Tuesday, September 11, 2007

Obesity prevention: From health promotion to health protection.

Friday 7 September the Dutch federation of university medical centers (NFU, see http://www.nfu.nl/) organized a meeting on how to fight the obesity epidemic. After a general introduction on the obesity trends and consequences by professor Jaap Seidel, VU University, Professor Liesbeth Mathus, Amsterdam University Medical Center, gave an overview of medical treatment possibilities, showing that the most promising treatment approach, with long-term follow-up and intensity, is often unavailable in the Netherlands.
Next, the meeting focused on lifestyle interventions to promote prevention of overweight and obesity. Professor Boyd Swinburn from Deakin University, Melbourne (Aus), see http://www.deakin.edu.au/hmnbs/ens/staff/index.php?username=swinburn, has argued that obesity is a normal reaction to an abnormal environment. This environment that provides opportunities and promotes eating energy dense foods almost anytime, anywhere, and enables avoidance of almost any physical activity, is regarded as the driving force behind the obesity epidemic. Swinburn depicts the obesity epidemic as a ‘runaway weight train’ with the obesogenic environment as the down hill track (see http://www.bmj.com/cgi/content/full/329/7468/736). Although most people have freedom of choice where foods and physical activities are concerned, they have to choose in an environment in which unhealthy food choices and lack of physical activity are the easy and intensively marketed choices.
The great accomplishments in public health in countries like the Netherlands, such as the eradication of a number of infectious diseases, improvements in traffic and food safety, and also the reduction in smoking prevalence have all been accomplished by means of an integral approach in which health protection measures, i.e. regulations and environmental change measures, such as building sewage systems, establishing and enforcing traffic laws, or taxing tobacco and creating smoke-free environments, were of key importance. However, despite the environmental causes for the obesity epidemic, obesity prevention efforts are still mostly based on health education and health promotion activities. Such health education is not strong enough to help slow down the weight train. I argued that we need a health protection approach to obesity prevention to finally make a difference. Such a health protection approach should include ‘safe’ food and physical activity environments in, for example, (pre) schools and worksites, a ban on food marketing to children and on unproven direct as well as indirect health claims for foods, and taking ‘protection’ of physical activity into account in all infrastructure projects so that physical activity will again become a necessary and routine part of daily living.