Why is there No Consensus on Obesity?

This post is taken in part from an answer I posted to a question on Quora (check out my Quora profile here, I try to post as often as I can). At the time I wrote the original post, I was in a bit of a time rush and did not have a chance to elaborate as fully as I wanted. This is my chance to expand. Enjoy.

The question: Why is it taking medical science so long to find a satisfactory explanation and cure for morbid obesity?

You could argue that this question is central to the current chronic disease epidemic in the US and the world. It is both sad and frustrating to see all the disconnect over obesity. For what seems like ages, the solution to the obesity epidemic has been eat less and exercise more. But as you can see by the continuing increase in the rates of obesity, this advice is not working.

Yet these ideas are what have been drilled into the heads of both the general public and healthcare professionals. As I’ll detail below, it is very difficult to change people’s minds, even when those principles aren’t working.

The issue is that eating too much and exercising too little is far too simplistic of an explanation for why obesity occurs. It is also misguided, shining the spotlight away from what science is showing to be major contributors to the development of obesity: namely the overabundance and over-consumption of sugars, processed grains, and refined vegetable oils. I’m not going to dig into this science in depth. This article is about why, even with new science pointing towards causes and treatments for obesity, we are still very far away from achieving “consensus”.

So to dig in, let me show you a few of the key issues leading to why we have no consensus explanation and treatment for obesity today.

1) Nutritional science and policies are misguided
To start with, as I noted above, our current nutritional guidelines are based mostly off the idea that too much food and too little exercise leads to obesity. However, science is pointing away from that idea more and more. Calories are not equal, and you cannot exercise your way out of an unhealthy diet. But there is a long history of how these ideas became the prevailing beliefs – connected with the ideas that all fats are bad and all carbs are good. It’s a combination of bad science/interpretation as well as economic and special interest factors.

2) Obesity is multi-factorial
To say that there are many different causes of obesity is an understatement. While I would argue the big players are excessive simple carbohydrates and vegetable oils, it would be naive to say that those are the sole causes. There are likely numerous factors (genetic, environmental, and who knows what else) that all contribute to why we get fat. Unfortunately, our research system is built to study single cause-and-effect relationships. Looking at and trying to solve complex multi-factorial conditions is not an easy undertaking.

3) Nutritional education is lacking
We as physicians receive barely any true education or training in the field of nutrition. And the training we do get is basically just repetition of the “eat less/exercise more” idea noted above. No digging into the science and mechanisms behind how the foods we eat affect our bodies. Nothing about the specific roles of foods in disease. Just repetition of guidelines. So when medical students become doctors, that’s all they know.

4) Medicine today is focused on acute diagnosis and treatment, not chronic disease
Nutrition, and the chronic diseases that come as a direct result of poor nutrition (basically ALL of them), are slow to develop. Our medical system is fantastic at treating acute illnesses, injuries, and complex life-threatening conditions. What it is not good at is preventing the slow buildup of damage that comes from a poor diet and results in obesity and diseases like diabetes, heart disease, cancer, and dementia. If we do not change the focus of our medical system (which is thankfully slowly starting to happen), we’ll be doomed to continue along this path.

5) Guidelines and group consensus take a long time to change
We have scientific evidence that certain nutritional changes can lead to improvement in obesity and type 2 diabetes (namely carbohydrate restriction). But even with this evidence, it takes a long time for scientific consensus to change, as people are generally slow to change their minds, and groups of people even slower.

As an example, the idea that hand washing was necessary to prevent passing infection took decades to become accepted after it was first postulated and shown to be effective. A similar kind of thing is happening with nutrition guidelines. And though the most recent guidelines show a step in the right direction, there is still a long way to go.That is likely to take years to happen, and that’s not even taking into account the next point.

6) Special interests are on the side of keeping dietary guidelines the way they are
There are a lot of food companies who rely on sales of processed foods containing large amounts of sugar, corn, wheat, soy, and other foods/ingredients high in easily digestible carbohydrates and vegetable oils. Given this fact, there is obviously a very strong motivation for companies/special interest groups to make sure food guidelines do not change to make their products look “unhealthy”. May sound a little conspiracy theory-ish, yes, but look at the recent uncovering of Coca-Cola and other companies paying for research studies that just happen to show results favoring their interests. Unfortunately, to believe that all research today is unbiased is naive.

7) New science takes a long time to work its way into clinical practice.
Let’s assume that somehow magically the scientific/medical community comes to a consensus regarding obesity. Even if this were to occur, it would still take time for that knowledge and those ideas to translate into the practice of medicine.

It is good to see that more and more physicians are seeing the problems with the way we have been taught to approach diet and exercise. Even the acceptance of the idea that diet can change and treat medical conditions is a huge step in the right direction. However, I’ve seen personally how slow science moves into the actual clinic.

8) Nutrition is a hotbed issue
I’ve heard said before that you can change a person’s religion easier than you can change their diet. This definitely rings true in our current society, where media reports of “THE BEST NEW DIET EVER” seem to ring out constantly. Not only that, but you have fierce debates between different dietary factions as to who is right and who is wrong. In a climate like this, it’s no wonder it’s so hard to develop a consensus on diet and obesity.

So what does this all mean?

It means don’t expect the medical system to cure obesity anytime soon.

But that doesn’t mean you’re helpless here. As I’ve talked about before on this blog, what is important is taking your health, and specifically your diet, into your own hands. If you do that, there is no reason why you won’t be able to live a long and healthy life.

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