Most of us get the food we think we want. The question is whether we really have a choice. Our choices are largely the product of an environment that shapes our lifestyles to a much larger extent than we often realise. An environment in which increased food supply, combined with major changes in food production and sophisticated use of promotion and persuasion, have cut the price of calories dramatically and made convenience foods all too available. At the same time, changing working and living conditions mean that fewer people prepare traditional meals from raw ingredients. Less physical activity at work, more women in the labor force, higher levels of stress and job insecurity, and longer working hours are all factors directly or indirectly contributing to dramatic changes in people’s lifestyle, which have caused a true global epidemic of obesity, one of the foremost public health emergencies of our time.
Until 1980, fewer than 1 in 10 people were obese. Since then, rates have doubled or tripled and in the majority of OECD countries, every other person is now overweight or obese. If recent trends continue, more than 2 out of 3 people will be overweight or obese in several OECD countries within the next 10 years. Severely obese people die 8-10 years earlier than those of normal weight, similar to smokers. Obesity is estimated to be responsible for 1% to 3% of total health expenditure (5% to 10% in the United States) and costs will rise rapidly in coming years.
Government policies have, inadvertently, also played a part. Examples include subsidies (e.g. in agriculture) and taxation affecting food prices; transport policies that encourage the use of private cars and make walking to work an oddity; urban planning policies that make commuting commonplace, and lead to the creation of deprived urban areas with no green grocers, many fast food outlets, and few playgrounds and sports facilities.
If adults’ lifestyle choices are so heavily influenced by an obesogenic environment, do children have any choice at all? Those with at least one obese parent are 3 to 4 times more likely to be obese themselves. This is partly genetic, but children share their parents’ unhealthy diets and lifestyles, an influence which has played an important role in the spread of obesity. They are exposed to pervasive and subtle food marketing which makes them believe that snacks, sugary drinks and fast food can be cool and fun. They are overwhelmed with all sorts of offers for sedentary pastimes, which are made to look so much more attractive than any sports and outdoor activities.
Food culture instead of health care
Is there a way out of all this? The provision of information by governments (e.g. health education campaigns to improve diets or increase physical activity) or the regulation of information (e.g. limits on advertising, guidelines on food labeling) are potentially useful, but governments are not always equipped for delivering complex communication strategies, and in some cases their action may be influenced by the very interests they attempts to counter. An effective prevention strategy must combine complementary strengths: population approaches – health promotion campaigns, taxes and subsidies, or government regulation – with individual approaches such as counseling by family doctors, to change what people perceive as the norm in healthy behavior. Hundreds of thousands of deaths from chronic diseases could be avoided every year in the OECD area for a tiny fraction of what we currently spend on health care.