Changing eating and physical activity patterns that predispose to weight gain remains the key concern of obesity prevention strategies, as the prevention of weight gain is dependent upon balancing energy intake and expenditure. Until recently, interventions aimed at the population control of obesity have focused on improving the knowledge and skills of individuals within the community in the belief that large-scale individual change will have an impact on the population weight status. However, such programs have had only limited success because they have not engaged all sections of the community and because the environment in which eating and exercise behaviors are made is now so antagonistic to healthy lifestyle choices that even the most motivated individuals find it difficult to make and sustain appropriate changes (101). Recent analyses of the obesity problem have focused discussion on moving beyond strategies that focus solely on changing personal or community behaviors to tackling some of the underlying structural and environmental determinants that shape these behaviors (47,69,102,103).
The International Obesity Task Force produced a "g diagrammatic ''causal web'' to highlight the complex | range of factors that have the potential to influence and | constrain healthy choices in relation to weight (104). -a The web presents a ''visual challenge'' to the notion of < free will by showing how such factors as global media and marketing, regional, national and local level policies relating to agriculture, urban design, education, and transport directly influence eating and physical activity in communities, homes, and schools (Fig. 4). ©
Tackling societal and environmental factors that underlie the development of obesity is covered in detail
in the following chapter. However, structural solutions and individual behavior change are not competing strategies in the prevention of weight gain. They are complementary and interdependent. The development of comprehensive programs of action to tackle obesity will require attention to both approaches. But, without structural change, individual-oriented behavior change strategies have the potential to worsen health disparities as the less advantaged members of the community have less latitude in physical activity and eating behaviors relating to obesity (47).
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