About this Research Topic

Background

Obesity and overweight are global health issues, and worldwide obesity has tripled since 1975. The impacts of obesity extend to diseases such as diabetes, chronic kidney disease, and non-communicable diseases generally. However, recently obesity has been established as a risk factor for COVID-19, an infectious disease. Obesity substantially increases the risk of COVID mortality. This has implications for evaluating the substantial disease burden of obesity, rising healthcare costs linked to rising obesity, and reductions in life expectancy linked to obesity. Many factors have been linked to upward trends in obesity, including changes in lifestyle and diet and the broader environment, including urban settlement patterns. Causal pathways are complex, with individual lifestyle choices, genetic factors, and environments intertwined in their impacts. Once primarily seen as a problem in developed societies, obesity and overweight are now rising in low- and middle-income countries (LMICs). Urbanization in LMICs has been linked to increased obesity and changes in diet described as nutrition transition. Children in LMICs are exposed to high-fat, high-sugar, and energy-dense but nutrient-poor foods, so that increases in childhood obesity occur while undernutrition issues remain unsolved.

Another paradox is that obesity and overweight are differentially distributed across social strata and tend to be higher among more deprived groups. So in 2015/2016, 40% of children in England's most deprived areas were overweight or obese, compared to 27% in the most affluent areas. Ethnic groups also differ in their risk of obesity and overweight. Such differences imply wide differences in obesity levels between regions and smaller neighborhoods, simply by virtue of population composition (social and ethnic mix). There is considerable spatial clustering in high obesity. However, other spatially contextual factors have been linked to spatial contrasts in obesity, such as differential access to healthy food outlets, as against fast food outlets. Access is generally worse in areas with above-average poverty. Variations in access are such that areas with poor access have been labeled food deserts. The impact of poverty is also more direct: poorer households may be more dependent on less healthy foods because they tend to be cheaper as well as more accessible. Differences in access to green space and exercise opportunities also impact obesity and are also differentially associated with social and ethnic structure, with worse access for areas with larger ethnic communities and higher deprivation. The nexus of food access, exercise access, and high obesity has often been seen from an environmental justice perspective.

Also implicated in varying spatial obesity are features of urban design and settlement (the built environment), with urban sprawl associated with varying physical activity levels, for example, due to extended car commuting. By contrast, compact areas with higher walkability have more opportunities for exercise and active commuting. The multifactorial nature of obesity means that public health interventions have a considerable focus, varying from diet and weight-management advice to community interventions. Measures to ameliorate the obesogenic environment have included attempts to improve access to physical fitness facilities, healthy food, and green spaces, as well as restrictions on advertising high-fat and high-sugar foods. Increases in obesity have occurred for both adults and children. Several studies advocate a life-course approach to obesity-related behaviors and health outcomes, and obesity prevention. The obesogenic environment for children includes schools, and child obesity prevention includes school-based physical activity intervention and attempts to limit the sitting of fast food outlets near schools. The multifactorial nature of obesity also affects the choice of evaluation strategy and explanatory model. Natural experiments are often used as a way to evaluate the impacts of obesity interventions when planned controlled experimental research designs are infeasible. Regarding explanatory studies, multi-level modeling has often been applied to examine geographic and socioeconomic variation in overweight and obesity, taking into account both individual risks and neighborhood context. Ecological (area-based) studies also have a role in establishing environmental risk factors.

This Research Topic aims to encompass contemporary perspectives on obesity trends in both developed societies and LMICs; obesity interventions; socioeconomic, demographic, and spatial obesity contrasts; obesogenic environments; health consequences of obesity; life-course perspectives; health behaviors (diet, activity) and obesity; and public health perspectives on obesity.

We welcome a range of article types, including original research (e.g., quantitative analyses), evaluation studies, conceptual and systematic reviews, and mini-reviews.

Keywords: obesity, food environment, obesogenic, obesity prevention, obesity in LMIC, physical activity, obesity consequences, obesity disease burden

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