Beyond One-Size-Fits-All for Obesity Prevention

The FittingCan we find an intervention to reduce the prevalence of obesity across the population? Marion Nestle tells us one-size-fits-all obesity prevention doesn’t have much promise in her view:

“My interpretation of the current status of obesity prevention research is that any single policy intervention is unlikely to show anything but small improvements. Pessimists will say such interventions are futile and should no longer be attempted. Optimist that I am, I disagree. We cannot expect single interventions to prevent population-based weight gain on their own, but they might help some people – and might help even more people if combined simultaneously with other interventions.”

Discerning and Constructive

The thrust of Nestle’s proposition has a profound appeal to us. As pragmatists, we have a commitment to recognizing the imperfect state of the world we inhabit – objective discernment. But we have an equal commitment to finding a constructive way forward – to build upon whatever we can find that is good, so that we might end up in a better place.

Thus, in the face of many claims that “we know what works” to prevent obesity, it’s refreshing to hear someone wisely say that we simply don’t have tools for obesity prevention that work very well by themselves. Pretending otherwise isn’t helpful, but it happens all the time.

Just this week, for example, Annals of Internal Medicine published a simple recommendation from the Women’s Preventive Services Initiative for preventing obesity in midlife women: counsel them not to gain weight.

It’s hard to read this without laughing out loud for the simple reason that by the time women reach middle age, they have received such advice many times – both directly and in pervasive cues from our fat phobic culture. This approach has been in play for decades while obesity prevalence climbed relentlessly.

Pretending that more advice to “watch your weight” will be helpful is an exercise in self-deception. At best.

Measure Twice, Cut Once

Nestle lays out her thoughts in a new invited commentary for JAMA Internal Medicine. She points to community-wide programs with multiple interventions as holding promise for meaningful effects. But perhaps the most important point she makes is that we must “keep trying” while we also “examine the results.” In other words, we must stay curious about what might work at the same time we objectively assess the outcomes.

Any good carpenter recognizes the advice to measure twice and cut once for a good outcome. Obesity prevention architects would do well to pay more attention to measurement.

Click here for Nestle’s commentary and here for the prevention guidance in Annals.

The Fitting, etching by Mary Cassatt / WikiArt

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August 6, 2022

One Response to “Beyond One-Size-Fits-All for Obesity Prevention”

  1. August 07, 2022 at 9:55 am, John DiTraglia said:

    It’s a long shot to hope that any combination or permutation of things that don’t work will work and very expensive and complicated to study.