According to the Centers for Disease Control and Prevention, roughly 42% of Americans were obese and 9.2% were severely obese in 2018 – up from 30.5% and 4.7% respectively in 2000. Despite efforts to reverse this trend, most physicians predict the rate of obesity in the US will continue to rise over the next 10 years.
Specifically, a survey of 515 physicians across 27 specialties fielded this winter by the global social platform Sermo and top researchers at Duke University and the University of North Carolina found 70% of respondents believe that more than half of US adults will be obese by 2030.
While this “ominous” trend may feel “inexorable,” there are several steps that the food and beverage industry can take to help reduce obesity, according to Dr. Murali Doraiswamy, a professor of psychiatry and medicine at Duke University School of Medicine and a scientific advisor to Sermo. But to do that, he explains in this episode of FoodNavigator-USA’s Soup-To-Nuts podcast, stakeholders first need to understand what is driving the rise in obesity, including the impact of fad diets and the potential for personalized nutrition.
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The current state of nutrition
Within the confines of a few different dietary patterns, nutrition recommendations in the US historically have followed a one-size-fits-all template that is based on a healthy populations, even though, as the CDC and Sermo data show many Americans are far from healthy.
This has led to the promotion a plethora of diets with varying levels of scientific support and marketing potential that have generated significant consumer confusion about what is healthy.
“Consumers are confused and they’re also frustrated with of the information and …many different fad diets coming out with so little evidence. Its really hard to tell what to recommend to patients. Two years ago, paleo was hot. This year, keto is hot. And then who knows? Vegan plant-based diet might be hot next year,” Doraiswamy said.
He explained part of the difficulty is that it takes 15-20 years to rigorously test the impact of each diet to the highest standard. Since this isn’t feasible, he said Sermo, which can tap 800,000 fully verified physicians across 90 specialties, uses the next best option – an expert consensus survey – to reveal the most likely impacts and results of different dietary patterns and interventions.
Among the ‘vexing’ questions that Doraiswamy said Sermo asked in this study was what contributes most to the US obesity epidemic, what should Americans eat to live a healthier lifestyle, and what strategies will most effectively help turn the tide on the epidemic.
What is behind the rising obesity epidemic?
Based on much of the information available to mainstream consumers, the answer to what is behind the obesity epidemic most likely would be attributed to lack of willpower or genetics – but according to Sermo, the real answer is environmental factors.
“Only 3% of doctors picked genetics as the biggest contributor to obesity, and 80% picked the environment. So, really what it’s saying is that there are massive societal forces that are interplaying” and to get the most impact shifts need to happen and individual and societal environmental levels, he said.
Which diet is the best?
Within this context, Doraiswamy acknowledged that different diets can provide structure for followers to navigate environmental factors, including unhealthy triggers that bombard consumers each time the enter a grocery store. But which diet is best? To find out, Sermo asked physicians to rank the best diets for short term weight loss and long-term optimal health, and to describe their own diets.
“Most diets have some benefits in the short term, but what we don’t know anything about is what are the long term risks and benefits of these diets,” Doraiswamy said.
Based on the survey, the safest and most effective diet based on the current information and physicians’ personal behavior and recommendations is the Mediterranean diet. Alternatively, Keto won only 5% of doctors’ recommendations, which Doraiswamy says indicates more research is necessary.
When considering which diet to recommend, survey respondents not only consider their patients’ health, but 44% also take into account the diet’s impact on the planet and climate change.
Personalized nutrition ‘is here to stay’ but more research is necessary
While following a diet provides effective guideposts for selecting healthier options, Doraiswamy reiterated a one-size-fits-all approach is limited, which opens the door for innovation around personalized nutrition.
“We’re at the dawn of the year of personalized nutrition and there are many unknowns,” but research suggests there are four main types of intervention: personalized advice from a dietitian based on behavior and diet; coaching based on behavior, diet and microbiome; personalized genetic counseling and a combination of all of these, he said.
Research shows that any type of personalized intervention is better than nothing, but that within the four groups recommendations based on behavior intervention was just as effective as those based on the microbiome or genome, he said.
This research, combined with Sermo’s survey results, suggests that early advances in personalized nutrition that focus on genomics, the microbiome or other physical markers may either be misplaced or only part of the answer.
“Genetic testing and the microbiome testing is not at the point where one can make a really credible science-based recommendation… The reality is you could be doing yourself more harm than good because if you are avoiding big chunks of different types of foods based genetic testing that is not proven then that’s not healthy,” Doraiswamy said.
Rather, he recommends making changes based on behavior and “deep phenotyping” using apps, wearable technology, sleep journals and other devices.
Macro-changes necessary
For personal attempts at adopting healthier lifestyles to be most effective, Doraiswamy argues several macro changes at the societal level also must occur. Pointing to the Sermo survey, he explains that these could include some experimental strategies like sugar taxes, increased involvement of dietitians in healthcare planning and broader support for exercise.
While many of these suggestions are tall orders that will require buy in by multiple sections of society, Doraiswamy said there are steps the food and beverage manufacturers and other industry stakeholders can take now to help address the obesity epidemic.
The first is simply to be an active partner in the fight against obesity.
His second suggestion is more progressive and that is to tie company profits to health outcomes associated with products similar to how some companies already connect sustainability goals with business outcomes.
Finally, he said, he would like to see more industry support for access by lower income Americans to healthier food that currently tends to be more premium priced. Several companies already are doing this through partnerships with governments, retailers and insurers to provide prescriptions to their products or offer them on a sliding cost scale.
