Obesogenic environment: barriers to maintaining a healthy diet

Over the past decades there has been a rise in the figures for overweight and obesity and noncommunicable chronic diseases (NCDs) at a global level, both in high income nations and in middle/low incomeones. According to WHO (the World Health Organisation) the global prevalence of obesity has nearly doubled between 1975 and 2016. Spain has also seen an increase in the prevalence of obesity and NCDs since 1987. This increase is worrying because NCDs are one of the major causes of death in the world and are a real problem for public health. What is more, they generate significant expenditure for the healthcare system, which has increased globally, thus compromising healthcare systems around the world.  To be precise, the cost to the National Health Service in Spain of financing treatment for overweight makes up 2% (2,000,000 Euros) of the annual budget. However, as several studies show, most deaths from NCDs and obesity can be prevented by implementing efficient Government policies to make it easier to follow healthy lifestyles and to offer equitable healthcare, while also attempting to reduce social inequalities.

Since over a decade ago, policies, strategies and action have been developed with the aim of reducing the problem of overweight and NCDs and so reduce their effects and repercussions on a global as well as a European level, and in Spain. However, with some exceptions, these have focussed mainly on changes in individual behaviour and have not been effective, being unable to slow down the obesity pandemic in any country in the world, because changes in dietary patterns cannot be explained solely by individual behaviour. Environment factors such as larger portions, the commercialising and formulation of foodstuffs, or a wider availability of unhealthy products play a vital role in these changes. Thus, together with these environment factors, political and economic systems, the supply of foodstuffs, socio-cultural and socioeconomic conditions and leisure and transport may all accentuate or mitigate the effect of the causes of overweight, obesity and NCDs. Likewise, the food system is made up of an interconnected network of food producers, industry and institutions, which are influenced by the policies in place at a particular time, and so it (the food system) can also lead to inappropriate eating habits. This system determines the food choices and preferences of the population, due to the rise in the offer of cheap, tasty and high-energy food, to better distribution methods meaning foodstuffs are more readily available, and to a much more persuasive publicity and marketing of food products. For all of the above reasons, one of the basic keys to understand and act upon the current obesity pandemic is to look at the environments.

 The first time the term «obesogenic environment» was used was in1997 in some research carried out by Swinburn and Egger, in which they refer to it as the influence environments have on promoting excess weight in the population, favouring more sedentary habits and/or unhealthy diets. The influence of the obesogenic environment is multi-factorial and affects both physical activity and diet. Thus, when referring to it, we identify different types: the built environment and the food environment, although both are interconnected.

The built environment encompasses the physical design, use of land and transport system of the city or neighbourhood, which affects the ease or difficulty in doing physical activity. Here we can find different elements which may be boosters or barriers, like the presence of parks or green areas, how easy it is to walk or cycle round the neighbourhood and the workplace.

On the other hand, the food environment encompasses every opportunity to get food, how accessible and available it is, and food advertising and marketing. There are different ways to access food such as shops, restaurants, home, the workplace or schools and other installations. 

The «Model of Community Nutrition Environments» describes how the food environment determines dietary behaviour. In this model, we start with a macro-environment which is food policies as one of the major factors of influence on eating habits, and these policies are regulated by the Government but also systematise the food industry. Such policies determine advertising, marketing and consumer information, and influence the environments closest to individuals, such as the community environment (kind and location of food shops and restaurants and ease of access to them); the kind of environment at home, school, in the workplace and other institutions (hospitals, charity canteens or soup kitchens…); and the consumer environment (availability of healthy choices, cost, promotion, location, nutritional information…). Thus, environmental, cultural, and social factors influence different individual aspects such as perception of the environment and psycho-social factors, which combine to determine eating patterns and behaviour, which can influence the development of excess weight and NCDs.

For all the reasons mentioned above, the preparation and adoption of food policies which enable us to acquire healthy foodstuffs, and which take the food environment into account have been declared essential and promising strategies to face society’s health problems by increasing the availability of and access to healthier food products.

Alba Martínez-García is a Doctor in Health Science and Assistant Professor in the Community Nursing, Preventive Medicine and Public Health Department at the Universidad de Alicante, and the lead researcher on the project «The role of collective feeding in restaurants in the development of the obesogenic environment» («El papel de la restauración colectiva en el desarrollo del ambiente obesogénico») (GRE21-10A). Likewise, Eva María Trescastro-López is a Doctor in Public Health and a Doctor Associate Professor in the Community Nursing, Preventive Medicine and Public Health Department at the Universidad de Alicante and a member of the Grupo Balmis de Investigación en Historia de la Ciencia, Cuidados en Salud y Alimentación (Balmis Group for research into the History of Science, Healthcare and diet).

For more information on this subject the following may be consulted:

Egger G, Swinburn B. An approach to the obesity pandemic. BMJ. 1997;315(7106):477-480. 

Swinburn B., Egger G., Raza F. Dissecting Obesogenic Environments: The Development and Application of a Framework for Identifying and Prioritizing Environmental Interventions for Obesity. Prev. Med. 1999;29:563–70.

Glanz K, Sallis JF, Saelens BE, Frank LD. Healthy nutrition environments: concepts and measures. Am J Health Promot. 2005 May-Jun;19(5):330-3, ii. 

Martínez-García A, Trescastro-López EM, Galiana-Sánchez ME, Pereyra-Zamora P. Data Collection Instruments for Obesogenic Environments in Adults: A Scoping Review. Int J Environ Res Public Health. 2019;16(8):1414. 

Martínez-García A, Trescastro-López EM, Galiana-Sánchez ME, Llorens-Ivorra C, Pereyra-Zamora P. Cultural Adaptation and Evaluation of the Perceived Nutrition Environment Measures Survey to the Mediterranean Spanish Context (NEMS-P-MED). Nutrients. 2020;12: 3257. 

Martínez-García A, Díez J, Fernández-Escobar C, Trescastro-López EM, Pereyra-Zamora P, Ariza C, Bilal U, Franco M. Adaptation and Evaluation of the Nutrition Environment Measures Survey in Stores to Assess Mediterranean Food Environments (NEMS-S-MED). Int J Environ Res Public Health. 2020; 17(19):7031. 

Fernández-Escobar C, Díez J, Martínez-García A, Bilal U, O’Flaherty M, Franco M. Food availability and affordability in a Mediterranean urban context: Associations by store type and area-level socioeconomic status. Public Health Nutrition. 2022; 1-21.