We must avoid quick fixes to mounting obesity epidemic

We must avoid quick fixes to mounting obesity epidemic

In early March, the World Obesity Foundation issued a chilling warning about the silent epidemic of our times: on the current trajectory, over half of the global population will be obese or overweight by 2035, with developing countries in Africa and Asia set to be hit hardest by this rising tide.

Following these sobering revelations, reports have now emerged that the World Health Organisation (WHO) will this month consider obesity drugs for inclusion on its “essential medicines list,” which facilitates wider access in low and middle-income countries. But despite their potential, certain public health experts have raised concerns over an overzealous use of these drugs, such as Novo Nordisk’s Saxenda and Wegovy, which arguably treat the symptom rather than the disease.

While obesity drugs have already been approved in Europe and other high-income areas, widespread consensus on their best use and ultimate utility remains elusive. As Europe gears up for its own fight against rising obesity, it should favour more holistic, systemic and preventative solutions aligned with the complex nature of this public health crisis.

Degenerating situation in Europe

Last year, the WHO laid out the European picture in no uncertain terms, deeming that obesity rates had reached “epidemic proportions.”

Nearly 60% of its adults are overweight while almost one-fifth are obese, reflecting a staggering two-fold rise over the past 20 years. Meanwhile, the WHO has qualified child obesity as “one of the most severe public health challenges of the 21st century,” warning that nearly one-third of children are overweight, while obesity affects 10% of girls and 14% of boys. This is particularly concerning given the tendency of childhood weight problems to continue into adulthood and fuel non-communicable diseases (NCDs) such as cancer, heart disease and diabetes that represent the continent’s leading causes of death.

But what’s driving this crisis? While public health authorities are always careful to avoid simplistic answers, more sedentary lifestyles paired with higher consumption of calorie-rich foods – or ‘junk food’ – have certainly played a strong part. Moreover, the COVID-19 pandemic has significantly exacerbated these existing trends, with the WHO noting that the effects of “unfavourable shifts” in physical activity and eating habits will echo through the coming years.

Broader cultural and environmental factors, such as a large rise in online gaming, have also been significant ‘structural drivers’ of obesity in Europe, while a new study published in late March cites expanding portion sizes as a likely contributor to the growth of obesity in recent decades.

Brussels’ faltering obesity action

Given Europe’s alarming obesity crisis, food policy has understandably shot up the agenda in Brussels. As part of its ‘Farm to Fork’ strategy for a healthy, sustainable food system, the European Commission plans to implement a harmonised Front-of-Package (FOP) food label in order to provide shoppers easily-digestible information on the nutritional value of groceries and influence healthier dietary choices.

Yet this seemingly straightforward initiative has been anything but, with member state factions backing rivalling FOP labelling systems. The France-backed Nutri-Score – which has also been voluntarily adopted in Germany, Spain and the Benelux countries – has undoubtedly been the most polarising of the labels, with strong opposition from a broad group of nations including Italy, the Czech Republic, Romania and Cyprus derailing what once seemed like an assured victory.

Criticism has often targeted Nutri-Score’s blunt, overly simplistic approach to tackling a disease as complex as obesity, which consists of an imbalanced algorithm that weighs ‘negative’ components, namely sugar, salt and fats, twice as heavily as ‘positive’ ones like fiber and protein to produce a healthiness grade ranging from a green ‘A’ to a red ‘E.’

Professors Michele O. Carruba and Enzo Nisoli, leading nutritionists from the University of Milan’s Center for Obesity Studies have highlighted the problem of such absolutist evaluations, emphasising that “there is no such thing as good or bad foods, but instead inappropriate types of consumption in terms of quantity and quality,” while also pointing out Nutri-Score’s consequent failure to account for individual nutritional needs.

Better way forward

Encouragingly, more promising approaches exist to improve dietary health and tackle obesity in Europe.

Personalised nutrition offers a particularly compelling alternative to broadbrush food labels, both in accounting for individual behavioural and biological specificities and in inspiring more active food choices. Research from economists at the University of Kent and Reading has led one of its co-authors, Dr. Adelina Gschwandtner, to conclude that “generalised diet recommendations are doing little to change our obesity problem,” and that solutions “informed by gender, personality type and body weight could significantly improve results.”

According to Nesta, a leading UK innovation agency, personalised nutrition has “emerged as having a potentially high chance of reducing obesity” by helping “consumers engage and learn more about the food they eat,” particularly if the required digital devices and apps are made widely accessible and affordable to avoid exacerbating existing health inequalities between high and low-income households.

Beyond the digital tech innovation of personalised nutrition, a range of cultural and environmental interventions must be pursued to prevent and reduce obesity. Ramping up public educational campaigns, such as the EU’s HealthyLifestyle4All, to promote sports participation and healthy diets provides a good starting point, yet these kinds of measures will not be enough.

Policymakers must give people not only the right information, but also the physical and financial means to adopt healthier lifestyles. Accordingly, investing in physical activity facilities–often sorely lacking in lower-income communities most impacted by obesity–is critical, as is expanding active travel infrastructure, such as cycle lanes and walking paths to encourage exercise.

Considering research which has found that countries with the highest levels of active travel have the lowest obesity rates, Europe’s existing culture and urban design conducive to walking and cycling puts it in a strong position relative to many other parts of the world. But given the magnitude of its obesity epidemic, it must rapidly and inclusively scale up these assets, while exhibiting caution with quick fixes, like obesity drugs and simplistic FOP labels, that fail to provide systemic, long-term solutions.

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