Part I: Musings On ObesityWeek 2014

by Jason Block, MD, MPH

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ObesityWeek is a combined meeting of The Obesity Society and the American Society of Metabolic and Bariatric Surgery, two leading organizations that explore clinical care, research, and policies regarding obesity and related diseases. This year, the meeting was held in Boston, Massachusetts, allowing a large contingent of our Obesity Prevention Program to attend. We asked all of them:  What did you learn at Obesity Week 2014?  Over the next few weeks, we’ll be posting their responses.

Source: Yale Rudd Center for Food Policy & Obesity

Here is my response to the question:

1)   Bariatric surgery leads to weight loss and metabolic improvements in myriad and complex ways: Bariatric surgery leads to substantial, sustained weight loss as well as improvements in conditions such as diabetes (about 30% of people with diabetes no longer have the disease 10 years after bariatric surgery). Clearly, the changes in the stomach and intestines made during surgery lead to restriction in the amount of food that patients can consume and contribute to these health improvements. But, the longer term success of surgery appears to be related, in large part, to a variety of other changes that happen after surgery: altered hormones; increased energy expenditure during rest, exercise, and sleep; and changes in the bacteria that live in the gut (microbiota). Because these factors play such a large part in long term success, further research might uncover new, non-surgical approaches to treat people with obesity. Lee Kaplan of Massachusetts General Hospital gave a fascinating review of these physiological post-surgical processes.

2)    Stigmatization of people with obesity is rampant: People with obesity are heavily stigmatized and discriminated against. Rebecca Puhl and her colleagues at the Rudd Center, now at the University of Connecticut, have done extensive research on this topic. They have documented how the media portrays people with obesity, often showing only their abdomen or displaying them from the back (“faceless,” as they describe). Even well intentioned efforts to bring attention to obesity and to promote change can use stigmatizing messages and images, backfiring and creating shame among people with obesity, rather than leading them to seek help. The Rudd Center has extensive materials on weight bias and has even created stock photos for use in the media. Notice my use of “people with obesity” rather than “obese people” or “the obese”. Using such “people first” language, as recommended by The Obesity Society and others, emphasizes that people have a disease and avoids labeling them as the disease itself.

3)    Obesity treatment programs and prevention policies are many and varied. Steve Gortmaker has been leading a team to define the cost effectiveness of 40 different policies, to give policymakers an idea of how best to spend resources. While clinical interventions such as bariatric surgery are remarkably effective, they score less well on cost effectiveness because of the expense of surgery and the relatively limited reach. This scenario is similar for policies like after-school programs, which can’t reach as many people as a population-wide change, such as a soda tax. Gortmaker’s team found that soda taxes score well because they affect entire populations even though they have only a small effect on each person in the population. 

4)    The Supplemental Nutrition Assistance Program (SNAP, the “food stamp” program) has come under increasing critique because of its relative lack of nutritional standards, especially when compared to the Women, Infants, and Children (WIC) program. To address this critique, the USDA conducted a pilot study in in Massachusetts, examining the effect of a fruit and vegetable incentive on dietary choices. SNAP participants in the pilot study received 30% cash back on purchases of fruits and vegetables.

What did they find? Fairly modest results. Study participants only increased their purchases of fruits and vegetables slightly (about1/4 of a cup per day on average more than non-participants), and, therefore, didn’t earn very much cash back ($3.65 each month). But, panelists at a session were encouraged by some benefit from the program and called for more pilot studies within SNAP. Maybe they can even launch a pilot to limit purchase of sugary drinks in SNAP, an initiative requested by Michael Bloomberg while he was mayor of New York City, but one that the US Department of Agriculture ultimately rejected. We won’t know what works best until we try!

More commentary on Obesity Week 2014 will follow this week. Check back frequently to see our team members' musing on the conference.