Obesity: Can we tackle complex, malfunctioning food systems?

Tractor in a field

Tim LobsteinTim Lobstein, Director of Policy at World Obesity Federation, looks at the state of nutrition policy and food systems in our obesogenic environment.

The World Health Organization (WHO) has acknowledged that obesity has “reached epidemic proportions”. It estimates that overweight is “now responsible for more deaths annually than underweight”.

No country has successfully reduced obesity prevalence across all population groups, and with children now ten times more likely to suffer excess body weight than they were a generation ago, the problem will take decades to resolve.

And that assumes we try to resolve it.

Tackling obesity with nutrition policy

A search of the policy literature will show over a hundred recommendations for tackling obesity, made by international and national expert bodies. All of them are thoughtfully considered, peer reviewed and carefully worded. Yet hardly any of them have been implemented.

To understand this better, the Lancet, with the World Obesity Federation, asked two leading international experts on obesity policy – Professors Boyd Swinburn and Bill Dietz – to chair a Lancet Commission. The invitation followed two highly acclaimed Lancet Series on obesity, in 2011 and 2015.

The Commission gathered 28 additional experts from across different disciplines, including agriculture, business and trade.

It was clear at the first meeting that the Commission needed to do more than produce another report that looked at obesity in isolation, but instead should examine the broader structural issues that give rise to obesity and their interaction with undernutrition and climate change – two other major threats to global health.

The Commission recognised that obesity and undernutrition are two products of the same problem: malfunctioning food supply systems. Obesity is also driven by low physical activity, in part due to car use, transport policies and urban design. Food supply and transport systems not only threaten our health but also contribute significantly to climate change.

A Global Syndemic

The Commission is calling this triple impact on health through obesity, undernutrition and climate change a “Global Syndemic”. A syndemic is a synergy of co-occurring pandemics which interact with each other in place and time, and have common societal or economic drivers. These interconnected and complex systems lie behind the challenges to introducing effective policies. Small changes make very little difference, and the system reacts, adapts and continues. To get big changes you have to make big changes. But for this to happen you need political will.

It is no secret that the makers of highly processed foods and beverages have the resources to resist government policymaking and use those resources daily to undermine policies for public health and to protect the status quo. Lobbying national governments to prevent significant change is now a major industry. For example, the US Congress has 100 senators and 435 representatives who are daily subjected to lobbying by an army of registered lobbyists: 215 for tobacco companies, 273 for alcohol companies, and 294 for food and beverage companies.

Agriculture and food production account for more than a quarter of greenhouse gas emissions. Global warming in turn may cause significant undernutrition through failed crops. The oceans are awash with plastic, and some 70 per cent of the commonest items washed up on beaches are linked to food and beverage consumption. The contaminants return to us through the food chain, with some endocrine-disrupting pollutants now recognised as increasing the risk of obesity.

Not just a question of calories

From this broader, complex systems perspective, thinking of obesity and undernutrition as simply a matter of too many or too few calories is not only inadequate as an explanation but seriously misleading, and likely to reinforce the lack of political will of the last two decades. Much more will be needed. The Lancet Commission report highlights the need for win-win and even triple-win interventions to tackle the Global Syndemic. Suggestions include:

  • Embed sustainability criteria in global development policies
  • Boost political demands for change through civil action
  • Rethink fiscal policies to ensure that full production costs are borne by the producer
  • Protect policymaking from corporate bullying through an international treaty
  • Strictly limit corporate influence on policymaking by curbing lobbying powers

The head of the United Nations’s Food and Agriculture Organization, Dr José Graziano da Silva, has stated that the “main reason for the increase in the prevalence of obesity and overweight is the inability of food systems to deliver healthy diets”.

This is an extraordinary admission that the system is malfunctioning. It will not mend itself and it strongly resists change. But change it must.