The EU faces alarming increases in obesity and associated health problems such as cardiovascular disease, cancer and diabetes. Worldwide, some 10 % of people are excessively overweight and obesity is on track to overtake smoking as the single biggest cause of preventable cancer in some countries. The issue is complex and rooted in the inactive nature of modern life characterized by extensive car use and widely available, affordable, and often unhealthy food.

Focusing specifically on adults, the EU-funded SPOTLIGHT project built on evidence that lifestyle-related interventions should not just deal with single social or environmental aspects but rather target a combination of individual, family, community, organizational and societal elements – the ‘causes of the causes’.

SPOTLIGHT analyzed around 80 community projects aimed at preventing obesity in different EU countries. Studies in Denmark, the Netherlands and the UK highlighted reliable funding and local community involvement – as well as balancing the need for rapid delivery with long-term continuation – as vital to the success and lasting impact of such projects.

SPOTLIGHT then developed an interactive, map-based database of these projects and a model for integrated multi-level approaches that could be applied by local authorities and public health practitioners across Europe. It disseminated the findings and recommendations among policymakers and scientists to support the implementation of such approaches. The aim was to counteract unhealthy behavior, prevent obesity and related chronic diseases, and reduce health inequalities linked to social status.

‘SPOTLIGHT has increased understanding of the relationship between social and physical environments, the importance of context around individuals in terms of obesity and the role of this context in things like sleep, diet, physical activity and health inequalities,’ says project coordinator Jeroen Lakerveld of Amsterdam UMC, location VUmc in the Netherlands. ‘We also better understand the factors that determine the success or failure of interventions.’

Mapping risk

Using Google Street View, SPOTLIGHT developed a tool for assessing environmental characteristics related to diet and physical activity within neighborhoods. It covered walking- and cycling-related features such as the presence of foot and bike paths, street lighting, pedestrian crossings, traffic calming measures, and bike rental facilities. It also looked at the availability of public transport; aesthetics including green spaces, litter and graffiti; land use; and the presence of grocery stores, food outlets and areas for exercise and recreation.

In one instance, 128 street segments in four Dutch urban neighborhoods of varying socio-economic status and housing density were assessed using the tool, which helped to confirm its reliability. A wider mapping exercise also encompassing Budapest, London, Paris and the Belgian city of Ghent, showed how likely residents of 60 neighborhoods were to become obese. This was combined with health and behavioral information for more than 6 000 residents of these neighborhoods in order to find links between environment and lifestyle.

Collection of Europe-wide data and gathering of expert and target-group perspectives enabled SPOTLIGHT to define the elements necessary to change lifestyles at different levels of society and in various contexts. The results were translated into dissemination materials designed for different stakeholders to support development and implementation of intervention approaches at individual, team and organizational levels.

Long-term prevention

Experience gained from SPOTLIGHT will maximize use of state-of-the-art knowledge, help policymakers invest in long-term prevention efforts and stimulate scientists to further explore ways of reducing obesity and associated social inequality.

‘Much of the learning has fed into new projects, analyses and approaches, and helped to shift the status quo among researchers,’ says Lakerveld. ‘Also, as well as more than 30 peer-reviewed scientific articles and methodological tools, the project resulted in three PhD theses and more than 15 Master’s theses.’