What Do We Know About Preventing Obesity?

Bowl and Book“Nutrition policies are intended to improve diet quality and decrease rising obesity prevalence . . . Although obesity prevention policies can improve diet quality, they are not expected to decrease the prevalence of obesity.” These words, from a recent review, lead us to wonder what we really know about preventing obesity.

Fortunately, on the closing day of the 2023 Boston Course in Obesity Medicine, Sriram Machineni delivered a remarkably clear and objective review of strategies and evidence for preventing obesity.

He tells us that universal prevention strategies may change the food and beverages that people buy. But evidence for an impact on overweight and obesity? That’s not available.

More selective prevention strategies – such as school-based strategies – may indeed have an effect on weight gain.

Intermediate Outcomes?

In our view, one of the most important ideas Machineni explained is the distinction between intermediate outcomes versus outcomes on measures of obesity. Intermediate outcomes are measures of healthy behaviors that we presume will lead to a reduction in obesity. The key word here is presume. He reminds us that such presumptions can wind up fooling us because the physiology of energy balance is complex and adaptive. Remember the drive for low-fat diets as a tool for preventing obesity?

That didn’t work out too well.

Perhaps this is why Sophia Hua, Caroline Collis, and Jason Block cautioned in their recent paper that obesity prevention strategies might serve to improve diet quality, but not to reduce the prevalence of obesity. Nonetheless, they write that we need to muster the political will to make lasting changes in dietary patterns – in the hope that the rate of rise in obesity might slow down versus what would happen without the policies (such as taxes and labeling) to “disincentivize unhealthy choices.”

Maybe we should aim higher – for strategies that can have a clear effect on obesity and health.

Click here for Machineni’s presentation and here for the paper by Hua, Collis, and Block.

Bowl and Book, painting by Juan Gris / WikiArt

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June 17, 2023

2 Responses to “What Do We Know About Preventing Obesity?”

  1. June 17, 2023 at 6:50 am, Adva Weinerman said:

    hi, I am reading these informations as a person who is very health minded, goes out of her way to lose weight for many years now and with zero success. I am still looking for the holy grail and I find through your articles and news that there is no one coming through with real understading re nutrition and how to lose weight for those who something is wrong and they are not helped with eating less and eating mostly the right things that are recommended. Nurtrition it seems to me now for a long time is the worst science in any way, re too many false ideas and no real help. Not your fault, I know.

  2. June 17, 2023 at 10:04 am, Allen Browne said:

    Presumption is the biggest problem.

    The bottom line should be incidence of the disease.

    Ironically, as one loses weight with physiologically based techniques, they eat less and then a healthy diet becomes even more important for health.

    1. Obesity is a disease
    2. We do not know how to prevent it – yet!
    3. We do know how to control it successfully and improve the health of people with obesity.
    4. We do know it is not the person’s fault.
    5. Prevention will come from work on the environmental modulators of the energy regulatory system – Stress, obesogens, sleep patterns, …