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By Matthew Rees

Food and Health Fact #153: Preventing or addressing obesity at the statewide level

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I recently listened to a thought-provoking podcast featuring Peter Attia, MD, interviewing David Allison, a long-time obesity researcher and currently the Dean of Indiana University’s School of Public Health.  

I highly recommend listening to the entire 140-minute interview. But for the sake of convenience I will be providing select excerpts from the interview in the days and weeks ahead, starting with the passage below. In it, Allison opines on what measures he believes would be most effective, at a statewide level, to prevent or address obesity. (The text has been lightly edited for clarity.)

When I talk to people, even physicians, even highly educated scholars, there’s this bifurcation. There's the data and those who look at the data, and if they really know the data and they're really honest, they say, “We agree. Surgery works, pharmaceuticals work, individualized or group-based clinical treatment with behavioral cognitive techniques works somewhat for some period of time, meal replacement formulas work somewhat for some period of time.”

But all the public health stuff we've tried now, if you really are honest, and you really scrape away the obfuscated data, there is virtually no evidence thus far that any of those community school public health things for obesity work. Doesn't mean that we won't get them someday, but right now they don't.

So when people come and say, [What do we do on a statewide basis]? I get this question a lot. [I ask] what's your goal? Is your goal to expose people to ideas? So that there's a really smart kid, the next Marie Curie, the next Einstein, the next George Washington Carver is there in that classroom? And maybe the thing you do to try to reduce obesity has no effect on obesity, but that kid is thinking about it for the next 15 years. And then when they become an adult, they go, “I got an idea.” And suddenly someone smarter than we are, or with new knowledge, cracks it. Is that your goal then? It's consciousness raising.

Is your goal to say to communities, “We know you're suffering, and we know this is concerning, and we want you to know we care, and we're trying. We're not going to necessarily reduce obesity levels, but we want you to know we care. You want farmers markets in the school parking lot, you want vending machines changed, you want running tracks built in your neighborhood, we'll build running tracks on and we'll feel better about it. We're caring for each other.” But it's probably not going to affect obesity given what we know right now.

Or do you say, “I actually want to have less people suffering with and from obesity, I want obesity levels in some definable, countable number of people to go down, and I want the health improve.” I'd say it's not going win you only feel-good awards, but surgery, pharmaceuticals, and to some extent, individualized treatment, cognitive behavioral group-based treatment, including things like meal replacements, those are ways to go.

If the state of Indiana handed me $10 million, and said “make a difference,” I would not go build farmers markets in schoolyards. I would say, “It'll only be a small number of people, but let's give bariatric surgery to a subset of people and that subset of people will likely live longer on average.”