Obesity prevention and public health.

Editors: David Crawford & Robert W Jeffery Publisher: Oxford University Press, Oxford, 2005 ISBN: 978-0-19-856600-7; hardcover, 352 pages; price 49.50 [pounds sterling] This book is both depressing and exciting. Depressing because it lays bare the inability of public health practitioners to respond adequately to the obesity pandemic. We have been content to observe its emergence and entrenchment in wealthy countries over the last three decades and more recently in low- and middle-income countries. Only in the last 5 years has the public health community become seriously engaged with the problems presented by obesity to the health of populations, and especially poor populations. The excitement comes when the contributing authors become less academic and begin to consider the opportunities for addressing the environmental causes of the obesity pandemic--regrettably this only comes towards the end of the book where the last three (out of fourteen) chapters begin to get serious about the public health options with a real chance of success. I read the book in a variety of obesegenic environments: an Indian Ocean atoll, a Beijing hotel, and a long-haul air flight. In each of these locations excessive amounts of food (mostly buffets) were readily available (and with no price disincentive since it was included in the room rate) and the natural environments were not conducive to serious physical activity--the temperature on the atoll and the pollution and traffic in Beijing. At least my physical activity options were not immediately harmful to my health. During my Beijing visit, 20 middle-school children and their teacher were killed by a truck while out jogging in the early morning. Even if physical activity is only a partial answer to obesity, it must be safe. The focus of the book--said by one of the contributors to be the first of its kind--is inevitably on the USA, both because this is where the obesity epidemic has achieved the greatest levels and received the most media attention and also where the surveillance data are the most complete. However, even for the USA the available data are grossly insufficient to identify the relative contributions of trends in food intake and physical activity pattern to the obesity epidemic. It is clear, however, that the most important contribution of obesity to the global burden of ill-health will occur in low- and middle-income countries. In almost all these countries the epidemic is rapidly taking hold driven by the nutrition transition and even more rapid changes in urban design, especially work and transportation patterns. …