I Wish I Were Far From the Madding Crowd

April 27, 2010

Institute of Medicine report on “Bridging the Evidence Gap in Obesity Prevention” – is their framework comprehensive enough?

The Institute of Medicine is the health arm of the National Academy of Sciences.  On April 23, 2010, it released a report, “Bridging the Evidence Gap in Obesity Prevention: A Framework to Inform Decision Making.”

New Framework Recommended for Decision Making and Research on Obesity Prevention

http://www.nationalacademies.org/morenews/20100423.html

April 23, 2010 — To battle the obesity epidemic in America, health care professionals and policymakers need relevant, useful data on the effectiveness of obesity prevention policies and programs. A new report from the Institute of Medicine identifies a new approach to decision making and research that uses a systems perspective to gain a broader understanding of the context of obesity and the many factors that influence it.

http://www.iom.edu/obesityframework

Is the IOM systems approach missing what could be a large component of the system?

The Institute of Medicine states that it is adopting a systems approach to obesity prevention.  That sounds pretty comprehensive, right?

Well, maybe not.  Cutting to the chase, this report appears to be limited to looking at obesity prevention interventions and not all obesity causes.  The focus is entirely on caloric and energy balance.  But what if, as Dr. Robert Lustig and others have argued, what you eat and how it is metabolized are factors in the obesity epidemic?  Energy intake and energy expenditure might not reveal the whole picture.

And what about the possibility that environmental exposure to chemicals might be a factor?  Quickly skimming the report, I found Figure 4-5, “The obesity ‘system’: a broad causal map” (p. 4-12 (p.80) of the online version of the report) shows a blurry version of the diagram, but I was able to find the original on Slide 9 of the presentation, “System Dynamics Simulation in Support of Obesity Prevention Decision-Making.”

Bobby Milstein and Jack Homer, For Institute of Medicine Committee on an Evidence Framework for Obesity Prevention Decision-Making, Irvine, California, March 16, 2009
http://www.iom.edu/~/media/Files/Activity%20Files/PublicHealth/ObesFramework/IOMIrvine16Mar09v52MilsteinHomer.ashx

The “map” shows Prevalence of Overweight & Related Diseases being affected by two causes, Healthiness of Diet & Activity Habits and Genetic Metabolic Rate Disorders.

But what if metabolic rate disorders are not strictly genetic, but can be epigenetic or can be directly caused by chemical exposure?

That idea does not appear to have crossed their minds.  The framework and approach that are recommended look like they have merit, but I would argue that the authors are not looking at as large a system as they should be.

The environmental factors they do mention are along the lines of the “activity environment” and the food environment.”

Without acknowledging the effects exposure to chemicals might have on people’s propensity towards overweight and obesity the report is more limited than it should have been.  The focus is totally on social and behavioral interventions.  While diet and activity are probably the most important factors in obesity for most people, it appears that no thought has been given to the possibility that by reducing exposure to chemicals we might be able to prevent or at least reduce the rates and extent of overweight and obesity.

Links to Report Information

There are links to several different items here.  The links above are to a news release and the Institute of Medicine (IOM) Report web page (i.e. the page for the project/activity).  Links below are to the full text of the report online, the report recommendations, a four page report brief, as well as links to a webcast and podcast of the briefing on the release of the report, links to related resources (which duplicate some of the other links), and links to pages on the meetings that led to the creation of the report.

Full Report online

Report at a Glance

  • Recommendations (HTML)
  • Report Brief (4 pp.) (PDF, HTML)

Report: Bridging the Evidence Gap in Obesity Prevention: A Framework to Inform Decision Making

Released: April 23, 2010

http://www.iom.edu/Reports/2010/Bridging-the-Evidence-Gap-in-Obesity-Prevention-A-Framework-to-Inform-Decision-Making.aspx

A Framework for Decision-Making for Obesity Prevention: Integrating Action with Evidence

http://www.iom.edu/Activities/PublicHealth/ObesFramework.aspx

Bridging the Evidence Gap in Obesity Prevention: A Framework to Inform Decision Making

http://www.nap.edu/webcast/webcast_detail.php?webcast_id=420

April 23, 2010
Running Time: 00:58:04
Format: RealAudio (Requires free RealPlayer)  Podcast: (mp3)
To battle the obesity epidemic in America, health care professionals and policymakers need relevant, useful data on the effectiveness of obesity prevention policies and programs. A new report from the Institute of Medicine identifies a new approach to decision making and research that uses a systems perspective to gain a broader understanding of the context of obesity and the many factors that influence it.

Related Resources:

Report Briefs
Full Report
Project Website

Previous Meetings

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