Public Health Nutrition

Research Paper

Policy options for obesity in Europe: a comparison of public health specialists with other stakeholders

Laura I González-Zapataa1a2a3 p1 c1, Carlos Alvarez-Dardeta1a3, Rocio Ortiz-Moncadaa1, Vicente Clementea1a3, Erik Millstonea4, Michelle Holdswortha5, Katerina Sarria6, Giulio Tarlaoa7, Zoltanne Horvatha8, Tim Lobsteina4 and Savvas Savvaa9

a1 Department of Public Health, Observatory of Public Policies and Health University of Alicante, Alicante, Spain

a2 Nutrition and Dietetics School, University of Antioquia, Medellín, Colombia

a3 CIBER en Epidemiología y Salud Pública (CIBERESP), University of Alicante, Alicante, Spain

a4 Science and Technology Policy Research, University of Sussex, Brighton, UK

a5 Institut de Recherche pour le développement (IRD), Montpellier, France

a6 Preventive Medicine & Nutrition Clinic, School of Medicine, University of Crete, Greece

a7 Institute of International Sociology, Gorizia, Italy

a8 Department of Dietetics and Nutrition Sciences, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary

a9 Research and Education Institute of Child Health, Strovolos, Cyprus


Objective To explore policy options that public health specialists (PHS) consider appropriate for combating obesity in Europe, and compare their preferences with those of other stakeholders (non-PHS).

Design Structured interviews using multicriteria mapping, a computer-based, decision-support tool.

Setting Nine European countries.

Subjects A total of 189 stakeholders. Twenty-seven interviewees were PHS and non-PHS included food, sports and health sectors.

Measurements A four-step approach was taken, i.e. selecting options, defining criteria, scoring options quantitatively and weighting the criteria to provide overall rankings of options. Interviews were recorded and transcribed to yield qualitative data.

Results The PHS concur with other stakeholders interviewed, as all emphasised the importance of educational initiatives in combating obesity, followed by policies to improve community sports facilities, introduce mandatory food labelling and controlling food and drink advertising. Further analyses revealed several significant differences. The non-PHS from the private sector ranked institutional reforms favourably; the PHS from non-Mediterranean countries supported the option of medicines to prevent obesity; and those PHS from Mediterranean countries endorsed the use of activity monitoring devices such as pedometers. As far as appraisal criteria were concerned, PHS considered efficacy and the economic impact on the public sector to be the most important.

Conclusion There is clear consensus among PHS and other stakeholders concerning the need for a package of policy options, which suggests that European-wide implementation could be successful. However, it would be advisable to avoid more contentious policy options such as taxation until future changes in public opinion.

(Received October 19 2007)

(Accepted April 03 2008)


c1 Corresponding author: Email

p1 Correspondence address: Dpto. Enf. Comunitaria, Med Preventiva y Salud Pública, e Historia de la Ciencia – Área de Medicina Preventiva y Salud Pública, Campus de Sant Vicente del Raspeig. Ap. 99 E-03080, Spain