Confessing to the Truth of Complexity in Obesity Policy

Complexity makes lousy sound bites. That basic fact of political life makes good health policy for obesity maddeningly difficult. We start with the fact that obesity is a complex, chronic disease. And then that complexity is multiplied by a complex environment. Health policies to reduce obesity must influence that environment.

To make good policy for obesity, confessing to the truth of complexity is the necessary first step.

In two new papers, two distinguished groups of scholars present this complexity and the need to address it with rigorous research.

Transparency, Empiric Evidence, and Subjective Values

In the International Journal of Obesity, Molly Richardson and colleagues present a compelling case for reconciling empiric evidence with subjective values to develop obesity related health policies. They describe methods for collecting scientific evidence and standards for evidence that can support policymaking.

We have rich resources and a wide range of methods for collecting evidence, which Richardson et al describe in excellent detail. But the problem often comes down to “subjectivity of the standards of evidence for decision making.”

Debates of policies to reduce sugar consumption provide a vivid example. On one side, we have Marion Nestle laughing because the answers are so obvious. On another, we have Nancy Kass saying “Public policy cannot be enacted simply based on a good idea.”

The answer, says Richardson, is two-fold. First, we need more research that can prove or disprove the effectiveness of an intervention. Second, we need transparency about subjective values. They play an important role in policymaking. They need explicit acknowledgement.

The Complex Relationship of Environment, Policy, and Eating Behaviors

In Obesity, Marlene Schwartz and colleagues describe the need for a more sophisticated understanding of how policy and the environment interact with individuals and their eating behaviors. Policy works at a distance from an individual. But it has the potential to have a big effect by reaching many people.

The complexity comes with reactance, compensatory behavior, and social norms. People rebel when told what to do. Thus we have a lively “Freedom Caucus” in Congress. When sugar-sweetened beverages are restricted, people might consume more alcohol. Social norms change in unpredictable ways. Policymakers have a mixed record from trying to influence those norms.

Sooner or later, we must confess. Health policy is “an unbelievably complex subject.” It gets even more complex when we start dealing honestly with obesity.

Click here for the paper by Richardson et al and here for the paper by Schwartz et al. And here, you’ll find an overview of a special issue of Obesity on the complexity of appetite regulation that explains the illustration above.

Before the Confession at the Entrance to a Village Church, painting by Vasily Vereshchagin / WikiArt

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March 17, 2017