If Diets Don't Work, What's the Solution to Obesity in America?

Some say it's time to scrap efforts to help individuals lose weight in favor of broad policy solutions.

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Some of her former colleagues in the treatment arena, while fully acknowledging that the environment encourages overeating, are still interested in developing therapies for individuals. Two smallish Swedish studies have suggested that cognitive therapy—which teaches people the mental and emotional skills they need to make and sustain change—can help people lose weight and keep it off for at least a year and a half, says Judith Beck, director of the Beck Institute for Cognitive Therapy and Research.

In addition to cognitive therapy, other approaches are being applied to binge eating and have potential to help general overeating. (Studies suggest that up to 30 percent of people seeking help at weight-loss clinics are binge eaters, according to Eunice Chen, codirector of the Eating Disorders Program at the University of Chicago Medical Center.) Dialectical behavioral therapy, as applied to eating disorders, assumes that sufferers are attempting to "suppress, avoid, or numb out emotional experiences so that they're less painful," says Debra Safer, a psychiatrist at Stanford University. The goal is to teach people to regulate their emotions, through techniques including mindfulness—paying attention to how you are feeling in the present and self-acceptance. Mindfulness on its own is already being used as a method to treat overeating. But efforts to roll out any of these techniques on a large scale as treatments for obesity are still in their infancy. "We are just now trying to articulate with data where the treatment of binge eating disorder fits into the treatment of obesity," says B. Timothy Walsh, a psychiatrist at Columbia University who studies both psychological and pharmaceutical treatments for eating disorders.

In the meantime, lacking a proven method for weight control and trapped in a world that encourages overeating and underexercising, what is an obese or overweight person to do? First, remember that we are all an experiment of one. Some people do lose weight and keep it off by modifying their own actions; studies have shown that in addition to changing their eating behaviors, those folks tend to get a lot of exercise and monitor themselves carefully by frequent weigh-ins or food diaries. It can't hurt to try some of the mindfulness techniques that are part of dialectical behavioral therapy and espoused on their own and some of the cognitive techniques, too.

Also, while you can't control everything about your environment, you can focus on your microenvironment. Cornell University's Brian Wansink has some great ideas about structuring your immediate surroundings to reduce the risk of mindless eating. And don't forget your social environment—recent research suggests social networks are important in promoting or discouraging obesity. "The data are pretty clear that adults are pretty much going to need ongoing care and support . . . we need to try to help them build that into their lives," says Denise Wilfley, director of the Weight Management and Eating Disorder Program at Washington University. That means making sure family and friends support healthful behavior whenever possible—and even extending that into the workplace, by bringing in fruit as an office snack for example, says Wilfley.