Winter's Path

Top 10 Advances of 2016 in Obesity and Health

If you’re looking for signs of progress in obesity and health, you can find it in 2016. Obesity is a tough nut to crack, so we don’t have breakthroughs and cures to report – yet. What we have is solid advances that will make life and health better for people concerned about obesity. Here’s our top ten.

1. Less Shaming. Progress reducing the reliance on shaming is number one because bias gets in the way of all other progress on obesity. Feeling shamed harm a person’s health and leads to more obesity. Presumptions and biases lead to reliance on ineffective strategies for addressing obesity. Fortunately, we have objective evidence this year of progress toward less shame and blame directed at people living with obesity.

2. Better Reporting. Health reporting about obesity has always skewed toward sensational headlines, headless belly pictures, and simplistic solutions. But 2016 was different, thanks largely to two organizations. In May, the New York Times began serious, solid reporting on obesity with an ongoing series titled “The Science of Fat.” Others are following this lead. Adding to the progress, the Obesity Action Coalition published a gallery of bias-free imagery. As the gallery gains traction, we’re seeing more often depicted as a human condition, not a disembodied aberration.

3. Prevention That Works. In March, CMS announced that Medicare will begin paying the YMCA and other providers to deliver lifestyle coaching known as the Diabetes Prevention Program (DPP) to people at risk for developing diabetes. This represents a huge step forward for delivering preventive care for obesity. Likewise, results from the REACH US project showed how community based prevention can actually reduce the prevalence of obesity in disadvantaged communities.

4. Metabolic Surgery Guidance. The superiority of metabolic surgery for putting type 2 diabetes into remission is becoming unmistakeable. Thus, an international collection of 45 medical groups published a consensus calling for its broader consideration, even in people with mild obesity and type 2 diabetes.

5. New Dietary Guidelines. The 2015 Dietary Guidelines for Americans actually debuted in January 2016. Despite all the fussy nitpicking that ensued, these guidelines improved substantially upon the last edition.

6. Declining Sugar Consumption. A red hot focus on sugar has produced significant drops in U.S. consumption of sugar and other sweeteners since 1999 – both in beverages and in total. The new Nutrition Facts label will highlight added sugar in food products and keep the pressure on.

7. Smarter Employers. Wellness programs are getting smarter and steering away from weight-based penalties that serve no purpose other than shifting health costs to people with pre-existing health problems. Employers increasingly recognize that those penalties alienate employees.

8. Cardiovascular Outcomes. Three different treatments for type 2 diabetes have now demonstrated a reduced risk for bad cardiovascular outcomes such as heart attacks and death. All of them – empagliflozin, liraglutide, and semaglutide – work without increasing a person’s weight and may even lead to weight loss. Empagliflozin has just been approved by FDA to reduce the risk of cardiovascular death in patients with both type 2 diabetes and heart disease. Semaglutide is a new drug, submitted in early December for FDA approval.

9. Fitness. Broad understanding of the profound health effects of physical activity means that fitness is now on its way to becoming a vital sign. A new scientific statement this year from the American Heart Association could well be a tipping point.

10. Mindfulness. Interest in mindfulness techniques for healthier eating behaviors and obesity care has been growing for years. Now a randomized, controlled trial has shown that mindfulness techniques can add to the the effectiveness of behavioral therapy for obesity.

Despite the need to do much more, 2016 has been a year for some good advances in obesity and health.

Winter’s Path, photograph © Scott McCracken / flickr

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December 26, 2016

5 Responses to “Top 10 Advances of 2016 in Obesity and Health”

  1. December 26, 2016 at 7:44 am, Susan Burke March said:

    Thanks for this compilation of important information. Happy New Year and here’s to a healthy 2017.

  2. December 26, 2016 at 9:49 pm, Bob Merberg said:

    Ted: I’m a fan of ConscienHealth. I appreciate the intelligent skepticism, fair-mindedness, and compassion you bring to it.
    I have thoughts about a couple of the items on your Top 10 Advances list, and appreciate the opportunity to share them here.

    Regarding #3, Prevention That Works… I understand that the Diabetes Prevention Program has drawn a consensus that it is the most evidence-based lifestyle weight-management program demonstrating long-term results. But I think the book is not yet closed on it. As you know, the DPP focuses on fat-gram tracking and, ultimately, calorie counting. I question whether the emphasis on these activities, especially the fat-gram tracking, is consistent with current thinking about dietary fat (including much of the research reported in the articles cited in the 2nd item on your list, “Better Reporting”). Also, it’s worth noting that the original DPP studies strongly promoted meal-replacement products, especially Slim Fast (which, along with some other Pharma and food companies, supported the DPP studies with free product). Finally, we often overlook that the original studies had a “run-in” process to screen out ineligible participants, whereby prospective participants tracked their dietary intake and activity for 3 weeks, largely to screen out non-adherents. None of this refutes the DPP findings, but it highlights the often overlooked fact that the DPP is a restrictive diet — no more or less so than any other diet that calls itself a “lifestyle program” — that (effective or not) may not reflect current research or be readily accepted by mainstream contemporary populations.

    Regarding #10, Mindfulness — I encourage your readers to follow your link to the original study. I agree with your statement that the study showed “that mindfulness techniques can add to the the effectiveness of behavioral therapy for obesity.” But it’s worth noting that “mindful decision-making” was just one of many components to the Acceptance-Based Therapy studied. I would not consider the study’s findings to be an endorsement of “mindfulness” in general or as a singular approach to weight management. For those interested in how the evidence on mindfulness compares to how mindfulness is being bought and sold on the market, I recommend AHQR’s Comparative Effectiveness Review on Meditation Programs for Psychological Stress and Well-Being

    I welcome your thoughts or the opinions of your other readers.


    • December 27, 2016 at 4:25 am, Ted said:

      Thanks for your thoughtful comments, Bob.

      You are right that the DPP is less than perfect. It simply has the advantage of being well-established and well-documented. It’s been adapted and accepted in many diverse settings. Meal replacements are an option in the DPP. They have a good evidence base for effectiveness in weight management. Were they “strongly promoted” in the DPP? That is a question that reasonable people can debate.

      Regarding mindfulness, I agree with being wary of over-promise (more perspective here). However, many people find mindfulness to be a help part of dietary strategies, especially when stress-related eating is an issue. The ABT study offers some legitimate evidence that they can be helpful as part of a sound weight management program. No miracle, but a useful tool.

      I think we’re in violent agreement “that mindfulness techniques can add to the the effectiveness of behavioral therapy for obesity.” This is important precisely because standard behavioral therapy for weight management is getting old and past due for refinements like this. You made that point quite well in your comments about the DPP.

  3. December 27, 2016 at 10:06 pm, Al Lewis said:

    Ted, I gotta vote with Bob on the DPP. I just don’t think they suddenly have found the secret sauce here. All the DPP-certified vendors are claiming incredible results…but they all basically boil down to short-term weight loss on active willing participants who stick with it.

    Still, this is a thought-provoking column and thanks for posting.

    • December 28, 2016 at 5:41 am, Ted said:

      Absolutely right, Al. No secret sauce. Just a solid framework, with well-documented results, that’s now more than 20 years old.