Managing Editor, HealthManagement
A survey of policymakers has revealed gaps in perception of the causes and management of overweight and obesity, which could affect the way in which countries make and implement policies to prevent, manage and treat the obesity epidemic.
The multi-country survey was conducted by the European Association for the Study of Obesity in association with C3 Collaborating for Health. The report summaries obesity realities and policy in Brazil, Bulgaria, Canada, Denmark, England, France, Germany, Italy, Mexico, Spain and the United States. Three hundred and thirty-three policymakers were surveyed about their knowledge of and opinions on the extent of overweight and obesity, responsibility for obesity, drivers of obesity, prevention, treatment and management and obesity priorities now and in the future.
Only 1 in 5 of those surveyed knew that the standard for obesity is when body mass index (BMI) is 30kg/m2. 66% did not have a clear idea of the prevalence of obesity while 84% did not know the extent of overweight. In addition, policymakers were not aware if there were national obesity targets in their country. The authors suggest, “Reporting against obesity targets would be helpful in raising awareness about progress among policymakers and the general public alike.”
Almost all the policymakers saw the responsibility for reducing obesity as individual, with family and the food industry having a powerful influence (see Figure). The main drivers were perceived as physical activity and marketing of and access to unhealthy food. Healthcare professionals were seen as less responsible, although there were marked differences between countries. Respondents in Bulgaria, Canada, Denmark, England, Mexico and the United States saw health professionals as having the most responsibility, whereas in Brazil, France, Germany, Italy and Spain at least a fifth of the policymakers regard health professionals as having no responsibility at all. The authors say, “All these actors have a role to play in creating an environment in which it is easier to be healthy – something that Mexico’s policymakers were the most likely to recognise. The lack of appreciation of, for example, the role of the government in Germany and the United States, healthcare professionals in Spain, or employers in France could be a barrier to progress.”
As to what drives overweight and obesity, the policymakers surveyed agreed only on lack of motivation and lack of physical activity. The report authors note that poverty does play a role in limiting the choices available to people to live a healthy lifestyle, but that not all the policymakers were aware of this. “Issues around food marketing and access to unhealthy food were acknowledged as important drivers of the obesity epidemic, particularly by Mexico’s policymakers.” Interestingly, they also failed to recognise that people’s perception is changing so that overweight is the “new normal.” The report notes that “This failure by many policymakers to understand that people’s perception of what is a ‘healthy’ weight is changing could reflect their relative lack of knowledge about ‘overweight’ – that the majority of people in many of the countries in the survey are now above a healthy weight.” In addition, policymakers were asked if identification and diagnosis of people who are overweight or obese works well in their country. In England, Italy and Spain, most felt it was addressed well. However, in Bulgaria, Canada, France, Germany and the United States, more than a quarter felt this was not the case (almost 60% in the United States). The authors suggest, “This lack of faith in the ability of the health system to identify people with obesity reflects the reality in many countries – and improvements will be dependent on ensuring that health professionals play more of a role.”
The report concludes, “There is clearly still more to be done to raise awareness among policymakers of the extent of obesity and overweight, the effectiveness and reach of different interventions, and the impact that obesity-prevention and management programmes are having (and could have) nationally. If policymakers have solid knowledge of the extent of the challenge posed by obesity, and the existing evidence for what can be done and who needs to be involved, national policies are more likely to be put in place that adequately address the reality of tackling obesity in the population.”