OCW2023: Preventing Obesity Care

Self Portrait, Edvard Munch“The only way to reverse our obesity epidemic is by preventing obesity in the first place.” This perfect expression of a perfectly unreal approach to obesity appears in The Hill today. Optimism about obesity treatment is “not warranted,” write Anthony Biglan and Diana Fishbein. Instead, businesses must stop selling us food “with an irresistible taste.” Like marketers of tobacco, alcohol, and social media, the food industry is intent on harming children’s health and must be stopped, they say. Preventing and not providing obesity care must be our focus, because, they insist, “we cannot treat our way out of the obesity epidemic.”

There’s just one little flaw in their logic. Nearly three quarters of the population already has obesity or overweight.

That ship has already sailed. The plane has left the gate. Obesity is endemic in the U.S.

Ignoring the entrenched, high prevalence of obesity will not make it go away.

Underestimating the Challenge of Preventing Obesity

Biglan and Fishbein describe a simple imperative: to stop the food industry from selling products that taste good in ever greater quantities.

Though we admire their can-do spirit, they would do well to look at the history of prior efforts. In the 80s and 90s, food policy wonks believed low-fat foods would be the answer for preventing obesity. Nope. That brought us fat-free cookies and two decades of rising obesity. In the 2000s, the answer was supposed to be cutting carbs and sugar. People started eating their burgers without a bun. Neither that nor two decades of declining sugar consumption reversed the rising trend of obesity. Now, some of the same people tell us that more plant-based foods can help. So we have oat milk and Impossible burgers to feast upon.

Just as public health campaigns served to bring tobacco use down, Biglan and Fishbein imagine policy makers can stop the marketing and consumption of food that tastes too good for our own good.

Their belief flies in the face of ample experience to suggest that it’s not so simple. We can live without tobacco. We can’t live without food.

Environmental Obesity DriversThe Challenge Is More Than Food

Prevention is indeed important for reducing the harm of obesity. But the cliché of preventing it “in the first place” is not an option. Furthermore, food policy alone has not yet proved adequate for preventing the rise in obesity.

Many other factors are in play. Our physical and technology environment presses us into more sedentary lives. Stress and distress trigger obesity, as we have seen so clearly in children with the COVID pandemic. Drug and chemical exposures disrupt metabolic regulation of body weight.

Preventing Obesity Care

So the most generous description we can offer for the Biglan-Fishbein strategy of relying exclusively on primary obesity prevention is that it is unwise.

We do need effective strategies for preventing obesity and reducing its prevalence. Quite a few people also need good care for the obesity they already have. As Paul Terry recently explained quite well in a scholarly prevention journal, “Today’s obesity problem will not be solved with either/or thinking.”

We need both treatment and prevention.

Click here if you would like to read the Biglan-Fishbein opinion piece.

Self Portrait, painting by Edvard Munch / WikiArt

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March 1, 2023

3 Responses to “OCW2023: Preventing Obesity Care”

  1. March 01, 2023 at 8:31 am, John DiTraglia said:

    we both need both and, and we only have treatment so far

  2. March 01, 2023 at 9:43 pm, Amy Klotz said:

    All of these trends in dietary advice you mention were exacerbated by the food industry and media. Yes, we registered dietitians said “less fat” and meant less fatty meats and fried foods – the food industry made low fat everything and called it healthy. The low carb craze was entirely the media; dietitians said less refined carbohydrates and the media said “no white foods”, “cut out all sugar”. Next we talked about the Mediterranean diet and/or the health benefits of vegetarian and vegan diets and the food industry answered with more processed foods and slapped on a label that says “plant based”.

    I have been a dietitian for over 25 years and our message has not actually changed too much… more fruits, vegetables, whole grains, beans, lean protein and low fat dairy. I understand obesity is complex and diet alone is not the answer. But the implication that the experts got it all wrong is incorrect. Our message has not been heard, in fact, it is continuously hijacked and manipulated by the media and food industry.

  3. March 05, 2023 at 10:47 am, Ondřej said:

    It’s more sbout how people react even if experts get it right and deliver the message well. Long term behaviour around food is likely not that affected by excellent knowledge of healrhy plate.