Should obesity prevention be a personal matter?

Obesity is now increasingly recognized as the “natural” consequence of societal changes that have occurred over the past decades to foster an increasingly obesogenic environment.

Yet, rather than focus on the root causes of these societal drivers of obesity, governments apparently prefer to make obesity prevention a personal matter, with a strong emphasis on trying to get individuals to change their lifestyles.

It is clearly far easier to simply tell people to eat more fruits and vegetables and to walk 10,000 steps than it is to provide them with the means or the environment that would actually allow them to do so.

A paper by Celeste Alvaro and colleagues from Dalhousie University, Halifax, Nova Scotia, Canada, published in the latest issue of Health Promotion International, explores why Canadian government policies, particularly those related to obesity, appear to be ‘stuck’ at promoting individual lifestyle change.

The paper uses key concepts within complexity and critical theories as a basis for trying to understand the continued emphasis on attempting to change individual lifestyle factors despite strong evidence showing that a change in the environment and conditions of poverty is truly what is needed to tackle obesity at the population level.

As the authors note, not just in Canada have health promotion programs and policies had a “lopsided” emphasis on individual lifestyles, with limited attention given to addressing the broader social, economic and political factors that create and produce obesogenic environments in the first place.

As the authors point out, “Individuals are continuously blamed for unsuccessful modifications to their lifestyle, even though living in an obesogenic environment makes achieving a healthy lifestyle close to impossible.”

Despite some attempts to change ‘environments’ (such as schools and workplaces), as recently undertaken in programs such as ActNow BC, they often fail to comprehensively address key economic issues underlying obesity, but rather focus on encouraging individual behavioral change.

The paper calls on both complexity theory to conceptualize governments as ‘systems’ with a history that shapes their current decisions and actions as well as critical theory to draw attention to power struggles within the policy implementation process, and to the role of dominant interests and ideologies in maintaining particular policies.

The authors provide several illustrative policy examples that highlight key concepts explaining why governments prefer to perpetuate and appear to be ‘locked’ into a focus on these largely ineffective lifestyle policies.

Although the paper may help better understand why governments are so reluctant to address the true underlying drivers of obesity, the authors admit that the path to actually and substantially moving government policies in the direction of fundamentally altering the obesogenic environment is far from clear.

Whether or not their suggestion that health promoters and others inside and outside the health field must develop collective action to catalyse the required changes across government and political sectors, will in the end move government in the right direction remains to be seen and may well prove overly optimistic.

Given that many ministries have a say in the drivers of the obesogenic environment but have left it largely to the seemingly powerless Ministries of Health to deal with the issue of obesity, the authors suggest that it may be time for a critical debate about how to promote the active, sustained and collective involvement of multiple sectors and groups to address obesity.

Clearly, as long a governments continue ignoring the real factors at play in the obesity epidemic, and remain focused on ‘reactive’ solutions that target individuals rather than society as a whole, prevention efforts are unlikely to translate into a meaningful decrease in the incidence and prevalence of obesity anytime soon.

Arya M. Sharma is a Professor of Medicine at the University of Alberta who blogs at Dr. Sharma’s Obesity Notes.

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