This article is written by Michelle Gooey, PhD candidate and Mitchell Bowden, Engagement Lead, Policy and Projects, Monash University, Australia with input from Tiffany Petre, Director, Obesity Collective, Australia; Ian Caterson, Professor Emeritus, University of Sydney, Australia; Brian Oldfield, Professor, Monash University, Australia; Johanna Ralston, Chief Executive Officer, World Obesity Federation, UK; Clare Mullen, Chairperson, Weight Issues Network, Australia and Deputy Director, Health Consumers’ Council WA, Australia; Helen Skouteris, Monash Warwick Alliance Joint Professor of Health and Social Care Improvement and Implementation Science, Monash University, Australia and University of Warwick, UK.

  • The problem: Current approaches to obesity often overlook the underlying environmental and biological factors.
  • Why it matters: This leads to undue emphasis on personal responsibility and individual action, which do little to address underlying causes.
  • The solution: Collaborative and shared action to deliver integrated, cross-sectoral, multi-level policies and strategies which promote equity and span prevention through to treatment.

Based on current trajectories, it is estimated that more than one billion adults worldwide will be living with obesity by 2030. While there is a good understanding of the environmental and biological “roots” of obesity, this information is often overlooked and the causes oversimplified to a focus on personal responsibility – resulting in individual blame. Because of the multiple contributing factors, system-level action is needed to achieve population-level health outcomes. That is, the delivery of integrated, cross-sectoral, multi-level policies and strategies that span prevention through to treatment and focus on promoting equity.

The Health and Social Care Unit (HSCU) at Monash University’s School of Public Health and Preventive Medicine, partnered with the journal Public Health Research and Practice (PHRP), with the support of VicHealth, to produce a special edition, ‘Reframing the obesity narrative’. This brought together a diverse group of authors, including people with lived experience, advocates, clinicians and academics, primarily Australian, but also with an international perspective. It explored issues such as the commercial determinants of unhealthy diets, weight stigma and inequities, and provided recommendations and priorities for further action.

By bridging the know-do gap from research to policy and practice, a more collaborative approach to obesity prevention and treatment can be developed.

The special edition was launched at the International Congress on Obesity, in Melbourne, Australia, in a dedicated session on Saturday, 22 October 2022. A fascinating panel discussion, chaired by HSCU’s Professor Helen Skouteris, explored the special edition’s content and key findings. The distinguished panel included Clare Mullen, now Chairperson of the Weight Issues Network (WIN); Professor Ian Caterson, clinician and clinical researcher; Professor Brian Oldfield, academic and current President of the Asia Oceania Association for the Study of Obesity; Tiffany Petre, Director of the Obesity Collective; and Johanna Ralston, Chief Executive Officer of the World Obesity Federation.

Collaboration was a key theme running through the workshop discussions, consistent with the special edition. In particular, panellists highlighted the need to:

  • Move beyond individual responsibility to an approach that brings about structural change by placing the focus on collective efforts at the systems level rather than the level of individual behaviour change.
  • Promote shared narrative and language to align messaging and create safety for people with lived experience to contribute meaningfully to solutions. Examples include using person-first language and non-stigmatising imagery, promoting a focus on health improvement rather than weight loss, encouraging people with lived experience to share their stories and testing key messages to challenge misconceptions.
  • Unite people with diverse experiences, knowledge and perspectives to enhance implementation and evaluation. Examples include research-practice coalitions, consumer-led and initiated research, support for community (including lived experience) action and developing an integrated and combined system across health and social care to support treatment and prevention better.
  • Strengthen community understanding of the underlying biology of obesity and the interaction with environmental drivers, to support moving the narrative from individual responsibility to promoting coordinated action across and within multiple sectors resulting in systems change.
  • Measure progress so that advances can be shared with, and monitored by, the community. Examples include a “recommendations watch” with a community scorecard and place-based community forums.

Approximately 40 individuals from across Australia, New Zealand, North America, Africa, Europe and Asia attended the workshop, contributing to an audience made up of researchers, policymakers, educators, advocates and healthcare providers. Having listened to and participated in these discussions, workshop attendees were then invited to participate in online, interactive polling to identify and prioritise areas for action. The highest-ranked policy gaps identified were: addressing the commercial determinants of obesity, addressing the social determinants of obesity, investing in consumer voices and providing structures for collaboration. The most commonly suggested avenues for promoting tangible action and change were generating political will and mobilising coalitions for advocacy.

Next steps

In Australia, the National Obesity Strategy and National Preventive Health Strategy offer an opportunity to make important changes to the way obesity is considered and addressed at a national policy level. At a time when the global agenda for obesity includes targets for national strategies and impact to 2030, Australia is well placed to deliver success and build collaborations with other countries in shared approaches. The discussions at the special edition launch emphasised the importance of engaging widely and the need to collaborate for successful implementation of the national strategies. Having diverse views and community leaders involved creates opportunities for shared ownership and more sustainable action for healthier communities. Broad leadership and shared understanding can also help address harmful and pervasive stigma often perpetuated in policy, research, community, media and practice settings. Considering both treatment and prevention perspectives, important partners could include those with lived experience, community representatives, transdisciplinary (e.g. health, education, social care) and cross-sectoral (e.g. public, private, not-for-profit) partners, researchers, clinicians, policymakers and practitioners. Organisations such as The Obesity Collective, WIN and the Obesity Policy Coalition already work together to drive change in Australia and can play an important role in connecting stakeholders, ensuring that multiple and relevant voices are heard. By bridging the know-do gap from research to policy and practice, a more collaborative approach to obesity prevention and treatment can be developed.

Acknowledgements

The panel and workshop organisers would like to thank Louise Baur, Jane Martin, Megan Howe and colleagues at Public Health Research and Practice, Juliana Betts, Alexandra Chung, Zuleika Arashiro and Konsita Kuswara for their contribution to the special edition launch. Michelle Gooey acknowledges support from a National Health and Medical Research Council (NHMRC) postgraduate scholarship (GNT2005401).

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