Yesterday I came across a fascinating new article on twitter via Maria Wolters which has some relevance to yesterday’s food industry video from Yoni Freedhoff. The article, published ahead of print in the journal BMC Public Health discusses whether we should scrap policy discussions of “obesity”, and instead focus on the issue of “caloric overconsumption”. It’s a fantastic and very readable paper, and available for free, so I’d strongly urge anyone with an interest in the policy/public health debates around obesity to check it out.
The abstract:
Background
Numerous policies have been proposed to address the public health problem of obesity, resulting in a policy cacophony. The noise of so many policy options renders it difficult for policymakers to determine which policies warrant implementation. This has resulted in calls for more and better evidence to support obesity policy. However, it is not clear that evidence is the solution. This paper argues that to address the policy cacophony it is necessary to rethink the problem of obesity, and more specifically, how the problem of obesity is framed. This paper argues that the frame ?obesity? be replaced by the frame ?caloric overconsumption?, concluding that the frame caloric overconsumption can overcome the obesity policy cacophony.
Discussion
Frames are important because they influence public policy. Understood as packages that define issues, frames influence how best to approach a problem. Consequently, debates over public policy are considered battles over framing, with small shifts in how an issue is framed resulting in significant changes to the policy environment. This paper presents a rationale for reframing the problem of obesity as caloric overconsumption. The frame ?obesity? contributes to the policy cacophony by including policies aimed at both energy output and energy input. However, research increasingly demonstrates that energy input is the primary cause of obesity, and that increases in energy input are largely attributable to the food environment. By focusing on policies that aim to prevent increases in energy input, the frame caloric overconsumption will reduce the noise of the obesity policy cacophony. While the proposed frame will face some challenges, particularly industry opposition, policies aimed at preventing caloric overconsumption have a clearer focus, and can be more politically palatable if caloric overconsumption is seen as an involuntary risk resulting from the food environment.
Summary
The paper concludes that policymakers will be able to make better sense of the obesity policy cacophony if the problem of obesity is reframed as caloric overconsumption. By focusing on a specific cause of obesity, energy input, the frame caloric overconsumption allows policymakers to focus on the most promising obesity prevention policies.
There are a bunch of interesting nuggets in the paper, including the argument that one problem with obesity is that it is an outcome, with a number of potential causes. This makes it difficult to come to consensus on proper policy options, especially when there are a lot of vested interests arguing for certain causes because it suits their bottom line (e.g. the food industry promoting physical activity).
The paper also argues that this reframing of the issue will allow us to focus on the primary cause of weight gain – excess food intake (and I’m hoping the myriad upstream factors that influence intake, such as sleep, screen time, etc). It goes on to suggest that this will shift the focus away from the issue of personal responsibility, making policy action more likely. I’m not convinced that would happen, and the author (Jacob J Shelley) does point out that this approach will not be a panacea, but I think it’s an argument worth considering.
One thing that is not discussed in much detail in the paper is how this reframing might be greeted by those in the Health At Every Size community. I’m assuming (perhaps naively) that they would welcome it, since it would get the focus off of body size and onto health behaviours.
Don’t forget to head over to the BMC Public Health site to read through the paper for yourself. I’d love to hear what you think in the comments.
Travis
Reference:
Shelley JJ. Addressing the policy cacophony does not require more evidence: an argument for reframing obesity as caloric overconsumption. BMC Public Health. 2012 Nov 30;12(1):1042. [Epub ahead of print]
The Reframing obesity as caloric overconsumption by Obesity Panacea, unless otherwise expressly stated, is licensed under a Creative Commons Attribution 3.0 Unported License.
TravisSaunders:
noranekokaburi (FreeCatLover)
mariawolters (Maria Wolters)
Gegeleduc (Geneviève Leduc)
LFitzgeorge (Lyndsay Fitzgeorge)
jeffvallance (Jeff Vallance, PhD)
chetm12 (Chet Mistry)
esargent184 (Elizabeth Sargent)
GeoHerod (Matt Herod)
Although I understand the motivation, the downside to this idea is that it minimizes the cause of at least a portion (and perhaps a sizeable portion) of obesity cases, which is sedentary behavior.
I’ve thought about that as well. Although there is a fair amount of evidence that sedentary behaviour actually influences obesity primarily by increasing food intake, rather than reducing energy expenditure. More info here:
http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=8687817
And so I think we’d still want to focus on things like sedentary behaviour, sleep, etc, if the goal was to reduce food intake. And I do believe that if we are trying to deal with the societal issue of consuming more calories than we burn, I think targeting the food intake is the one that is going to have the greatest gains.
“there is a fair amount of evidence that sedentary behaviour actually influences obesity primarily by increasing food intake, rather than reducing energy expenditure”
Possible, however even if true that doesn’t neccessarily mean that restricting activity and then compensating by restricting intake is optimal. Focusing on activity might still make more sense, especially since it is often healther for other reasons having nothing to do with calories.
I think the focus should be on health, not weight, and even the part of weight that we do care about should focus on healthy habits, not restricting caloric intake. There just isn’t any way around that interpretation of the “caloric overcomsumption frame” for the majority of people no matter how the author is themselves thinking about it for their own purposes.
So if there is a confusion among policy makers about what evidence supports what policies, we should reframe the question across the board so that everyone involved in policy decisions are led to look at the evidence from a particular (albeit misleading) slant in order to lessen their confusion. Better wrong than confused. I don’t quite buy it. But the author isn’t wrong, are they?
If there’s a confusion over evidence, it’s because the causes aren’t clear, or because of confusion introduced by advocacy groups.
If the former, then this suggestion pretty much just welcomes us to Orwell’s 1984 belatedly. The “reframe” is just a way of shutting down the dialog over causal models as they apply to policy, for political purposes. Just because increasing intake is the issue doesn’t mean “you eat too much” is the most constructive way to look at it in every context. And that’s the obvious way it will be applied to individuals (most people will indeed know that “caloric overconsumption” is thinly disguised wonk speak for “eats too much.”)
Now in either case that’s probably not fair of me because the problem isn’t that we’re fat and have metabolic diseases, the problem is simply that we eat too much, according to the author’s take on the research so far. No confusion there, right? So we should be focused on restricting intake rather than establishing healthier behaviors. Pretty clear now that confusion has been cleared away.
We know how well that approach works. Just decide to eat less and watch your health improve.
Lots of low calorie empty nutrition and artificial sweetners marketed as diet food, lots of willpower exerted to try to refrain from eating, lots of guilt about not being able to restrict for very long. It’s all so effective if we frame metabolic diseases instead as taking in too many calories.
To me it sounds pretty much like the same mistake most people were making until they discovered that restricting caloric intake only works when you’re locked in a ward, or (sometimes) when you’ve had intestine removed or stomach stapled.
I’m thinking this author has a political axe to grind more than having any useful or constructive take on the subject, and I don’t want them grinding it anywhere near me if I can help it. I’d rather see the science done and interpreted without the policy wonks trying to “reframe” it for their own uses, even if it confuses some people and I’d rather see clear thinking about causal models applied rather than politically skewed oversimplifications.
If you lock everyone in a ward then simply restricting their intake works beautifully. I’ll take my chances on the outside with intelligently crafted habits. If that means I back off from false certainty and oversimplified causal models and face a little confusion, I’m good with that.
So if there is a confusion among policy makers about what evidence supports what policies, we should reframe the question across the board so that everyone involved in policy decisions are led to look at the evidence from a particular (albeit misleading) slant in order to lessen their confusion. Better wrong than confused. I don’t quite buy it. But the author isn’t wrong, are they?
This assumes that the current framing of the issue is somehow the correct one. I understand the argument that it’s dirty pool to reframe an issue to benefit your cause. Except that’s exactly what Coke does every time they argue that it’s all about energy balance and moderation. I don’t think there’s any harm in reframing the issue in a variety of ways, in order to get a view of an issue from multiple perspectives.
As for the concerns about caloric restriction, one of the arguments is that reframing the issue will help people move away from this focus on personal behaviour, and focus more on policy’s that reduce the obesogenic nature of the environment (less food ads, healthier food, whatever).
I do share your concerns that this could lead to reduced focus on metabolic health and other behaviours that are healthy but not directly related to energy balance (e.g. sleep). As I mentioned above you can still make the case that these things reduce “caloric overconsumption” by increasing energy expenditure and/or reducing energy intake (remembering that “overconsumption” is relative – the higher your energy expenditure, the more you can consume and remain in energy balance).
Thanks Travis, I think I understand your perspective. It can be interpreted in a more constructive way than I interepreted it in my reply. However I strongly suspect that the connotations of “caloric overconsumption” will be broadly very different than the good intentions of the author assume. Just my own take at this point.
Excellent point. The way things are interpreted by people working in the field and the way they are interpreted once they are released upon society could be very different!
Precisely. I have no faith in this approach being interpreted in any way other than “blame the fatties”. And please be assured Travis, that I am not accusing you of doing so.
Ha, thanks WRG
I feel terribly uncomfortable with this approach, since it assumes that overweight is entirely due to overeating. In other words, it’s a polite approach to avoid saying what most people believe: that if only overweight people stopped stuffing their faces with Twinkies and took a walk, they’d lose the weight faster than snow melts on a warm day in March.
I fear that it’s just a repackaged version of “eat less – move more”, or the “nightmare on ELMM street”, as Arya Sharma calls it.
It also avoids dealing with the sticky problem that people almost inevitably encounter as soon as they lose some weight: they must permanently reduce their caloric intake to levels far below what those who have never been fat can eat if they want to avoid regaining weight in very short order.
Though it may seem impossible to believe, there are many overweight people out there who can easily and quickly gain weight on 1,500 calories per day, and often much less. Sorry, we’re not all pigs who just need to be “shown the light” about our gluttonous ways, nor do we all take the car across the street to buy our next litre of Coke and extra-large bag of chips.
HAES proponents, on the other hand, know that you can eat a well-balanced, healthy diet that is not high in calories and engage in regular, moderate activity and still be fat…though you can also be healthy. And that’s what HAES is all about: engaging in healthy activities in order to improve one’s health, not change one’s weight, although some shift in weight (up or down) may take place.
Thanks for commenting!
I’m a bit surprised, since this is putting the focus on healthy behaviours – e.g. eating roughly the same number of calories you’re burning. That can happen at a really wide range of body weights. In contrast, consistent positive energy balance and high weight gain over time is likely going to result in health problems eventually. The way I’m interpreting this, it’s not even about losing weight – just getting into neutral energy balance or reducing positive energy balance. So it completely gets away from the idea that your BMI is what we need to be focusing on. I don’t see how we get from that to statements about gluttonous pigs…
On a different note, should we not be making policies that promote healthy behaviours just because they might also influence energy balance or body weight? There are a number of good reasons to encourage better sleep hygiene or limit junk food advertising to kids. I’m not reading this as showing people “the light”, but instead trying to change the environment the people live in, since one of the stated goals is to get away from the idea of personal responsibility. That seems like a positive development to me.
I came across this post via a Google Alert on the term “Health At Every Size®.” (Please note the registered mark symbol. HAES is a registered mark designed to protect the weight-neutral approach from misuse or co-opting for weight-loss goals.)
Clearly, the article you cite here is still completely invested in weight-loss goals (“preventing ‘obesity’”), by the blame-shifting maneuver of focus on calories. (Really? No one’s thought of that before? Better alert Weight Watchers!) Any project that involves weight-loss goals is, by definition, anathema to the weight-neutral HAES approach.
I’m a longtime fat rights activist and I’ve been fortunate to spend a lot of time in HAES community. Sure, health is an important goal. So is social justice. I hold to the HAES approach because it advances both goals without harming either. The same is simply not true of all current weight-focused, weight-loss interventions. The traditional focus on weight damages physical/psychological health for people of all sizes and directly/inevitably promotes weight-based prejudice and discrimination. You may think you’re interested in the health of fat people. But unless fat people have a right to exist, there’s no point in even talking about our alleged health concerns.
Hi Marilyn,
Thanks for your comments, although I don’t follow all of them.
Clearly, the article you cite here is still completely invested in weight-loss goals (“preventing ‘obesity’”), by the blame-shifting maneuver of focus on calories. (Really? No one’s thought of that before? Better alert Weight Watchers!) Any project that involves weight-loss goals is, by definition, anathema to the weight-neutral HAES approach.
Could you expand on that a bit? Reducing positive energy balance (e.g. getting to the point where caloric intake = caloric expenditure) does not mean “weight loss” in any way. It means preventing or slowing persistent weight gain. That can happen at *any* body weight. Being in a constant state of positive energy balance is not a healthy situation (note that I am *not* saying that being overweight or obese is not a healthy situation – your energy intake and expenditure can be perfectly balanced with a BMI of 50 just as easily (probably more easily) than at a BMI of 15), and so adopting policies that make it easier for people to balance caloric intake and expenditure, regardless of their body weight, seems like a good idea to me. Because right now we’re in an environment that makes it quite easy to consume more calories than you burn, which has health consequences even if we completely ignore body weight.
That’s why from my reading this idea would fit well with HAES, since it’s taking the focus away from BMI/body weight, and placing it on promoting healthy behaviours. The bulk of the comments here would suggest that I am mistaken
@Marilyn Wann: I agree with you. It seems disingenuous to believe that framing caloric “over-consumption” (rather than focusing on weight gain) empowers anyone to shift attention away from weight outcomes because—if not determined by measurable changes in weight outcomes, such as number of lbs. gained or lost—how does one measure (or determine) if an overconsumption of calories has occurred? In other words, the measuring standard for determininng calorie over (or under ) consumption still relies on weight outcomes (number of lbs. gained, lost, or unchanged.)
Also, I see no health problems or potential risks that inevitably result from weight gains caused by increased caloric intake (or so-called “caloric overconsumption). Last month, for instance, I experienced a period of several weeks during which I felt MUCH hungrier than usual and therefore I ate a lot more food (more calories) than usual. I did not attempt to restrict, or to balance energy intake with energy output. Sure, I gained a few pounds, but no harm resulted. After my ravenous appetite subsided to it former (usual) levels, I then experienced another unusual phase, one during which I simply didn’t feel nearly as hungry as usual. Hence, whatever weight was gained previously as a result of increased caloric intake (over several weeks) simply disappeared gradually during the following few weeks. Based on many previous lived experiences with similar ebbs and flows in hunger (appetite levels), I now believe that if I had attempted to restrict my intake (to balance caloric intake with output), my body’s internal homeostatic mechanisms would have most likely encountered a far more confusing and challenging process when working to reestablish my body’s energy equilibrium (and homeostasis).
Perhaps our social norms (based on “expert” advice) that encourage us to (repeatedly or chronically) attempt to consciously predict and control our body’s complex physiological processes and outcomes (related to eating, for example) merely inject greater complications (via complex hormonal responses, for instance) and thus physiologically construct needlessly convoluted imbalances into otherwise relatively smooth-running (and mutually interdependent) systems.
I agree with caloric over-consumption as the root cause for obesity. Food choice as much as the amount of food eaten is the problem.
Being kind to each individual is essential as we all battle this epidemic. Activity is a factor, of course. We understand that genes and emotional issues are a contributors to addiction. But there comes a time when tough conversations are essential. We must be outspoken, blunt, even to the point of rudeness; to call things by their proper names without any beating about the bush. We don’t tiptoe around and say over-consumption of alcohol is okay because we don’t want to hurt the feelings of people with alcohol addictions. That is ludicrous.
The blame lies with our food culture and the industrialist drivers in the food industry. Make that the focus, not victimizing every obese person. Fight back against over-comsumption. It’s killing us.
I want to comment a little on “overcomsumption is the root cause.” I’m not picking on the previous post specifically but that phrase brings to my mind one of the things that makes me most uneasy about the suggestion.
I’ve done causal analysis as a critical part of my profession for decades and I honestly find that until we review methodology prior to starting, most people truly have no idea what root cause analysis means. I suspect the word “root” confuses them, and indeed it is very misleading. Root cause analysis actually refers to the process of identifying preventable causes by tracing them back to other causes. It doesn’t mean finding a single cause that supposedly has no causes itself, as if we were looking for the “uncaused cause.” I know it sounds silly put that way, but when people refer to “the root cause” without any qualification of context, that’s what it implies
That makes no sense logically. “Root” really refers to rooting out, an ongoing process that stops under predetermined analytical conditions, it doesn’t refer to identifying a mythical single parent node in a hypothetical causal tree. When people do that, it means they are either very weak analysts or else that they have an agenda other than just inquiry into preventable causes.
Obviously overcomsumption is itself caused by other things. People didn’t en masse decide collectively to eat more out of a magical act of collective unconscious or divine inspiration, they began eating more because of other things. A legitimate root cause analysis identifies any preventable causes among those other things, it doesn’t stop just because things are getting too complicated for some policy makers.
Sorry for getting so verbose over a quibble, but the mistake is natural and I think most people faced with this “overconsumption is the cause” will interpret it in similar ways, and I suggest that may be a costly error in the long run.
Obviously overcomsumption is itself caused by other things. People didn’t en masse decide collectively to eat more out of a magical act of collective unconscious or divine inspiration, they began eating more because of other things. A legitimate root cause analysis identifies any preventable causes among those other things, it doesn’t stop just because things are getting too complicated for some policy makers.
I agree that the word “root” is a problem when talking about causes of obesity and leads to an infinite regress that would be counterproductive. This is why I use the phrase “primary cause” – and even this is a very qualified claim. Part of the rationale I present for reframing is the commonly used formula that “obesity is the result of a sustained caloric imbalance, where energy input exceeds energy output.” Of the two factors in the equation, I argue that energy input is the primary cause. This allows one to ask the important question of why: if energy input is the primarily cause of obesity, what is causing increases in energy input? The food environment seems to be a pretty good answer to that question, where overconsumption is not only encouraged is a logical response. This is not to suggest that the food environments are the *only* thing that causes overconsumption, but they play a very crucial role, particularly at a population level.
I should note, I do not think it is necessary to determine a “root” cause of obesity to identify meaningful and promising preventive measures. Indeed, trying to determine “root causes” of public health problems will lead to the of social problems. For the purposes of developing public health policies, it is necessary to identify places in the causal chain where an impact can be made, and the prevention of caloric overconsumption is presented in the paper as a promising route for effecting change .
Clearly, I don’t know how to use HTML tags very well – apologies! Where the hyperlink starts it was supposed to say “public healthification” and the link was supposed to take you to the paper.
Jacob, thanks very much for your considered replies here. I think you’ve made your ideas and reasoning very clear, and I appreciate that. My primary concern was whether the change in framing itself is really helpful, and to whom. I don’t doubt that you yourself understand the kind of analysis needed or that you intended appropriate analysis with your suggestion. I am not involved at all in many of the areas you are, so I am not qualified to speak to them, I just speak with regard to how someone outside the field sees that reframe. Thanks again!
I find it interesting that HAES ™ proponents read this approach as a thinly veiled version of “more of the same” while you (Travis) see it as something weight neutral.
Maybe it is weight neutral for someone whose weight has always stayed approximately the same and who has never been told (nay admonished) to count calories in order to lose weight.
But for someone who has lived through the horrors of counting and measuring every morsel that passes their lips, it truly is just more of the same.
I really don’t think we have the slightest idea why Mr. A maintains pretty much exactly the same weight for his entire adult life while Ms. B steadily gains. It is easy and satisfying for people on the A team to believe that they are morally superior to the B team (although many just take their steady weight for granted and go about their lives without taking a moment to consider what they ate last night or what they’ll have for breakfast this morning).
Until we have a real understanding of why it is so difficult for some people to maintain this calorie – energy equilibrium, we will continue to rely on simplistic tools (yes, as Marilyn says, “Weight Watchers, anyone?”) and continue to believe the mainstream opinion that (sorry to repeat myself) it’s all a question of fatties simply being gluttonous sloths. Yes, I’m repeating myself because I read a lot of articles in the mainstream and electronic media and that’s what most people think. The viciousness that runs rampant in the comments section of virtually all articles on weight is mind boggling. Perhaps in the rarified world of academia, the bias is much more subtle, but I would suggest that the approach you outline in this post simply constitutes further fodder for the fat haters. Nothing more, nothing less.
I think this is a great idea, personally. Lots of people of every size overeat, it’s not healthy to eat tons of crap, even if you’re skinny. I would also think those who are big who claim to eat no more than anybody else should actually appreciate this, though I also understand the defensiveness. I used to be fat, it’s a sensitive and touchy subject.
I think just for increasing diabetes alone, forget what anybody bloody looks like, we need to do something drastic. I don’t see it getting to some George Orwell nightmare, but maybe more a case of, as Kelly Brownell calls it, “optimal defaults”. As in, making it easier to do the healthy thing, as opposed to how it is now, when you have to really try very hard to not eat the Std American Diet.
I agree, the concept of addressing overconsumption is perfectly reasonable, perhaps even trivially obvious. My argument is with the reframing of the larger problem of obesity as eating too much. If we were to reframe it, I suggest it should be to healthy consumption and activity rather than excessive consumption. People don’t neccessarily perceive themselves as eating too much, and often they are eating things that don’t nourish them and eating less of them doesn’t help very much in the long run.
So I think the frame, from the perspective of policy and the message to individuals, should be nourishing themselves, not restricting consumption. And from an environmental perspective, it is nourishing basic needs that we would focus on, as well as identifying ways to stop rewarding encouraging and reinforcing overconsumption. That’s not at all, to me anyway, implied by the frame of “caloric overconsumption.” I can see how it can be used in that way however, so I realize people differ fundamentally on this.
Todd, the promotion of healthy consumption and the promotion of activity have, on the whole, been ineffective as public health strategies – especially for obesity prevention. The problem requires more than an “educate people about how to live better” response. Simply encouraging people to eat “nourishing” foods is not enough, particularly in food environments over which people have little to no control. In addition to the nefarious tactics of the food industry, where unhealthful foods are continually portrayed as being nourishing, many do not have access to affordable nourishing foods or have the time or skill to prepare such foods, etc.
Promoting solutions like “intelligently crafted habits”, “nourishing basic needs”, and “healthy consumption” are likely to only further the stigmatization and discrimination of obese peoples, who will be held personally responsible for their decisions. The frame I’m proposing moves away from notions of personal responsibility by identifying the food environment as the reason for involuntary overconsumption.
First and foremost, many thanks to Travis for posting my article and then taking the time to alert me to the fact that he had. Having people engage and respond to my article is at once exhilarating and a bit terrifying. For the record, I’d like to make it clear at the outset that I have no axe to grind and I am certainly not a “fat hater” or aim to “blame the fatties”. I’d also like to thank people for their comments and criticisms. This article is included under BMC Public Health’s debate category for a reason!
I too find it interesting that many here find the article is a “thinly veiled version of ‘more of the same’”, as noted by WRG. With respect, I wonder if that is a first impression based on assumptions more than the substance of the article. Obviously, having written the article, I see potential for reframing to shift the policy environment. But the article actually has very little to say about weight-loss. If anything, it speaks more to preventing weight gain – better put, it speaks to preventing involuntary weight gain.
It is difficult for me to see how the article constitutes fodder for fat haters, however. A central reason for reframing the issue is to move away from the idea of personal responsibility for obesity, and to focus on the involuntariness of caloric overconsumption. Toxic food environments are identified in the article as the problem, where caloric overconsumption is a logical and, in some instances, unavoidable response.
Importantly, the article makes no claims about healthy weights – the clinical term “obesity” is purposefully used and “fat” avoided. Additionally, the paper goes to great lengths to illustrate why energy intake is involuntary. Quite the opposite of accusing people of being pigs or gluttonous!
I welcome specific comments on the article from anyone who is so inclined. I’m also happy to continue the discussion with anyone interested. I have elected to not respond in further detail to specific comments here as I do not want to use Travis’ blog as a platform for defending my argument. Again, I am grateful that he thought it worthwhile to post about my article, and I am thankful to each of you for taking time to respond.
Jacob, as I think you imply to some degree in your article, the point of a “frame” is to set people’s thinking in a particular way and suggest particular kinds of analysis and solutions. So your concern should in principle, I think, be to determine how your frame is making people think in practice. As opposed to how you anticipate it make them think in theory. I think you are getting very valuable data here regarding how your frame is interpreted by different people. I don’t think it’s a matter of people missing your point, I think it’s an intrinsic problem with the “framing” approach, we are trying to direct people’s thoughts but their interpretation depends on their prior knowledge and attitudes.
“Caloric overconsumption” has reasonable interpretations for suggesting solutions, certainly. I think that is perfectly defensible. The point is not whether you can defend it but whether other people you are addressing with your frame will think that way. If not, the frame doesn’t do the job you intend.
Many of us obviously see its implications automatically as “you are eating too much and the solution is for you to put your fork down.”
Some of us see that as blaming the individual entirely for eating too much. Some of us instead see it as neglecting the role of activity in health and the role of other preventable causes in overeating.
The term obesity implies pathological overweight. The term overconsumption implies eating too much. What solutions are in people’s minds for each frame? To me the overconsumption frame is only helpful to the degree that people interpret it the way you mean it, and I find that hard to imagine, both because of the way it makes me think at first and because of the other responses here.
I think it begs the question to say that people are not understanding the substance of your paper. Your own point is that the frame itself is supposed to help things. Is it?
Todd, thanks again for the comments. Sorry for the delayed response.
You asked above whether a change in framing is really helpful, and, if so, helpful to whom. Obviously, I see potential for reframing, or would not have written the article (note: I am not alone in calling for reframing obesity, see, for example, Dorfman and Wallack’s paper, Moving Nutrition Upstream: The Case for Reframing Obesity). I contend that reframing will be helpful for policymakers, and as a way of addressing the obesity policy cacophony (see Lang and Rayner).
Presently, policymakers are trying to determine which policies, if any, are effective for preventing obesity and thus warrant consideration. In addition to being a complex problem, there are a variety of stakeholders with competing ideas about how to solve the problem of obesity. The result is that many people simply calling for more evidence or more complex policy responses. This will simply add to the noise of the policy cacophony.
If we reframe the problem, we can eliminate some of the noise. I suggest the frame caloric overconsumption because research increasingly suggests that increased energy consumption is a primary cause of obesity. Rather than trying to prevent obesity, I’m suggesting that policies should aim to prevent caloric overconsumption. Although an imperfect comparison for many reasons, caloric overconsumption is to obesity what smoking is to lung cancer. Clearly not all lung cancer is attributable to smoking, just as not all obesity is attributable to caloric overconsumption, but just as preventing smoking will reduce instances of lung cancer so too do I believe that the prevention of caloric overconsumption will reduce instances of obesity. And, just like the prevention of smoking has positive implications beyond the prevention of lung cancer, the prevention of caloric overconsumption has positive implications beyond the prevention of obesity. The fact that obesity is a complex issue that involves more than eating does not detract from the need to prevent caloric overconsumption – particularly given that caloric overconsumption is an involuntary risk foisted upon individuals by toxic food environments.
I do take note, and find it interesting, that many who have responded to my argument seem to suggest that it will not work at an individual level, and that it is simply more of the same. I don’t think it is more of the same – the argument is not that we should be saying “eat less” to individuals but rather that we should be supporting policies that address the obesogenic and toxic food environment. It is unfair to expect people to control their energy intake when the food environment is geared towards increasing energy consumption, when “choice” is more illusory than real, when adequate regulation of the food industry is lacking … I could go on and on.
Admittedly, I am not entirely surprised with some of the responses my paper has received. I certainly did not expect widespread acceptance. I would suggest that some of the responses reflect the control of industry frames, where any mention of calories or energy intake is deemed to be a matter of personal responsibility. Industry has continually promoted the idea that the blame for overconsumption lies with individuals. I see reframing as helping eradicate the notion of “put the fork down” and to shift blame away from individuals who ultimately have little control.
In addition, a clearer distinction has to be drawn between treatment and prevention, as they are not the same. Restricting calories might not be a very promising solution for treating obesity, but that does not mean prevention overconsumption will fail as a preventive strategy. All too often I fear treatment and prevention are assessed in the same manner. I also am reluctant to give up on preventive efforts to shift behaviours when there have been inadequate shifts in the environment (whether physical, social, economic, policy, etc.) to support positive behaviour change. Without such systemic changes, it is like telling someone to swim upstream and then being surprised that they are fighting the current!
Overall, I agree that work needs to be done to ensure that caloric overconsumption is interpreted as intended in my article, but I think this is entirely possible if policymakers, academics, researchers, advocacy groups, etc., are willing to adopt the proposed frame.
Dang… I should really not pretend I know anything about coding – sadly, I even tried you se a “HTML tag tester.” *Sigh*
Jacob, thanks very much, I appreciate you taking the time and effort to respond in detail and also your frustration with markup termination tags.
There’s an old saying that a joke isn’t really very funny if you have to explain why it’s funny. I respectfully suggest the same may be true of a “frame.” With that suggestion, I
Thanks again.
Thanks for that, Jacob!
Wrong wrong wrong wrong wrong, all WRONG!
We’ve been telling fat people since forever to just eat less…. has it worked so far? Why would it suddenly work in the future? BTW fat people are happy to eat less if you give them a drug to reduce hunger, but there is no such drug.
Read this link….
http://www.drsharma.ca/more-of-the-same-leads-to-more-of-the-same.html
Hi Kindke,
My argument isn’t that people should just eat less – my argument is that the food environment has to change ( e.g., “make the healthy choice the easy choice”), and that this will require a shift in the policy environment which can be brought about by reframing.
I am familiar with Dr. Sharma’s work, and I’m pleased that he seems to be familiar with mine: http://www.drsharma.ca/should-public-health-focus-on-calories-in.html.
Does a strict caloric over-consumption lens fail to consider the unique hormonal and metabolic effect of different macronutrients? Eating 100 calories of steak triggers a unique metabolic effect compared to 100 calories from wheat pasta, such as the macronutrient’s thermic effect, and the hormones involved in digestion, in particular the role of insulin. So does fat metabolism (and therefore obesity) then become about diet composition rather than strictly the number of calories contained in the diet?
http://healthoptimize.blogspot.com/2012/12/challenging-nutrition-dogma-is-it.html
Craig,
I haven’t read Taubes’ book, although it is now on the to-read list, so I hesitate to comment about his particular arguments. I am also not a scientist, but a legal scholar, and so rely heavily on the peer-reviewed research of others. That said, while there might be a difference in how people digest and use calories from different foods, the fact remains that the food environment promotes overeating in general. Even if one accepted that you could eat as much salmon as you wanted without ever getting obese, the reality is that few people will only eat salmon, are in the position to be able to just eat salmon, etc. The danger I see in the approach of “eat only the right things and you’ll be fine” is that, once again, the individual is being blamed if they do not eat properly.
Hopefully others more familiar with Taubes’ argument will share their thoughts.
Thanks for the comment.
I agree entirely, Jacob.
There is definitely truth to the notion that some calories are better or worse than others, but a big part of that is that some calories (like pasta) are much less filling than others (like steak), which is why they more easily lead to over-consumption. And of course it tends to be the less filling, high calorie foods which are promoted in the current food environment.
Policies that successfully promote the consumption of healthier, less energy dense foods are going to have the dual effect of improving diet composition and reducing caloric intake in one swoop.
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I will not say the science supports something radically different then caloric overconsumption, but there is a rather large body of data that suggests it is not the amount of food as much as the type. Similarly there is well established research that shows when people cut back on calories and dial up the exercise meter they just get hungrier. I tried a conventional approach with some success in losing weight, but I eventually saw the pounds creeping back in even though I’d kept the same exercise routine.
I’ve since been working for 7 months on the Smarter Science of Slim (book title) approach. I am more tone, lost inches faster, am lighter than when I graduated high school. His approach seems counter intuitive, but between my own background and the research articles I have followed up on it is all legitimate.