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.