How optimistic should clinicians be about lessening obesity in the United States? “As a clinician, I feel the way a clinician felt before real advances in cancer started to happen. I feel pessimistic; I feel a lack of confidence that I can do anything,” says NEJM Catalyst Leadership Board Founder Tom Lee. He asks Weight Watchers’ Chief Scientific Officer, Gary Foster, and Sara Bleich, Harvard T.H. Chan Professor of Public Health Policy, how much progress they think we could realistically make within the next decade, and what it would take to get there.
“I’m cautiously optimistic that we can address the problem of obesity,” says Bleich. “What we know is that if nothing else happens, if there are no effective interventions, rates are just going to keep going up.”
Bleich feels optimism toward policy and food environment changes that could move the needle, such as sugary beverage taxes and menu labeling. But she stresses that a piecemeal approach won’t be enough. “We have to think more comprehensively about how to tackle this problem,” she says. “The challenge of being too optimistic is not realizing that there is so much complexity in trying to deal with the problem of obesity, and if you squeeze on one thing, it’s sort of like a balloon and it pops up somewhere else — you have these unintended consequences.”
For example, in a menu labeling experiment with college students, males purchased more calories because they wanted more bang for their buck. “Think really carefully both about what the intent is, about policy, and then how you measure both it and unintended consequences,” says Bleich.
Foster’s level of optimism “is a 6 or a 7 on a 1 to 10 scale,” he says. “The thing that doesn’t make me a 10 at the moment is that the data, the empirical basis for some of the things we’re trying, isn’t there.”
That’s no excuse to not try anything unless there is randomized control trial data to support it, Foster adds. “Having said that, any time we implement anything — whether it’s a clinic-based intervention or policy-based intervention — we need to be committed and mindful and not defensive about collecting data.”
Where Foster is optimistic is in examining obesity from a variety of perspectives. He explains that before Weight Watchers, he “was chasing efficacy” from academic-based interventions guided by NIH grants. “I wasn’t paying a lot of attention to what the perspective was of what in my world now is called the consumer or in this world is called the patient,” he says.
But experience at Weight Watchers showed that “we can come up with the most efficacious thing in the world, but if consumers/patients can’t wrap their minds around it, if it’s not consistent with the way they view weight management — which changes, by the way; it’s much different than it was 5 years ago — then we’re not going to be able to do very well.”
Still, Foster is hopeful about collecting consumer data on responses to new interventions. “That kind of thinking can really change the field: that we certainly are empirical, based on data, but that we also take the consumer perspective.”
From the NEJM Catalyst event Patient Behavior Change: Building Blocks for Success, held at Duke University, April 4, 2018.