Citerank: (21) 348675Adopt a whole systems approach to obesityTackling obesity effectively—accomplishing a population wide-shift—requires a comprehensive and integrated whole systems approach, involving a range of measures focusing on individuals, social and other systems, including at the local and community level, and on the interrelated physical, physiological, social and cognitive factors that determine health outcomes.565CA4D9, 348702Individuals and FamiliesThe actions and choices of individuals and families are fundamental to the challenge of tackling obesity. 84E4A378, 348703Actions – Industry2794CAE1, 348780Causes of obesityUnderstanding the causes of obesity is critical to the success of prevention and treatment strategies. However, while (simply put) obesity occurs when energy intake from food and drink consumption is greater than energy expenditure through the body’s metabolism and physical activity over a prolonged period (resulting in the accumulation of excess body fat), in reality many complex behavioural and societal factors contribute systemically to the current crisis and no single influence dominates.555CD992, 352281Changes required across many different policy areasObesity has to be seen as not just a technical, food, physical activity or healthcare problem but a challenge for what sort of society is being built. Small, incremental, publicity-driven (i.e. social market-based) changes might suit the existing balance of policy interests, but a more extensive, co-ordinated, cross-sectoral action would be more effective.1198CE71, 352314Actions – Central Government2794CAE1, 352387Previous physical activities replaced by industrially generated energyIndustrial development allows many different aspects of life that previously involved daily physical activity to be accomplished through industrially generated energy instead; for example, the substitution of motorised transport for walking and cycling, a shift from manual and agricultural work towards office work, and a multitude of labour saving devices at work and in the home.555CD992, 352388Advertising and marketing reinforce new eating patterns Marketing and advertising instil and reinforce new cultural norms about what (e.g. fast food) and how to eat (e.g. snacking), and how much (e.g. larger portions) to eat.555CD992, 352389Reluctance to talk about and address implications of own weightThe weight of the population continues to rise despite media imagery of thin models encouraging a slim ideal that is far out of reach for most of the public. In this context, “Fat” remains an emotive and stigmatic subject – and often perceived as an insult – which makes it harder for people to acknowledge, confront and address their own obesity (and harder for others including health professionals to encourage them to do so too).555CD992, 352391Industrial development changes what and how people eatEconomic and industrial development has tended to be accompanied by a historic shift in patterns of food consumption from diets high in cereal and fibre to diets high in sugars, fat, animal-source food and highly-processed foods – creating a socio-cultural environment in which obesity is more likely to emerge in the population.555CD992, 352399Successive governments have made counterproductive policy choicesThe growing prevalence of obesity in the UK is partly the result of well-intentioned but counterproductive policy choices made by successive governments over several decades.555CD992, 352400Many individuals are consuming more energy than they are expendingPublic Health England estimates that the average man in England is consuming around 300 calories a day more than they would need were they a healthy body weight.555CD992, 399547Adopt a whole systems approach to obesityTackling obesity effectively—accomplishing a population wide-shift—requires a comprehensive and integrated whole systems approach, involving a range of measures focusing on individuals, social and other systems, including at the local and community level, and on the interrelated physical, physiological, social and cognitive factors that determine health outcomes.565CA4D9, 399558Changes required across many different policy areasObesity has to be seen as not just a technical, food, physical activity or healthcare problem but a challenge for what sort of society is being built. Small, incremental, publicity-driven (i.e. social market-based) changes might suit the existing balance of policy interests, but a more extensive, co-ordinated, cross-sectoral action would be more effective.1198CE71, 399887Causes of obesityUnderstanding the causes of obesity is critical to the success of prevention and treatment strategies. However, while (simply put) obesity occurs when energy intake from food and drink consumption is greater than energy expenditure through the body’s metabolism and physical activity over a prolonged period (resulting in the accumulation of excess body fat), in reality many complex behavioural and societal factors contribute systemically to the current crisis and no single influence dominates.555CD992, 399890Successive governments have made counterproductive policy choicesThe growing prevalence of obesity in the UK is partly the result of well-intentioned but counterproductive policy choices made by successive governments over several decades.555CD992, 399891Many individuals are consuming more energy than they are expendingPublic Health England estimates that the average man in England is consuming around 300 calories a day more than they would need were they a healthy body weight.555CD992, 399896Industrial development changes what and how people eatEconomic and industrial development has tended to be accompanied by a historic shift in patterns of food consumption from diets high in cereal and fibre to diets high in sugars, fat, animal-source food and highly-processed foods – creating a socio-cultural environment in which obesity is more likely to emerge in the population.555CD992, 399907Reluctance to talk about and address implications of own weightThe weight of the population continues to rise despite media imagery of thin models encouraging a slim ideal that is far out of reach for most of the public. In this context, “Fat” remains an emotive and stigmatic subject – and often perceived as an insult – which makes it harder for people to acknowledge, confront and address their own obesity (and harder for others including health professionals to encourage them to do so too).555CD992, 399917Advertising and marketing reinforce new eating patterns Marketing and advertising instil and reinforce new cultural norms about what (e.g. fast food) and how to eat (e.g. snacking), and how much (e.g. larger portions) to eat.555CD992, 399923Previous physical activities replaced by industrially generated energyIndustrial development allows many different aspects of life that previously involved daily physical activity to be accomplished through industrially generated energy instead; for example, the substitution of motorised transport for walking and cycling, a shift from manual and agricultural work towards office work, and a multitude of labour saving devices at work and in the home.555CD992

New insights from the science of behaviour change could lead to significantly improved policy outcomes, and at lower cost, than the way many conventional policy tools are currently used.

We set out nine of the most robust (non-coercive) influences on our behaviour, captured in a simple mnemonic – MINDSPACE – which can be used as a quick checklist when making policy:

> Messenger: we are heavily influenced by who communicates information

> Incentives: our responses to incentives are shaped by predictable mental shortcuts such as strongly avoiding losses

> Norms: we are strongly influenced by what others do

> Defaults: we „go with the flow‟ of pre-set options

> Salience: our attention is drawn to what is novel and seems relevant to us

> Priming: our acts are often influenced by sub-conscious cues

> Affect our emotional associations can powerfully shape our actions

> Commitments: we seek to be consistent with our public promises, and reciprocate acts

> Ego: we act in ways that make us feel better about ourselves.

For the most part, however, MINDSPACE powerfully complements and improves conventional policy tools, rather than acting as a replacement for them.

MINDSPACE may also help identify any barriers that are currently preventing changes in behaviour.

Citerank: (28) 340964Tackling obesity in the UKWith concern growing that the Foresight analysis—that 50% of the UK population could be obese by 2050, at an annual cost to the nation of around £50 billion per year [2]—substantially underestimates the scale of the unfolding obesity crisis, the College of Contemporary Health is working with the wider policy community to develop a whole systems map of the obesity crisis and the potential responses.7F1CEB7, 348675Adopt a whole systems approach to obesityTackling obesity effectively—accomplishing a population wide-shift—requires a comprehensive and integrated whole systems approach, involving a range of measures focusing on individuals, social and other systems, including at the local and community level, and on the interrelated physical, physiological, social and cognitive factors that determine health outcomes.565CA4D9, 348688Impacts of obesityObesity presents a significant threat to the health of the UK population and a significant drain on the nation's financial resources. 24.9% of adults in England are obese—with a body mass index of over 30—62% of adults are either overweight or obese (with a BMI of over 25), and 32% of 10–11-year-olds are overweight or obese. The annual cost of obesity to the UK is estimated to be £27bn–£46bn [1], [2]; although international comparisons suggest that the true cost could be significantly higher.57DE7179, 348767A potentially unsustainable financial burden on the health systemThe range of obesity's impacts makes accurate economic analysis challenging; however, a November 2014 study from the McKinsey Global Institute placed the annual economic impact on the UK at around $73bn (£46bn). Earlier analysis and modelling for the 2007 Foresight Report suggested a cost to the NHS of around £4.2bn annually to treat people with health problems related to elevated BMI and a total wider cost to the economy of around £15.8bn (rising to £27bn by 2015 and £49.9bn by 2050).57DE7179, 348770Tackling obesityMany policy interventions have been suggested to address the obesity crisis across multiple studies—and indeed many such measures have been implemented, and are being implemented, now. There's recognition too that these interventions need to be part of a coherent and comprehensive whole systems strategy [4]; with some grounds for optimism that such an approach has the potential to accomplish a significant reduction in the prevalence of obesity in the UK across the next decade. [2]565CA4D9, 348775Modelling suggests the majority of UK population may be obese by 2050The prevalence of obesity in the UK more than doubled in the 25 years to 2007. In England, nearly a quarter of adults and about 10% of children were obese in 2007, with a further 20–25% of children overweight. The Foresight report extrapolated that 40% of Britons might be being obese by 2025, with Britain being a mainly obese society by 2050.1198CE71, 348776A profound impact on the health of the populationObesity is responsible for more than 9,000 premature deaths each year in England, reduces life expectancy on average by nine years, and is a major risk factor in wide range of serious health problems including Type 2 diabetes (5 x), cancer (3 x the risk of colon cancer), and heart disease (2.5 x).57DE7179, 348779Involve all stakeholders in the process of changeReversing the rising trend and addressing the prospect of the rising health burden and societal costs will be demanding and will necessitate major changes in behaviour – not only in individuals, but also in families, communities, organisations and economic markets.565CA4D9, 348780Causes of obesityUnderstanding the causes of obesity is critical to the success of prevention and treatment strategies. However, while (simply put) obesity occurs when energy intake from food and drink consumption is greater than energy expenditure through the body’s metabolism and physical activity over a prolonged period (resulting in the accumulation of excess body fat), in reality many complex behavioural and societal factors contribute systemically to the current crisis and no single influence dominates.555CD992, 351674Inequality of impactAlthough obesity occurs across all population groups, it impacts disproportionately on the socially and economically disadvantaged and some ethnic minorities. [8]57DE7179, 352390Industrial way of life is obesogenicRapid societal changes—for example, in food production, motorised transport and work/home lifestyle patterns—have placed human physiology (which has evolved to cope with an under-supply of food and high energy expenditure) under new stresses, and revealed an underlying genetic tendency to accumulate and conserve energy (i.e. gain weight) in a high proportion of the population. In this sense, obesity can be construed as a normal physiological response to an abnormal environment.555CD992, 352390Industrial way of life is obesogenicRapid societal changes—for example, in food production, motorised transport and work/home lifestyle patterns—have placed human physiology (which has evolved to cope with an under-supply of food and high energy expenditure) under new stresses, and revealed an underlying genetic tendency to accumulate and conserve energy (i.e. gain weight) in a high proportion of the population. In this sense, obesity can be construed as a normal physiological response to an abnormal environment.555CD992, 365986Foresight – Obesity System MapObesity occurs when energy intake from food and drink consumption is greater than energy expenditure through the body’s metabolism and physical activity over a prolonged period, resulting in the accumulation of excess body fat. However there are many complex behavioural and societal factors that combine to contribute to the causes of obesity.7F1CEB7, 366467Encourage active transport (walking and cycling)Government authorities redesign urban planning to facilitate and encourage walking and cycling.565CA4D9, 366990What costs should be included in the financial analysis?What cost factors should be included in the assessment of the overall financial impact of obesity on the UK economy?8FFB597, 399546Tackling obesityMany policy interventions have been suggested to address the obesity crisis across multiple studies—and indeed many such measures have been implemented, and are being implemented, now. There's recognition too that these interventions need to be part of a coherent and comprehensive whole systems strategy [4]; with some grounds for optimism that such an approach has the potential to accomplish a significant reduction in the prevalence of obesity in the UK across the next decade. [2]565CA4D9, 399547Adopt a whole systems approach to obesityTackling obesity effectively—accomplishing a population wide-shift—requires a comprehensive and integrated whole systems approach, involving a range of measures focusing on individuals, social and other systems, including at the local and community level, and on the interrelated physical, physiological, social and cognitive factors that determine health outcomes.565CA4D9, 399557Involve all stakeholders in the process of changeReversing the rising trend and addressing the prospect of the rising health burden and societal costs will be demanding and will necessitate major changes in behaviour – not only in individuals, but also in families, communities, organisations and economic markets.565CA4D9, 399599Encourage active transport (walking and cycling)Government authorities redesign urban planning to facilitate and encourage walking and cycling.565CA4D9, 399887Causes of obesityUnderstanding the causes of obesity is critical to the success of prevention and treatment strategies. However, while (simply put) obesity occurs when energy intake from food and drink consumption is greater than energy expenditure through the body’s metabolism and physical activity over a prolonged period (resulting in the accumulation of excess body fat), in reality many complex behavioural and societal factors contribute systemically to the current crisis and no single influence dominates.555CD992, 399889Industrial way of life is obesogenicRapid societal changes—for example, in food production, motorised transport and work/home lifestyle patterns—have placed human physiology (which has evolved to cope with an under-supply of food and high energy expenditure) under new stresses, and revealed an underlying genetic tendency to accumulate and conserve energy (i.e. gain weight) in a high proportion of the population. In this sense, obesity can be construed as a normal physiological response to an abnormal environment.555CD992, 399889Industrial way of life is obesogenicRapid societal changes—for example, in food production, motorised transport and work/home lifestyle patterns—have placed human physiology (which has evolved to cope with an under-supply of food and high energy expenditure) under new stresses, and revealed an underlying genetic tendency to accumulate and conserve energy (i.e. gain weight) in a high proportion of the population. In this sense, obesity can be construed as a normal physiological response to an abnormal environment.555CD992, 399972Impacts of obesityObesity presents a significant threat to the health of the UK population and a significant drain on the nation's financial resources. 23% of adults are obese—with a body mass index of over 30—61% of adults are either overweight or obese (with a BMI of over 25), and 33% of 10–11-year-olds are overweight or obese. The annual cost of obesity to the UK economy has been estimated to be £27bn–£46bn [1], [2]; although international comparisons suggest that the true cost could be significantly higher.57DE7179, 399973A potentially unsustainable financial burden on the health systemThe range of obesity's impacts makes accurate economic analysis challenging; however, a November 2014 study from the McKinsey Global Institute placed the annual economic impact on the UK at around $73bn (£46bn). Earlier analysis and modelling for the 2007 Foresight Report suggested a cost to the NHS of around £4.2bn annually to treat people with health problems related to elevated BMI and a total wider cost to the economy of around £15.8bn (rising to £27bn by 2015 and £49.9bn by 2050).57DE7179, 399974A profound impact on the health of the populationObesity is responsible for more than 9,000 premature deaths each year in England, reduces life expectancy on average by nine years, and is a major risk factor in wide range of serious health problems including Type 2 diabetes (5 x), cancer (3 x the risk of colon cancer), and heart disease (2.5 x).57DE7179, 399978Modelling suggests the majority of UK population may be obese by 2050The prevalence of obesity in the UK more than doubled in the 25 years to 2007. In England, nearly a quarter of adults and about 10% of children were obese in 2007, with a further 20–25% of children overweight. The Foresight report extrapolated that 40% of Britons might be being obese by 2025, with Britain being a mainly obese society by 2050.1198CE71, 399980What costs should be included in the financial analysis?What cost factors should be included in the assessment of the overall financial impact of obesity on the UK economy?8FFB597, 399984Inequality of impactAlthough obesity occurs across all population groups, it impacts disproportionately on the socially and economically disadvantaged and some ethnic minorities. [8]57DE7179

Over the last few decades, rates of obesity have been rapidly rising, first across the developed world and, more recently, in developing countries. The health impacts can be myriad and serious, and the implications for individuals and for governments – including increasing health-care costs and falling economic output – are clear. Policymakers will be faced with the financial consequences of obesity – and they are well placed to take action to control the epidemic and its health repercussions, through better prevention (involving many government departments) and management. However, are their perceptions of obesity and obesity policy accurate? Do they appreciate the extent of the epidemic, the drivers of obesity, and the tools and actions that need to be taken to make a difference?

To address these questions, the European Association for the Study of Obesity, with C3 Collaborating for Health, surveyed 333 policymakers, from legislative and executive branches of government, in 11 countries – Brazil, Bulgaria, Canada, Denmark, England, France, Germany, Italy, Mexico, Spain and the United States. * Those who took part were selected for their position in government, not for their particular responsibility for obesity.

The survey found that almost all the policymakers saw the individual as having responsibility for reducing obesity in the future – with family and the food industry also having a powerful influence. Other groups, such as health-care professionals, government, society and employers were seen as less responsible. Similarly, while physical activity, and marketing of and access to unhealthy food, were seen by a large majority of the policymakers as being important drivers of obesity, there was less consensus on the strength of the role played by issues such as limited finance and genetics.

Policymakers varied in their response to questions on national obesity policy and tools and their effectiveness – and, as the country summaries make clear in the first part of this report, the countries vary greatly in the extent to which policies to tackle obesity are in place. Policymakers’ perceptions of national policy and knowledge of policies and the impact of different approaches (such as lifestyle interventions, drug treatment and surgery) differed, both in terms of whether they are a good course of action and whether they are currently in place and effective.

The survey also uncovered some gaps in knowledge among many of the policymakers. For example, policymakers were often not fully informed on the prevalence of obesity and (in particular) overweight, and their responses about progress and policy do not always reflect reality.