Who Cares Why Obesity Is Going Global?

The new publication in Lancet presents a stark picture of obesity going global:

If post-2000 trends continue, the probability of meeting the global obesity target is virtually zero. Rather, if these trends continue, by 2025, global obesity prevalence will reach 18% in men and surpass 21% in women; severe obesity will surpass 6% in men and 9% in women. Nonetheless, underweight remains prevalent in the world’s poorest regions, especially in south Asia.

A companion commentary notes that the many calls to action on global obesity are ungrounded by evidence:

Many proposals exist for comprehensive sets of advisory and legislative policies aimed at tackling obesity. Such presentations greatly outnumber interventions that have robust evidential support. Evaluations that use methods that allow for reasonable causal inference have been applied to several of these approaches with generally disappointing  results, yet they have had little influence on the flow or content of the many “calls to action” on global obesity.

Everyone, it seems, has solutions for obesity. Eat well! Let’s move! Put healthy foods everywhere! Activate employers! Make schools the heart of health! Integrate physical activity every day every way! Tax those darn sodas!

But curiosity about obesity itself is totally lacking. As thoughtful as these two papers in Lancet are, you will find no consideration of the need to understand obesity and its causes. These papers and most policy proposals for addressing obesity simply assume that obesity is a nutrition problem.

The reality is that the growing prevalence of obesity is a problem of complex, adaptive systems. Those systems lead people and animals to store too much energy in the form of adipose tissue that harms their health. Without understanding these systems and how they interact. Taking random shots at this problem will have little effect.

We have spent three decades pushing hard on simplistic solutions for obesity that simply don’t work. It’s time to get serious about research to deliver a deeper understanding of the problem and solutions grounded in evidence for their effectiveness.

Click here for the Lancet publication of the NCD Risk Factor Collaboration. Click here for the companion commentary. Click here for perspective on obesity as a problem of complex adaptive systems.

Earth, photograph by Luca Parmitano via flickr

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April 5, 2016