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Foresight obesity systems map demonstrating at its centre ('core') the imbalance between appetite regulation and sedentary existence. , Media; , social; , psychological; , economic; , food; , activity; , infrastructure; , developmental; , biological; , medical;-c, positive influence;-&, negative influence. (From Vandenbroeck et al. (4) .)
Source publication
Successfully tackling obesity is a long-term commitment. Current levels of obesity in the population have been >/=30 years in the making. Not only will this position take time to reverse but there will be a considerable time lag before health and economic benefits are achieved through reductions in the morbidity from obesity-related diseases. There...
Context in source publication
Context 1
... body energy needs, the consequence of low physical activity; this asymmetry of appetite regulation favours over-consumption because of a strong and rapid response to hunger cues and an incomplete response to satiety or 'fullness'. Over time, minor extents of positive energy balance result in overweight and obesity. The obesity systems map ( Fig. 1) identifies at its centre (or 'core') problems of appetite regulation and sedentary existence. By applying scientific and other evidence, the map demonstrates that energy balance (or imbalance) is determined by a complex multi-faceted system of determinants (causes) in which no individual influence dominates (4) . The systems map can ...
Citations
... Obesity is a precursor to a number of diseases, which have important long-term individual and social consequences. Obesity is typically comorbid with heart conditions, hypertension, diabetes type B, cancer or sleep apnea (DiBonaventura et al., 2018;Kopelman, 2009;Perichart-Perera et al., 2007). In addition, research indicates that obesity in children and adolescents is directly associated with high blood pressure (Flores-Huerta et al., 2009;Perichart-Perera et al., 2007). ...
Mexico has the highest prevalence globally for children who are overweight. We conducted a qualitative study to understand childhood obesity in Mexico and the complex factors at play. Data were collected at three elementary schools in a low socio-economic area in Mexico City. Semi-structured interviews were conducted with 60 children, 24 parents and 28 teachers. The children interviewed were between the ages of 8 and 12 years old. Interview texts were analysed using NVivo 9 and 10 and thematic discourse analysis was used. Findings revealed how children’s choices around nutrition and physical activity were constrained by their environment and discursive constructions.
... Ng et al. state that national success stories addressing obesity have not been reported in the last 33 years and the prevalence of obesity continues to rise [5]. The whole of society approach is important [25] as governments need to make the living and working environments compatible with the health education messages being disseminated; citizens need to be able to access health information, healthy food items, and environments that are conducive to exercise. ...
Objectives . The objectives of the study were to measure actual BMI in patients attending chronic disease clinics in health centres and to relate this to the patients’ own perceptions of their body image and the need to lose weight. Study Design . A cross sectional study. Methods . The actual BMIs in patients who attended chronic disease clinics in 14 health centres were measured. All participants were asked to state where they thought they were on a visual body image scale and were also asked if they thought they needed to lose weight. Results . All participants approached agreed to participate (RR 100%). 70% of patients were found to have a raised BMI. Approximately 73% of patients using the visual scale indicated that an overweight or obese BMI was ideal for them. Conclusions . Patients think they are thinner than they actually are, with obvious implications for health and health seeking behaviour. A whole of society approach is needed to change weight status perceptions and improve exercise and dietary behaviour.
... Given the increasing numbers of the monogenic contributors, the majority of the obesity cases in the human population are believed to be polygenic [6]. On the other hand, overnutrition related to unhealthy eating habits probably drives the rising global prevalence of overweight and obesity [7,8]. In spite of the self-evident link between overnutrition and obesity, the underlying mechanisms that cause obesity and its related metabolic diseases due to excessive intake of nutrients have not been fully understood. ...
Currently, two-thirds of American adults are overweight or obese. This high prevalence of overweight/obesity negatively affects the health of the population, as obese individuals tend to develop several chronic diseases, such as type 2 diabetes and cardiovascular diseases. Due to obesity's impact on health, medical costs, and longevity, the rise in the number of obese people has become a public health concern. Both genetic and environmental/dietary factors play a role in the development of metabolic diseases. Intuitively, it seems to be obvious to link over-nutrition to the development of obesity and other metabolic diseases. However, the underlying mechanisms are still unclear. Dietary nutrients not only provide energy derived from macronutrients, but also factors such as micronutrients with regulatory roles. How micronutrients, such as vitamin A (VA; retinol), regulate macronutrient homeostasis is still an ongoing research topic. As an essential micronutrient, VA plays a key role in the general health of an individual. This review summarizes recent research progress regarding VA's role in carbohydrate, lipid, and protein metabolism. Due to the large amount of information regarding VA functions, this review focusses on metabolism in metabolic active organs and tissues. Additionally, some perspectives for future studies will be provided.
... Although concern amongst public health scholars and advocates has often centered on fast food and other away-from-home foods, efforts to boost consumption of healthy home-cooked foods have become increasingly common across the US Programs include the Supplemental Nutrition Assistance Program (SNAP) Healthy Incentives Pilot aimed at increasing purchase of fruits and vegetables and the Women, Infants, and Children (WIC) Farmer's Market Nutrition program, which provides coupons for the purchase of locally grown produce212223. In both the UK and the US, promotion of home cooking has been viewed as a major strategy to reduce obesity2425262728. However, these initiatives assume that if consumers are able to purchase healthy foods, they can and will prepare them at home. ...
... One possible solution is the return of home economics classes as part of the school curriculum, which could teach young people how to combine healthy convenience items such as canned beans or whole-wheat pasta with foods prepared from scratch [79] to minimize both time and cost. This approach, which has already been initiated in the UK25262780] may be a key strategy for helping Americans reduce weight gain and improve dietary intake. In the US, the Cooking Matters program has been rolled out across 40 states, employing 6-week courses to teach children, adults and families at risk of hunger how to purchase and prepare healthy food [81]. ...
Background
It has been well-documented that Americans have shifted towards eating out more and cooking at home less. However, little is known about whether these trends have continued into the 21st century, and whether these trends are consistent amongst low-income individuals, who are increasingly the target of public health programs that promote home cooking. The objective of this study is to examine how patterns of home cooking and home food consumption have changed from 1965 to 2008 by socio-demographic groups.
Methods
This is a cross-sectional analysis of data from 6 nationally representative US dietary surveys and 6 US time-use studies conducted between 1965 and 2008. Subjects are adults aged 19 to 60 years (n= 38,565 for dietary surveys and n=55,424 for time-use surveys). Weighted means of daily energy intake by food source, proportion who cooked, and time spent cooking were analyzed for trends from 1965–1966 to 2007–2008 by gender and income. T-tests were conducted to determine statistical differences over time.
Results
The percentage of daily energy consumed from home food sources and time spent in food preparation decreased significantly for all socioeconomic groups between 1965–1966 and 2007–2008 (p ≤ 0.001), with the largest declines occurring between 1965 and 1992. In 2007–2008, foods from the home supply accounted for 65 to 72% of total daily energy, with 54 to 57% reporting cooking activities. The low income group showed the greatest decline in the proportion cooking, but consumed more daily energy from home sources and spent more time cooking than high income individuals in 2007–2008 (p ≤ 0.001).
Conclusions
US adults have decreased consumption of foods from the home supply and reduced time spent cooking since 1965, but this trend appears to have leveled off, with no substantial decrease occurring after the mid-1990’s. Across socioeconomic groups, people consume the majority of daily energy from the home food supply, yet only slightly more than half spend any time cooking on a given day. Efforts to boost the healthfulness of the US diet should focus on promoting the preparation of healthy foods at home while incorporating limits on time available for cooking.
... Obesity, poor nutrition and inadequate levels of physical activity can be identified as wicked health promotion problems, contributing to significant rates of non-communicable disease in both developed and developing countries (Lobstein and Jackson-Leach, 2006;Wang and Lobstein, 2006; World Cancer Research Fund/ American Institute for Cancer Research, 2009). The drivers of obesity, nutrition and physical activity are recognized to be multiple, diverse and complex (Hammond, 2009), including both personal behaviours and aspects of the physical, economic, socio-cultural and political environments that shape them (Egger and Swinburn, 1997;Shiell, 2008;Vandenbroeck et al., 2008;Kopelman, 2010). Given this complexity of causation, solutions focused on individuals and single responses have been shown to be inadequate (Swinburn and Egger, 2004;Hill et al., 2007;van der Horst et al., 2007;Walton and Signal, 2010). ...
... While the volume of research describing the extent of obesity, physical activity and nutrition issues and causative associations is immense, there is much less research relating to intervention. Authors that have considered policy responses are increasingly calling for comprehensive portfolio type approaches, with action across multiple levels of governance (Swinburn et al., 2005;Lang and Rayner, 2007;Brescoll et al., 2008;Story et al., 2008;Kopelman, 2010). To date, there have been few attempts to consider how an understanding of complex causation could inform policy action, or identify theoretically informed processes for prioritization amongst possible interventions. ...
... To date, there have been few attempts to consider how an understanding of complex causation could inform policy action, or identify theoretically informed processes for prioritization amongst possible interventions. Within the limited number of studies that have introduced a complex view of obesity causation concrete intervention proposals have been lacking (Butland et al., 2007;Shiell, 2008;Hammond, 2009;Kopelman, 2010). The current study has demonstrated a method to identify interventions that acknowledges the complexity of health promotion issues and the importance of environment whilst taking account of the views of the community and the concerns of the policy environment. ...
This paper reports on a complex environmental approach to addressing 'wicked' health promotion problems devised to inform policy for enhancing food security and physical activity among Māori, Pacific and low-income people in New Zealand. This multi-phase research utilized literature reviews, focus groups, stakeholder workshops and key informant interviews. Participants included members of affected communities, policy-makers and academics. Results suggest that food security and physical activity 'emerge' from complex systems. Key areas for intervention include availability of money within households; the cost of food; improvements in urban design and culturally specific physical activity programmes. Seventeen prioritized intervention areas were explored in-depth and recommendations for action identified. These include healthy food subsidies, increasing the statutory minimum wage rate and enhancing open space and connectivity in communities. This approach has moved away from seeking individual solutions to complex social problems. In doing so, it has enabled the mapping of the relevant systems and the identification of a range of interventions while taking account of the views of affected communities and the concerns of policy-makers. The complex environmental approach used in this research provides a method to identify how to intervene in complex systems that may be relevant to other 'wicked' health promotion problems.
... 5,175,176 A whole-system approach, involving many sectors, is crucial to tackling the obesity and salt epidemics. [5][6][7][175][176][177][178][179][180] Integrated action is required by national and local governments, industry and communities, and families and the societies in which they live. Potential policies include the following initiatives: to assess and understand the size and nature of the problem; to establish communication strategies to improve public knowledge about food and behaviours relating to food; to engage with the food industry to set fair and progressive standards and targets for nutrient contents in processed foods, food labelling, and market advertising; to implement multiple progressive inter ventions to change behaviours at all levels (individual, local, national, and global); and to serially monitor the eff ects of the above inter ventions. ...
... Potential policies include the following initiatives: to assess and understand the size and nature of the problem; to establish communication strategies to improve public knowledge about food and behaviours relating to food; to engage with the food industry to set fair and progressive standards and targets for nutrient contents in processed foods, food labelling, and market advertising; to implement multiple progressive inter ventions to change behaviours at all levels (individual, local, national, and global); and to serially monitor the eff ects of the above inter ventions. [176][177][178][179][180] Population-wide salt-reduction programmes that are led by governments and engage with industry to remove salt at its source could be highly cost eff ective. In the USA, modest, population-wide reductions in dietary salt of up to 3 g per day (1·2 g of sodium per day) are projected to reduce the annual number of new cases of stroke by 32 000 to 66 000, similar to the benefi ts of populationwide reductions in tobacco use, obesity, and cholesterol levels. ...
Poor nutrition in the first year of a mother's life and undernutrition in utero, infancy, childhood, and adulthood predispose individuals to stroke in later life, but the mechanism of increased stroke risk is unclear. Overnutrition also increases the risk of stroke, probably by accelerating the development of obesity, hypertension, hyperlipidaemia, and diabetes. Reliable evidence suggests that dietary supplementation with antioxidant vitamins, B vitamins, and calcium does not reduce the risk of stroke. Less reliable evidence suggests that stroke can be prevented by diets that are prudent, aligned to the Mediterranean or DASH (Dietary Approaches to Stop Hypertension) diets, low in salt and added sugars, high in potassium, and meet, but do not exceed, energy requirements. Trials in progress are examining the effects of vitamin D and marine omega-3 fatty acid supplementation on incidence of stroke. Future challenges include the need to improve the quality of evidence linking many nutrients, foods, and dietary patterns to the risk of stroke.
... In 2009, 61.3% of adults (aged 16 or over), and 28.3% of children (aged 2-10) in England were overweight or obese (1) . Improving the quality of the diet while also reducing per capita energy intake to achieve and maintain a healthy weight among the British represents a key policy objective (2)(3)(4) . The reduction of added sugar, specifically those from sugar-sweetened beverages (SSBs; namely all caloric soft drinks, fruit drinks and sugar-sweetened coffees and teas) and other high energy beverages such as juices and alcohol has been included in most documents concerned with obesity not only in the Great Britain, but also globally (5,6) . ...
... a. Trends In Daily per Capita Dairy Beverage Consumption Among Adults (19-64y) in the UK, 1986-1987, 2000-2001, 2008-2009 b. Trends In Daily per Capita Non-Dairy Caloric Beverage Consumption Among Adults(19-64y) inThe UK, 1986-1987-2009 ...
Many dietary recommendations include reduction of excessive intake of sugar-sweetened beverages (SSB) and other energy-rich beverages such as juices and alcohol. The present study examines surveys of both individual dietary intake data and household food expenditure surveys to provide a picture of patterns and trends in beverage intake and purchases in Great Britain from 1986 to 2009, and estimates the potential for pricing policy to promote more healthful beverage purchase patterns. In 2008-9, beverages accounted for 21, 14 and 18 % of daily energy intake for children aged 1·5-18 and 4-18 years, and adults (19-64 years), respectively. Since the 1990s, the most important shifts have been a reduction in consumption of high-fat dairy products and an increased consumption of fruit juices and reduced-fat milk among preschoolers, children and adolescents. Among adults, consumption of high-fat milk beverages, sweetened tea and coffee and other energy-containing drinks fell, but reduced-fat milk, alcohol (particularly beer) and fruit juice rose. In testing taxation as an option for shifting beverage purchase patterns, we calculate that a 10 % increase in the price of SSB could potentially result in a decrease of 7·5 ml/capita per d. A similar 10 % tax on high-fat milk is associated with a reduction of high-fat milk purchases by 5 ml/capita per d and increased reduced-fat milk purchase by 7 ml/capita per d. This analysis implies that taxation or other methods of shifting relative costs of these beverages could be a way to improve beverage choices in Great Britain.
... A few countries have begun to systematically search for ways to enhance our understanding and use of more basic food stuffs. This is why the UK has instituted cooking classes for all youth (5)(6)(7). This is why there is a greater push towards increasing incentives for low-income consumers to consume fruits and vegetables purchased in local farmers markets in the USA (8). ...
... Although in the UK obesity prevention programmes of a large array have existed for a long time, the Foresight Obesity Project represented a milestone in national systematic efforts to produce a sustainable response to obesity (5)(6)(7). This systematic government effort began with quantitative modelling of the growth of obesity, the economic effect of this and the effect on the national health system (142). ...
The world has experienced a marked shift in the global BMI distribution towards reduced undernutrition and increased obesity. The collision between human biology, shaped over the millennia and modern technology, globalization, government policies and food industry practices have worked to create far-reaching energy imbalance across the globe. A prime example is the clash between our drinking habits and our biology. The shift from water and breast milk as the only beverages available, to a vast array of caloric beverages was very rapid, shaped both by our tastes and aggressive marketing of the beverage industry. Our biology, shaped over millennia by daily consumption of water and seasonal availability of food, was not ready to compensate for the liquid energies. Other dietary changes were similarly significant, particularly the shift towards increased frequency of eating and larger portions. The roles of the food and beverage production, distribution and marketing sectors in not only shaping our diet but also accelerating these changes must be understood. Apart from the role of beverages, there is much less consensus about the role of various components of our diet in energy imbalance. Understanding the determinants of change in the key components of our diet through an array of research provides insights into some of the options we face in attempting to attain a great balance between energy intake and expenditures while creating an overall healthier dietary pattern. A few countries are systematically addressing the causes of poor dietary and physical activity patterns and high energy imbalance.
... The U.K.'s sociological perspective. The U.K. introduced the Foresight Tackling Obesities: Future Choices Project in 2005, the goal of which was to produce a sustainable response to obesity in the U.K. over a 40-year period [3][4][5]. This systematic government effort began with quantitative modeling of the increase in obesity, its economic effects, and the impact on the national health system [6]. ...
The U.S.’s and U.K.’s efforts to combat obesity reflect underlying differences in the two countries’ understandings of obesity’s causes. Virtual Mentor is a monthly bioethics journal published by the American Medical Association.
Stroke remains the second leading cause of mortality and a leading cause of disability. Stroke burden in low- and middle-income countries (LMICs) constitutes over three quarters of the global stroke burden and shows an upward trend. A higher incidence among young adults, higher mortality, and lower quality of stroke care compared to that in high-income countries (HICs) is a huge challenge. This chapter places an emphasis on the need to think outside the norm with regard to reducing stroke burden in LMICs. Reducing the burden of stroke in LMICs goes far beyond the role of the health sector and the current focus on treatment. There is a need for a focus on prevention and positive health choices of the populace. The political, economic, social, cultural, and environmental sectors should all be involved in this drive through advocacy, mediation, and education. There is a need to harmonize the activities carried out by various stakeholders for efficiency as various interests of the society can be discussed from various perspectives to enhance efficiency and impact.
