Containing the obesity epidemic in Australia: an updated causal model and a study design

Abstract

The obesity epidemic persists, despite countless strategic efforts made to counter it. The aim of my research was to discover if there is a new approach to be taken to contain the obesity epidemic. In the final chapter of this thesis, I present a study design intended to test the efficacy of a novel and scalable obesity intervention strategy.

In Chapter 1, which provides detail about the obesity problem I am addressing, I point out that the obesity epidemic is contributed to in two (related) ways: an increasing body mass index (BMI) amongst the present population and an increased risk that high BMI will affect future generations. This observation, although seemingly obvious, is rarely pointed out, and is the first indication that the causality of the obesity epidemic is not well understood. I suggest that there is a prevalent causal understanding of the obesity epidemic, which fails to discern causes of obesity from causes of the obesity epidemic and, as a result, accurately depicts neither. I call this view, modelled in Chapter 2, The Conventional View. Two additional models are presented, which address the weaknesses of The Conventional View. In Chapter 3 I argue that if my updated causal model of the obesity epidemic, An Updated View, is more accurate than The Conventional View the goals of most current obesity interventions are suboptimal. This argument follows being able to show that the goals of current obesity intervention strategies are based on The Conventional View.

The study design presented in the final chapter is the main contribution of this thesis. An obesity intervention strategy delivered to pregnant women targets causal factors prominent in An Updated View. There are two main questions addressed by the hypotheses in this study. Firstly, will the treatment enable glucose control? And then, will improved glucose control translate into a reduced risk of obesity for women (the present population) and their children (future generations)? In other words, will the intervention reduce the obesity epidemic?