Obesity is preventable but there is still no single model for prevention and no country has managed to convincingly reverse the growing trend, estimated in 2016 to be 650 million adults. Globally, the increase in obesity will have catastrophic consequences for the economy and for population health. ‘Desperate times breed desperate measures’ and this paper outlines the shift that many governments are being forced to make to halt the growth of obesity. Moving to the extremes means that the planning and coordination of strategies places an equal emphasis on top-down (policy, regulation, and taxation) and bottom-up (local actions, self-help groups, volunteerism) interventions. There is still an important role for communication, the middle-ground between the extremes of bottom-up and top-down, but governments must use ‘power-over’ measures to take control of the causes of obesity. Bringing the public with them will be crucial to success and can be achieved through a sharing of resources, a ‘power-with’, to combine top-down and bottom-up interventions in the future.
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