Obesity is a global public health problem that contributes to poor health and reduced quality of life for many.1 Average body weights have been increasing and obesity rates have been rising in most countries in the world over the past three decades in adults and children.1-4 While there is some indication that rates have levelled off they remain high. In the US, about 35 per cent of the adult population are obese and another third are overweight.1-4 In the UK, adult obesity is increasing. In 2011, 26 per cent of men and 29 per cent of women were obese.5 Despite clear recognition of the problem obesity presents to health and quality of life, efforts to reduce obesity have not met with any wide-scale success.
An article in Science in 2003 suggested a paradigm shift in prioritising strategies to reduce obesity.6 It used an energy balance framework to examine how obesity became so prevalent in the US and considered the likely success of different strategies to reduce body weight and obesity. The term 'energy gap' was coined to estimate the degree of behaviour change required for specific changes in body weight. It concluded that the energy gap for preventing weight gain was small and that a 'small changes' approach to preventing excessive weight gain could be effective in helping combat obesity.
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