Looking Beyond Diet and Exercise in Diabetes and Obesity

Landscape with Black PigsWe’re stuck. This assessment sums up frustration with efforts to reduce the harm of obesity and diabetes in public health. For many decades we have remained fixated on a paradigm that tells us obesity and diabetes are rising because our patterns of diet and exercise are all wrong.

Writing in the Guardian, Amy McLennan tells us that diabetes prevention policy focused solely on diet and exercise “keeps failing.” It may be time to “let go of 50-year-old ways of thinking,” she tells us.

Stuck on Diet and Exercise

Similarly, for two years, Ximena Ramos Salas and Brad Hussey have been working through expert consultations on obesity prevention. They found a consensus that systems level changes – beyond individual diet and exercise behaviors – are necessary to achieve better outcomes. But traditional research and program funding structures get in the way. One of the experts they interviewed told them:

“We’re in this loop with obesity prevention, where folks have gotten comfortable with tried-and -true ‘interventions’ they believe in as a matter of theology, because it funds their careers. You have these community-based projects for which there has been copious funding over the years, but they don’t want to be bothered with providing data about whether or not the approach actually works.”

Most of the experts they polled said they do not feel sufficiently empowered to advocate with funders for more effective approaches.

A Broader Perspective in a Pacific Island Nation

Similarly, McLennan found a preoccupation with diet and exercise in Nauru. She writes:

“In the early 2010s, I set out to study obesity in Nauru. Building on previous research, I aimed to trace how people’s diets and physical activity had changed throughout the 20th century. Yet during my year on the island, it became clear that diet and activity were not the most significant changes the people of Nauru felt they had experienced.”

Patterns of diet and exercise are only part of a much larger pattern of social, cultural, environmental, and economic factors driving high rates of diabetes and obesity. McLennan explained this in Food, Culture & Society. She describes how her study of Nauru “shows how nutritional science can undermine other cultures’ ways of engaging with food linguistically, socially, and also experientially.”


Does questioning ineffective dogma make us prevention heretics? The opposite is true. Looking beyond diet and exercise alone might be the very best way to advance the cause of preventing the harm to health that diabetes and obesity are causing. Probing questions are essential for discovering a better way forward.

Click here for McLennan’s commentary in the Guardian and here for her paper in Food, Culture & Society. For more from the work of Hussey and Ramos Salas, click here and here.

Landscape with Black Pigs, painting by Paul Gauguin / WikiArt

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April 3, 2024