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A major deficiency of paradigms of obesity has been their omission of factors which influence both extra- and intra- individual variations in energy balance—in particular the influence of environment, biology and behavioural factors on equilibrium body fat levels.
Environmental influences. Abnormalities of biology or psychology cannot explain the big increases in obesity in modern societies. For this we need to look to the environment. Environmental influences on obesity occur either within a macro or micro environmental setting and can have either a physical or socio-cultural basis.
Macro environmental influences at the physical level are those components of the larger world such as the food supply or technology. At the socio-cultural level, the macro environment represents population and community attitudes, values and norms. The micro environment refers to the immediate physical and social environments such as in the home, amongst peers and social contacts, pressures and attitudes in the family and immediate community. All of these environments can influence body fat levels through the mediation of energy intake or energy expenditure.
Environmental influences represent the public health arm of the obesity problem. While these exist, programs aimed at influencing behaviour at the individual level could only be expected to have limited effect. Any comprehensive approach to the prevention and treatment of overfatness and obesity must then consider both the macro and micro environments.
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