Principle of minimal intervention applied to treatment of obesity – pros and cons

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When it comes to general philosophy of Asymptotic Nutrition Approach, I often speak of the principle of minimal intervention, i.e. the notion that we should make as little changes as possible to the existing eating habits of the person being treated, while still accomplishing our goal.

There are several reasons why I think this might be a wise idea:

  • the less changes you make, the less stress it causes to the person
  • small unobtrusive changes are more likely to be sustainable
  • radical changes to eating habits can do harm, even if it wasn’t intended, for example, simply by trying to eat more healthy foods, one can become so extreme in it as to develop an eating disorder. In fact obsession with healthy eating is already recognized by some as an eating disorder: Orthorexia Nervosa.
  • big commitment to our eating habits can become overwhelming, even if the person does not develop an eating disorder
  • the old, existing eating habits of the person being treated, no matter how unhealthy they might have been, are also some sort of practical default state towards which the person naturally tends (with other circumstances remaining the same). If we deviate too much from everything the person knew about how and what they should eat, the efforts to make changes can at some point suddenly crash, with the person returning to old eating habits, or perhaps even making them worse, especially if they’ve felt deprived

Being generally cautious and conservative when it comes to making any changes to our eating habits, in general I am a proponent of the principle of minimal intervention, and perhaps the main reason for it is that I am aware of 2 things:

  • just how dangerous eating disorders can be, so it’s better to try to avoid triggering them no matter what
  • just how dangerous and disheartening it is when our new eating plan fails, crashes, and we give up all of it, return to our old ways, re-gaing all the weight, usually with some more… This yo-yo effect is not only unhealthy, it is also psychologically devastating, and it diminishes our confidence that we can ever adopt healthy eating habits and reach a healthy weight.

Since messing with anyone’s eating habits is such a scary business, in many cases this principle of minimal intervantion, transforms in fact into the principle of zero intervention.

Or in other words, in many cases of excessive weight, the best thing we can do is to do nothing!

This was already covered in the article “Who should lose weight?”, but I will give you a short answer here as well: Generally only people with BMI over 30, clinically defined as obese should consider losing weigth, and only if the projected benefits of having their weight under control outweighs the projected risks of such endeavor. This means that for all the rest, the best thing to do, might be to do nothing!

However, this principle of minimal intervention, can also be criticized on several grounds:

  • If people make very little changes, they might feel like they are doing nothing, so they might not take their new eating habits seriously… to the point that they don’t do even this little thing that was required.
  • Not directly related to this topic, but some studies have suggested that churches that have more strict requirements for their members are more likely to keep the members… It’s theorized that when people invest a lot of effort, commitment, etc… to a certain idea, they are less likely to give up, because giving up would mean that all of their effort was in vain… So they have a lot to lose. And not only that they would need to accept that their effort was in vain, they would also need to accept that on some level they were wrong. Which is a big blow to ego. For the same reasons many extreme dietary approaches have extremely commited followers – they’ve invested so much of their time and energy in following these approaches, that they really don’t want to give up after all that.
  • Some people indeed have very unhealthy eating habits, regardless of whether they’re overweight or obese or not… telling such people to do nothing about their terrible eating habits would be extremely irresponsible… Being silent about what they do to their bodies would make us accomplices in their self-destruction. It would make us some sort of enablers…
  • If my hypothesis that obesity is not a disease but a symptom of pathological cultural approaches to food and eating (which I call hyperrexia culturae) is true, then this such pathological culture needs to be replaced with a better one, and a minimal intervention can hardly be enough to develop an entire culture.

For each of these criticisms, there are several responses that seek to redeem the principle of minimal intervention:

  • Regarding too little changes feeling like nothing and not being taken seriously: the thing that can help you is knowing why exactly you’re doing it in this way, and why exactly this will work in long term – this should be enough for you to allow you to make a psychological commitment. You can also rejoice in knowing that you’re not repeating the same mistakes that so many others have done before, who have made drastic changes, only to give up eventually and nullify thier efforts, perhaps even damaging their health in the process.
  • Regarding only extreme approaches having comitted followers… there might be some truth to it, but to a certain point. If the nutritional approach in question ultimately holds no substance to it, no weight to it, ultimately its followers will give up, and the longer time they spent brainwashed in their dietary cult, the eventual crash will be more painful and dangerous both physically and psychologically… I’m not saying all radical approaches to food eventually fail… but those that are very extreme, while having no real merit, in most of the cases fail spectacularly, regardless of how long they were followed or how comitted their followers were.
  • Regarding people with extremely unhealthy eating habits – well, it should be stated, minimal intervention is not a solution for such people. In this day and age it is relatively easy to get informed about basics of healthy eating habits, so most people, have at least some basic idea about what it means to have a good nutrition. If you know deep down, that you’re just eating junk, please stop it! The percentage of people with so twisted eating habits that they need to be pretty much remade from scratch is very small though, but perhaps it’s higher than we would guess. But if you feel you’re one of them… forget about minimal intervention, as you need to make big changes. And such big changes merit consultation with a doctor, nutritionist, and perhaps even a mental health professional, because extremely unhealthy ways of eating may be a consequence of many types of mental disturbances.
  • Regarding our patholocial food culture (if hyperrexia culturae is considered a disease), or pathology causing culture (if it just leads to the disease of obesity) – and the need for it to be replaced by better one… yeah, this might be difficult to achieve if our intervention is truly minimal, but there is a quirky solution to it. We can take normal to the extreme and take pride of it! Cherishing the fact that of all eating approaches out there we have chosen the most normal and sensible one. We can develop the culture of normalcy and moderation, or even better we can re-discover or re-invent our normal food culture as it was just before the arrival of the epidemic of obesity and metabolical disorders. This might be easier said than done, because at that time it’s not only eating habits that were different, but our whole lifestyle… so it might be difficult to do it now in altered circumstances… But if people can claim to emulate prehistoric diets, why would it be so difficult to emulate and apply the diet that was the norm, just some decades ago??? Here I’ll also say something about aesthetics of it… as I believe whatever we do needs to be beautiful in some way: embracing normality, in such an enthusiastic way has a name in fashion: it’s called normcore (portmanteau of the words normal and hardcore). This same approach can be applied to nutrition – enthusiastically embracing normalcy, in sort of hardcore way – and this is the secret ingredient that can give edge to the principle of minimal intervention, and make a plain, normal diet, which I believe IS the best and most sustainable option in the long term, make it interesting and edgy.

I will end this article by saying that “First, do no harm!” is the basic principle in medicine in general, and nutrition should follow it too. The principle of minimal intervention is directly derived from the principle of doing no harm. The principle itself is wise and well motivated in spite of having certain weaknesses that we have explored in this article, and for which I hope this article has helped find solutions.

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