Five Mistakes Holding Us Back from Reducing Obesity

A few mistakes holding us back from making progress against obesity come up again and again, testing the patience of people who devote their careers to addressing obesity as the serious chronic disease that it is.

1. Simplistic presumptions get repeated with a frequency that is mind numbing. A prime example is the stale assertion that obesity is simply the result of consuming more calories than one burns. Peter Attia offers an explanation (here) for why this simplistic thinking is inadequate. David Allison presented a thoughtful review at the recent ASN conference, “Advances and Controversies in Clinical Nutrition,” that you can read about here. The bottom line: human energy consumption, storage, and expenditure is far more complex than simplistic rules of thumb would lead you to believe. The body adapts and the efficiency of each of these processes varies dramatically. Everyone is different and even within a single person, these functions can make huge shifts in response to changes in circumstance.
    
2. Timid research results from simplistic assumptions and a reluctance to challenge conventional thinking. Behavioral tools for diet and exercise — as important as they are — keep getting tested and re-tested with similar results. Meanwhile, probative research to challenge assumptions about mechanisms and causes for obesity is much more rare. Krista Casazza published a thoughtful perspective on this problem in Clinical Obesity (here).
    
3. Blame and shame are tools that healthcare professionals employ commonly in addressing obesity, more often than not without even realizing it. Both implicit and explicit bias against people with obesity is well-documented. All too often, any discussion about obesity begins and ends with a provider telling a patient, “you should lose some weight,” as if that were an inspired thought that had never occurred to a person with obesity. New research from Kimberly Gudzune (here) documents that such interactions lead to worse clinical outcomes.
    
4. Wasteful animus too often fills public dialogue about obesity policy and strategies to address the problem. Just as patients face blame and stigma, experts in food production and research are marginalized by ad hominem attacks that get in the way of productive dialogue and problem-solving. Read more on this problem here.
    
5. Preoccupation with weight and appearance obscures the real goal of treating obesity — achieving optimal health and a sustainable healthy weight for the long term. So much energy goes into how much weight loss can happen right now. People all but ignore the long-term outcomes that matter more. Michael Rosenbaum has assembled substantial data to support the belief that the treatments for long-term maintenance of a healthy weight in people with obesity will need to be different than the treatments to achieve acute weight loss. You can read more from Rosenbaum on this subject here.

 
“Success does not consist in never making mistakes, but in never making the same one a second time.” — George Bernard Shaw

Road Block, photograph © Anna Lee / flickr

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