Stuck in a Circle

Stuck in a False Choice

A new analysis in the American Journal of Preventive Medicine estimates the potential cost effectiveness of preventing childhood obesity by taxing sugar-sweetened beverages, by taxing junk food advertising to kids, by policy changes for early childhood education, and by active physical education. It’s an interesting exercise in modeling what could happen and what it would cost to implement these strategies on a broad scale. But the authors’ conclusion presents us with a false choice:

The cost effectiveness of these preventive interventions is greater than that seen for published clinical interventions to treat obesity.

It’s zippy conclusion that lines up with deeply entrenched convictions about an ounce of prevention being worth a pound of cure. Two big problems get in the way of embracing this conclusion.

First is the circular reasoning. The authors concede that robust evidence is lacking for outcomes of implementing these prevention strategies on a wide scale. So the analysis is based on assumptions that, when implemented, the interventions will be effective at the levels used as inputs to this model. The conclusion of better cost effectiveness is based on an assumption of effectiveness.

The second problem is more fundamental. Why must we keep getting stuck in this false choice between preventing obesity and caring for the people who are already being harmed by it? Both prevention and clinical care are worthy endeavors.

Both of them depend upon a deeper understanding of the processes driving the increased prevalence of obesity that we are living with. Assumptions aren’t good enough.

Click here to read the analysis.

Stuck in a Circle, photograph © an untrained eye / flickr

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