Banwell Cathy, Hinde Sarah, Dixon Jane, Sibthorpe Beverly
National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia.
Eur J Public Health. 2005 Dec;15(6):564-8. doi: 10.1093/eurpub/cki034. Epub 2005 Sep 1.
In Australia, as elsewhere in the developed world, researchers and policy makers have expressed concern about rising rates of obesity. Explanations for the increasing weight of the Australian population have focused on both declining levels of physical activity and changes in food consumption patterns.
The primary aim of our study was to determine the views of obesity, dietary and physical activity experts, about the most important social trends that have contributed to Australia's obesogenic environment over the last 50 years. We used a modified Delphi technique to successfully contact 50 such experts to obtain their views on this topic. The process involved a semi-structured interview with each expert to identify the trends and then a round of ranking of the trends by these experts. A second aim was to comment on the utility of expert opinion in public policy.
The experts identified the most important social trends as 'escalating car reliance', 'increasing "busy-ness" and lack of time' and 'rising use of convenience and pre-prepared food'. Because we asked experts to explain their responses, a diversity of opinion emerged on both the aetiology of these trends and how the environment is embodied to produce rising levels of obesity.
We reflect on the implications of this dissensus for the utility of expert opinion in public policy and argue that one way through the smorgasboard of competing expert explanations for health differentials, including obesity levels, is practice-based evidence gathered through community level action research.
在澳大利亚，与其他发达国家一样，研究人员和政策制定者对肥胖率不断上升表示担忧。澳大利亚人口体重增加的原因既包括身体活动水平下降，也包括食物消费模式的变化。
我们研究的主要目的是确定肥胖、饮食和身体活动方面的专家对过去50年中导致澳大利亚致胖环境的最重要社会趋势的看法。我们采用改良的德尔菲技术成功联系了50位此类专家，以获取他们对该主题的看法。该过程包括对每位专家进行半结构化访谈以确定趋势，然后由这些专家对趋势进行一轮排序。第二个目的是评论专家意见在公共政策中的效用。
专家们确定最重要的社会趋势为“对汽车的依赖不断增加”、“日益忙碌和缺乏时间”以及“方便食品和预制食品的使用增加”。由于我们要求专家解释他们的回答，因此在这些趋势的病因以及环境如何导致肥胖水平上升方面出现了多种观点。
我们思考了这种分歧对专家意见在公共政策中的效用的影响，并认为在众多关于健康差异（包括肥胖水平）的相互竞争的专家解释中找到出路的一种方法是通过社区层面的行动研究收集基于实践的证据。
