Public Health Approaches
to the Management of Obesity
ROBERT W. JEFFERY
The purpose of this chapter is to discuss the treatment of obesity from a public health perspective. Its primary thesis is that there are important differences between the medical and public health views of the problem and that these differences have implications for treatment.
Public health interventions for obesity should not simply be thought of as medical interventions disseminated on a larger scale. A public health perspective leads to consideration of environmental strategies that are quite different from those used in clinical management of obesity (see Chapter 112). Here, the success of the current generation of community programs for obesity control is described and alternative public health approaches are proposed.
Differences between medical and public health models begin with the definition of “obesity” itself. From a medical perspective, obesity is an individual-level variable. Patients are obese because their body fatness is high compared with population norms or biological ideals. From a public health perspective, however, “obesity” is defined in terms of average fatness in the population as a whole or the percentage of the population that exceeds a certain fatness level (prevalence). Obesity is a public health problem when its prevalence in a population is higher than that in other groups.
Public health and medical models also differ in the emphasis given to causal variables. The medical model searches for causes in variables that differ between individuals, including individual differences in genetics and in acquired characteristics (biological, psychological, and behavioral) that make some individuals susceptible to obesity.
The public health model recognizes individual differences as a source of variability,