Can We Stop Faking the Answers to Obesity?
Let’s get something straight. We do not know the answers to obesity. This observation is neither bad nor good. It’s simply true. U.S. News offers a harsh assessment of progress against obesity during the Obama administration:
Obesity increased overall despite an administration that made addressing it a priority.
Progress against obesity has been limited, and rates among adults continued to climb from 33.7 percent when Obama took office to 37.7 percent by 2014, according to the Centers for Disease Control and Prevention. In addition, Dr. Tom Frieden, the CDC’s director, recently said the agency had failed to reach its goals for tackling childhood obesity.
Pretending that this is not so gets in the way of progress.
Obesity is harder to prevent than cancer. It’s also harder to treat. Cancer deaths have dropped by 25% since they peaked in 1991. Driving down smoking rates has prevented millions of cancer deaths. At the same time, cancer detection and treatment keeps getting better. So people diagnosed with cancer are living longer, healthier lives than ever before. That progress resulted from decades of intensive research.
By contrast, obesity rates continue to climb, despite our best efforts to prevent it. Good evidence for obesity prevention that makes a big difference has been elusive. We have evidence-based treatments that help. But we need more and better options.
Bariatric surgery offers dramatic and lasting benefits for many people. It’s uniquely effective for putting type 2 diabetes into remission. But those benefits involve tradeoffs and a degree of commitment that is daunting. Behavioral treatment and pharmacotherapy can be very helpful, but the efficacy is extremely variable. Some people have dramatic, lasting results. Others see very little benefit.
Behind all of this is a simple fact. Obesity is a complex collection of diseases that we don’t yet understand very well. Many people assume it’s simply a problem of poor nutrition and sedentary lifestyles. Those are important factors, but many others come into play.
Neuroscience, endocrinology, microbiology, physiology, population health, and many other research disciplines are bringing better insight into obesity. But we have a long way to go.
We cannot get there without recognizing the challenge we face and committing the resources necessary to meet it. Until then, obesity prevalence will remain stubbornly high. The burden of disease that results from obesity will continue to grow.
The first step is to admit to ourselves that we don’t have the answers we need. Then we can pursue those answers in earnest.
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January 21, 2017