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Menu of policy options for the ROOTS World Obesity Day Declaration

Ahead of World Obesity Day on 4 March 2020, obesity organisations around the world were asked to provide areas for policy advocacy, applicable to their own national setting, that address the ROOTS of obesity as set out in the World Obesity Day Declaration. These suggestions are listed below. They are not universally applicable; rather, they are to provide ideas and inspiration that can be adopted or adapted in-country as appropriate – and we hope that you find them useful.

Recognise officially that obesity is a chronic, multifactorial disease as well as a driver of other diseases, with serious implications for individuals, families, societies and economies.

  • Develop, fund, and accelerate to scale strategies to address obesity, including resourcing and implementing a comprehensive evidence-based multi-sector national obesity plan, informed by existing chronic disease management principles and practice.

  • Ensure a ‘whole of government’, cross-departmental approach to action on obesity, including the ministries of [health, education, finance, treasury, agriculture, commerce, welfare, media/culture– etc. as appropriate].

  • Integrate obesity in existing chronic disease prevention and management strategies, recognising that obesity is both a disease and a risk factor in other chronic diseases.

  • Call for much greater investment in obesity prevention and treatment as a cost-effective strategy to ensure the health of individuals, families and society, and to ensure the sustainability of the health system.

  • Utilise the skills, experience and knowledge of civil society – particularly people living with obesity and young people – in the development, implementation and monitoring of obesity planning and strategy.

  • Include obesity prevention, treatment and management within universal health coverage packages.

  • Incorporate the rights of people with obesity within human rights legislation, workplace regulations, healthcare systems and education, and ensure that legislative tools are used effectively to tackle pervasive and unacceptable stigma, discrimination and bullying.

  • Ensure national plans include actions that address the inequalities and stigma faced by people with obesity, for instance in education, in health care settings and in the workplace.

  • Build gender inequality considerations into all obesity policymaking.

  • Collaborate with researchers, health care professionals, people living with obesity and policymakers to analyse the implications of treating obesity as a chronic disease for clinical practice and public policy.

  • Publicly acknowledge that weight bias and stigma are barriers to helping people with obesity.

  • Use people-first language at all times when communicating about obesity.

  • Incentivise the creation of anti-stigma policies in schools, workplaces and health care settings.

  • Implement the WHO’s Best Buys in Non-communicable Diseases, including taxation of unhealthy food products, with the revenue being spent on advancing prevention and control of NCDs including obesity.

  • Educate, encourage and empower city-level officials to recognise obesity as a chronic disease and to develop locally appropriate guidelines for obesity prevention and treatment.

  • Reach out to other elected officials and send them World Obesity Day materials.

  • Educate public health professionals about obesity as a chronic disease.

  • Work with medical associations and professional bodies to recognise obesity medicine as a medical specialty.

Obesity monitoring and surveillance, and innovative research into the causes and effective strategies for preventing and treating obesity, must be vigorously promoted and supported.

  • Establish and fund monitoring and evaluation systems that are reliable, regularly conducted and fit-for-purpose, to enable a full understanding of obesity prevalence, its determinants, treatment, costs and policy implementation.

  • Work across geographic regions (e.g. the European Union or CARICOM) to ensure up-to-date, robust, transparent, comparable reporting on obesity, including progress towards national and international obesity and nutrition targets and goals.

  • Support and fund independent research programmes to identify, test and pilot prevention and treatment solutions.

  • Fund and act upon surveillance and research into the effects of commercial determinants on obesity.

  • Fund and act upon surveillance and research into the effects of social determinants on obesity.

  • Require research funded by government to actively seek the involvement of people with obesity in the development, prioritisation and conduct of research.

  • Utilise all forms of monitoring and surveillance, including case studies, benchmarking, shadow reporting and scorecards developed by civil society.

  • Provide technical assistance and share knowledge in evaluation of obesity to other contexts (e.g. evaluation of national action plans or implementation of the WHO Best Buys).

Obesity prevention strategies must be developed, tested and implemented across the life course, from pre-conception, through childhood, and into older age.

  • Implement, monitor and fund comprehensive freely/widely available programmes to promote good nutrition, physical activity, health and wellbeing.

  • Design, implement and monitor the impact of appropriately targeted public behaviour-change/social-marketing campaigns

  • Ensure that publicly funded health literacy programmes include obesity prevention and target all generations.

  • Strengthen consumers’ rights to product and health-related information.

  • Adopt and promote an evidence-based and nationally appropriate nutrient profiling model (such as that developed by WHO/Europe) for use by manufacturers, retailers and media, to guide the formulation, labelling and marketing of food and beverages.

  • Mandate a clear food labelling system to clearly identify foods high in fat, salt, sugar and calories, based on a comprehensive nutrient profiling system.

  • Provide safe water and promote its consumption across the whole population.

  • Work to ensure that the recommendations of the World Health Organization’s Global Action Plan on Physical Activity 2018–2030: More Active People for a Healthier World (GAPPA) are implemented across all communities.

  • Protect and promote access to green spaces in urban areas, including community gardens, orchards and parks.

  • Establish regulations and standards for social support programmes based on national and international dietary guidelines.

  • Ensure good nutrition and appropriate physical activity access for vulnerable populations, such as those living in or using in care facilities.

  • Support and incentivise workplace interventions on obesity prevention of obesity and, where applicable, treatment and management.

  • Implement health promotion programmes for all public-sector employees, including incentivising and promoting access to nutritious food and active transport options.

  • Remove HFSS products from public settings, including schools, hospitals and government institutions.

  • Develop comprehensive policies to ensure that the environments within which children live, learn and play are health-promoting.

  • Acknowledge and act upon the importance of the first 1,000 days as key for lifelong health.

  • Provide evidence-informed advice on obesity prevention and management before conception, during pregnancy and during the lactation period, particularly for women with obesity and their partners.

  • Fully implement the WHO International Code on Marketing of Breast-milk Substitutes and relevant subsequent World Health Assembly resolutions on breastmilk substitutes and complementary foods for children aged under three.

  • Establish breastfeeding programmes and require access to breastfeeding facilities in the workplace

  • Adopt a child-rights approach, based on international obligations set out in the UN Convention on the Rights of the Child, to protect children from the harmful effect of marketing and other commercial practices that are linked to obesity.

  • Fully implement the recommendations of the World Health Organization’s Commission on Ending Childhood Obesity (ECHO), nationally and locally.

  • Develop and incentivise health-promoting programmes in publicly and privately funded schools and early-years environments.

  • Put in place systems that assess schools not only on academic outcomes but also on physical and mental health of students.

  • Fully implement the WHO’s ‘Set of recommendations on the marketing of foods and non-alcoholic beverages to children’ (2010).

  • Take strong legislative steps to ensure that children under 18 are not exposed to marketing for ultra-processed high fat/salt/sugar food and beverages.

  • Levy an effective tax on sugar-sweetened beverages and analyse its administration and impact.

  • Consider levying penalties on the food industry for manufacturing and supplying products of low nutritional value and rewarding best practice for companies that are committed to removing harmful products from the market.

  • Incentivise the food industry to address portion size and nutrient composition of products, particularly those targeted at children and adolescents.

Treatment of obesity, using evidence-based, dignified, non-stigmatising and person-centred approaches – including behavioural, pharmacological, digital, nutritional, physical-activity-based and surgical interventions – should be accessible to all people with obesity

  • Ensure that weight-management services are equitably offered and progressively realised for people of all ages, including as part of universal health coverage packages.

  • Ensure that obesity treatment and management is included in national health insurance packages, providing access to health care professionals, psychological support, physical activity, nutrition and bariatric surgery.

  • Work with private health insurance companies to ensure that obesity treatment, management and prevention is included in their health insurance packages.

  • Work with relevant stakeholders to produce and promote guidelines, standards and practical tools to promote effective, evidence-based obesity care.

  • Develop or adapt evidence-based and patient-centred clinical practice guidelines to support the management of obesity in primary care.

  • Determine access to treatment based on locally appropriate criteria, developed by independent experts.

  • Support the establishment of interdisciplinary teams to provide comprehensive and holistic care for people living with obesity.

  • Build capacity of community health workers to support people with obesity in primary health care settings.

  • Ensure that publicly funded health literacy programmes include obesity treatment and weight management.

  • Ensure that family-based, multi-component and evidence-informed weight-management services for children can be appropriately and equitably accessed.

  • Expand training for health care professionals on obesity, including mandating education on obesity prevention and treatment in medical school curricula.

  • Demand that health care professionals communicate about obesity using people-first language and in a non-stigmatising way.

  • Provide support and education for people living with obesity so they are empowered to seek appropriate treatment pathways and support.

  • Raise awareness among people living with obesity of the existence of obesity specialists and how to contact them.

  • Regulate the commercial weight-loss industry to ensure products and services offered are in line with evidence/public health programmes.

Systems-based approaches should be applied to the management of obesity, aimed at strengthening health systems, enabling obesity’s incorporation into primary and secondary care, and addressing the environmental, social and commercial roots of obesity.

  • Integrate large-scale prevention into primary care, including training primary care clinicians to treat obesity and to prescribe viable lifestyle changes to people with obesity, taking into account specific needs and context.

  • Scale up evidence-based, patient-centred, individual and population-level interventions to prevent and treat obesity across the life course.

  • Fund and support civil society to build a community of empowered patient advocates.

  • Provide platforms for collaboration in addressing obesity across diverse stakeholder groups, including people living with obesity, health care professionals, non-governmental organisations, local government, the private sector (as appropriate), academia etc.

  • Strength local government capacity and resources to implement appropriate comprehensive city-level and community-focused interventions.

  • Utilise systems thinking when planning and implementing national obesity policies

  • Work with the technology sector to develop digital interventions to motivate and support obesity prevention, treatment and management.

  • Strengthen capacity and resources among local government to promote healthy urban environments and fund active transport options.

  • Address overweight and obesity under the framework of malnutrition in all its forms, adopting a Global Syndemic approach, particularly in low- and middle-income countries.

  • Reorient agricultural and other fiscal policies related to food systems to support better nutrition and environmental outcomes.

  • Incentivise nutrition policies that foster a farm-to-plate food system that is affordable, healthy and sustainable for people and planet – for example, through the use of subsidies.

  • Protect international trade agreements from interference by commercial interests that may impact on public-health goals, including utilising human rights legislation to ensure agreements do not violate the right to health.

  • Establish, fund and oversee mechanisms to limit conflict of interests in public-health policy and research, ensuring that commercial interests cannot undermine object public interest decision making.

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