Saturday, November 3, 2012

Obesity Prevention: applying lessons from anti-tobacco campaigns

The recent OMA policy paper on the prevention of obesity has referred to obesity as health challenge which requires immediate and aggressive action.

The OMA has released several recommendations on how to reduce the incidence of obesity in Ontario by considering some of the strategies that were effective in reducing rates of tobacco use. A summary of the recommendations can be found here from the October issue of the Ontario Medical Review:

While I personally agree with these recommendations, barring some debate about definitions, such as "low nutritious foods", the connection to the anti-tobacco campaign of recent decades is an awkward one, at best.

It is correctly stated that "tobacco and food products are different in many ways, and unlike food, tobacco products have no safe level of use". Indeed, tobacco and food products are very different in and of themselves, in relation to human health and disease, and, as I will argue, in their simplicity when aspiring to decrease the incidence of a chronic disease.

Point #1: Tobacco is optional, food is compulsory.
The paper states that tobacco products do not have a safe level of use, but that food products do. Not only do food products have a safe level of use, but they are required for sustaining life.

Point #2: Tobacco is not beneficial, foods are often beneficial
Tobacco products do not promote physiological function or well-being of humans in any way - rather they are associated with physiological dysfunction and disease. On the contrary, many foods promote health and well-being.

Points #3: Tobacco is simple, food is complex
Tobacco is a consumer product available for purchase if one so chooses. Food is not simply one product on the shelf...there are myriad types of foods available on the market...some good, some bad. Further to this, obesity, the ultimate goal of these changes in food policy, is a result of many factors at various levels of the socio-ecological model.

The OMA policy paper is a major step in the right direction towards altering the obesogenic environment, and ultimately to reducing the incidence of obesity in children and in adults. Despite only addressing one side of the energy equation, their recommendations could have large impacts on the prevention and reduction of obesity. There are indeed several lessons learned from the campaign against tobacco that can be applied to obesity, and I commend the OMA for these recommendations  However, I fear that comparing tobacco with obesity - by suggesting that "we reduced smoking levels, so we can therefore reduce obesity levels" - does a disfavor to the fight against obesity.

Tobacco is optional, it is easy to convince people that it is bad because it has no health benefits, and it is simple in that it is one consumer product. Food is compulsory, it is much more difficult to navigate the good food/bad food environment for consumers, and food is complex - it is not just a product on the shelf. Further to this, obesity is far much more than just food - it is the result of an imbalance in the energy equation, but is promoted by numerous factors in the obesogenic environment.

In comparison, reducing smoking rates was easy. Reducing obesity is a whole different box of french fries.