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Stagnation in the clinical, community and public health domain of obesity: the need for probative research

In 1796, prompted by his mentor’s enjoinder, thought turned to action as Edward Jenner subjected his conjecture regarding smallpox resistance resulting from cowpox exposure to empirical testing. This hypothesis test revolutionized post-18th century medicine leading eventually to the smallpox vaccine. Indeed, higher order thinking links philosophy and science, but they are distinguished by the latter’s emphasis on systematic experimentation. In the context of obesity research, although we philosophize and debate the value and application of various public health messages as though the answers are ‘known’ for all intents and purposes, the strength of our progress has not matched the strength of our exhortations. We offer that one key factor limiting our success in identifying effective intervention and prevention strategies is the disproportionate effort spent on activities that serve to focus attention on popular conjectures as opposed to rigorously testing those conjectures with probative research. Hunter recognized that conjecture, regardless of how seemingly persuasive and reasonable, is still speculation until validated by experimentation. Our key point here is not that mainstream obesity researchers and activists mistake or misportray conjecture as proven fact (although this occurs also), but rather that even among many of those who recognize the benefits of many popular proposals as conjectural, inordinate time, energy and money is spent on non-probative studies that seemed aimed at repeatedly calling attention to a proposition or generating emotion around the proposition rather than testing the proposition. As two commentators stated after an Institute of Medicine (IOM) Committee released a new set of recommendations and the National Institutes of Health (NIH), the Centers for Disease Control (CDC) and IOM released the documentary Weight of the Nation ‘. . . rather than evaluate the strategies’ effectiveness, they (the committee members) are just shouting them even louder’ (1) and ‘The nation’s most powerful anti-obesity groups are teaming up for a new HBO cable network documentary – but it pushes the same tired advice’ (1). Experimentation is conceptually simple, but often neglected. Although some public health advocates are dismissive of the plausibility and need for randomized experiments of public health recommendations and approaches, as discussed elsewhere, randomization, although sometimes challenging, is eminently doable in the public health domain (2). Suppose, for example, we propose that reducing access to or consumption of fast food will result in weight loss or less weight gain. On the surface, it seems like a reasonable claim and has been the basis for numerous public health policies and recommendations. But has the claim been verified? The answer is no. It would not be trivial to, for example, randomize a clinical obesity doi: 10.1111/j.1758-8111.2012.00052.x