The Big Picture on Obesity

It’s projected that in some European countries, over 1 in 3 adults will be obese by 2025—and the risk factors begin mounting before birth.

Despite the massive and growing magnitude of the problem, accurate data—and, in turn, effective policies to tackle childhood obesity—are thin, said Franco Sassi, who heads up the just-launched STOP project (Science and Technology in childhood Obesity Policy). Armed with a €9.95 million grant from the European Commission’s Horizon 2020 Research Programme for Sustainable Food Security, it’s the largest research project tackling childhood obesity in Europe.

Led by the Imperial College Business School in London, STOP will take 4 key steps in as many years to prevent and treat childhood obesity across Europe, particularly among under-12s:

1. Measure the problem, using what Sassi calls “the sheer power of super computers” to fill in gaps in obesity data.
2. Illuminate the causes of childhood obesity, including a study of 17 cohorts of children across Europe, from pre-birth to environmental factors to commercial influences.
3. Identify the policy approaches most likely to shift behavior.
4. Translate that information into usable policy tools for governments and other stakeholders, including the food industry.

GHN spoke with Sassi, the project’s principal investigator, about balancing economic and health interests, the power of messaging, what works, and what doesn’t:

You've been researching obesity for over 10 years. What gap will STOP fill?

It may sound unbelievable because there is so much talk about childhood obesity, but we know very little about how many children are obese, how they're distributed in the society, which social groups are more likely to be obese, and how these obesity rates change over time.

That must pose challenges for implementing effective policies. What has worked and what hasn’t?

When I was at the OECD (the Organization for Economic Cooperation and Development), we reviewed what countries were doing to address the obesity epidemic more generally. And the main conclusion was that very few countries were taking effective steps. Most countries did things they thought people would feel good about, like campaigns in schools to educate children on healthy habits. But we know that these campaigns are not particularly effective.

The reason being, very simply, that children are exposed to all sorts of incentives—from commercial advertising as well as digital devices that are commonplace … and much more powerful than any education that grade school teachers can deliver.

Part of this project involves drawing up suggestions to guide government policy—and attitudes to regulation vary widely across countries. What kind of resistance do you expect?

Different countries have different sensitivities… The US is clearly one of the countries where talking about strict regulation and taxation is most difficult. But nevertheless, the US has managed to implement soda taxes at least in 2 jurisdictions that I'm aware of. In Europe, quite a few countries use these taxes.

But there have been lots of controversies in Europe about different types of food labeling. The United Kingdom has chosen to use what they call traffic light food labeling, using the same color-coding as traffic lights to identify products that are more-or-less healthy. The rest of Europe has rejected this approach—mainly under pressure from the southern European countries, where the food industry is very strong and very opposed to this type of labeling.

But the mere existence of these measures—is that a sign of progress?

When I started working on obesity over 10 years ago, no countries would have seriously considered the taxation of food products for the sake of fighting obesity. Today, the policy environment is changing very rapidly, as governments finally realize how big the problem is.

You’ll be looking at genetic makeup as a determinant of obesity—including factors that arise before birth. How?

We’ll have access to measurements that no other previous study has collected, particularly biomarkers down to the molecular level. We'll be looking for early signs of childhood obesity in blood samples from our cohorts. The idea is that we would find characteristics of the environment children were exposed to in utero that would affect their likelihood of becoming obese later.                                   

You’ve pointed to a lack of data on this, but what do we know about the nuances in how obesity manifests differently between countries and income levels?

I think there are 2 issues above all: a country's culture about individual choice versus government regulation, and different economic interests. One thing I’ve always found quite striking is that food or dietary guidelines in various countries differ in a way that reflects national industries. A country like France, with a huge production of dairy products, clearly emphasizes the importance of eating a certain amount of dairy products. Essentially, dietary guidelines are a function of the economic interests of a country, which of course from a public health perspective is very undesirable. But it does reflect the complexity of policymaking.

You may end up encouraging regulations that could hurt the food industry’s profits—at the same time, there’s no avoiding its paramount role. So what's that dynamic going to be like?

There is no question that the food industry has been contributing to the problem with the changing nature of the foods that they've been making available, and how they've promoted them. But it’s equally true that no solution can really be found that excludes the food industry.

We want to engage industry in a competition to identify economically viable solutions—because clearly, if industry sees a profit opportunity in making healthier foods available, they will pursue it. But so far … producing and commercializing unhealthy foods has been more profitable.

Coca-Cola, Pepsi Cola, they will all tell you that in many countries, their diet products outsell their standard products. So consumers have been increasing the demand for healthy products regardless of government intervention—and that’s the best way to get corporations to act.

So it’s a delicate dance between regulating and incentivizing the food industry…. and market freedom…

Yes, I think it's not an either/or. In the same way that big corporations will always be free to pursue their market strategies whether or not they are consistent with health goals, I think governments will also be entitled to pursue policies in the interest of public health, whether or not industry likes them. I think governments should be entitled to continue in their efforts to tax unhealthy foods and regulate the food market more generally.

At the same time, I think governments can come together with the industry. It may come to a point that taxes or regulation are no longer needed. I would welcome that time but at the moment, I think we need both.

This interview has been lightly edited for length and clarity.

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