Engaging Multiple Arenas, Public and Personal, Will More Effectively Fight Obesity
For the first time in human history in the year 2000 more of us became overweight or obese than were underweight (Caballero, 2007). Today if any one of us in the developed world lives the life served up by the dominant culture we will sooner or later become overweight and inexorably creep, over time, to obesity. This is because the teetering balance between the food energy we ingest and the physical energy we use up has in the last forty years come crashing down on the side of excess food energy.
We evolved to eat primarily edible leaves, tubers, scarce fruits and grains, and even scarcer meats and fishes while our lifestyle traditionally required so much walking, carrying, and hand labor that all but the most wealthy and gluttonous of us were perpetually lean. Those who observe our world’s food supply note that we produce enough calories worldwide to feed us more than two times over. And these calories are not evenly distributed among the world’s peoples. The majority of these excess calories reside in the snack and prepared food aisles and fast food outlets of the developed and developing world. So while some of the world is still starving, the remainder is being killed more slowly by food excess. The forces of global economics advertise, package, and supply enough extra calories to fatten up those same souls who have had nearly every physical exertion removed from their daily life.
For most of the last forty years as we grew slowly rounder, our healthcare givers chided us to lose weight. We were told to diet, to exercise more, to take diet pills if that failed. Some of us, more and more all the time, have resorted to bariatric surgery which reduces our chances of dying of cardiovascular diseases but seems to significantly increase our chances of dying instead from accidents and suicide (Adams, 2007).
What scientists have nearly uniformly observed is that all of these brave individual attempts to lose weight cause modest weight losses that are soon swallowed up by the larger forces at work in our obesogenic society. The phrase obesogenic society was coined in 1996 by the Australian population health researcher, Boyd Swinburn, and his colleagues to describe a society that sickens its people with convenience and plenty (Dixon, 2006). Data is beginning to mount documenting this. A shocking study by Harvard researchers Nicholas Christakis and James Fowler trumpeted from the New England Journal of Medicine last year, “Obesity is contagious!” (Christakis, 2007). This 2007 work observed overweight and obesity moving plague-like from individual to individual throughout the thousands of subjects observed over the forty years of the Framingham Heart Study. Weight increases occurred across all socio-economic, age, gender, and education classes.
So what can be done to help us lose our extra pounds and halt our creep toward obesity? Researcher Anjali Jain wrote in 2005 in his systematic review of treatments for overweight in both individuals and populations:
It may also be helpful to pose the question differently. Why are some people not obese despite living in an obesity promoting environment? Lean individuals have probably found ways to moderate eating habits and to exercise regularly, but knowing the details of how they achieve these practices could be revealing. Do they exercise every day, do they ever dine at restaurants? Do they hike in the mountains on weekends or walk to school with their children? How and at what age did they develop their good eating and exercise habits? Detailed qualitative research to investigate the factors that help protect high risk people (such as those with obese parents) in particular from becoming obese may help us to understand the key biological, social, and environmental factors leading to successful weight control (Jain, p. 1388).
At this point there seems near universal agreement that those who maintain healthy weight move more, on the order of an hour of moderate exercise a day. They eat less fat and fewer overall calories, generally avoiding fast food. They watch less than 10 hours of TV a week, and they keep track of their weight, often with weekly weigh-ins (NWDR Facts, 2008; Jain, 2005; and many, many others). Encouragingly a recent study examined the number of extra kilocalories the average American needs to burn daily to keep from gaining weight over time. The number, approximately 10 kcal a day, was surprisingly low—equivalent to only two or three extra minutes of walking daily (Veerman, 2007).
But what about losing weight? What do we know about what works? Despite the millions of dollars spent trying, conventional medicine offers little that works—diet faithfully, exercise regularly, and take weight-loss drugs and expect to lose 3 to 5 kg., which you will likely regain after a year. For the severely obese, suggest surgery. However, behavior change methods from the world of business, psychology, and Integral Theory offer some intriguing adjuncts that hint at improving success rates.
Robert Kegan is a Harvard educator who has studied adult learning and development for several decades. His 2001 book, How the Way We Talk Can Change the Way We Work: Seven Languages for Transformation, begins:
The late William Perry...was a gifted trainer of therapists, counselors and consultants. “Whenever someone comes to me for help,” he used to say, “I listen very hard and ask myself, ‘What does this person really want--and what will they do to keep from getting it?’” (Kegan, 2001, p.1).
Kegan goes on to describe a tendency for human desire for change to be sabotaged by a system of unconscious countervailing assumptions that lead to stalemate, thwarting change. Though How the Way We Talk is written for a business audience, Kegan could also be describing the powerful dynamic equilibrium that perplexes dieters. The fat desire to lose weight, they diet by forgoing favorite foods. Meanwhile, unconsciously, they hold a belief that eating is a reward or a stress relieving activity. The very act of dieting—“depriving” themselves—becomes stressful, driving them to eat. In this example of a human dynamic equilibrium, change in one place drives compensating change in another. The net effect is no systemic change, no sustained weight loss. Kegan suggests transcending this stalemate by purposefully uncovering hidden countervailing assumptions within the human psyche through awareness practices outlined in his book.
Others from outside healthcare have suggested practices for stimulating truly transformational behavior change. George Leonard and Michael Murphy in The Life We are Given and the brilliant philosopher Ken Wilber, associated with developing Integral Theory, outline methods of their own. These thinkers concur that bringing awareness to mental and physical processes is transformative. They also suggest making multiple changes simultaneously across numerous life arenas for more rapid stimulation of change. Accordingly, for example, the person who begins walking to work, getting in touch with their unexamined selves through therapy or awareness practice, who makes new connections in the community, and limits their consumption of sweets and fats is more likely to experience transformative weight change than someone who merely diets. Attention to multiple lines synergistically speeds transformation. Interestingly, a recent empirical study of nearly 1,300 dieters, some using multiple behavioral interventions noted that multiple interventions have more than three times the effectiveness of single changes (Johnson, et al., 2008).
Wilber suggests a model that may offer suggestions as to which interventions might lead to productive change for a particular dieter. Wilber suggests charting interior and exterior resources at both the personal, and cultural/environmental level. He suggests that effective intervenors will assess four aspects of the patient:
• his or her personal interior thoughts, beliefs, hopes, etc.,
• his or her interior collective such as cultural beliefs,
• his or her observable personal characteristics such as genetics, BMI, metabolism, etc.,
and, finally,
• his or her observable environmental characteristics such as type of neighborhood, sidewalks, access to high-quality food, etc.
Based on the particular strengths and deficits an individual and his or her culture/environment exhibits, multiple interventions will be appropriate. For example cognitive behavioral therapy, spiritual support, nutrition education, portion control, and a certain type of exercise may be prescribed. Wilber suggests that seemingly unrelated interventions like providing music lessons, yoga, or planting a garden may enhance transformative change (Wilber, 2000a and 2000b).
Given the alarming rate of our slide towards obesity, time is of the essence in engaging the battle on multiple fronts. The full range of public health measures, similar to those used in the campaign against cigarette smoking, should continue and expand. These measures alone, however, are not enough. Attention practices and multiple interventions based on an individual’s strengths, preferences, beliefs, and needs show promise for effecting change at the personal level. Studies should be done to investigate these potentially effective treatments.
Caballero, B. (2007). The global epidemic of obesity: An overview. Epidemiologic Reviews, 29(2007), 1-5.
Christakis, N. A., & Fowler, J. H. (2007). The spread of obesity in a large social network over 32 years. The New England Journal of Medicine, 357(18), 370-379.
Dixon, J., Banwell, C., and Hinde, S. (2006). Cities, consumption and health. Fenner Conference 2006, Canberra, Australia. Conference address accessed on August 10, 2008 from
http://nceph.anu.edu.au/Fenner2006/program.htm
Jain, A. (2005). Treating obesity in individuals and populations. British Medical Journal, 33, 1387-1390.
Johnson, S., L., P. A., Cummins, C. O., Johnson, J. L., Dyment, S. J., Wright, J. A., et al. (2008). Transtheoretical model-based multiple behavior intervention for weight management: Effectiveness on a population basis. Preventive Medicine, 46, 238-246.
Kegan, R., & Lahey, L. L. (2001). How the way we talk can change the way we work: Seven languages for transformation. San Francisco: Jossey-Bass.
Leonard, G., & Murphy, M. (1995). The life we are given. New York, NY: G. P. Putnam's Sons.
National Weight Control Registry (2008). NWCR facts. Retrieved August, 10, 2008, from
http://www.nwcr.ws/Research/default.htm
Wilber, K. (2000a). Grace and grit: Spiritualtiy and healing in the life and death of Treya Killam Wilber (Second ed.). Boston, MA: Shambhala Publications, Inc.
Wilber, K. (2000b). One taste. Boston, MA: Shambhala Publications, Inc.
Veerman, J. L., Barendregt, J. J., van Beeck, E. F., Seidell, J. C., & Mackenbach, J. P. (2007). Stemming the obesity epidemic: A tantalizing prospect. Obesity, 15(9), 235-2370.
We evolved to eat primarily edible leaves, tubers, scarce fruits and grains, and even scarcer meats and fishes while our lifestyle traditionally required so much walking, carrying, and hand labor that all but the most wealthy and gluttonous of us were perpetually lean. Those who observe our world’s food supply note that we produce enough calories worldwide to feed us more than two times over. And these calories are not evenly distributed among the world’s peoples. The majority of these excess calories reside in the snack and prepared food aisles and fast food outlets of the developed and developing world. So while some of the world is still starving, the remainder is being killed more slowly by food excess. The forces of global economics advertise, package, and supply enough extra calories to fatten up those same souls who have had nearly every physical exertion removed from their daily life.
For most of the last forty years as we grew slowly rounder, our healthcare givers chided us to lose weight. We were told to diet, to exercise more, to take diet pills if that failed. Some of us, more and more all the time, have resorted to bariatric surgery which reduces our chances of dying of cardiovascular diseases but seems to significantly increase our chances of dying instead from accidents and suicide (Adams, 2007).
What scientists have nearly uniformly observed is that all of these brave individual attempts to lose weight cause modest weight losses that are soon swallowed up by the larger forces at work in our obesogenic society. The phrase obesogenic society was coined in 1996 by the Australian population health researcher, Boyd Swinburn, and his colleagues to describe a society that sickens its people with convenience and plenty (Dixon, 2006). Data is beginning to mount documenting this. A shocking study by Harvard researchers Nicholas Christakis and James Fowler trumpeted from the New England Journal of Medicine last year, “Obesity is contagious!” (Christakis, 2007). This 2007 work observed overweight and obesity moving plague-like from individual to individual throughout the thousands of subjects observed over the forty years of the Framingham Heart Study. Weight increases occurred across all socio-economic, age, gender, and education classes.
So what can be done to help us lose our extra pounds and halt our creep toward obesity? Researcher Anjali Jain wrote in 2005 in his systematic review of treatments for overweight in both individuals and populations:
It may also be helpful to pose the question differently. Why are some people not obese despite living in an obesity promoting environment? Lean individuals have probably found ways to moderate eating habits and to exercise regularly, but knowing the details of how they achieve these practices could be revealing. Do they exercise every day, do they ever dine at restaurants? Do they hike in the mountains on weekends or walk to school with their children? How and at what age did they develop their good eating and exercise habits? Detailed qualitative research to investigate the factors that help protect high risk people (such as those with obese parents) in particular from becoming obese may help us to understand the key biological, social, and environmental factors leading to successful weight control (Jain, p. 1388).
At this point there seems near universal agreement that those who maintain healthy weight move more, on the order of an hour of moderate exercise a day. They eat less fat and fewer overall calories, generally avoiding fast food. They watch less than 10 hours of TV a week, and they keep track of their weight, often with weekly weigh-ins (NWDR Facts, 2008; Jain, 2005; and many, many others). Encouragingly a recent study examined the number of extra kilocalories the average American needs to burn daily to keep from gaining weight over time. The number, approximately 10 kcal a day, was surprisingly low—equivalent to only two or three extra minutes of walking daily (Veerman, 2007).
But what about losing weight? What do we know about what works? Despite the millions of dollars spent trying, conventional medicine offers little that works—diet faithfully, exercise regularly, and take weight-loss drugs and expect to lose 3 to 5 kg., which you will likely regain after a year. For the severely obese, suggest surgery. However, behavior change methods from the world of business, psychology, and Integral Theory offer some intriguing adjuncts that hint at improving success rates.
Robert Kegan is a Harvard educator who has studied adult learning and development for several decades. His 2001 book, How the Way We Talk Can Change the Way We Work: Seven Languages for Transformation, begins:
The late William Perry...was a gifted trainer of therapists, counselors and consultants. “Whenever someone comes to me for help,” he used to say, “I listen very hard and ask myself, ‘What does this person really want--and what will they do to keep from getting it?’” (Kegan, 2001, p.1).
Kegan goes on to describe a tendency for human desire for change to be sabotaged by a system of unconscious countervailing assumptions that lead to stalemate, thwarting change. Though How the Way We Talk is written for a business audience, Kegan could also be describing the powerful dynamic equilibrium that perplexes dieters. The fat desire to lose weight, they diet by forgoing favorite foods. Meanwhile, unconsciously, they hold a belief that eating is a reward or a stress relieving activity. The very act of dieting—“depriving” themselves—becomes stressful, driving them to eat. In this example of a human dynamic equilibrium, change in one place drives compensating change in another. The net effect is no systemic change, no sustained weight loss. Kegan suggests transcending this stalemate by purposefully uncovering hidden countervailing assumptions within the human psyche through awareness practices outlined in his book.
Others from outside healthcare have suggested practices for stimulating truly transformational behavior change. George Leonard and Michael Murphy in The Life We are Given and the brilliant philosopher Ken Wilber, associated with developing Integral Theory, outline methods of their own. These thinkers concur that bringing awareness to mental and physical processes is transformative. They also suggest making multiple changes simultaneously across numerous life arenas for more rapid stimulation of change. Accordingly, for example, the person who begins walking to work, getting in touch with their unexamined selves through therapy or awareness practice, who makes new connections in the community, and limits their consumption of sweets and fats is more likely to experience transformative weight change than someone who merely diets. Attention to multiple lines synergistically speeds transformation. Interestingly, a recent empirical study of nearly 1,300 dieters, some using multiple behavioral interventions noted that multiple interventions have more than three times the effectiveness of single changes (Johnson, et al., 2008).
Wilber suggests a model that may offer suggestions as to which interventions might lead to productive change for a particular dieter. Wilber suggests charting interior and exterior resources at both the personal, and cultural/environmental level. He suggests that effective intervenors will assess four aspects of the patient:
• his or her personal interior thoughts, beliefs, hopes, etc.,
• his or her interior collective such as cultural beliefs,
• his or her observable personal characteristics such as genetics, BMI, metabolism, etc.,
and, finally,
• his or her observable environmental characteristics such as type of neighborhood, sidewalks, access to high-quality food, etc.
Based on the particular strengths and deficits an individual and his or her culture/environment exhibits, multiple interventions will be appropriate. For example cognitive behavioral therapy, spiritual support, nutrition education, portion control, and a certain type of exercise may be prescribed. Wilber suggests that seemingly unrelated interventions like providing music lessons, yoga, or planting a garden may enhance transformative change (Wilber, 2000a and 2000b).
Given the alarming rate of our slide towards obesity, time is of the essence in engaging the battle on multiple fronts. The full range of public health measures, similar to those used in the campaign against cigarette smoking, should continue and expand. These measures alone, however, are not enough. Attention practices and multiple interventions based on an individual’s strengths, preferences, beliefs, and needs show promise for effecting change at the personal level. Studies should be done to investigate these potentially effective treatments.
References
Adams, T. D., Gress, R. E., Smith, S. C., Halverson, R. C., Simper, S. C., Rosamond, W. D., et al. (2007). Long-term mortality after gastric bypass surgery. The New England Journal of Medicine, 357(8), 753-761.Caballero, B. (2007). The global epidemic of obesity: An overview. Epidemiologic Reviews, 29(2007), 1-5.
Christakis, N. A., & Fowler, J. H. (2007). The spread of obesity in a large social network over 32 years. The New England Journal of Medicine, 357(18), 370-379.
Dixon, J., Banwell, C., and Hinde, S. (2006). Cities, consumption and health. Fenner Conference 2006, Canberra, Australia. Conference address accessed on August 10, 2008 from
http://nceph.anu.edu.au/Fenner2006/program.htm
Jain, A. (2005). Treating obesity in individuals and populations. British Medical Journal, 33, 1387-1390.
Johnson, S., L., P. A., Cummins, C. O., Johnson, J. L., Dyment, S. J., Wright, J. A., et al. (2008). Transtheoretical model-based multiple behavior intervention for weight management: Effectiveness on a population basis. Preventive Medicine, 46, 238-246.
Kegan, R., & Lahey, L. L. (2001). How the way we talk can change the way we work: Seven languages for transformation. San Francisco: Jossey-Bass.
Leonard, G., & Murphy, M. (1995). The life we are given. New York, NY: G. P. Putnam's Sons.
National Weight Control Registry (2008). NWCR facts. Retrieved August, 10, 2008, from
http://www.nwcr.ws/Research/default.htm
Wilber, K. (2000a). Grace and grit: Spiritualtiy and healing in the life and death of Treya Killam Wilber (Second ed.). Boston, MA: Shambhala Publications, Inc.
Wilber, K. (2000b). One taste. Boston, MA: Shambhala Publications, Inc.
Veerman, J. L., Barendregt, J. J., van Beeck, E. F., Seidell, J. C., & Mackenbach, J. P. (2007). Stemming the obesity epidemic: A tantalizing prospect. Obesity, 15(9), 235-2370.
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