The Distorted Lens of Behavioral Risks for Global Health

Two updated analyses from the Global Burden of Disease (GBD) Study came out in the Lancet over the weekend. They bring a very specific lens to the problem of non-communicable diseases (NCDs) and their looming implications for global health. Through this lens, the focus is on risk factors – high BMI and high blood glucose levels. This is clear in conclusions from the report on data through 2021:

“Troubling increases in high fasting glucose, high BMI, and other risk factors related to obesity and metabolic syndrome indicate an urgent need to identify and implement interventions.”

From Disease to Risk to Lifestyle

From that fleeting mention of obesity, the authors shift quickly to a focus on BMI and dietary behavior as the problem and the solution. Co-author Michael Brauer explains that he views lifestyle as the key:

“Though metabolic in nature, developing these risk factors can often be influenced by various lifestyle factors, especially among younger generations. They also are indicative of an aging population that is more likely to develop these conditions with time. Targeting the reduction of preventable, non-communicable diseases through modifiable risk factors presents an enormous opportunity to pre-emptively alter the trajectory of global health through policy and education.”

Healthy Lifestyles for All the World

The GBD study group builds on this view of global health through the lens of lifestyle risks. They produced a forecast scenario to say that behavioral and metabolic risk factors can be less of a problem:

“This scenario assumes exposure to high adult BMI, high systolic blood pressure, high LDL cholesterol, and high fasting plasma glucose are linearly eliminated by 2050 in all locations. It further assumes that exposure to nonoptimal diet for all GBD diet-related risk factors is likewise eliminated by 2050; ie, all dietary components included in GBD will be consumed at the level that minimises health risk for that dietary component. In addition, we assumed a linear reduction of current tobacco smokers to zero by 2050 as well as no new smokers after 2022 in all locations.”

Presuming it’s OK to lump “nonoptimal diet” together with tobacco smoking is a pretty big leap. Eliminating that “nonoptimal diet” suggests that we should know what an optimal diet is for all the world.

This seems a bit detached from the reality of diversity in human dietary patterns. It is also out of touch with the complexity of obesity. This chronic disease results from many factors beyond dietary behaviors.

Click here and here for the two new publications. Commentaries published with them are here and here. And finally, media releases from the study group are here and here.

Earth Paternoster, painting by Nicholas Roerich / WikiArt

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May 20, 2024

2 Responses to “The Distorted Lens of Behavioral Risks for Global Health”

  1. May 20, 2024 at 9:30 am, Allen Browne said:

    Admitting what we don’t know is harder than claiming to know what is unfortunately not correct. 😥


  2. May 20, 2024 at 6:28 pm, Jennie Brand-Miller said:

    There’s an easy way to determine if education on optimal diet is associated with lower BMI. The average BMI of diabetes educators should be lower than average. I know it will be confounded by other factors (tobacco use) but simple observation suggests it is not lower (and perhaps it’s higher?). I hope this question does not come across as disrespectful (certainly that’s not intended). I want to see real causes identified.