Marc has a thoughtful piece in the Atlantic where he discusses his own struggles with obesity, his discussion to undergo bariatric surgery and our current obesity policy.
This observation is especially poignant
IF WE CAN’T EASILY cure obesity, we’ve got two choices: we rely on medical science to ameliorate its effects, in which case we consign the obese to a miserable life waiting for that one pill or Nature article that solves it all; or we get serious about helping to prevent people, and especially children, from becoming overweight and obese in the first place. (Eighty percent of people who were overweight at ages 10 to 15 are obese at 25.) This is the province of policy makers: state legislatures, school boards, members of Congress, executive-branch members, even corporate boards.
However, it is important to accept that we know as little about preventing obesity as we do about curing it. There is no significant evidence that I am aware of to believe that preventing obesity is any easier than curing it.
It is possible that the modern rise in obesity involves some form of addiction and that some people are more genetically prone. In the same way that many can drink all they want and never become alcoholics, some can eat all they want and never become obese. In this case prevention might seem to make a lot sense.
This may be true. I don’t know of strong evidence to suggest that is. However, even if it is true it doesn’t tell us what we need to do to prevent obesity. We can’t ask that people abstain from food.
We could ask that they abstain from all “unhealthy food” though that would require a good grasp on exactly what healthy food is. This is something that we do not have. Note that as little as 12 years ago most doctors would have considered pasta a health food, while virtually few would today.
However, even that is not likely to be the answer. Ice cream and soft drinks existed in the 1950s yet the obesity epidemic was under control. If there is a specific tipping point, then we don’t know what it is.
To make social policy and to be sure we are not doing more harm than good we need a serious Theory of Obesity. One that accounts for all of the stylized facts. One that can explain the rise in the epidemic, the strong genetic association, the tens of millions of failed attempts to loose weight and the stunning success of bariatric surgery and Fen-Phen.
It must also be able to explain how for 5000 years since the formation of the first human cities our environment was close enough to our evolutionary environment to avoid obesity but in the last 35 the entire world has suddenly tipped into a spiraling obesity.
These are not easy questions. This is not an easy problem. By far the most important thing we need at this juncture is humility. When we start monkeying around with government policy that impacts the very sustenance of individuals then the potential for doing more harm than good is great.