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.
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.
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.
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.
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]