Professor Sir Peter Gluckman, Co-chair of the World Health Organization’s Commission on Ending Childhood Obesity, provides insight into the obesity problem in Asia and explains the critical need for a multi-stakeholder solution in working to end the epidemic.
Obesity is a multi-factorial problem. At the heart of it we’re talking about three things – healthy eating, healthy physical exercise and health starting from the beginning of life, or the life-course approach. It’s not just a matter of what adults do; it’s a matter of what children do, it’s a matter of how infants are fed, it’s how pregnancies are undertaken. While the treatment of obesity is very complex, the best strategy for dealing with obesity is to stop people from becoming obese in the first place.
In addressing childhood and adolescent obesity, the Commission on Ending Childhood Obesity (ECHO) believes it is critical to consider two main factors: the obesogenic environment and the life-course approach.
An obesogenic environment refers to the sum of influences that promote obesity in the life of an individual or a population. Typically, due to influences through surrounding conditions, norms and behaviours, people in an obesogenic environment tend to eat unhealthy foods in excess and partake in little physical exercise. Ultimately, what people eat comes down to an interaction within an environment that is created by companies, marketing, social arrangements, peer pressure and how they live their lives; their biology; and their behaviour, which is partly influenced by these externalities, partly by their own learning and partly by their understandings.
In order to understand these behaviours, a life-course approach is important so as to develop an understanding of the influences on an individual’s life – starting from the preconception stage, through gestation, childhood, adolescence, young adulthood and midlife periods – and how they might affect chronic disease risk and health outcomes in later life. This is done through identification of underlying biological, behavioural and psychosocial factors that operate across the life span.
The situation in Asia
In Asia, what we’re facing is two important phenomena – one being the interplay of social and economic elements, and the second being major changes in dietary habits.
Hence, in Asian populations, we’re faced with striking a delicate, difficult balance. Unfortunately, we still have too much malnutrition and micro-nutrient deficiencies in the region. On the other extreme, with excess calorie intake and inadequate exercise, we have a real burden of diabetes and heart disease ahead of us. That is why the developmental component is so important in Asia – from prenatal health through the life stages in an individual’s life – to stop people on the pathway to being even mildly obese.
Constructive engagement toward a solution
There is no magic bullet to solving the rise of the growing obesity epidemic in Asia or the rest of the world, but the private sector has a role to play. There has to be accord and proper undertakings among industry, government and civil society – real progress can only be made by constructive, transparent and accountable engagement with the private sector, and some degree of regulation may be necessary.
At the end of the day, food is provided by companies either in manufacturing or retail, and so we need productive engagement of industry. But this contains all sorts of complexities – namely the fact that the industry is not monolithic – it ranges from multinationals to local artisan providers, from healthy to unhealthy food providers, and so forth. We need to find ways to encourage companies to produce healthier products, even as they sustain their income line.
How that’s achieved is complicated by the nature of society, political ideology, and by the strength of actors in the sector. There is inherent scepticism about whether industry can truly be capable of being a responsible corporate citizen. Saying that, it can be done, and has indeed been done. What is needed is open, honest dialogue – among government, industry, civil society and other relevant stakeholders.
The role industry must play
Within the private sector, it’s crucial that companies recognise that it is in their long-term interests to promote genuine public health, in order to have a healthier population that will live longer and be economically more viable, as healthier foods are often harder to access due to economic factors. In this regard, industry has a very important role to play.
There has to be accord among government, public health officials, industry and civil society about the definition and objectives of a healthy lifestyle message. Good nutritional education should be promoted both in the populations and schools, so that consumer demand comes from healthier foods that include fruits and vegetables. If consumers understand what healthy eating and lifestyle is, the industry will move toward what the consumer wants.
But moving ahead, all said and done, the reality of the global food chain is that regulation at a national level has an important but a somewhat limited role – the practicality of how the global food chain works means we do need to find better ways of partnering with industry. At the same time, that doesn’t mean industry gets a blank cheque. Regulation is not the sole answer to the obesity problem, and industry needs to step up and shoulder some of the responsibilities. Companies will have to earn and maintain the trust of a variety of stakeholders.
At the end of the day, to reduce levels of obesity, a lot is required from governments, from the private sector and from civil society. It’s not an easy task; it will require a lot of work by many people to make a difference.
The draft final report of the Commission on Ending Childhood Obesity was has been released and is open for comment from relevant stakeholders until 13 November 2015. The report can be found here.
Professor Sir Peter Gluckman
Sir Peter is also the Chief Science Advisor to the New Zealand Prime Minister. He was formerly Professor of Paediatric and Perinatal Biology and Director of the National Research Centre for Growth and Development (now called 'Gravida: National Centre for Growth and Development'), hosted by the University of Auckland. He also served as Head of the Department of Paediatrics and Dean of the University's Faculty of Medical and Health Sciences as well as the founding Director of the Liggins Institute.
Sir Peter holds honorary chairs at the National University of Singapore and the University of Southampton; and is a member of the Institute of Medicine of National Academies of Science of the United States, a Fellow of the Academy of Medical Sciences of Great Britain and a Fellow of the Royal Society of London. In Singapore, Sir Peter is also a special guest of the newly launched Asia Roundtable on Food Innovation for Improved Nutrition (ARoFIIN).
Throughout his career, Sir Peter’s research research has focused on children’s growth and development and what gives people a healthy start to life: understanding how a baby's environment between conception and birth influences its childhood development and lifelong health.