Editorial

Preventing obesity – in theory and practice?

Obesity has become a global epidemic (1). Body weights

are increasing at an alarming rate in developing as well as

industrialized countries. In China, the recent rise in obesity

prevalence from 1 to 2%, although still at a very low level,

has serious consequences when seen in perspective of the

huge population.

Recent years have seen the development, marketing and

introduction of new anti-obesity drugs. Most have signifi-

cant favourable effects on body weight and comorbidities

for study periods up to 2 years. A 5–10% sustained weight

reduction has been suggested as a realistic target for long-

term treatment with these drugs. However, most obese

patients clearly feel unhappy with such a modest weight

reduction and are desperately seeking more effective treat-

ment (2). Surgery results in greater weight loss. However,

it is complicated and resource demanding, and relapses are

common.

Recognizing the limitations of treatment, many profes-

sionals are now turning to prevention as the key to fight-

ing the escalating epidemic of overweight subjects and

obesity. To date, however, preventing obesity in children

and adults has not been particularly successful. In a review

of the effectiveness of prevention and treatment interven-

tions in children (3), only one study meeting adequate sci-

entific standards showed positive effects. This was based

around family therapy. In the same review, only three

studies aimed at preventing obesity in the community met

the inclusion criteria. These studies were generally health

education programmes, lasting for up to 10 years, which

included multimedia education, newsletter feedback and

various types of social and behavioural management pro-

grammes. Only modest effects were obtained, and weight

tended to quickly revert to pre-intervention levels once the

programme was terminated.

In a satellite symposium held in Stockholm prior to the

8th International Congress of Obesity in August 1998, pre-

vention in its widest sense was discussed (4). Opportunities

for intervention in settings and sectors such as education,

employment, the media, and transport and urban planning

were discussed. Prevention activities in these areas are not

generally familiar to the practising physician.

Inactivity seems to be one of the main factors explaining

why body weight has increased over recent decades in the

Western world. We live in a highly mechanized society, to

the extent that efforts to increase physical activity levels

include health education messages to get off the bus one

stop earlier or to park our cars further away. Reinvention

of everyday physical activity as something enjoyable and

natural will require a major shift in paradigm, especially

for those individuals who use energy saving devices to the

extreme.

Schools are an important place to begin promoting

healthy diet and activity habits. In many countries, where

school lunches are provided free or at little cost, the quality

of food and the setting of the school cafeteria do not

promote a weight-conscious mind. Likewise, physical activ-

ity programmes in schools are often under threat. Children

who enjoy sports tend to be physically active anyway, but

it is becoming increasingly important to develop activity

programmes for children with a propensity to obesity – and

to make these activities enjoyable.

Legislation to promote and support healthy food and/or

to ban unhealthy food has been tried in some countries –

generally with only limited success. It appears difficult to

employ this method in a free society with all its inherent

risks for abuse on the black market.

In discussing the prevention of obesity from a public

health perspective, the role of the media is often brought

up. Obesity-related health messages, particularly on tele-

vision, are generally negative (5). Furthermore, hours of

television watching have been linked to body fatness sug-

gesting that television viewing promotes over-eating and

under-exercising. However, television and other media

could offer important tools for reaching individuals in the

lower socio-economic classes who are vulnerable to obesity

but who are also more prone to spending their time in front

of the television. Such techniques still have to be explored.

Obesity is clearly becoming more and more costly to

society. New and effective prevention strategies are ur-

gently needed to deal with the problem. If efforts are to

succeed in at least postponing clinical symptoms, consid-

erable amounts of creativity, unconventional approaches

and rethinking are needed.

Some progress has been made. Following the first World

Health Organization Expert Consultation on Obesity in

June 1997, a framework and commitment for co-ordinated

world-wide action have begun to emerge. The International

Obesity Task Force (IOTF) is leading a global initiative to

raise awareness, develop policy recommendations and ini-

tiate the trial and implementation of prevention and man-

agement strategies. The Milan Declaration, signed by all

24 member countries of the European Association for the

Study of Obesity at the 9th European Congress of Obesity

in Italy in June 1999, represents the first of what is hoped

will be a series of regional commitments to this important

initiative.

S. Rössner

obesity reviews

© 2000 The International Association for the Study of Obesity. obesity reviews 1, 3–4 3

References

1. World Health Organization. Obesity. Preventing and Manag-ing the Global Epidemic. Report of a WHO Consultation on

Obesity. Geneva, 3–5 June 1997. World Health Organization:

Geneva, 1997.

2. Glenny A-M, O’Meara S, Melville A, Sheldon TA, Wilson C.

The treatment and prevention of obesity: a systematic review of

the literature. Int J Obes 1997; 21: 715–737.

4 Editorial obesity reviews

© 2000 The International Association for the Study of Obesity. obesity reviews 1, 3–4

3. Foster GD, Wadden TA, Vogt RA, Brewer G. What is a rea-

sonable weight loss? Patients’ expectations and evaluations of

obesity treatment outcomes. J Consult Clin Pshychol 1997; 65:

79–85.

4. Rössner S. (ed) Prevention of obesity: Berzelius symposium 42.

Appetite 1998; 31: 407–436.

5. Jeffery RW, French SA. Epidemic obesity in the United States:

are fast food and television contributing? Am J Public Health1998; 88: 277–280.