17 December 2014
Obesity is ruining lives, burdening health-care systems and damaging economies. Early intervention – against childhood obesity – offers a crucial opportunity for prevention, but multidimensional policies are needed.
Amina Aitsi-Selmi
Dr Amina Aitsi-Selmi
Former Consultant, Centre on Global Health Security


Overweight Chinese students are served a nutritionally balanced lunch during a break from training at a camp held for overweight children in Beijing, China. Photo by Kevin Frayer/Getty Images.
Chinese students are served a nutritionally balanced lunch at a camp held for overweight children in Beijing, China. Photo by Getty Images.


As rising incomes and the effects of globalization have changed diets in many countries, the need to tackle rising obesity has become a pressing public health issue. Interventions to prevent childhood obesity offer some of the greatest potential to effect positive change, but consistent progress will need to draw on a confluence of interlinking factors – including, but not limited to, multisectoral cooperation, community participation, national and cross-border economic policy-making, and – not least – a shift in social norms.

The negative effects of increased obesity are well documented. Obesity can shorten life by almost a decade and result in decades spent in ill health, generally as a result of obesity-related diabetes, heart problems and cancers. Obesity has become a matter of concern for policy-makers, for finance ministers seeking to curb spiralling health-care costs, for emergency services called upon to evacuate severely obese people, and even for armed forces – some of which now struggle to recruit physically fit personnel.

Rising obesity levels worldwide are, in part, a legacy of the industrialization of food production in the mid-20th century, tied to a culture of mass consumption of manufactured goods (sweet snacks, soft drinks, processed food) and a parallel increase in sedentary lifestyles. Mass media and advertising also have an important role in normalizing unhealthy diets, and young minds constitute particularly fertile ground.

Contrary to some perceptions, the problem is not confined to affluent Western countries. Countries in the Middle East (e.g. Egypt) and the Pacific Islands are among those with the highest female obesity levels, for example. Indeed low- and middle-income countries are at a particular disadvantage owing to the fact that obesity-related diseases can coexist with undernutrition and infections. This mixed burden of disease reflects the uneven effects of rapid globalization, economic development and accompanying cultural shifts – all of which have resulted in a complex social distribution of disease that cannot be satisfactorily addressed by the local public health capacity in affected countries. Sophisticated global sellers of processed foods, aware of the lower education levels of the general population in these settings, exploit the information asymmetry between themselves and new consumers to promote their products.

Childhood interventions that establish healthy eating and exercise habits early in life are where some of the biggest gains could be made. Effective strategic interventions will require a multisectoral, multicomponent approach that engages not only families and schools but also partners in communities (including businesses that sell food). Substantive change would also rely on leveraging national and global economic policy instruments, with the aim of shaping dietary preferences as well as food production and marketing to create environments in which healthy choices are easy for children and their families.

Leaders from a diversity of sectors around the world are calling for a wider engagement from society. Mission Readiness – a coalition of retired US military leaders – released a landmark report in 2010 on the effects of childhood obesity on military recruitment. The report estimated that over a quarter of the US military’s target group are ‘too fat to fight’, leading retired four-star US army general Johnnie E. Wilson to conclude that childhood obesity is ‘a potential threat to our national security’.

Where the military has an advantage over civilian society is in mobilizing support, thanks in part to a collective understanding that the consequences of obesity in one member of a fighting unit can be significant if not fatal for others. This has led naturally to a more comprehensive response. In other words, a collective problem was given a collective solution.

As this suggests, tackling the global obesity epidemic – starting with children –­ will require wide-ranging action. Policies will need to tap into the societal causes of obesity, and redefine social norms, cultural beliefs and economic practices to create a healthy environment for children to develop. The inherent tensions between the public interest and the dynamics of a profit-driven economic system that relies on food consumption are self-evident. However, these should be negotiated with the end goal in mind: to achieve sustainable development that is conducive to public health, environmentally sound and yet also able to accommodate economic growth imperatives.

Anti-obesity policies also promise co-benefits for the climate change agenda. As mentioned in a recent Chatham House research paper, changing our consumption habits can be beneficial for people’s health and for the environment. Walking, cycling and improved diets (increased vegetable and fruit consumption, and reduced red- and processed-meat consumption) can reduce greenhouse gas emissions as well as reducing the risk of obesity and therefore diabetes, heart disease and cancer.

The year ahead presents a significant opportunity to push for the convergence of three landmark UN policy instruments: the post-2015 sustainable development goals, the 2015 climate change agreements and the post-2015 framework on disaster risk reduction, but time is short. Conservative estimates suggest that half of the UK population will be obese by 2050; globally, one in 10 individuals is obese at present. The worldwide financial cost of obesity is about the same as that of smoking or armed conflict, and greater than alcoholism or climate change. We have a problem and strategic solutions, but greater political will to move forward is needed. 

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