Obesity: The Importance of Separating Conjecture from Knowing

“Conjecture is good, but knowing is better.” This bit of wisdom from the Indiana University School of Public Health came to mind yesterday at the Roundtable on Obesity Solutions, hosted by the National Academy of Sciences. The subject of the day was the relationship between culture and obesity – really quite a fascinating subject. Four scholars in health policy, public health, journalism, and physiology offered novel perspectives and research on the intersection of American culture, obesity, and health.

They gave us much to think about, but most of all, raised an important question. How can we move from conjecture about obesity, its causes, and strategies for overcoming it toward knowing how best to respond – based on more than conjecture.

Consumer Culture:
A Critical Factor in Obesity?

Perhaps the most interesting presentation of the day came from UCLA’s Frederick Zimmerman. He told us the American culture of consumerism is a critical factor in the rise of obesity over the last four decades. Four tenets define this culture, he said:

– People must be free to consume.
– Consumption is achievement.
– Money talks.
– Wealthy people are smart.

Writing about this for Health Affairs, Zimmerman, along with Paul Hughes-Cromwick and Steven Teutsch, concluded that an imbalance in American culture is driving us to poorer health outcomes:

“While each of America’s cultural attributes is virtuous, the imbalance of those attributes has led to self-destructive policies. Rebalancing our portfolio of shared cultural values can vastly improve our policy options.”

We find it hard to disagree.

Moving Beyond Conjecture

As moral proposition, we can accept the importance of moving from a culture of unrestrained consumption toward placing a greater value on sustainability. That part is easy. The hard part is to come up with policies that are both consistent with this value and effective in reducing the harm of obesity.

This is where many strategies for obesity prevention have failed us. They sound good, support our values, but then turn out to have little effectiveness for blunting the rise in obesity prevalence.

Mere conjecture about what might be effective – whether it’s nutrition labeling or a soda tax – is not good enough. Randomized studies might not be possible for testing the effectiveness of health policies, but we have other options for evaluating their effectiveness.

We need greater rigor to separate what feels right and ought to work from policies that have a genuine effect.

Click here for the Health Affairs article by Zimmerman, Hughes-Cromwick, and Teutsch. For more on the need to rethink obesity related health policies, click here.

Tree of Knowledge, painting by Hilma af Klint / WikiArt

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September 28, 2023