Implications of “Miniscule” Effects in Obesity Prevention
In BMJ Public Health, Annabel Davies and colleagues have published a new analysis of interventions to prevent obesity in children. They started with data from two Cochrane systematic reviews published in 2024 (here and here) and applied a Bayesian multi-level meta-regression analysis. What they found were obesity prevention effects that range from being small and beneficial to being small and harmful. In short, present approaches are unlikely to yield more than miniscule effects on obesity in children and youth.
Resistance to “Medicalization”
Knowing this, it frankly becomes painful to hear people lament medical interventions to care for young persons living with obesity.
“Is it the right way to go to medicalize very young children with drugs because of what is, in part, a societal issue?” Naveed Sattar, an expert in obesity medicine, asks this question even as he describes the considerable benefits of effectively treating obesity in children.
Others are more resolute in insisting that prevention should be the primary focus. “If we want to make inroads around the problem of obesity, we have to focus on prevention,” says Sara Bleich.
The Need for Effective Prevention
These mixed feelings are perfectly reasonable. But it would be easier to make strong calls for obesity prevention in children if we had interventions that clearly work. Dean David Allison of the Indiana University School of Public Health explains:
“Can one imagine explaining to a school superintendent whose budget is overstretched that they should devote funds to programs with minuscule effects? And, how could a grant applicant look a funder in the eye and request funds for the 205th such study when the first 204 have fared so poorly, unless that proposed 205th was radically different than the first 204.
“We need to develop programs with larger effects to promote them in good conscience.”
Clearly, we need obesity prevention tools with effects that are strong. And we need to set aside the false dichotomy of prevention versus treatment for obesity. Both are essential.
Click here for the new paper by Davies et al and here for perspective on the future of obesity prevention.
Wanderer Above the Sea of Fog, painting by Caspar David Friedrich / Wikipedia
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May 24, 2025
May 25, 2025 at 2:47 am, Mary-Jo said:
Stronger, more effective prevention and treatment strategies for obesity were being discussed, researched, studied BEFORE prevalence deemed obesity an epidemic. Treatment options have improved, so that’s great, much more needed, especially access. In area of prevention, imo, better OVERALL well-child healthcare and follow-up attention to any indicators pointing to development of obesity, would help, especially in the USA.
May 25, 2025 at 10:43 am, Richard Atkinson said:
Excellent column. David Allison’s figure for prior studies on treatment of obesity in children is impressive but underestimates the futility of simple diet, exercise, and behavior modification. If the search terms, “diet and physical activity and obesity and treatment and children” is put into PubMed there are 3,888 citations listed. The time is way past to scream “Repeating the same thing over and over and expecting a different result this time is insanity.” Diet and physical activity are critical for a healthy lifestyle and everyone should follow them. Pretending that they are a sufficient prevention or treatment for childhood obesity is a travesty.
May 31, 2025 at 2:19 pm, Valerie M. O'Hara said:
important column Ted – agree with Richard Atkinson. Just as DPP is offered to those with pre-DM, obesity prevention is not appropriate (and sadly not effective) when treatment is required once the disease exists. Healthy living goals apply to all. Agree both prevention and treatment work are needed