Should A Political Prescription For Obesity Not Also Include Better Treatments?
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.
@DrSharma
Edmonton, AB
Tuesday, October 28, 2014
Excellent post – thank you.
Tuesday, October 28, 2014
Dr Sharma
I have never seen any comment on your website on the use of low carb diets to assist with the reduction of obesity. Have you investigated this method of treatment for the persons of 100 pounds and less? There have been enough studies that are showing this as a better method than the controlled calorie plans. I would be interested in your comments on this.
Wednesday, October 29, 2014
Studies show no difference in the long-term outcomes with different diets (low-carb or otherwise). There is some evidence that high-protein diets have slightly better long-term results. I recommend using whatever diet works for you as long as you are meeting your nutritional requirements and can stick with it.
Thursday, October 30, 2014
Thanks for your comments on our editorial, Dr Sharma. While you make some valuable points you misinterpret our editorial and suggests that we are naively arguing that taxation and regulation of high-calorie and nutrient-poor food products is the ONLY viable approach to the obesity epidemic. Which, clearly, it is not. We are in no way in denial about the need for a multi-pronged, multi-generational approach in response to rising obesity. The problem of population level obesity is multifactorial and has been decades in evolution. Political solutions that involve laws and taxation will take years to show benefits – and obviously effective treatment and lifestyle-choice solutions will continue to be necessary. But that does not mean that we shouldn’t back political solutions as part of a more comprehensive strategy for treating obesity and NCDs in the longer term.
You can read my full response here: http://cmajblogs.com/defending-political-treatment-of-obesity/
The organization of world trade has developed in the last century to make trade between countries and movement of goods between international locations as easy as possible. This has improved the economic well-being of the populations of many countries and we shouldn’t dismiss that. But it is worth acknowledging a stark difference between the global organization of trade and global organization of health. Organization of trade is slick, supported by international laws and treaties, and has the buy-in of the majority of the world’s countries. Conversely, the organization of health on a global scale is poorly organized in so far as it is not supported by global level legislation or by international treaties, but merely by sets of ‘recommendations’. At present, Big Food and Big Beverage are empowered to market their wares at us pretty-much unrestricted while very little joined-up policy exists to curb the negative health effects of this.
The Canadian government is not the only government to have largely ignored food regulation policy. Dr Sharma dismisses our argument by saying that that ‘actual data from government intervention on reducing the consumption of the said foods is so far lacking’, which would seem disingenuous. Of course not many data exist. Very few governments have enacted any laws. [In fact, there is evidence – which Dr Brian Goldman mentioned in his blog on our editorial]
Unfortunately when the obesity experts pooh-pooh the political prescription for obesity they just empower governments to feel no remorse at all about being spineless and shifting all responsibility for preventing obesity to the ‘consumer’. Dismissing the global health angle is just shortsighted.
Saturday, November 1, 2014
I am not pooh-poohing or arguing against the need for political strategies to promote better health. I am just objecting to the notion that efforts at prevention will, in the foreseeable future, present a viable alternative to getting serious about finding better treatments and making these widely accessible to the people already living with this disease.
As much as I would love to see societal and policy measures ultimately reduce the global burden of obesity, not even the greatest optimists believe that we will achieve a notable reduction in obesity rates in the coming decades – as I pointed out, even a 30% reduction in the prevalence of obesity still leaves us with millions of overweight and obese Canadians in desperate need of treatment.