Wednesday 22 / January / 2025
Obesity is a complex public health issue that necessitates a multifaceted approach to address and reverse the trend globally. From 1990 to 2022, the rates in children and adolescents climbed fourfold, from 2% to 8% worldwide, while in adults they more than doubled, from 7% to 16%. In Oman, over half of the Omani population is overweight or obese, with 30% having obesity , body mass index of over 30 kg/m2. Obesity is a major risk factor for chronic diseases like cardiovascular diseases, diabetes, musculoskeletal disorders, and certain cancers. Childhood obesity increases the chance of developing related illnesses early in life and can last into adulthood if not treated. Since obesity is a complex medical problem, governments in all sectors have an obligation to address the growing burden of obesity at the individual, healthcare, societal levels with the aim to have health in all policies.
At the individual level, understanding the sociodemographic determinants of developing obesity is critical to addressing the problem. These include the circumstances under which individuals are born, grow, work, live, and age, as well as the system in place to deal with illness. It also involves the societal norm around obesity, as well as knowledge about the consequences of the problem. Addressing the sociodemographic determinants of health is crucial for preventing obesity, promoting healthy lifestyles, and achieving societal justice. Having said that, there are other elements beyond the individual level that must be addressed to combat obesity.
At the healthcare setting, the Ministry of Health is working hard to screen for, manage, and promote awareness of the impact of obesity on one’s health among all individuals attending healthcare facility. Beyond that, it conducts frequent campaigns to raise awareness of the health consequences of obesity in developing non-communicable diseases. Additionally, patients with obesity receive all available assistance (including medical and surgical) to treat obesity and its complications. However, this is not enough. With an increasing prevalence of obesity, we must consider solutions outside the scope of the Ministry of Health. Aside from individual counselling, therapeutic and surgical approaches will help at the personal level but will not be enough to manage the epidemic throughout the country. The government will require a broader population-based approach to tackle this issue.
At the educational level, there should be a clearly defined “national meal program” that covers all preschool and school levels, both public and private. Unfortunately, some schools continue to serve unhealthy foods such as uncarbonated soft drinks, junk food, and fast food, as well as sugary drinks, with no clear plan to incorporate healthy options, like fruits, into their meal plan. A similar scenario exists at the higher educational institutes. To combat unhealthy diets, some countries implement regulations at higher education institutions to reduce unhealthy food consumption. One example is discontinuing the serving of sugary and uncarbonated soft drinks in the canteen. Other ideas include introducing health education about healthy meals and a food pyramid that explains the healthy portion within the educational curriculum starting from preschool stage throughout all educational levels.
At the societal level, many countries understand the importance of building an environment to combat obesity. The built environment, which includes man-made environments such as buildings, parks, amenities, and infrastructure, has been proposed as a potential driver of obesogenic behaviours and obesity. Several measures can help in reduce the impact of obesogenic environment. First, expanding the amount of green space where adults and kids can engage in outdoor physical activities. This should be part of municipal planning so each residence has a well-designed green area with a playground where children may enjoy outdoor activities. Second, introducing sideway rails for pedestrians and cyclists should be defined on selected roads to ensure safe and enjoyable use. Third, public transportation should be improved to lessen reliance on personal vehicles. Evidence suggests that switching from personal to public transportation through new well-designed infrastructure or altered ticket pricing reduces the risk of obesity. Increased fruit and vegetable store distribution near schools and residential areas, while reducing fast food retail outlets, may increase access and consumption of healthy foods.
Another term that has recently been identified as a significant contributor to the development of obesity by influencing one’s choices is the “commercial determinants of health.” It is defined as private-sector activities that influence people’s health, either positively or negatively. These activities can be used to lobby and influence health policies. This is evident in multi-corporate tobacco companies and fast-food establishments. Their influence on food choice manifests itself in a variety of ways, including, but not limited to, increasing fast food supply chains, improving product design and packaging, introducing additive flavour, increasing portion size, supporting research, mass advertising, and price promotion. Additionally, participation in corporate social responsibility (CSR) initiatives, such as participating in initiatives at health or education sectors, aims at enhancing the community’s reputation and thus increase consumption of unhealth products. Furthermore, the way different markets are designed, where fast, unhealthy food is placed in areas that are easily accessible and seen in the market, while healthy options are placed far away or on higher shelves, all have an impact on consumer choice. The use of billboards, social media, and other places to advertise unhealthy options can also impact one’s decision. Understanding these tactics is the first step to pinpointing the factors that influence one’s choice and proposing measures to combat hazardous choices.
Obesity poses significant threats to individuals, health sectors, and communities as whole. A population-based approach should be prioritized, involving all sectors in planning and management.
Health should be at the heart of every policy, and policies should align with the health mission of reducing the root cause of noncommunicable disease, including obesity.
Early detection and management of obesity in life can prevent the progression of noncommunicable diseases. Understanding all the factors that may lead to obesity is critical to managing it successfully. Investing in nationwide surveys can help identify and address the sociodemographic, health-related, and societal factors that contribute to obesity and address then in timely manner.
Salma Al-Kalbani is a Family Medicine and Public Health Doctor
