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Type: Theses
Title: International evidence and experiences in regulatory approaches targeting nutritional aspects of population-level obesity prevention
Author: Sisnowski, Jana
Issue Date: 2016
School/Discipline: School of Public Health
Abstract: High prevalence of overweight and obesity remains a pressing health concern for most industrialised nations. As preventive approaches based on individuals’ capacity for behaviour change have largely failed to impact population weight, governments have begun to implement policies to regulate food environments with a view to improving nutrition and health outcomes. This thesis comprises four studies, presented as two peer-reviewed journal articles and two manuscripts, examining the evidence and experiences generated by Organisation for Economic Cooperation and Development jurisdictions’ regulatory targeting of the nutritional aspects of obesity prevention. Article 1 provides an overview of regulatory approaches addressing dietary risk factors for obesity enacted in the United States and the European Union since 2004. The findings from a systematic search of primary and secondary legislation databases demonstrate that such approaches are currently limited in reach and scope. No jurisdiction has enacted a comprehensive suite of complementary actions addressing different components of the food environment; however, the existence of discrete interventions indicates some political will for innovation. Article 2 employs a realist review perspective to systematically investigate the effect of “real-world” policies addressing population nutrition. The review examines: (1) the effect of interventions on average BMI/weight and calorie intake or proxy measures and (2) indicators measuring parameters on assumed causal pathways to changed consumption patterns. Results drawn from peer-reviewed articles and grey literature reports demonstrate that isolated regulatory interventions reliably improve intermediate outcomes, but fail to affect consumption at levels of clinical significance. Article 3 is a case study of obesity prevention in New York City. Combining a documentary review and key informant interviews, the analysis demonstrates that there is scope to redefine municipal responsibilities for public health. In particular, results indicate that policy change in the emerging and contested field of regulatory obesity prevention needs strong political leadership. Executive-driven nutrition policy is shown to offer an expedient mechanism to protect expert-designed measures from the influence of competing interests. The analysis also demonstrates the importance of building community support, the value of incremental change, and the impact of contentious public discussion on social norms around nutrition. Article 4 considers how local governments can prepare for systematic engagement in population-level obesity prevention, using the 2011 South Australian Public Health Act as an example. Analysis shows that South Australia can potentially employ a range of levers to address food environments and nutrition under this legislation; particularly through the Health Minister’s authority to issue Codes of Practice relating to specified industries or activities based on health concerns. The operationalization of this and other legal instruments for nutritional obesity prevention should be supported by a greater focus on whole-of-government responsibility for public health in general purpose legislation. Together, these studies give a nuanced picture of the current state of regulatory obesity prevention as it relates to nutrition policy and food environments. As well as indicating directions for future research, particularly regarding the long-term effects of existing interventions and the assessment of new policy approaches, this body of work provides insights and clear recommendations for future food and obesity prevention policy.
Advisor: Street, Jacqueline Mary
Braunack-Mayer, Annette Joy
Handsley, Elizabeth
Dissertation Note: Thesis (Ph.D.) (Research by Publication) -- University of Adelaide, School of Public Health, 2016.
Keywords: nutrition policy
public health
noncommunicable disease prevention
obesity and overweight
government regulation
Research by Publication
Provenance: This electronic version is made publicly available by the University of Adelaide in accordance with its open access policy for student theses. Copyright in this thesis remains with the author. This thesis may incorporate third party material which has been used by the author pursuant to Fair Dealing exceptions. If you are the owner of any included third party copyright material you wish to be removed from this electronic version, please complete the take down form located at:
DOI: 10.4225/55/590945a2576bc
Appears in Collections:Research Theses

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