Table 1.

The nine multilevel responsibilities and examples of strategies required for tackling obesity.

	Level of responsibility	Some action strategies
1	National	Prioritize the problem with focus on health inequalities and the socially disadvantaged; Health/Environment impact assessments; Legislation—“sin” taxes, ban sugary drinks in schools and junk food advertising
2	Food system	Equitable, sustainable food security; Food industry to reformulate products with healthier ingredients; Marketing transparency; Food labeling
3	Education system	Nutrition, cooking, activity, and lifestyle education throughout school years; Infrastructure for regular exercise; Monitoring weight and eating disorders?; School lunches, Eating manners
4	Medical system	Health care system; Motivational, non-judgmental, shared-decision approach to obesity counseling; Insurance coverage; Personal example
5	Public health	Health literacy for breast feeding, nutrition, and lifestyle choices according to social context; Positive deviance examples
6	Local authority, municipality	Promoting safe, leptogenic environments for all ages, especially in deprived residential areas; Farmers markets; Healthy Cities initiatives; Milan urban food policy pact
7	Society, community	Family and communal meals; Cultural attitudes (norms, values, social support); Peer groups; Binge eating; Social media and influencers; Role models; Gender sensitivity; Civil society; Media
8	Parental	Intra-uterine effects; Breast feeding; Parenting skills; Nutrition and lifestyle education; Regulation of screen time; Personal example
9	Individual	Lifestyle choices; Self-management, self-efficacy skills; Stress management; Coping strategies; Learned behaviors; Personality; Sense of humor
		Biology: Genetics; Epigenetics; Metabolic efficiency; Endocrine status; Energy homeostasis; Brain reward neurocircuitry