A Little Boy Lost

OCW2021: Treat or Prevent Obesity? A False Choice

Today in Obesity Care Week (OCW2021) the focus is treatment and prevention of obesity. Note that the focus is both. Not one or the other. For decades now, we have watched ineffective talk about a false choice: shall we resolve to treat obesity or prevent it? “We can’t treat our way out of this epidemic,” says one school of thought. The competing school asks how can we prevent something that already affects nearly three quarters of the population?

Thus we have watched four decades pass as efforts to reduce obesity have yielded very little. Perhaps now we are ready to learn the lesson of this debacle. Solving the problem of obesity will require us to follow both tracks, to treat and prevent obesity. Because in truth, these tracks run in parallel. These efforts work together if they work at all.

Treating Obesity

In 2013, the American Medical Association finally crossed the threshold of recognizing that obesity is a complex chronic disease. Excess adiposity that harms health defines it, not BMI. Though BMI is a useful tool for obesity research, it has serious limits.

Genetic susceptibility and environmental triggers work together to cause obesity in an individual. It is highly heritable – in a given environment, 70 percent of an individual’s risk for obesity comes from the genes they inherit.

Behavioral strategies for treating obesity have always been the starting point. For some people, they make a huge difference. For others, they yield next to nothing. So treating obesity requires more options if it is to be effective. Anti-obesity medications and surgery are good options that help some people tremendously. Those options are getting better and more options are on the way. But what works for one doesn’t work for all, so we need all the options we can get.

Looking for Levers to Bend the Curve

The last four decades have brought us a succession of “answers” for preventing obesity. In the 1980s, the most popular strategy was to promote low-fat, higher carb diets. When that didn’t work, sugar became the villain in our food supply causing obesity. For two decades now, sugar consumption has been dropping, but obesity prevalence has kept climbing.

Right now, for good reasons, it seems like ultra-processed foods might play a role in this unsolved problem. Thus, we can be sure that the global food industry will face ever increasing pressure and blame for the rising tide of obesity around the world.

But the truth is that as much as we know, we have much more to learn about preventing obesity. With much of the population already affected, efforts to both treat and prevent obesity will be necessary for some time to come. With curiosity, objectivity, and care for the people affected, we will get better at this.

And that’s what Obesity Care Week is all about in 2021.

Click here to learn more about OCW2021 and follow the #OCW2021 hashtag on your favorite social media channel. ConscienHealth is proud to be a champion for this important work.

Little Boy Lost, illustration by Dorothy Lathrop / WikiArt

Subscribe by email to follow the accumulating evidence and observations that shape our view of health, obesity, and policy.


March 2, 2021

4 Responses to “OCW2021: Treat or Prevent Obesity? A False Choice”

  1. March 02, 2021 at 9:28 am, Allen Browne said:

    Hear, Hear!!!

  2. March 02, 2021 at 4:18 pm, Louise Baur said:

    Choosing to either treat or prevent obesity, is a bit like choosing to either treat or prevent lung cancer. Should we provide high quality evidence-based surgery, radiotherapy and drug therapy for those with long cancer, or should we try to decrease the sales and use of tobacco? The answer is of course that we need both approaches. This is the same for many other chronic diseases, and it should be the same for obesity. Treat or prevent is a false dichotomy for a disease that has a complex aetiology and may have significant complications.

    • March 02, 2021 at 4:52 pm, Ted said:

      Thank you, Louise. You are 100% correct.

  3. March 03, 2021 at 9:34 am, Lucy Di Santo said:

    Being that research has found that 70% of obesity etiology is heritable, it makes sense that the best outcomes would result from the optimum m treatment for a condition like depression; this bring a combination of medication along with a behavioral therapy and social support network. This can look very similar to treating concurrent diseases like depression and addiction.