ECO2023: Seeking the Determinants of Obesity

One question that holds us captive in obesity is the question of its origins. Why has its prevalence been rising so relentlessly now for decades? At ECO2023, this question inserted itself into one of the major themes of the meeting – a pursuit of the determinants of obesity.

Commercial Determinants

Emma Boyland and Aileen McGloin chaired a session this morning on the commercial determinants of health. Sharon Friel explained the dysfunctional power dynamics in capitalism that undermine health. She told us that just four industries cause at least one third of all global deaths. Food, tobacco, alcohol, and fossil fuels are the culprits.

It would seem that the business model for the food industry – whether by design or accident – contributes to obesity and thus poor health outcomes. Travis Masterson presented to explain how tech companies provide powerful tools that food marketers can use to influence our diet patterns.

Social Determinants

While the meeting has plenty of content on the social determinants of health, there was no better introduction to this than the opening plenary by Michael Marmot. He told us it makes no sense to treat people for obesity and then send them back to social conditions and inequities that made them sick in the first place. This is not an either/or preposition. Rather it is a recognition that inequity contributes to chronic stress, producing a physiological response. One of the results is obesity and other health problems that come with it.

Environmental Determinants

On Thursday, EASO President-Elect Volkan Yumuk chaired a joint symposium with the European Society of Endocrinology on endocrine disrupting chemicals that clearly contribute to the prevalence of obesity in the population. Jacqueline Bowman-Busato, who heads policy for EASO, explained that we have an opportunity to regulate endocrine disruptors through consumer protection pathways.

Ironically, this may be a more productive path for protecting health than health policy mechanisms.

Speculation, Evidence, and Action

At the end of the day, we are left with the fact that many influences play a role in the relentless trend toward ever more obesity. The common presumption is that food is the major contributor, while physical, tech, social, chemical, and drug environments play lesser roles. But credible arguments can be made that our food environment has evolved in response to obesity as well as it has prompted it.

Meanwhile, we don’t have a very good track record to responding to any of these determinants in ways that influence trends toward ever more obesity. Perhaps we should look for better evidence for what will be effective and rely less on our favorite presumptions.

One thing is certain, though. Understanding and addressing the determinants of obesity must never substitute for empowerment, support, and care of people who are already living with obesity.

Click here for more on the commercial determinants of health and here for more on the contribution of endocrine disrupting chemicals. For perspective on how much we do and do not know about the causes of obesity, click here and here.

Jacqueline Bowman-Busato at ECO2023, photograph by Ted Kyle / ConscienHealth

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May 19, 2023