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The attribution of responsibility for overweight and obesity to people in England is increasingly entrenched. Recent initiatives include treating childhood obesity as evidence of childhood neglect, so that legal social service powers can be used to remove children from parenting and prosecute parents [121], classifying certain excessive eating habits such as Prader-Willi syndrome as evidence of mental illness for the purposes of detention powers under the Mental Health Act. [122], and blame obesity for increased cancer levels [123]. In the UK, public health policy emphasizes responsibility and choice, rather than the public health context of obesity, has hardened against the use of laws and regulations to promote public health goals. However, even in this environment of personal responsibility for health, the law can still be a useful tool for bringing about changes in the physical and socio-economic environment [124] that influence our lifestyles and lifestyle choices. This means that for people who choose to use NHS health services, all healthcare at the point of delivery is free. The state, and therefore the taxpayer, bears the entire economic burden of obesity-related diseases, possibly at the expense of other health treatments. The potential cost of chronic diseases to the health care system has provided an important impetus for government action to address obesity. The cost element of obesity plays a larger role in the obesity debate in the UK than in states with private health systems, assuming that individual obesity causes economic damage to the state.

These cost factors can distort public health initiatives. For example, it has been argued that people who have become obese as a result of their lifestyle choices should be denied NHS services. Assisted fertility specialists have suggested that overweight childless women should not be eligible for NHS fertility treatment [25]. Arguments against regulation based on the right to individual life choices are considered less important if it is the state and, therefore, other taxpayers who have to pay for the negative consequences of that choice. A change in legislation in line with both the spirit and the letter of the EU directive would have significant health benefits, especially for food preparation and family nutritional habits, but also for family life. The French labor code, for example, limits weekly working time to 35 hours, with a recent change allowing workers to work up to 39 hours, costing the employer more. English industry maintains that this was a disaster for the French economy [81] and would be detrimental to England [82]. Not all comments agree [83] and there is evidence that the Directive now organises work more efficiently and productively. The improvement of the diet in France (French families eat more than twice as often foods based on basic ingredients [84]) and the better management of work-life balance in France [85] are undisputed.

It is a question of priorities. If the government is serious about obesity, then an amendment to the Hours of Work Act to support a change in work culture so that family time is recognized and valued would be a starting point. Thus, obesity eventually became a personal problem. The former Prime Minister indicated that people now wanted a government that saw its role as empowering the individual, not trying to make decisions for them. This can only work on the basis of a different relationship between citizens and the state. The role of government was to provide practical support to people who lacked basic knowledge to help them use health information. The Minister of Public Health agreed: “. We`re talking about very simple messages: exercise a little more, eat better, make sure your kids do the same.”[73] The Minister of Health noted that individuals must now take responsibility for their own health: “We have already intervened, but there are limits to what the government can do. People need to want to change their lifestyles and take responsibility for their health” [74]. Obesity is one of the most pressing public health problems in England. Public health interventions to prevent the rise in obesity are a government priority [16].

22% of men and 23% of women in England are classified as obese and the Department of Health predicts that by 2010 this figure will rise to 33% of men and 28% of women [17]. Obesity has become a public obsession. Newspapers, popular magazines, TV and radio shows, and government quotes have created a considerable amount of often conflicting information and advice on how to lose weight. The language is sometimes sensational and emotional. Newspapers have proclaimed an “obesity time bomb”, a “crisis with devastating effects on the health of the nation” [18] and a “toxic time bomb” in which children are “doomed to be overweight” [19]. Language can also be judgmental. Obesity is “largely a consequence of people eating junk food and leading a sedentary lifestyle” [20]. To be obese in today`s England is to be an object of public control and increasingly an object of public condemnation, assuming that obesity is a matter of self-control. However, public health research suggests that “uncertainty about the etiology of obesity remains one of the main barriers to developing effective prevention and treatment strategies” [21]. The most commonly used legal mechanism was to increase opportunities for energy consumption in the form of physical activity standards in schools (96% of states).

Improving access to information on healthy behaviours through curriculum standards for physical education followed closely. Legal mechanisms that are supposed to directly influence energy intake — for example, through food standards for school meals or competitive foods — were comparatively less common, in only 16 percent and 34 percent of states, respectively. The greatest variation in the content of legal mechanisms was evenly split between those who wanted to directly influence energy intake (10) and those who changed the information environment (10). Thus, while more and more States have successfully adopted laws to influence energy consumption, there is more and more experience in the field of legal mechanisms to change dietary habits and access to health and nutrition information. This week, the World Health Organization`s (WHO) Commission to End Childhood Obesity (ECHO) released its final report: Ending Childhood Obesity. ECHO`s report stresses the importance of a comprehensive and integrated approach to tackling childhood obesity, including medical interventions, public education campaigns and laws and regulations. Today, I will examine the role that laws and regulations can play in reversing the transition to obesogenic environments and addressing the alarming levels of childhood obesity faced by communities around the world. There is no doubt that obesity increases the risk of many other medical problems such as type 2 diabetes, high blood pressure, heart disease, some forms of cancer, sleep apnea, acid reflux, and musculoskeletal problems (often the back, hips, and knees), to name a few. These health problems require expensive medical treatments, not to mention work-related costs. Our classification system and research show that no obesity legislation enacted during the study period specifically targeted the level of interpersonal influence. This is an important finding because it shows that an area crucial to shaping obesity-related behaviours and habits has not been the subject of significant political activity.

While a change in household eating habits is likely to be an essential component of any policy intervention that successfully reduces obesity rates in the long term, it can be particularly difficult for policymakers to develop politically feasible and socially acceptable interventions at this ecological level. Proposed changes to the Supplementary Nutrition Assistance Program (SNAP) that would restrict the purchase of foods that do not meet certain nutritional standards are an example of how a legal mechanism that reduces access to obese foods could indirectly target the home environment [59]. Ultimately, efforts to quantify the impact of current or proposed interventions need to evolve, with a focus on linking health laws and outcomes to a robust theoretical model of health behaviour change. Both studies conclude that more research needs to be done before a causal link can be proven, but that laws that limit factors commonly associated with obesity appear to have a measurable impact on obesity rates. This underscores the urgent need for public health officials to continue work to continue studying nutrition and its impact on health outcomes, as well as working with local legislators to find solutions to the crisis. Research shows a link between breastfeeding and the prevention of childhood obesity [46,47]. Breastfeeding rates in the UK are among the lowest in Europe and lower than in many other countries [48]. In the UK, 76% of mothers breastfeed their babies when they leave hospital [49], but this figure drops to 42% when the baby is 6 weeks old. In Australia, for example, 84% of mothers start breastfeeding and breastfeed longer [50].

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