Desired Behavior versus Health Improvement

A new systematic review prompts us to wonder once again, what is the point of public health interventions targeting obesity? Is it to nudge people toward desired behavior or is it health improvement? Sandrine Lioret and colleagues recently published a systematic review of efforts to improve behaviors or prevent obesity in children during their first thousand days of life. The focus was on children in high income countries who came from socially and economically disadvantaged families.

To make a long story short, in this narrative systematic review of 24 studies, the researchers found only four studies that gave any indication of an effect on anthropometric (body size and weight) measures. But most of the studies found an effect on behaviors. So the conclusion is that these interventions are “promising” for reducing obesity risk in disadvantaged families.

Health Behavior Interventions

This analysis does a fine job of mapping 30 years of research on early life interventions for changing health behaviors presumed to have a causal relationship with obesity. The interventions targeted things like feeding practices, eating behaviors, physical and sedentary activity, and sleep. The authors were able to identify the characteristics that were more likely to make a difference in desired behavior, but not health improvement. With so few of the studies showing even a small effect on obesity itself, the evidence for effective interventions is woefully scant.

Perhaps the time will come to step back and reassess whether the real goal of these studies is to prevent obesity. Even now, it seems like the goal might be more reasonably described as promoting healthy behaviors.

Social Adversity

Yet another review prompts us to think that we might be on the wrong track altogether. Trying to prevent obesity by promoting presumably healthy behaviors might be ineffective. Erik Hemmingsson and colleagues suggest that social adversity might be a more important target. They write:

“Social adversity, when combined with genetic predisposition, thereby substantially contributes to highly effective transmission of obesity from parents to offspring, as well as to obesity development within current generations. Prevention efforts may benefit from mitigating multiple types of social adversity in individuals, families, and communities, notably poverty and financial strain, and by improving education levels.”

Grace

As a matter of fact, every one of us will do things that add to health risks. But some some of us have advantages – biological, social, or economic – to help us overcome any harm. To incessantly focus upon behavior as the explanation for obesity is graceless. And grace is essential because it allows people to move ahead and cope with adversity.

We much prefer a focus on overcoming adversity instead of bringing blame and shame into the subject of health. Good health can be an aspiration instead of a guilt trip.

Click here for the Lioret review and here for the Hemmingsson review. For empirical insights on experiencing grace, click here.

The Triumph of Virtue Over Vice, painting by Paolo Veronese / WikiArt

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November 27, 2022