Policies can create environments to make healthy choices easier, and provide greater support and expand incentives for children (and adults) to achieve healthy weights.49
Significant research has demonstrated the public health impact of obesity, and has created a case for action. Research has also identified contributing factors, suggesting points for intervention. Recent priority-setting exercises by organizations working to address the impact of obesity on chronic disease have defined a range of opportunities to act, and interventions have been evaluated. This consensus reflects a synthesis of available evidence, including that regarding political feasibility; to create recommendations for policies requires a process that follows a framework for prioritizing change.11
The recommendations included here comprise action towards the next best steps
Our exploration of roadblocks for policy change encompassed in laws for healthy eating and activity in Canada concludes ‘jurisdictional wrangling, the threat of legal challenges, ideological opposition, and questions about effectiveness may stall adoption of legislation'. The authors argue that ‘a comprehensive approach must be built piece by piece, and it would be a mistake to allow skepticism about the impact of single legislative or policy interventions to preclude any action at all'.13
The need for a ‘comprehensive approach' became clear as we worked on recommendations. For example, while Quebec's QCPA is held as a model internationally, cross-border leakage and contested standards limit its comprehensiveness. Our recommendations take a step towards broader impact.
Jurisdictional responsibilities were also evident. While federal-provincial-municipal jurisdictions may blur when addressing marketing, clear opportunities exist at several levels of government to take independent action. In addition, opportunities for constructive intersectoral action to address obesity also exist.50
Obesity, healthy eating, and physical activity are not solely a concern of the health sector. While health impacts of obesity may be most acutely recognized by the health system, sources of and solutions to obesity lie in other sectors and policies: agriculture, transportation, education, and consumer protection. Private industry is implicated in both causes and solutions. We focused on ‘how to' address obesity in an integrated manner, with considerations to inter-ministerial/sectoral collaboration as recommended by the WHO.24
The experience of the province of Quebec in implementing a ‘whole of government' approach suggests the need to frame the problem of obesity as a societal problem, not just a health problem – thereby calling for health-promoting policies in other sectors.51
Engaging non-health sectors and ministries in identifying their roles in the problem helps to set more inclusive public agendas. The health sector may play a leading or coordinating role. Quebec's Public Health Act, for example, mandates health impact assessment (HIA) of legislation and policies. Legislated HIA, appropriately evaluated, would be highly supportive of moving recommendations forward. Although we direct many recommendations to governments, non-governmental organizations (NGOs) help by synthesizing evidence and funding pilot projects to assess effectiveness of interventions, with the implication that effective pilots could then be scaled up and funded by governments. NGOs, coalitions, voluntary organizations, and segments of the private sector, with all levels of government, are key to moving recommendations forward.