The most promising interventions for addressing obesity and improving public health | David Allison

If you had to guess, and if you presuppose that there is an intervention or a set of interventions that could improve public health outcomes, what would your guesses be? What would you guess to test? General education, not nutrition education. General education. There is provocative data. I don't want to say definitive data. There are provocative data strongly suggesting that general education, especially for girls and women, leads to lower BMIs, lesser rates of obesity, and lesser diabetes than less education. So there are some studies in Europe of policies where someone puts in a policy and it effectively gives a cohort of people more education. And then you see in that cohort less obesity, especially among women. There's a famous study by the Rameys, who were a husband-wife investigative team who actually worked at UAB when I first got there. And they started this study decades ago at UNC. And it was sort of Head Start on steroids. They called it the ABC-Aderian or Bec-Aderian study. And they gave these kids the super Head Start program. And it was mostly just general education. There may have been a little nutrition education, but mostly just general education. It wasn't a weight loss study. It wasn't intended to be. Thirty years later, they followed them up. There's a paper in science on this. Guess what? The women have less obesity. The Moving to Opportunity study, funded by the Department of Housing and Urban Development, took families who lived in so-called poor neighborhoods. And they gave them either, randomly assigned them, either to control, because they basically got nothing, or to housing vouchers. But the housing vouchers required that they move to less poor neighborhoods. And what they then found, years later in follow-up, again published in science and in the Journal of Medicine, is that there was less obesity and diabetes in those assigned to move to the less poor neighborhoods and given the financial wherewithal to do so. So I could go on. But these are things that suggest to that education, general education, may help. And I think that may speak to this whole socioeconomic thing we started about way earlier. What is it about higher socioeconomic status that, at least in some groups, not all, but at least in white women, seems to be associated with less obesity? And I don't know what the causal mechanisms are, but that might be my best. Somebody said to me, you're going to be the king for a year. You've got the federal budget. You can take this big chunk of money, and you can make an impact in obesity and diabetes. I would say, I'm going to divide it into four parts. One part is going to be surgery, and it's going to be both providing it and continue to study it. The next one's going to be pharmaceuticals, both providing it and continuing to study it. Third part is going to be some general education, maybe general well-being, safety, security, starting in early childhood to see whether that alone is enough. And it may be really reducing disparities. Back to Confucius. Confucius said, we are not so concerned with an absence of wealth. We are concerned with a disparity of wealth. And so it may be that reducing disparities is really important. And then the fourth part would be basic research. And I'd like to say, let's look at senolytics and let's look at microchimerism and all the things that you talk about so often in your podcast that abut against both metabolism and obesity and nutrition, but also the fundamentalists in essence. So I'd love to say, can we use microchimerism to restore people to younger metabolic states? Can we use senolytics to do that? That would be my fourth bucket, those basic science questions.