PS1 Fat fate and disease - from science to global policy
Office of Chief Science Advsor to the Prime Minister
Attempts to deal with the obesity epidemic based solely on adult behavioural change have been rather disappointing. Indeed the evidence that biological, developmental and contextual factors are operating from the earliest stages in development and indeed across generations is compelling. The marked individual differences in the sensitivity to the obesogenic environment need to be understood at both the individual and population level. There is considerable evidence showing that the fetus and neonate are affected by the environment created by its mother and these have longer-term metabolic consequences including obesity and the implications for non-communicable disease (NCD). But while this evidence emerged over 30 years ago, it is only in the past 5 years it has gained traction in the policy domain. A number of barriers, both scientific and societal, existed to the incorporation of this knowledge into public policy. These barriers included an over-simplistic understanding of the phenomenon, a failure to appreciate its normative nature and multiple mechanisms that are best understood in a evolutionary medicine context, a lack of compelling biological mechanistic explanations and estimates of the size of the developmental component. These issues have largely been addressed to the extent needed for policy recommendations although there are areas of research that need further promotion – in particular those related to the development of eating behaviours and satiety control. However in part because of the Millennium Development Goals that brought an emphasis to maternal and girls’ health and because of scientific progress as reflected in the “ first 1000 days” movement, the first recognition of the developmental and epigenetic component to obesity was noted in the political declaration of the UN General Assembly in 2011. This led the WHO and an increasing number of governments to start to formulate developmental strategies to confront obesity. The World Health Assembly in May 2016 adopted the report of the Commission on Ending Childhood Obesity and this has major implications for national and global health policy. I will discuss these developments from both a scientific and public policy perspective.