[Primary prevention of adult obesity. an interdisciplinary analysis].
The primary prevention of adult obesity requires combined efforts by stakeholders at various societal levels, based on the knowledge from multiple disciplines. The goal of the present study was, therefore, to analyze current preventive approaches and delineate implications for future prevention research and practice by integrating knowledge from genetics, law, economics, psychology, and social ethics (Figure 1). Inconclusive evidence on the etiology of obesity, a complex, multifactorial condition, likely complicates prevention, contributing to a lack of specificity regarding target groups, focus, and techniques of prevention. Given the urgency and significance of the "obesity problem" that requires immediate and effective solutions, it is recommended that the various existing and developing prevention programs are evaluated to ensure orientation at current risk factor research. Results from genetic risk factor research can be used as a rationale to increase specificity of preventive measures regarding identification of high-risk groups, timing, and goals of prevention. Further, it is important to evaluate prevention programs for systematic application of behavior modification techniques and consideration of individual risk factors and resources to ensure promotion of long-term behavior change that leads to weight maintenance and a reduction of incidence rates of obesity in adults (Figure 3). Although the primary prevention of childhood obesity may lead to a reduction of incidence rates of obesity in adults, high rates of adult-onset obesity and the related medical and psychosocial sequelae in adulthood underscore the necessity of preventive efforts for adults. Concerning the environmental basis of obesity prevention, in many countries, the institutional and legal framework of preventive approaches requires further examination in order to improve funding, coordination between multiple stakeholders, and implementation of prevention in the health-care system. Evidence on risk factors for obesity is also crucial to inform network approaches and to justify restrictive legal options for the purpose of prevention. Here, self-defeating sanctions of the relevant industries may be a viable first step toward obesity prevention. As taxes or subsidies are limited in feasibility (Figure 2), relevant industries could be involved in the design and promotion of "healthy" products, stimulating greater request of such products. Network approaches appear suited to involve companies and other relevant stakeholders of prevention efforts on adult obesity. Yet these approaches require greater societal conscience about the severity of the obesity problem in adults and its multifactorial etiology. Recognizing the multifactorial etiology of obesity and acknowledging that weight regulation is only somewhat within personal responsibility may therefore lead to destigmatize obese individuals as the focus is shifted away from blaming them toward a more realistic understanding of this condition. Responsibility for the development of obesity and the prevention of weight gain is in multiple areas: law, policy, industry, health-care institutions, medical professions, and the individual - all should contribute to obesity prevention. Overall, the current analysis shows that an interdisciplinary perspective furthers understanding of the complexity of this condition and can inform public-health strategies on the prevention of adult obesity.
Hilbert
Anja
A
Abteilung Klinische Psychologie und Psychotherapie, Fachbereich Psychologie, Philipps-Universität, Marburg. hilbert@staff.uni-marburg.de
Ried
Jens
J
Schneider
Daniel
D
Juttner
Clemens
C
Sosna
Marc
M
Dabrock
Peter
P
Lingenfelder
Michael
M
Voit
Wolfgang
W
Rief
Winfried
W
Hebebrand
Johannes
J
D000328:Adult; D017048:Health Care Costs / Q000706:statistics & numerical data; D006291:Health Policy; D006801:Humans; D038622:Internationality; D009765:Obesity / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control*; D010348:Patient Care Team / Q000191:economics / Q000458:organization & administration*; D011322:Primary Prevention / Q000191:economics* / Q000458:organization & administration*