Maziak W, Ward K D, Stockton M B
Department of Health and Sport Sciences, and Center for Community Health, The University of Memphis, Memphis, TN 38152, USA.
Obes Rev. 2008 Jan;9(1):35-42. doi: 10.1111/j.1467-789X.2007.00376.x.
Childhood obesity is increasing worldwide, raising alarm about future trends of cardiovascular disease, diabetes and cancer. This article discusses what may underlie our failure to respond effectively to the obesity epidemic, and presents a wider perspective for future research and public health agendas. So far targeting individual-level determinants and clinical aspects of childhood obesity has produced limited success. There is growing interest in understanding the wider determinants of obesity such as the built environment (e.g. walkability), social interactions, food marketing and prices, but much needs to be learned. Particularly, we need to identify distal modifiable factors with multiple potential that would make them attractive for people and policymakers alike. For example, walking-biking-friendly cities can reduce obesity as well as energy consumption, air pollution and traffic delays. Such agenda needs to be driven by strong evidence from research involving multi-level influences on behaviour, as well as the study of wider politico-economic trends affecting people's choices. This article highlights available evidence and arguments for research and policy needed to curb the obesity epidemic. The upstream approach underlying these arguments aims to make healthy choices not only the most rational, but also the most feasible and affordable.
儿童肥胖问题在全球范围内日益严重，这引发了人们对心血管疾病、糖尿病和癌症未来发展趋势的担忧。本文探讨了我们未能有效应对肥胖流行的潜在原因，并为未来的研究和公共卫生议程提供了更广阔的视角。到目前为止，针对儿童肥胖的个体层面决定因素和临床方面的干预措施取得的成功有限。人们越来越关注理解肥胖的更广泛决定因素，如建筑环境（如步行便利性）、社会互动、食品营销和价格，但仍有许多需要学习的地方。特别是，我们需要确定具有多种潜力的可改变的远端因素，这些因素对个人和政策制定者都具有吸引力。例如，对步行和骑自行车友好的城市可以减少肥胖，以及能源消耗、空气污染和交通延误。这样的议程需要基于涉及行为的多层次影响的研究的有力证据，以及对影响人们选择的更广泛政治经济趋势的研究。本文强调了遏制肥胖流行所需的研究和政策的现有证据和论点。这些论点所基于的上游方法旨在使健康选择不仅是最合理的，而且是最可行和最实惠的。
