Abstract
Increases in pediatric overweight and obesity throughout the European Union (EU) generate concern because of the many associated co-morbidities, psychosocial effects, and economic costs. A variety of policy approaches have been implemented, but counteracting weight gain has proven challenging. Do differences in public opinion about policy options to fight the problem exist among EU countries? We obtained data for our study from the Eurobarometer and include representative samples from all EU Member States plus four prospective countries. Our results suggest strong consistency among EU countries in support for two policies: providing information to parents and more physical activity in schools. For improving children's diets, our data show widespread support for providing parents with information, education programs in schools, and restrictions on advertising. For reducing childhood obesity, more physical activity in schools received the most support followed by education and advertising restrictions. There was very little support for imposing taxes on unhealthy food.
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Editorial Note
The obesity epidemic
Here we publish another article that refines our understanding of the global obesity epidemic, an epidemic that exists, ironically, at the same time that severe hunger and starvation afflict many developing world populations. A collection of JPHP articles on obesity can be found on our website. Suggs and McIntyre describe attitudes in Europe toward policies intended to affect food consumption and physical activity, both contributors to the epidemic.
Another report contributes to knowledge and understanding of the epidemic. In October 2010, the Organization for Economic Cooperation and Development (OECD) released its policy-oriented report on the problem: Obesity and the Economics of Prevention – fit not fat. The article by Suggs and McIntyre, and the OECD report reflect good research. The question remains, what will be the most effective strategy against obesity to protect populations and prevent disease? Neither tries to answer this public health question. Both focus far more on individual food and activity choices rather than on changing the environment that influences them.
Our perspective is influenced by the experience of the United States, where the epidemic first became visible – then has grown – and continues to grow explosively. The US Centers for Disease Control website illustrates the shocking spread of obesity in a series of maps from 1985 to 2009. Thanks to our Editorial Board member Marion Nestle and her book, Food Politics: How the Food Industry Influences Nutrition and Health, JPHP took on the population health strategy challenge of the obesity issue very early. As Editors of a policy journal, we posed the question: what strategies could complement, and be more effective than, a primary focus on the behavior of individuals?
The obesity epidemic is new, but its policy progenitors date back centuries. Almost every country has policies to prepare for and avoid famine. (Recently, Russia stopped exporting wheat, as bad weather destroyed its crops.) In the United States, the government has long subsidized food production, generating surpluses of food crops, milk, and meat. Food prices have fallen, absorbing an ever smaller fraction of personal income for food.
In this artificial market, the profits of large food producers flourished. Economic concentration has meant that a few corporations dominate the food industry. These firms, integrated vertically, own everything from the farms to the wholesale distributors of meat, milk, produce, and processed foods. Seed stocks, pesticides, and fertilizer are part of the same industry. Farms and farmers contribute only a small part of the final ‘value’ in what the consumer buys. (In the last 30 years, the number of hog farms in the United States has decreased by 89 per cent, with only four per cent of hogs now ever sold in the open market.)
Food that arrives in US supermarkets is, by historical standards, cheap, tasty (sweeter and saltier), and convenient to prepare. Advertising is pervasive: food companies pay supermarkets to place their products on the most visible shelves and they pay movie and television producers to place their products on camera.
A food company increases its profits by capturing an ever greater share of the market – and by selling more food (and calories) to the same people. Thus, larger segments of the population become overweight. This anti-health behavior of the food industry is spreading globally in the hands of Nestle, PepsiCo, Unilever, Kraft, Dole, JBS S.A., Smithfield, General Mills, Danone, and others.
As food is essential to human survival, the challenge is not to eliminate the food industry but to constrain what and how much it markets. Consider the tobacco industry that deliberately addicted children to cigarettes as early as possible, and continued to market cigarettes even when they knew the health dangers. As public health practitioners learned slowly, public knowledge has never been sufficient to counter tobacco industry marketing. Constraining the food industry to protect the public can benefit from lessons of anti-smoking efforts, despite the obvious differences in the products.
Although many factors beyond excessive consumption contribute to obesity – the environment affecting activity as well as child and parent education – a strategy directed entirely or even predominantly at these elements will not be sufficient. The goal of any public health strategy destined to succeed must be to change how much and what foods are marketed to populations around the world. Some egregious examples illustrate the guile of the industry. ‘Foods’ such as soft drinks are formulated to make those who drink them hungry sooner, rather than later. These products have been aggressively marketed to teens in and around schools (where parental oversight is conspicuously absent). A viable public health strategy will hold the food industry responsible for the health consequences of its behavior – and provide clues for more effective deterrence of obesity.
Different countries will employ different strategies. In the United States, the tort law tradition has made it possible for victims of cigarettes to sue for damages; some are testing a similar approach to consequences of dangerous marketing of food, particularly to vulnerable populations like school children.
Other countries may be able to use government and community leverage to assure more socially responsible food industry practices. Finland has had some notable success with regulatory and community strategies. The acclaimed North Karelia Project convinced stores to substitute lower fat and less salty products for the customary ones; families, schools, and workplaces to prepare healthier meals; and farmers to switch from dairy products to fish and berries. After a famine more than a century ago, in reaction to which the government encouraged cattle and milk production, the region yielded too much milk and meat. When cardiovascular disease killed striking numbers of seemingly healthy forestry workers at early ages (∼40s), families looked for help to understand the reasons – and the North Karelia Project was born. In any location, those wishing to improve the health of populations must focus more on behavior – not just the behavior of individuals, but first and foremost, the behavior of the food industry.
The Editors
Editorial Note: The obesity epidemicEuropean countries have chosen many different strategies to address overweight and obesity in children and support for these strategies varies across the European Union.
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Suggs, L., McIntyre, C. European Union public opinion on policy measures to address childhood overweight and obesity. J Public Health Pol 32, 91–106 (2011). https://doi.org/10.1057/jphp.2010.44
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DOI: https://doi.org/10.1057/jphp.2010.44