We want to know which interventions might reduce obesity. However, existing research focuses on only some part of the chain of effects between intervention & better health, and many of those effects tend to be small. On the bright side, the association between BMI and health is also smaller than many might fear. Ultimately, the solution is likely to be small, slow, steady steps.

1. Overcoming obesity :
small, slow and steady steps
Stephen S Holden
MGSM

2. kcal
IN
kcal
OUT
body fat
BMI
weight
Food…
(Selected,
purchased,
served,
consumed)
Activity
Learning
Memory
Motivation
Perception
Beliefs
Attitudes
Intentions
Cognitions Behaviors
Energy-
balance
Promo
Education
Price
Place
Availability
Nudges
Product
Portion size
Labeling
Intervention Obesity
BP
longevity
QoL
Health
The chain of effect

3. Cognitions Behaviors
Energy-
balance
Intervention Obesity Health
Ideal !
r2=1.0
r2=1.0
r2=1.0
r2=1.0

4. Cognitions Behaviors
Energy-
balance
Intervention Obesity Health
Estimated !
r2=64%
• r2=64% - Robinson &al 2016 (r=.8), self-servedcons’d

5. Cognitions Behaviors
Energy-
balance
Intervention Obesity Health
Cognition  Behavior
r2<30%
• r2<30% - Baranowski et al. 2003
• r2=25% - Glasman & Albarracin 2006 (r=.5)

6. Cognitions Behaviors
Energy-
balance
Intervention Obesity Health
Intervention  Behavior
r2=1-5%
• r2=1% - Zlatevska et al. 2014, PS  intended cons’n (d=.18)
• r2=5% - Zlatevska et al. 2014, PS  actual cons’n (d=.45)
• r2=6% - Holden et al. 2015, plate  intended cons’n (d=.5)
• r2=3% - Holden et al. 2015, plate  consumed (d=.35)
• r2=0% - Zlatevska & Holden unpub, ED  cons’n (d=.07)
• r2=9% - Zlatevska & Holden unpub, ED  energy intake (d=.63)

7. Cognitions Behaviors
Energy-
balance
Intervention Obesity Health
Compensation !
? ? ? ?
• eat more, eat less later
• eat more, exercise more
• eat less, but higher ED
• buy less SSB, buy more fruit juice

8. Cognitions Behaviors
Energy-
balance
Intervention Obesity Health
Behavior  Obesity
r2<10%
• r2=10% - Yen &al (2009),
lifestyle/demo/dietary bhvr  BMI

9. Cognitions Behaviors
Energy-
balance
Intervention Obesity Health
Food PS  Obesity
r2= ???
• r2=??? – Herman &al (2016)
• r2=??? - Crino &al (2016), pop’n level actions

10. Cognitions Behaviors
Energy-
balance
Intervention Obesity Health
Obesity  Health
r2=1%
• r2=1% - Aune &al 2016, (RR
𝐵𝑀𝐼 40
𝐵𝑀𝐼 25
= 2.5, non-smokers)
• r2=1% - Mehta & Chang 2006 (HR
𝐵𝑀𝐼 35+
𝐵𝑀𝐼 18,5−25
< 2)

11. Cognitions Behaviors
Energy-
balance
Intervention Obesity Health
The challenge !
r2<10%
r2=1+%
r2=1 to 5%

13. The Steps
SMALL
- fx of interventions
- fx of obesity
SLOW
- long-term vision
- small change ≠ no change
STEADY
- science is subtle
- ethics is more so

14. Overcoming obesity :
small, slow and steady steps
Stephen S Holden
MGSM