Taking measures in times of crisis: The political economy of obesity prevention in Spain

- Spanish health policy has had little effect on obesity rate, particularly among lower classes.
- Universal causes are stressed to the detriment of local contexts.
- Socioeconomic constraints are partially considered and individual responsibility is emphasized.
- The economic crisis shows the relevance of social determinants of health.
- Prevention actions aimed at citizens should be less vertical and more participatory.

This article reports on a qualitative analysis of the measures proposed at the international level, but with a special focus on those adopted in Spain during the last decade. Analyzing biomedical definition of obesity as an epidemic and costly disease, this text aims is to unpack the conceptual structure of the obesity prevention model, and to reflect on the limitations of a top-down pattern of health education and communication in health that, focusing on individual aspects of lifestyles, has involved very little citizen participation in general, and less still by those diagnosed as overweight. In the process of translating international guidelines into national action plans, the effects of historical changes and socioeconomic interests have been largely ignored, and the symbolic and material needs of the stakeholders have gone unrecognized. The discussion considers the minor role attributed in public health policy to the food and eating as social practice, to the specific structural factors that have taken on greater importance during the economic crisis - job insecurity, depressed wages, austerity measures - and to the social determinants of the differential distribution of obesity - social class, gender, ethnicity, age - and suggests that this inattention to their impact may underlie the failure of these strategies to halt the apparently growing obesity rate.