Obesity: interpreting results and validity of causal frameworks

Identification of Key Results
Results of this research highlight the need for a comprehensive approach to addressing the public health concern of obesity. Although obesity and its defining features like BMI are causally related to lifestyle factors like diet and activity levels, the research shows that the situation is more complex than that. There is a range of socioeconomic, ethnic, cultural, and political variables that also affect the prevalence of the disease. Identifying these outlying variables may be the key to resolving the obesity epidemic.
The obesity ecological model (OEM) has proven to be one of the most effective strategies for epidemiological analysis because it takes into account environmental and personal factors (Egger, Swinburn & Rossner, 2003). Using a multifactorial model like the OEM allows epidemiologists to take into account factors like age, race, socioeconomic class status, and compounding medical conditions. Key results of the study are as follows.
First, although the obesity epidemic has affected diverse communities around the world, it can be traced to a number of shared variables including dietary and other lifestyle choices. These are variables that are preventable and controllable, meaning that the obesity epidemic itself is preventable and controllable. The research also shows that while numbers and trends have shifted, the overall trend has been towards increased cases in developing nations.
Second, environmental and contextual variables cannot be ruled out. These variables include socioeconomic class status, the political culture and climate, religion, the economy, and worldview (Hu, 2008; Mela, 2005).
Third, developmental psychology and life course theory has been shown to be relevant to the etiology of obesity in some populations (Hu, 2008). Specifically, the results of the longitudinal ALSPAC (Avon Longitudinal Study of Parents And Children) study shows that fetal exposure, breastfeeding, parental impacts, school atmosphere and transition into adulthood are all critical nodes or junctures in childhood development (Reilly, Armstrong, Dorosty, et al, 2005).
Fourth, in addition to applying developmental psychology theories to the epidemiology of obesity, it is effective to apply systems theory. Systems theory takes into account family and other mezzo level variables impacting population health. The Sobko, Svensson, Ek, et al (2011) research using the Early STOPP (STockholm Obesity Prevention Program) program is illustrative and provides insight into how a similar pilot study could be applied elsewhere.
Implications
The implications of this research on the obesity epidemic are global, including potential changes to public policy. To meet HealthyPeople 2020 objectives, epidemiologists are challenged to come up with comprehensive interventions that can target minority populations and other target markets with unique messages. However, public service announcements and public relations campaigns are only one of the many strategies that have been revealed to be necessary for mitigating problems. The healthcare sector also needs to play a more active role in shaping the normative culture. Lifestyle factors like diet and exercise can be changed, but healthcare practitioners need to take the lead in promoting preventative rather than reactive solutions to the obesity problem. This research shows that the vast majority of obesity cases are preventable.
Also, epidemiologists need to consider the complex array of intersecting variables that may impact the prevalence and progression of disease etiology. In the cases of obesity, factors that are sometimes overlooked include socioeconomic class status, the political culture and climate, religion, the economy, and worldview (Hu, 2008; Mela, 2005). If epidemiologists focus on each of these variables and how it impacts obesity rates, prevalence, and disease progression, then it may be possible to develop more effective public policies targeting specific communities.
Given the results of the ALSPAC, public health programs should target specific junctures during which obesity interventions should be given. Those critical junctures include fetal exposure, breastfeeding, parental impacts, school atmosphere and transition into adulthood. Also, the results of the Early STOPP program show how it may be possible to identify early risk factors. Based on systems theory, the results show that an individual’s obesity is interconnected with family issues including family dynamics, beliefs, attitudes, and eating habits. If overweight parents are identified as being risk factors, then healthcare workers may be able to more effectively target preventative programs to this population.
Overall, the results show that the obesity epidemic is costly but preventable. To reverse or at least mitigate the problem, it is important to identify specific outbreaks and at-risk communities alike. Interventions need to be targeted to those communities to be cost-effective.
Validity
Internally and externally valid, this research presents the findings of numerous studies that address the obesity epidemic from an international perspective. Causality could not be determined using the methodologies described in this research. None of the programs examined used an experimental design to prove its own validity. However, an abundance of research does indeed highlight the direct causal relationship between lifestyle (diet and exercise) on BMI and obesity status. From here, epidemiologists can offer public health policy analysts suggestions on how to craft ideal interventions for target communities.




References

Egger, G., Swinburn, B., & Rossner, S. (2003). Dusting off the epidemiological triad: could it work with obesity?. Obesity reviews, 4(2), 115-119.
Hu, F. (2008). Obesity epidemiology. Oxford University Press.
Mela, D (2005). Food, diet and obesity. Elsevier.
Reilly, J. J., Armstrong, J., Dorosty, A. R., Emmett, P. M., Ness, A., Rogers, I., ... & Sherriff, A. (2005). Early life risk factors for obesity in childhood: cohort study. Bmj, 330(7504), 1357.
Sobko, T., Svensson, V., Ek, A., Ekstedt, M., Karlsson, H., Johansson, E., ... & Marcus, C. (2011). A randomised controlled trial for overweight and obese parents to prevent childhood obesity-Early STOPP (STockholm Obesity Prevention Program). BMC Public Health, 11(1), 336.