Tuesday, October 16, 2012

More of the Same Leads to More of the Same

An editorial by Nikhil Dhurandar from the Pennington Biomedical Research Centre, Baton Rouge, LA, published in this month’s issue of the International Journal of Obesity, boldly suggests that it is time to move beyond conventional approaches to obesity prevention and management.

He notes that

“in 1958, Albert Stunkard stated, that ‘Most obese persons will not stay in treatment for obesity. Of those who stay in treatment most will not lose weight and of those who do lose weight, most will regain it’. In 2012, 54-years and numerous studies later, we seem to be at the same point”.

Yet, we continue investing (both research and healthcare dollars) into ever repeating cycles of ‘lifestyle’ or ‘behavioural’ interventions, with almost nothing to show for in terms of population impact.

This, according to Dhurandar, is simply due to the fact that too many folks working in the obesity field (not to mention those, who have no expertise in this area at all), continue to believe that long-term weight management is something that any reasonably motivated individual should be able to do. (which is also why we blame anyone, who is obese, for simply not trying hard enough – the key underlying assumption at the root of weight-bias and discrimination).

Many working in the obesity field continue to believe that the reason all previous attempts at lifestyle interventions for obesity have essentially failed, is simply because we have not (yet?) tried hard enough.

Dhurandhar (and I) are not talking about the occasional successful cases, who do mange to do so. The very fact that we find it remarkable that someone can actually lose and sustain significant weight simply by changing their behaviour, is because it is indeed ‘remarkable’. If this were easy and the norm – no one would even take notice.

To paraphrase Dhurandhar, proclaiming the overriding role of the ‘obesogenic’ environment (at the macro level) and the importance of individual volitional behaviour (at the micro level), largely ignores the overwhelming evidence regarding the important role that human psychology and physiology plays in undermining efforts to change both our environments and behavours.

Thus, for e.g. while we may wish to believe that presenting consumers with more information about caloric content of foods will make them eat fewer calories, this idea is simply not borne out by the research on this issue.

Dhurandhar clearly believes that more of the same will yield more of the same and that it is perhaps time to pay far greater attention to ‘unconventional’ drivers of the epidemic that may be amenable to treatments – he includes biological drivers, sleep deprivation, environmental toxins, and infectious agents in this list.

I would add stress, lack of time, mental health problems, and medications.

AMS
Batesville, IN
ResearchBlogging.orgDhurandhar NV (2012). When commonsense does not make sense. International journal of obesity (2005), 36 (10), 1332-3 PMID: 23044903

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2 Responses to “More of the Same Leads to More of the Same”

  1. fredt says:

    And then society ignores or make it difficult for those of us who have made the necessary changes to our lives.

  2. Lucy A. says:

    I am feeling fairly tough because I am having a hard time maintaining the positive changes that I had developed after taking the weight wise education modules and not being approved for surgery and discharged from the weight wise clinic. I feel totally abandonded with no moral support from anyone within the medical community that has no idea how hard it is to lose weight or keep it off. I can only take comfort in that I have lost 35 pounds, normalized my lipid profile, and am finally dowm to size 18 pants–but that does not make it easy to keep up with the food journalling, the water drinking, and the walking that needs to be maintained.

    You did really well getting education modules for those of us to learn how to eat normal serving sizes–now could you develop a program that can help those of us who do not qualify for surgery. Please note none of the information in the nutritional modules was new for me it was placed into a form that I could put into practice.

    Thank you for you time, patience, and and expertize in weight management–and trying to assist as many people as you can.

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