Many other chapters in this handbook have highlighted the complex, multifactorial nature of the etiology of obesity. Some of these factors are nonchangeable such as genetics, gender, and age, and others, such as physiological disturbances in hormonal regulatory systems, can only be dealt with at an individual level (if at all). However, this still leaves a large number of potential influences over energy intake or energy expenditure and thus body weight regulation which could be the focus of interventions to prevent obesity. Unfortunately, we have gained few insights into the most effective obesity prevention strategies from the limited number of programs that have attempted to address this issue in the past (see Sec. VII of this chapter). Thus it is necessary to speculate on what are the key behaviours to address that are most likely to support the attainment and maintenance of energy balance at both an individual and population level.
The prevention of obesity does not necessarily draw on the same strategies employed to treat obesity. The treatment of obesity requires the creation of a relatively large energy deficit, usually in excess of 500 kcal (2000 kJ) per day, which needs to be sustained for the period of weight loss. This usually involves moderate change in current diet and physical activity patterns, but is often achieved with more radical change. In contrast, the prevention of weight gain may only require very minor but long-term energy adjustments in the region of 50 kcal or less a day to avoid the accumulation of excess energy over time and prevent an increase in body fat stores. Thus the most effective prevention strategies may not necessarily be based on what makes the biggest contribution to the development of energy imbalance. Instead effective prevention strategies will need to focus on changes that are achievable, sustainable, simple, relevant to a large proportion of the target population, and capable of contributing to increased energy expenditure or decreased energy intake or both. Changes that may only result in a small reduction in energy intake or small increase in energy expenditure in an individual may be effective strategies when applied across the population. Additionally, given the level of concern expressed about eating disorders among certain susceptible subgroups of the population, it may be wise to ensure that prevention strategies are unlikely to contribute significantly to inappropriate eating behaviors.
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