An obesogenic island in the Mediterranean: mapping potential drivers of obesity in Malta.

OBJECTIVE: The prevalence of childhood and adult obesity in Malta is among the highest in the world. Although increasingly recognised as a public health problem with substantial future economic implications for the national health and social care systems, understanding the context underlying the burden of obesity is necessary for the development of appropriate counter-strategies. DESIGN: We conducted a contextual analysis to explore factors that may have potentially contributed to the establishment of an obesogenic environment in Malta. A search of the literature published between 1990 and 2013 was conducted in MEDLINE and EMBASE. Twenty-two full-text articles were retrieved. Additional publications were identified following recommendations by Maltese public health experts; a review of relevant websites; and thorough hand searching of back issues of the Malta Medical Journal since 1990. SETTING: Malta. SUBJECTS: Whole population, with a focus on children. RESULTS: Results are organised and presented using the ANalysis Grid for Elements Linked to Obesity (ANGELO) framework. Physical, economic, policy and socio-cultural dimensions of the Maltese obesogenic environment are explored. CONCLUSIONS: Malta's obesity rates may be the result of an obesogenic environment characterised by limited infrastructure for active living combined with an energy-dense food supply. Further research is required to identify and quantify the strength of interactions between these potential environmental drivers of obesity in order to enable appropriate countermeasures to be developed

The strategies of alcohol industry SAPROs : Inaccurate information, misleading language and the use of confounders to downplay and misrepresent the risk of cancer

Peer reviewe

Voluntary agreements between government and business - a scoping review of the literature with specific reference to the Public Health Responsibility Deal.

OBJECTIVES: A scoping review was conducted to synthesise the findings of evaluations of voluntary agreements between business and government. It aimed to summarise the types of agreements that exist, how they work in practice, the conditions for their success and how they had been evaluated. METHODS: Voluntary agreements were included if they involved a transparent signing-up process and where businesses agreed to carry out specific actions or to achieve specific outcomes. Studies of any design published in English were included. RESULTS: 47 studies were identified. Voluntary agreements may help to improve relationships between government and business, and can help both parties agree on target-setting and data-sharing. Governments may also use the experience to help develop subsequent legislation. For voluntary agreements to be successful, targets should be ambitious and clearly defined, with robust independent monitoring. Public knowledge of agreements can help encourage participation and ensure compliance. CONCLUSIONS: If properly implemented and monitored, voluntary agreements can be an effective policy approach, though there is little evidence on whether they are more effective than compulsory approaches. Some of the most effective voluntary agreements include substantial disincentives for non-participation and sanctions for non-compliance. Many countries are moving towards these more formal approaches to voluntary agreements

Investigating system-level drivers of obesity with adolescents: a group model-building exercise

Background: Capturing voices of young people on issues that affect them is crucial for developing effective, relevant public health policies. We report the use of group model building with young people to identify their views on drivers of adolescent obesity. This is the first stage of the Co-Create project, designed to develop—with adolescents—potential interventions to reduce obesity prevalence. Methods: Co-Create uses an innovative, participatory, multi-staged methodology, underpinned by a systems approach. We followed a group model building script to generate causal loop diagrams, with 16-18-year-olds from three UK schools (mean number of participants per school 14), of factors perceived to contribute to diet and physical activity and, therefore, obesity. Schools were recruited using a sampling frame to represent three quartiles from the index of multiple deprivation ranking of local authorities. Findings: All causal loop diagrams showed that participants identified advertising, the low cost of and easy access to unhealthy food, social media, lack of physical activity, and stress, body image, and other mental health factors as drivers of diet and physical activity and, therefore, obesity. There were no notable differences in themes between the causal loop diagrams. Interpretation: Use of group model building, a participatory systems methodology, captures obesity drivers pertinent to young people, the ways these drivers are intertwined, and potential leverage points for action. This process creates a helpful abstraction from individual behaviour by drawing out system-level, rather than individual, drivers of obesity, although findings are limited to the perceptions of participants and these results represent only urban environments. The results from this first stage of the Co-Create project help generate system-level hypotheses on policy responses to obesity that resonate with young people. In subsequent Co-Create workstreams, adolescents will be recruited to explore interventions to be discussed with policy makers and other stakeholders. The potential effects of the co-created, obesity-related interventions will be simulated using systems dynamics modelling. Funding: EU Horizon 20/20 research and innovation programme for Sustainable Food Security (grant agreement 774210)

Decision-making criteria among European patients: exploring patient preferences for primary care services

Background: Health economics preference-based techniques, such as discrete choice experiments (DCEs), are often used to inform public health policy on patients’ priorities when choosing health care. Although there is general evidence about patients’ satisfaction with general-practice (GP) care in Europe, to our knowledge no comparisons are available that measure patients’ preferences in different European countries, and use patients’ priorities to propose policy changes. Methods: A DCE was designed and used to capture patients’ preferences for GP care in Germany, England and Slovenia. In the three countries, 841 eligible patients were identified across nine GP practices. The DCE questions compared multiple health-care practices (including their ‘current GP practice’), described by the following attributes: ‘information’ received from the GP, ‘booking time’, ‘waiting time’ in the GP practice, ‘listened to’, as well as being able to receive the ‘best care’ available for their condition. Results were compared across countries looking at the attributes’ importance and rankings, patients’ willingness-to-wait for unit changes to the attributes’ levels and changes in policy. Results: A total of 692 respondents (75% response rate) returned questionnaires suitable for analysis. In England and Slovenia, patients were satisfied with their ‘current practice’, but they valued changes to alternative practices. All attributes influenced decision-making, and ‘best care’ or ‘information’ were more valued than others. In Germany, almost all respondents constantly preferred their ‘current practice’, and other factors did not change their preference. Conclusion: European patients have strong preference for their ‘status quo’, but alternative GP practices could compensate for it and offer more valued care

Health and economic consequences of projected obesity trends in Malta

Background: Globally, there is increasing concern about the potential health and economic consequences of current obesity trends. This study assessed the impact of unchecked obesity and the benefits of reducing population weight levels in Malta. Methods: Body mass index rates, disease burden and direct health care costs for breast and colon cancer, coronary heart disease, diabetes, hypertension and stroke in Malta were projected to 2035 using a two-stage microsimulation model. Two scenarios were modelled for population weight reduction. Research: By 2035, uncontrolled overweight and obesity are projected to result in a 62% increase in stroke prevalence, a 27% increase in obesity-related cancers and a 16% increase in prevalence of hypertension. The prevalence of coronary heart disease developing as a consequence of obesity is expected to double within the next two decades. Associated cumulative direct health care costs will amount to around €814 million by 2035. However, a 5% reduction in the average population body mass index by 2035 is projected to result in a saving of €141 million in health expenditure on obesity-related conditions over the intervening 20 years. Conclusion: These findings have important implications for obesity policy in Malta and other European nations with similar health systems and levels of population obesity, thus highlighting the need for effective population-level preventive strategies.peer-reviewe

Последствия прогнозируемых тенденций ожирения для здравоохранения и экономики на Мальте

Общая информация: Во всем мире потенциальные последствия текущих тенденций в области ожирения для здравоохранения и экономики вы зывают нарастающее беспокойство. В настоящем исследовании дается оценка последствий неконтролируемого распространения ожирения и той пользы, которую инициативы по снижению массы тела могут прине сти для населения Мальты. Методы: С помощью двухэтапного имитационного микромоделирования были спроецированы, на период до 2035 г., показатели индекса массы тела, бремени болезней и прямых затрат на медицинское обслуживание в связи с раком молочной железы и раком толстого кишечника и прямой кишки, ишемической болезнью сердца, диабетом, гипертонией и инсультом на Мальте. Были смоделированы два сценария снижения массы тела у населения. Исследование: По прогнозу, к 2035 г. неконтролируемое распространение избыточной массы тела и ожирения приведут к повышению распространенности инсультов на 62%, связанных с ожирением онкологических заболеваний – на 27% и гипертонии – на 16%. Распространенность ишемической болезни сердца, возникающей в результате ожирения, как ожидается, за ближайшие два десятилетия удвоится. Связанные с этим суммарные прямые затраты на медицинское обслуживание к 2035 г. вырастут приблизительно до 814 млн евро. Вместе с тем, снижение среднего индекса массы тела среди населения на 5% к 2035 г. позволит в ближайшие 20 лет снизить расходы системы здравоохранения, связанные с про блемой ожирения, на 141 млн евро. Вывод: Результаты исследования важны для разработки стратегий борьбы с ожирением на Мальте и в других европейских странах со схожими системами здравоохранения и аналогичной распространенностью ожирения. Полученные данные подчеркивают необходимость эффективных стратегий профилактики на уровне всего населенияpeer-reviewe

How the food, beverage and alcohol industries presented the Public Health Responsibility Deal in UK print and online media reports

The Public Health Responsibility Deal (RD) in England is a public–private partnership between government, industry and other stakeholders aiming to improve public health in four key areas: food, alcohol, health at work and physical activity. Wider literature shows that industry engages in framing of public health policy problems, solutions and its role in solutions that is favourable to its interests. As part of an evaluation of the RD, we conducted a media analysis to explore how industry spokespersons (from commercial enterprises, trade associations and social aspects/public relations organisations) represented the RD in newspaper and online reports. We systematically searched databases indexing articles of British national newspapers and the online news services of national broadcasters for articles published between 2010 and 2015. After application of inclusion criteria, we identified 247 relevant articles. We extracted direct quotations by industry spokespersons and analysed them thematically. Media reporting about the RD provided industry spokespersons with a high-profile platform to present frames relating to food, beverages and alcohol that were favourable to advancing or protecting industry positions and agendas. Framing of issues addressed responsibility for public health problems, policy options and the role of industry, also legitimising industry spokespersons to advocate a position on how public health policy should evolve. Media analysis can elucidate industry discourses around public health and examine their engagement in framing to extend their influence in public health policy

Obstacles to the recognition of medical prescriptions issued in one EU country and presented in another

A study involving the presentation of 192 Belgian or Finnish prescriptions in pharmacies in five other member states was undertaken to assess whether, as envisaged by European Union law, prescriptions issued in one member state are recognized by pharmacists in another and to identify factors that influence such decisions. Overall, pharmacists were willing to dispense in 108 cases. Detailed results show important differences depending on the country where prescriptions are presented and whether prescriptions were written by INN and in English, as opposed to prescriptions written by brand in a national language

What policies are there and what policies are missing? A Photovoice study of adolescents' perspectives on obesity‐prevention policies in their local environment

Ana Rito: Departamento de Alimentação e Nutrição do INSA; Centre for Studies and Research in Social Dynamics and Health - CEIDSS.Part of Special Issue: The CO‐CREATE Project:Co‐creating policy with youthThe aim of this study was to investigate adolescents' critical awareness of whether obesity prevention policies targeting physical activity (PA) and nutrition were operating in their local community. Participants were 41 adolescents (aged 16–18, 90%women) recruited from three communities in Poland. Prior to this study, they were involved in obesity-prevention participatory initiatives (conducted within the CO-CREATE project), where obesity-related public policy limitations were analyzed in a youth-led discussion. A Photovoice exercise was designed to capture obesity-related public policies that were either present or absent in young people's local environments. The photographs (N=213) were coded and mapped according to the policy themes they illustrated, using the MOVING and NOURISHING frameworks. The public policies represented in the photographs are most frequently related to: healthy retail or food service environments; food advertising or promotion; structures and surroundings that promote PA; and infrastructure and opportunities that support public or active transport. Adolescents are critically aware of the presence and lack of specific public policies operating in their local environment, particularly policies affecting structural aspects of food and PA environments. Policy-oriented photovoice exercises may prompt critical awareness among adolescents and empower them to contribute to obesity prevention policy processes.KEYWORDSadolescence, framework, obesity prevention policies, PhotovoiceAbbreviations:CO-CREATE, confronting obesity: co-creating policy with youth; PA, physical activity; SES, socioeconomic status; YPAR, youth-led participatory action research.Received: 11 April 2023 Revised: 15 June 2023 Accepted: 13 July 2023DOI: 10.1111/obr.13617This is an open access article under the terms of theCreative Commons Attribution-NonCommercialLicense, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.The CO-CREATE project has received funding from the European Union's Horizon 2020 research and innovation program under grant agreement no. 774210.info:eu-repo/semantics/publishedVersio