Following on from the publication of the Foresight Report1 by the previous UK Government, there is now a broad recognition that the obesity epidemic is largely driven by changes in modern advanced economies with high levels of motorised transport and the easy availability of cheap high energy foods, which are skilfully marketed to encourage ever greater consumption. The Foresight report also presented a highly elaborate ‘systems map’ which visually depicts obesity as a complex systems problem with multiple ‘malfunctions’ in many different individual and societal domains. Once obesity is viewed as a complex system, thoroughly embedded in many aspects of modern living, the likely futility of single component interventions or exhortations around personal behaviour change is easy to appreciate.
In our recently published policy review of environmental and policy interventions that may help to address the obesity problem in Scotland2, we sought to acknowledge from the outset the need for a multi-component approach that addresses societies major obesity drivers and at the same time make the best and most appropriate use of the voluminous and rapidly expanding research literature on the topic. Using Swinburn and colleagues’ Analysis Grid for Environments linked to Obesity (ANGELO), we were able to devise a purposive sampling method that was comprehensive without being exhaustive. Identified policy interventions were categorised across four domains (Physical, Economic, Legislative and Socio-cultural) and their respective strength of supporting scientific evidence cross tabulated against potential population impact. It was then possible to construct a ‘portfolio matrix’ of policy options for each of the four domains, setting out the degree of promise afforded by each intervention. In this way, relatively well proven highly targeted investment programmes could be seen to be balanced against larger population scale interventions with correspondingly higher risks and potential benefits. Table 1 shows the results such of a portfolio matrix breakdown for two of the four ANGELO domains combined (Economic and Legislative).
One of only two policy interventions which scored the highest degree of likely promise was the addition of a sales tax on sugar-sweetened beverages. These drinks have one of the highest consumer price sensitivities of major food and drink items and account for a significant proportion of ‘empty calories’ (i.e. with no nutritional benefit)3. An effective tax which reduces consumption therefore has the clear potential to help address one route of excess energy consumption and there is good evidence to support a potentially greater impact in groups most at risk of obesity and related ill-health4.
Highlighting specific interventions as having greater promise than others however, should not detract from the need for a multi-component approach which should always be a guiding principle in dealing with complex public health problems such as population obesity5. Nevertheless, statutory and environmental measures, which require no effort on behalf of the consumer or target group are always likely to represent the strongest levers for effective change and should therefore be central to any strategy aimed at the control and prevention of population obesity and overweight6.
John Mooney MFPH
Scottish Collaboration for Public Health Research and Policy (SCPHRP)
To obtain a free hard copy of the policy review, please send your address and contact details to
Renee Ingram at SCPHRP: firstname.lastname@example.org
This article, written by John Mooney of SCPHRP, was originally published in the SCPN Newsletter Volume 3, Issue 1.
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