Obesity is Not an Epidemic, it’s a Business Model

Outside of the rare occurrences where obesity is genetic, it is not something that just happens to us. It is the result of a food system that strongly encourages unhealthy eating. But this is good news. If obesity is largely a human-organised system rather than an epidemic, we can change that system.

Ozempic - a miracle weight loss drug?

Do you remember when you heard the news that there was a COVID-19 vaccine? At first, I didn’t dare believe it – I didn’t want to get my hopes up. But when it turned out that it wasn’t some overexaggerated clickbait story, I felt so relieved. Suddenly, the seemingly never-ending pandemic had an end in sight, and it felt like we could finally move forward again.

These last years, that same sense of hope has been echoing in the coverage of a new type-2 diabetes drug called Ozempic. Have we really found a miracle drug against unwanted and unhealthy excess weight? Even though reality turns out to be a bit more nuanced, the collective hope at the first reports was remarkable. As if, here too, we are all waiting for a miracle solution to a hopeless crisis: the obesity epidemic. But what if it's our society, not the individual, that needs to be cured of obesity?

Ozempic was originally approved to treat people with Type 2 diabetes. There has been a spike in demand with people capitalising on its weight loss benefits. Photo via Getty. 

The link between our living environment and obesity 

Obesity is consistently reported as an “epidemic” in health reports. The word choice portrays obesity as a natural phenomenon that “just happens to us”, very much like a disease that manifests itself beyond our control. The term carries with it an ingrained fatalism. So, of course, we will have high hopes when a medical cure presents itself for this metaphorical epidemic.

However, obesity is not an infectious disease or some novel virus. It’s the inevitable result of a food system strongly encouraging unhealthy eating habits. Let’s take a look at the situation in Flanders, the Dutch-speaking part of Belgium with a population of almost 7 million, and where I’m writing this article from. According to a study done by Sciensano, the Belgian research institute of National Public Health and Animal Welfare, 88% of Flemings live in a so-called ‘food swamp’, an area with more unhealthy than healthy retailers.¹ 

A “food swamp” is similar to a “food desert”, where access to fresh fruit and vegetables is limited, but “food swamps” are further characterised by a high level of fast food outlets and highly processed foods.

According to another study by Sciensano, Flemish supermarkets fill 75% of their shelves with unhealthy foods.² And that is a huge problem since Belgians buy 85% of their food in supermarkets.³ Moreover, in the Netherlands, the Superlist study shows that not only supermarkets’ products but also their promotions and shopping environment encourage excessive consumption of sugars and fats.⁴ 

The Flemish Institute for Healthy Living (Vlaams Instituut Gezond Leven), which issues advice on healthy eating, bluntly characterises Flanders as an ‘obesogenic food environment’.⁵ As an individual, you can still make healthy choices, but it requires lots of effort, motivation, know-how and time to ignore the easy, (seemingly) cheapest but ultimately unhealthy food options. It’s therefore alarming that Flanders’ deepest food swamps and unhealthiest supermarket assortments are often found in socially vulnerable neighbourhoods.

Learn more about how your eating habits are influenced by where you live

Behind this toxic food environment lies a systemic, economic dynamic. After all, addictive fast food forms an interesting business model. Ultra-processed foods are exclusively made by for-profit businesses, and are considerably more profitable than other types of food.⁶ There are financial winners in this system (like supermarkets and large food companies), while our healthcare system and a large group of individual citizens, mostly with little food skills or financial resources, bears the cost.

Obesity isn’t inevitable - how Rikolto is turning the tide

In some ways, this is good news. If obesity is often driven by human-organised systems rather than an uncontrollable epidemic, we have the means to change that system. After all, a society doesn’t have to be a victim of its own food environment - it can design it in a healthier way. At Rikolto, an international NGO working towards sustainable food systems, we focus on two important food environments in Europe: schools and supermarkets.

Developing healthy eating habits at school

Many schools have already put food literacy on the teaching menu. But we also have to keep in mind that schools are our children’s primary food environment from infancy to adolescence. Apart from home, it’s the place where we learn the most about food and develop eating habits. With an integrated school policy, we can instil healthy eating habits in our youngsters from the very beginning. 

Currently, Rikolto works with 12 schools in Leuven, 5 schools in Ghent and 5 secondary schools in Antwerp every year. 

We are currently working on this across Europe through the SchoolFood4Change programme. As part of this programme, we train cooks, caterers and public procurers at the city level to make school meals more nourishing for children and sustainable for the planet. We encourage schools to go further than just what’s on the menu and to really transform their food culture  - by promoting food literacy, providing healthy and sustainable food, partnering with farmers and local actors, and implementing a food policy in each school. This is what we call a ‘whole school food approach’. 

A whole-school food approach is important because no European country is on track to meet its obesity reduction goals by 2025, and agriculture accounts for one-third of global greenhouse gas emissions.⁷ By reaching children with delicious, nutritious and sustainable food, we can start to address both these problems while inspiring the younger generation to form lifelong healthy eating habits.

Obesity in childhood is likely to continue into adulthood and is associated with chronic psychosocial and heart problems, as well as early death.

Nudging healthy and sustainable food choices in supermarkets 

Our second focus lies with supermarkets. In Europe, we buy most of our food in supermarkets so they are a particularly influential link in the food chain. They hold the levers to make healthy eating the standard for everyone, not just for a privileged minority who has the necessary time, knowledge and resources. Through factors like their marketing strategy, shopping environment and overall policy, supermarkets can nudge our food choices to be more healthy, plant-based and sustainable. 

Moreover, through their buying practices, supermarkets can also stimulate upstream supply chain actors to deliver more healthy and sustainable food. Consequently, this would enable young people to continue their healthy and sustainable eating habits after they leave school. That is why we monitor and compare supermarkets’ efforts and work with them to find ways to make effective progress. One example are the in-store nudging experiments Carrefour recently carried out together with Ghent University, as part of the EIT Food project ‘SUCCESS’, headed by Rikolto.  For example, supermarkets can increase the sale of plant-based alternatives by positioning them on the shelves next to meal kits. 

Superlist is a long-term research project being led by Rikolto. It examines how supermarkets are using their policies, assortment, promotions and store environment to make sustainable food the norm.

How policy can help detoxify our food environment

There is a lot of enthusiasm for a healthier food system among schools, local authorities, caterers, farmers and, last but not least, citizens – whether as pupils, parents or consumers. However, there is often a lack of time, resources and a guiding framework to structurally embed good practices. And even though supermarkets do recognise their social role, they often seem caught in a commercial logic, driven by a hyper-competitive context.

However, that context is not a done deal. That’s exactly why our political leaders must take charge. With clear guidelines, legislation, appropriate incentives and suitable investment,  they can make a significant difference.  They can create a level playing field for economic actors like supermarkets to fully commit to healthy food options. They can create the framework in which food swamps transform into food oases. Our political leaders must recognise that they hold the power to detoxify our food environment.

Of course, the challenges are huge, but so are the potential social gains - from longer, healthier lives to sustainable food systems that protect our planet. By making our food environment healthier, step by step, we can crack the system behind obesity. And then, maybe, we won’t act like we just found out the moon is covered in gold when the next miracle cure for obesity hits the papers.