Tuesday, October 28, 2014
In the latest issue of the Canadian Medical Association Journal, the editors opine on the need for a political prescription for obesity – in short taxation and regulation of high-calorie and nutrient-poor food products as the only viable approach to the obesity epidemic. As may be expected, they use the analogy of tobacco as a justification for this approach (given that actual data from government intervention on reducing the consumption of the said foods is so far lacking).
Be that as it may, what caught my attention in the article was the following passage:
“Treating obesity does not work well; preventing it would be better. The global failure to manage obesity, now considered by the American Medical Association to be a disease, may be considered a failure of the evidence-based medicine approach to treating disease….We know that most restrictive diets result in only short-term weight loss that frequently reverses and worsens in the long term, but dietary changes that are sustainable as a lifestyle choice may work. Physical activity is not enough to prevent or treat obesity and overweight, unless it is combined with some kind of dietary intervention. Family and community interventions may work somewhat better than interventions aimed at individuals, but their implementation is patchy. Bariatric surgery has good results in the treatment of morbid obesity, but its use is always going to be limited and a last resort. Pharmaceutical agents may work to some extent, but may have nasty adverse effects.”
The interesting thought here is that the authors parade the lack of effective treatment as a justification for prevention, when I would rather have used this state of affairs to call for greater investments in finding better treatments.
Not that I am not in favour of prevention – indeed, I am all for preventing heart disease, diabetes, cancer, depression, bone and joint disease and everything else.
But, at no point would I ever call for prevention as an alternative to finding better treatments for any of these conditions.
The fact that people still die of cancer should never justify us abandoning the search for better treatments – indeed, as far I can see, the whole Pink Ribbon Industry apparently focusses on “finding the cure” – not on “finding better ways to prevent breast cancer” (even if most experts believe that much of breast cancer is indeed preventable).
Just because we still have no effective treatments for a host of other conditions, should we abandon the search for better treatments for these conditions?
In short, what irks me most about this article is not the call for prevention – indeed I am all for it!
But when the lack of effective (or safe) treatments is used to justify this call, I must disagree.
No matter how much we restrict and tax the food industry, there will always be people around, who despite their best efforts, will struggle with excess weight. Indeed, there is no reason to believe (at least not for anyone who understands the physiology of obesity) that any form of “prevention” will reverse the epidemic in those who already have the problem – i.e. in about 6 Mill Canadians. (even if we somehow miraculously reduced obesity in the population by 30% through “preventive measures” (well beyond even the most optimistic predictions) – we would still need treatments for 4 Mill Canadians – adults and kids!)
The longer we wait to find and implement effective treatments, the longer these individuals will struggle with a condition that should deserve the same efforts at treatment as we afford individuals with other “lifestyle” diseases (including heart disease, diabetes and cancer).
Let us not forget that treatments for other common conditions (e.g. hypertension, hypercholesterolemia and diabetes) were once lacking – today millions around the world benefit from these treatments – indeed, it is probably safe to say that these medications probably save more lives each year than any known efforts at regulating industry that I know of.
Indeed, if we wish to find more effective ways to manage obesity, we need to vastly increase our efforts at finding better treatments – not abandon them.
Prevention is never an alternative to also having effective treatments. The two go hand-in-hand.