News Flash: Obesity Is Rising, Dig Faster

Just in time for the holidays, the New England Journal of Medicine has a hot news flash for us. Obesity is rising. Soon – by the end of the coming decade – the prevalence will be 50 percent in the U.S. Moreover, severe obesity will have risen to affect 25 percent of the U.S. population.

But the answer is straightforward, says the new study’s lead author, Zachary Ward:

Prevention is going to be key to better managing this epidemic.

How’s That Working?

The apocryphal definition of insanity (no, Einstein was not the source) is doing the same thing over and over again and expecting different results. By this definition, the response to this latest analysis of obesity trends is insane.

Without a doubt, prevention and health promotion are vitally important for public health. But prevention alone will not solve a problem that already today affects roughly 40 percent of the population. We’ve been working on prevention of obesity for three decades and the trend has been relentless. Ever upward. This is a clue that prevention efforts to date have not worked as intended. Full stop.

More Soda Taxes?

The authors of this study point to a previous study by several of the same authors as a model of how well this will work. In this study, they compared bariatric surgery to soda taxes on the basis of cost effectiveness. Nevermind that soda taxes have never proven to reduce the prevalence of obesity. They keep people from drinking soda and we assume that will reverse the trend of rising obesity. Soda taxes don’t cost anything. They generate revenue.

On the other hand, bariatric surgery is expensive. Sure, it works for the person who has obesity. But it’s costly. So obviously, say these authors, soda taxes are a more cost-effective strategy. But only if their assumptions are correct. Unfortunately the assumptions are a bit shaky.

Talking to CNN, Tuft’s Aviva Most explained the challenges:

Given how notoriously difficult obesity is to treat once it’s established, you can see that we’re in an untenable situation. The societal cost is high, both in terms of obesity-related health consequences and healthcare expenditures which could bring us to our knees.

There’s no rosy picture here, but I don’t think we can throw in the towel. It will probably take lots of federal, state and local policy interventions and regulations to have a big impact. We can’t rely on individual behavior change in an environment that is so obesity promoting.

Needed: Objectivity, Curiosity, and Care

If there’s been any progress in thinking about obesity, it’s the recognition that individual behavior change won’t solve the problem. Dr. Most acknowledges that in her comments above.

Just as we’ve come to terms with that fact, we need to be objective about what’s working and what’s not. We need to work harder on prevention that delivers real results. Not just hypothetical efficacy.

But prevention alone will not solve a problem that now affects 40 percent of the population. We need to be curious about what can do more to slow or reverse to problem in people who are already affected.

Even as we look for better options, we must tear down the barriers to care for people living with obesity. Without better care for these people, the impact of this chronic disease will continue to grow. We have tools that can help. We must make them available.

Click here for the new paper in the New England Journal of Medicine and here for reporting from CNN.

Digging in Watery Sand, photograph © lunita lu / flickr

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December 19, 2019