The present study sought to investigate public support for and determinants of obesity prevention in a representative population‐based sample. Overall, obesity prevention was supported by the majority of the population. Consistent with previous research, there was a consensus in favour of prevention of childhood obesity8,9,10,11,12
; in addition, our study highlighted substantial support of information‐based prevention targeting the adult population. Less support was found for regulative environmental interventions.9,10,12
In summary, the results show a high public readiness for obesity prevention with a focus on individual behaviour change, but not for prevention with a focus on regulation and restriction. Of note, readiness for financial support was considerable: 60.5% of the population was willing to spend at least some extra money per year for obesity prevention; one‐third of participants was willing to spend even more than €20 (US$26.34, £13.46) per year.
New insights were gained into the determinants of prevention support. According to our expectations, causal attributions of obesity were particularly important predictors for prevention support. Most of the variance of prevention support was explained by causal attributions to the food environment. Women regarded such influences as more potent than men, possibly because they are traditionally more involved in feeding than men. A further predictor of prevention support was causal attribution to a lack of physical activity. It is important to note that, although obesity was mainly attributed to behavioural factors, environmental and genetic risk factors were considered only by a minority of participants. Apparently, recent research demonstrating major environmental and genetic influences on the development of obesity has hardly been received by the public.23,24
However, greater consideration of both environmental and genetic factors could impact prevention support—for example, in favour of environmental or regulative measures.14
Further significant predictors of prevention support were, as expected, perceived significance of obesity and societal responsibility for a solution to the obesity problem. Moreover, consistent with previous findings, the sociodemographic characteristics of higher age and female gender,10,11,14
and, plausibly, residence in the eastern, former socialist, part of the country emerged as significant predictors.
Overall, our results suggest a high level of problem identification. Extending previous research,9,10,12,14
it was detailed that most participants recognised obesity as a major health problem, were familiar with obesity‐related sequelae and only slightly overestimated modifiability of body weight through behavioural weight loss. However, participants largely overestimated prevalence rates of obesity: they did not seem to distinguish overweight from obesity, and the definition of obesity as “very overweight” or “excess body fat” that was repeatedly given by assessors throughout the interview was apparently not sufficient to promote an accurate understanding of the obesity concept.
The results provide several clear implications for policy‐making. Policy‐makers can build on substantial support for childhood obesity prevention and information interventions, although acceptance of regulations is low. As support of obesity prevention largely depends on causal attributions and as the aetiological importance of environmental and genetic factors is not sufficiently recognised, it seems particularly relevant to promote communication of research findings on environmental and genetic factors to the public. Furthermore, education on the definition of obesity is clearly indicated. Specifically, education on the role of physical inactivity for the development of obesity should be directed to those with lower socioeconomic status and younger age. Prevention programmes may further need to be carefully introduced to men and younger people. Finally, societal responsibility, emerging as a major determinant of prevention, could be strengthened and utilised when prevention measures are implemented.
The results need to be interpreted with due consideration to the strengths and limitations of the present study. The strengths include addressing timely and important questions in the context of current public health initiatives on obesity prevention. Compared with previous survey investigations that concentrated on childhood prevention, our study comprehensively focused on obesity prevention in both children and adults, and placed emphasis on assessment of support for specific prevention measures to provide valuable information for policy‐making. Use of PCAs allowed for structuring results across multiple specific items. It needs to be noted, however, that, as with most surveys, the interview was not evaluated for test‐statistic properties in an independent sample. Furthermore, this investigation was conducted in a sample representative of age, sex and state of residence. Although many precautions for avoiding sampling biases have been undertaken (eg, random digit dialling methodology, coverage of non‐registered telephone numbers, structured computer‐assisted telephone interviewing) and although our study yielded a response rate comparable to other representative health surveys,17
lower socioeconomic groups that usually have higher obesity risk were probably under‐represented, as shown in a comparison with population data from the Federal Statistical Office regarding net household income and education. It would, however, be desirable to specifically assess knowledge about obesity and prevention support in these groups, as they are the main target groups of prevention.
Overall, our results indicate that the population is ready for obesity prevention. Addressing specific information needs regarding the definition, prevalence and causes of obesity could further enhance the public's understanding of this prevalent and complex condition and help to establish sustainable preventive interventions.
What this paper adds
- Previous survey investigations on public views of childhood obesity showed varying levels of support for obesity prevention. It was largely unclear which factors account for prevention support in obesity.
- The present study shows strong support for prevention measures focusing on individual behaviour change in both children and adults, but less support for regulations.
- Prevention support was largely determined through causal attributions and problem identification, for which an information deficit was identified.
- Policy‐makers can build upon substantial support for childhood obesity prevention and information interventions in adults.
- Addressing specific education needs on problem identification and risk factors of obesity could enhance the public's understanding of this complex condition and help to establish obesity prevention.