Potato, Potahto, Prevention and Treatment for Obesity

Earlier this year, a leading group of public health experts in obesity wrote of “patchy progress on obesity prevention.” They lamented “overly simple dichotomies” that “dominate the thinking about obesity and its solutions.” Prevention and treatment is one of the false dichotomies they named. A new publication of 15-year outcomes from the Diabetes Prevention Program (DPP) underscores the absurdity of this tug of war.

At the end of the original DPP study in 2001, participants in all three arms of the study were offered lifestyle training. Folks in the intensive lifestyle intervention group got twice-a-year reinforcement and folks in the metformin group got unmasked metformin. With follow-up through January, 2014, the lifestyle group was still 27% less likely to develop diabetes than the folks who were originally assigned to the control group.

So is this the prevention of diabetes or the treatment of obesity? And why does it matter?

It only matters because many health plans still use archaic exclusions for the treatment of obesity as an excuse to block access to this kind of care for people with obesity. But certainly, people who are committed to public health or to the health of individuals with obesity should be equally committed to such interventions. And such interventions should not be seen as diverting resources from efforts to change the dynamics that have brought us an excess of obesity. Both endeavors are important. When two-thirds of the population has excess weight or obesity, access to evidence-based obesity care is essential for preventing chronic diseases.

In cardiovascular disease, such arguments are long gone. Whether we’re treating hypertension and high cholesterol or preventing strokes and heart attacks, it just doesn’t matter.

Call it treatment or call it prevention. Just take away the roadblocks and get it done.

Click here to read the study and here to read a companion commentary.

Baby Potatoes, photograph © Jimmy Cardosi / flickr

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November 2, 2015