Agriculture Reference
In-Depth Information
no longer sufficient health care resources to offer treatment to all, and in develop-
ing countries limited resources will quickly be exhausted by the need for expensive
treatment for obesity-related disease (WHO 2000).
contRollIng the PRoblem: the PReventIon ImPeRAtIve
Reversal of obesity once established at the level of the individual is extremely difficult.
Many clinical approaches have been tried, ranging from behavior modification tech-
niques to pharmacological and surgical approaches. All have produced minimal to only
moderate successes long term. Thus, prevention is the only productive way forward.
Preventive interventions have until recently also focused on individual behavior
change and have produced some short-term success, but there is limited evidence
for sustainability. Recently, there has been a rather remarkable recognition that
broader, more “upstream” policy and program actions are called for if the obesity
epidemic is to be controlled. WHO has called for multisectoral policies that simul-
taneously address prevention of excess weight gain, promotion of weight main-
tenance in adulthood, medical management of obesity-driven comorbidities, and
promotion of weight loss (WHO 2000). A few national-level programs, notably
in Norway and in Mauritius, have successfully reversed the trend toward high-
fat, energy-dense diets with a combination of agricultural policies, subsidies and
price manipulation, and public education (Friel et al. 2007). Norway, over a period
of 20 years beginning in 1975, utilized a combination of consumer and producer
price and income subsidies, regulation of food processing and labeling, and public
education and saw a reduction in consumption of saturated fat and reduced aver-
age blood cholesterol in the population (Norum et al. 1997). Mauritius, through a
combination of price policy, mass media, and educational activity in various ven-
ues saw a fall in the prevalence of hypertension by 15%, of cigarette consumption
by 11% in men and 7% in women, and in mean serum cholesterol by about 10%
(Dowse et al. 1995). A number of local and community-based initiatives have had
success in increasing physical activity and altering the food environment in key
venues such as schools and workplaces.
Turning the obesity epidemic around requires attention at many levels and cannot
be managed by health care professionals alone. Just as rapid environmental change
has promoted the epidemic, changes in the physical and social environment will be
required to control it. Urban planning to promote more walking; school systems that
plan curricula to allow for physical activity and the availability of healthy foods and
beverages; work site innovations to improve worker health; regulation of marketing
and advertising of energy-dense, low-nutrient food products, particularly to children;
and health promotion to the public all are required. Health promotion activities need
to be directed at more than individual behavior but also at making physical activity
and healthy eating societal norms for all parts of the population.
It is clear that committed and targeted actions are required at many levels if the
obesity epidemic and its consequences are to be controlled or reversed within the
next decades (Schwarz and Brownell 2005, Friel et al. 2007). The fact that over-
weight may be regarded as culturally desirable or at least acceptable in many cultural
contexts means that the health consequences need to be clearly spelled out for policy
