Charging on Horseback

Obesity Is Getting Worse, Let’s Stay the Course

The more things change, the more they stay the same. French writer Jean-Baptiste Alphonse Karr coined that phrase in 1849. But we can thank the Robert Wood Johnson Foundation and the Trust for America’s Health for keeping it current. They’ve issued the 2018 edition of their annual State of Obesity Report. Therein they tell us – at long last – the truth. The impact of obesity is getting worse. That’s a welcome change from earlier attempts to say everything’s working as planned.

But what’s staying the same is the prescription for solving the problem. “Support and expand policies and programs aimed at addressing obesity.” In other words, let’s keep this good work going and do more of it.

Remarkable Inconsistency

It’s striking. In one breath this report tells how obesity is worse than ever. Rates are higher than ever. Some states are seeing especially high rates, but no state has seen a meaningful reduction. The prevalence of childhood obesity – 18.5 percent – is the highest ever recorded.

And then, they tell us they have the solution to this problem. The Trust’s CEO, John Auerbach, says in the press release for the report:

The good news is that there is growing evidence that certain prevention programs can reverse these trends. But we won’t see meaningful declines in state and national obesity rates until they are implemented throughout the nation and receive sustained support.

In other words, the only problem is that we need to do more of all this highly effective stuff we’re already doing.

Time to Get Curious About What Really Works

At best, the assertion that current prevention programs can reverse these bad trends is speculation. At worst, it’s wishful thinking perpetuated by people with a conflict of interest. The conflict is not a profit motive. It’s an intellectual commitment to one’s noble ideas. It’s white hat bias at work.

We are quite pleased to see the Trust and RWJF recognizing that the problem of obesity is not resolving itself. Just a little over three years ago, they were trying to tell us that “we’ve turned the corner on this obesity epidemic.”

Right now we have a smorgasbord of programs that sound good. Better school nutrition. More fruits and vegetables. Less sugar. Menu labeling. Complete Streets to promote walking and biking. These might all be good things to do. But they might not all have an impact on obesity. It’s even possible that most of them won’t.

So now the time has come to take the next step. It’s time for curiosity and critical thinking about what really works. It’s time to engage with skeptics and people who have keen scientific minds for thinking about the difference between what sounds good and what really works.

In other words, it’s time to rethink obesity and come up with fresh strategies that will actually work. It’s time to test our sacred assumptions.

Click here for the full report from the Trust and RWJF. For the press release that goes with it, click here. For relevant perspective from our friend, Ximena Ramos Salas, click here.

Charging on Horseback, painting by Theodore Gericault / WikiArt

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October 18, 2018

6 Responses to “Obesity Is Getting Worse, Let’s Stay the Course”

  1. October 18, 2018 at 7:39 am, Al Lewis said:

    Seems like the prevalence of childhood obesity is greater than the prevalence of adult obesity was several decades ago. Yikes!

  2. October 18, 2018 at 8:43 am, Mary-Jo said:

    We need some good prospective studies on these programs and strategies that supposedly do help to get measures of effects, documentable data, reproducibility, etc. I had a study protocol all set to roll out years ago measuring the added value of a ‘therapeutic’ dietitian ( not just a foodservice dietitian) working in schools to help those students who can’t get access (either because they can’t afford it, no insurance, or didn’t want to take time off to go to a medical office or just not offered access) to treatment and/or education for diet and nutrition-related issues (including obesity, but also for other conditions — food allergies, sports nutrition, poor eating habits, etc.). The said dietitian could also be a resource for teachers and families. A school dietitian could follow children for up to 12 years! And data for long term studies could be kept. This is what I did in international schools for 20 years and it was a great way to catch several children at early stages. But, data was needed to ascertain the added value before going ahead hiring dietitians in schools. So, I put together a formal study protocol. Bill Dietz thought it was a good protocol, as well as my professional organization, the AND, and I got several other nods that it was a robust and interesting study protocol, but no one who could execute it would take it on. People gave a million and one reasons why not. I often felt these answers were not good enough.

    • October 18, 2018 at 10:47 am, Ted said:

      We are suffering from the effects of a lack of curiosity.

  3. October 18, 2018 at 11:10 am, Allen Browne said:

    It’s remarkable how the report accurately states the lack of success so far in our attempts at prevention and then, with no justification or basis, says let’s continue in a more widespread fashion. While obesity prevention techniques are no doubt good for health and should not be “thrown out”, we need to look at prevention appreciating the physiological basis of the disease of obesity and with an open mind. We need to take a road between trying the old stuff again and succumbing to despair at lack of success. It’s time for a deep breath and renewed vigor.

    • October 18, 2018 at 11:31 am, Ted said:

      Agree completely, Allen.

  4. October 26, 2018 at 12:34 pm, Justin Ryder said:

    Excellent perspective, Ted. RWJF is unwilling to fund the science that takes the necessary steps toward progress. We as a field need to push the agenda forward for innovative solutions, rather than eat better and move more.