Let’s act on the best available evidence on obesityBMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f3015 (Published 22 May 2013) Cite this as: BMJ 2013;346:f3015
- J Lennert Veerman, senior research fellow1
Taubes argues that we “start anew” in obesity research.1 From a public health perspective, I have five reflections on his essay.
Firstly, he juxtaposes the energy balance against a failure of hormonal/metabolic regulation. However, the two are not mutually exclusive. Did previous generations of researchers really consider energy imbalance as the “cause” of obesity without thinking that other factors might influence that balance?
Secondly, in saying “All we have are speculations,” Taubes is throwing out the baby with the bathwater. Granted, some research is substandard, but he ignores the excellent work that has also been done, while paradoxically citing some of it.
Thirdly, Taubes’s views are paralysing. If we don’t know anything, we can’t do anything. We are reduced to waiting for the results from research funded by the Nutrition Science Initiative. (But that will be rewarding: according to the organisation’s website, it will “find out, once and for all, what we need to eat to be healthy”—sounds more like miracle than science.)
Fourthly, Taubes does not mention societal influences. Our metabolic hard wiring may make us vulnerable to overdosing with sugar, but our basic metabolic processes have not changed over the past decades, whereas our waistlines have expanded. The question is what environmental factors drive us to consume more energy than we use and how these changed over time.
Finally, Taubes’s insistence on accepting evidence only from randomised controlled trials is too restrictive. This means discarding promising interventions to reduce the burden of obesity, such as limits on food advertising to children2 and taxation of sugar sweetened drinks.3 No trial evidence of such population targeted interventions is available and possibly never will be.
New good quality research is welcome. But rather than wait for perfect evidence, we have to act on best available evidence.
Cite this as: BMJ 2013;346:f3015
Competing interests: None declared.
Full response at www.bmj.com/content/346/bmj.f1050/rr/642372.