Why Are Some Population Interventions for Diet and Obesity More Equitable and Effective Than Others? The Role of Individual Agency

We now find ourselves in a world in which one in three adults is overweight or obese [1].Unhealthy diets are an important determinant of overweight and obesity and also contribute directly to a variety of other causes of disability and death.In fact, together with physical inactivity, dietary risk factors are responsible for 10% of disability-adjusted life years lost globally [2].Like many risk factors, unhealthy diets are not evenly distributed in the population.In most developed countries, and increasingly in developing countries too, obesity and unhealthy diets are more common in more socioeconomically disadvantaged groups [3,4].Socioeconomic inequalities in health and disease are at least partly due to these inequalities in diet and obesity.Many governments have responded to the challenge of unhealthy diets and obesity with strategies that focus on advice, guidance, and encouragement to adopt healthier lifestyles.In England, the government’s current “flagship” obesity prevention programme is Change4Life.This social marketing campaign uses mass media and other avenues to inform and educate the public about the harms of excess weight and the benefits of being more active and eating more healthfully.Simple strategies for changing behaviour are also offered.Similar programmes operate elsewhere, including MangerBouger in France and Let’s Move in the United States. Summary Points• Public health interventions can be described according to where they lie on two continuums: the population and high-risk approaches anchor one continuum, while the other continuum captures the personal resources (or “agency”) individuals have to use to benefit from interventions.