Attacking Obesity

The diversity of disciplines represented at the annual meeting of The Obesity Society parallels the reach of the obesity epidemic itself.

Primary care physicians, endocrinologists, pharmacologists, bariatric surgeons, psychiatrists, psychologists, social workers, educators, nutritionists, and food service workers have spent the past five days in Orlando, Fla., wrestling the obesity beast, trying to shed light on why it is so intractable and discussing interventions that may tame it. Following are a few observations from the meeting:

Courtesy of the Rudd Center for Food Policy & Obesity

1. Although obesity in the United States is being attacked full-force from all sides with drugs, surgery, and psychosocial and behavioral interventions, its prevalence is expected to continue to climb as those born in the 1980s (when the obesity epidemic began) age into their “prime years of obesity incidence,” according to data presented by Whitney Robinson, Ph.D. of the University of North Carolina at Chapel Hill. Dr. Robinson and colleagues used height and weight data measured from 1971-2008 in the National Health and Nutrition Examination Survey (NHANES) to quantify cohort effects as a way to estimate obesity trends. They determined that cohorts born in the 1980s had significantly increased obesity risk versus those born in the late 1960s. The cohort effects, which are those not attributable to the additive effects of age and period, for the 1979-1983 and the 1984-1988 birth cohorts relative to the late 1960s cohort were 1.18 and 1.21, respectively.

Although it is well understood that period effects representing widespread environmental influences have driven increases in obesity prevalence, Dr. Robinson reported, “obesity in adults born in the 1980s shows positive cohort effects as well.”  This finding suggests that even if the obesigenic environment stabilizes, obesity prevalence could continue to increase, particularly in the absence of widespread environmental change.

2. Technology is becoming an ubiquitous weapon in the obesity armamentarium, as evidenced by the many presentations focusing on computer-, Internet- and even smart phone-based strategies. For example, in one late-breaking presentation, Kelly H. Webber, Ph.D. and Dr. Stephanie A. Rose of the University of Kentucky, Lexington, described a pilot study comparing the impact of an Internet behavioral weight loss program alone and in combination with portion-controlled food provision. The study demonstrated that the short-term effect of the combination approach was particularly beneficial.

Similarly, Melissa A. Napolitano, Ph.D. of Temple University in Philadelphia presented a pilot trial of a virtual reality-based psycho-educational intervention for modeling weight loss skills. The findings demonstrated short-term success, with outcomes approximating those found in conventional behavioral weight loss programs.

Finally, a comprehensive evaluation of available iPhone apps for weight loss, presented by Penny Deck, a Ph.D. student at Simon Fraser University, demonstrated the considerable variation in the degree to which the applications follow evidence-based recommendations for weight loss. In particular, she noted, “most of the apps demonstrated poor adherence to such recommendations as basing goals on behaviors vs. weight and advocating small sustainable changes.”

All of the technology interventions are still too young to have long-term outcomes data. It is therefore too early to determine whether their short-term efficacy is a function of the interventions themselves or their novelty. In a presentation describing the apparent benefits of a church-based telemedicine weight loss intervention, Gary Foster, Ph.D., of Temple University observed that most behavioral weight loss interventions are effective in the short term, “but what we really need are long-term studies to evaluate their continued efficacy over time.”

3. Anti-obesity prejudice is pervasive in all sectors of society, including among individuals and organizations in positions of influence. In response to a query from an attendee about the FDA’s reluctance to approve amphetamines for weight loss but not for attention deficit disorder, Dr. George Bray, chief of the division of Clinical Obesity and Metabolism at Pennington Biomedical Research Center in Baton Rouge, La., attributed the double standard to the cultural perception that obesity is an aesthetic problem. “ADHD is viewed as a disease, while obesity is perceived to be a moral deficit,” he said.

The cultural stigma is perpetuated by the news media and even by medical professionals through the photographic and video portrayal of overweight people using headless body shots, primarily focusing on unflattering views of the abdomen or lower body, often in sloppy attire and eating unhealthfully, according to Dr. Arya Sharma, chair in obesity research and management at the University of Alberta in Edmonton, Canada.

To counter the prejudice, the Rudd Center for Food Policy and Obesity at Yale University and The Obesity Society have developed a document called Guidelines for the Portrayal of Obese Persons in the Media, which was available in the meeting press room. The Rudd Center also offers a gallery of more positive images that it makes available to the press.

–By Diana Mahoney