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By Melissa Sweet . Published by ABC Books , June 2007 . Paperback, 471 pages with index. RRP $32.95. ISBN 9780733321818 .

Reviewed by Jane Dixon

National Centre for Epidemiology and Population Health, Australian National University

I begin this review by declaring a prior interest: I was interviewed by Melissa Sweet in the course of her research and she and I have had several conversations about any duplication with my book (co-edited with Dorothy Broom) on the same topic, The 7 deadly sins of obesity (University of NSW Press, 2007). I will also admit upfront that I view our respective books as offering two complementary perspectives. The Dixon and Broom book provides in-depth coverage on seven social trends that are influencing rising obesity rates in Australia and has relatively little to say about the practical steps that can be taken to halt the trajectory. Sweet's book reverses the emphasis and is a highly literate and evidence-based self-help guide for families and communities concerned to act now on the available evidence.

Sweet begins her book by explaining the nature of the ‘conspiracy’ that features in the title. “It's called the modern world,” she argues. Popularising the social epidemiology of obesity, she continues: “Being caught up in this conspiracy is like being swept along by a fast-flowing river. All the forces are pushing you in one direction [away from healthy lifestyles] and it takes some effort and strength to go against the flow.” The book then dedicates itself to identifying “the effort and strength” that are required to counteract the conspiracy.

One further building block is erected in the book's early pages, and that is to demolish the utility of individual or societal obsessions about weight. Sweet argues that the bodily impact of the modern world will most effectively be challenged through an obsession with “gaining health rather than losing weight”.

The book is constructed as a survival guide to the ‘big fat conspiracy’ and is organised in three sections. The first aims to help readers reframe their perspective on childhood obesity, away from the media and government-dominated one of shame-and-blame and parental responsibility. It describes the contours of the modern world that encourage unhealthy lifestyles: time pressures, car dependence, and the relentless child-centred marketing and advertising of foodstuffs. Two chapters lay out the latest evidence about how to understand children's bodies in terms of healthy weight and size, and why healthy lifestyles for children are so important.

Sections two and three are devoted to what families and communities can do to seize greater control over their environments. The section on families provides guidance on parenting styles, modelling healthy lifestyles and assessing how to go about making changes to family routines and dynamics. It is peppered throughout with quotes from interviews that Sweet conducted with parents, community leaders, academics and professionals. From the science, it distils tips and principles for behaviour change.

The section on communities provides examples as to how schools, governments, child care services and other sectors are acting to support improvements to diets and physical activity. There are inspirational case studies, which are followed by three appendices: 10 pages of links to resource materials and two well-organised sections with chapter-by-chapter references and endnotes that provide further useful references for each chapter. This last section would make an excellent springboard for ‘town-hall meetings’, convened to galvanise community action around healthy lifestyles. Academics and journalists working in the public health and obesity fields will also find Sweet's appendices to be extremely useful.

The book's style and contents are, however, aimed squarely at parents and social commentators who are concerned about the health and well-being of future generations. The layout is reader-friendly; double-spaced text interspersed with shaded boxes highlighting the main points.

In a recent issue of this journal, Professor Boyd Swinburn wrote a review of an American book (Susan Okie's Fed up! Winning the war against childhood obesity), which covers similar ground to the Sweet book. The positive qualities of that book are reflected in Sweet's book: “a very readable, reliable, and informative book that translates the scientific evidence for a lay audience”. Moreover, The big fat conspiracy addresses two of the three criticisms that Swinburn levels at Okie's book. First, this is a book that is firmly rooted in the Australian context and as such is relevant to our social and political conditions. Second, while she draws on the biomedical paradigm, Sweet's analysis comes from a social ecology perspective that is entirely congruent with the emphases adopted by the International Obesity Taskforce and the World Health Organization technical papers on obesity.

Like the Okie book, this one does not contain an equity perspective. It could be that Sweet is adopting the Geoffrey Rose adage on the need to address societal-level problems by enrolling the whole population in any change strategy. However, planners of public health interventions recognise that the “strength and effort” required by less advantaged communities are of a different order and magnitude to the capacities available to educated and affluent communities. Describing the operation of a twin population and at-risk community strategy could usefully form the basis of the next book on the subject of obesity prevention.