Obesity: “Prevention Is Better Than Cure”?

“Prevention is better than cure. We don’t even want people to gain excess weight. We want to have a food system in which people can eat healthily and not become fat.”

This assertion came at the end of three days of an outstanding program for presenting and discussing theories, conjectures, and evidence about the causes of obesity.

Disconnected

Such thinking about obesity prevention is remarkably common. But it’s out of touch with reality in several important ways.

First and foremost, much of the population is already living with obesity. “That’s me they’re dismissing,” says a good friend when someone says to forget about obesity care or cures. The implicit message is that people living with obesity – and there are a lot of us – are simply lost souls.

This is wrong.

It’s also disconnected from the reality that obesity has always been a factor in population health and always will be. Diversity in body size, shape, and adiposity is a fact of life. Many people have been living with obesity since their earliest days of life. They didn’t just “gain excess weight.” Their bodies were wired for it from the beginning.

Finally, that sentiment is disconnected from the reality that many people with obesity eat quite healthily and lead active lives. But they have a complex, chronic disease that impairs their health. To say that “we” are not interested in care or a cure for these people is callous. Even though the callousness is surely unintentional.

An Utterly False Choice

The construct that pits prevention and cure against each other is completely false and destructive.

Think of other problems we face. Is it acceptable to say that we only want prevention for breast cancer? Could we accept the idea that we will only invest our efforts in preventing hunger – not assistance for people who are already facing it?

But that construct also presents a false choice because without care for obesity, one cannot prevent it. Obesity travels in families across generations. Deny mothers and fathers access to care or a cure for this metabolic disease and you make the odds of preventing it in the next generation quite daunting.

Yet, this is the state of affairs in health policy related to obesity. Access to care is abysmally poor and people seeking it must face relentless stigma, bias, and outright blame.

A Ounce of Prevention

The old saw about an ounce of prevention being worth a pound of cure is not totally off the mark. But it doesn’t mean that cure is worthless – especially when a problem is already widespread.

In the face of an infectious disease pandemic, the response was not a false dichotomy of prevention versus care. We rapidly developed ways to reduce the spread of COVID-19 and better ways to treat it. For a non-communicable disease such as obesity, the response should be no less caring.

Click here for an excellent summary of the program on obesity causes, avoiding the false dichotomy of treatment versus prevention. For more about false dichotomies in global health, click here.

Woman with Arms Folded, painting by Chaim Soutine / WikiArt

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October 23, 2022