Thinking Big: New Ideas for Preventing Obesity

At a dentist appointment last year, obesity researcher Sara Bleich had an epiphany.

“I noticed that [the dentist] had really bad teeth,” recalls Bleich, PhD, an assistant professor in Health Policy and Management, “and I thought to myself, How can this dentist possibly take care of my teeth if his teeth are so bad?”

The thought triggered another question that led to a novel research study: Can heavy doctors provide appropriate care for overweight and obese patients?

Bleich’s leap from a dentist’s teeth to doctors’ weight is the kind of original thinking that drives her research. She’s also examined how race affects obese patients’ care and sought new ways to steer teens away from sugar-laden drinks.

For the “very practical” Sara Bleich, obesity research provides an opportunity to develop innovative solutions to a complex problem.

For Bleich, who describes herself as “very practical,” obesity research provides an opportunity to develop innovative solutions to a complex problem. “Because of [the epidemic’s] reach, it’s very policy relevant,” she says, “and because it’s so complicated, there can be lots of creative solutions.” She focuses on devising environmental strategies that help people cut calories—food placement in stores, price incentives, exercise-friendly cities, for example—and improving obesity care.

Her explorations of obesity’s infrequently studied aspects stand out in a field known for dire surveillance studies and standard evaluations of diet and exercise interventions.

“We need to have studies that really are feasible, that we can actually learn from, and we need to find solutions that are practical and reach large numbers of the population,” says Mary Story, PhD, RD, a professor at the University of Minnesota School of Public Health. Story directs the Robert Wood Johnson Foundation’s Healthy Eating Research Program, which supported Bleich’s research on sugar-sweetened beverages.

The sugary drinks study, published in the December 2011 American Journal of Public Health, analyzed the impact on sales of different caloric-information messages. Bleich arranged for corner stores in Baltimore to randomly display signs with different messages: that a bottle of soda or fruit juice has about 250 calories, contains 10 percent of your daily calories or requires 50 minutes of running to work off its calories.

While providing any calorie information significantly decreased the number of teens’ sugary-drink purchases, the sign equating one drink to nearly an hour of running reduced the odds by half.

Such interventions that resonate with teens could easily work in a variety of settings, observes Story. “This is the type of research we really need,” she says, noting that the study is the first to test a calorie-labeling intervention at point-of-purchase settings in stores.

Bleich saw another opportunity in patient care. Following previous research that had shown doctors, in general, do a poor job of diagnosing obesity and providing related care, she embarked on her doctors’ weight study. It found that physicians with normal weight are more likely than overweight doctors to diagnose obesity and discuss weight loss with patients. She is now working to determine whether having an overweight doctor affects a patient’s trust in the physician’s advice.

Another study involving race yielded striking results: Black obese patients are less likely to receive care from both white and black physicians. Bleich speculates that doctors, overall, may have negative perceptions toward black patients or feel that these patients have fewer resources for exercise and healthy eating. “I think that in the short term, physicians need better training in how to care for obese patients,” Bleich says. “They simply don’t have the skills.”