Homeopathic Pharmacy in the Austrian Town of Retz

Homeopathic Behavior Change in Public Health for Obesity

Slowly, but surely, the world is waking up to realize that obesity is not a problem of bad behavior by the people who live with it. Of course, this is not to say that healthy behaviors are unhelpful for our well-being. Good health habits can benefit anyone. But thinking that behavior change can reverse obesity, in most cases, is an exercise in self-deception. It doesn’t fix the underlying problems with physiology causing obesity. Even high-dose behavioral therapy yields mostly modest improvements in obesity. So why is there such a persistent belief in the prescription of homeopathic (i.e., low) doses of behavior change as a public health solution for obesity?

Low-Dose Behavior Change Is Ineffective

In 2011, the USPSTF completed an exhaustive review of behavioral therapy for its effect on health in obesity and overweight. That review found that to have a meaningful effect on health, the therapy had to be intensive. Interventions with low or moderate intensity (fewer than 12 sessions per year) might have a trivial effect, but not an effect that would be sufficient or durable enough to improve a person’s health.

Even with high intensity, the results are modest, though they do produce measurable health gains. Slowing the progression of pre-diabetes is perhaps the best example of this.

Population-Based Interventions for Small Behavior Changes

So it should not be surprising that population-based public health interventions have only managed to show very modest effects on behavior. But no effects to date on health outcomes. A recent systematic review and meta-analysis of obesity prevention in school-age children could find no more than “a very small positive effect on body mass index for school-based studies, but not after-school programs, community or home-based studies.” Note that this very small effect was only for BMI. Not for any health outcome.

Likewise, as we have noted, we have yet to see any evidence that beverage taxes or food labeling yield any effect on health outcomes. Only modest changes in behavior.

Can We Start Looking for More Potent Strategies?

Other justifications for strategies to promote changes in health-related behaviors are certainly possible. However, relying on such strategies to address the public health effects of obesity seems comparable to relying on homeopathic doses of medicine to cure a real disease. Compelling evidence does not exist to tell us that this is likely in either case.

So it seems wise to start looking for more potent strategies to reverse the harm to population health that obesity is increasingly causing.

For perspective on the opportunity to learn from what doesn’t work in public health, click here.

Homeopathic Pharmacy in the Austrian Town of Retz, photograph by Topi Pigula, licensed under CC BY-SA 4.0

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July 23, 2023