Toward the reduction of population obesity: macrolevel environmental approaches to the problems of food, eating, and obesity.

The authors reviewed the evidential basis of three environmental approaches to reducing population obesity: What are the effects of (a) taxing or subsidizing foods, (b) manipulating the ease of food access, and (c) restricting access to certain foods? A narrative review evaluated evidence using National Heart, Lung, and Blood Institute criteria. There was strong evidence that subsidization influences food purchases, but not necessarily food consumption or body weight. Ease of food access may influence food purchases, and possibly food intake and body weight. Data on restriction were lacking. More studies are needed to justify that altering these macro-environmental variables will necessarily reduce population obesity. A proposed conceptual model posits that the steps through environmental interventions may exert intended and unintended influences on body weight and obesity prevalence. Contemplated policy changes should weigh scientific evidence with social judgments and values concerning changes to the environment.