Why Are Some Population Interventions for Diet and Obesity More Equitable and Effective Than Others? The Role of Individual Agency
Open accessAbstract
We now find ourselves in a world in which one in three adults is overweight or obese [1].Unhealthy diets are an important determinant of overweight and obesity and also contribute directly to a variety of other causes of disability and death.In fact, together with physical inactivity, dietary risk factors are responsible for 10% of disability-adjusted life years lost globally [2].Like many risk factors, unhealthy diets are not evenly distributed in the population.In most developed countries, and increasingly in developing countries too, obesity and unhealthy diets are more common in more socioeconomically disadvantaged groups [3,4].Socioeconomic inequalities in health and disease are at least partly due to these inequalities in diet and obesity.Many governments have responded to the challenge of unhealthy diets and obesity with strategies that focus on advice, guidance, and encouragement to adopt healthier lifestyles.In England, the government's current "flagship" obesity prevention programme is Change4Life.This social marketing campaign uses mass media and other avenues to inform and educate the public about the harms of excess weight and the benefits of being more active and eating more healthfully.Simple strategies for changing behaviour are also offered.Similar programmes operate elsewhere, including MangerBouger in France and Let's Move in the United States. Summary Points• Public health interventions can be described according to where they lie on two continuums: the population and high-risk approaches anchor one continuum, while the other continuum captures the personal resources (or "agency") individuals have to use to benefit from interventions.
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These efforts have had little impact on obesity prevalence, in part because healthy foods and participating in sports and other active lifestyles are not accessible or affordable for people with low income and autonomy.
“These have had little impact on obesity prevalence, in part because healthy foods and participating in sports and other active lifestyles are not accessible or affordable for people with low income and autonomy.55–59”
From Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults (2024) · cites this paper as [56]
The Conclusion says high-agency diet and obesity interventions are likely to be less effective, and the ‘Why Are Low-Agency Population Interventions Underused?’ section says low-income parents often struggle to afford fruit and vegetables. The paper does not establish that these efforts have had little impact on obesity prevalence or that sports and other active lifestyles are inaccessible or unaffordable. Page numbers are unavailable in our copy. (LLM, conf=0.86)
Experimental — accuracy not yet measuredMarked inequalities exist in the treatment of obesity.
“Marked inequalities exist in the treatment of obesity, 103,104 and the disconnect between accessibility to these new treatments and need risks exacerbating this problem.”
From The societal implications of using glucagon-like peptide-1 receptor agonists for the treatment of obesity (2025) · cites this paper as [104]
The Summary Points and Conclusion discuss socioeconomic inequalities in obesity and the equity of population prevention interventions, not inequalities in access to obesity treatment. Searches for treatment access, bariatric surgery, pharmacotherapy, and clinical interventions found no passage establishing the attributed claim. (LLM, conf=0.76)
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- Authors
- Adams, J., Mytton, O., White, M., & Monsivais, P.
- Affiliations
- University of Cambridge (GB)
- Corresponding author
- Adams, Jean
- Venue
- PLOS Medicine
- Publisher
- Public Library of Science (PLoS)
- Published
- 2016-04-05
- Volume
- 13
- Issue
- 4
- Pages
- e1001990
- ISSN
- 1549-1277 (ISSN-L)
- 1549-1676
- PMC
- PMC4821622
- OpenAlex
- W2325559971
- Cited by
- 492
- References
- 29
- Citations by year
- 2026: 34 · 2025: 51 · 2024: 66 · 2023: 61 · 2022: 74 · 2021: 65 · 2020: 43 · 2019: 30 · 2018: 34 · 2017: 24 · 2016: 8
- FWCI
- 31.73
- Type
- journal article
- Language
- en
- Update notices
- correction (2016-05-24)
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS Medicine (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Apollo (University of Cambridge) (submittedVersion, cc-by)
- Funders
- Wellcome Trust
- United Kingdom Clinical Research Collaboration
- Cancer Research UK
- National Institute for Health and Care Research
- British Heart Foundation
- Centre for Diet and Activity Research
- Medical Research Council (MR/K023187/1, MC_UU_12015/6)
- Economic and Social Research Council (ES/G007462/1)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Health Sciences › Health Professions › Pharmacy › Obesity and Health Practices
- Health Sciences › Health Professions › General Health Professions › Public Health Policies and Education
- Keywords
- obesity prevention, unhealthy diet, population-level interventions, individual agency, socioeconomic inequalities in health, health equity, social marketing campaign, behavior change, public health policy
- MeSH terms
- Health Equity, Diet, Government Agencies, Health Policy, Health Promotion, Humans, Health Knowledge, Attitudes, Practice, Life Style, Motor Activity, National Health Programs, Obesity, Preventive Health Services, Public Health, Risk Factors, Program Evaluation, Health Behavior, Program Development, Risk Assessment, Government Regulation, Risk Reduction Behavior, Healthcare Disparities, Consumer Health Information
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