Obesity and diet-related chronic diseases, such as cardiovascular disease and type 2 diabetes, are leading global health problems. According to the World Health Organisation (WHO), the number of people with obesity worldwide has tripled since 1975. As many as two billion adults and 38 million children under five are overweight.
‘The COVID-19 pandemic has once again brought us face to face with the severity of obesity and diet-related chronic diseases,’ says Maartje Poelman of the Consumption and Healthy Lifestyles (CHL) group. Having obesity increases the risk of severe illness, hospitalization and mortality due to a COVID-19 infection.
While many people know what a healthy and sustainable diet should include, it challenging for them to make healthy and sustainable choices. To date, most public health and nutrition policies have been developed on the basis of improving knowledge about healthy eating. ‘This is based on the notion that education is key to a healthy diet,' says Poelman. ‘However from a behavioural science and health perspective we know it is not that simple. Food choices are complex. We know social and physical environments have a strong influence on our eating behaviour.’
A systems change required
At CHL, we ask questions such as: How do our social and physical environment influence food choices? What underlying mechanisms play a role in this? How can socio-economic differences in food choices be explained? Answering these questions allows us also to design better tools to support optimal food choices: How can we develop effective and long-lasting interventions to improve healthy and sustainable food choices? At the same time, it is key to tailor solutions centred on end-users and stakeholders needs and circumstances.
If we want to collectively switch to a healthier and more sustainable eating pattern, a systems change is required, Poelman observes. ‘Just look at the streetscape and in supermarkets. For example, in shopping streets, the majority of foods on offer comprise unhealthy and highly processed convenience foods. It is no different in supermarkets. Approximately 70% of the supermarket assortment and price promotions do not align with a healthy diet. To curb the obesity pandemic, healthy and sustainable foods must become the norm.’
Something is not right
Poelman critiques the account that this is patronising the consumer: 'If you encourage people to make better food choices by offering and promoting a wider range of healthy and sustainable alternatives, that would be patronising, but if you promote unhealthy and unsustainable products, it is called 'marketing', which is not seen as an issue. Something is not right there!’
Researchers know that social norms play an important role in behaviour. ‘We found that the more fast food outlets there are in a neighbourhood, the more people believed it was normal to consume fast food. Currently, local governments are exploring the possibility of introducing zoning laws to prohibit the placement of new fast food outlets. In a recent study we also identified multiple actions that can be implemented by our national government to create a healthier food environment’, Poelman says.
A system change takes a long time, but Poelman is cautiously optimistic. ‘The system can be changed. Political support for tackling the food environment to promote a healthy lifestyle is more prominent now than, say, ten years ago. The Dutch National Prevention Agreement also addresses the food environment, although actions proposed remain quite generic and voluntary. It is however encouraging to see that knowledge derived from behavioural and health sciences is now being incorporated in policy.’
The European Union Farm2Fork strategy also defines important strategies for a food environment that makes it easier for consumers to make healthy and sustainable choices. Poelman draws the comparison with tobacco: 'It took a long time, but now we have reached the point where policies discourage the use of tobacco products, which has resulted in a reduction in the number of smokers. Although tobacco is a different product, we can learn from these approaches taken to improve population health. It is a matter of politics, but as scientists we lay an important foundation under these policy choices.’