We Shall Not Go to Market Today

Obesity Prevention: That Is Not Going to Happen

Yesterday, the National Academies Roundtable on Obesity Solutions hosted a workshop on engaging communities to address structural drivers of obesity. Midway in the workshop, a rare moment of candor popped up. Someone from the audience asked, how do we move toward programs that deliver an actual effect on obesity prevalence in the population? Rafael Pérez-Escamilla answered plainly. “That is not going to happen,” he said. Obesity is simply too complex and multifactorial for us to expect the prevalence to come down anytime soon. In short, puffery about obesity prevention is not tethered to the reality of this problem.

Then we moved on to more beautiful rhetoric about about how we can prevent obesity through community engagement.

The False Dichotomy

Nikhil Dhurandhar opened the workshop with an excellent review of the causes and contributors to obesity. He explained that it’s really a collection of diseases with multiple causes, contributors, and clinical expressions. Addressing obesity requires effective treatment for the people who have it and more effective efforts to reduce or prevent the expression of more obesity in more people.

In short, he told us we cannot accept a false choice between providing effective care for people with obesity and preventing more of it in the population. We need both.

Right now, we are making progress by leaps and bounds in treating obesity for people who have it. But, as Pérez-Escamilla told us bluntly, we’re not so good at preventing it.

Finding Prevention That Works

So well-meaning people who care about the health of their communities spent much time promoting things that are all good for us. Breastfeeding, access to whole and fresh foods, a built environment that prompts us to live more active lives – these are all things that are surely life enhancing. They are things that policy makers have been discussing as “solutions” to obesity for decades now.

But unfortunately, empiric data tells us that we have not seen promotion of these good things move the needle on obesity in a good direction. Obesity prevalence just keeps on rising. In JAMA Pediatrics yesterday, Kathy Hu and Amanda Staiano told us that obesity in children and youth continued rising for all races and ethnicities through 2020. We clearly have not figured this thing out.

To actually turn obesity trends around will require genuine curiosity and objective research to find better strategies with bigger effects. We cannot accept that obesity prevention “is not going to happen.”

But we do need to get serious about finding better ways to approach it.

For Dhurandhar’s excellent presentation, click here, and also here for an excellent summary of the workshop by Leah Whigham. For the paper by Hu and Staiano, click here.

We Shall Not Go to Market Today, painting by Paul Gauguin / WikiArt

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July 26, 2022

4 Responses to “Obesity Prevention: That Is Not Going to Happen”

  1. July 26, 2022 at 12:28 pm, John DiTraglia said:

    As a pediatrician, thank you for getting me off the hook. Prevention was always a bright shining lie.

  2. July 26, 2022 at 1:23 pm, David Brown said:

    Obesity experts are not going to be able to explain what caused the obesity epidemic until they began paying attention to endocannabinoid system research and commentary. For example: “Increasing evidence suggests that an overactive endocannabinoid system (ECS) may contribute to the development of diabetes by promoting energy intake and storage, impairing both glucose and lipid metabolism, by exerting pro‐apoptotic effects in pancreatic beta cells and by facilitating inflammation in pancreatic islets.” https://pubmed.ncbi.nlm.nih.gov/26076890/

    Also this: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3677644/

  3. July 26, 2022 at 5:31 pm, Michael Jones said:

    We will certainly not move the needle on prevention if we are not even taking into consideration risk factors for obesity in those we treat (eg. family history, early upward trending bmi, unhealthy nutrition prior to excessive weight gain, etc.). I have PCPs not referring folks with obesity because they are not “big enough” (according to the patients who have subsequently self-referred). Then we have the proclivity of many physicians to place almost any diagnosis at a higher priority and treat with obesogenic drugs unnecessarily. Lots of barriers. Lots more work to do.

  4. July 27, 2022 at 6:59 am, Michael Jones said:

    Thanks for that post @DavidBrown. The ECS is being considered, along with many other more recently discovered influences on the energy regulatory system. As I mentioned earlier, lots of barriers and the wheels are turning too slowly.