Since the 1950s, the conventional wisdom on obesity has been simple: it is fundamentally caused by or results from a net positive energy balance—another way of saying that we get fat because we overeat. We consume more energy than we expend. The conventional wisdom has also held, however, that efforts to cure the problem by inducing undereating or a negative energy balance—either by counselling patients to eat less or exercise more—are remarkably ineffective.
Put these two notions together and the result should be a palpable sense of cognitive dissonance. Take, for instance, The Handbook of Obesity, published in 1998 and edited by three of the most influential authorities in the field. “Dietary therapy,” it says, “remains the cornerstone of treatment and the reduction of energy intake continues to be the basis of successful weight reduction programs.” And yet it simultaneously describes the results of such dietary therapy as “poor and not long-lasting.”1
Rather than resolve this dissonance by questioning our beliefs about the cause of obesity, the tendency is to blame the public (and obese patients implicitly) for not faithfully following our advice. And we embrace the relatively new assumption that obesity must be a multifactorial and complex disorder. This makes our failures to either treat the disorder or rein in the burgeoning epidemics of obesity worldwide somehow understandable, acceptable.
Another possibility, though, is that our fundamental understanding of the aetiology of the disorder is indeed incorrect, and this is the reason for the lack of progress. If this is true, and it certainly could be, then rectifying this aetiological misconception is absolutely critical to future progress.
Read the full essay here: http://www.bmj.com/content/346/bmj.f1050
Graham
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