The Wedding of Psyche

3 Ways Much of Obesity Policy Is Like Human Sacrifice

Reporting on the state of obesity in America this week leaves the impression that much of obesity policy is like ancient human sacrifice rituals. Here are a few reasons:

  1. It’s our custom. The response to rising rates of obesity has followed an unwavering formula since the trend was first detected. We promote the current notion of a healthy diet and plenty of physical activity. When the trend persists, we just push harder. It’s as if the only tools we have are a hammer and a screwdriver, so everything looks like nails and screws.
  2. We have no evidence it works. We don’t mean to say that a healthy diet and physical activity are not good. But it’s not so clear that promoting them has the power to change the dynamics of the obesity epidemic. All the while we have pursued different flavors of the same approach, we have seen no real change in the epidemic. Though we may be reaching the limits of how many people are susceptible to obesity, severe obesity rates continue to rise. Yet we keep seeing headlines like “Obesity Crisis May Be Stabilizing.” Such headlines have been coming at us for nearly a decade now.
  3. Fear trumps curiosity. Human sacrifice never worked, but people were driven to it by fear. Despite substantial gaps in our knowledge about the causes and effective treatments for obesity, we find little curiosity to drive an ambitious research agenda. Fear mongering about obesity doesn’t seem to generate curiosity. Google Trends for “cancer research” and “obesity research” reports 20 times more interest in cancer research. Many in public health circles seem to think they know all the answers — encourage people to eat less and move more. Problem solved.

This week, the Trust for America’s Health and Robert Wood Johnson Foundation released a collection of reports under the banner of The State of Obesity: Better Policies for a Healthier America. But reading through the reports, a more accurate subtitle would be More of the Same Policies for a Healthier America. Nowhere in this report is there a call for innovative research. No mention of treatment can be found. The emphasis of the report is on “success worth heralding” that is “early and fragile,” along with a call to “focus on some of the highest-impact approaches.” What are these high-impact approaches? They are:

Implementation of policies to: increase physical activity before, during and after school; offer nutritious food and beverages at school; make healthy, affordable food prevalent in all communities; ensure healthy food and beverage marketing practices; engage healthcare professionals to more effectively prevent obesity both within and outside the clinic walls, in collaboration with community partners; and intensify our focus on prevention in early childhood.

The trouble is that evidence for the impact of these policies, especially for a “high impact,” is lacking.

While we stubbornly pursue a mostly unchanging strategy, people are harmed. They are harmed by limited access to the few evidence-based treatments that are available. They are harmed by the shame and blame that is heaped upon them for a disease that is mostly driven by biological susceptibility. And they are harmed by the slow rate of progress toward truly evidence-based prevention and treatment strategies.

We need to invest in the science of obesity and let go of the mythology.

Click here for more from Reuters on the current status of obesity rates in the U.S., click here for the report from the Robert Wood Johnson Foundation and the Trust for America’s Health, and click here for the Strategic Plan for NIH Obesity Research.

The Wedding of Psyche, Painting by Edward Burne-Jones from WikiArt

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2 Responses to “3 Ways Much of Obesity Policy Is Like Human Sacrifice”

  1. September 12, 2014 at 2:01 pm, Deborah Cohen said:

    I agree we are not pursuing policies that would make a quick dent in obesity.
    The most promising policies are :
    1) Standardizing portion sizes, the way we standardize the size of alcoholic beverages. That way people wouldn’t automatically be served more than one portion, but they could still order more, if one portion wasn’t enough for them.
    2) Limiting impulse marketing (also the way we have done for tobacco and alcohol). No candy at the cash register, no junk food on end aisle displays or in vending machines. There are multiple ways to limit strategies that encourage people to make bad choices without careful deliberation.
    3) Massive counter-advertising. It worked for tobacco– but these days we are afraid to say the truth about the impact of processed foods. For every food add that promotes and unhealthy choice there should be one to counter it. This would be a lot stronger than trying to ban food advertising.

    • September 12, 2014 at 2:23 pm, Ted said:

      I agree that your ideas have merit. I am also mindful of the complexity of obesity and the need for validation of promising strategies. That leaves me thinking there are no bad ideas, but plenty that are untested and therefore open to questions.