What Works for Obesity, if Not Shaming?

Popular culture is having a moment. All the talk about fat shaming that started two weeks ago is still echoing through the media – supporting a clear view that explicit weight bias is a bad thing. Apparently some people really did think that shaming people might be a tool for making them healthier. So the next question – posed in the New York Times opinion section – is what’s the alternative? What works for reversing the obesity epidemic?

Keep It Simple?

Underlying the question is the assumption that this must be simple. Bruce Lee at Johns Hopkins addresses that assumption head on. When asked what’s the one thing we must do to stop obesity, he has a simple answer. “Stop asking that question.”

This is a complex problem caused by a perfect storm of many factors. Searching for a fix for obesity is like thinking in the 1970s that we would find a cure for cancer. Instead, we found some cures, many good treatments, and some good public health strategies. But no tidy solutions.

Obesity is no different in that regard.

False Analogies to Hygiene

One option the Times explores is more paternalistic government policies. Maybe that will do the trick. After all, Japan has some of the lowest prevalence of obesity in the world and they’ve relied on heavy handed policies. They quote Noah Smith, who compares such policies to hygiene measures like handwashing that did wonders for public health.

Unfortunately, this thinking has two problems. First and foremost, handwashing is a voluntary behavior. But BMI is a physical characteristic. So the analogy is false.

The Japanese Example

In addition, obesity is a growing problem in Japan. And it’s not trivial. Problems with obesity appear in the Japanese population at a BMI above 25. The actual prevalence is about 25 percent in Japan, and it’s rising. Using Western criteria for obesity and claiming that Japan has a miraculously low obesity prevalence is simply false. Japan has yet to find what works for reversing its obesity trends.

Grounding in Science

Harvard’s Lee Kaplan tells us that we need to stay grounded in science:

The inference (sometimes overt) that obesity is under voluntary control reinforces a misunderstanding of the biology and stigma against people with this problem.

In fact, obesity is a biological problem triggered by many environmental factors. Not just bad personal choices. OAC CEO Joe Nadglowski sums it up for us quite well:

I’m glad to hear people are realizing that shaming is a bad idea. The next step is to look beyond other simplistic approaches that are unhelpful. We need more sound strategies, grounded in science.

What works for reversing obesity trends? Obviously, we don’t know yet. The prevalence keeps going up. But if we want to make progress, we need more objectivity, more curiosity, and better care for the people affected.

Click here for the opinion piece from the Times. Here and here you will find more on the problem of obesity in Japan.

A Working Bike, photograph © Vélocia / flickr

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October 19, 2019