The American Academy of Pediatrics (AAP) once again takes the lead in recommendations to promote weight control. New guidelines suggest that parents and physicians avoid recommending dieting — including in teens who are overweight or obese. The recommendation seems paradoxical. Parents are advised to not comment on their own weight or their child’s weight. The experts suggest simple promotion of a healthy diet and regular exercise. Parents can lead by example and society as a whole can create social norms to encourage salubrious eating and activity habits. The new guidelines also suggest that families eat meals together as often as possible. There’s some evidence to suggest that family meals may limit weight problems.
The recommendations should be adopted for all and not be limited to children or teens. Is the problem of obesity so dire?
- $190 billion -- The added medical costs every year that are estimated to stem from obesity-related problems which represents 21% of total U.S. health care costs.
- $164 billion -- The Society of Actuaries estimates that U.S. employers are losing this amount in productivity each year due to obesity-related issues with employees.
- $580 billion -- The Robert Wood Johnson Foundation predicts that annual economic productivity loss due to obesity could hit this staggering amount by 2030.
The above data combines the devastating effects of a myriad of complications of obesity
- heart disease and blood lipid abnormalities.
- type 2 diabetes.
- sleep apnea
- reproductive problems.
- certain cancers.
Why did experts recommend avoiding dieting? There is a reason that there are hundreds of diets and a new one appears every few months...none of them work. Dieting is a failed endeavor for long term success. Adopting new eating habits can make a long-term difference. The data on recidivism for weight loss is staggering. The problem is enormously challenging but has never consistently been approached with a deep understanding of behavioral psychology of the type advocated by cognitive neuroscientists .
Fad diets and new gym memberships virtually never create sustained changes in eating and exercise behaviors. Unfortunately the mere recommendation by the AAP will not have any effect on the problem. Cognitively aware interventions combined with good social policy hold the key to addressing the epidemic of inactivity (see sitting is the new smoking) and obesity. Calling for more exercise carries its own frustrations. Many are reluctant to and do not enjoy exercise. Being in a setting surrounded by athletic fit individuals can be a major impediment to starting an exercise regimen. Focusing on activity, not exercise may be a good start. Parking far away from stores in the parking lot, taking the stairs rather than elevators and standing desks in the workplace are likely to be better received than jogging, biking or weight training. Incremental goals such as increasing numbers of steps per day from baseline is more likely to be adopted. Frankly the most important exercise is walking away from the fridge.
Creating an environment which leads to healthy eating habits is crucial. It is impossible to eat too much ice cream, chocolate or junk food if they are not in the kitchen. Benefit plans creating incentives to getting to a BMI of 25 when you have a BMI of 35 are frustrating and counterproductive. Exacerbating shame guilt and making the goal so unrealistic as to create a defeatist attitude. Goals should be small, realistic and incremental. Creating social norms in schools and the workplace can help support the behavioral change.
The government can create strong incentives by taxing highly processed and low nutritional value foods and using the revenues to subsidize the price of healthy foods like fresh fruits and vegetables. Creating more access to healthy foods in food deserts is a worthy policy goal. The investment in walking and bike paths to encourage activity is also likely to move toward of goal of a more fit society.
By using cognitively aware solutions and incremental interventions combined with strong social policy incentives, we will make a great start to eliminate suffering, disease and premature mortality.
Nicolas Argy, MD, JD
Copyright © 2016 Nicolas Argy