Out of Order

Obesity Policy: Incomplete or Completely Off Target?

In a pair of point-counterpoint essays, the Journal of  Health Politics, Policy, and Law is presenting two frank assessments of obesity policy: incomplete or completely off target. John Cawley offers the more optimistic assessment. He suggests that some of the present, incomplete efforts, if combined, could produce important changes.

Malana Essington and Attila Hertelendy paint a picture of policies that are completely off target. They say that “a long history of public policy has done little to effectively reduce obesity among children” because of inconsistent application of best practices for scientific evidence review. Consequently, “public policy may be targeting the wrong behaviors and the wrong problem.”

Introducing these essays, Harold Pollack says:

I find both essays chastening when set against the overstated claims made on behalf of many prevention interventions, and when set against the huge underlying public health problems we seek to address.


It’s interesting that Cawley and Pollack both mention and then completely dismiss the “dramatic” benefits of bariatric surgery, characterizing it as less than ideal and an “ironic exception” to the ineffectiveness of everything else. Essington ignores it completely.

At least Cawley acknowledges the dangers of nihilism. He proposes building upon what works modestly. He and others would do well to consider also building upon what works well — bariatric surgery — and looking for ways to overcome its limitations.

In our experience, efforts to address obesity are indeed impaired by bias that favors “predrawn conclusions,” as Essington suggests. But ironically, her own discussion of the problem is weakened by defining obesity exclusively as a dietary problem. She rejects a medical definition for obesity, saying that it “absolves individuals of personal responsibility for diet and health and wellness.”

These observations that nothing is working particularly well in obesity should be a call to action. Claims that childhood obesity is declining come from cherry-picked statistics put forward by people who are defending tired, ineffective policies.

Progress will not come until we invest adequately in innovative research to fully define the biological basis for obesity. We will have to look beyond simplistic concepts of lifestyle, diet, and exercise. Our current understanding of this disease is woefully incomplete.

Click here for the introduction by Pollack, here for Cawley’s perspective, and here for Essington’s.

Out of Order, photograph © Jeffrey Melton / flickr

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March 4, 2016