Intended for healthcare professionals


Unequal weight: equity oriented policy responses to the global obesity epidemic

BMJ 2007; 335 doi: (Published 13 December 2007) Cite this as: BMJ 2007;335:1241
  1. Sharon Friel, principal research fellow1,
  2. Mickey Chopra, director2,
  3. David Satcher, director3
  1. 1Commission on Social Determinants of Health, Department of Epidemiology and Public Health, University College London, London WC1E 6BT
  2. 2Health Systems Research Unit, Medical Research Council, Capetown, South Africa
  3. 3Center of Excellence on Health Disparities, Morehouse School of Medicine, Atlanta, GA 30310, USA
  1. Correspondence to: S Friel s.friel{at}
  • Accepted 14 September 2007

The health professions need to spearhead a concerted intersectoral response to obesity, say Sharon Friel, Mickey Chopra, and David Satcher

Obesity is a global problem, unequally distributed between and within countries. In affluent societies excess weight is more common among socially disadvantaged groups,1 but the inverse is true in low income countries (fig 1).2

Fig 1 Age standardised prevalence ratio for obesity in women in low, lower-middle, and upper-middle income economies, 1992-2000 (Source: Montiero et al)

Summary points

  • The global obesity epidemic is unequally distributed within and between countries

  • It is being fuelled by economic and psychosocial factors as well as increased availability of energy dense food and reduced physical activity

  • Tackling it requires concerted action at national and international level to promote a more equal distribution of affordable nutritious food, and improved, more equitable, living and working conditions

Obesity and its unequal distribution is a consequence of the complex system operating at global, national, and local levels, shaping how we trade, live, learn, and work. Focusing only on direct action to make people eat more healthily and be more physically active misses the heart of the problem: the underlying unequal distribution of factors that support the opportunity to be a healthy weight. Unless this oversight is addressed the obesity epidemic and its inequities will persist and possibly increase.

A change in diet towards highly refined foods and meat and dairy products containing high levels of saturated fats has been occurring globally since the middle of the 20th century. This, together with marked reductions in energy expenditure, is believed to have contributed to the rise in levels of obesity.3 Of concern in this paper are the causes of, and solutions to, these large scale changes in diet and physical activity and their unequal social distribution.

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