title: Developing national obesity policy in middle-income countries: a case study from North Africa.
abstract: BACKGROUND
  The prevalence of overweight and obesity is a rapidly growing threat to public health in both Morocco and Tunisia, where it is reaching similar proportions to high-income countries. Despite this, a national strategy for obesity does not exist in either country. The aim of this study was to explore the views of key stakeholders towards a range of policies to prevent obesity, and thus guide policy makers in their decision making on a national level.
  
  
  METHODS
  Using Multicriteria Mapping, data were gathered from 82 stakeholders (from 33 categories in Morocco and 36 in Tunisia) who appraised 12 obesity policy options by reference to criteria of their own choosing.
  
  
  RESULTS
  The feasibility of policies in practical or political terms and their cost were perceived as more important than how effective they would be in reducing obesity. There was most consensus and preference for options targeting individuals through health education, compared with options that aimed at changing the environment, i.e. modifying food supply and demand (providing healthier menus/changing food composition/food sold in schools); controlling information (advertising controls/mandatory labelling) or improving access to physical activity. In Tunisia, there was almost universal consensus that at least some environmental-level options are required, but in Morocco, participants highlighted the need to raise awareness within the population and policy makers that obesity is a public health problem, accompanied by improving literacy before such measures would be accepted.
  
  
  CONCLUSIONS
  Whilst there is broad interest in a range of policy options, those measures targeting behaviour change through education were most valued. The different socioeconomic, political and cultural contexts of countries need to be accounted for when prioritizing obesity policy. Obesity was not recognized as a major public health priority; therefore, convincing policy makers about the need to prioritize action to prevent obesity, particularly in Morocco, will be a crucial first step.
authors.affiliation: School of Health and Related Research (ScHARR), Public Health Section, The University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK. E-mail: michelle.holdsworth@sheffield.ac.uk.
authors.forename: Michelle
authors.initials: M
authors.lastname: Holdsworth
authors.forename: Jalila
authors.initials: J
authors.lastname: El Ati
authors.forename: Abdellatif
authors.initials: A
authors.lastname: Bour
authors.forename: Yves
authors.initials: Y
authors.lastname: Kameli
authors.forename: Abdelfettah
authors.initials: A
authors.lastname: Derouiche
authors.forename: Erik
authors.initials: E
authors.lastname: Millstone
authors.forename: Francis
authors.initials: F
authors.lastname: Delpeuch
mesh_terms: D000288:Administrative Personnel; D003906:Developing Countries; D006291:Health Policy; D006801:Humans; D009018:Morocco; D009765:Obesity / Q000517:prevention & control*; D019982:Organizational Case Studies; D011050:Policy Making; D014416:Tunisia