The role of law in the control of obesity in England: looking at the contribution of law to a healthy food culture

Obesity Stigma: Causes, Consequences, and Potential Solutions

PURPOSE OF REVIEW

This review aims to examine (i) the aetiology of obesity; (ii) how and why a perception of personal responsibility for obesity so dominantly frames this condition and how this mindset leads to stigma; (iii) the consequences of obesity stigma for people living with obesity, and for the public support for interventions to prevent and manage this condition; and (iv) potential strategies to diminish our focus on personal responsibility for the development of obesity, to enable a reduction of obesity stigma, and to move towards effective interventions to prevent and manage obesity within the population.

RECENT FINDINGS

We summarise literature which shows that obesity stems from a complex interplay of genetic and environment factors most of which are outside an individual's control. Despite this, evidence of obesity stigmatisation remains abundant throughout areas of media, entertainment, social media and the internet, advertising, news outlets, and the political and public health landscape. This has damaging consequences including psychological, physical, and socioeconomic harm. Obesity stigma does not prevent obesity. A combined, concerted, and sustained effort from multiple stakeholders and key decision-makers within society is required to dispel myths around personal responsibility for body weight, and to foster more empathy for people living in larger bodies. This also sets the scene for more effective policies and interventions, targeting the social and environmental drivers of health, to ultimately improve population health.

Is Obesity Policy in England Fit for Purpose? Analysis of Government Strategies and Policies, 1992-2020

Policy Points This analysis finds that government obesity policies in England have largely been proposed in a way that does not readily lead to implementation; that governments rarely commission evaluations of previous government strategies or learn from policy failures; that governments have tended to adopt less interventionist policy approaches; and that policies largely make high demands on individual agency, meaning they rely on individuals to make behavior changes rather than shaping external influences and are thus less likely to be effective or equitable. These findings may help explain why after 30 years of proposed government obesity policies, obesity prevalence and health inequities still have not been successfully reduced. If policymakers address the issues identified in this analysis, population obesity could be tackled more successfully, which has added urgency given the COVID-19 pandemic.

CONTEXT

In England, the majority of adults, and more than a quarter of children aged 2 to 15 years live with obesity or excess weight. From 1992 to 2020, even though the government published 14 obesity strategies in England, the prevalence of obesity has not been reduced. We aimed to determine whether such government strategies and policies have been fit for purpose regarding their strategic focus, nature, basis in theory and evidence, and implementation viability.

METHOD

We undertook a mixed-methods study, involving a document review and analysis of government strategies either wholly or partially dedicated to tackling obesity in England. We developed a theory-based analytical framework, using content analysis and applied thematic analysis (ATA) to code all policies. Our interpretation drew on quantitative findings and thematic analysis.

FINDINGS

We identified and analyzed 14 government strategies published from 1992 to 2020 containing 689 wide-ranging policies. Policies were largely proposed in a way that would be unlikely to lead to implementation; the majority were not interventionist and made high demands on individual agency, meaning that they relied on individuals to make behavior changes rather than shaping external influences, and are thus less likely to be effective or to reduce health inequalities.

CONCLUSIONS

The government obesity strategies' failure to reduce the prevalence of obesity in England for almost 30 years may be due to weaknesses in the policies' design, leading to a lack of effectiveness, but they may also be due to failures of implementation and evaluation. These failures appear to have led to insufficient or no policy learning and governments proposing similar or identical policies repeatedly over many years. Governments should learn from their earlier policy failures. They should prioritize policies that make minimal demands on individuals and have the potential for population-wide reach so as to maximize their potential for equitable impacts. Policies should be proposed in ways that readily lead to implementation and evaluation.

Effect of national culture on BMI: a multilevel analysis of 53 countries

Background

To investigate the association between national culture and national BMI in 53 low-middle- and high-income countries.

Methods

Data from World Health Survey conducted in 2002–2004 in low-middle- and high-income countries were used. Participants aged 18 years and over were selected using multistage, stratified cluster sampling. BMI was used as an outcome variable. Culture of the countries was measured using Hofstede’s cultural dimensions: Uncertainty avoidance, individualism, Power Distance and masculinity. The potential determinants of individual-level BMI were participants’ sex, age, marital status, education, occupation as well as household-wealth and location (rural/urban) at the individual-level. The country-level factors used were average national income (GNI-PPP), income inequality (Gini-index) and Hofstede’s cultural dimensions. A two-level random-intercepts and fixed-slopes model structure with individuals nested within countries were fitted, treating BMI as a continuous outcome variable.

Results

A sample of 156,192 people from 53 countries was included in this analysis. The design-based (weighted) mean BMI (SE) in these 53 countries was 23.95(0.08). Uncertainty avoidance (UAI) and individualism (IDV) were significantly associated with BMI, showing that people in more individualistic or high uncertainty avoidance countries had higher BMI than collectivist or low uncertainty avoidance ones. This model explained that one unit increase in UAI or IDV was associated with 0.03 unit increase in BMI. Power distance and masculinity were not associated with BMI of the people. National level Income was also significantly associated with individual-level BMI.

Conclusion

National culture has a substantial association with BMI of the individuals in the country. This association is important for understanding the pattern of obesity or overweight across different cultures and countries. It is also important to recognise the importance of the association of culture and BMI in developing public health interventions to reduce obesity or overweight.

Seven-year itch: the UK Government's difficult relationship with the food and drink industry since Healthy Lives, Healthy People: A Call to Action on Obesity in England (2011)

OBJECTIVE

Unhealthy food and drink consumption is associated with a range of physical and mental health concerns. In response, public health policies have been developed targeting a reduction in obesity in particular. In the present commentary we argue that government-industry partnerships have reduced the effectiveness of resultant policies and explore why.

DESIGN

Perspectives of authors.

SETTING

UK.ParticipantsPopulations in the UK; UK Government.

RESULTS

Industry involvement has presented three interrelated challenges for the UK Government: (i) balancing collaboration while maintaining appropriate distance from industry stakeholders; (ii) resultant production of 'watertight' and effective legislation or intervention; and (iii) actual or perceived limited sanctioning or bargaining power.

CONCLUSIONS

Industry involvement in public health policy making has led to weak action. Support with policy implementation (rather than development) and genuine 'buy-in' from industry could accelerate the pace of public health improvement.

Obesity prevention and personal responsibility: the case of front-of-pack food labelling in Australia

BACKGROUND

In Australia, the food industry and public health groups are locked in serious struggle for regulatory influence over the terms of front-of-pack food labelling. Clear, unambiguous labelling of the nutritional content of pre-packaged foods and of standardized food items sold in chain restaurants is consistent with the prevailing philosophy of 'personal responsibility'. An interpretive, front-of-pack labelling scheme has the capacity to encourage healthier patterns of eating, and to be a catalyst for improvements in the nutritional quality of food products through re-formulation. On the other hand, the strength of opposition of the Australian Food and Grocery Council to 'Traffic Light Labelling', and its efforts to promote a non-interpretive, voluntary scheme, invite the interpretation that the food industry is resistant to any reforms that could destabilise current (unhealthy) purchasing patterns and the revenues they represent.

DISCUSSION

This article argues that although policies that aim to educate consumers about the nutritional content of food are welcome, they are only one part of a broader basket of policies that are needed to make progress on obesity prevention and public health nutrition. However, to the extent that food labelling has the capacity to inform and empower consumers to make healthier choices--and to be a catalyst for improving the nutritional quality of commercial recipes--it has an important role to play. Furthermore, given the dietary impact of meals eaten in fast food and franchise restaurants, interpretive labelling requirements should not be restricted to pre-packaged foods.

SUMMARY

Food industry resistance to an interpretive food labelling scheme is an important test for government, and a case study of how self-interest prompts industry to promote weaker, voluntary schemes that pre-empt and undermine progressive public health regulation.

Nutrigenomic targeting of carbohydrate craving behavior: can we manage obesity and aberrant craving behaviors with neurochemical pathway manipulation by Immunological Compatible Substances (nutrients) using a Genetic Positioning System (GPS) Map?

Genetic mediated physiological processes that rely on both pharmacological and nutritional principles hold great promise for the successful therapeutic targeting of reduced carbohydrate craving, body-friendly fat loss, healthy body recomposition, and overall wellness. By integrating an assembly of scientific knowledge on inheritable characteristics and environmental mediators of gene expression, we review the relationship of genes, hormones, neurotransmitters, and nutrients as they correct unwanted weight gain coupled with unhappiness. In contrast to a simple one-locus, one-mechanism focus on pharmaceuticals alone, we hypothesize that the use of nutrigenomic treatment targeting multi-physiological neurological, immunological, and metabolic pathways will enable clinicians to intercede in the process of lipogenesis by promoting lipolysis while attenuating aberrant glucose cravings. In turn, this approach will enhance wellness in a safe and predictable manner through the use of a Genetic Positioning System (GPS) Map. The GPS Map, while presently incomplete, ultimately will serve not only as a blueprint for personalized medicine in the treatment of obesity, but also for the development of strategies for reducing many harmful addictive behaviors and promoting optimal health by using substances compatible with the body's immune system.

Obesity: should there be a law against it? Introduction to a symposium

The rapid rise in rates of overweight and obesity among adults and children in Australia and New Zealand has intensified debate about the most effective policies for obesity prevention. Law has much to contribute to this policy discussion, although its role is often misunderstood. The articles in this symposium follow on from a conference hosted in September 2006 by the Centre for Health Governance, Law & Ethics in the Faculty of Law, University of Sydney, titled: Obesity: should there be a law against it? In different ways, these articles provide a variety of perspectives on regulatory responses to obesity, including theoretical justifications for a legal approach, conceptual models that assist in making sense of law's role, as well as specific legal strategies for obesity prevention in various settings.