Potential obesity-related policy approaches have recently been receiving more attention. Although some have been implemented and others only proposed, few have been formally evaluated. We discuss the relevance, and in some cases irrelevance, of some of the types of evidence that are often brought to bear in considering obesity-related policy decisions. We discuss major methods used to generate such evidence, emphasizing study design and the varying quality of the evidence obtained. Third, we consider what the standards of evidence should be in various contexts, who ought to set those standards, as well as the inherent subjectivity involved in making policy decisions. Finally, we suggest greater transparency from both academics and policymakers in the acknowledgment of subjectivities so they can distinguish and communicate the roles of empirical evidence and subjective values in the formulation of policy.
This is a preview of subscription content, access via your institution
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Rent or buy this article
Get just this article for as long as you need it
Prices may be subject to local taxes which are calculated during checkout
Dawson W . Taxation by weight. Vol. 1. Printed and Published by the Office of the British Medical Association: London, UK. Available from: (accessed on 11 March 2016).
Holwell RJ . Case 1:08-cv-01000-RJH. [Memorandum Opinion and Order]. Doc 42 2008; 1–27 Available at: http://lawyersusaonline.com/wp-files/pdfs/CALORIE.pdf (accessed on March 2016).
Cawley J . Does anything work to reduce obesity? (Yes, modestly). J Health Polit Policy Law 2016; 41: 463–472.
Essington M, Hertelendy AJ . Legislating weight loss: are antiobesity public health policies making an impact? J Health Polit Policy Law 2016; 41: 453–461.
Dhurandhar EJ, Kaiser KA, Dawson JA, Alcorn AS, Keating KD, Allison DB . Predicting adult weight change in the real world: a systematic review and meta-analysis accounting for compensatory changes in energy intake or expenditure. Int J Obes 2015; 39: 1181–1187.
Wang YC, Hsiao A, Orleans CT, Gortmaker SL . The caloric calculator: average caloric impact of childhood obesity interventions. Am J Prev Med 2013; 45: e3–e13.
Thaler RH, Sunstein CR . Nudge: Improving Decisions About Health, Wealth, and Happiness. Yale University Press: New Haven, CT, USA, 2008.
Rozin R, Scott S, Dingley M, Urbanek JK, Jiang H, Kaltenbach M . Nudge to nobesity I: minor changes in the accessibility decrease food intake. Judgm Decis Mak 2011; 6: 323–332.
Hanks A, Wansink B, Just D, Schulze W . From Coke to Coors: a field study of a fat tax and its unintended consequences. J Nutr Educ Behav 2013; 45: S40.
Matjasko JL, Cawley JH, Baker-Goering MM, Yokum DV . Applying behavioral economics to public health policy: illustrative examples and promising directions. Am J Prev Med 2016; 50: S13–S19.
Howlett M . Matching Policy Tools & Their Targets: Beyond Nudges and Utility Maximation in Policy Design. Presented at European Consortium for Political Research; 24–28 April 2016, Pisa, Italy.
Marlow ML . Market test or government guess? Are government efforts to 'nudge' us to lose weight really based on science? Regulation 2014; 37: 48–54.
Kaiser KA, Brown AW, Bohan Brown MM, Shikany JM, Mattes RD, Allison DB . Increased fruit and vegetable intake has no discernible effect on weight loss: a systematic review and meta-analysis. Am J Clin Nutr 2014; 100: 567–576.
Ledoux TA, Hingle MD, Baranowski T . Relationship of fruit and vegetable intake with adiposity: a systematic review. Obes Rev 2011; 12: e143–e150.
Mook DG . In defense of external invalidity. Am Psychol 1983; 38: 379–387.
Reynolds S, Streiner D . Why we do not abstract analogue studies of treatment outcome and scale development. Evid Based Ment Health 1998; 1: 101–102.
Epstein LH, Dearing KK, Roba LG, Finkelstein E . The influence of taxes and subsidies on energy purchased in an experimental purchasing study. Psychol Sci 2010; 21: 406–414.
Patsopoulos NA . A pragmatic view on pragmatic trials. Dialogues Clin Neurosci 2011; 13: 217–224.
Allison DB . Evidence, discourse and values in obesity-oriented policy: menu labeling as a conversation starter. Int J Obes 2011; 35: 464–471.
Brown AW, Allison DB . Unintended consequences of obesity-targeted health policy. Virtual Mentor 2013; 15: 339–346.
Ramos Salas X . The ineffectiveness and unintended consequences of the public health war on obesity. Can J Public Health 2015; 106: e79–e81.
Gendall P, Hoek J, Taylor R, Mann J, Krebs J, Parry-Strong A . Should support for obesity interventions or perceptions of their perceived effectiveness shape policy? Aust N Z J Public Health 2015; 39: 172–176.
Suh Y, Puhl R, Liu S, Milici FF . Support for laws to prohibit weight discrimination in the United States: public attitudes from 2011 to 2013. Obesity (Silver Spring) 2014; 22: 1872–1879.
Pollard CM, Daly A, Moore M, Binns CW . Public say food regulatory policies to improve health in Western Australia are important: population survey results. Aust N Z J Public Health 2013; 37: 475–482.
Zarefsky D . ‘Public Sentiment Is Everything’: Lincoln’s View of Political Persuasion. J Abraham Lincoln Assoc 1994; 15: 23–40.
Robbins RNJ, Lundell H, Meyerson J . Views of city, county, and state policy makers about childhood obesity in New York State, 2010-2011. Prev Chronic Dis 2013; 10: E195.
Kyle T . UK Proposal for Explicit Weight Discrimination in Healthcare. Available at: http://conscienhealth.org/2016/09/uk-proposal-explicit-weight-discrimination-healthcare/ (accessed 5 September 2016).
Abrams L . A Case for Shaming Obese People, Tastefully. The Atlantic. Published January 23, 2013. Available at: http://www.theatlantic.com/health/archive/2013/01/a-case-for-shaming-obese-people-tastefully/267446/ (accessed 8 September 2016).
Obesity Action Coalition. Obesity Action Coalition Calls on the State of Mississippi House of Representatives to Withdraw House Bill 282 Discriminating Against Those Affected by Obesity. Published 1 February 2008. Available at: http://www.prnewswire.com/news-releases/obesity-action-coalition-calls-on-the-state-of-mississippi-house-of-representatives-to-withdraw-house-bill-282-discriminating-against-those-affected-by-obesity-56763767.html (accessed 8 September 2016).
Gelman A . Tracking public opinion with biased polls. The Washington Post. Published 8 April 2014. Available at: https://www.washingtonpost.com/news/monkey-cage/wp/2014/04/09/tracking-public-opinion-with-biased-polls/ (accessed 8 September 2016).
Newport F . The Scientific Approach to Question Wording Differences. Gallup. Published 5 September 2003. Available at: http://www.gallup.com/poll/9193/scientific-approach-question-wording-differences.aspx (accessed 8 September 2016).
Adams J, American Imprint Collection (Library of Congress). A Defence of the Constitutions of Government of the United States of America. London printed, Boston re-printed and sold by Edmund Freeman1788.
Mill JS . On liberty. In: Eliot CW (ed). The Internet Wiretap, vol 25. Harvard Classics, P.F. Collier & Son: New York, NY, USA, 1909.
Kylie M. Science Says Fat Shaming Backfires — So Can We Finally Stop It? Self Published on 15 September 2014. Available at: http://www.yourtango.com/2014225975/love-your-body-science-says-fat-shaming-backfires-so-can-we-finally-stop-it (accessed 8 September 2016).
Jackson SE, Steptoe A, Beeken RJ, Croker H, Wardle J . Perceived weight discrimination in England: a population-based study of adults aged 50 years. Int J Obes 2015; 39: 858–864.
Swinburn BA, Caterson I, Seidell JC, James WP . Diet, nutrition and the prevention of excess weight gain and obesity. Public Health Nutr 2004; 7: 123–146.
Byar DP, Simon RM, Friedewald WT, Schlesselman JJ, DeMets DL, Ellenberg JH et al. Randomized clinical trials. Perspectives on some recent ideas. N Engl J Med 1976; 295: 74–80.
Mozaffarian D, Ludwig DS . Why is the federal government afraid of fat? New York Times. Published 9 July 2015. Available at: http://www.nytimes.com/2015/07/09/opinion/why-is-the-federal-government-afraid-of-fat.html?_r=0 (accessed 8 September 2016).
Mozaffarian D, Ludwig DS . The 2015 US Dietary Guidelines: lifting the ban on total dietary fat. JAMA 2015; 313: 2421–2422.
Keller A, Bucher Della Torre S . Sugar-sweetened beverages and obesity among children and adolescents: a review of systematic literature reviews. Child Obes 2015; 11: 338–346.
Peikes D, Geonnotti K, Wang W . Using Pragmatic Clinical Trials to Test the Effectiveness of Patient-Centered Medical Home Model in Real-World Setting. Agency for Healthcare Research and Quality: Rockville, MD, USA, 2013.
Ludwig J, Sanbonmatsu L, Gennetian L, Adam E, Duncan GJ, Katz LF et al. Neighborhoods, obesity, and diabetes—a randomized social experiment. N Engl J Med 2011; 365: 1509–1519.
Van Eemeren FH, Grootendorst R . Fallacies in pragma-dialectical perspective. Argumentation 1987; 1: 283–301.
Smith GC, Pell JP . Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials. BMJ 2003; 327: 1459–1461.
Cummings L . Argument from analogy. Reasoning and Public Health: New Ways of Coping with Uncertainty. Springer International Publishing: Cham, Switzerland, 2015, pp93–120.
Hill AB . The environment and disease: association or causation? Proc R Soc Med 1965; 58: 295–300.
Grutters JP, van Asselt MB, Chalkidou K, Joore MA . Healthy decisions: towards uncertainty tolerance in healthcare policy. Pharmacoeconomics 2015; 33: 1–4.
Majumdar SR, Soumerai SB . The unhealthy state of health policy research. Health Aff (Millwood) 2009; 28: w900–w908.
Rubin DB . Practical implications of modes of statistical inference for causal effects and the critical role of the assignment mechanism. Biometrics 1991; 47: 1213–1234.
Ouadah-Boussouf N, Babin PJ . Pharmacological evaluation of the mechanisms involved in increased adiposity in zebrafish triggered by the environmental contaminant tributyltin. Toxicol Appl Pharmacol 2016; 294: 32–42.
Grun F, Blumberg B . Environmental obesogens: organotins and endocrine disruption via nuclear receptor signaling. Endocrinology 2006; 147: S50–S55.
Reference Manual on Scientific Evidence, 3rd edn. The National Academies Press: Washington, DC, USA, 2011.
Albert RK . ‘Lies, damned lies...’ and observational studies in comparative effectiveness research. Am J Respir Crit Care Med 2013; 187: 1173–1177.
Taubes G . Epidemiology faces its limits. Science 1995; 269: 164–169.
Schoenfeld JD, Ioannidis JP . Is everything we eat associated with cancer? A systematic cookbook review. Am J Clin Nutr 2013; 97: 127–134.
Bohan Brown MM, Brown AW, Allison DB . Nutritional epidemiology in practice: learning from data or promulgating beliefs? Am J Clin Nutr 2013; 97: 5–6.
Young SS, Karr A . Deming, data and observational studies: a process out of control and needing fixing. Significance 2011; 8: 116–120.
Elbel B, Gyamfi J, Kersh R . Child and adolescent fast-food choice and the influence of calorie labeling: a natural experiment. Int J Obes 2011; 35: 493–500.
Naylor PJ, Olstad DL, Therrien S . An intervention to enhance the food environment in public recreation and sport settings: a natural experiment in British Columbia, Canada. Child Obes 2015; 11: 364–374.
Benjamin Neelon SE, Namenek Brouwer RJ, Østbye T, Evenson KR, Neelon B, Martinie A et al. A community-based intervention increases physical activity and reduces obesity in school-age children in North Carolina. Child Obes 2015; 11: 297–303.
Madsen KA . School-based body mass index screening and parent notification: a statewide natural experiment. Arch Pediatr Adolesc Med 2011; 165: 987–992.
Crombie I, Davies H . What is Meta-Analysis?. Hayword Medical Communications: London, UK, 2009.
Shuster JJ, Gieser PW . Meta-analysis and prospective meta-analysis in childhood leukemia clinical research. Ann Oncol 1996; 7: 1009–1014.
George BJ, Beasley TM, Brown AW, Dawson J, Dimova R, Divers J et al. Common scientific and statistical errors in obesity research. Obesity (Silver Spring) 2016; 24: 781–790.
Metcalf CJ, Edmunds WJ, Lessler J . Six challenges in modelling for public health policy. Epidemics 2015; 10: 93–96.
Hawkes C, Smith TG, Jewell J, Wardle J, Hammond RA, Friel S et al. Smart food policies for obesity prevention. Lancet 2015; 385: 2410–2421.
Backholer K, Beauchamp A, Ball K, Turrell G, Martin J, Woods J et al. A framework for evaluating the impact of obesity prevention strategies on socioeconomic inequalities in weight. Am J Public Health 2014; 104: e43–e50.
Dietz WH, Bland MG, Gortmaker SL, Molloy M, Schmid TL . Policy tools for the childhood obesity epidemic. J Law Med Ethics 2002; 30 (suppl): 83–87.
Levy DT, Mabry PL, Wang YC, Gortmaker S, Huang TT, Marsh T et al. Simulation models of obesity: a review of the literature and implications for research and policy. Obes Rev 2011; 12: 378–394.
Ruff RR, Zhen C . Estimating the effects of a calorie-based sugar-sweetened beverage tax on weight and obesity in New York City adults using dynamic loss models. Ann Epidemiol 2015; 25: 350–357.
Gortmaker SL, Wang YC, Long MW, Giles CM, Ward ZJ, Barrett JL et al. Three interventions that reduce childhood obesity are projected to save more than they cost to implement. Health Aff (Millwood) 2015; 34: 1932–1939.
Cummings L . Informal fallacies as cognitive heuristics in public health reasoning. Informal Log 2014; 34: 1–37.
Donaldson EA, Cohen JE, Villanti AC, Kanarek NF, Barry CL, Rutkow L . Patterns and predictors of state adult obesity prevention legislation enactment in US states: 2010-2013. Prev Med 2015; 74: 117–122.
Society for Prevention Research. Standards of Evidence. Criteria for Efficacy, Effectiveness, and Dissemination. Available at: http://www.preventionresearch.org/StandardsofEvidencebook.pdf.accessed 82016.
National Public Radio (Producer). How Much Is Too Much? New Study Casts Doubts On Sugar Guidelines, 19 Decdember 2016. Retrieved from: http://www.npr.org/templates/transcript/transcript.php?storyId=505867535.
National Academy of Medicine (Panel). 2016 Annual Meeting Session 3 Question and Answer: Evidence of Preventing Obesity and Diabetes at the Population Level and Promising New Directions, 24 October 2016. Retrieved from: https://www.youtube.com/watch?v=I8RyxGfQyWg&list=PLqRL5HO_hA8faH-DrOXZV7sAHuGMdktom&index=26.
Nancy Kass (Presenter). Obesity Prevention policies in the United States: which approaches make the most ethical sense? UT Southwestern Health Sciences Digital Library and Learning Center, 8 November 2016. Retrieved from: https://repositories.tdl.org/utswmed-ir/handle/2152.5/3892.
Bradford Hill, Austin (Presenter). President’s Address Section of Occupational Medicine: The Environment and Disease: Association or Causation? 295-300, 14 January 1965. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1898525/pdf/procrsmed00196-0010.pdf.
Casazza K, Allison DB . Stagnation in the clinical, community and public health domain of obesity: the need for probative research. Clin Obes 2012; 2: 83–85.
Metzger MW, McDade TW . Breastfeeding as obesity prevention in the United States: a sibling difference model. Am J Hum Biol 2010; 22: 291–296.
Nelson MC, Gordon-Larsen P, Adair LS . Are adolescents who were breast-fed less likely to be overweight? Analyses of sibling pairs to reduce confounding. Epidemiology 2005; 16: 247–253.
Fontaine KR, Robertson HT, Holst C, Desmond R, Stunkard AJ, Sørensen TI et al. Is socioeconomic status of the rearing environment causally related to obesity in the offspring? PLoS ONE 2011; 6: e27692.
Gibson J, McKenzie D, Stillman S . What happens to diet and child health when migration splits households? Evidence from a migration lottery program. Food Policy 2011; 36: 7–15.
Yakusheva O, Kapinos K, Weiss M . Peer effects and the freshman 15: evidence from a natural experiment. Econ Hum Biol 2011; 9: 119–132.
Braakmann N . The causal relationship between education, health and health related behaviour: evidence from a natural experiment in England. J Health Econ 2011; 30: 753–763.
Jones-Smith JC, Dow WH, Chichlowska K . Association between casino opening or expansion and risk of childhood overweight and obesity. JAMA 2014; 311: 929–936.
Voss J, Allison DA, Webber BJ, Otto JL, Clark LL . Lower obesity rate during residence at high altitude among a military population with frequent migration: a quasi experimental model for investigating spatial causation. PLoS ONE 2014; 9: e93493.
Allison DB, Paultre F, Heymsfield SB, Pi-Sunyer FX . Is the intra-uterine period really a critical period for the development of adiposity? Int J Obes Relat Metab Disord 1995; 19: 397–402.
Mehta T, Allison DB . From measurement to analysis reporting: grand challenges in nutritional methodology. Front Nutr 2014; 1: 6.
Allison DB, Bassaganya-Riera J, Burlingame B, Brown AW, le Coutre J, Dickson SL et al. Goals in nutrition science 2015-2020. Front Nutr 2015; 2: 26.
Allison DB, Brown AW, George BJ, Kaiser KA . Reproducibility: a tragedy of errors. Nature 2016; 530: 27–29.
Dietz T . Bringing values and deliberation to science communication. Proc Natl Acad Sci USA 2013; 110: 14081–14087.
This work is supported in part by the NIH (T32HL105349) and the Nutrition Obesity Research Center (P30DK0563360). The opinions expressed are those of the authors and do not necessarily represent those of the NIH or any other organization. We gratefully acknowledge Gregory Pavela, Alexandra S Allison, Ted Kyle, Jennifer Holmes, Olivia Affuso, Paula Chandler-Laney and Daniel L Smith Jr for input on this manuscript.
DBA has received financial support from numerous nonprofit and from profit organizations including government, litigators, food and beverage, pharmaceutical and publishing companies. The remaining authors declare no conflict of interest.
Rights and permissions
About this article
Cite this article
Richardson, M., Williams, M., Fontaine, K. et al. The development of scientific evidence for health policies for obesity: why and how?. Int J Obes 41, 840–848 (2017). https://doi.org/10.1038/ijo.2017.71
This article is cited by
Epidemiology of Obesity in Adults: Latest Trends
Current Obesity Reports (2018)
Health policies for obesity: how to get there!
International Journal of Obesity (2017)