Prevention Conference VII
Authors: Rebecca M. Mullis, Steven N. Blair, Louis J. Aronne, Dennis M. Bier, Margo A. Denke, William Dietz, Karen A. Donato, Adam Drewnowski, Simone A. French, Barbara V. Howard, Thomas N. Robinson, Boyd Swinburn, Howell Wechsler
Journal: Circulation (2004)

besity is a worldwide problem, not just an issue for industri- alized nations.Therefore, we need to examine opportunities for prevention and treatment from a global perspective. Global PerspectiveThe prevalence, or epidemic, of obesity is increasing in most countries throughout the world.The issues for addressing both its prevention and treatment will differ from one country to another, according to the stage of the epidemic, cultural and economic circumstances, and the commitment of the public and politicians.In some less-affluent countries the conditions that promote the positive energy balance that leads to obesity have yet to be identified.In such instances, true primordial prevention (ie, preventing the environmental conditions for obesity from occurring) may be possible.These conditions could include promoting traditional eating patterns, preserving opportunities for active transport (walking, cycling, public transport), and protecting environments against the expansion of automobile travel.In most countries, however, those conditions are present already, and therefore the response to the epidemic will involve both primary prevention (preventing the incidence of new cases of obesity) and secondary prevention (treatment of obesity to reduce complications and prevent further weight gain). High-Risk and Population-Based ApproachesHigh-risk and population-based approaches are complementary strategies that provide a continuum of interventions.Supportive environments will increase healthy food and activity choices and promote the adoption of these behaviors for the whole population, including overweight persons who are attempting to make behavioral changes.Supportive environments will increase consumer pressure for those goods, services, and environments and ensure that they will continue to be provided. Epidemiological TriadThe epidemiological triad (host, vector, environment; Figure) was used originally to address infectious disease epidemics, but other, noncommunicable diseases also have benefited from this broad approach. 1Mortality from tobacco-caused diseases, cardiovascular diseases, injuries received in traffic accidents, cervical cancer, and cot death all have decreased in countries that have instituted broad medical and public health programs to prevent and treat these diseases.The lessons learned from these successful programs can be applied to the prevention of obesity.Although the treatment of obesity occurs commonly in healthcare settings, many settings and sectors need to be engaged for optimal effectiveness in the prevention of obesity.The use of a settings/sectors framework is useful for conceptualizing and planning interventions and actions.Within each setting/sector, a broad view is needed, and the epidemiological triad helps identify strategies for action.The agent (final common pathway) for obesity is positive energy balance.Some host factors are not modifiable.These factors include genetic makeup, age, and gender.Other factors are modifiable, such as behaviors and individual attitudes.The vectors for reduced energy expenditure are time-and energy-saving devices such as cars, computers, power tools, and appliances, and devices and activities that consume time, such as watching television and videos and playing computer games.The vectors that contribute to passive overconsumption of total energy may include energy-dense