Are ‘Behaviour Change’ Approaches to Obesity and Health Effective? A case Study from Samoa

‘Behaviour Change’ approaches in public health strategies have been used in Pacific Island countries to address the problem of dietary and lifestyle changes that are believed to be the cause of rising rates of obesity and associated NCDS. We consider the limitations of this approach in the context of Samoa’s socioeconomic situation and public health policy and propose that an ‘obesogenic’ environment and structural factors are causational and require policy measures that go beyond the scope of responsibilities of the Samoa Ministry of Health

The perceived obesogenic environment survey in the Flemish municipal context – the CIVISANO project

Background The prevalence of obesity worldwide has been steadily increasing. This has generated an uptake in research determining the cause of obesity. One of the primary drivers that have been identified is the “obesogenic environment', which is an environment that contains features that increase excess weight in individuals or populations. Obesogenic environments are unevenly distributed with socio-economically disadvantaged neighbourhoods being more affected. Methods This survey is part of the CIVISANO (‘Community-based participatory research to tackle the disparities in health-enhancing lifestyle within the municipality environment') project, which will be conducted in two municipalities. Respondents will be socio-economically disadvantaged adults between 25- and 65-years old. To gain information on individual characteristics and perceptions of the obesogenic environment, residents will be invited to complete a survey. Since it is known that socio-economically disadvantaged respondents are difficult to reach a non-random active recruitment approach will be applied. The following variables are included in the survey: sociodemographic information, subjective health and anthropometrics, dietary habits, food security and physical activity. Items from the SPOTLIGHT project survey and NEMS-P survey were added to assess respondent's perceptions of features of the obesogenic environment. Additional variables on individual characteristics were based on items from the Belgian National Health Interview Survey of 2019. Results Through the survey, we expect to gain insight into the perceptions of socio-economically disadvantaged adults on obesogenic features of their local environment. Initial results from the survey will be available in the upcoming months. Conclusions The construction of instruments to assess the context-specific features, which can be compared with objective measurements, can increase our knowledge of contextual determinants of the obesogenic environment. Key messages The first Flemish survey that focuses on perceptions of socio-economically disadvantaged adults on obesogenic features of their local environment in the municipal context. Gaining a better understanding of the local obesogenic environment creates an opportunity to promote and strengthen the development of effective local interventions to build healthier environments.

Factors of an Obesogenic Environment That Influence in Human Food Behavior

This bibliographic research sought to address environmental aspects that can influence human eating behavior. It addressed the influence of the media in the choice of food, the importance of the family as an interferer in the process of forming children’s eating habits, as well as the accessibility to foods rich in fat, sodium and sugar, which has become greater due to the growing emergence of fast food chains, making the habit of eating outside the home more constant, driving, in a way, the greater consumption of these caloric foods, which contributes to the emergence of obesity. Therefore, it is possible to conclude that it is essential that interventions are carried out in this environment that can contribute to the installation and maintenance of obesity, as the environmental scenario is considered modifiable and can influence the process of building the child’s eating habits and, consequently, of the adult individual.

1303 Obesity: A Growing Concern in Gynaecological Surgery

Introduction Obesity is becoming a major concern in healthcare. The rise in obesity has now reached alarming levels. Obesity is driven by the economic growth, unbalanced diet, and a sedentary lifestyle. Obesity has played a disastrous role in the health of many but significantly has had a detrimental health effect among girls and women. This review focuses on the effect of obesity on various aspects of women’s health including prognosis after gynaecological surgery. Method The search engine used for this literature review was Ovid MEDLINE. Only studies reported in English have been included in this review. The snowball and citation searching method was used to find further relevant articles. Results Various genetic components have been identified to increase the risk of obesity which is further exacerbated with the current obesogenic environment. Women with a BMI≥35 had longer surgeries and an increased rate of severe postoperative adverse events. Additionally, women with a higher BMI had an increased risk of cervical cancer due to under-diagnosis of cervical precancerous lesions, though obesity did not directly alter the association between preoperative biopsy and final tumour grade. Conclusions Despite increased awareness, obesity is still a major contributor of mortality and morbidity. Women in particular are facing severe consequences of the obesogenic environment. In women obesity not only increases their risk of developing gynaecological conditions but also adversely affects prognosis after surgical treatment. In the face of an obesogenic environment, it is important to sought out potential ways to reduce the risk of surgical complications in obese patients.

The COVID-19 pandemic: an unprecedented tragedy in the battle against childhood obesity

The childhood obesity pandemic has emerged as an important public health problem in many countries. Obese children are likely to become obese adults, and adult obesity is associated with an increased risk of morbidity. Therefore, controlling the childhood obesity epidemic has become a top public health priority worldwide. The current coronavirus disease 2019 (COVID-19) pandemic may significantly impede this important mission and constitute an unprecedented tragedy in the global battle against childhood obesity. This manuscript presents evidence that the COVID-19 pandemic will aggravate the childhood obesity epidemic and lead to significant weight gain in school children by creating an unprecedented obesogenic environment. Within the last few months, many countries took uncompromising measures in response to the COVID-19 pandemic, including school closures and quarantine. While these steps are often necessary to ensure infection control, they may have a significant negative effect on children's mental and physical health. Physical, nutritional, and psychosocial factors that promote obesity in children during this special situation complementarily contribute to an unprecedented obesogenic environment. Large-scale quarantine and home confinement will impose new and unfamiliar stressors on children, thereby worsening the childhood obesity epidemic. Most importantly, adverse childhood events resulting from a predicted increase in domestic violence within the next few months will significantly contribute to this concern. The scenario presented in this review is of paramount public health importance and must be considered during future pandemic planning. Involved stakeholders, including governments, schools, and families, must make all possible efforts to minimize the impact of the COVID-19 epidemic on childhood obesity.

Genetic associations with temporal shifts in obesity and severe obesity during the obesity epidemic in Norway: A longitudinal population-based cohort (the HUNT Study)

Background Obesity has tripled worldwide since 1975 as environments are becoming more obesogenic. Our study investigates how changes in population weight and obesity over time are associated with genetic predisposition in the context of an obesogenic environment over 6 decades and examines the robustness of the findings using sibling design. Methods and findings A total of 67,110 individuals aged 13–80 years in the Nord-Trøndelag region of Norway participated with repeated standardized body mass index (BMI) measurements from 1966 to 2019 and were genotyped in a longitudinal population-based health study, the Trøndelag Health Study (the HUNT Study). Genotyping required survival to and participation in the HUNT Study in the 1990s or 2000s. Linear mixed models with observations nested within individuals were used to model the association between a genome-wide polygenic score (GPS) for BMI and BMI, while generalized estimating equations were used for obesity (BMI ≥ 30 kg/m2) and severe obesity (BMI ≥ 35 kg/m2). The increase in the average BMI and prevalence of obesity was steeper among the genetically predisposed. Among 35-year-old men, the prevalence of obesity for the least predisposed tenth increased from 0.9% (95% confidence interval [CI] 0.6% to 1.2%) to 6.5% (95% CI 5.0% to 8.0%), while the most predisposed tenth increased from 14.2% (95% CI 12.6% to 15.7%) to 39.6% (95% CI 36.1% to 43.0%). Equivalently for women of the same age, the prevalence of obesity for the least predisposed tenth increased from 1.1% (95% CI 0.7% to1.5%) to 7.6% (95% CI 6.0% to 9.2%), while the most predisposed tenth increased from 15.4% (95% CI 13.7% to 17.2%) to 42.0% (95% CI 38.7% to 45.4%). Thus, for 35-year-old men and women, respectively, the absolute change in the prevalence of obesity from 1966 to 2019 was 19.8 percentage points (95% CI 16.2 to 23.5, p < 0.0001) and 20.0 percentage points (95% CI 16.4 to 23.7, p < 0.0001) greater for the most predisposed tenth compared with the least predisposed tenth, defined using the GPS for BMI. The corresponding absolute changes in the prevalence of severe obesity for men and women, respectively, were 8.5 percentage points (95% CI 6.3 to 10.7, p < 0.0001) and 12.6 percentage points (95% CI 9.6 to 15.6, p < 0.0001) greater for the most predisposed tenth. The greater increase in BMI in genetically predisposed individuals over time was apparent after adjustment for family-level confounding using a sibling design. Key limitations include a slightly lower survival to date of genetic testing for the older cohorts and that we apply a contemporary genetic score to past time periods. Future research should validate our findings using a polygenic risk score constructed from historical data. Conclusions In the context of increasingly obesogenic changes in our environment over 6 decades, our findings reveal a growing inequality in the risk for obesity and severe obesity across GPS tenths. Our results suggest that while obesity is a partially heritable trait, it is still modifiable by environmental factors. While it may be possible to identify those most susceptible to environmental change, who thus have the most to gain from preventive measures, efforts to reverse the obesogenic environment will benefit the whole population and help resolve the obesity epidemic.