Confronting the epidemic: the need for global solutions.

The growth in the global epidemic of obesity is fundamentally linked to economic factors. The rising prevalence of overweight and obesity has occurred during a period when the real cost of the main components of many processed foods has declined significantly,partly due to state subsidies in the protected markets of Western economies. It is suggested that the vigorous promotion of foods high in fats and sugars, and intensive marketing to children, have aggravated the problems of obesity. The metabolic syndrome, a recent feature of the epidemic, now is a marker for the health impact of obesity both in the US and other countries. The IOTF suggests that global populations will continue to become progressively heavier if present consumption forecasts are sustained, with obesity imposing a burden of social and economic costs that no country, least of all developing countries with limited resources, can afford. Commitments to deliver effective action are needed from non-health sectors such as culture and education, commerce and trade, development,planning, and transport. Only a comprehensive and integrated international approach, based on an effective implementation of the WHO global strategy on diet, physical activity and health, offers any real hope of arresting the public health catastrophe unfolding throughout the world.

Eating and obesity--the new world disorder.

Obesity is not a new phenomenon. Paleolithic artefacts, some almost 35,000 years old, depict obesity in its classical gynoid form, suggesting that early hunter-gathers were not entirely safeguarded by the assumed Stone Age diet. Nevertheless it has been convincingly argued by Boyd Eaton and others that the 21st century epidemic of non-communicable diseases (NCDs), including obesity, is attributable to mankind no longer enjoying the diet of our ancestors for which we remain genetically and metabolically programmed. Even if our forebears seemed to revere obesity sufficiently to carve out stone "venuses", it is still unclear if they were documenting a commonplace feature, although the frequency with which these venuses appear across thousands of years and even thousands of miles apart might suggest that obesity, in women at least, was not a complete rarity.

The 'Sydney Principles' for reducing the commercial promotion of foods and beverages to children.

A set of seven principles (the 'Sydney Principles') was developed by an International Obesity Taskforce (IOTF) Working Group to guide action on changing food and beverage marketing practices that target children. The aim of the present communication is to present the Sydney Principles and report on feedback received from a global consultation (November 2006 to April 2007) on the Principles. The Principles state that actions to reduce marketing to children should: (i) support the rights of children; (ii) afford substantial protection to children; (iii) be statutory in nature; (iv) take a wide definition of commercial promotions; (v) guarantee commercial-free childhood settings; (vi) include cross-border media; and (vii) be evaluated, monitored and enforced. The draft principles were widely disseminated and 220 responses were received from professional and scientific associations, consumer bodies, industry bodies, health professionals and others. There was virtually universal agreement on the need to have a set of principles to guide action in this contentious area of marketing to children. Apart from industry opposition to the third principle calling for a statutory approach and several comments about the implementation challenges, there was strong support for each of the Sydney Principles. Feedback on two specific issues of contention related to the age range to which restrictions should apply (most nominating age 16 or 18 years) and the types of products to be included (31% nominating all products, 24% all food and beverages, and 45% energy-dense, nutrient-poor foods and beverages). The Sydney Principles, which took a children's rights-based approach, should be used to benchmark action to reduce marketing to children. The age definition for a child and the types of products which should have marketing restrictions may better suit a risk-based approach at this stage. The Sydney Principles should guide the formation of an International Code on Food and Beverage Marketing to Children.

The obesity epidemic, metabolic syndrome and future prevention strategies.

UNLABELLED: The epidemic of obesity and overweight poses a major challenge to the prevention of chronic noncommunicable diseases throughout the world. In some developing countries it presents a double burden alongside enduring problems of undernutrition. Current IOTF estimates suggest that at least 1.1 billion adults are overweight including 312 million who are obese. The prevalence of obesity has doubled or even risen threefold in less than two decades, while in children this is rising at an even faster rate in some regions of Europe to levels of up to 36% in parts of Italy and elsewhere. The comparative burden of disease due to raised body mass index is among the top five leading risk factors in both developed and low mortality developing countries. When viewed in conjunction with the burden of raised cholesterol and hypertension, these components of the metabolic syndrome form the major cause of mortality and disease in Europe and are guaranteed to increase with the rising trend in overweight and obesity while amplifying the burden of cardiovascular disease. The increase in childhood obesity will, unchecked, accentuate the rise in early adult type 2 diabetes and cardiovascular disease. CONCLUSIONS: A fundamental policy shift is required to widen responsibility for the prevention of diet, activity and weight-related ill health across the whole of Europe's population. Only such a comprehensive approach offers any realistic prospect of averting a public health catastrophe for Europe and indeed for the whole world.