Obesity is increasing at epidemic rates around the world (International Agency for Research on Cancer 2002). Within the US, the epidemic is clearly shown spreading across the country (see map).
Public health recommendations call for adults to stay within the recommended BMI range (18.5-24.9) and avoid weight gain. Accordingly, in its Global Strategy on Diet, Physical Activity, and Health, the WHO identifies energy balance and maintenance of a healthy weight as a public health priority and charges member states to develop and support multisectoral programs to address weight, diet, and physical activity; thereby decreasing noncommunicable disease world wide (World Health Organization 2004).
Programmatic and realistic recommendations include interventions that integrate physical activity and diet for more sustained behaviour change. At the grade school level, Gortmaker and colleagues have successfully integrated approaches to diet, activity, and TV viewing into the school curriculum, achieving a sustained intervention and significant increases in fruit and vegetable consumption, reduction in TV viewing (Gortmaker, Cheung et al. 1999) and in a second study also reducing obesity (Gortmaker, Peterson et al. 1999) . In adult populations, a randomized trial achieved sustained weight reduction over two years through diet and activity interventions by health care providers, and resulted in reduced progression to diabetes among men and women at elevated risk (Knowler, Barrett-Connor et al. 2002).
Whole community interventions are exemplified by one in Belgium that included multiple strategies (media campaign, environmental approaches, use of pedometers, and local projects) and resulted in a significant increase in the proportion of the population achieving a target of 10,000 steps per day (De Cocker, De Bourdeaudhuij et al. 2007).
CDC recommendations for combating overweight and obesity can be found at http://www.cdc.gov/obesity/recommendations.html. These include community based strategies; school based obesity prevention; and clinical guidelines.
Given the preponderance of evidence that sugar-sweetened beverages increase the risk of obesity and diabetes, a growing number of interventions are now focused on strategies to reduce intake through substitution of other beverages that do not contribute to the excess energy intake. In addition to individual behaviour change, strategies that alter access through limiting on-school campus sale and increasing taxation or removing tax protection may further reinforce behaviour change.