Tackling obesogenic environments would be effective and widely supported

A new review shows policies to tackle obesogenic environments are equitable, acceptable and cheap to implement.

Margot Neveux and Tim Lobstein, World Obesity Federation

With obesity prevalence continuing to rise worldwide, the member states of the World Health Assembly agreed in 2013 to work towards a target, by 2025, of no increase in the prevalence of adult obesity or diabetes above 2010 levels.

To meet their commitments, governments declared their intention to support programmes to promote better health and to implement policies to reduce the obesogenicity of the environment.

Recommended actions

Prominent among the proposed policies are three recommended by the World Health Organization (i) fiscal measures in the form of taxes or levies on products such as sugar-sweetened beverages, (ii) informative nutritional labelling on the front of packaged foods and beverages, and (iii) restrictions on the exposure of children to the promotional marketing of specified foods and beverages.

By the start of 2020, there were 37 regional or national governments with taxes or levies on sugar-sweetened products, 6 governments with mandatory front-of-pack interpretative labelling schemes, and over 30 countries with some form of mandatory restriction on marketing of foods to children on one or more media platforms.

Support for policy-making

In order to encourage policy-makers in all governments to implement similar policies, World Obesity undertook a narrative review to look at the costs of these policies, their impact on health disparities, and their acceptability to different parties.

We are aware that policy-makers face resistance to introducing these types of policy, both from commercial interests who anticipate lost sales, and from political and ideological opponents to the increased regulation of markets. For policies to be implemented they need evidence of effectiveness, and that a policy is proportionate for the problem, that it is not overly costly, and that it will not increase health disparities. They also need to know that the policies will be acceptable to health professionals, to parents and to the public at large.

Results

The narrative review of the literature has now been published in Obesity Science and Practice as an open-access paper. The paper finds:

• All three policy interventions – beverage taxes, front-of-pack labelling, and advertising restrictions – were likely to be low cost and highly cost-effective;
• Restrictions on marketing has the greatest long-term impact with a $6.6 saving for every dollar invested;
• There is evidence of a favourable impact of food taxes on different social groups by income or education levels, with people from lower socioeconomic status seeing the greatest health benefits;
• The effectiveness of front-of-pack nutritional labelling is dependent on the format of the label, with the ones requiring the least literacy or numeracy having the greatest impact, especially on consumers with lower levels of income and education;
• Children’s exposure to promotional marketing of unhealthy products may have a social gradient, and therefore restrictions on marketing would help counter disparities in health outcomes;
• The review confirmed the assumption that stakeholders with commercial interest show resistance to the implementation of regulatory policies.

The reviewers concluded that there was sufficient evidence for policy-makers to adopt all three of the policies examined. According to the review:

* Sugar-sweetened beverage taxes are likely to be highly cost-effective, moderately favourable for health equity, moderately supported by public (depending on the use of revenues), strongly supported by health professionals and civil society groups, and moderately opposed by commercial interests.

* Front-of-pack nutritional labelling is likely to be highly cost-effective, moderately favourable for health equity (especially when not purely numerical), moderately supported by public, strongly supported by health professionals and civil society groups (depending on the format) and moderately opposed by commercial interests (depending on the format). Front-of-pack warning signals are likely to be highly cost effective, highly favourable for health equity, moderately supported by the public, highly supported by civil society groups and health professionals, and highly opposed by commercial interests.

* Restriction of children’s exposure to marketing is likely to be very highly cost-effective (shown in the longer term, with a lack of analysis for the shorter term), moderately favourable for health equity, moderately to strongly supported by the public, strongly supported by health professionals and civil society groups, and moderately to strongly opposed by commercial interests (unless voluntary).

According to the review, the evidence for all three policy interventions supports their adoption and promotion by international, national and local authorities, as part of a portfolio of measures to tackle obesogenic environments.

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