Excess body weight is a major individual, societal and economic problem as it is spreading globally, still increasing rapidly, and can have many and varied health consequences. In its more severe forms, obesity places huge financial burdens on governments and individuals and has been reported to account for up to six per cent of total health care costs in some developed countries.
There is a negative stigma attached to overweight and obesity and a high public awareness of the associated health risks as reflected in a wealth of dietary advice published almost daily. Public health campaigns have long warned against excess body fat and promoted messages highlighting the importance of a healthy diet and moderate exercise. Yet it is a conundrum that much of current prevention strategies for limiting weight gain seems to be simply ignored by individuals and society alike. Individuals continuously make choices in their everyday life to evade a multitude of risks, but excess weight gain seems not to be prioritised. Society continues to provide tempting food choices and facilitates sedentary lifestyles. Intensive promotion of energy-dense food and drink to children and adults has created a new food model of convenience. The structure of the built environment affects obesity by restricting physical activity.
In its simplest form it is clear that excess weight gain is caused by an imbalance between an individual’s energy consumed and energy spent, acknowledging genetic differences in metabolic rate. Obesity could be seen as an unintended consequence of affluence leading to overindulgence, a sedentary lifestyle and bad food choices by the individual. However, it is now commonly agreed that the reasons for the growth in overweight and obesity are multifactorial. Instead of seeing it as a weakness of the individual, it makes much more sense to view obesity as a societal problem involving the interaction of the individual with what has been called the “obesogenic” society.
The twenty-first century is a fast moving society where multitasking and food convenience are promoted. Time has become increasingly precious and fast food that can provide satiety in the shortest time possible has become the norm in an increasing number of societies. Globally, the availability of energy-dense and refined foods for easy consumption, foods often high in fat and sugar, have led to excessive energy intake. Sugar and fat are powerful sources of neurobiological rewards. Energy-dense foods provide more sensory enjoyment and more pleasure.
Fast food has become synonymous with time efficiency and has become a middle class status symbol of efficiency in poor countries. But fast food has also, because of its success, become food that is low in price and affordable for people on low income and the poor in rich countries.
It is time for an overall system change. We need to rethink the way we design cities and make them conducive to a healthy lifestyle. Healthcare systems should focus more on prevention and primary care. We need to reconnect with food and teach food skills to young people. We need to take back our urban environment and stop letting it become an advertising space for food and drink companies selling unhealthy choices. Without decisive action, overweight and obesity might become the new normal.