Shifting paradigms is difficult, but that does not mean we can’t try. Recently, I have been continuing the discussion that I started to think about in 2012 when I started my PhD. It is all about drawing a bright line between health promotion and obesity prevention. We need to be sure to be clear about what we mean when we talk about each.

To understand this, we must answer five fundamental questions.

Contributing to Weight Bias

Is the framing of obesity prevention interventions contributing unintentionally to weight bias?

The answer is yes. By framing obesity as a individual responsibility issue preventable mainly through healthy eating and physical activity, we are contributing to weight bias and stigma.

Engaging People

Are we engaging people living with obesity in the development of obesity prevention strategies?

The answer is mostly not. Most obesity prevention interventions do not reflect the realities of people living with obesity.

The Aim of Prevention

What are we trying to prevent in obesity prevention interventions? Are we measuring health outcomes related to the new clinical definition of obesity (excess or dysfunctional adiposity that impairs health) either at the individual or population levels?

The answer is that we are measuring mostly anthropometric outcomes such as weight and BMI. Public health has not operationalized the new clinical definition of obesity.

You might ask, why is this? Because BMI is the best tool we have. It is simple. It’s easy. And it’s affordable. All of these reasons – are they preventing us from really shifting paradigms in obesity prevention programs, strategies, and policies? It is time for us to work together and shift the way we measure obesity prevention outcomes. The shift should be toward health, people centred, and social focused outcomes.

Effectiveness

Have obesity prevention strategies been effective to date?

The answer is complicated by the fact that we continue to measure BMI as the primary outcome. We need to create interventions that go beyond individual behaviours and stop framing weight as a behaviour. We need to critically reflect on why decades of obesity prevention strategies have not been effective and consider critically the barriers to high level/structural interventions.

Conflicting Narratives

Do we currently have two narratives of obesity – one in public health and one in clinical sectors?

In my opinion, we are working in silos. There is no collaboration. There is no integration between health promotion and primary, secondary, or tertiary prevention programs and policies. The consequence – pure confusion that leaves people at a standstill. Of course we need all of these levels of interventions (health promotion, primary, secondary, and tertiary prevention) but let’s be clear on what each intervention is doing.

Health promotion interventions are about improving the conditions that make health achievable to everyone. Health promotion interventions improve population health outcomes. They may not be directly preventing obesity or any other specific chronic disease but they contribute to health equity.

I am grateful to be working with the European Association for the Study of Obesity (EASO), Replica Communications, and Bias180 to advance this paradigm shift. We are on a mission and we will get there.

Click here for more on rethinking obesity prevention paradigms in our report on expert consultations. For my presentation on this subject at the recent EASO Masterclass, click here.

 
Many thanks to Ximena Ramos Salas, both for today’s post and for her tireless work to advance this cause.

 
A Thin Bright Line in Earth’s Atmosphere, ISS photograph by NASA / Wikimedia Commons