The Entrance to Giverny Under Snow

Preventing Obesity at the Entrance to Causal Pathways

We face a pivot point for public health strategies to prevent obesity. The advent of advanced medicines for obesity treatment brings critical questions. Can we find better strategies for preventing obesity at the entrance to causal pathways for it? Or will we instead depend solely on medical interventions to reduce the harm it causes?

These questions evoke strong feelings in public discourse. “That scares me,” says an epidemiologist about evidence that bariatric surgery may have important health benefits for young persons with severe obesity. Fear and anger mix freely in this dialogue, as Professor Graham MacGregor illustrates, saying:

“The question is, what are you going to do about it? Are you going to let the food industry go on feeding us this rubbish and promoting it … and then give drugs to try and stop the effects of all this unhealthy food?

So it’s refreshing to see a rigorous interdisciplinary approach for grappling with these questions about upstream causes of obesity, published this week in BMC Medicine.

Bayesian Network Modeling

Wanchuang Zhu and colleagues from the Perkins Center at the University of Sydney created a Bayesian network model to reveal potential entrance points to causal pathways for childhood obesity – and suggest opportunities for preventing it. Senior author Sally Cripps described the approach:

“This is a truly multidisciplinary piece of research. Data alone is never enough to uncover the complex set of interacting factors which lead to childhood obesity. But by combining the skills of mathematicians and computer scientists with obesity and nutritional experts we have been able to predict and model what has never been clearly articulated before – showing the complex interplay between multiple upstream, downstream and causal factors, and how these play out over time for children and families.”

Of course, while modeling is useful, it’s merely a tool for seeking answers, not an oracle that dispenses them.

Looking Beyond Food Choices

These researchers were willing to look beyond the presumption that the problem of obesity begins and ends with food choices. Co-author Louise Baur explains:

“We tend to ignore the root causes of childhood obesity which include social disadvantage, and of course, this is not something parents or children choose for themselves. While healthy eating and activity interventions are important, the solutions lie not just in the domain of health departments.”

Starting a Conversation

Decades of presumptions that food and exercise policies could reverse trends in obesity prevalence have not worked out too well. Ximena Ramos-Salas sees the emergence of fresh thinking:

“It’s time to start the conversation about how we can change long-standing concepts in obesity prevention and health promotion, and create a new plan that addresses the complex causes of obesity. This will be the discussion focus at our upcoming workshop during the European Congress on Obesity in Dublin, Ireland on May 17, 2023.”

These are promising signs that we might soon find a more effective approach to obesity prevention.

Click here for the new analysis in BMC Medicine and here for further perspective.

The Entrance to Giverny Under Snow, painting by Claude Monet / WikiArt

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March 23, 2023