The obesity1–4 epidemic has grown worldwide, in countries both rich and poor, and among all segments of society. Action by government and other relevant institutions is clearly needed to halt the obesity problem, but what action is justified? In tobacco control, the adverse behavior is more readily identified, but even in this case major successes of the past have been linked to the application and implementation of a broad range of policies.5,6 Obesity control policy is in many ways more complex.
Obesity is caused by a chronic energy imbalance involving both dietary intake and physical activity patterns. While these behavioral patterns and their environmental determinants are complex, important drivers of the obesity epidemic have been identified.7 Evidence indicates that increases in energy intake are driving recent obesity increases.7–12 Key drivers include changes in the global food system that moved from individual to mass preparation, “lowered the time price of food consumption,”8 produced more highly processed food (adding sugar, fats, salt and flavour enhancers), and marketed them with increasingly effective techniques. Marketing foods and beverages is especially effective among children,13,14 is associated with obesity prevalence,15 and has been a focus of policy strategies.