obesity proposal essay

Obesity Essay

Last updated on: Feb 9, 2023

Obesity Essay: A Complete Guide and Topics

By: Nova A.

11 min read

Reviewed By: Jacklyn H.

Published on: Aug 31, 2021

Are you assigned to write an essay about obesity? The first step is to define obesity.

The obesity epidemic is a major issue facing our country right now. It's complicated- it could be genetic or due to your environment, but either way, there are ways that you can fix it!

Learn all about what causes weight gain and get tips on how you can get healthy again.

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What is Obesity

What is obesity? Obesity and BMI (body mass index) are both tools of measurement that are used by doctors to assess body fat according to the height, age, and gender of a person. If the BMI is between 25 to 29.9, that means the person has excess weight and body fat.

If the BMI exceeds 30, that means the person is obese. Obesity is a condition that increases the risk of developing cardiovascular diseases, high blood pressure, and other medical conditions like metabolic syndrome, arthritis, and even some types of cancer.

Obesity Definition

Obesity is defined by the World Health Organization as an accumulation of abnormal and excess body fat that comes with several risk factors. It is measured by the body mass index BMI, body weight (in kilograms) divided by the square of a person’s height (in meters).

Obesity in America

Obesity is on the verge of becoming an epidemic as 1 in every 3 Americans can be categorized as overweight and obese. Currently, America is an obese country, and it continues to get worse.

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Causes of obesity

Do you see any obese or overweight people around you?

You likely do.

This is because fast-food chains are becoming more and more common, people are less active, and fruits and vegetables are more expensive than processed foods, thus making them less available to the majority of society. These are the primary causes of obesity.

Obesity is a disease that affects all age groups, including children and elderly people.

Now that you are familiar with the topic of obesity, writing an essay won’t be that difficult for you.

How to Write an Obesity Essay

The format of an obesity essay is similar to writing any other essay. If you need help regarding how to write an obesity essay, it is the same as writing any other essay.

Obesity Essay Introduction

The trick is to start your essay with an interesting and catchy sentence. This will help attract the reader's attention and motivate them to read further. You don’t want to lose the reader’s interest in the beginning and leave a bad impression, especially if the reader is your teacher.

A hook sentence is usually used to open the introductory paragraph of an essay in order to make it interesting. When writing an essay on obesity, the hook sentence can be in the form of an interesting fact or statistic.

Head on to this detailed article on hook examples to get a better idea.

Once you have hooked the reader, the next step is to provide them with relevant background information about the topic. Don’t give away too much at this stage or bombard them with excess information that the reader ends up getting bored with. Only share information that is necessary for the reader to understand your topic.

Next, write a strong thesis statement at the end of your essay, be sure that your thesis identifies the purpose of your essay in a clear and concise manner. Also, keep in mind that the thesis statement should be easy to justify as the body of your essay will revolve around it.

Body Paragraphs

The details related to your topic are to be included in the body paragraphs of your essay. You can use statistics, facts, and figures related to obesity to reinforce your thesis throughout your essay.

If you are writing a cause-and-effect obesity essay, you can mention different causes of obesity and how it can affect a person’s overall health. The number of body paragraphs can increase depending on the parameters of the assignment as set forth by your instructor.

Start each body paragraph with a topic sentence that is the crux of its content. It is necessary to write an engaging topic sentence as it helps grab the reader’s interest. Check out this detailed blog on writing a topic sentence to further understand it.

End your essay with a conclusion by restating your research and tying it to your thesis statement. You can also propose possible solutions to control obesity in your conclusion. Make sure that your conclusion is short yet powerful.

Obesity Essay Examples

Essay about Obesity (PDF)

Childhood Obesity Essay (PDF)

Obesity in America Essay (PDF)

Essay about Obesity Cause and Effects (PDF)

Satire Essay on Obesity (PDF) 

Obesity Argumentative Essay (PDF)

Obesity Essay Topics

Choosing a topic might seem an overwhelming task as you may have many ideas for your assignment. Brainstorm different ideas and narrow them down to one, quality topic.

If you need some examples to help you with your essay topic related to obesity, dive into this article and choose from the list of obesity essay topics.

Childhood Obesity

As mentioned earlier, obesity can affect any age group, including children. Obesity can cause several future health problems as children age.

Here are a few topics you can choose from and discuss for your childhood obesity essay:

• What are the causes of increasing obesity in children?
• Obese parents may be at risk for having children with obesity.
• What is the ratio of obesity between adults and children?
• What are the possible treatments for obese children?
• Are there any social programs that can help children with combating obesity?
• Has technology boosted the rate of obesity in children?
• Are children spending more time on gadgets instead of playing outside?
• Schools should encourage regular exercises and sports for children.
• How can sports and other physical activities protect children from becoming obese?
• Can childhood abuse be a cause of obesity among children?
• What is the relationship between neglect in childhood and obesity in adulthood?
• Does obesity have any effect on the psychological condition and well-being of a child?
• Are electronic medical records effective in diagnosing obesity among children?
• Obesity can affect the academic performance of your child.
• Do you believe that children who are raised by a single parent can be vulnerable to obesity?
• You can promote interesting exercises to encourage children.
• What is the main cause of obesity, and why is it increasing with every passing day?
• Schools and colleges should work harder to develop methodologies to decrease childhood obesity.
• The government should not allow schools and colleges to include sweet or fatty snacks as a part of their lunch.
• If a mother is obese, can it affect the health of the child?
• Children who gain weight frequently can develop chronic diseases.

Obesity Argumentative Essay Topics

Do you want to write an argumentative essay on the topic of obesity?

The following list can help you with that!

Here are some examples you can choose from for your argumentative essay about obesity:

• Can vegetables and fruits decrease the chances of obesity?
• Should you go for surgery to overcome obesity?
• Are there any harmful side effects?
• Can obesity be related to the mental condition of an individual?
• Are parents responsible for controlling obesity in childhood?
• What are the most effective measures to prevent the increase in the obesity rate?
• Why is the obesity rate increasing in the United States?
• Can the lifestyle of a person be a cause of obesity?
• Does the economic situation of a country affect the obesity rate?
• How is obesity considered an international health issue?
• Can technology and gadgets affect obesity rates?
• What can be the possible reasons for obesity in a school?
• How can we address the issue of obesity?
• Is obesity a chronic disease?
• Is obesity a major cause of heart attacks?
• Are the junk food chains causing an increase in obesity?
• Do nutritional programs help in reducing the obesity rate?
• How can the right type of diet help with obesity?
• Why should we encourage sports activities in schools and colleges?
• Can obesity affect a person’s behavior?

Health Related Topics for Research Paper

If you are writing a research paper, you can explain the cause and effect of obesity.

Here are a few topics that link to the cause and effects of obesity.Review the literature of previous articles related to obesity. Describe the ideas presented in the previous papers.

• Can family history cause obesity in future generations?
• Can we predict obesity through genetic testing?
• What is the cause of the increasing obesity rate?
• Do you think the increase in fast-food restaurants is a cause of the rising obesity rate?
• Is the ratio of obese women greater than obese men?
• Why are women more prone to be obese as compared to men?
• Stress can be a cause of obesity. Mention the reasons how mental health can be related to physical health.
• Is urban life a cause of the increasing obesity rate?
• People from cities are prone to be obese as compared to people from the countryside.
• How obesity affects the life expectancy of people? What are possible solutions to decrease the obesity rate?
• Do family eating habits affect or trigger obesity?
• How do eating habits affect the health of an individual?
• How can obesity affect the future of a child?
• Obese children are more prone to get bullied in high school and college.
• Why should schools encourage more sports and exercise for children?

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Topics for Essay on Obesity as a Problem

Do you think a rise in obesity rate can affect the economy of a country?

Here are some topics for your assistance regarding your economics related obesity essay.

• Does socioeconomic status affect the possibility of obesity in an individual?
• Analyze the film and write a review on “Fed Up” – an obesity epidemic.
• Share your reviews on the movie “The Weight of The Nation.”
• Should we increase the prices of fast food and decrease the prices of fruits and vegetables to decrease obesity?
• Do you think healthy food prices can be a cause of obesity?
• Describe what measures other countries have taken in order to control obesity?
• The government should play an important role in controlling obesity. What precautions should they take?
• Do you think obesity can be one of the reasons children get bullied?
• Do obese people experience any sort of discrimination or inappropriate behavior due to their weight?
• Are there any legal protections for people who suffer from discrimination due to their weight?
• Which communities have a higher percentage of obesity in the United States?
• Discuss the side effects of the fast-food industry and their advertisements on children.
• Describe how the increasing obesity rate has affected the economic condition of the United States.
• What is the current percentage of obesity all over the world? Is the obesity rate increasing with every passing day?
• Why is the obesity rate higher in the United States as compared to other countries?
• Do Asians have a greater percentage of obese people as compared to Europe?
• Does the cultural difference affect the eating habits of an individual?
• Obesity and body shaming.
• Why is a skinny body considered to be ideal? Is it an effective way to reduce the obesity rate?

Obesity Solution Essay Topics

With all the developments in medicine and technology, we still don’t have exact measures to treat obesity.

Here are some insights you can discuss in your essay:

• How do obese people suffer from metabolic complications?
• Describe the fat distribution in obese people.
• Is type 2 diabetes related to obesity?
• Are obese people more prone to suffer from diabetes in the future?
• How are cardiac diseases related to obesity?
• Can obesity affect a woman’s childbearing time phase?
• Describe the digestive diseases related to obesity.
• Obesity may be genetic.
• Obesity can cause a higher risk of suffering a heart attack.
• What are the causes of obesity? What health problems can be caused if an individual suffers from obesity?
• What are the side effects of surgery to overcome obesity?
• Which drugs are effective when it comes to the treatment of obesity?
• Is there a difference between being obese and overweight?
• Can obesity affect the sociological perspective of an individual?
• Explain how an obesity treatment works.
• How can the government help people to lose weight and improve public health?

Writing an essay is a challenging yet rewarding task. All you need is to be organized and clear when it comes to academic writing.

• Choose a topic you would like to write on.
• Organize your thoughts.
• Pen down your ideas.
• Compose a perfect essay that will help you ace your subject.
• Proofread and revise your paper.

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As a Digital Content Strategist, Nova Allison has eight years of experience in writing both technical and scientific content. With a focus on developing online content plans that engage audiences, Nova strives to write pieces that are not only informative but captivating as well.

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Evaluation proposal of a national community-based obesity prevention programme: a novel approach considering the complexity perspective

Irma huiberts.

1 Department of Public and Occupational Health, Amsterdam UMC, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081BT Amsterdam, The Netherlands

2 Mulier Instituut, Utrecht, The Netherlands

Amika Singh

3 Center for Physically Active Learning, Faculty of Education, Arts and Sports. Western, Norway University of Applied Sciences, Sogndal, Norway

Frank J. van Lenthe

4 Department of Public Health, Erasmus Medical Centre, Rotterdam, The Netherlands

5 Faculty of Geosciences, Utrecht University, Utrecht, The Netherlands

Mai Chinapaw

Dorine collard, associated data.

Not applicable.

Community-based obesity prevention programmes are considered an important strategy to curb the obesity epidemic. The JOGG (Youth At a Healthy Weight) approach is a large-scale community-based programme for childhood obesity prevention in the Netherlands that has been implemented over the past ten years. Practice-based development of the programme, both at the national and local level, increasingly poses challenges for its evaluation. One considerable challenge is the increasing acknowledgement of the complexity in the JOGG-approach, characterized by (a) objectives that vary locally, (b) adaptions to the programme over time in response to a community’s shifting needs, challenges and opportunities, and (c) emergent outcomes and non-linear causality.

We propose an evaluation framework that highlights elements of the complex local practice, including the local programme theory, implementation, adaption, the influence of context and feedback loops and intended as well as emergent and unintended outcomes. By studying each of these elements in practice, we hope to learn about principles that guide effective obesity prevention across contexts. The results of the proposed evaluation will inform both practice and research.

Considering complexity in evaluation is a relatively new challenge in public health and therefore an emergent research area. The proposed framework for complex evaluations allows to retrospectively evaluate a programme that was implemented and developed in practice, and enables us to learn from practice-based experiences. Following the ISBNPA Dare2Share initiative, we kindly invite other researchers in the field to share their ideas and experiences regarding integration of complexity in evaluation.

Worldwide, obesity is considered a pressing health concern, with immense consequences for population health and economy [ 1 ]. Over the past decades obesity and overweight prevalence has continued to rise [ 2 , 3 ]. In order to stop this increasing trend, a large variety of programmes have been introduced to promote healthy dietary and physical activity behaviours and consequently prevent obesity [ 4 – 8 ].

The strategy of obesity prevention programmes in the population strongly evolved over the past decades. Early strategies were aimed at individual behaviour change [ 9 – 11 ]. Informed by socio-ecological frameworks of behaviour, later strategies of obesity prevention acknowledged the importance of environmental factors as drivers of unhealthy behaviour [ 12 , 13 ]. Consequently, many prevention programmes implemented multiple interventions aimed at both individual and environmental drivers of obesity in multiple settings in which people live (e.g. neighbourhoods and schools). Community-based obesity prevention (CBOP) programmes [ 14 ] became a popular strategy targeting drivers of unhealthy behaviour at the local level, in which local stakeholders play an important role. Interventions in CBOP programmes are developed with and implemented by community stakeholders.

In response to the growing awareness of the complexity of obesity prevention [ 15 ], the design of CBOP programmes became increasingly complexity-oriented over the past years [ 16 ]. In this perspective, complexity refers to the context in which a programme is implemented, rather than (only) a property of the programme itself [ 17 – 20 ]. This context is considered a complex system of interdependent and constantly evolving elements. Within this complexity perspective it is acknowledged that the outcomes and impact of a programme are likely to vary between contexts and emerge as the programme interacts with the context. This means that even apparently simple programmes and interventions can result in varying outcomes in different local contexts [ 17 ]. The extent to which this complexity perspective is integrated within CBOP programmes ranges from dynamic programme adaptions in response the community’s changing needs, possibilities and challenges, to mapping and leveraging the characteristics of the context in order to change the whole obesity driving system [ 5 ].

Appropriate study designs for the evaluation of complex programmes are needed. Until recently, evaluation designs for CBOP programmes were commonly (quasi-) experimental designs that solely focus on the effect of the programme or specific programme components on health behaviours or obesity [ 21 ]. Experimental evaluation designs pose several challenges for complex CBOP programmes [ 20 , 22 – 24 ], including a strong focus on predetermined and linear causal outcomes and processes, and to a lesser extent on programme development over time and context. As a consequence, much is still unknown about how CBOP programmes impact communities and obesity prevalence, and which mechanisms underly success or failure of such programmes [ 5 , 7 , 21 ].

In order to address these challenges and support future development of CBOP programmes, an evaluation approach is needed that considers complexity in the evaluation [ 20 , 24 , 25 ]. This approach requires novel types of research questions, a shift in thinking about how a programme contributes to behaviour change and obesity prevalence, and different (application of) research methods to study process and impact. So far, evaluation designs that consider complexity in its research questions and approach have been relatively uncommon in public health evaluation [ 20 , 26 , 27 ]. Some alternative approaches that do provide insight in working mechanisms of complex programmes and the interaction with local context, have been developed in other disciplines, including realist evaluation [ 28 ], developmental evaluation [ 29 ] and systems approaches [ 30 , 31 ]. To the best of our knowledge, their use in the evaluation of CBOP programmes is still limited [ 21 , 26 ].

In this paper we use a practical example of a CBOP programme to explain why alternative approaches to evaluation are sometimes more suitable than commonly used effect evaluations. In addition, we present and share our evaluation approach that considers the complexity of CBOP and actively invite other researchers to deliberate on this. By doing this we aim to contribute to the debate on how alternative evaluation approaches and methods can be applied in the evaluation of complex public health programmes.

We developed the evaluation approach presented in this paper for the evaluation of a national CBOP programme in the Netherlands, the JOGG (Youth At a Healthy Weight) approach, which has been implemented and developed in practice over the past ten years. Evaluation of this programme aims at gaining a better understanding of how the programme successfully contributes to obesity prevention in practice.

Community-based obesity prevention: the JOGG-approach

Background and core components of the jogg-approach.

The JOGG-approach was based on the French EPODE programme, which had showed promising results for CBOP [ 32 , 33 ]. EPODE describes four core components that should be implemented in collaboration with community stakeholders: i) generating political commitment, ii) establishing public–private partnerships, iii) using social marketing techniques and iv) monitoring and evaluation [ 32 , 34 ]. Each local JOGG-community uses these core components to support community engagement and collaboratively create a more ‘healthy environment’, thereby stimulating children’s healthy lifestyle in order to prevent childhood overweight and obesity. Community stakeholders are to be involved even they do not have a specific objective in public health (e.g. spatial planning sectors in local government or restaurants) with the premise that health should be considered in all policies. See van Koperen et al. [ 34 ] for the full logic model of the EPODE programme. The JOGG-organisation added the component ‘connecting prevention and care’, to encourage JOGG-communities to link interventions and stakeholders involved in the care for overweight children to overweight prevention efforts in the community.

Much is still unknown about how and for whom these EPODE-based or similar CBOP programmes work. Recent studies show mixed results [ 7 , 8 , 35 – 37 ], which may be due to the large heterogeneity between the programmes, the diversity of contexts in which they were implemented, and heterogeneity in evaluation designs and research methods. The core components of EPODE were at the time developed based on existing theories [ 38 ] and practice [ 34 ]. Few studies have since then focussed on further studying the core components or causal links between the core components and intended outcomes [ 21 , 39 ].

Organisation structure: a national JOGG-organisation and local JOGG-communities

The JOGG-approach is planned and implemented both at the national and local level, which enables influencing both macro-environmental structures (e.g. policies within the national sports sector or food sector) as well as local environmental settings (e.g. in schools and local government). The national JOGG organisation, funded by the Dutch government, creates awareness about childhood overweight and a healthy lifestyle, develops partnerships, lobbies and implements actions at the national level. In addition, the national organisation is responsible for the strategic development of the local JOGG-approach.

At the local level a JOGG-team, consisting of a local JOGG-manager and policy officer, coordinates the development and implementation of the JOGG-approach. A local action plan is developed that fits the local context, challenges and possibilities (for example local demographics or political environment). This action plan is developed in collaboration with community stakeholders (e.g. schools, welfare organisations, sports clubs or private partners).

JOGG-communities are supported by the national organisation. Support structure includes personal support from JOGG advisors and coaches, ready-made communication and campaign materials, road maps and knowledge exchange in an online portal, training sessions and network meetings. The national organisation does not provide financial support, the local JOGG-team is responsible for mobilizing their own (financial) resources.

Development of the JOGG-approach: 10 years in practice

The JOGG-approach was first implemented in 2010 in the Netherlands as part of a national healthy weight agreement, a partnership between government, private and public partners, initiated by the ministry of Public Health, Welfare and Sport. To date, JOGG is an independent organisation and more than 170 Dutch municipalities are implementing the JOGG-approach.

Since the start in 2010, the national JOGG-organisation has continued to develop the JOGG-approach based on (1) practice-based experience in different communities, (2) knowledge exchange within the EPODE international network, and (3) collaboration with scientific partners. Over the years, the JOGG-approach developed from a multi-component programme into a CBOP programme, that builds on a socio-ecological model of health, community capacity building and recognizes the complexity of the context in which it is implemented. These changes reflect the development of CBOP programmes overall.

From targeting children individually to targeting children’s environment

Over time, the national JOGG-organisation gradually shifted focus from targeting the individual child to targeting children’s environment. The first years, the JOGG-approach mainly included implementing standardized social marketing materials (e.g. campaigns, events and activities that raised awareness and knowledge about health behaviours) in order to accomplish behavioural changes at the individual level. Later, the national JOGG-organisation started focussing on identifying and targeting environmental properties that drive children’s health behaviours at the local level such as schools food and drink policies and neighbourhood playgrounds. JOGG removed the core component ‘using social marketing techniques’ from their programme logic model. Creating the healthy environment became the core aim of the approach.

To date, the JOGG-organisation defines seven settings in children’s environment: family, school and child care, neighbourhood, sports clubs, leisure time settings (e.g. playgrounds or parks), work and media. The national JOGG-organisation recognises different levels of influence within these settings (see Fig.  1 ), which correspond with existing ecological models for health promotion [ 40 ]. The first level is the individual level: children’s behaviour, awareness, knowledge, attitudes and skills. Children’s direct social connections, for example family, peers and professionals (e.g. teachers) form the second level. The third level includes the formal and informal organisations which are present in children’s environment (e.g. schools, health services, voluntary agencies or religious organisations) and their policies and practices. The fourth level, the community level, is the community structure in which these organisations operate. For example the role of each organisation in the community, resource distribution, relations and collaborations between these organisations. This structure influences practices within the organisations, for example whether children at risk for obesity are identified and referred to fitting care. Lastly, the community and its organisations operate in a wider context of local policies and laws, the fifth level. Practices and processes on each level are inherently related and are ideally considered collectively when targeting children’s environment.

Settings and levels in the healthy environment targeted by the JOGG-approach

From collaboration in partnerships to community capacity building

From the first years onwards, stakeholders in the community (e.g. schools or food retailers) were involved in the implementation of activities, interventions and campaigns planned by the local JOGG-team [ 41 ]. Over the past five years, the JOGG-approach focus shifted to more structural community involvement through community capacity building, as shared ownership was added as a new core component in the approach. Community capacity building includes creating awareness and shared ownership of a problem in the community and providing stakeholders with support, skills and resources to develop solutions and take action together [ 42 – 44 ]. By building capacity among enthusiastic leaders within local stakeholder organisations in children’s environment, enthusiasm and ownership is spread, and thereby capacity for action can diffuse through whole organisations. Ideally, community stakeholders do not solely support or implement actions, they initiate, develop and manage actions from or within their own organisation, based on their insights and experiences. This ensures that the approach fits the local needs and challenges and that actions are sustained. Implementation of the JOGG-approach by the JOGG-team changed from implementing activities and interventions to community capacity building: creating a network of community stakeholders, encouraging and facilitating them to take action and maintaining an overview of the network and its (collaborative) actions to ensure coherence and contribution to the overall goals of the local approach.

A growing recognition of complexity

The EPODE logic model on which the JOGG-approach was based [ 34 ] illustrates a linear theory of behaviour change. Over time, the JOGG-approach integrated a growing recognition of complexity: it appeared to be not only tailored to the local context in the design phase of the local programme, it also adapted over time. The local JOGG-team is increasingly encouraged to be responsive to changing needs, opportunities, challenges and (unintended) outcomes and to adapt the approach as needed [ 41 ]. As a consequence the local JOGG-approach is continuously changing and new objectives and actions emerge over time.

In line with this, the complex causality between the JOGG-approach, the context in which it is implemented and changes they aim to bring about throughout different settings and levels of children’s environment is recognised by the national JOGG-organisation [ 45 ]. The stakeholders and organisations within these settings are not passive or isolated recipients of the JOGG-teams efforts. They exist within a wider context and interact with each other. Consequently, the causal pathway from planning and implementation to individual-level effects consists of many, unpredictable and sometimes long mutually reinforcing and non-linear cause-effect chains, that may differ across contexts.

Evaluating the JOGG-approach

An appropriate evaluation approach.

As is the case with many other CBOP programmes [ 5 , 7 , 21 ], evaluations of the JOGG-approach have so far consisted of summative and formative evaluations, with research questions mainly directed at monitoring implemented activities, evaluating whether programme components were implemented as intended [ 46 , 47 ] and evaluating whether the programme worked to accomplish the predefined outcomes, specifically on overweight and obesity prevalence [ 48 – 50 ]. Such evaluation approaches are less appropriate for the current evaluation, which aims to gain a better understanding of how the programme works in practice. First of all, because these evaluation approaches produce limited information on how the programme works. The main focus on predetermined outcomes and programme components hardly leaves room for building an understanding of why a local programme’s implementation is or is not successful and learning from practice-based programme development.

Second, past evaluations have done little justice to the inherent complexity of the JOGG-approach. Specifically, programme development at the local level and necessary adaptions during implementation were not acknowledged in evaluation. An evaluation approach and corresponding research questions that values adaptive implementation as a key component of the JOGG-approach and enables learning from local successes and failures is more suitable.

Further, the focus on solely predetermined outcomes and programme components is not sufficient. Due to the adaptive nature of the programme and varying contexts in which it is implemented, it may focus on issues or objectives that are no longer relevant and overlook unanticipated programme developments or outcomes. A broader perspective is required to consider all potential consequences of the JOGG-approach, on different levels in the community, including emerging or unintended outcomes and non-linear causal relations.

Evaluation framework

As a foundation for the evaluation of the JOGG-approach we use the conceptual model of Jolley [ 23 ]. This model addresses the challenges of evaluating complex community-based health promotion, including the role of evaluation to support future development of a program, by building on theory based evaluation [ 51 , 52 ], complexity theory [ 18 , 53 ] and developmental evaluation [ 29 ]. The model provides a framework in which the JOGG-approach is recognised as a complex and adaptive process, regardless of the complexity of the programme itself (Fig. ​ (Fig.2 2 ).

Evaluation framework of the JOGG-approach, adapted from Jolley [ 23 ]

The planning phase in the model specifies the overarching JOGG programme as intended by the national JOGG-organisation, which is based on scientific evidence and practice-based knowledge. In each JOGG-community (local practice) the national programme theory is tailored to the local context and resources and is then implemented. By ‘implementation’ in this framework we mean the implementation strategies [ 54 ], all methods or techniques, that are employed by the JOGG-team to bring the programme theory into practice, in order to reach intended outcomes. This is considered a continuous and adaptive process, influenced by external factors and feedback loops. Evaluation supports both local and national developments of the JOGG-approach. Rapid feedback to stakeholders supports the adaptive implementation process at the local level. In accordance with Jolley’s model, the evaluation aims to capture perspectives of all stakeholders involved in the local approach (e.g. policy officers, private partners, professionals, target groups). Their experience and knowledge is considered a valuable source of information about the implementation process and outcomes of the local JOGG-approach. Evaluation results from the local level will feed back to the national level to support further programme development through practice-based knowledge. Compared to Jolley’s original model we added the ‘validation’ arrow from practice-based knowledge to evidence. When sufficiently validated, lessons from practice fill the ‘evidence’ bucket on which programme theories of CBOP programmes are based. Evaluation studies across different context contribute to the validation of practice-based knowledge [ 23 , 25 , 29 ].

Research questions, design and methods

Research questions, design and methods for the evaluation (Table ​ (Table1) 1 ) are derived from the components of the model in Fig.  2 and its underlying theories. The evaluation of the JOGG-approach will consist of two phases. Phase 1 will focus on collecting knowledge from local practice. The second phase of the evaluation will then focus on validating practice-based knowledge.

Research questions and methods for the evaluation of the JOGG-approach

Phase 1 practice-based knowledge

Following the planning and implementation process in Fig.  2 , the first research questions in phase 1 of the evaluation focus on the feasibility and validity of the JOGG-approach’s programme theory at both national and local level. Research questions include whether the national and (explicit or implicit) local programme theories are feasible, logical, likely contribute to childhood obesity prevention, based on the best available evidence and knowledge and what context and resource factors influenced the local translation of the national programme theory. The answers to these questions will provide insight in whether national programme theory successfully guided programme planning in local practice and whether a local programme is likely to yield results.

After this first step we address what lessons can be learned from local implementation and adaption and how they were influenced by external influences and feedback. Research questions appropriate for this step focus on what internal and external factors influenced the implementation process and in what way the local programme was adapted in response to emergent issues. The answers to these research questions will help us to unravel what (combination of) elements of the adaptive implementation process (e.g. adjustments to the approach, responses to internal or external factors) contribute to successful implementation and eventually outcomes in the community.

In order to gain insight in the impact of the JOGG-approach on the ‘healthy environment’ in the community, an essential aim in the national programme theory, the research questions focus on identifying outcomes on different levels in the healthy environment (policy, community, organisational). Intended outcomes as well as unintended and emergent outcomes are taken into account. Intended outcomes are the goals as defined in the national and local programme theory. Emergent outcomes are outcomes that emerge in response to external factors or during the implementation process, for example when new goals are developed through collaboration with stakeholders [ 55 ]. Unintended outcomes can for example occur when the response to a programme depends on the context [ 18 ]. Since the JOGG-approach aims for structural impact in the community, we specifically focus on structural outcomes of the JOGG-approach.

In the last step in phase 1 of the evaluation we focus on the extraction of practice-based principles for effectiveness, those elements of the local JOGG-approach and adaptive implementation process that contributed to the accomplished outcomes in the community. Taken together, the answers to the research questions in phase 1 provide insights in the success of the adaptive planning and implementation process, the external factors that played a role and the outcomes that were accomplished through this process. In this last step we critically review the JOGG-approach’s contribution to these outcomes. The principles of effectiveness that are identified in this phase of the evaluation fill the ‘practice-based knowledge bucket’ from which the national JOGG-organisation informs their programme theory. Validating these principles across contexts is part of phase 2 in the evaluation.

Design and methods

In order to answer the research questions in phase 1, we use a multiple case study design. Such a design is suitable for studying dynamic programme implementation and development within the real-life context, from multiple perspectives [ 56 ]. The large number of communities using the JOGG-approach makes it possible to do multiple case studies, considering one community as a case, and to identify principles for effectiveness that work across a range of contexts. In the multiple case studies we will use qualitative methods to answer the research questions. Qualitative methods are well suited to collect new information on what happens and why [ 57 ]. Iteratively, qualitative data will help us understand how the programme unfolded in a community and how it contributed to outcomes [ 58 ].

Research questions regarding the local programme theory will be answered applying document analysis of local programme documents and interviews with the local JOGG-team. Then, two recently developed methods will be applied to shape data collection and analysis to answer the research questions regarding implementation, adaption, external influences and outcomes, i.e. Ripple Effects Mapping [ 59 ] and the Critical Event Card [ 60 , 61 ]. Both methods involve the participation of relevant stakeholders by sharing their knowledge and experiences, thereby providing insight in the complex interplay between implementation, context and outcomes. The Critical Event Card tool specifically provides insight into how and why the local JOGG-approach developed over time [ 60 , 61 ], through the analysis of the critical events that characterize the evolution of the complex and adaptive programme. Ripple Effects Mapping [ 59 ] focusses on the outcomes of the JOGG-approach. This method was specifically designed to evaluate both intended and emergent outcomes of community-based programmes, across different levels in the community. It involves a group session in which different community-stakeholders participate to provide their perspective on the outcomes and collaboratively explore the contribution of the JOGG-approach.

Analysis: explanation building and principles for effectiveness

From each case community, practice-based principles for effectiveness will be formulated: the underlying principles that contributed to effectiveness in the local context and may provide guidance for effective action in other contexts [ 23 , 29 ]. These can be formulated through the process of explanation building, which constitutes building a causal explanation about how and why certain outcomes have occurred in a case [ 62 ]. The answers to the research questions in the framework regarding local programme theory, implementation, adaption, outcomes and context, resources, external influences and feedback loops at play in each case study help build this explanation. Explanations can be visualized using a systems-based logic model [ 63 – 65 ], which provides insight into the complex causal relations between programme components, outcomes and their interaction (with context). By iteratively comparing explanatory propositions and the logic model from a case with findings from new cases, we expect to be able to gradually refine the model, for example by adding or unpacking components or processes [ 63 ].

The principles for effectiveness form a set of hypothesis that can be validated in the second phase of the study. Principles should eventually provide simple and pragmatic guidance for action [ 66 ] for effective community-based obesity prevention across contexts [ 29 ]. This means identifying those (combinations of) programme components that underly significant and/or structural impact in communities, for example because they set into motion a reinforcing feedback loop. To be generalizable across contexts, principles should describe the function of a programme component or action, rather than the exact form [ 18 , 67 – 69 ]. For example, rather than formulating the action ‘organising stakeholder meetings’ a principle should provide insight in the function of this action, for example ‘building a trusting relationship with and among community stakeholders’. The exact formulation of principles for effectiveness remains to be debated and we believe it is relevant to further discuss, share ideas and experiment with different approaches. Principles could for example be formulated as simple guidance for action (e.g. ‘ensure visibility of stakeholders’ successes to other stakeholders’) or include more complex hypothesis on the causal relations between programme components, context factors and outcomes (e.g. as a causal loop diagram or parts of the systems-based logic model).

Phase 2 validating principles for effectiveness

The second phase of the study focusses on the validation of the formulated principles for effectiveness. In this phase, additional qualitative or quantitative data may be collected. Principles may be validated using more traditional summative evaluation questions and methods. The decision on the specific methods for the second phase of the evaluation will be taken depending on the results of phase 1. The evaluation approach itself is in this way responsive to the emerging understanding of the programme through evaluation [ 23 , 29 , 68 ]. It remains to be debated how to adequately consider complexity in this phase of the study, especially when applying more traditional summative methods for evaluation.

We have proposed an evaluation approach for the JOGG-approach, a large scale community-based programme for childhood obesity prevention in the Netherlands. The evaluation of comparable programmes has been challenging, given their complexity. Which is characterized by objectives that vary locally, adaptive programme developments over time, emergent outcomes and non-linear causality. We argued that with the aim to learn about the programme components that successfully contribute to obesity prevention, the focus on only predetermined programme components and outcomes in evaluation is insufficient. The current evaluation proposal therefore focusses on the whole adaptive implementation process. The presented evaluation framework includes research questions that focus on the national and local programme theory, implementation, the interaction with local context, both intended and unintended outcomes and adaption. By focussing on these components, using complexity sensitive qualitative research methods (e.g. Ripple Effects Mapping), we aim to extract practice-based knowledge about effective principles of the programme. We expect that these principles can be used to further develop the programme and further research can focus on validating these principles for effectiveness.

The framework will be applied retrospectively, which comes with some limitations. Indeed, it is subject to several threats to the validity, including recall bias in stakeholders and selection bias due to poor documentation or staff turnover [ 62 ]. Clearly, the risk of bias increases when the period covered in the framework increases. As some communities have implemented the JOGG-approach for over ten years, this may result in spurious causal inferences about the contribution of the JOGG-approach to outcomes in the community. In order to mitigate potential biases, several methodological elements are incorporated in the framework. First, combining data sources and methods (document analysis and interviews with different and purposively selected stakeholders) aims to increase the accuracy, as different perspectives on the same event they can be checked against each other [ 62 ]. Second, the use of timelining within the interviews helps situating participants in the past [ 60 ] and the use of the Critical Event Card tool within analyses allows to separate material evidence of events from stakeholders’ experiences and compare these [ 61 ]. Further, when identifying principles for effectiveness, cross-case analysis and explanation building are important analytical techniques to make evidence based and correct causal inferences in case studies [ 62 ]. The second study phase is explicitly aimed at validating formulated principles for effectiveness.

Despite the limitations of retrospective research, the application of the proposed framework provides valuable information. Given the fact that much is still unknown about the factors underlying success and failure of such programmes [ 5 , 7 , 21 ] and the impact and sustainability of these programmes in the long run [ 70 ], the expected results of the proposed evaluation, i.e. the principles for effectiveness, address some highly relevant gaps in the body of evidence of CBOP programmes. The evaluation of the JOGG-approach, which has been implemented in many different community contexts over the past 10 years, provides a unique opportunity to unravel these factors and their complex interplay (with context).

The application of a complexity perspective on the evaluation of public health programmes and interventions is not new. Over the past years different approaches and methods have been developed and applied [ 26 , 30 ], for example system mapping and modelling, network analysis and the use of a complexity perspective as a lens in qualitative data analysis [ 58 ]. The proposed evaluation of the JOGG-approach however, does differ from what has been developed so far in several ways. First, existing complex evaluations mostly build on the premise that the programme was or will be designed with a complexity perspective in mind (e.g. [ 71 , 72 ]). Like many other CBOP programmes however, the JOGG-approach was originally designed as a ‘simple’ programme, in which over time a greater acknowledgement of complexity was integrated. The proposed evaluation provides an opportunity to evaluate the JOGG-approach, a programme that was not specifically designed from a complexity perspective. The proposed evaluation approach may therefore be relevant for many other CBOP programmes.

Second, most existing evaluation methods and approaches that consider the complexity perspective, require to follow changes in a community system from before the start of the programme to draw conclusions about system changes over time. However, as programmes and policies are also developed in practice, without involvement of researchers in its development and implementation, other methods are also needed [ 25 ]. The proposed evaluation of the JOGG-approach is suitable to evaluate a programme that, like the JOGG-approach, was developed in practice and learn from the adaptive implementation of the programme.

Third, existing complex evaluation methods and approaches that consider the complexity perspective rarely facilitate the translation of the findings to programme planners and decision makers [ 26 ]. The proposed evaluation of the JOGG-approach is specifically aimed at generating results that inform programme planners, policy makers and health promotion practitioners to further improve the programme as well as scientist to inform the development and implementation of other CBOP programmes.

The evaluation proposal described in this paper takes into account the complexity of a CBOP programme and is designed to provide insight in how the programme works. Such approaches to public health evaluation have not been given much priority in the past, and only limited guidance exists in how to apply such perspective [ 27 ]. By sharing our evaluation approach we aimed to contribute to the necessary debate and progress in this area.

Our approach is yet to be tested, and requires further specifications and developments, for example on how principles for effectiveness can best be unravelled and validated. We therefore call on other researchers to share their ideas, trials, reflections and lessons. The evaluation of complex CBOP programmes, or complex health promotion in general is not easy and relatively new, sharing ideas, approaches and lessons will support the development of appropriate and feasible evaluation approaches and methods.

Acknowledgements

Not applicable

Abbreviations

Authors’ contributions

DC and AS secured funding for this study and were responsible for the overall development of the JOGG evaluation project. DC, AS and IH contributed to the conceptualisation of the evaluation approach presented in the paper. IH drafted the original manuscripts. DS, AS, FvL and MC all contributed considerably to revising the manuscript. All authors read and approved the final manuscript.

This research is funded by the national JOGG-organisation, supported by the Dutch ministry of Public Health, Welfare and Sport. The national JOGG-organisation had no role in the design of the study or writing of the manuscript.

Availability of data and materials

Declarations.

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Obesity - Free Essay Examples And Topic Ideas

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How To Write an Essay About Obesity

Understanding obesity.

Before writing an essay about obesity, it's crucial to understand what obesity is and its implications. Obesity is a medical condition characterized by an excess accumulation of body fat, often defined by a body mass index (BMI) of 30 or higher. It is not just a cosmetic concern but a complex health issue associated with various diseases, such as heart disease, diabetes, and high blood pressure. Start your essay by outlining the causes of obesity, which may include genetic factors, lack of physical activity, unhealthy eating patterns, and environmental and psychological factors. Discuss the global prevalence of obesity and its rise in recent decades, indicating a significant public health concern.

Developing a Thesis Statement

A strong essay on obesity should be centered around a clear, concise thesis statement. This statement should present a specific viewpoint or argument about obesity. For instance, you might discuss the societal factors contributing to the rise of obesity, analyze the effectiveness of current interventions and policies, or argue the need for a multifaceted approach to tackle this health issue. Your thesis will guide the direction of your essay and ensure a structured and coherent analysis.

Gathering Supporting Evidence

To support your thesis, gather evidence from a variety of sources, including medical studies, public health reports, and statistical data. This might include data on obesity rates in different populations, research on the health risks associated with obesity, or studies evaluating the effectiveness of diet and exercise programs. Use this evidence to support your thesis and build a persuasive argument. Be sure to consider different perspectives and address potential counterarguments.

Analyzing the Impact of Obesity

Dedicate a section of your essay to analyzing the impact of obesity. Discuss the physical health consequences, such as increased risk of chronic diseases, as well as the psychological and social implications, including stigma and reduced quality of life. Consider the economic burden of obesity on healthcare systems and society. This analysis should provide a comprehensive understanding of the far-reaching effects of obesity.

Concluding the Essay

Conclude your essay by summarizing the main points of your discussion and restating your thesis in light of the evidence provided. Your conclusion should tie together your analysis and emphasize the significance of addressing obesity as a critical public health issue. You might also want to suggest areas for future research or propose potential strategies to combat the obesity epidemic.

Reviewing and Refining Your Essay

After completing your essay, review and edit it for clarity and coherence. Ensure that your arguments are well-structured and supported by evidence. Check for grammatical accuracy and ensure that your essay flows logically from one point to the next. Consider seeking feedback from peers, healthcare professionals, or educators to further refine your essay. A well-written essay on obesity will not only demonstrate your understanding of the issue but also your ability to engage with complex health and societal challenges.

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A Proposal for an Obesity and Physical Activity WIC Program Intervention

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Home — Essay Samples — Nursing & Health — Obesity — Obesity in America

Obesity in America

• Categories: Childhood Obesity Obesity

About this sample

Words: 704 |

Published: Jan 30, 2024

Words: 704 | Pages: 2 | 4 min read

Table of contents

Introduction, historical context and causes of obesity, health impacts of obesity, economic and social impacts of obesity, government policies and interventions, role of education and media in addressing obesity.

• Centers for Disease Control and Prevention. (2020, June 29). Adult Obesity Facts. https://www.cdc.gov/obesity/data/adult.html
• Alpert, J. (2018, July 18). The Policy and Politics of Obesity Prevention. Health Affairs. https://www.healthaffairs.org/do/10.1377/hblog20180712.613083/full/
• Swinburn, B. A., Sacks, G., Hall, K. D., McPherson, K., Finegood, D. T., Moodie, M. L., & Gortmaker, S. L. (2011). The global obesity pandemic: shaped by global drivers and local environments. The Lancet, 378(9793), 804-814. https://doi.org/10.1016/S0140-6736(11)60813-1
• Cohen, D. A., & Babey, S. H. (2012). Contextual influences on eating behaviours: heuristic processing and dietary choices. Obesity Reviews, 13(9), 766-779. https://doi.org/10.1111/j.1467-789X.2012.01001.x

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Article Contents

1. why is rising obesity a problem, 2. what determines food choices, 3. what can governments do to reduce obesity, 4. final comments, obesity, poverty and public policy.

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Rachel Griffith, Obesity, Poverty and Public Policy, The Economic Journal , Volume 132, Issue 644, May 2022, Pages 1235–1258, https://doi.org/10.1093/ej/ueac013

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Obesity rates in the United Kingdom, and around the world, are high and rising. They are higher, and rising faster, amongst people growing up and living in deprivation. These patterns raise potential concerns about both market failures and equity. There is much that policy can do to address these concerns. However, policy can also do harm if it is poorly targeted or has unintended consequences. In order to design effective policies we need an understanding of who we are trying to target, and for what reasons. This paper provides an overview of some of the evidence, and some recent policy initiatives.

Obesity rates in the UK, and around the world, are high and rising. They are higher, and rising faster, amongst people growing up and living in deprivation. Rising obesity is a concern because it suggests that there are potential market failures that are leading people to make suboptimal choices about the foods they eat and the activities they engage in. These choices are potentially suboptimal in the sense that they may lead to higher than anticipated costs for the person themselves in the future and for wider society. Even if markets are functioning well, obesity may also potentially be a concern for equity reasons. If some children, for example those from disadvantaged backgrounds, are not able to access sufficient nourishment for healthy development, then there might be a role for policy intervention to provide greater equality of opportunity by ensuring access to a nutritious diet.

This paper provides an overview of the main evidence (and lack of evidence) on why obesity is an issue of public policy concern, what are some of the factors that might be driving rising obesity and its association with deprivation, and where policy might be most effective at improving welfare. There is much that public policy can do in terms of changing market signals, such as relative prices, and changing the choice environment to encourage people to make choices that better align with their own long-term interests. However, policy can also do harm if it is poorly targeted or has unintended consequences. In order to design effective policies we need an understanding of who we are trying to target, and for what reasons.

Obesity has risen dramatically in recent years in the UK and around the world. 1 Obesity is defined using the ‘body mass index’ (BMI), which is the ratio of weight to height squared (kilograms per |${\rm metre}^2$|⁠ ). BMI is a simple summary statistic used by medical professionals as an indicator of whether an individual is overweight (or underweight) and how overweight they are. An adult is obese when their BMI is over 30, they are morbid or severely obese when their BMI is over 40. BMI is not a perfect indicator, nor is it the only indicator that medical professionals care about. 2 For example, excess fat around the waist is another indicator. However, BMI is relatively easy to measure and track across time and locations, it is correlated with other measures, and it is seen as useful as a broad and relatively easy to measure indicator.

In England in 2018 nearly one in three adults was obese, and around one in twenty-five were morbidly obese. The rate of obesity in adults has doubled since 1993, shown in Figure  1 . Obesity rates are higher in more deprived areas (see Table 5 of NHSDigital, 2019 ). The statistics show similar trends in Scotland, Wales and Northern Ireland and other parts of the world.

Adult Obesity Rate in England.

Notes: Obese is defined as a BMI over 30; morbid or severely obese is defined as a BMI over 40.

Source . Table 6 of NHSDigital ( 2019 ).

Obesity in children is also high, for example, around one in five 10–11 year olds in England were obese in 2019. Worryingly, children are becoming obese at younger ages and are staying obese into adulthood (Johnson et al ., 2015 ). Obesity is more prevalent in more deprived areas, with children living in the most deprived regions being nearly twice as likely to be obese as those living in the least deprived regions. If we focus on children that are severely obese, the rate in the most deprived regions is over four times the least deprived areas (NHSDigital, 2020 ). 3

The gap in obesity rates between children growing up in the least and most deprived areas has widened over the last decade, as shown in Figure  2 . Panel (a) shows that in 2006 the gap was 8.5 percentage points; by 2019, it had grown to 13.3. Panel (b) shows that, for severely obese children, the gap between the share of children in the least and most deprived areas grew from 3.1 percentage points in 2006 to 5.3 in 2019.

Child Obesity Rate in England, by Deprivation.

Notes: Location is measured by the postcode of the child’s school. The dashed lines show 95% confidence intervals. See footnote 3 for definitions of the least and most deprived regions. Details on how obesity in children is measured is available in NHS ( 2011 ).

Source . Tables 13(a) and 14(b) of NHSDigital ( 2020 ).

Rising obesity is a concern because it suggests that there might be market failures that are leading people to make suboptimal choices. These market failures could arise if people do not fully account for the costs that obesity imposes on wider society, and on themselves, in the future when they make consumption choices. While there are many good papers that try to estimate the extent of these social costs, 4 the magnitude and nature of these costs (and in particular how they vary across different people), and what market failures are causing them, is still not fully understood. 5 However, policy-makers (and many others) believe that these costs are large, particularly amongst children, and especially amongst those growing up in deprivation.

Even if markets are functioning well, obesity may also potentially be a concern for equity reasons. Ensuring that all children, including those from disadvantaged backgrounds, are well nourished seems a corner stone of the provision of equality of opportunity. It is well established that child nutrition has important impacts on later life outcomes (see, among others, Currie, 2009 ; Almond et al ., 2018 and Lundborg et al ., 2021 ). Higher and growing rates of obesity amongst children from disadvantaged backgrounds might indicate that these children are not able to access sufficient nourishment, and suggest a role for policy intervention to provide greater equality of opportunity.

Obesity is associated with, and potentially causes, a number of adverse health, social and economic outcomes. Obesity arises due to a caloric imbalance (too many calories consumed relative to expended) leading to excess weight. It is also associated with, and might be an indicator of, a potentially unhealthy balance of nutrients, for example, a diet with too many sugars and carbohydrates. Obesity can also be associated with food insecurity (the inability to regularly access a healthy diet) if, when people do have the resources and ability to obtain food, they choose low-cost calorie-dense foods with a low nutritional value.

The main medical concern about excess weight is that it indicates an excess of fat (too much bone or muscle is not a problem). Excess fat is thought to increase an individual’s risk factor for a number of diseases, including metabolic syndrome, high blood pressure, atherosclerosis, heart disease, diabetes, high blood cholesterol, cancers and sleep disorders (NIH, 2021 ). The increased risk of these diseases likely increases costs to the healthcare system, both through an increase in the prevalence or severity of these diseases, and also because the costs of treating obese patients can be higher than normal weight individuals. Hospital admissions either directly attributable to obesity, or where obesity was a factor, are more prevalent amongst individuals from more deprived areas (NHS, 2020 ).

Obesity in childhood can have significant impacts on physical and psychological health (Sahoo et al ., 2015 ). The widening gap in obesity rates between children growing up in the least and most deprived areas raises the concern that obesity, and associated poor nutrition, may be important drivers of long-term inequalities. There is no strong causal evidence on the impact of obesity and poor nutrition on outcomes, but Public Health England (PHE) and the Centers for Disease Control and Prevention (CDC) in the United States highlight being obese as at least correlated with long-term harms in children, for example, through increased school absences and behavioural problems. We do not have good evidence on whether these effects are all driven by poor health, which feeds through to poor social and educational outcomes, or whether other factors are also at play. But at least amongst public health officials there is a concern that as well as affecting health, childhood obesity can have potentially important consequences for children’s long-term social and economic outcomes. 6 Economists have formalised the costs and related effects that fall on the person themselves in the future as ‘internalities’ . 7 For children, they are likely too young to understand the long-term consequences of eating an unhealthy diet, and so it is not factored into their decision-making, and for some children at least, their parents may also not fully account for these effects either.

Obesity is the result of an imbalance in energy consumed and energy expended. A common question is whether it matters what type of calories you eat, or is it only calories (net of energy expended on activities) that matter? Many governments give advice on the ‘optimal’ combination of foods; 8 however, the evidence seems to suggest that many different combinations of foods can yield healthy outcomes. 9 Recently, attention has focused on processed foods as leading to poor health outcomes, rather than foods containing any particular macro nutrients. 10

Excess consumption of some types of foods is also associated, and possibly causally so, with specific diseases. For example, high consumption of foods that have a lot of ‘free sugars’ (sugars added in manufacturing) can cause insulin resistance, which can cause diabetes (Ludwig, 2002 ; Kalra and Gupta, 2014 ; Imamura et al ., 2015 ). High consumption of salt can harden your arteries, leading to high blood pressure and cardiovascular disease (Trieu et al ., 2015 ).

Excess sugar consumption has been a particular target of policy-makers around the world. To see one reason why, consider Figure  3 . The horizontal axis shows age, and the vertical access shows grams of added sugar per day. Added sugar does not include naturally occurring sugars, for example in fruit or milk. The red dashed line is the UK government’s recommended maximum daily consumption based on medical advice. The solid black line shows the mean daily consumption reported in the National Diet and Nutrition Survey (NDNS); the dashed black lines show 95% confidence intervals. The NDNS is a continuous, cross-sectional survey. It is designed to collect detailed, quantitative information on food consumption, nutrient intake and nutritional status of the general population aged 1.5 years and over. The survey covers a representative sample of around 1,000 people per year. Respondents are asked to record consumption of all foods over two days. What is clear from panel (a) is that consumption is way above the recommended maximum at all ages, but particularly at younger ages. Panels (b)–(d) show that in fact almost all young children consume more than the medically recommended amounts of added sugar.

Sugar Consumption by Age.

Source . Panel (a) is Figure  1 , panels (b)–(d) are Figure  2 of Griffith et al . ( 2020 ), using National Diet and Nutrition Survey (NDNS).

Another common question is—if weight gain results from eating more calories than you burn in activity, is it only calories that matter, or does increasing activity through exercise lead to weight loss? In principle yes, but the relationship between exercise and weight loss is complicated. Exercise is good for you for all sorts of reasons, but some evidence suggests that on its own it might not lead to a lot of weight loss. This is partly because you would have to increase the amount of exercise you do by quite a lot, and also because the body responds in complicated ways that might mitigate some of the effects of increasing exercise on weight loss (see, for example, Prentice and Jebb, 2004 and Jebb, 2015 ). On the other hand, the analysis in Griffith et al . (2016a ) suggests that a reduction in the strenuousness of daily life may be at least partially responsible for the increase in obesity in adults over the 1980s and 1990s in the UK.

In this section we discuss some of the important factors that determine food choices. If markets are functioning well then consumers’ choices will be determined by market prices, income and the attributes of consumption that yield (positive or negative) utility. For markets to function well requires that consumers have good information about these attributes and about the utility they generate, and that consumers can and do act on this information appropriately; it also requires that consumers can access the foods they want to buy and that prices reflect costs.

We highlight some of the possible reasons that people might be making suboptimal choices, due to market failures or resource constraints. This is important because in order to design good policy we need to understand why some people are making bad choices. In the next section we consider how some specific policies might encourage people to make better choices, or to otherwise mitigate the negative consequences of their suboptimal choices, and whether they might also have other unintended consequences.

2.1. Food Prices

The price of foods is obviously an important determinant of consumers’ choices, and many policies aim to change relatives prices of different food products or food groups in order to incentivise producers and consumers to account for the excess social costs of consumption. In this section we highlight some of the main recent trends in food prices.

2.1.1. Price levels

From the 1980s until the mid-2000s, food prices have fallen in OECD countries; see OECD ( 2020 ). In the UK, this was particularly the case (Griffith et al ., 2015 ). The reduction in food prices benefited poorer households, for whom foods represent a significant share of their budget, and a much higher proportion than for richer households. While access to cheaper food could have contributed to people eating more, increasing the overall price of food seems unlikely to be an effective way to reduce obesity or improve diet quality. It will hit the poorest hardest, and the increase would likely have to be very large to have an appreciable impact. Food prices in the UK increased dramatically in the mid-2000s due to the depreciation of the sterling, though fell back below the OECD average reasonably quickly, but now look likely to rise again due to increased trade costs due to Brexit. There is so far no indication that these large price rises are having a positive impact on health or reducing obesity.

2.1.2. Relative prices

Changing the relative prices of different foods is a policy that many governments are pursuing, for example by introducing taxes on sugar sweetened beverages. The National Food Strategy (Dimbleby, 2021 ) has recommended expanding this to a more general tax on added sugar.

How do the prices of different food products and food groups vary with the healthiness of that product? This is not a simple question to answer. One common approach is to show that the average price per calorie of more healthy products is higher than that of less healthy products. 11

However, this comparison of prices misses the key point. Why do some foods cost more than others? The price of a product depends on the interaction of supply and demand factors. If something costs more to make or grow then this will typically be reflected in a higher price. However, if there are social costs to the consumption of some foods—that is, if the costs of production do not fully reflect the costs to society of that product being consumed—then the price might be ‘too low’, in the sense that there may be a benefit (in terms of higher social welfare) if government intervened to raise the price above the market price. It is the existence of these social costs that provide a rationale for taxes on unhealthy foods, such as sugary drinks. The appropriate level of these taxes does not depend on the differences in price between healthy and unhealthy products, but on the magnitude of the social costs that are associated with the consumption of unhealthy foods.

Another reason why the price of two products that cost the same to produce might differ is if firms have market power that enables them to mark prices up above marginal cost. If one product is much more popular, and has fewer substitutes, than another, then the firm can markup the price by more. Processed foods are typically produced and sold in more concentrated markets with more advertising, so if anything, we would expect the price of these products to be marked up above marginal costs by more than products where producers have less market power.

If healthy foods are more expensive to produce, there may also be equity reasons to provide targeted subsidies to low-income households to reduce the costs of healthy foods. For example, Healthy Start Vouchers and Free School Meals (discussed further in Subsection  3.4 ) do that in the UK.

2.1.3. Time use and prices

Some foods take time to prepare, and both the technology of food product and the opportunity cost of time can affect the costs of doing this. Households may increase their time spent searching for lower prices or in home production in order to reduce the costs of consumption at some points in time (Stigler, 1961 ; Becker, 1965 ; Aguiar and Hurst, 2007 ). They may also change the composition of their shopping basket (e.g., switching from a preferred brand to a cheaper generic product) to maintain its nutritional quality for a given cost.

Several papers study the ways that households reduced the prices they paid in response to the adverse shocks to incomes and food prices over the 2007–8 recession. Unlike during previous recessions in the UK the amount that households spent on food did not keep pace with rising food prices, and this led some to infer a substantial reduction in the size and nutritional quality of households’ food baskets (see, for example, Lock et al ., 2009 ; Taylor-Robinson et al ., 2013 ), with similar concerns in the United States (US Department of Agriculture, 2010 ; US Department of Agriculture, 2013 ). Griffith et al . ( 2016b ) showed that in the UK households were able to exploit various mechanisms to smooth, or ‘insure’, the quantity and nutritional quality of their food basket in the face of these adverse shocks. Evidence from the United States suggests that, as economic conditions worsened, households spent more time shopping and thus paid lower prices (Kaplan and Menzio, 2015 ), increased their use of sales, switched to generic products (Nevo and Wong, 2019 ) and switched to low-price retailers (Coibion et al ., 2014 ).

The costs of making and eating nutritious foods is not just the money spent on buying the ingredients, but also the time spent in preparation. Griffith et al . ( 2022 ) showed that over the last several decades the share of the food budget that goes on ingredients fell, while the share on processed foods increased. This is surprising because they also showed that the market prices of ingredients declined most. The distinction between ingredients and prepared foods is particularly relevant due to the recent attention on processed foods as leading to poor health outcomes, discussed above.

Griffith et al . ( 2022 ) documented that time spent on food management, which includes shopping and cooking, declined between 1974 and 2000; Cutler et al . ( 2003 ) showed the same is true in the United States. Mean hours on food management have fallen, with women reducing time spent and men increasing time spent on these activities, but not by enough to compensate for the reduction by women. Women are spending more time in the labour market; labour force participation has increased, hours worked conditional on participation have increased and wage offers have increased. Putting these together, Griffith et al . ( 2022 ) constructed a shadow price of a home cooked meal. The shadow price reflects both the costs of purchasing the ingredients and the time needed to prepare it for consumption, where the cost of time is estimated and has increased due to outside labour market opportunities for women. Figure  4 shows that, while market prices have fallen, the shadow price—the cost of home cooked food—has increased.

Market and Shadow Prices of Foods.

Notes : The shadow price incorporates the observed wage for labour market participants, and the maximum of the estimated market wage or the estimated reservation wage for non-participants.

Source . Figure 4.2 of Griffith et al . ( 2022 ).

2.2. Income

There is clearly a strong correlation between deprivation and obesity (see Figure  2 for example), and more generally there are strong intergenerational correlations in health and income (see, for example, Case et al ., 2002 ). However, convincingly identifying the causal impacts of income on obesity and nutrition in a developed countries context remains a challenge.

A large and growing literature suggests that even relatively mild negative economic shocks in childhood can have long lasting negative impacts, although these are heterogeneous (see the survey in Almond et al ., 2018 ). For example, Hoynes et al . ( 2016 ) used the roll out of the Food Stamp Program in the United States in the 1960s and early 1970s to show that access to food stamps in childhood leads to a significant reduction in the incidence of metabolic syndrome (conditions that include obesity, high blood pressure, heart disease and diabetes) and, for women, an increase in economic self-sufficiency. However, a literature that looks at the short-run impacts of economic shocks suggests that diet quality is either not affected by, or is improved by, adverse economic conditions, 12 and Adda et al . ( 2009 ) showed that permanent income shocks have little effect on a range of health outcomes.

Another way that income and deprivation might affect the nutritional quality of individuals’ diets is through the availability of healthy foods. Many papers have documented that healthy foods are less available, or cost more, in lower income neighbourhoods—what is referred to as ‘food deserts’. 13

One important question, on which there is still limited evidence, is what is the direction of causation in this observed relationship. The food offering in any location is a result of supply and demand factors. Is the supply of healthy foods driven by restrictions to supply, or by differences in demand preferences by consumers in those locations? Allcott et al . ( 2019a ) provided evidence for the United States that it is largely differences in preferences, and not supply constraints. The answer to this is important for policy design; either response might merit policy intervention, but the effective policy will differ. Even where differences in the food offering are driven by differences in the market demand curve, it might be that individuals within a market with a restricted offering have preferences that differ from the mean, and they are affected by supply constraints.

In the next section we discuss some of the ways that income might interact with other factors to affect the way that people make decisions, and that might lead to market failures and suboptimal outcomes.

2.3. Information, Cognition, Self-Control and Advertising

In addition to prices and incomes economists have long studied the importance of information, and the ways that information is processed, in determining consumer choices (see, for example, Stigler, 1961 ; Nelson, 1970 ; Loewenstein et al ., 2014 ), and the role of information in promoting healthier food choices (see, for example, Schofield and Mullainathan, 2008 ; Wisdom et al ., 2010 ; Reutskaja et al ., 2011 ).

There is a long history of government policies that aim at providing information and education, for example, on the safety benefits of wearing seat belts and the health consequences of smoking. There have been many information campaigns on food and nutrition; in the UK these have included the Eatwell Guide, the five-a-day campaign, Change4life and nutrient labelling regulations, amongst many others.

Information campaigns will be most effective where people want, but lack, information. One important reason that some campaigns might not be that successful is if people already have the information they need (people probably already know that vegetables are good for them). However, work by behavioural economists suggests that people do not always fully pay attention to the information they have when making decisions (Bordalo et al ., 2013 ), for example, some people may group products into categories in order to reduce ‘cognitive overload’ (Mullainathan et al ., 2008 ). Work by Sendhil Mullainathan and colleagues 14 has looked at the impact of poverty on cognition. The poor often behave in less capable ways, which can perpetuate them staying in poverty. This body of work argues that poverty directly impedes cognitive function, because poverty-related concerns consume mental resources, leaving less for other tasks. The fact of being poor means that you have to cope not only with a shortfall of money, but also with many other calls on cognitive resources. This view suggests that the poor are less capable not because of inherent traits, but because the very context of poverty imposes a load of concerns on people that impedes cognitive capacity.

Another reason that people might not fully take account of all of the information available to them is that they might succumb to temptation due to self-control problems. Read and Van Leeuwen ( 1998 ) and Sadoff et al . ( 2020 ) provided some of the most direct evidence (based on experiments in the field) of self-control problems in diet. Cherchye et al . ( 2017 ) showed that, as well as some people eating a healthier diet than others, there is considerable variation in the quality of most individuals’ diets over time that cannot be explained by standard factors such as prices and incomes, and which is likely to be at least partially driven by self-control problems in food choice.

An extensive psychological literature shows that individual choice behaviour varies with context and time, and that individuals sometimes use self-regulation and behaviour modification in an attempt to mitigate these influences (see the references and discussion in Rabin, 1998 and DellaVigna, 2009 ). For example, experimental evidence suggests that individuals may be willing to impose (sometimes costly) commitments on themselves. 15 New Years’ resolutions to eat a more healthy diet are an example of a common form of self-regulation and behaviour modification with regards to diet (Dai et al ., 2014 ; 2015 ).

Figure  5 shows an example of these fluctuations in diet quality over the calendar year. Panel (a) shows variation in the nutritional quality of food purchased by a large sample of UK households. 16 This suggests a clear ‘reset’ in January of each year to a healthier diet, with a decline over the year. Panel (b) shows the same trend in Google searches for the term ‘healthy foods’.

Variation in Diet Quality.

Source . Figures 1(b) and 2(a) in Cherchye et al . ( 2017 ).

Cherchye et al . ( 2017 ) used information on individuals’ stated preferences and attitudes to investigate whether greater fluctuations in the share of calories from healthy food reflect impulsive behaviour. Their findings suggest that fluctuations are larger for individuals who state that they are more impulsive (e.g., spend money without thinking). They relate their findings to the literature that finds empirical evidence of considerable within-individual variation in choice behaviour in other settings, 17 as well as in grocery purchases using alternative identification strategies. 18 They formalise this behaviour in a two-selves model of food purchasing behaviour in the spirit of this literature, in which individuals’ food choices are the outcome of an intra-personal bargaining process between a healthy and an unhealthy self. 19

What affects might advertising have on food choices? In the economics literature advertising is modelled as either informative (it gives consumers information about a characteristic of the product) or distortionary (it gives consumers misleading information, or distracts them from information they have). 20 Informative advertising will improve the choices that consumers make, while distortionary advertising will lead to worse choices. Another important distinction for our purposes here is whether the impact of advertising is to expand the market, or whether it is largely rivalrous, leading to shifts in market share between firms within a market. If advertising expands a market then it is more likely to have adverse impacts on nutrition (if the products being advertised are less nutritious), whereas if advertising largely leads consumers to switch between products that have similar nutrient value (e.g., between Coca Cola and Pepsi) then its impact on nutrition will likely be smaller. We return to discuss this further in Subsection  3.3 .

Advertising might amplify problems of temptation and self-control; the products that are advertised most heavily are also those that are the least healthy (see, for example, the figure on UK advertising expenditure by food group in Abi-Rafeh et al ., 2021 ). Experimental evidence shows that children exposed to food advertising ate more and were more likely to be obese. 21 Advertisers can frame a consumers’ view of a product using a desirable product category, or transfer desirable attributes from other products in the same category in the consumers’ mind. For example, in the context of food advertising, a kind of chewing gum can be viewed as healthy by ‘coarse’ thinking consumers if it is advertised as low-fat (Schofield and Mullainathan, 2008 ). This may be particularly true for people living in poverty who have a lot of other things to worry about and so experience cognitive overload (Mani et al ., 2013 ).

Griffith et al . ( 2018a ) attempted to measure exposure of consumers to food advertising in the UK, and estimated that households in the lowest income quartile see something like 20% more adverts for unhealthy foods than households in the highest income quartile; this is because they watch more TV, and they watch at a time and watch TV shows on which these adverts are more likely to be shown.

Governments are considering, and have implemented, a large range of policies that change relative prices, alter the choice environment, provide information and education to consumers, incentivise firms to reformulate, encourage a more active lifestyle and more. Policies that are aimed at correcting market failures should reduce externalities (costs imposed on wider society) and internalities (costs imposed on the person themselves in the future), while minimising any unintended adverse consequences. Policies that are aimed at alleviating equity concerns should be well targeted and minimise deadweight costs.

Designing and implementing policies that meet these ambitions is difficult. 22 That does not mean that it is not worth trying, but it is important to recognise that policies can (inadvertently) do harm as well as good. For example, poorly designed taxes might fail to improve outcomes if people with high externalities or internalities do not respond, yet could impose additional costs on exactly those people it is intended to help.

3.1. Corrective Taxes

Corrective taxes are a common approach to tackle externalities. 23 Increasing the overall price of food seems unlikely to be an effective way to reduce obesity. It will hit the poorest hardest, and the increase would likely have to be very large to have an appreciable impact. Instead, corrective taxes generally aim to change relative prices , i.e., to increase the price of less healthy foods relative to more healthy foods.

To date, one of the most popular corrective taxes aimed at reducing obesity and improving nutrition is taxes on sugary soft drinks. 24 The UK introduced the Soft Drinks Industry Levy in 2018, and Dimbleby ( 2021 ) is recommending broader taxes on added sugar and salt in the UK. Griffith et al . ( 2020 ) reviewed twenty-seven studies of taxes in eleven jurisdictions—all studies find that taxes lead to increased prices—pass-through is lower in smaller jurisdictions; in settings like the UK, taxes are fully passed through to prices. Most studies find that taxes led to substantial reductions in purchases of soda. Allcott et al . ( 2019b ) provided further discussion of the evidence.

One key ingredient to understanding whether soda taxes are effective is to know whether they lead to reductions in consumption in those individuals who generate the largest externalities and internalities. Unfortunately, we do not have good estimates of the scale or distribution of externalities and internalities; this is a key piece of missing evidence. Policy-makers in the UK and elsewhere have targeted some specific groups more than others, including the young, poor and heavy sugar consumers. One question is whether these groups are responsive to taxes. If they are, and if policy-makers are right that they suffer higher internalities, then they gain in the long run due to reduced internalities, which compensates them for the loss from higher prices. However, if they are not responsive to taxes then they do not benefit from reduction in internalities, and they are made worse off because they pay higher prices.

Dubois et al . ( 2020 ) used UK data to study how well targeted taxes on sugary drinks are, and in doing so tackle a number of methodological challenges. It is important to capture heterogeneity in preferences and in responses across people, and in order to study how well targeted the policy is, to be able to relate this heterogeneity to demographics of interest. They focused on the young, poor and heavy sugar consumers because policy-makers have focused on these groups, for which they believe consumption leads to high internalities. Dubois et al . ( 2020 ) exploited longitudinal data and relaxed some of the parametric assumptions imposed by traditional methods for estimating demand in differentiated product markets. Their results show that high sugar consumers would be less responsive to a tax than low sugar consumers, but that the young are more responsive than the old, so this form of tax is well targeted in one dimension, but not the other.

O’Connell and Smith ( 2020 ) considered the design of taxes on sugar-sweetened beverages, accounting for the fact that firms have market power, showing how optimal policy depends on the relative size of price-cost margins among externality generating goods and alternative products, and the degree of consumer switching across these product sets. They showed that taking these factors into account can substantially increase the welfare improvements achieved by these taxes.

3.2. Incentivising Reformulation

Consumer information campaigns, such as those to promote greater consumption of fruit and vegetables (Stables et al ., 2002 ; Capacci and Mazzocchi, 2011 ) and reduce salt consumption (PHE, 2020b ), have been a favoured policy of governments. However, changing the behaviour of a large number of consumers can be challenging, for many of the reasons discussed above, and strong evidence on their effectiveness has been limited. Because of this, many governments have focused instead on encouraging and incentivising firms to reformulate (see, for example, Vagnoni and Prpa, 2021 ).

Griffith et al . ( 2017 ) showed that following a large public health campaign in the UK resulted in a decline in dietary salt intake but that this was entirely attributable to product reformulation; consumer switching between products worked in the opposite direction and led to a slight increase in the salt intensity of grocery products purchased.

When the UK soft drinks industry levy was introduced, an explicit aim was to encourage reformulation. The tax has two rates. Products that contain between 5–8 g of sugar per 100 mL are taxed at the rate of 18p per litre of drink, and those that contains 8 g of sugar per 100 mL or more are taxed at 24p per litre of drink. Because the tax is based on volume, not directly on sugar, the tax rate within a band declines in sugar intensity; see the dashed line in Figure  6 . The idea behind this design was to give producers incentives to reformulate to just below 8 g and just below 5 g. These points were chosen with detailed knowledge of the industry, and the technological feasibility of reformulation.

Reformulation Following the SDIL.

Notes: The dashed line shows the tax per gram of sugar under the UK Soft Drinks Industry Levy (SDIL), which was introduced on April 6, 2018. The bars are based on the Kantar (FMCG) Purchase Panel (Take Home) 2016–9 (Kantar UK, 2020 ). The figure was created in Stata using three lines of code: ‘replace sugars=sugars/100’ to make the variable gram of sugar per 100 g, ‘collapse (mean) sugars,by(rf prodcode)’ to make the data at the product (rather than transaction) level, and ‘twoway histogram sugars if (lowsugarcaloriefat==‘Regular’ |$|$| lowsugarcaloriefat==‘Standard’) & sugars |$\lt $| =20, width(0.25) lc(black) fc(black) frac |$||$| line taxpersugar sugars if (lowsugarcaloriefat==‘Regular’ |$|$| lowsugarcaloriefat==‘Standard’) & sugars |$\lt $| =20, lc(black) lp(dash) lw(thick) yaxis(2) legend(off)’ to draw the figure.

The different panels in Figure  6 show the evolution of the distribution of soft drinks available in the market by sugar intensity. Prior to the introduction of the tax (panels (a) and (b)) there was a mass point of products with around 10 g of sugar per 100 g; this is approximately the sugar intensity of a standard can of Coca Cola. After the tax (panels (c) and (d)) we see a shift towards lower sugar intensity, with a pronounced shifting to reformulate below 5 g per 100 g, the lower tax threshold, and by 2019 we see considerable bunching just below this point. 25

This result is somewhat surprising, as standard models do not suggest that the optimal tax design is tiered in this way. Nonetheless, it seems in this case that the introduction of the tax was at least associated with reformulation. However, more work is needed to understand whether this design was what caused the reformulation. What would a more standard linear corrective tax on sugar have achieved? If, for some reason, this banded design was more effective, what does it require in terms of information about the technology of production to know where to position the bands if it was to be extended to other products.

3.3. Changing the Choice Environment

A large number of policies aim to change the choice environment in which consumers make decisions, by altering the products that consumers perceive to be in their choice set, removing temptation and changing the way that information is presented. These types of policies (sometimes called ‘nudge’ policies) are attractive because they are often low cost to the policy-maker and might be less regressive than taxes (Farhi and Gabaix, 2020 ).

Regulations specify how nutritional information is presented to consumers (for example, through simpler front-of-package labelling 26 and standards of measurement), how and when products can be advertised (for example, the UK bans online advertising of products that are high in fat, sugar or salt (DCMS and DHSC, 2021 ), where products can be sold (for example, fast food outlets are restricted near schools, 27 and sugary treats are discouraged from being placed near the check out counter), amongst others.

Above we raised the possibility that advertising distorts choices, and we saw that unhealthy foods, and particularly very sugary products, are the most advertised. Dubois et al . ( 2018 ) studied the impact of banning advertising for junk food (using the market for crisps, or potato chips, as an example). They modelled consumer choice and firm behaviour, in a model where firms compete in prices and advertising. They showed that advertising affects the choices that consumers make, and affects firms’ strategic behaviours. However, in order to interpret the welfare impacts of this ban, we have to take a stance on whether advertising is informative of distortionary. 28 Dubois et al . ( 2018 ) did not have a strategy for identifying whether advertising for crisps is informative or persuasive, so they calculated the welfare impact of banning advertising in both situations.

Subjectively looking at adverts for junk food, which show sports stars and models eating crisps, it seems likely that they distract people from characteristics of the product that people do not like (for example, price and the bad health consequences of eating crisps), and lead people to choose to buy more junk food (than they would in the absence of adverts). In the case where adverts are persuasive and distort consumers’ decision-making the impact of banning junk food adverts is to lead consumers to pay more attention to the unattractive characteristics (price and unhealthiness). Because firms can no longer compete in advertising, and because consumers pay more attention to prices, price competition increases, and this leads prices to fall. So while banning persuasive advertising reduces purchases of junk foods, it also leads to a reduction in prices, which partially mitigates that impact.

In 2007 adverts for food and drink that are high in fat, salt or sugar (HFSS)—junk foods—were banned from children’s TV in the UK (see Section 8 of Conway, 2021 ). This led to a reduction in the number of adverts for HFSS that children viewed, but firms' response to the advertising restrictions partially mitigated this (Ofcom, 2010 ). Firms adapted their advertising strategies in a number of ways, such as shifting the timing of adverts to avoid showing them during children’s programs, and changed the nature of the adverts they showed. Despite the ban, most adverts that children see on TV are for junk foods (Griffith et al ., 2018a ), and because of this the UK government is currently legislating to extend restrictions to adverts for high in fat, salt or sugar (see Griffith et al ., 2019 and DHSC and DCMS, 2021 ).

3.4. Cash and In-Kind Benefits

Above we have cited evidence that poor nutrition is clearly associated with poverty, and argued that it is likely that this at least partially represents a causal relationship (although conclusive scientific evidence on this is still lacking). For example, it may be that poverty impedes cognitive functioning. Even in the absence of market failures associated with poverty, it might be that households living in poverty might not be able to obtain as nutritious of a diet as households with higher incomes. Society might take the view, particularly for children, that this is not the level of inequality we prefer, and want policies that improve the diet quality of children growing up in poverty.

Child poverty in the UK increased from 2011–2 to 2016–7, the first increase sustained over such a substantial period since the 1990s (Bourquin et al ., 2020 ). Out-of-work households are more likely to be in poverty—about 60% are in poverty, with the poverty rate in working households more like 20%. However, the share of households who are workless is reasonably low in the UK, or at least it was prior to the pandemic, so more children living in poverty are living in households with at least some work. We do not yet know the full impact of the COVID-19 pandemic, but it looks likely to be worse in households in poverty, and it may increase worklessness and poverty amongst some groups. The UK government introduced increases in benefits to help people through the pandemic; however, these were temporary (Waters and Wernham, 2021 ), and there have been large real-term cuts in the generosity of out-of-work benefits over the decade before the pandemic (Bourquin et al ., 2020 ). 29

The main policies in the UK that target children in poverty and/or child nutrition include cash benefits (such as the child credit component of universal credit), and in-kind and conditional benefits, such as Free School Meals and Healthy Start Vouchers.

Reforms to universal credit are the most direct way to lift households out of income poverty. A household on benefits currently gets around £3,000 per year for an extra child. However, increasing this would be expensive, and possibly not that well targeted at the poorest children or at improving nutrition. The value of Free School Meals and Healthy Start Vouchers is much lower, but they are targeted at out-of-work families or families with very low earnings. That means that boosting these benefits would benefit, on average, the very poorest households, compared to say raising Universal Credit standard allowances or the child elements.

Healthy Start Vouchers have been shown to be effective at improving nutritional outcomes (see, for example, Griffith et al ., 2018b ); however, take-up varies across these benefits. Figure  7 shows that it is lower for Healthy Start Vouchers, and has declined in recent years. Addressing this would need to be a priority to make this a more effective policy. Healthy Start vouchers are also available for low-income pregnant women before they give birth to their child; this is one of the few benefits that is available to (low-income) pregnant women, a time that is thought to be important for later life health outcomes (see, among others, Case et al ., 2002 ; Currie 2009 ; Almond and Currie, 2011 ; Almond et al ., 2018 ).

Take-Up Rates of Different Child-Related Benefits, 2011–8.

Notes: The decline in take-up of child benefit is related to the introduction of the high income child benefit charge in 2013.

Source . Figure  2 of Augsburg et al . ( 2021 ) from Crawley and Dodds ( 2018 ), HMRC ( 2019 ; 2020 ) and Holford and Rabe ( 2020 ).

Free School Meals provide food directly to children, so are likely to be particularly effective if we think that an important problem is that parents are able or do not provide sufficient nutritional foods (for any of the reasons discussed above). There may be challenges in expanding Free School Meals depending how it was expanded. For example, in April 2020 the government introduced the COVID Summer Food Fund, which aimed to provide Free School Meals to children when they were not in school; however, half of children eligible for free school meals were not able to access this programme (Crawford et al ., 2020 ). Children who attended school were almost six times more likely to get a free school meal than children who did not. Families of children who had a free school meal were more likely to use a food bank than families who could not. Augsburg et al . ( 2021 ) provided further discussion of these policies.

There is growing concern about the impacts that arise from people making suboptimal choices regarding food consumption. Market failures related to information, cognition and a lack of self-control potentially lead to high costs on wider society and on the person themselves in the future. In addition, obesity and poor nutrition seem likely to be important constraints on the opportunities of children, particularly those growing up in deprivation, raising equity concerns.

There is much that policy can potentially do in terms of changing market signals, such as relative prices, and policies that change the choice environment to encourage people to make choices that better align with their own long-term interests. But to design these policies well we need a better understanding of who we are trying to target, and for what reasons.

We do not know enough about the magnitude and distributions of the market failures: what are the major externalities and who generates most of them, and what are the unanticipated future costs that are caused by obesity and poor nutrition and how do the vary across people? There is a growing body of evidence on these issues, but much of it is still anecdotal or based on correlations. A better evidence base on this is not simply of academic interest, it is essential to design a well-targeted policy. Poorly targeted and poorly designed policies can do harm to the individuals they are aiming to help.

Many of these policies will also interact in important ways. For example, soda taxes increase the prices of sugary drinks and reduce consumption through the price channel, but taxes may also change firms’ other strategic choices, such as advertising. Advertising itself can shape demand, affecting price elasticities, and has long-term effects on demand, leading to dynamic considerations. Careful consideration needs to be given to designing policies that are robust to these concerns. More work needs to be done to understand these interactions, and to understand how dynamic firm and consumer responses affect our evaluation of how effective and well targeted different policies will be.

It is also important to remember that there are potential equity as well as efficiency concerns. If poverty is an important factor driving the growth in obesity then it is also important to look at policies that directly lift people out of deprivation. The long-term decline (until recent rises) in food prices has had important welfare benefits for low-income households. Policies that lead to increased prices without improving nutritional outcomes will have adverse consequences for these households.

This paper draws heavily on joint work with a number of people who I have had the privilege to work with, in particular Pierre Dubois, Martin O’Connell and Kate Smith. I gratefully acknowledge financial support from the European Research Council (ERC) under ERC-2015-AdG-694822, the Economic and Social Research Council (ESRC) under the Centre for the Microeconomic Analysis of Public Policy (CPP), grant number RES-544-28-0001. Data supplied by TNS UK Limited. The use of TNS UK Ltd. data in this work does not imply the endorsement of TNS UK Ltd. in relation to the interpretation or analysis of the data. All errors and omissions remain the responsibility of the author.

This paper was originally delivered as the Past President’s Address at the RES 2021 Annual Conference.

See, for example, Ritchie and Roser ( 2017 ), NHS ( 2020 ), WHO ( 2021 ).

See Harvard School of Public Policy ( 2012 ) for a discussion of why BMI is used, and NHS ( 2019 ).

These statistics are based on the index of multiple deprivation (IMD), which is the official measure of relative deprivation for small areas (lower super output areas) in England. IMD deciles are calculated by ranking the 32,844 small areas in England from most deprived to least deprived and dividing them into ten equal groups. The most deprived line in the figure shows the mean for children living in the 10% of most deprived small areas nationally (decile 1), the least deprived are those living in the 10% of least deprived small areas nationally (decile 10). Further details are available at: https://www.gov.uk/government/statistics/english-indices-of-deprivation-2019 .

I will not attempt to survey this literature here, but see, for example, Bhattacharya and Sood ( 2011 ) and Allcott et al . ( 2019b ), both of whom discuss this issue in the US context.

See the useful articulation of what compelling evidence for suboptimal choices would look like in Bernheim and Taubinsky ( 2018 ).

See the summary in CDC ( 2021 ) and the references therein, including Vaidya ( 2006 ), Lloyd et al . ( 2012 ), Narang and Mathew ( 2012 ), Cote et al . ( 2013 ), Halfon et al . ( 2013 ), Mohanan et al . ( 2014 ), Pollock ( 2015 ), Morrison et al . ( 2015 ), Lundborg et al . ( 2021 ). See also PHE ( 2020a ).

See, for example, https://en.wikipedia.org/wiki/Internality and Herrnstein et al . ( 1993 ).

For example, many countries publish dietary reference intakes (Trumbo et al ., 2002 or public guidance such as the UK Eatwell Guide ( https://www.nhs.uk/live-well/eat-well/the-eatwell-guide/ ).

See, Venn ( 2020 ), and the systematic literature review in Fogelholm et al . ( 2012 ), which suggests that the combination of macro nutrients is not important for weight loss.

See, for example, Monteiro et al . ( 2019 ), WHO ( 2020 ).

One problem with this approach is that on the vertical axis (price per calorie) calories appear as the denominator and the measure on the horizontal axis is increasing in calorie density. This creates a mechanical relationship in the two variables. An alternative way to measure the cost of a product is price per kilogram. However, weight is often not a particularly useful unit of comparison across different food products.

Some examples include the following. Studying variation over time across US states, Ruhm (2000) showed that diets become less healthy and obesity increases when the economic situation improves. Dehejia and Lleras-Muney (2004) found that babies conceived in recessions have a lower probability of bad outcomes, such as low birth weight, congenital malformations and post-neonatal mortality. Griffith et al . ( 2016b ) and the papers cited above showed that, when households experienced negative income shocks over the 2007–8 recession, they were largely able to maintain the quality of their diet by adjusting shopping effort (searching out products on sale, visiting more stores to find cheaper offers) and compromising on non-nutritional characteristics (e.g., switching from branded to store brand products, buying in bulk).

This literature is mainly from the United States—see the references in Allcott et al . ( 2019a )—however, it has also been put forward by public health researchers in the UK—see, for example, https://www.sheffield.ac.uk/social-sciences/news/12-million-living-uk-food-deserts-studys-shows .

See, among others, Banerjee and Mullainathan ( 2010 ), Shah et al . ( 2012 ; 2018 ), Mani et al . ( 2013 ; 2020 ), Schilbach et al . ( 2016 ).

See Read and Van Leeuwen ( 1998 ), Read et al . ( 1999 ), Trope and Fishbach ( 2000 ), Ariely and Wertenbroch ( 2002 ) and Gilbert et al . ( 2002 ).

The figure is based on data on households’ shopping baskets. Each food product is categorised based on the Nutritional Profile Model (NPM). The NPM is the measure used in the UK to categorise foods for regulatory purposes (DHSC, 2011 ). It combines measures of ‘unhealthy’ characteristics (energy, saturated fat, sugars and sodium) and ‘healthy’ characteristics (fruit, vegetable and nut content, fibre and protein) into a single index. Products are assigned a score between −15 and 30: a higher NPS indicates a less healthy food product. For example, fruits and vegetables mostly have NPS scores less than zero, while chocolate bars, sweets and crisps tend to have NPS scores that are above 5.

See Oster and Morton ( 2005 ), Ashraf et al . ( 2006 ), DellaVigna and Malmendier ( 2006 ), Bucciol ( 2012 ) and Hinnosaar ( 2016 ).

See Shapiro ( 2005 ), Milkman et al . ( 2010 ) and Sadoff et al . ( 2020 ).

The model draws on insights from the literature on collective household models; see Chiappori ( 1988 ; 1992 ), Browning and Chiappori ( 1998 ), Chiappori and Ekeland ( 2009 ), Dunbar et al . ( 2013 ) and Browning et al . ( 2013 ).

Bagwell ( 2007 ) provided a comprehensive discussion about the impact of advertising on consumer choice.

See a review of the epidemiology and public health literatures in Boyland et al . ( 2016 ), Norman et al . ( 2018 ) and Russell et al . ( 2019 ) showed that children exposed to TV adverts for less healthy foods consume more food in the immediate period after watching them; Boyland et al . ( 2016 ) and Norman et al . ( 2018 ) showed that exposure to advertising for less healthy foods also influences food preferences and purchasing patterns.

One indicator of this difficulty is the fact that there is a large industry of diet and exercise programs on which many people spend a lot of time and money, with limited success.

Subsidies for healthy foods is another potential policy; see, for example, DHSC ( 2021 ). Price floors are another policy that has been advocated by the World Health Organisation; see the evaluation of the introduction of a price floor on alcohol in Scotland in Griffith et al . ( 2022 ).

As of April 2021, over fifty jurisdictions had implemented taxes on sugary soft drinks (GFRP, 2021 ).

Dickson et al . ( 2021 ) showed evidence of reformulation in response to the UK sugar tax include; Barahona et al . ( 2020 ) showed evidence that breakfast cereal producers in Chile reformulated in response to the introduction of new labelling regulations.

A number of studies show that front-of-package labels are effective in shifting consumption towards healthier products; see, among others, Rudd Center for Food Policy & Obesity ( 2008 ), Allais et al . ( 2015 ), Barahona et al . ( 2020 ), Fichera and von Hinke ( 2020 ).

Currie et al . ( 2010 ) showed that proximity to fast food outlets increase the probability of gaining weight amongst US teenagers.

These cuts were partly due to relatively high inflation combined with the cash-terms freeze to many benefits claimed by workless households, as well as to reductions in generosity due to the introduction of universal credit. The temporary increases only unwind these cuts by a small proportion.

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