Bright Light at Russell's Corners

Looking in the Dark for Answers to Obesity

“There is more to obesity than meets the eye,” write James René Jolin and Fatima Cody Stanford in the Postgraduate Medical Journal. But too often, visible behaviors and appearances guide our responses to this disease. So we end up wondering why the result of earnest efforts to reduce it in both individuals and the population have yielded so very little. Blinded by what we see and the presumptions we hold about obesity, we wind up looking in the dark for answers to obesity.

The Prime Presumption: Behaviors and Food

The overwhelming presumption about obesity is that it’s all about unhealthy food and behaviors. Holding tightly to this presumption, then, it makes perfect sense that intensive behavioral therapy (IBT) should move the needle. After all, we have good clinical studies to show that people with prediabetes can cut their risks for progressing to type 2 diabetes with the help of such therapy. As a tool for coping with overweight and obesity, IBT can indeed be useful.

But often, it’s not the complete answer. In fact, for some persons, it may simply not have much of an effect. Yet it can be hard to let go of the presumption that it must be effective.

A Case in Point

Take the example of a new paper in JAMA Network Open. Researchers looked for evidence that IBT with the Diabetes Prevention Program could work for reducing diabetes risk factors in Latino youths. They designed and pre-registered a good protocol with a randomized, controlled design and a prespecified primary outcome – insulin sensitivity.

But the results did not line up with what the researchers expected. Insulin sensitivity for the intervention group was no different from the usual care control group. Nor did glucose tolerance improve compared to the control group. These null results came at both six and twelve months. Another secondary measure, weight-related quality of life, showed no benefit over the control group at six months. But there was a benefit at twelve.

Despite observing mostly null effects, the authors conclude that this program worked well:

“These findings suggest that increasing access to diabetes prevention services among high-risk youths may lead to reductions in type 2 diabetes rates in underserved populations.”

More Than Behavior and Food

In looking for answers to obesity, we must look beyond the presumption that it’s all about food and behavior.  Jolin and Stanford explain the importance:

“Effective, destigmatizing obesity policy must dispel the notion that personal choice or behaviour is the sole determinant of an individual’s weight and reflect a more accurate view of obesity’s nuanced etiology. To the extent that simplicity is necessary, however, the adage encouraging us to probe beyond outward appearances remains instructive – but with a minor modification: there is more to obesity than meets the eye.”

Letting go of our presumptions about obesity is hard, but those presumptions keep us looking for answers in the dark.

Click here for the study of IBT in Latino youth and here for the editorial by Jolin and Stanford. For perspective on exaggerated effectiveness claims in obesity interventions for youth, click here.

Bright Light at Russell’s Corners, painting by George Ault / WikiArt

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September 24, 2022