Paper short abstract:

This article raises the question of whether the limited importance given Spanish public health policies to macro/micro structural factors and to social determinants of health that account for the unequal social distribution of obesity may be the cause of the apparent failure to reduce its incidence.

Paper long abstract:

Taking as its point of departure the WHO's warning at the beginning of the 21st century about the challenges posed by the global obesity epidemic, this article analyzes the principal strategies in Spain for combating what is understood as a serious public health problem that occasions enormous health care expenditures.

Locating the principal causes in processes of modernization, the Spanish health authorities have adopted measures during the past decade that show, at least on paper, that the state has tried to position itself as sociomedical regulator of healthy lifestyles at the same time that it extends responsibility to other social sectors such as the food and restaurant industries and local administrations. In practice, however, most efforts are directed to the general public and are based almost exclusively on nutritional education and public awareness campaigns about healthy eating. These strategies reduce costs in a crisis times, but judging by the continuing increase in obesity over the past five years, they are also less than effective. State interventions in social sectors that have helped to create and perpetuate an "obesogenic environment" are limited to the purely cosmetic, such as nutritional labeling and portion size, and rely heavily on medicalization, stressing the individual's responsibility for dietary regulation and weight reduction, and lifestyle change through regular exercise.

This article raises the question of whether the limited importance given in public health policies to micro/macro structural factors and to social determinants of health may be the cause of the apparent failure to reduce its incidence