The socio-cultural macro environment represents the values, expectations and attitudes of the wider social environment. Community attitudes to convenience foods and leisure saving technologies are examples. A hedonistic and materialistic atmosphere where moderation is considered unfashionable is common in many sectors of Western societies. Where this is coupled with easy access to palatable, high-fat foods and reduced necessity for energy expenditure, obesity levels are likely to increase. In Australia, an advertising expenditure of $1 million per day on food stuffs, confectionery and soft drinks is combatted by an equivalent amount per year spent on public health education, some of which is presumably aimed at eating for reduced body fatness.

With increased affluence there is also an increased opportunity for over-indulgence through the social processes of dining out, business lunches, social festivities and celebrations. There are also cultural and ethnic differences in food preferences and exercise availability: European-style food is usually higher in fat, for example, than Asian foods; some foods, such as pork, have traditionally held a higher social status than vegetables or fruit in different cultures; opportunities for exercise are reduced for some ethnic and religious groups such as Middle Eastern and Muslim women.

Male attitudes to health are known to differ from those of females. Men have typically been less responsive to health messages, attend doctors less often, but suffer more from most forms of illness than women. This has been attributed to social and attitudinal differences between the sexes—men feel more isolated and vulnerable if they admit any concern about their health. Overcoming these attitudes is a major obstacle to providing acceptable fat loss programs for men. Cultural attitudes in some ethnic groups also mean that partner support for fat loss practices, particularly by males for females, is low or non-existent.

Social attitudes to physical activity can influence participation. Increased interest in jogging in the 1970s for example, followed by aerobics and then weight training in the 1980s, formed the pattern of a social ‘trend’. It is doubtful, however, if these have compensated for the decreases in physical activity that have occurred at the workplace or the decreases in other ‘incidental’ activity in day-to-day life. Multi-event sports like triathlons have become popular, but this is usually only amongst the very fit. Fun runs and community activities, however, have the potential to attract large numbers of people who may otherwise remain inactive. Socially acceptable forms of activity differ according to ethnic group, nationality, age and gender. Being fat carries a negative status, but more so for women, and being inactive also carries a negative status, but more so for men.

The influence of the socio-cultural macro environment has been particularly noticeable in countries like the UK and the Netherlands. The overall nutrient intake in the food in both countries is similar, but the obesity rate in Britain is increasing at a much greater rate than in Holland. According to Dr Wim Saris, from the University of Limburg, this might be put down simply to the fact that only 3 per cent of British transport involves the bicycle, whereas the equivalent figure is over 30 per cent in the Netherlands.

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