresearch.

KEYNOTESPEECHONTHEIMPORTANCEOFSSHRESEARCHINHORIZON2020

PatriciaReilly,CabinetMemberofEUCommissionerMaìreGeoghain‐Quinn,beganherpresenta‐tionbyacknowledgingtheconcernthatobesitycausesforsociety.ShereferredtotheOECDpublica‐tion“HealthataGlance:Europe2012”,publishedinNovember2012asaveryimportantreferenceforHorizon2020(21).Thepublicationdocumentsashockingnumberofobeseandoverweightpeople inEurope,anditalsoindicatesthatmanyparentsdonotrecogniseoverweightintheirownchildren.

Ms.Reilly emphasised theburdenofobesityonpublichealthandfinancialsystemsandtheneedto take action in terms of prevention and care.Ms. Reilly touched on the EU research invest‐ments made through FP7. For example, 300millioneurowasinvestedthroughFP7tounder‐stand obesity, nutrition, food choices, lifestyleinterventions, etc. ForHorizon 2020,Ms. Reillypointed out research needs such as new bi‐omarkers. diagnostics and personalised ap‐proaches, the unmatched opportunity for com‐parative studies of the practices across Europeto identify what works, as well as the need to

involve regulators to facilitate the acquisition of new knowledge. Horizon 2020 will fund researchbasedon these challenges,whichmakes the interdisciplinaryapproachparamount. Shepointedout

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that, according to the Commission proposal, the health challenge in Horizon 2020 is the largest intermsofbudgetallocation.Sheendedthekeynotebystatingthatthisworkshop,representingdiffer‐entscientific fieldsandastrongwillingnesstoworktogether, isthekindofforumshewouldliketoaddressmoreoften–peoplewhoarereadytobreakthesilosanddevelopnewsolutionstogether.

SOCIALSCIENCESANDHUMANITIESINOBESITYRESEARCH:HOWANDWHYSHOULDWEDOIT?

Dr.HarryRutter,LondonSchoolofHygieneandTropicalMedicine,UK,presentedtheargumentforaddressingobesityasacomplexphenomenon inclosecollaborationacrossacademicdisciplines.Dr.Rutterstatedthatcurrentbiomedicalresearchisgenerallybasedonlinearcauseandeffectmodelswhichareinadequatetoexplainthecomplexadaptivesystemofobesity.Biomedicalscienceuseses‐tablishedtoolstogenerateevidencebasedonnewandexistingknowledge.Bycontrast,thesocialsci‐encesandhumanities seek tocreatenewunderstandingsofknownphenomena.Combining the twoapproachesbuildsonthestrengthsofeachtocreatenewsynergies.Dr.Ruttermadethepointthatwetendtostudyaverylimitedpartof thebroadandcomplexphenomenonofobesity, suchasthecosteffectivenessofacertainintervention.Wetherebyexcludeanenormousamountof(potential)knowledgebynotworkingtogethertocombineperspectivesandapproaches.Byfocusingonlyonthecost‐effectivenessofparticularinter‐ventions, forexample,wemiss tremendousopportunities toaddressandunderstand thewhole, complexphenomenonofobesity.Thus, there isno single,predictable, one‐size‐fits‐allanswer to solve obesity. Instead, the aim should be to im‐provetheoverallunderstatingofthesystembyapplyingmul‐tipleperspectivesratherthansingle, linearmodels.Althoughacademiaand fundingsystems tend to rewardspecialisationandknowledgeofnarrowandspecificareas,theneedforre‐searcherswho can understand andmake links between dif‐ferentareasshouldberecognisedtoassureanimpactonobe‐sityresearch.Dr.Rutteralsostressedthechangingparadigminpublichealthfromacutediseasesituationstowardschronicdiseases.Thisrequiresashiftinthewaycareandtreatmentistackled–forexample,intermsofnewrelationsbetweendoctorsandpatients.Inconclusion,Dr.Rutteremphasisedfourmainpoints: Tobreakdownbarriers,workacrossdisciplines,andtakeasystemperspective Todevelopmethodologicalworktoidentify,create,anddevelopnewresearchmethods Tochangefundingpossibilitiesandrewardsystems Tointegratesocialsciencesandhumanitiesasessentialifwearesuccessfullytotackleobesity

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THEFUTUREOFOBESITYRESEARCH:WHATSHOULDBEDONEANDWHATWILLTHEIMPACTBE?

Thissessionwasdevotedtoapresentationofstakeholders’perspectivesandtheirparticularneedsfornewapproachesandpossibilities inwhichsocialsciencesandhumanitiescanplayamajorrole.Thequestionwas:“Whatshouldbedoneinfutureobesityresearchandwhatwilltheimpactbe?”

EuropeanCommission,Directorate‐GeneralforHealthandConsumerpolicyDeputyHeadofUnitPhilippeRoux referred to theEUWhitePaperonnutritionandobesitypub‐lishedin2007 (3),which looksbroadlyat thischallengeandreflectsthe ideasof thescientistsat thetimeandthepoliticalforcesatstake.Thestrategyhasnosingleprioritybecauseallprioritiesareinter‐

linked.Mr.Rouxpointedoutthefollow‐ing focus areas in developingknowledgeaboutobesity: Establishing the evidence based on

scientificknowledge.This isunder‐taken in cooperation with theWorldHealthOrganization.

Makingthehealthychoiceavailable. Healthinequalities. The relationship between obesity

andchronicdiseases.Mr.Rouxrecommendedthatwe ‘start fastandimprove’while,at thesametime,moving inmultipledirectionsinordertotestdifferentwaystointervene.Multidisciplinaryapproachesandtheevaluationof cost‐effectiveness are very important. Furthermore, a common andmutual understanding of keyelements in focusamongthescientistsandstakeholderswillpavethewayforsuccessinsupportinganddeliveringresearchwithahighimpact.

TheWorldHealthOrganization(WHO)Dr.JoaoBreda,ProgrammeManagerfromWHOEurope,brieflyintroducedtheWHOEuropeoffice,which comprises 53 countries. Theefforts ofWHO Europe in the areaof obesity started in 2006‐2007.Themandate is based on theWHOEurope Action Plan for Food andNutrition Policy 2007‐2012 (22). Dr.Breda illustrated the high preva‐lence of overweight in differentcountriesandagegroupsaswellasthe high prevalence of physical in‐activity and unhealthy diets. Theresults of foresight studies and the

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predictedrapid increases inobesityacrossEuropeaswemovetowards2030werehighlighted.Thefact thatmanycountriesonlyhave insufficientdataornodataatall tocreate theevidencebase forobesityandoverweight,wasemphasisedasasignificantEuropeanchallenge.Dr. Breda’s recommendations for future research priorities focused on: the early stages of life andachieving a minimum of denominators, understanding the links between obesity and other non‐communicablediseases,questioningtheuseofBodyMassIndex(BMI)tomeasureoverweight,deter‐minantsandRF,understandingsocialdeterminantsofhealthandsocialeconomicstatus (SES),gov‐ernanceofobesity,andtheroleofcivilsociety.Hesuggestedthatthesocioeconomicaspectsofobesityneedtobebetterunderstood.Forinstance,itappearsthattherelationshipbetweenlowsocioeconomicstatusandobesitydiffersamongcountries,andfurtherresearchisneededtounderstandthesedifferences.

ExperiencesworkingwiththefoodindustryProfessorWimSaris,MaastrichtUniversityMedicalCentre,TheNetherlands,andcoordinatorofthe“JointProgrammingInitiativeHealthyDietforaHealthyLife”wasinvitedtogivehiscon‐tributionbasedonhisexperiencesworkingwiththefoodindustryandincoordinatingtheFP6project,Diogenes.Heunderlinedtheimportanceofpersonalisedapproachestopreventandtreatobesitysinceindividualsaredifferentnotonlyinlifestyleandculturebutinbiologicaltraitssuchasenergyefficien‐cy.ProfessorSarissuggestedaprioritisedorderofthesevenpredefinedthemesoftheworkshop.ProfessorSarisalsopointedouttheneedtounderstandthecosts,effects,andconsequencesofobesityinordertoconvincepoliticiansthatactionisneededtotackleobesityandtomonitortheeffectoftheactions taken. Professor Saris stressed theimportance of scientific excellence, well‐established networks, and large‐scale longi‐tudinal intervention studies in order to im‐plementthesuggestedresearchsuccessfully.He also mentioned the significant im‐portance of establishing comparable datasets across countries, as many Europeancountries have obesity surveillance systemsthatareuncoordinated,impossibletomerge,andthereforeincomparable.Inordertoreal‐isetheresearchenvisioned,collaborationbetweendifferentfundingagencies–nationalandEuropean–isaprerequisite,andthisiswhattheJointProgrammingInitiative(JPI)triestodo.TheJPI“HealthyDietforaHealthyLife”wasintroducedasanexample.

HORIZON2020:IndependentexpertgrouponpublichealthresearchProfessor Thorkild I.A. Sørensen, Capital Region of Denmark & University of Copenhagen,Denmark,wasinvitedinhiscapacityaschairmanofanindependentexpertgroupthatwasrequestedto advise DG Research and Innovation (European Commission) on the implementation of Horizon2020intheareaofpublichealthresearchforthechapteron“SocietalChallenge”.Hegaveabriefsyn‐

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thesis of the draft recommendations preparedby the expert groupon four issues raisedby theDGResearchandInnovation: Whatshouldthefuturethematicpriorities in

Horizon2020be? What is the best way to structure European

publichealthresearchinthefuture? Howdowedevelopstrongerlinksandsyner‐

giesbetweennational researchactivitiesandpolicy agendas as well as EU‐funded re‐search?

How do we improve the generation of evi‐dence frompublic health research in the de‐velopmentofpublichealthpolicy?

ThereportissupposedtobedeliveredtotheEUCommissionbyearlyMarch2013andwillbemadepubliclyavailable.

EXPERIENCESFROMFORMERSUCCESSFULEU‐PROJECTS:FROMBESTPRACTICETONEXTPRACTICE

Followingthestakeholdersession,threepreviousEU‐fundedresearchprojectswerepresented:HEL‐ENA,IDEFIX,andEATWELL.Thepurposewastoinspiretheparticipantsbydiscussinggoodandlessgoodexperienceswithobesity‐relatedtransdisciplinaryresearchprojects.

EUFP6ProjectHELENATheHELENAproject (23) fundedunder the 6th FrameworkProgrammewaspresentedbyProfessorMariaMarcelaGonzalezGross,UniversidadPolitécnicadeMadrid, Spain.HELENA focused onhealthylifestyleandnutritioninadolescence.HELENAwassuccessfulincombiningtheuseofquanti‐tative datawith qualitativemethods to understand the food choices of youngpeople. Novel resultsweregeneratedthroughacross‐disciplinaryapproach,whichotherwisewouldnothavebeenpossible.The results includednewknowledge about the relationshipbetweenphysical activity and total andabdominalfatandbetweenphysicalactivityandvitaminD,whichinfluencesbonemass;andthepro‐jectidentifieddifferentclustersofbehaviouralpreferencesintermsofdietandphysicalactivity.Theproject also explored and identified the reasons for snacking and snack choices among adoles‐cents. ProfessorGonzalezGrossconcludedby summarising thebenefits of combining the social sci‐encesandhumanitiesandthebiomedicalapproaches–forexample,SSHanswersthe“why”questionrelatedtolifestyle,behaviour,andchoicepatternsandobservesandconductsresearchonthebasisoftheobjectiveapproachappliedbybiomedical sciences.Together, they canaddress theobesity chal‐lengeinaholisticwayforwhichthereisastrongneed.

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AprimaryresultofHELENAwas thecreationofahealthy lifestylepyramid. Itconsistsof four facesandabase:dailyfoodintake,dailyactivities(e.g.,sedentaryactivity,sleeppatterns,physicalactivity),

the foodpyramid, and health and hy‐giene.Professor Gonzalez Gross highlightedthe successful communication effortsbased on HELENA in terms of scien‐tific publications, conference presen‐tations, PhD theses, and stakeholderinteraction.HELENAalsowonaEuro‐pean award as “Communication Star”inMarch2011,and itwasselectedasa“SuccessStory”bytheEUin2011.

EUFP6ProjectIDEFICSThe IDEFICS study (24), funded under the 6th Framework Programme, was presented byProfessorWolfgangAhrensandProfessor Iris Pigeot from the Leibniz Institute for PreventionResearch andEpidemiology–BIPSinBremen,Germany.IDEFICS focused ondietary‐ and lifestyle‐inducedhealtheffects in infants andchildren and tried toidentifyrelevantfactorstoexplainweightdifferences.Thestudylookedatdiet,physicalactivity,andstress.IDEFICS generated data from ques‐tionnaires directed to parents aboutsocialfactors,diet,andmedicalhistory.It was combined with physical andbiological examinations and quantita‐tive data about, e.g., the BMI of thechildren in the sample. IDEFICS hasconcluded that adherence to recom‐mendations regarding sufficientphysi‐cal activity, limited screen time, suffi‐cientsleepdurationandanactivefami‐lylifealtogethermayreducetheriskofchildren becoming overweight orobesetoalmost10%ofthosewhodonotmeetanyoftheserecommendationsAkeyconclusionwasthat the family setting is important in terms of intervention. For example, parental overweight andtimespentinfrontofascreenaresignificantriskfactorsforchildhoodobesity.IDEFICSresultedinsixkeyrecommendationsfornutrition,physicalactivity,andstress–thethreeriskfactors studied: daily intake ofwater rather than sweet drinks, daily intake of fruit and vegetables,

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limitedTVwatching,dailyphysicalactivityandoutdoorplay,spendingtimewiththefamily,andade‐quatesleep.Childrenthatadheretothesesixrecommendationshavealowriskofdevelopingobesity.Recently,theprojectI.FamilywasinitiatedwiththeaimofcontinuingtheIDEFICSstudy,followingthesamesampleofchildrenandfocusingonthefamilysettingtodevelopnew,effectiveinterventions.

EUFP7ProjectEATWELLTheEATWELLproject(25),fundedunderthe7thFrameworkProgramme,waspresentedbyDr.Barba‐raNiedzwiedzka,JagiellonianUniversity,Poland.ThebackgroundofEATWELLwasapoliticalde‐siretocreateappropriateevidenceforobesity‐relatedinterventionpolicies.EATWELLseekstointe‐gratedifferentperspectives,expertise,andmethodstoevaluatethenatureandeffectivenessofinter‐ventionsandtodevelopnewmethodsforfutureinterven‐tions.Theprojectincludesdisciplinessuchashealtheconomics,statistics,policyandpsychology,nutrition,marketing,andinformationscience. Itallowed for theuseofquantitativeaswellasqualitativemethodstoanswerquestionsraisedsuchas thebenchmarkingofpolicies, theeffectivenessofinterventions,investigatingthesuitabilityofprivatesectormarketing in public campaigns, the public acceptance ofinterventions, and recommendations for future interven‐tions.The results of theEATWELLproject include thedevelop‐ment of large‐scale interventions, the identification ofevaluation gaps and faults, the identification of missingdata, and recommendations for future actions to preventobesity.

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WHAT’SNEXTINEUROPEANHEALTHRESEARCH?

NathalieVercruysse,scientificofficerfordiabetesandobesi‐ty,DGResearchand Innovation, gaveapresentationonbehalfofthedeputyheadofunit,AnnaLönnroth.ShebrieflyoutlinedtheHorizon2020frameworkprogrammeforresearchandinnovation‐inparticular,thepillarfocusingonsocietalchallengesincludinghealth.ThesignificantchallengetobeaddressedistheincreasingamountexpendedonchronicdiseasesandthepressureonEuro‐peanhealthcaresystems,generatingavitalneedfornewsolutionsand innovations. Ms. Vercruysse also reminded the audienceabout the investments made under FP7 in obesity‐related re‐search.TurningbacktoHorizon2020,itwasmadeclearthattheoverarching objective of the challenge for “Health, DemographicChange andWell‐being” is “to provide better healthwhilemain‐taininganeconomicallysustainablehealthcaresystem”.Tomoveforwardinthisrespect,wemust improveourabilityto

address the healthcare challenge (while keeping costs under control), to invest in technologies forhealthpromotion,toenabletheimplementationofnewsolutionsinhealthcare,andtoimprovepre‐diction,prevention,andmanagementofchronicdiseases.

CONCLUDINGREMARKS

ProfessorGemaFrühbeck,PresidentofEASO,Spain,closedtheworkshopbyremindingthepartic‐ipantsabout theaimofdevelopinga transdisciplinaryapproachtoobesity researchasstatedat theEASOconference“FromBiologytoSociety”inFebruary2012.ProfessorFrühbeckemphasisedobesityasavery complex challenge and the need toexploit all perspectives in order to under‐stand the interaction between behaviour,environment, nutrition, genetics and epige‐netics, social circumstances, etc. She alsohighlighted the need to understand thenetworksandrelationsaroundobesity–forexample, social networks, the relationshipbetween obesity and other chronic condi‐tions, and the need to combine differentsciences or approaches in order to under‐standtheindividualcausesandcircumstancesthatleadtoobesity.ProfessorFrühbeckconcludedbythankingtheorganisersfortakingtheinitiativetoorganisethisworkshopandtheparticipantsfortheiractivecontributionsthroughoutthetwodays.

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RESULTS FROM THEWORKSHOP: SOCIETAL CHALLENGES & DEMANDS,FUTURERESEARCHPOTENTIAL,ANDPOSSIBLEIMPACT

The followingpages contain a table of suggestions related to the seven themes on obesity researchdiscussedanddevelopedintheworkshop.Thesevenoverarchingthemeswereinspiredbyareviewofpolitical literatureandreportshighlightingsomeoftheexpectationsandpotential forfutureobesityresearch,aspreviouslyidentifiedbypoliticalstakeholdersandresearchers(foradditionalinformationontheliteratureandreports,pleasevisitourwebsite).

Thesesuggestionsmustnotbeviewedasexhaustivebutasinspirationforthepotentialthatexistsinsocialsciencesandhumanitiesresearch.Thespecificinputundereachheadingislistedinnoparticu‐larorderofpriority.

Thethemesarelistedinthefollowingorder:

Theobesityepidemic:costs,effects,andconsequences Rethinkingpolicyandinterventions Valuesandnorms–blameandstigmafromthecitizens’perspective Disseminationofinformation:Power,knowledge,andthecitizen Socialstructures,urbanenvironment,andchoicearchitecture Socialinequality,thelife‐courseperspective,andvulnerablegroups SSHwithinmedicalsciences:Towardscross‐disciplinaryresearch

Foreachofthethemes,wehavegatheredtheconcretefindingsintoatable.Thefirstcolumnshowsthesocietal challenge that stakeholders, political literature, and reports highlight as being important toaddress. In the second column, the research potential that has been identified in the workshop islisted, showing the futurepotentialof combiningdifferent researchdisciplines. In the third column,thepotential impact forsociety, industry,andcitizens isoutlined. Thecollectivetableshouldgivearespectableoverviewofsomeoftheunexploitedopportunitiesthatcanbeprovidedbythesocialsci‐encesandhumanitiesorthroughcollaborationsacrossvariousacademicdisciplines.

Belowthetableof theseventhemes,wehave includedaboxcontaining informationonpossiblere‐searchpartners,potentialstakeholders,andcertainroadblocks, showcasing thepossibilitiesandthechallengesthataccompanyallofthethemesaddressingobesity.

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THEOBESITYEPIDEMIC:COSTS,EFFECTS,ANDCONSEQUENCES

SOCIETALCHALLENGE&DEMAND FUTURERESEARCHPOTENTIAL IMPACT

Goodpublichealthisessentialforeconomicandsocialdevelopment(6,13).However,theoverallpictureofthechallenges,effects,andconse‐quencesoftheobesityepidemicarenotknownindetail.Therefore,thereisaneedforastronger,moretrans‐parent,andevidence‐basedover‐viewofthechallengetoachievethehighestattainablestandardofhealth(5,20).

Toensureeffectivemeasurementofthescaleoftheobesityepidemic,theavailability,comparability,anddis‐seminationofdataonobesityneedtobeimproved.Asthisneedstobedoneacrossmemberstates,itmustincludeageographicandsocioeco‐nomicdistributiontoformarobustcommonevidencebase(1,2,4)andcommonindicatorsofobesityrelat‐edsocietalcosts(3,4,8,13).

Theeconomicandsocietaleffectsofdifferinglevelsofobesityacrosslifespananddifferentsubgroupsshouldalsobeaddressed,includinghealthcarecosts,absencefromwork,productivity,qualityanddurationoflife,andweightstigmaanddiscrimi‐nation(2,13).

Thesocialsciencesandhumanitiescanhelpcreatenewtools,measure‐ments,anddatabases,expandingthescopeforassessingtheextentandcostsofobesity,thecostsandbene‐fitsofintervention,andinvestmentsinpreventionandtreatment.

Addressingtheextenttowhicheco‐nomicevaluationsguideorshouldguideobesitypolicyactions.Howdosuchevaluationsmeasurehealth,andcouldwebenefitfromothermeasures?Investigatingmoralcosts,benefits,valuesandethicalissues,andthejustificationofinterventions,andlearningfromvariationininter‐ventionsandhealthcaresystemsacrossEurope.

Analysingtheeffectoftheeconomiccrisisonobesity‐relatedbehavioursandhealthinequalitiesbyapplyingbehaviouraleconomicapproachesandtherebyaddressingtheconse‐quencesofchangingeconomiccondi‐tions.

Addressingtheinequalitiesandcon‐sequencesofobesitytreatment.Weknowthatlowersocialeconomicstatus(SES)isassociatedwithahigherlikelihoodofbecomingobese,butweshouldexaminewhethertreatmentandpreventionofobesityarealsodistortedbySES.

Theclassicperceptionsoftheeco‐nomicimpactofobesity–forexam‐ple,theclaimthat“throughouttheirlives,personswithobesityandover‐weightmight'consume'lesshealthcarethan'healthy'people”isoftenputforwardasanargumentforintervention,butwedonotknowwhetherthisargumentisvalidorthe

Thecreationofabettercommondatabaseformonitoringtheobesityepidemicanditsdistri‐butionacrosssegmentsofthepopulationandmemberstates.

Thecreationofarobustcom‐monevidencebaseforpolicydevelopment.

Betterandmorecomprehen‐siveevaluationoftheeffectsofinterventionsandpolicies.

Richer,broader,andmoreaccu‐ratemeasurementsofthecon‐sequencesandcostsofobesity‐relatedissues–forexample,totalcostofsurgery,treatments,andpreventionstrategiesandtherelationshipbetweenexpenditureandsocietalandpersonalisedbenefits.

Amorenuancedviewofeffectsonqualityoflifeandthedistributivejusticeofobesityandbettermeasuresfortacklingobesity.

Theresearchwillhelpdevelopmoreeffectivehealthcaresec‐tors,improvecitizens’healthandwell‐being,andreducehealthinequalitiesinEurope.

Supportfortakingthecurrenteconomicsituationintoaccountinanti‐obesitypolicies.

Identificationofproblemsrelat‐edtothefailureofeffectivepreventionandtreatment‐whetherlinkedtothepromotionofstigma,obesogenicenviron‐ments,orculturalnormsindiffer‐entSESgroups.Thiswillleadtobettertreatmentoutcomesand

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effectofsuchstatementsandcoun‐terproductiveimpactssuchasstig‐matisationandmoraldecay.

reducetreatmentcosts.

Bydevelopingnewcohortsofpatientsreceivingdifferentformsoftreatment,wewillbeabletodifferentiatebetweendifferentcausesoftreatmentandpre‐ventionfailure

Acriticalexaminationoftheclas‐siceconomicargumentsandas‐sumptionsmayleadtomorere‐alisticpolicyobjectivesandbetterpublichealthpolicies.

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RETHINKINGPOLICYANDINTERVENTIONS

SOCIETALCHALLENGE&DEMAND FUTURERESEARCHPOTENTIAL IMPACT

Risinghealthcareexpenditureposesagreaterchallengethanevertogov‐ernmentsinmanycountries;healthcarecostsaregrowingfasterthanGDP(6).Weknowthatobesityisacomplexchallengeinfluencedbymultiplefactors.Therefore,itcallsforpoliciesandsolutionsthatcanincorporateandembracethiscom‐plexityandforinter‐sectorialap‐proachesaddressingmorethanjusthealthissues(5,9,13).

Atasocietallevel,policymakersshouldbemademoreawareoftheimportanceanddevelopmentofobe‐sity(11),andtheirpoliticalwilltoaddressobesityatthepoliticalra‐therthantheindividuallevelmustalsobeincreased(7,9).Tosupportthisdevelopment,weneedabetterwaytore‐examinecriticallythecurrentmechanismsforhealth,healthpolicy,publichealthstructures,andhealthcaredelivery(5).

Thereisaneedtointegratepoliticalperspectivesonfoodandconsump‐tion,sports,urbanplanning,andtransportationinordertorethinkobesitypoliciesandmakethemmoreefficient,intelligent,andinno‐vative(3,14,13).

Obesityshouldbeseennotonlyasaresponsibilityfornationalgovern‐mentsbutasacollectivechallengethatneedstobeaddressedacrosssectorstoachievecollectivebehav‐iouralchange.Thisshouldbedonebyinvolving,e.g.,public‐privatepartnerships,SMEs,NGOs,andothernetworksthatareabletoengageboththeprivatesectorandtheciti‐zens(3,13).

Designingnewtypesofeffectivein‐terventionsbyengagingthetargetgroup(theirvaluesandviews),bringingtogetherexpertise,andtak‐ingintoaccountculturally‐andso‐cially‐formedconceptions.

Criticalexaminationofpreventionpolicies:whatarethedriversforpolicymakersandhowispolicyshaped(forwhom,when,how,andwhy?)

Improvingstate‐of‐the‐artmeas‐urementsofcostsandbenefitsbyaddressingtheimpactofinterven‐tionsandshort‐andlong‐termef‐fects(immediatecostsanddelayedbenefits).

Howdoweoptimisethepathfromevidence‐basedresearchtopolicyimplementationinordertocreatemore(cost‐)effectivepoliciesandinterventions?

Addressingtheimpactofwelfareregimesonobesitylevelsindifferentsocialstrata,cultures,andmemberstatesinordertoidentifymoreeffi‐cientpolicies.

Developingthepotentialforcom‐parativestudiesacrossmemberstatesandexploringtheuseofdif‐ferencesbetweenmemberstatesasaresourceinordertolearnfromnaturalexperimentsandinterven‐tions.

Examiningwhenandhowtointer‐veneandincludingtheuseofre‐wards,nudging,andeconomicincen‐tives.

Examiningwhetherandtowhatex‐tentrewardingandnudgingfunction

Thesocialsciencesandhumani‐tieswillhelpqualifypolicies,healthservicesandinterven‐tionsbyanalysingandcomparingeffectsofvariousinterventionregimes,includingtheirunintend‐edconsequences,andbyaddress‐ingunderlyingissuesoflegitima‐cy,responsibility,andcosts,broadlyunderstood.

Creatingnewpolicymakingmethodsbydevelopingabetterunderstandingofrationalandirrationalincentivesforactorssuchascorporations,consumers,andpoliticians.

Developingframeworksforef‐fectiveimplementationandtheintegrationofinterventions(includingsustainablepublic‐privatepartnershipsandsustain‐ablepoliticalcommitment)andresearchtoolsforquantitativeandqualitativeevaluationofinte‐gratedapproaches.Developingcapacity‐buildingthroughbroadpublicaction.

Creatingnewinterventionsthroughcriticalreflectiontoinfluencebehaviourbyfocusingonchangingbeliefsand/orem‐powerment.

Abetterunderstandingandiden‐tificationofthecollectivesocialcostsofobesityandrewardstruc‐tureswillmakepossibleabetteruseofmotivationalfactorsthatmaybeimplementedearlierthanmedicalones.

Creatingmoreeffectivehealthcareservices.

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Publichealthstrategiesshouldnotincreasetheburdenontheobese(15).Thereisaneedforamorecriticalexaminationofintendedandunin‐tendedconsequencesofpreventionpoliciesandthecomparativeandcausalconnectionsaffectingthein‐creaseofobesitybothnationallyandbetweenmemberstates.

Thereisaneedforaclearerpictureoftheeffectivenessofcurrentmeth‐ods,approaches,andpoliciesto‐wardsthepreventionandtreatmentofobesity.Advancedinformationsystemsandcomputationaltech‐niquesforthecollectionandanalysisofdataaswellasthemodellingofobesitytrendsandlikelyresultsofanactioncouldsupportthisagenda(1,8,18).

Betterassessmentofcomplianceandeffectiveness(economic,social,psy‐chological,andmedical)(1,3,10)andsystematicidentificationofactionsatthenationalorlocallevelisneeded.Thisshouldbedonebyoptimisingdedicatedobesityinterventionsandbygeneralchangesinhealthcaresystems,policy,andeconomicstrat‐egies,incl.taxesandenvironments.Thisinformationshouldalsofilltheknowledgegapbycreatingmoresustainable,evidence‐basedinitia‐tivesforfamilies,clinicalhealthcarepractice,childcare,andschoolorcommunitysettingsandpavethewayforabetterevaluationandas‐sessmentofpoliticalandmedicalinterventions(8).

inthelongerterm.

Strengtheningtheevidencebasefor‘consumerbehaviour’andregulatoryactiontochangeobesity‐relatedbe‐haviours.

Analysinghowpublicconceptionsofpublichealth,theacceptanceofin‐terventionintogoverningofpeople’sliveshasdevelopedthroughouthis‐toryandacrosscountries,govern‐mentalregimes,andcultures.

Howdoweperceiveandrankvaluessuchasliberty,health,equity,andresponsibilityinpublichealthpoli‐ciesandwhy?Howareassumptionsofresponsibilityjustified?

Addressingthebalanceofsocietalandindividualresponsibilityandautonomyandre‐evaluatingtheideaofpaternalismaswellaspersonalresponsibilityinpublichealth.

Exploringtherole,effect,andpoten‐tialofsocialmarketingandstake‐holderengagementinpreventingandtreatingobesity.Whateconomicorbehaviouralinterventionsareeffectiveinchangingbehaviouronthesupplierside,andwhataretheethicallimitationsformarketingandbrandingin,e.g.,thefashionindustryorthemedia?

Whatconceptionsofthegoodlifeinrelationtohealthcanbefoundinlocalcommunities,andhowcouldtheybeadaptedforeffectivepublichealthinterventions?

Howandwhydoesthedefinitionofhealthdifferfromthedefinitionofpreventivecare,andwhatimplica‐tionsfollowfromdifferentviews?

StrengtheningcallsforbetterpublichealthlegislationsuchasarevisedPublicHealthActthatcanre‐balancehealthagainsteco‐nomicinterests.

Makingnormativeassumptionsexplicitinprogramsandinter‐ventions,therebytakingintoac‐countpersonalresponsibilityforhealthandreducingvictim‐blaming.

Generatinginnovativetrajecto‐riesforunderstandingobesitybysidesteppingestablishedscien‐tificdefinitionsanddrawingonotherpossiblewaysoflearningfromrelevantpractices.

Gathering,highlighting,anddis‐seminatingthegoodpracticesthatalreadyexist,therebyenhancingcorporatesocialresponsibility(CSR),improvinghealthser‐vices,andinspiringnewwaysoflife.

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VALUESANDNORMS–BLAMEANDSTIGMAFROMTHECITIZENS’PERSPECTIVE

SOCIETALCHALLENGE&DEMAND FUTURERESEARCHPOTENTIAL IMPACT

Obesityisablatantlyvisibleandcomplexconditioninsocietyimpli‐catingmultipleandoftenhighlyper‐sonalissuesfortheindividual.Therefore,avoidanceofstigmatisa‐tionisparamountinaddressingandcommunicatingaboutobesity(14).

Norms,values,andguiltinrelationtoobesityneedtobeaddressedaswellasthecausesandeffectsofstigmaandhowobesityisperceivedtofindwaystoavoidstigmatisation(9,21).Furthermore,theframingofobesityindifferentarenasappearstohaveanimpactonthediscourseofobesity,whichshouldbeexploredandaddressed.

Tounderstandbetterhowobesityisperceivedbycitizens,society,andpolicymakers,weshouldatthesametimeforceourselvestoreflectonquestionssuchas‘whatdowecon‐sidernormal?’intermsofobesityand‘whatunintendedconsequencesfollowfromourperceptionofnor‐mality?’(11,15).

Inaddressingindividualresponsibil‐ity,safetyshouldnotonlyincludephysicalsafetybutalsoincorporate‘psychologicalsafety’.Weshouldatthesametimetrytoexplaininwhatformandhowtheroleofresponsibil‐ityshouldbeimplementedinpoli‐ciesandinsociety?(11).

Theprimaryunderstandingofobesi‐tyindicatesthatobesityissimplycausedbytheindividual’slackofexerciseorhighfoodintake,buttheextenttowhichresearchonappetiteandfoodintakebehaviourhasreallyhelpedusunderstandtheproblemsofobesepeopleappearstobelim‐

WhatistheextentofstigmatisationanddiscriminationacrossEuropeinrelationtomedicaltreatment,em‐ployment,promotion,andeduca‐tion?Howisstigmatisationexperi‐encedindifferentpopulationgroupsandfromdifferentperspectives?

Howisobesitysociallyconstructed?Bywhomandhowisitmediatedasaphenomenonindifferentsettingsandthroughdifferentchannels–forexample,inthemedia,thefashionindustry,andsports?Howdoesthisdifferacrosscountries,cultures,andlanguages?

DoesBMIfunctionasavehicleforstigmatisationbythehealthcaresec‐tor,thecommunityandthemedia,andself‐stigmatisation?Howcanstigmatisationbepreventedbychangingdiscourses,narratives,andfocusareas–forexample,bymovingfrom‘avoidingobesity’to‘enjoyingahealthylifestyle’?

Whatvaluesareembeddedinkeyterms,waysofspeakingaboutobesi‐ty,anddifferentconceptsofobesity,andwhy?

Howdostigmatisingattitudeswork?Whatcausesstigmatisation,andwhatarestigmatizingpractices?Howcantheybeavoided?Whataretheindividualandsocietalcostsofstigmatisation?

Theinterrelationshipandinteractionofstigma,responsibility,shame,andguilt‐aswellaspublicopinionandthelegitimacyofobesity‐relatedhealthservicesandpolicies.

Howispublicacceptanceofobesity‐relatedhealthservicesshapedand

Thesocialsciencesandhumani‐tieswillqualifytheunderstandingandreframingoftheconceptofobesityandnormalitybyhigh‐lightingvaluesandnormsunder‐lyingvariousperspectivesonobe‐sityandhelpustounderstandandcounteractblame,stigmati‐sation,anddiscriminationagainstobeseindividuals.

Modernisingclassicinterventionsand,possibly,revisingproposedinterventionstoavoidnaïvein‐terventionsandnegativeim‐pactonbothobeseandnon‐obeseindividuals.

Opportunitiestoestablishneweducationsandeducationma‐terialforthehealthcaresector,individuals,andthemedia–forexample,materialfortrainingjournalists,newphoto‐librariesofobeserolemodels,andnewedu‐cationalbooksincorporatingknowledgefromnewresearch.

Newmethodsforpublicdialogueanddebateandanewbasisforanti‐stigmacampaignsandpol‐icymakingthatcouldreducestigma.

Creatingmoresensitivescreen‐ingsforobesitytocounterweightvictim‐blamingandthereduc‐tionofstigmatisingattitudes.

Supportingpsychologicalwell‐being,whichsupportsweightloss,abetterhealthandimprovedqualityoflifeforthecitizens.

Betterunderstandingofthepsy‐chologyofstigmatisationtohelpovercomeobesity‐relatedbarri‐

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ited.Therefore,wealsoneedtoseeobesityasaresponsetothelivingconditionsoflatemodernsocietyratherthana‘lifestyledisease’tohelpavoidthestigmatisationofindi‐viduals(14).

Boththephysicalandso‐cial/emotionalsequelaeofobesity,whichmayincludestigmatisationandbeingbullied,affectqualityoflifeinchildrenandadults(8).

Weoftenthinkofobesityasself‐inflicted,butitisassociatedwithpsychiatricdisordersinsomecases,includingdepressionandbinge‐eatingdisorder.Thescopeandeffectofthesecasesshouldbeinvestigatedfurther.

affectedbysociety?

Creatingabetterunderstandingofhowandwhynon‐obesecitizensstaynon‐obese,andhowformerlyobesepeoplehavebeenabletomaintaintheirnewweightaftersuccessfulinterventions.Thebidirectionallinkbetweenappetitecontrolandtherewardsystemshouldbeexplored.

Howisitpossibletounderstandthepsychologicalandsocialunderpin‐ningsofobesitybyfocusingonindi‐vidualexperiencesratherthanpureoutcomesfrominterventions?Andhowcaneffectiveexperiencesandstrategiesbesharedbetweenpa‐tientstoreducesufferingandcom‐pensatoryovereatingandtoimprovecopingskills?

Howcantheconceptofobesitybereframednottofocusonbodyweight,appearance,andbodyshapebutonspecificbehaviourssuchasphysicalactivity,healthyeating,andwell‐being?

Whatvaluesandnormsdefinenor‐maloraverageweight?Addressingtheparadoxofstigmatisingandpathologisingoverweightandobesi‐tyandviewsonaverageconditionsasoutsideofthenorm.Howisitpos‐sibletoaddresstheinter‐relatedstigmatisationfactors,i.e.obesity,social‐economicstatus(SES),ethnic‐ity,gender,andage,andhowdoweaddressthestigmatisationofchil‐dren?

ers.

Promotingethicalbehaviourinindustryandsocietyatlargetoenhancewell‐beingandgovern‐mentpolicies.

Creatingawarenessofadverseeffectsandvictim‐blamingamongmedicalprofessionalsandenhancingthequalityandeffectivenessofmedicalservices.

Innovativeplatformsforthehealthcaresectortofacilitatethetransferofcopingstrategiesbetweenpatients,therebybring‐ingcitizensexperiencesandca‐pacitiesintoplay.

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DISSEMINATIONOFINFORMATION:POWER,KNOWLEDGE,ANDTHECITIZEN

SOCIETALCHALLENGE&DEMAND FUTURERESEARCHPOTENTIAL IMPACT

Conventionally,wesupplyinfor‐mationtocitizensaboutwhatishealthyandwhatisnot,butthismethodhasnotproventobeeffec‐tiveinpromotingandsustainingahealthylifestyle(5).Instead,weshouldexplorenovelapproachesthatcombineeducation,personal‐isedinformation,andtechnologicaladvancestocommunicateinfor‐mationmoreeffectivelyaboutthecausesandconsequencesofobesityfromalayperspective(6,15).

Weneedconsistent,coherent,andclearmessagesforcitizensfromin‐dustryandsociety,developedanddisseminatedthroughmultiplechannelsandinformsappropriatetothelocalcultureandenvironment.Specifictargetgroupsalongwithageandgendershouldbetakenintoac‐countwithafocusonhowtocreatenewandmoreeffectivetypesofedu‐cationtoaddressinformationgapsandavoidconflictingmessages(2,3,21).

Anotherquestionishowtoensurethatbiasedinformationfromadver‐tisingandmarketingdoesnotfalselymisleadconsumersandtheextenttowhichalackofmedialiteracyinvul‐nerableconsumers(e.g.,children)affectsthedevelopmentofobesity(11)?

Thereisaneedfornewconsumerpoliciesthataimatempoweringpeopletomakeinformedchoicesabouttheirdiet,exercise,andlife‐styleingeneral(1).Atthesametime,weneedabetterunderstandingoftheoveralleffectofincreasedem‐powerment.Newmodesofempow‐ermentandpotentialadverseeffectsshouldbeexploredwithafocuson

Howisitpossibletogettherightinformationtotherightcitizensinlightofcompetingmessagesandthefactthatthemessageswillchangeovertimeasaconsequenceofnew,emergingevidence?

How,why,andwhenisinformationseenasvalidorbiasedbytheindi‐vidual?How,where,andwhenarepeopleseekinghealthinformationinmodernsociety?Howisinformationbeingre‐distributed,andwhataretheconsequencesofthis?

Cansocialmediabeusedasaplat‐formforhealthcommunication,andhowcaninformationbeframedindifferentsettings?

Whataretheeffectsofandpotentialfor‘personalisedinformation’?Shouldindividualsbegiven‘clear‐cutmessages’orinsightinto‘thecomplexityofobesity’?

Howdowemakethehealthychoiceavailableandattractive,andhowdoweturninformationandinterven‐tionsintopositivedailyroutines,connectingwithcommunitiesandcitizensineverydaylife?

Howisitpossibletoconnecttocommunitiesandcreatenewandmoreeffectivetypesofeducationandinformationrespectingtheciti‐zens’ownviewofandrighttothegoodlife?

Howmayhealthliteracy,availability,andaccessibilitytocoherentandcredibleinformationabouthealthyeatingandotherlifestylechoicesbedisseminatedacrossmemberstates,ages,andsocioeconomicclasses?

Thesocialsciencesandhumani‐tieswillenrichobesityresearchandunderstandingbyfocusingonhowdiscoursesofobesity,pre‐vention,food,physicalactivity,and‘thegoodlife’areformed,disseminated,andperceivedamongvariousactorsandontheroleandconsequencesofempow‐erment,marketing,andtheover‐loadofinformation.

Providingeffectiveinformationcampaignsandlegislationtoprotectcitizensandenhancepublicsupportforhealthpoli‐ciesthatpromotebetteroverallhealth.

Raisingawarenessofthenormsrelatedtovalidknowledgeandopeningthemupfordiscussiontobringnewinformationintoplayfornewandmoreeffectivemodesofdissemination.

Creatinginterventionsthatareeffectiveandcommunicableinareal‐worldsettingandnotmerelyresearchsettingsbyprovidingnewpossibilitiesforproperimplementation.

Supportingachangeinthedis‐courseonobesityfromafocusonpreventingobesityasadiseasetoenjoymentandexercise.

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particulargroupsortimepointsinlifeandonbarrierstoimplementingnewdecisiontechniquesandmodelsforbetterinvolvementoftargetgroups(11).

Wealsoneedtounderstandbetterhowlearninganddevelopmentalfactorsinfluencetheinitiationandmaintenanceofbehavioursthatpromotehealthylifestyles–forex‐ample,toencouragehealthydietsanddecisions,weightloss,orthepreventionofexcessweightgain(8,13).

Howdoes(unequal)accesstoinfor‐mationaffecthealthinequalitiesandwhatmeasurescanimprovetheac‐cessvulnerablegroupshavetohealthinformation?

Whataretheeffectsoftheempow‐ermentofcitizens,andwhataretheeffectsofadvertisingandmarketingvs.educationandinformation‐whatcouldbelearned?

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SOCIALSTRUCTURES,URBANENVIRONMENT,ANDCHOICEARCHITECTURE

SOCIETALCHALLENGE&DEMAND FUTURERESEARCHPOTENTIAL IMPACT

Weknowthatsocialstructures(in‐cludinginfrastructure,theenviron‐ment,andbehaviour)playacrucialroleinthedevelopmentandoccur‐renceofobesity(13,19).Asanexample,thepresenceofsidewalksandmorestreetconnectivityinneighbour‐hoodsisassociatedwithmorephysi‐calactivityandfeweroverweightandobesepeople(8),andtheuseofbehaviouralandnutritionalstrate‐giesandtargetedlifestylestrategiescanofferadegreeofweightlossap‐proximatelydoublethatprovidedbydrugs(10).

Researchhassuggestedlinksbe‐tweenobesityandthephysicalenvi‐ronmentsincemanyaspectschangewhenpeoplemovefromoneplacetoanother.Whenpeoplemovefromruraltourbanenvironments,theirBMItendstoriseasanormalre‐sponsebynormalpeopletoanab‐normalenvironment(17).Further‐more,theimpactoftheenvironmenthasatendencytochangefromalife‐courseperspectiveandonmultiplelevels.Thiscallsforlongitudinalandmultifacetedstudiesaswellascom‐munity‐basedparticipatoryresearch,whichengagesandinvolvescommu‐nitymembersininterpreting,de‐signing,andimplementinglarge‐scaleresearchindiversecommuni‐ties(7,8).

Weneedabetterunderstandingofthedifferentaspectsaffectingade‐clineinphysicalactivitylevelsacrossEuropeandtolearnfromfactorsinfluencingbehaviourhowbettertosupportpro‐activeandwell‐informedcitizens(3).Abetterunder‐standingisneededofthewayspub‐licpoliciescanaddressanobesogen‐

Whatarethegapsbetweenactiveandsedentarylifestyles,andwhichdomainsoflifeshouldbetargeted?

Howdourbanenvironmentssuchasfoodavailability,foodpromotion,foodoutlets,andsupermarketsaffectphysicalactivityaswellasfoodcon‐sumption?

Whatalterationsinurbanplanningandbetweenruralandurbanenvi‐ronmentswithinandacrossmemberstatesaffectthedevelopmentofobe‐sity?

Studyingtherhythmandcontextofeverydaylife(time,space,anddailyroutines)byanalysing‘subjective’environments,narrativesoftem‐poralstructures,physicalactivity,andregistrationofeatingandseden‐tarybehaviourindifferentsocialsettings.Collectingandobservingcollectivedatawithnewelectronicdevices(ICT).

Exploringwaysforchoicearchitec‐tureandnudgingtobeusedeffec‐tivelytochangerelevantbehaviour.

Howisitpossibletocombiningintel‐ligentandaestheticpleasingarchi‐tectureincorporatingphysicalactivi‐tyintodailyroutines?

Howcanresearchinarchitecture,engineering,andbuildingsbeim‐plementedtocoordinate,integrate,regulate,andpromoteahealthylife‐style,physicalactivity,andthemostfavourablechoicefortheindividual?

Howwillitbepossibletodevelopbottom‐upapproachesinarchitec‐tureandurbanplanningbyinvolvingthecommunitiesandcitizensfrom

Thesocialsciencesandhumani‐tieswillcontributetounderstand‐inghowsocialstructuresandcon‐creteenvironmentsshapeoraf‐fectthebehaviour,choices,andpreferencesoftheindividualvis‐à‐visobesityandhowchoicear‐chitecturefunctionsandinflu‐encescitizens,policies,andsocie‐ties.

Supportingeffortstomakethehealthyoptionthedefaultandpreferredoption.

Betterknowledgeabouttheim‐pactofsocialfactorsonenvi‐ronment.

Anewperspectiveforbetterandmoreeffectiveurbanenviron‐mentsthatpromotephysicalactivityineverydaylife.

Newmethodsforurbanplan‐ning,transportation,anddevel‐opinginfrastructureinvolvingcitizensandactivatingcommu‐nitiesforuser‐driveninnova‐tion.

Providingnewapproachestocommunityengagementthatcanimprovecitizeninvolvementin,e.g.,urbanplanningfortheeffectiveempowermentandcommitmentofcitizens.

Developingandpromotingtheeffectiveuseofintelligentnudg‐ing,offeringcitizensattractive,healthyoptionsand,thereby,re‐ducingineffectivecontrolmechanisms,legislation,andbureaucracy.

Developingnewmodelsforcor‐

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icenvironment(physicalandsocio‐cultural)favouringsedentariness(2,10)aswellasknowledgeofthemeasuresandtaxonomyofabroaderspectrumofobesity‐relatedbehav‐iour(13).

Thereisaneedforabetterunder‐standingofintelligentchoicearchi‐tecturethatcanhelpmakethehealthyoptionavailable,facilitatetheincorporationofthesedailyrou‐tines(2,3,10,13),andtherebycounter‐balancetheenormousapparatusofcleveradvertisingfromtheindustry,whichnudgespeopletobuyandconsumetheirproducts(13,17,16).

anearlystage?Howandwhydochangesemerge,andhowcantheybestbeimplemented?

Howcanmarketingandmarketmechanismsbeusedtopromoteahealthylifestyle?Howdoweevalu‐ateormonitortheeffectsofsuchmechanisms?Canthischangebehav‐iourofthesuppliers?

Studyingthebiological(brain,me‐tabolism,genetics),behavioural(foodchoice,appetite,activity,sed‐entariness),andenvironmental(physical,social)interface–particu‐larly,inthesettingofchangesthatoccuras“naturalevents”

poratesocialresponsibility(CSR)thatincorporatehealthin‐dicatorsandmeasuresofqualityoflifetotackleobesityandover‐weight.

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SOCIALINEQUALITY,THELIFE‐COURSEPERSPECTIVE,ANDVULNERABLEGROUPS

SOCIETALCHALLENGE&DEMAND FUTURERESEARCHPOTENTIAL IMPACT

One’slifestyleis,tosomeextent,influencedbysocialposition,incomeandeducation,ethnicityandminori‐tystatus,urbanenvironment,andphasesoflifecourse(2,3,8).Toim‐provehealthequalityandtoacquirenewinsightintothesequestions,researchshouldtrytodisentanglethecausesofobesityinhigh‐riskpopulations,criticalperiods,andlifeevents(3,5).

Thereisaneedforabetterunder‐standingoftheevolutionofhealthinequalities,theeffectivenessofpol‐iciesaimingtoreducetheseinequali‐ties,andtheinterplaybetweenthedifferenttypesofinequality(1).

Therecognisedcombinedburdenofbeing‘obese,young,andunem‐ployed’or‘obeseandaging’andtheviciouscircleofobesitythatleadstomoreunhealthylifestylesandine‐qualitiesinhealthandsocialstatusshouldbeaddressedtoprovideabetterunderstandofhowtoobtainimprovedqualityoflife(8,9,13).

Furthermore,thesociocultural,envi‐ronmental,andgeneticpathwaysresponsiblefortheoccurrenceofobesityinpersonsconnectedthroughsocialnetworksandinmi‐noritygroupsshouldbeaddressed(7,8).

Childrenareofparticularrelevancewithrespecttoobesityandhealthperseand,especially,earlylearnedbehavioursthatdetermineprefer‐encesandbehaviourslaterinlife(2,8,13,21).Furthermore,theincreasingburdenofdiseaseanddisabilityinthecontextofanageingpopulationcallsforwaystopreventobesityand

Examiningthedifferentaspectsanddimensionsofinequalitywithspecialregardtovulnerablegroups(wealth,education,culture,stress,migration,ethnicity,religion,gender,agegroup,SES,etc.)andtheirinterconnectivity.

Usingdifferencesbetweenmemberstatesanddemographicsasnaturallaboratoriesforlarge‐scalecompara‐tivestudiestoimproveourunder‐standingofhowsocialinequalitydiffersacrossEuropeandwhy.

Studyingtemporalpatternsinobesi‐tydevelopmentvialongitudinalco‐hortscombinedwithin‐depthquali‐tativeinvestigationofrelevantsub‐groups.

Identifyingcriticalperiodsoflifethrough‘lifecourse’epidemiologyinvolvingfamilylifehistoriesandnarratives.

Addressingthecriticalwindowsforsusceptibilityandeffectivepreven‐tions/interventions,includingthebiological(pubertyormenopause),social(parents’divorce,unemploy‐ment,lossofspouse),andinstitu‐tional(schoolstartorretirement)windows.

Studyingdivergentpathsandthelifeeventsandcounter‐storiesofpeoplebreaking‘bad’habitsandchanginglifecourse–forexample,obesechil‐drenwhodonotbecomeobeseasadults–andbringingthisknowledgeintoplayinprimaryandsecondaryprevention.

Understandingandidentifyingave‐nuesfortacklingknowledgeandeducationgapsandtheirconse‐quences.Asanexample:could

Thesocialsciencesandhumani‐tieswillcontributetoresearchandpoliciesbyexaminingvulner‐ableand/ormarginalizedsocialgroupsandtheirlifeopportunitiesandchallengesandbygivingthemavoiceinobesity.

Theresearchcancontributetopolicydevelopmentinthefieldofsocialinequalityandobesitybypresentingdifferentinterpre‐tationsoftheissuesandtheirconsequences.

Adaptingpublichealthinter‐ventionandinformationtopeo‐ple’swayoflivingandpreferencesformoreeffectiveinterventions.

Developingnewapproachesandinsightstotackleobesityandpromotehealthbetterinanageingsociety.

Raisingself‐esteeminvulnera‐blegroups,whichcouldleadtogreatereffectivenessforhealthinformationandareductionofhealthinequalities.

Developmentofethicalguide‐linesformarketingandrespon‐siblemarketingmechanisms,whichmaycontributetohealthyconsumption.

Targetedandefficientinterven‐tionsinchildrenandadoles‐centswhoarealreadyobeseatcriticaltimepointsorbelongtovulnerablegroups.

Improvingplatformsandinter‐ventionsthattargetpotentialandchallengesrelatedtoimmigrationandincorporatetheindividual

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itsco‐morbiditiesthroughoutlife(8,13).

Thereisalsoaneedinsocietytoidentify,test,andmonitorbettertheeffectsoftargetedmeasures,thecontent,andthedeliverychannelsofpreventionmessagestopromotehealthydietsandphysicalactivityinpopulationgroupsandhouseholdsbelongingtocertainsocioeconomiccategoriesandtoenablethesegroupstoadopthealthierlifestyles(3,8).Atthesametime,thelong‐termeffectsoftargetedpreventionortreatmentstrategiesshouldbead‐dressed(3).

brandingofunhealthyproductstovulnerablegroupsberegulatedandhow?

Analysingtheinterplaybetweenobesogenicenvironmentsvs.cul‐ture‐ethnicityvs.socio‐economicstatus?Why,howandwhendoinsti‐tutionalinitiativesmakeadifferenceforobeseorunhealthymigrants?

perceivedinspecificculturalandlife‐coursecontexts.

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SSHWITHINMEDICALSCIENCES:TOWARDSCROSS‐DISCIPLINARYRESEARCH

SOCIETALCHALLENGE&DEMAND FUTURERESEARCHPOTENTIAL IMPACT

Thechallengeoftheobesityepidem‐iccallsforintegratedtransdiscipli‐narythinking,explorativeapproach‐es,hypothesisgenerationandtest‐ing,dataintegration,andevidenceassessmentacrossabroadspectrumofdisciplines.Bydoingthis,weop‐timisetheprocessoftranslatingre‐searchintoproductsandservices,whichwillcreatehigherimpactfortheend‐users.Atthesametime,itcouldsupportthepromotionofen‐trepreneurshipintheacademiccommunity,creatingmoreinnova‐tiveproducts,andsupporttheeco‐nomicrecoveryanddevelopmentinsociety(4,8,12,13,14).

Understandingdeterminantsofhealthandtheroleandinterphasesofenvironmental,behavioural,socio‐economic,andgeneticfactorsintheirbroadestsenses–i.e.,the’exposome’–callsfordifferentap‐proachesandmultiplescientificdis‐ciplinestobeintegratedtoaddressobesityasacomplexphenomenon(12,13).

Insightsareneededintobehaviouralandsocialmodelsandaspectsandsocialattitudesandaspirationsinrelationtopersonalisedhealthtech‐nologiesandmobileand/orportabletoolsincludinginformationandcommunicationtechnologies(ICT)(2,4,8,14).

Socialepidemiologycouldbein‐volvedinestablishingcohortsandexploringexistingageingEuropeancohortsinaddressingtheinteractionbetweengenesandlifestyleaswellasidentifyinggeneticandphysiolog‐icaldeterminantsof‐andinterac‐

Addressingobesityasacomplexconditionbytryingtoreflect‘real‐life’settingsandotherfactorsout‐sidebiomedicinethroughtheinte‐grationofqualitativeresearchmeth‐odsandinterpretativemethodsfromthehumanities.

Establishingandfullyharvestingthepotentialintrans‐Europeanbirthcohortsacrosslifespanstounder‐standtheroleandinteractionbe‐tweengenetic,physiological,social,andsocietalfactorsasdeterminantsofvarioushealthoutcomes.

Exploringtransdisciplinarypheno‐typingtoenableustomovebeyondBMIbyusingmultilevelanalysisfrom,e.g.,psychosocialtraits,genet‐ics,physicalactivity,biochemistry,andtheexplorationofthebiologicalexpressionofeatingbehaviour.

Exploringexistingandlong‐termcohortscouldaddressnewanddif‐ferentaspectsofobesityinordertounderstandbettertheinterplaybe‐tweendifferentbiological,social,andsocietalparametersaffectingthedevelopmentofobesity.

Addressingthechallengesofbalanc‐ingtheresearchaimsofunderstand‐ingcomplexityandidentifyingsinglekeycomponentsinthecause,pre‐vention,diagnostics,andtreatmentofobesity.

Conductingfollow‐upresearchoninterventionsandprogrammestomakethemmoreeffectiveandinclu‐sive–forexample,bylearningfromfamiliesinvolvedinthetreatmentofobesechildren,whatitmeanstolivewithobesity,andhowtreatment

Thesocialsciencesandhumani‐tiesincollaborationwitharangeofdisciplinesfrommedicalandrelatedscienceswillenrichobesi‐tyresearchandpoliciesbyad‐dressingthecomplexityofobesi‐ty,byqualifyingandbroadeningthestandardbiomedicalperspec‐tiveonobesity,andbyenhancinginterventionsandprogrammestofittheindividualandthesocialcontextbetter.

Novelresearchcollaborationsacrossdisciplinescanoptimisetheapplicationfactorofresearchresultsleadingto,e.g.,theeasierimplementationofinterventionsandthedevelopmentofinnova‐tiveproductsandsolutionsforthehealthandcaresectorandindustry.

Moretargetedinterventionsincludingabetterunderstand‐ingofbehaviouralfactorsrelat‐edtoweightlossandregainingweight.

Developingselectionmethodsthatprovideabetterbalancebetween,ononehand,evidenceandcosteffectivenessand,ontheotherhand,thehighimpactofapplyingthecomplexfind‐ingsandapproachesfromtransdisciplinaryresearchcollab‐orations.

Developingaplatformfortransdisciplinaryresearchtoincreasetheeffectivenessofchallenge‐drivenresearch.

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tionswith–behaviour(1,13).

Advancedphenotypinginneworfollow‐upstudiesonexistingcohortsshouldincludenoveltechnologiesandinformationsystemsforrecord‐inglifestylepatternsandpsycho‐socialdataandenvirotypinglivingconditions(3,13,14,15).Socialpeerpres‐sure,traditions,culture,andmythsmaybeaddressed(1).

Forclinicalinterventions,integratedapproachesand‘toolbox’elementspromotinghealthydietsandphysicalactivityshouldbeidentifiedandtransferredtoscalableinnovationandinterventions,includingtheuseofinformationandcommunicationtechnologies(ICT)androbots(2,8,14).

Thedilemmaof’whentointervene’(preventionvs.treatment)andhowtostrengthencomplianceshouldbeinvestigatedincollaborationsbe‐tweenSSHandmedicalresearch(10).

programmesarereceived andadopted.

Exploringthegreatpotentialfornewresearchthatcanprovideabetterunderstandingoftheinteractionbetweendifferentsocial,societal,andinstitutionalfactors(schoolstart,marriage,movingout)andbiologicalfactorssuchaspreconcep‐tion,pregnancy,andmenopauseinrelationtoobesity.

Understandingthesocial,cultural,economic,andpoliticaldriversofbehaviourandthelinktoneuroen‐docrinefunctions.

Developingsocialepidemiologicalstudiesatgroupandpopulationlev‐elsinordertoassesstheroleofsuchfactorsinunderlyingcauses,motiva‐tions,andindicatorsoftheobesityepidemic.

Exploringobesitydevelopmentasthebiologicalprocessofthein‐creaseddevelopmentofadiposetis‐sueandtheaccumulationoftriglyc‐eridesthatmaybearesponsetoaspuriouslysensedneedforfuturereserveenergy.

Supportingandexploringthecrea‐tionofunifiedtheoriesaboutobesitybyintegratinginacoherentwaythepre‐existingevidencefromalldisci‐plines,theopenquestions,andthederivedhypotheses.

Exploringtransdisciplinarity:Where,how,andwhydodifferentscientificdisciplines(e.g.,epidemiologicalstudiesonvulnerablegroups)inter‐sectwithresearchfromthesocialsciencesandhumanities?Howisitpossibletoachieverealintegrationofscientificdisciplines,andhowcanwechallengethedominatinghierar‐chiesinthesciences?

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ACADEMICCOLLABORATIONPARTNERSANDPARTICIPANTS

Advertising,advocacyanalysts,architecture,anthropology,behaviouralscience,biochemistry,biosemiotics (andtheirresearchsubjectsdocumentingeverydaylivestointegratebetterthevoiceandnatureofcitizens),clinicians,cohortstudies,communication,consumerresearch,CSRresearchers,demographists,designers,discourseanaly‐sis,economics,educators,endocrinology,epidemiology,ethics,ethnography,ethnology,foodanddietarybehav‐iourscience,genetics,geography,governanceandpolitics,thehealthandcaresector,healtheconomy,history,internetinstitutes,journalism,lawandadvocacy,linguistics,longitudinalstudiesinvolvingsocialscientists,neu‐robiology,neuroscience,nutrition,marketing,mediaanalysisexperts,media,mediasciences,medicine,medicsandpractitioners,metabolismresearch,onlinecommunities,philosophy,physicalactivityandsports,policyana‐lysts,politicalscience,psychology,publichealthandpublichealthethics,scienceandtechnologystudies,socialepidemiology,socialmarketing,socialpsychology,sociology,urbanplanning.

POTENTIALSTAKEHOLDERSFORFUTURERESEARCH

Citizens(obeseandnormalweight),citizenandpatientorganisations,clinicians,theconstructionindustry,con‐sumerassociations,educationalinstitutionsandsystems(universities,highschools,schools),employers,envi‐ronmentalorganisations,theEU,Europeanmemberstates,financeministers(nationalandinternational),thefoodandbeverageindustry(incl.thefastfoodindustry),governmentsandpolicymakers(nationalandinterna‐tional),governmentalhealthserviceproviders,healthcaresectors(nationalandinternational),healthinsuranceproviders,healthprofessionalassociationsandnon‐governmentaladvocacyorganisations,healthpromotionor‐ganisations,medicaldoctors,newsagencies,NGOs,theOECD,onlinemedia,thepharmaceuticalindustry,thephysicalactivityindustry,primarycarephysicians,publichealthorganisationsandgovernmentalprofessionalsatalllevelsfrominternationalorganisations(WHO,OECDandEU),regionalandlocalinstitutions(municipalitiesandtheirinstitutions–forexample,schools,kindergartens,highschools,hospitals),researchnetworksandor‐ganisations,scientificsocieties,self‐organisingcommunities,tradeunions,treatmentservicesandprofessionals,urbanplannersandcounter‐movements,theWorldHealthOrganization(WHO).

POSSIBLEROADBLOCKSTORESEARCH

Economicmethodsand‘hard’measurementsarethemostcommonsortsofevidencebasetoday.Therefore,newmeasurementsthatare‘softer’andmoreinclusive–measuringeffectandnotmerelyeffectiveness–couldbedifficulttoacknowledgeandimplementproperlyinscientificcommunitiesandinsociety.

Itmightbeadetourtoask'whataretheworldviewsandnormsembeddedincurrentnutritionscience'ortoask'howdo'goodprofessionals'work,andwhatcanwelearnfromit?’becausethesequestionsdonotfitmostofthedominantmodelsforscientificknowledge.However,thepromiseisthatthismightbeinnovativeandproductiveinthelongrun.

Citizens,industry,healthprofessionals,scientists,healthpolicymakersandmediamightfinditdifficulttoaccepttheirowncontributionstostigmatisation.

Themanydifferentandopposingpoint‐of‐viewsof‘thehealthychoice’maybethemainobstacle.Somehealthinformationisnotsupportedbyresearchbutissolelybasedonassumptions.So,weneedtobeabletodetermine

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betterwhenand,moreimportantly,underwhatcircumstancesinformationcanbeconsideredvalid.

Transdisciplinarycooperationisrequiredfortheproperimplementationofnewinnovativecommunication.Atthesametime,itwillenhancethecomplexityoftheprocess.Weknow,forinstance,aboutthedifficultiesofget‐tingpeoplesufferingfromobesitytoshiftfromhealthcaretophysicalactivityprovidersinthepublicdomain,andwealsoknowaboutthemisperceptionsofpolicymakersregardingtheacceptanceofhealth‐enhancingactivitiesbythepublic.Furthermore,thelackofacommonlanguage,limitedpublicacceptance,limitedfreedom,andthedifficultyofinvolvingthefoodindustrywithscienceresearchprojectscouldalsoprovetobeanobstacle.

Thepitfallsofscientificcollaborationshavetobeexploredandovercome.Themethodologicalframeworkisavailable,butitneedstobedevelopedandimprovedtodealwiththecombinationofdatafromdifferentsources.Datacollectionandpublishingshouldbeplannedatanearlystage.Inaddressingmarketstructuresandcommer‐cialintereststoprotectcitizens,corporateincentivesforgenerating‘opposingviews’shouldbeconsidered.

Theoverlapbetweensocioeconomicstatusandmigrationandethnicityissuesareanareaoffutureresearch,butthedifficultyofsegmentingtheseissuescancreatedifficultiesindeterminingandreachingtargetgroups.Itisimportanttoincludebothmajorlong‐termcohortstudiesandqualitativesocialscienceresearch,butlackofknowledgeandmutualrecognitionwithinthescientificcommunitymaybeabarrierwithrespecttothis.

Thedominanceofcertaindisciplinesmayexcludeorhindercollaborationwithrespecttowhatisconsideredknowledgeandempiricaldata.Toavoidsuchobstacles,thedisciplinesneedtoacknowledgediversemethodolo‐giesorcreatenewcommonmethods.

Lackofacommonlanguagebetweendisciplines.

Cohortstudiesalmostalwayslackopportunitiesforin‐depthsocialresearch.Mosttransdisciplinaryresearchandthedevelopmentofnewcohortsandresourcepopulationstaketimetoestablish,develop,andmaintain.There‐fore,thefundingsystemsshouldconsiderthepossibilityofsupportingprojectswithalongerduration.

Anotherroadblockmightbegettingtop‐levelresearchersinallprimarilybiomedicaldisciplinestoabandonanynaiveenergy‐balance‐basedthinkingandfocusonobesityresearchdrivenbymoreunifying,inclusiveandcom‐plextheories.

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CONCLUDINGREMARKS

As illustrated in this report, there is a greatpotential in obesity research conducted in the settingofsocialsciencesandhumanitiesandinvolvingthecollectiverangeofacademicdisciplines.

InordertobuilduponthenoteworthySSHexperiencesalreadyavailable,wegatheredsomeofthebestresearcherswithinthesocialsciencesandhumanitiestosupportthecreationandstrengtheningofthenetworkofresearcherswithinterest,ability,andexperienceinobesityresearch.Attheworkshop,wecreateda forumforSSHandresearchers frombiomedical fieldsof research todiscussandshape thefutureofobesityresearchandto facilitatethecreationofnewtransdisciplinarycollaborationsacrossEurope.

Theresearchquestionsandpotentialdefinedintheworkshoparequitedifferentinappearance–offer‐ingcomplexityandreflection,whichaffectstheanswersofferedtosociety.Inaddition,thetypeofim‐pactderivedfromtheworkshopisalsoconsiderablydifferentfromtheimpactofferedbythebiomedi‐calsciencesalone:thecreationofarobustevidencebaseonthecosts,development,andconsequencesofobesitytreatmentandprevention,morenuancedviewsofqualityoflife,anewbasisforanti‐stigmacampaigns,andtheenhancementofethicalguidanceforindustryandsociety,tonamejustafew.

However,bringingsomeofthebrightestresearcherstogetherisonlypartofthesolution.

Anotherissueofequalimportanceistheplatformfromwhichtheresearchistoevolve.Horizon2020callsfornewformsofresearchthatcanprovidesolutionsforthegreatchallengesinsocietythatwearenot able to resolve through research conducted in the traditionalmono‐disciplinary silos alone. Theplatformisbeingbuilt;thepoliticalwill isthere;andbothpoliticiansandstakeholdersseemreadytoacknowledgeandacceptthenewscientificconstellationsandtheirinnovativeresearchideas.

Furthermore,thescientificcommunitiesareready.ScientistsfromtheEuropeanmemberstatesaswellas theEuropeanAssociation for theStudyofObesityhavesteppedup to theplateanddisplayed thereadinessandability todeliver the innovativeresearchsoughtbysociety. It is important thatweactnow.

Ifwesucceed incontinuing thisdevelopment,buildingupon thesignificantexpertiseandstrongnet‐worksacrossacademicdisciplines,andaretherebyabletogenerateinnovativeresearchideasthatcansupport society and citizens, the expectations for better understanding andmeeting the challenge ofobesityseembrighterthaneverbefore.

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BIBLIOGRAPHY1. COM(2011)811,ProposalforaCOUNCILDECISIONEstablishingtheSpecificProgrammeImplementingHorizon2020‐TheFrame‐

workProgrammeforResearchandInnovation(2014‐2020)2. COM(2005)637,GreenPaper.PromotingHealthyDietsandPhysicalActivity:AEuropeanDimensionforthePreventionofOver‐

weight,ObesityandChronicDiseases3. COM(2007)279,WhitePaperonaStrategyforEuropeonNutrition,OverweightandObesity‐RelatedHealthIssues4. Health,DemographicChangeandWell‐Being.AdvisoryWorkshoponHorizon2020CommonStrategicFramework,6&7July2011

Summary5. WHO:EUR/RC62/8Health2020:PolicyFrameworkandStrategy,20126. WHO:EUR/RC62/9Health2020:AEuropeanPolicyFrameworksupportingActionacrossGovernmentandSocietyforHealthand

Well‐Being(2012)(sameasabove)7. Diabesity–AWorld‐WideChallenge:TowardsaGlobalInitiativeonGene‐EnvironmentInteractionsinDiabetes/ObesityinSpecific

Populations.EuropeanCommission20128. StrategicPlanforNIHObesityResearch(2011)9. ReportfromtheBriefingonObesityResearch:“TheObesityEpidemicinEurope–SocietalChallengeandResearchNeeds”1March

2012intheEuropeanParliament(2012)10. “WhatIstheValueofObesityResearch?”,JohnE.Blundell,JohannesHebebrand,Jean‐MichelOppert,onbehalfoftheEASOScientific

AdvisoryBoardExpertGroup,ObesFacts2010;3:279–28211. “WhatIstheValueofObesityResearch?”–CommentonBlundellJE,HebebrandJ,OppertJM.,“Whatisthevalueofobesityresearch?”

ObesFacts2012;5:298‐304TommyL.S.Visscheretal12. “Wherenextforobesity?”,HarryRutter,LancetVol378,August27,201113. Obesity:TheGatewaytoIllHealth:AStatementfromEASOonaRisingPublicHealthProblemandtheNeedforResearchandInno‐

vationinEurope(2012)14. ReportoftheDanishConsultationProcess‐ObesityResearchtowards2020,Denmark201115. RoadmapforTacklingObesityinHORIZON2020,Germany201216. BehaviourChange,Report(2011)HLPaper179,HouseofLords,ScienceandTechnologySelectCommittee,2ndReportofSession

2010–1217. “UrgentlyNeeded:AFrameworkConventionforObesityControl”,Editorial,LancetVol378,August27,201118. “ReversingtheTideofObesity”,WilliamHDietz,pages744‐746,27August2011,LancetVol378,August27,201119. CopenhagenResearchForum:VisionsforHorizon2020fromCopenhagenResearchForum,201220. CopenhagenResearchForumII:RecommendationsfortheOptimalImplementationofHorizon2020,201221. OECD(2012),HealthataGlance:Europe2012,OECDPublishing.http://dx.doi.org/10.1787/9789264183896‐en22. WHO:EuropeanActionPlanforFoodandNutritionPolicy2007‐2012,200823. http://www.fp7‐helena.org/24. http://www.idefics.eu/25. http://eatwellproject.eu/