The Lancet, Volume 378, Issue 9809, Page 2069, 17 December 2011

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doi:10.1016/S0140-6736(11)61896-5Cite or Link Using DOI

The battle against obesity: lessons from tobacco

Eric P Heymann a, David Goldsmith a

The Lancet's Obesity Series (Aug 27)1 profiles the most important current non-communicable threat to health.2 Unless successfully addressed, the attendant health-economic costs are unsustainable.1—3

There are striking parallels between obesity and cigarette smoking; we believe this comparison to be fruitful (webappendix). People's second and third decades seem pivotal to susceptibility to both risk factors.2 Whereas many initiatives against smoking have been partly successful—eg, embracing harm reduction, tobacco substitution, and understanding why people start smoking or successfully desist4—there is little evidence for interventions that produce lasting effects on current degrees of overweight and obesity.1, 5

Medicine and society have allowed weight gain, overweight, and obesity to develop into the accepted norm. To become, or to stay, overweight needs to be much harder. Although not underestimating the complexity, we advocate:

• A simple, universal, system for people to understand their previous, current, predicted, and desirable weights, and the health implications thereof (eg, “life weight charts” extending from adolescence to old age). This system could help stop obesity from seeming like someone else's problem.
• Early detection of obese children, with targeted educational intervention programmes for individuals and their families.
• Legislative or policy action that targets individual choices about energy expenditure, retarding or reversing inertial upwards drift in societal weight.
• Aggressive intervention for the seriously obese (ie, those with a body-mass index >35 kg/m2) by exhortation, taxation, and increased health-care insurance premiums, coupled with positive presentation of change options.
• Mandating corporate responsibilities about production, distribution, pricing, and taxation of foodstuffs.

We declare that we have no conflicts of interest.

WebExtra Content

Supplementary webappendix

PDF (100K)

References

1 The Lancet. Urgently needed: a framework convention for obesity control. Lancet 2011; 378: 741. Full Text | PDF(70KB) |CrossRef | PubMed

2 United Nations. Political declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases. http://www.un.org/ga/search/view_doc.asp?symbol=A%2F66%2FL.1&Lang=E. (accessed accessed Nov 2, 2011).

3 Swinburn BA, Sacks G, Hall KD, et al. The global obesity pandemic, shaped by global drivers and local environments. Lancet2011; 378: 804-814. Summary | Full Text | PDF(357KB) | CrossRef | PubMed

4 Department of Health. Healthy lives, healthy people: a tobacco control plan for England.http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_124917. (accessed accessed Nov 1, 2011).

5 Gortmaker SL, Swinburn BA, Levy D, et al. Changing the future of obesity—science, policy, and action. Lancet 2011; 378: 838-847. Summary | Full Text | PDF(112KB) | CrossRef | PubMed

a King's Health Partners, Guy's Hospital, London SE1 9RT, UK