The Pool of London

The Cause of Obesity Is Whatever I Say It Is

Camilla Kingdon is president of the Royal College of Paediatrics and Child Health and she has the cause of the whole childhood obesity thing figured out. “The primary cause is clear,” she writes in the Guardian. It’s poverty. She describes how her thinking has evolved:

“In the last few years, I have been forced to take a step back and look at the broader, economic picture. I regularly find myself having to deliberately roll back on some of the advice I would have given before, with the families I see often unable to afford green leafy vegetables or meat. At the end of the day, it is cheaper to put chicken nuggets and chips on a plate than it is to buy fruit and vegetables. Families on low incomes face impossible decisions when feeding their children.”

Maybe So

Prevalence of Overweight or Obesity in Brighton and England 2006-2019The case study of Brighton lends credence to Kingdon’s conclusions. Leaders there believe they have found strategies that contribute to a supportive environment for obesity reduction. A substantial part of their efforts have focused upon food poverty. The results are encouraging, as Leah Salm and colleagues document with a new paper in Food Security. Yet they are quick to say that definitive evidence is still lacking:

“Our study design leaves us unable to conclude a causal relationship between this approach and the comparatively positive picture of child overweight and obesity, even though we find it plausible.

“Brighton has its own unique attributes (as any local context does) which limit the direct replicability of the city’s approach elsewhere. Nevertheless, this case study offers a view of factors, mechanisms, and lessons – developed with the participation of many key actors in the city’s public health and food landscape – in fostering partnerships for obesity reduction through a whole systems approach.”

Unsatisfying Ambiguity

Such ambiguity is a problem for policymakers who need to project confidence in their mastery of a problem. We frequently explain here that the causes of obesity are complex and simple fixes are not very realistic. This is equally true with the problems of poverty which Kingdon describes as a root cause of childhood obesity.

But the public gravitates to simpler answers. Ambiguity and nuance are not popular taglines.

Human Suffering

Immediate relief for problems of poverty is not easy to find, just as effective strategies for reversing trends in obesity have been elusive. We can learn from experience, though. The case study of Brighton is worth our attention. We should not forget that childhood poverty in the U.S. hit the lowest rate ever recorded in 2022. That’s no small feat in the midst of a pandemic.

Though human suffering is persistent, smart public policies can make a measurable difference – if only we will pay attention and learn from both successes and failures. Poverty, by itself, may not explain the relentless rise in childhood obesity. But success in altering these trends will be unlikely if we neglect poverty as a factor.

Click here for Kingdon’s commentary and here for the study of obesity efforts in Brighton.

The Pool of London, painting by Andre Derain / WikiArt

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April 23, 2023