AcademyHealth Panel Weighs in on Evidence Behind Obesity Prevention

AcademyHealth Panel Weighs in on Evidence Behind Obesity Prevention


In 2013 I was on the planning committee for the
Academy Health National Health Policy Conference and as we were discussing various
issues that we want to be covering in February, I said there’s one big issue out there that’s facing
this country, and that’s the obesity epidemic. And so I had suggested to the planning
committee that we convene a panel that brings together both the advocates, the decision
makers, and the people who advise decision makers, and the researchers. There are a lot of arguments in
policy circles about whether we have enough evidence to act to address
the obesity crisis. And what you often hear from the public health advocates is that we’ve
got the evidence, we just need to move forward. And what you hear from many decision makers
both in public policy circles and in business is that the evidence doesn’t apply, it isn’t
strong enough, you’re asking us to spend a lot of money without a lot of confirmation
that we’ll get return on investment. The challenge here is that different players have
different standards or you could even say, different needs. Policy makers want something simple,
and they want something quick, but they want to be able to say it’s proven. Researchers
are always skeptical about whether we’ve proven what works. The randomized control trial is
often considered the gold standard, that’s a separate discussion as to whether that’s
a viable option. Program managers are probably more interested in seeing evidence informed
approaches. They want to know, not just whether a very elegant trial supported by the National
Institutes of Health worked in this very select population. But they want to know what it
means to take this kind of program to scale. It was kind of interesting to see where there
was agreement, where there were differences. One, there was strong agreement that the obesity
epidemic is real and that we need to be thinking about how to address it. It will have major
implications, and is already having major implications for Americans’ health, and America’s
health care spending. I think policy makers see, intuitively, that it’s the right thing
to do. And not doing something to address this issue, I believe that the trend we’ve
been on, have been on, would continue to worsen. Remaining at issue is that there’s a growing
body of evidence of interventions that have worked, but as I mentioned, there is an issue
of do they scale, do they generalize, how far can we push those. But at the same time,
I think there was at least some agreement that given the magnitude of the crisis, holding
up too high an evidence bar is probably working against us. And one of the panelists concluded
that we need to move away from the poles of feel-good policy at one end, and analysis
paralysis at the other end, and move in the middle to think about new kinds of evidence,
new kinds of evaluations, and be clear about what’s at stake in terms of making these interventions. We can’t just go out and do what feels good, what feels right, or what’s politically expedient.
But we cannot have the paralysis of the analysis on the other end. We can not just do nothing,
because we don’t have perfect evidence. And there are many other situations where we have
to go out, you know we go to war with imperfect evidence, we do all kinds of expensive things
with human costs. Decision makers have to do something, the patient is on the table,
so to speak. You got to do something. So what we want to do, is get in the middle of this,
or at the right point, the sweet spot and use the best information we can find to answer
the most policy relevant questions. I think we had a good airing of the issues, I was
pleased to see that people who were selected for the fact that they came in with very different
points of view, in fact could find a fair amount of common ground. And I think having
AcademyHealth sponsor this in particular was good. We had a good audience of health services
researchers who can begin to think about not just what evidence do we have today, but as
we move forward, what evidence do we need to be generating in the future. And as we’re
designing interventions, how do we design interventions in a way that they provide us
with new knowledge about what happens next.

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