Introduction

Smoking and obesity are two of the most important global health risk factors. Extensive evidence is available on the broader global determinants of tobacco consumption such as trade liberalisation,1 the global marketing of tobacco,2 and smuggling.3 This has led to a comprehensive response from the global public health community, culminating in the Framework Convention on Tobacco Control. At first glance the consumption of food is very different from that of tobacco. After all, food is not a deadly product and people need to eat every day to satisfy basic physiological requirements. Perhaps this is why the public health response to overnutrition has been largely based on the need for individuals to change their behaviour. But this approach is generally ineffective.4 We argue that an analysis of the broader global determinants of overnutrition will lead to a more comprehensive and effective global response.

Trends in obesity

In the United States, obesity has risen by 74% in the past decade, with at least one in five adults now classified as obese.5 Similar trends are seen in most Western countries.6 In the Middle East and North Africa, and in much of Eastern Europe and Latin America, levels of overweight and obesity in women are similar to, or exceed, those of the United States.7

Total energy (calories) supplied by food and beverages has increased as food has become more processed and more energy dense. In North America, fat and sugar account for more than half the total dietary energy intake.8 These changing dietary patterns are becoming mirrored in developing countries. For all developing countries combined, the per capita supply of beef, mutton, goat, pork, poultry, eggs, and milk rose by an average of 50% between 1973 and 1996.9 The transition towards a more energy dense diet is also …