Public Policy and the
Prevention of Obesity
KELLY D. BROWNELL
We are losing the war on obesity. Its prevalence is rising in country after country, with no signs of reversal (see Chapters 74, 75, 76, and 77). The primary cause, environmental factors leading to poor diet and physical inactivity, are growing worse (see Chapter 78). In all likelihood, its prevalence will continue to increase. This dire situation argues for taking bold action and making fundamental breaks from existing approaches.
Prevention of obesity is of massive public health importance. Obesity, once established, carries with it significant medical and psychosocial morbidity, and is most difficult to treat. Treatment is expensive and can be questioned on grounds of poor efficacy, not to mention effectiveness. As noted in Chapter 78, the number of cases of obesity reversed by treatment is minuscule compared to the number of new cases entering the obese population. It is clear that treatment will not influence prevalence at the national level.
Whether the focus is on treatment or prevention of obesity, it is logical to base an approach on causes. It is now common to explain obesity with a combination of biological, environmental, and individual variables. This stance issues forth from a medical model, in which causes are sought for individual cases (see Chapter 111), and does not readily lead to clear notions for either treatment or prevention. This may explain in part why modern treatment for obesity is based relatively little on theory or on studies of causal factors.
Breaking from the medical model to consider a public health model focuses attention on why the population is overweight and what can be done at the population level to re-