Woulda, Coulda, Shoulda Prevented Obesity

Why haven’t we prevented obesity yet? Over and over again, we hear the rallying cry. In the Huffington Post, we read that we’ve got to continue focusing on nutrition and physical activity to make further progress controlling obesity. But with obesity rates at an all time high – 38% of American Adults – exactly how much obesity are we preventing?

The Leading Cause of Preventable Death?

In a similar vein, Cleveland Clinic’s Glen Taksler reported recently that obesity is the top cause of preventable death. He explained:

We examined the change in mortality that might have been expected if various risk factors – high blood pressure, alcohol misuse, etc. – were eliminated. We rank-ordered the results by the expected improvement in years of life that could have been survived across the U.S. population.

Modifiable behavioral risk factors pose a substantial mortality burden in the U.S. These preliminary results continue to highlight the importance of weight loss, diabetes management and healthy eating in the U.S. population.

Taksler’s analysis depends upon a simple sorting. What can you modify?

Blinded by Our Biases?

The underlying assumption is that obesity is simple. Eat healthy, lose weight, live longer. The trouble is that it’s not working that way in real life. Americans obsess about healthy eating. Nutrition information is everywhere. Yet obesity rates are stubbornly high.

It’s not even working that way in clinical trials. Intensive behavioral support by trained professionals definitely improves health. But it doesn’t cure obesity. It produces a 5-10% reduction in weight.

The fatal flaw underneath all of that thinking is that people with obesity just made bad decisions. That’s why they have obesity. But that thinking is flawed. It ignores the genetic factors that account for about 70 percent of a person’s obesity risk.

Obesity is not a health behavior. It’s not even the simple result of health behaviors. It’s a complex, chronic disease with many different causes. Is it preventable? Maybe.

But the truth is, we don’t really know how to prevent it. All we have are presumptions about what woulda, coulda, and shoulda prevented obesity.

Click here and here to read more about Taksler’s presentation at the Society of General Internal Medicine annual meeting.

Regret, photograph © Kyle Albert / flickr

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May 6, 2017

3 Responses to “Woulda, Coulda, Shoulda Prevented Obesity”

  1. May 06, 2017 at 9:54 am, Joe Gitchell said:

    Thanks, Ted–such important points, especially when viewed through the AHCA/Trump-Ryancare pre-ex lens.


    • May 06, 2017 at 2:19 pm, Ted said:

      Thanks, Joe!

  2. May 11, 2017 at 10:44 am, Allen Browne said:

    So many blinders:
    massive data demonstrating diet and activity do not work for most people
    Knowledge for at least 50 years about the physiology and homeostasis of body composition and energy management

    What will break the logjam and let data and reason reign?