Portal de Periódicos da CAPES

Focusing on weight is not the answer to America's obesity epidemic.

2008; American Psychological Association; Volume: 63; Issue: 3 Linguagem: Inglês

10.1037/0003-066x.63.3.203

1935-990X

A. Janet Tomiyama, Traci Mann,

Pharmacology and Obesity Treatment

port Mann et al.’s position, but Van Strien et al. found that this weight gain was more closely associated with the tendency to overeat than with dietary restraint. Van Strien et al. suggested that clinicians should focus on combating the tendency to overeat (i.e., external and/or emotional eat- ing) rather than on encouraging dietary re- straint. That is, instead of trying to rein- force the fragile undereating approach, we should turn our attention to eradicating overeating by reducing overeating tenden- cies (through some form of behavioral ther- apy). This clinical approach would necessi- tate identifying which people are primarily external eaters and which are emotional eaters before any intervention is attempted (see Van Strien, 2002). No one denies the benefits of exercise, for which Mann et al. (2007) are strong advocates. An exercise regimen, however, does not address overeating tendencies and therefore may be ineffective or even coun- terproductive (insofar as exercise may “jus- tify” overeating). Further, we must ac- knowledge that exercise may improve health without necessarily lowering weight. Muscle weighs more than fat does, so los- ing fat is not necessarily the same as losing weight. The campaign against the obesity epidemic has tended to focus on weight instead of fat and health. Exercise, if it increases health and lean body mass with- out reducing weight, may discourage peo- ple who are obsessed (as is much of the medical community) with weight. In any case, insofar as obesity stems from over- eating, the research agenda for dealing with the obesity epidemic cannot afford to ig- nore the “intake” side of the caloric equa- tion. Developing interventions based on the specifics of the clients’ overeating tenden- cies ought to find a place on the agenda. REFERENCES Bruch, H. (1961). Transformation of oral im- pulses in eating disorders: A conceptual ap- proach. Psychiatric Quarterly, 35, 458 – 481. Fletcher, A. M. (2003). Renewed hope for self- change. American Psychologist, 58, 822. Herman, C. P., & Polivy, J. (2004). The self- regulation of eating: Theoretical and practical problems. In R. F. Baumeister & K. D. Vohs (Eds.), Handbook of self-regulation: Re- search, theory, and applications (pp. 492– 508). New York: Guilford Press. Mann, T., Tomiyama, A. J., Westling, E., Lew, A.-M., Samuels, B., & Chatman, J. (2007). Medicare’s search for effective obesity treat- ments: Diets are not the answer. American Psychologist, 62, 220 –233. Polivy, J., & Herman, C. P. (1985). Dieting and bingeing: A causal analysis. American Psy- chologist, 40, 193–201. April 2008 ● American Psychologist Polivy, J., & Herman, C. P. (2002). If at first you don’t succeed: False hopes of self-change. American Psychologist, 57, 677– 689. Schachter, S. (1968). Obesity and eating. Sci- ence, 161, 751–756. Stunkard, A. J. (1975). From explanation to ac- tion in psychosomatic medicine: The case of obesity. Psychosomatic Medicine, 37, 195– Van Strien, T. (2002). Dutch Eating Behaviour Questionnaire: Manual. London: Harcourt Assessment. Van Strien, T., Van de Laar, F. A., Van Leeuwe, J. F. J., Lucassen, P. L. B. J., Van den Hoogen, H. J. M., Rutten, G. E. H. M., & Van Weel, C. (2007). The dieting dilemma in patients with newly diagnosed Type 2 diabetes: Does di- etary restraint predict weight gain 4 years after diagnosis? Health Psychology, 26, 105–112. Full disclosure of interest: Tatjana van Strien has a copyright and royalty interest in the Dutch Eating Behaviour Questionnaire (DEBQ) and manual. Correspondence concerning this comment should be addressed to C. Peter Herman, Depart- ment of Psychology, University of Toronto, To- ronto, Ontario M5S 3G3, Canada. E-mail: herman@psych.utoronto.ca DOI:10.1037/0003-066X.63.3.203 Focusing on Weight Is Not the Answer to America’s Obesity Epidemic A. Janet Tomiyama and Traci Mann University of California, Los Angeles The two comments on our article, “Medi- care’s Search for Effective Obesity Treat- ments: Diets Are Not the Answer” (Mann et al., April 2007), state opposing views of the validity and novelty of our conclusions. In his comment, Applebaum (2008) claimed that our conclusion is “provocative and un- proven” (p. 200), whereas Herman, Van Strien, and Polivy (2008) generally agreed with our findings but stated that “this con- clusion is hardly new” (p. 202). Research on obesity treatment often leads to polariz- ing views, and our aim was to present a dispassionate analysis of the methodologi- cal issues in the long-term studies of diets. We believe we accomplished this goal, and the conclusions we presented were based on this analysis. Applebaum (2008) disputed our con- clusion about long-term weight regain by citing the laws of thermodynamics. We do not dispute these laws, and indeed, we pro- vided support for them when we cited re- search showing that people initially lose 5%–10% of their starting weight on diets. However, short-term weight losses are not a cure for obesity, so the intent of our review was to show what happens to indi- viduals on diets in the long term. We found that the majority of dieters regained most or all of the weight they lost. We did not explore mechanisms of weight regain in our review, but it is likely that many of the dieters were unable to sustain the strict calorie reduction over a long period of time. When Applebaum (2008) compared common calorie-restrictive diets to food ra- tions in various concentration camps, he seemed to be suggesting that the levels of caloric restriction in dieting studies are ex- treme and that before we condemn dieting we must look at more realistic caloric re- striction levels. Although we would not have made this point in the same way as Applebaum, we do think it is worth con- sidering diets that involve less extreme ca- loric limits. Before we can accept his con- clusion that this type of diet is effective, however, we must test these interventions in rigorous, unbiased long-term studies. Both Applebaum (2008) and Herman et al. (2008) took issue with our comments recommending exercise. Applebaum ar- gued that even overeating a tiny amount of food renders the weight-loss effect of ex- ercise inconsequential, and Herman et al. noted that exercise tends to give individu- als a justification for overeating. Regard- less of whether either point has been em- pirically supported (Applebaum, for example, cited just one non-peer-reviewed source), we note (as did Herman et al.) that it has been shown that exercise confers direct health benefits even if it does not necessar- ily lead to weight loss. In contrast to Her- man et al., we find this outcome to be reason enough to recommend exercise as a response to the obesity epidemic. It has been a source of much surprise to us that the medical community is, as Herman et al. pointed out, “obsessed . . . with weight” (p. 203) when it seems that the usual focus of the medical community during epidemics is squarely on health. We propose that the research community (including ourselves) shift the focus of obesity research toward direct measures of health, such as blood pressure or insulin resistance, and away from weight, which is an imperfect indica- tor of current or future health problems. Herman et al. (2008) also noted that the calorie-restricting diets we reviewed are but one tactic to treat obesity, and they emphasized the potential utility of a differ- ent tactic, which is to eliminate overeating. Although this was not the focus of our review, the preliminary research Herman et al. cited indicates that this may be a prom- ising path for an identifiable group of indi-