Our understanding of the science of obesity has progressed by leaps and bounds over the past few decades, revealing a complex etiology involving interactions among genetic, biological, environmental, socio-economic, psychological, and behavioral factors. We still have a long way to go to fully understand that complexity, but we know enough today to dismiss the notion that obesity arises simply from poor personal choices or a lack of willpower when it comes to healthy eating and engaging in physical activity.
You would never know that, however, when looking at historical and current interventions ostensibly aimed at “preventing obesity.” Careers have been built in this space, and copious amounts of funding dispensed the world over in the name of obesity prevention.
However, one could look at obesity prevalence rates over the past 30+ years, and see they raise important questions about how effective our current approaches have been, and where we might do better.
In most disease spheres, this would beg several questions: Are we doing the right things? In the right way? Do we even know what works? What evidence are we collecting? Are we avoiding unintended, and potentially stigmatizing, consequences when we are trying to prevent obesity? Are we undermining the value of health promotion if people improve their eating habits and physical activity without losing weight?
This highlights an ongoing tension, as many prevention approaches continue to prioritize individual behaviours related to eating healthfully and engaging in more physical activity. Even upstream policy interventions are developed with the reductionist assumption that changing the food environment will prevent obesity in the long term by changing individual behaviours and reducing energy intake at the population level. The idea that energy intake is solely driven by personal food choices, rather than by the interaction of complex biological, physiological, psychosocial, environmental, and commercial factors, is deeply ingrained and has long shaped the obesity prevention research agenda. The reality is that healthy choices are not accessible to most individuals and populations because the environments in which we all live are not health-promoting. We should change the health-disrupting environments in which we all live to improve overall population health, not just to prevent weight gain and obesity.
The concept of prevention is also seductive to governments and other players in the obesity policy space (i.e., the people who fund research and prevention/treatment). While individual-level initiatives such as physical activity programs, nutrition apps, and behavioural counselling can support people in managing their health, preventing and addressing obesity within a chronic disease framework requires more complex, coordinated, and resource-intensive approaches that depend on sustained, long-term investment across healthcare systems and broader social and structural determinants.
And, after today’s media scrum to gain cheap political points for the announcement of yet another eat-less-move-more “obesity prevention” program, few if any will remember to check back in a few years to see how effective it was. Meanwhile, millions of people who are at risk for developing obesity are simply told to “just try harder” and “maintain a healthy weight”.
The root of it all is implicit obesity bias, the refusal to move on from the antiquated, unscientific, stigmatizing, and ultimately useless idea that obesity is simply about too much food and not enough movement. Obesity should be understood as biological susceptibility interacting with both upstream and downstream drivers, where individuals who are more susceptible are now exposed to environments that promote and sustain weight gain and adiposity-related conditions, including social, economic, and structural factors.
For more on the need for an obesity prevention reset, check out our latest paper in Current Obesity Reports.