Shining the ‘Spotlight’ on Obesity

In his seminal book, ‘The Strategy of Preventive Medicine,’ the English epidemiologist Geoffrey Rose suggested that true epidemiology involves looking not just at the cause of a disease, but at the ‘cause of the cause’ and the ‘cause of the cause of the cause’ [1] . A quarter of a century earlier, Susan Sontag (‘Illness as Metaphor’) stated that: ‘any important disease whose causality is murky and for which treatment is ineffectual, tends to be awash in significance’ [2] . Marry these two thoughts, apply them to obesity, and you could come up with a different approach to managing the problem than what has been standard to date. Explanations for the obesity pandemic have been many and varied. However, its concurrent onset in many countries and rapid rise over the past 3–4 decades suggests a pervasive underlying driver. There is a need therefore to consider beyond immediate (proximal) drivers such as diet and inactivity, which help explain individual variations in body weights in a benign environment, to more distal drivers that may help to explain its ubiquitousness in a variety of populations ( fig. 1 ). This is the basis of the cross-European SPOTLIGHT (Sustainable Prevention of Obesity Through Integrated Strategies) project [3] . SPOTLIGHT is a multi-centre approach designed to provide evidence-based support for community-focussed multi-level interventions in obesity. It acknowledges the generally ineffectual approaches to date of focussing at the individual level and the potential significance of investigating determinants at a more distant level. A question remains however as to how distal the levels of causality that are considered need to be. Accumulating evidence suggests that certain factors in modern growth-oriented, market-based economies make them more or less likely to produce negative effects of overconsumption, such as obesity. Several researchers have considered the effects of inequality: Marmot and collegues [4] , for example, have shown the impact of income differentials and workplace status on a range of health and social problems. Pickett et al. [5] and Wilkinson and Pickett [6] showed a relationship between inequality, as measured by the ratio of the difference between the richest and poorest 20% of income earners (RP20), and obesity in OECD countries, but no relationship between obesity and average income. Received: March 27, 2012 Accepted: March 28, 2012 Published online: April 21, 2012