Obesity Causes: So Just Fix It Already!

Frustration or amazement. Take your pick. John Speakman brought a close to three days of some of the best presentations ever on the causes of obesity and summed things up nicely:

“The causes of obesity turn out to be exceedingly complex. Although I’ve learned a lot, we’ve not reached any sort of conclusion about what it is.”

The truth of this complexity is either exciting or frustrating. Literally thousands of genes can contribute to a person’s susceptibility. Just about everyone thinks that the evolution of our food supply has contributed to obesity, but it is exceedingly complex in its variety and composition. So no one has yet demonstrated which aspects of it can really explain the rise. And food is not the only contributor.

It’s also plain to see that the clinical identification of obesity is still very rudimentary because BMI is such a simple and crude signal for the problem. We are most surely dealing with a collection of clinical problems – not just a single condition. More complexity.

In this complexity, we can see an exciting opportunity to explore this large problem, break it down, and solve it methodically, piece by piece.

Tobacco vs Hypertension

In the face of all this complexity, though, another impulse is to look for analogies in other problems that have challenged public health. Tobacco is a favorite. In summarizing the meeting, Sir Stephen O’Rahilly cautioned against relying on that template:

“I don’t think tobacco control is a very good analogy for obesity because eating food is not the same as smoking a rolled up piece of a single plant material.

“However, there are better public health analogies. When I was a junior doctor in London and Dublin, our wards were full of people suffering the end-stage consequences of uncontrolled hypertension – intracranial hemorrhages, heart failure, renal failure. That problem has pretty much disappeared. We did it slowly and gradually over 40 years. It was a combination of public health measures and smart, safe pharmacotherapy.”

Just Do Something

The impulse to act now and assess later is irresistable. In the closing discussion Professor Jonathan Wells articulated it quite well:

“My feeling is there’s still a gap between the kind of obesity research that’s done and the kind that is actually going to have an impact. Prevention is better than cure. We don’t want people to gain excess weight. We want to have a food system in which people can eat healthily and not actually become fat.”

The impulse he expresses will not fade. Nor will the drive for a better understanding of this problem. We can only hope that these distinct motivations can work in a complementary way. With sufficient curiosity, scientists can learn to distinguish what has an effect from the many efforts to date that have had none.

At the same time, we can drive toward a better fundamental understanding of this complex problem – causes, cures, and prevention measures that work.

These thoughts barely scratch the surface of our learning from this epic meeting. Please, take the time to listen to every one of these 35 sessions. You’ll find the details here and the sessions themselves here, here, and here.

John Speakman Closing Three Days of Theories, Conjectures, and Evidence for the Causes of Obesity

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October 20, 2022