ECO2023: Ready for a Rethink of Prevention?

PondererFor decades, faith that healthy eating and active living would be sufficient to prevent obesity has motivated an impressive array of obesity prevention programs and research. But it has yielded very little in terms of measurable progress for reversing unhealthy trends. In the face of treatment options with dramatic efficacy gains, a crisis of faith is becoming inevitable. At ECO2023 tomorrow, sessions throughout the day will be asking: are we ready for a rethink of obesity prevention?

It starts in the morning with a masterclass in obesity. In quick succession, Ximena Ramos Salas, Maria Bryant, and Luca Busetto will ask if we are speaking the same language when we talk about health promotion, prevention, and treatment of obesity. Decades of watching people talk past each other tells us the answer is almost certainly not.

From there, we will move to a late morning workshop on rethinking obesity prevention for the 21st century and an afternoon session on systems thinking for obesity and public health.

Stuck on Ineffective “Solutions”

It seems we are stuck on ineffective approaches to obesity prevention that yield – at best – small effects. In Lancet’s eClinicalMedicine recently, Rebecca Hodder published a systematic review of obesity prevention programs for school-aged children. They could find no more than “a small positive effect.”

Yet the focus remains very strong on changing individual behaviors. In the abstract for his research presentation at ECO2023, James Nobles tells us:

“The current evidence base around obesity prevention is heavily skewed towards intervention at the individual behaviour change level. This has negative implications for how local policy makers may seek to address population-level obesity.”

Teaching, taxing, nudging, and inspiring individuals to adopt healthy eating and active living is not turning the tide on obesity trends.

Can We Refocus on Systems Driving Obesity?

The problem lies with complex systems that push the population toward more obesity. It’s not just food or personal choices about diet and physical activity. It is the interaction of systems that define our environment, expose us to drugs, chemicals, and stress that promote obesity, and then puts pleasing food in front of us everywhere we go. All while limiting the need for physical effort to move through the day. Alter one piece of these systems and others quickly compensate.

Ramos-Salas tells us that we must move toward changing those systems:

“From a conceptual perspective, there seems to be a general understanding of the need to embrace the complexity of obesity and the need to move the primary obesity prevention field forward using systems-oriented approaches. However, the reality on the ground remains very focused on individual levers for change. That represents a huge disparity to overcome if we truly want to prevent obesity. So the question becomes how do we get all the relevant players together to move forward?”

At ECO2023, we look forward to the opportunity to rethink prevention, shifting toward systems science to develop more effective approaches.

For further perspective on the role of systems in obesity and its prevention, click here and here.

The Ponderer, painting by Vilho Lampi / WikiArt

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May 16, 2023