Bombak Responds

I welcome Lekkas and Stankov’s response, as I do developments in systems theory.^1,2 However, they have missed the point of my article. My focus is translation and application of knowledge to policy and medical practice. Given the prevalence of obesity, we must consider the framing of body and health in preventive public health with these people in mind. In fact, knowing the pervasiveness of stigma and its health effects,³ respecting these implications is a particularly constructive application of the precautionary principal.

Less so than arguing against environmental reforms, I contended such reforms should not be applied based on the poorly supported and marginalizing hope of producing thinner populations.⁴ I state, “By focusing on other measures of health and well-being, or sustainability, livability, and accessibility, valuable and legitimately effective reforms could be undertaken.” ^(p.e63) Systems thinking (undefined by Lekkas and Stankov) expands what we perceive as problems.⁵ This is compatible with rethinking using weight as a health outcome. Also relevant to systems thinking is the engagement, relationship-building, and nonlinear thinking that characterizes my proposed approach.

Lekkas and Stankov contend I use absolutes in my article. Obesity discourse derives its stigmatizing potential, in part, from depicting its underlining science as certain.⁶ It is only fair this evidence be evaluated according to its own standard. My position on obesogenic environments was based on recent reviews of environmental obesity research. I specifically critiqued the reductionist approach of the research included in the reviews. That more inclusive and multifaceted research exists is heartening but does not eliminate the implications of the larger body of work. While promising, actual systems theory in obesity research remains limited, and its translation to practice, what ultimately matters to health outcomes, remains elusive.^1,7,8

Essentially, I am concerned that regardless of how broad the scope, our prevention approaches still inexorably narrow to the individual. It is this individual we inevitably assume is behaving “unhealthily” and who must be “nudged” in the correct direction. As Lekkas and Stankov argue, unconscious factors may have an important effect on behaviors. Therefore, I ask that we remain reflexive about who we assume “unhealthy” individuals are, the behaviors we ascribe to them, what size we presume their bodies should be, and how we tend to racialize, class, and gender them.⁴ Otherwise, as their letter seems to suggest, we may state we’re focusing on systems but end by pushing individuals, ever-so-innocuously, into their “rightful” places.