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This chapter explores the economics of obesity prevention, particularly the available evidence on the cost-effectiveness of interventions and how the economic credentials for obesity prevention might be developed. It begins with a discussion of the contribution that the discipline of economics can make to an understanding of obesity prevention, explaining the separate but related tasks of description, prediction, and evaluation. Using these concepts, the chapter then explores what is known about the economics of obesity prevention. First, the depth and quality of the available economic literature on obesity is reviewed, and then Australia is used as a case study to illustrate the application of economic methods to describe the disease burden and to evaluate options for change.

The case for a preventative approach to the obesity epidemic is compelling. Obesity poses what is arguably one of the most significant threats to population health that is currently faced. The data presented in this book highlight just how common obesity has become in children and in adults across the globe, and how it impacts disproportionately on the poor. This chapter presents a summary of the discussions in the preceding chapters.

This chapter presents a conceptualization of the causes of population obesity, discusses the implications of this conceptualization for public health interventions, and reviews empirical work that has attempted to address obesity treatment and prevention in entire populations. Youth interventions have been delivered primarily through schools. Adult interventions have used heterogeneous delivery modes. All have relied heavily on educational messages encouraging greater physical activity and a more healthy diet. The overall outcomes of these interventions are thought to be very modestly positive, with the strongest results seen in programmes for children that have high physical activity requirements. Unfortunately, the sizes of the overall effect seen in these studies are considerably smaller than the rate of increase in population obesity.

While tobacco-control experts in many developed countries announce remarkable reductions in tobacco consumption, nutrition and physical activity experts in these same countries bemoan the growing epidemic of obesity. Food and physical activity differ substantially from tobacco in that they are essential to life. Whereas the goal with tobacco control is to eliminate all use, obesity control focuses on reducing some behaviours (excessive and unhealthy food intake) and increasing others (physical activity). On the other hand, both tobacco control and obesity control involve influencing complex behaviours. For example, many overweight people struggle with tendencies similar to smokers by compulsively ingesting food for gratification even though they have surpassed their nutritional requirements. Such similarities suggest that there may be some overlap between obesity control and tobacco control. This chapter builds on and updates previously published work in seeking to draw lessons from the successes of the tobacco-control experience that can be applied to efforts to reduce and prevent obesity.

It is well known that obesity affects populations in both developed and developing countries, with significant consequences for public health. What is less understood is the role of the food and beverage industry in reducing the prevalence of obesity and its long-term consequences on individuals and, potentially, society. This chapter addresses the industry's role in obesity prevention by citing examples of industry-led initiatives offering early indicators that the industry can contribute to the effort of global obesity prevention.

This chapter analyses the potential of food regulation as a policy instrument for obesity prevention in developing countries. Following a review of the scope of food regulation, it provides an assessment of the feasibility of different food-regulatory approaches, from the perspective of working within the rules and provisions of the WTO agreements. It describes the activities that need to be undertaken to justify the implementation of food-regulatory approaches. These approaches are illustrated at Tonga as a case study. Finally, the chapter looks at the challenges in developing and implementing food regulatory approaches and makes suggestions to advance the case for incorporating food-regulatory approaches as integral components in a broad obesity-prevention policy framework.

Communities have been highlighted as key settings for obesity-prevention interventions. Community-based obesity-prevention interventions can target individual behaviour, e.g., through the provision of information, advice, support, and feedback at a group or personal level. These interventions can also target the environment of a community, sometimes through policy changes, so that healthy changes can be made more easily. This chapter provides an overview of the issues and challenges in developing and implementing community-based obesity-prevention intervention programmes. It briefly discusses the quality of available evidence, describes current community-based initiatives and the challenges in designing and managing them, and discusses the nature of the evidence required to inform policy and practice.

This chapter focuses on three key issues: firstly, the necessity of a shared vision; secondly, whether or not to trust the food industry; and thirdly, what should be done next. In order to move forward, a shared vision is needed of the causes of obesity and a philosophy of prevention. The strategy of trying to increase personal responsibility has not worked. Instead, the focus must be shifted to changing the environment so that it facilitates healthy eating behaviours and physical activity. The next question to be asked is: can the food instustry be trusted? In watching the behaviour of the food industry in recent years, their strategies have become apparent. The chapter describes elements of the food industry ‘playbook’ and questions the influence of the industry on the government. Finally, it recommends a number of targeted actions. Among these are making policy changes to protect children from commercialism, and creating coalitions with groups concerned about the environment and sustainability. Finally, the chapter also describes a more productive role for the food industry, and ends with example innovations that have succeeded at the local level.

As the world's population of the overweight and obese continues to soar, the critical need for governmental policy initiatives to stop, and ultimately reverse, this raging epidemic grows more imperative still. This chapter examines the state of regulatory and legislative affairs in the USA and considers another legal resource, litigation, which has provided a useful arrow in the public health quiver. Legal action has been successful in holding the tobacco industry responsible for the devastating health costs arising from its harmful product. The tobacco example, coupled with the alarming escalation of overweight and obesity in the USA and governmental failure to mount a meaningful anti-obesity campaign, has led public health advocates to look to litigation as a way of confronting this epidemic.

This chapter introduces social marketing approach and its possible applications in the field of obesity prevention. Because social marketing approaches to obesity are just beginning to emerge, it draws on the social marketing approaches in the public health literature more generally. It shows that several features of social marketing thinking have already been successfully included in public health planning processes. However, although social marketing shares many features with other related public health planning processes, it is distinguished by the systematic emphasis marketers place on the strategic integration of the elements in marketing's conceptual framework.

Urban planning — the process by which built environments are shaped and managed — aims to balance social, economic, and environmental concerns and needs. Public health was once central to this dynamic. However, in the decades following de-industrialization in developed countries, it became eclipsed by the exigencies of economic regeneration, and renewal and health were considered only in relation to issues such as pollution and contaminated land. Over the past two decades, however, there has been an increasing awareness that urban planning needs to re-engage with broader issues of health. Indeed, there have been suggestions that there is evidence to implicate the built environment as a factor in the obesity epidemic. This chapter explores those aspects of the obesity crisis on which planning and transportation policies may have a direct influence. It examines international research but mainly looks at how planning might respond from a British perspective. It is hoped, however, that the principles and policies discussed can be translated to other planning systems and structures.

This chapter explores the rapidly expanding canon of work examining the ‘obesogenic’ nature of urban environments and the ways in which this epistemology crosscuts efforts to create an incidentally sensible city. It examines the conflicting body of evidence concerning the causal relationships between the environmental determinants of health, body mass index (BMI), physical activity and nutrition. It questions the consistencies, limitations and generalisability of such studies when transferred across into the pragmatic realm of obesity prevention policies and interventions. It is hardly surprising that health is now a measure of the ‘good city’. The recent trend of ranking cities based on a host of factors such as liveability by publications such as Business Week and Human Resources company, Mercer, now extends to their citizens' relative fitness or fatness.

Inspired by the power of having specific health data for one's own community, leaders of the Jewish community in Chicago undertook the steps necessary to conduct a similar survey within the most densely populated Jewish neighbourhoods. This unique survey, the Jewish Community Health Survey of West Rogers Park and Peterson Park identified many health issues within the community. Of these, childhood obesity was selected by community members as the most important problem to address because it was found to affect a large percentage of children and because it foreshadowed serious health consequences for the future. This chapter presents additional details about childhood obesity in this community, including age and gender differences and possible determinants. It then describes the rates among children in Jewish day schools in Chicago. This intervention, the Jewish Day School Wellness Initiative, has produced substantial changes within the schools and students of the Associated Talmud Torah school system over a four-year intervention period.

One approach for reversing the obesity epidemic is to use economic strategies to change the costs and benefits of behaviours related to obesity in an effort to change positively the energy-balance equation. To date, these strategies have taken the following forms: (i) monetary incentives for weight loss or activities that promote weight loss, (ii) increased insurance premiums for people who are obese, and (iii) ‘fat’ taxes on unhealthy foods in efforts to reduce their consumption. This chapter discusses the economic rationale for each approach and assesses the evidence of effectiveness in both the short and the long run. It concludes with a discussion of future areas of research on the role of economic incentives or disincentives for encouraging sustained weight loss.

Social marketing research continues to change as campaign strategies change due to new technologies. Single new media approaches, such as text messaging campaigns and apps, represented the early model. Multimedia approaches have become the paradigm. Research on the effectiveness of multiple modalities, and optimization of channel combinations, is needed to fully integrate new technologies into the field. The chapter covers case examples from the text4baby program, which addresses multiple behavior change, to text messaging, an integrated multimedia intervention to address obesity among South African black women, and to use of social media for video narrative storytelling to prevent drug use among adolescents.

Social marketing has a growing evidence base. However, there are challenges in reviewing the literature due to inconsistent reporting and description of programs. There has been growth in the evidence base both through more rigorous evaluation of social marketing campaigns, including large efforts in tobacco control, obesity prevention, and drug use. There is growing recognition of the importance of monitoring and process evaluation. But, gaps in the evidence persist, and application of the full spectrum of benchmark criteria and research continuum stages discussed in Chapter 1 is often lacking. Gaps in the current evidence base should be filled using innovative methods and by harnessing new technologies, such as social media and mobile devices.

This chapter is organized into two parts. It begins with a review of recent efforts to curb unhealthy marketing to kids and then moves on to discuss current efforts to apply marketing strategies for health promotion. The chapter discusses the ways in which changes in the media environment have affected food marketing to kids. Strategies to address healthy food purchases in the supermarket and in the school cafeteria also are discussed. The chapter concludes with reflections on the challenges that public health practitioners will likely continue to face as shifts in the ways we shop and spend our leisure time increasingly go online.