Tackling overweight and obesity: does the public health message match the science?

Abstract

BackgroundDespite the increasing understanding of the mechanisms relating to weight loss and maintenance, there are currently no validated public health interventions that are able to achieve sustained long-term weight loss or to stem the increasing prevalence of obesity in the population. We aimed to examine the models of energy balance underpinning current research about weight-loss intervention from the field of public health, and to determine whether they are consistent with the model provided by basic science. EMBASE was searched for papers published in 2011 on weight-loss interventions. We extracted details of the population, nature of the intervention, and key findings for 27 articles.DiscussionMost public health interventions identified were based on a simple model of energy balance, and thus attempted to reduce caloric consumption and/or increase physical activity in order to create a negative energy balance. There appeared to be little consideration of homeostatic feedback mechanisms and their effect on weight-loss success. It seems that there has been a lack of translation between recent advances in understanding of the basic science behind weight loss, and the concepts underpinning the increasingly urgent efforts to reduce excess weight in the population.SummaryPublic health weight-loss interventions seem to be based on an outdated understanding of the science. Their continued failure to achieve any meaningful, long-term results reflects the need to develop intervention science that is integrated with knowledge from basic science. Instead of asking why people persist in eating too much and exercising too little, the key questions of obesity research should address those factors (environmental, behavioral or otherwise) that lead to dysregulation of the homeostatic mechanism of energy regulation. There is a need for a multidisciplinary approach in the design of future weight-loss interventions in order to improve long-term weight-loss success.

All roads bring to Rome: a different way for predicting success in the therapy of obesity through psychological features

“…In fact, in the patient series described above, less than one out of three subjects lost more than 5 % of initial body weight at the six-month follow-up. This result is in line with previous studies [2][3][4], and it confirms the need for a more accurate selection of patients to be enrolled in lifestyle intervention programs. In fact, if it had been possible to identify in advance patients bound to success, then a large amount of resources would have been saved.…”

“…However, this therapeutic approach, which requires a remarkable investment in professional resources, is characterized by a high proportion of treatment failures [1][2][3][4]. As a consequence, relevant resources are dissipated for the treatment of unresponsive individuals.…”

Top 10 Research Questions Related to Energy Balance

“…Several excellent articles have recently addressed myths and preconceptions surrounding obesity and their detrimental impact on public opinion, mass media, and scientific decision making, and many of the topics covered are directly related to the study of energy balance (Bray, 2008;Casazza et al, 2013;Finkelstein & Bilger, 2012;Hafekost, Lawrence, Mitrou, O'Sullivan, & Zubrick, 2013;Hebert, Allison, Archer, Lavie, & Blair, 2013). Each of these articles are extremely informative and are suggested reading for more information on the topic.…”

“…Despite these barriers, more research studies are needed involving repeated measurements of EE, EI, and ES during a period of time greater than 6 months with designs that consider energy balance not as a simplistic model but instead an interrelated and dynamic regulatory system (Hafekost et al, 2013;Hall et al, 2012;Hand et al, 2013). Researchers should utilize highly valid and reliable measures (e.g., objective activity monitoring using accelerometers and other devices instead of self-report; Hand et al, 2013) and should utilize statistical techniques to correct for known errors in other measures (e.g., adjusting for level of social desirability in dietary measures; Hebert et al, 2002).…”

“…For the purposes of this manuscript, perhaps the most important misunderstanding is in regards to the application of the energy balance equation itself. For example, one recent review of public health interventions to reduce obesity found nearly all were based primarily on a simplistic model of energy balance (i.e., "eat less, move more") with little consideration of the dynamic ENERGY BALANCE RESEARCH relationship of the energy balance components (Hafekost et al, 2013). Further, individuals and the popular media often confuse the limitations of the energy balance model in describing the small factors that influence the energy balance components as a failure of the model itself (Bray, 2008).…”