Sacks G, Swinburn B, Lawrence M
School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia.
Obes Rev. 2009 Jan;10(1):76-86. doi: 10.1111/j.1467-789X.2008.00524.x. Epub 2008 Aug 26.
A comprehensive policy approach is needed to control the growing obesity epidemic. This paper proposes the Obesity Policy Action (OPA) framework, modified from the World Health Organization framework for the implementation of the Global Strategy on Diet, Physical Activity and Health, to provide specific guidance for governments to systematically identify areas for obesity policy action. The proposed framework incorporates three different public health approaches to addressing obesity: (i) 'upstream' policies influence either the broad social and economic conditions of society (e.g. taxation, education, social security) or the food and physical activity environments to make healthy eating and physical activity choices easier; (ii) 'midstream' policies are aimed at directly influencing population behaviours; and (iii) 'downstream' policies support health services and clinical interventions. A set of grids for analysing potential policies to support obesity prevention and management is presented. The general pattern that emerges from populating the analysis grids as they relate to the Australian context is that all sectors and levels of government, non-governmental organizations and private businesses have multiple opportunities to contribute to reducing obesity. The proposed framework and analysis grids provide a comprehensive approach to mapping the policy environment related to obesity, and a tool for identifying policy gaps, barriers and opportunities.
需要采取全面的政策措施来控制日益严重的肥胖流行问题。本文提出了肥胖政策行动（OPA）框架，该框架是在世界卫生组织《饮食、身体活动与健康全球战略》实施框架的基础上修改而来，旨在为各国政府系统地确定肥胖政策行动领域提供具体指导。提议的框架纳入了三种不同的应对肥胖的公共卫生方法：（i）“上游”政策影响社会的广泛社会和经济状况（如税收、教育、社会保障）或食物及身体活动环境，以使健康饮食和身体活动选择更加容易；（ii）“中游”政策旨在直接影响人群行为；（iii）“下游”政策支持卫生服务和临床干预。本文还给出了一组用于分析支持肥胖预防和管理的潜在政策的网格。根据澳大利亚的情况填写分析网格后呈现出的总体模式是，各级政府、非政府组织和私营企业的所有部门都有多种机会为减少肥胖做出贡献。提议的框架和分析网格提供了一种全面的方法来描绘与肥胖相关的政策环境，以及一种识别政策差距、障碍和机会的工具。
