Who’s Naïve About Obesity?

“It’s naïve to think that we don’t know what’s causing the excess of obesity and that we don’t have the policy solutions that will prevent it.” This thought, from a senior scientist at a noted school of public health, popped up during a discussion last week in a working group of NASEM on obesity.

The scientist was expressing a familiar set of feelings. This shouldn’t be so hard. Prevention would be so much better and cheaper than medical treatment for all these people with obesity.

For decades now, such feelings have been a leitmotif. It echoes the biblical lament of David: “How long, O Lord?” This offers a hint that the problem might be with us for quite a long time.

Do We Know?

So how much do we really know about what’s causing the excess of obesity and how to reverse it? The short and honest answer is that we know quite a lot and yet nothing definitive. Some of the smartest scientists from all over the world gathered last summer to discuss the first half of this question. John Speakman, one of three eminent scientists who organized this meeting, summed it up by saying:

“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.”

On the other half of the question – do we know how to reverse the trends in obesity? – the Lancet Commision on obesity explains our reason for doubts:

“There has been an unabated rise in obesity prevalence in all countries in the past four decades, and no country has succeeded in reversing its obesity epidemic.”

Of course, it’s possible that the knowledge exists and that everyone, all over the world, has simply failed to apply it. Though many people express this view to us, a review of the evidence shows that interventions have only a “slight” effect on BMI z-scores and the certainty of that evidence is only “low to moderate.”

Hope Is Essential

The human response to a difficult situation is to tell ourselves that everything will be alright. Hope is essential to motivate us to work at solving a difficult problem. So we agree with the feeling that the rise in obesity is a problem we can solve. We’re quickly getting better at treating it. We must and we can get better at reversing the excess prevalence.

But back to the original question: who’s naïve about obesity? The only truthful answer would be that anyone who thinks they have it all figured out is naïve.

For more perspective on obesity prevention and barriers to progress, click here and here. For more on what we know about the causes of obesity, we recommend this essay by Julia Belluz.

Young Boy Feeding Rabbits, naïve art by John Bradley / WikiArt

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February 5, 2023