Fighting the obesity epidemic

Soz.Praventivmed. 48 (2003) 339–340 0303-8408/03/060339–02 DOI 10.1007/s00038-003-3124-1 © Birkhauser Verlag, Basel, 2003 Dear editors, Dr. Vuille (2003) raises in his comment some important issues related to the so-called obesity epidemic. While we have no ready-to-use solutions it is very important to acknowledge the existence of the obesity epidemic and the need for a variety of means to fight it. Dr. Vuille proposes to solve the problem by undertaking more research to understand the cause of obesity. Indeed, more research is needed, but is this the most promising way to focus on? If we are lucky we may discover some so far unknown protective factors – how long will this take? Do we have the time to wait for some miracle discovery and then face the problem to find ways to “deliver” it to the general population? Today, we do know two very important factors influencing obesity: lack of physical activity combined with high energy intake. Indeed, we know this for quite a while. But this must not imply that we should not focus on these factors. They are the best we currently know and for most people concerned decreased energy intake and increased physical activity will result in a weight loss. However, the real issue is that so far obesity is not recognised as a non-communicable disease and funds spent towards the prevention of it are still rather limited. Unfortunately, the book entitled “15 proven ways to fight the obesity epidemic” does not yet exist. We therefore need considerable resources to be able to fund projects with different approaches to eventually identify the best strategies. It clearly needs a multidisciplinary approach taking into account factors like environment, transportation, society, education, motivation of industry and politicians, legislation and many more. Our health programme „Suisse Balance“ (www.suissebalance.ch) is a first step aiming to find new strategies to correct present energy imbalance found in alarming proportions of the Swiss population by combining healthy nutrition and increased physical activity. Success is not warranted – good ideas are sparse. But if one or several projects may prove to be successful on a local level we have the chance (and the obligation) to transpose them to a national setting. Combined with findings and success stories out of other disciplines (see above) we may be able to find a working strategy. Eating less combined with moving more is a simple strategy to loose weight and – even knowing that it is difficult – we have to try to persuade people to change their behaviour towards this “easy” solution. We disagree with Dr. Vuille’s view that it is impossible to change people’s behaviour and that mass campaigns are always ineffective. Successful campaigns run in the area of infectious diseases prove different. E.g., in Switzerland, the innovative national “STOP AIDS” campaign (www.stopaids.ch) lead to a marked increase in the use of condoms. Further, experiences gained in Finland from the North Karelia Project (Puska et al. 2001) present interesting approaches how to change people’s behaviour. Dr. Vuille started an important and much needed discussion. Discussions like this one have to be lead to increase the public awareness of the disease obesity and its consequences. It is of major importance to gain the political acceptance that the allocation of additional funds to nutrition prevention and health promotion is worthwhile. Yet, being successful in fighting the obesity epidemic is not only a question of money but also of smart ideas and successful multi-disciplinary collaborations. The “so-called” obesity epidemic is real – to be able to fight it we need the commitment and willingness of health professionals and politicians.