1. The global nature of obesity, its causes and what needs to be done Boyd Swinburn Director, WHO Collaborating Centre for Obesity Prevention Deakin University Melbourne Holding Corporations to Account

4. O I T Y P R E V A L E INDIVIDUAL Energy Expenditure POPULATION % OBESE OR UNDERWT Food intake : Nutrient density Source: see Kumanyika Ann Rev Pub Health 2001; 22:293-308 “ Causal Web” FACTORS INTERNATIONAL Development Globalization of markets School Food & Activity WORK/ SCHOOL/ HOME Infections Labour Worksite Food & Activity Leisure Activity/ Facilities Agriculture/ Gardens/ Local markets COMMUNITY LOCALITY Health Care System Public Safety Public Transport Manufactured/ Imported Food Sanitation NATIONAL/ REGIONAL Food & Nutrition Urbanization Education Health Social Security Transport Family & Home National perspective Media & Culture Media programs & advertising Biology

5. An Ecological Model of Diet, Physical Activity, and Obesity Health Outcomes Behaviors Influences Gordon-Larsen. NHLBI Workshop: Predictors of Obesity, Weight Gain, Diet, and Physical Activity; August 2004, Bethesda MD Energy Balance Eating Dietary patterns, nutrient intake Sedentary Behaviors TV, computer use, driving Physical Activity Recreation, transportation, occupation, domestic Body Weight, Fat, & Distribution Risk Factors, CVD, Diabetes, Cancers, Costs Biological & Demographic Age, sex , race/ethnicity, SES, genes Psychological Beliefs, preferences, emotions, self-efficacy, intentions, pros, cons, behavior change skills, body image, motivation, knowledge Social/Cultural Social support, modeling, family factors, social norms, cultural beliefs, acculturation Physical Environment Access to & quality of foods, recreational facilities, cars, sedentary entertainment; urban design, transportation infrastructure, information environment Policies/Incentives Cost of foods, physical activities, & sedentary behaviors; incentives for behaviors; regulation of environments Organizational Practices, programs, norms, & policies in schools, worksite, Health care settings, businesses, community orgs

6. A Graphical Model of Childhood Obesity x 1 x 2 x 5 x 10 x 12 x 8 x 15 x 17 x 14 x 3 x 4 x 9 x 16 Economic Educational Environmental Parents’ nutritional knowledge Parents’ values Diet Physical activity Physical fitness Triceps skinfold thickness x 18 x 11 Waist circumference x 13 Body mass index Time x 6 Child’s values x 7 Child’s nutritional knowledge y 1 Cost of Diet Non-alcoholic fatty liver disease Sleep apnoea Hypertension Type II diabetes QA Life expectancy Chalabi and Dowie 2004 Social factors Behavioural factors Intermediate outcome measures Health outcome Health response Cognitive states

8. R Uauy, 2007 Nutrition Related Susceptibility (life-course exposure) Energy Balance Energy dense diets (fat &sugar) Physical Activity Appetite & food intake Control Pre & postnatal growth Macronutrient quality Micronutrient balance Hormonal response to diet Underlying Factors Access to safe and healthy foods (quantity and quality) Balancing Energy Intake and expenditure Factors affecting food and PA supply chain Policies affecting marketing, advertisement, subsidies Urban space and facilities for active lives (household school & workplace) Psycho-social determinants of food intake and PA Basic Causes Community empowerment demand for: safe & healthy foods, active lives Public and private sector response to people’s health demands Government response in protection of public interest International and National framework policies: health, education, agriculture, economic, urbanization, recreation, transport, trade Legislative framework and norms: to promote, support and protect right to safe and nutritious foods. present efforts potential for future effectiveness Adipocyte Cell Growth Hormones Receptors OBESITY Genetic Monogenic Polygenic Epigenetic genes

10. www.foresight.gov.uk/obesity

14. Variability in population obesity rates Source: Ulijaszek SJ & H Lofink. Annual Review of Anthropology 2006, 35:337-60.

16. Kg per person per year

17. Kg per person per year

19. Influencing food choices Food corporations High profits (= high consumption) Taste (HFSS) Portion size Low price High value Convenient Accessible Target groups Selective disclosure Claims Taxes Subsidies Schools Children Labelling Food claim regs Guidelines Standards Governments Social, economic, political outcomes Products Price Placement Promotion Food choices

20. Influencing food choices Taste (HFSS) Portion size Low price High value Convenient Accessible Target groups Selective disclosure Claims 1 4 3 2 5 6 8 7 Food corporations High profits (= high consumption) Taxes Subsidies Schools Children Labelling Food claim regs Guidelines Standards Governments Social, economic, political outcomes Products Price Placement Promotion Food choices

22. www.iotf.org/sydneyprinciples