How Hard and Helpful Is It to Admit We Don’t Know?

Empty and Full Abstracts of a Head“What happens when health officials tell the full truth?” asked David Leonhardt in the New York Times recently. He was writing about the value of admitting to uncertainty in public health. In a similar vein, Paul Krugman wrote recently about the power of admitting that nobody knows the right answer to a thorny problem. And yet, in obesity, getting to the truth that we don’t know all the right answers for this problem has been very hard for public health authorities to do.

“We Know What Works”

Confident assurances that “we know what works” to prevent obesity are easy to find. They roll off the tongues of folks from CDC who lead the programs addressing obesity. Certainty sells if you want funding for your programs. Ambiguity is less inspiring.

In the 1980s and 1990s, experts exuded confidence about the power of low-fat diets to prevent obesity. So that became an overarching principle of dietary policy. Obesity prevalence grew. Right around the turn of the new millenium, thought leaders decided that sugar was the problem. “It’s toxic,” said David Lustig. And now, after two decades of declining sugar consumption, we also have two more decades of rising obesity rates. Question the power of taxes on sugar sweetened beverages to prevent obesity and you can be sure you’ll get an earful about how effective they are.

The American Heart Association says it’s simple. Life’s Simple Seven is their trademark program for cardiovascular health. They recommend watching three clinical measures and adopting four healthy behaviors. In their scheme, having a BMI below 25 is one of those simple, healthy behaviors. But it’s pretty clear that when the doctor simply says, “watch your weight,” it doesn’t help much. Effective behavioral approaches to obesity require a more complete approach. Not just glib advice.

Falling Behind on Prevention

Over and over again, public health authorities present us with a false dichotomy that pits prevention against treatment. Clearly we need both treatment and prevention to overcome the harm that obesity does to health.

But right now, we are falling behind on prevention. Rigorous research is bringing more effective treatments for obesity than we have ever had before. More advances are in the pipeline because the standards are high for proving that benefits outweigh risks. Big pharma can’t just say, “We know what works.” They have to show their work. Provide compelling evidence.

Too many leaders in public health are not living up to rigorous standards for evidence of what works and what doesn’t in preventing obesity. There is great value in saying we don’t have all then answers and then rigorously pursuing better knowledge. When we do that, the advice we give along the way is more honest. Adapting to new information becomes easier. Trust can grow.

Click here and here for more from Leonhardt and Krugman on the value of admitting to what we don’t know.

Empty and Full Abstracts of a Head, study for a sculpture by Umberto Boccioni / WikiArt

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October 22, 2021

One Response to “How Hard and Helpful Is It to Admit We Don’t Know?”

  1. October 22, 2021 at 9:03 am, Mary-Jo said:

    There are strategies that work for treatments of people with obesity, but, at this point, in the USA, but also in other countries, available for those that can afford it, because the options that can deliver real results, assessing and respecting a person’s history of the disease, their pathophysiological circumstances, their SES, the time and expertise needed for monitoring— well, the healthcare systems just don’t support the effective treatments.
    For public health and prevention, I REALLY don’t know?! Such great ideas are generated at conferences, from think tanks, from experts about how to constructively progress — change the built environment to encourage more activity in safe spaces; produce and market more wholesome food supply; stigmatize, bias, bully less; show understanding, support, empathy more; provide enlightened, multifactorial approaches with HCPs who are knowledgeable, but progress is slow, society is resistant to changing its mindset. It’s heartbreaking. We don’t know a lot, but we know enough to have an effect on incidence and prevalence if only we can more rigorously pursue ways to implement best treatments, best prevention strategies.