Why address treatment guidelines for obesity?
We are writing this letter in response to the letters on treatment guidelines in the February Monitor. There is no question that obesity is a major public health problem. Two-thirds of Americans are overweight, including one-third who are obese. Obesity is the No. 2 killer in the United States (and is expected to become No. 1). Because of obesity, children born in 2000 will live shorter lives than we will — and among children born in 2000, 33 percent of boys, 39 percent of girls and 50 percent of African-American girls will develop diabetes in their lives. Obesity also becomes a personal health problem when the individual self-identifies as such and seeks help. Psychologists — both researchers and clinicians — are uniquely prepared to help.
There is excellent scientific evidence that obesity can be treated successfully. Prominent psychologists, such as Drs. Kelly Brownell, Leonard Epstein and Rena Wing, have contributed enormously to our understanding of biopsychosocial factors that contribute to obesity, and this knowledge has been instrumental in developing evidencebased treatments that effectively promote and maintain weight loss. For example, the Diabetes Prevention Trial — an NIH-supported RCT — was terminated early because lifestyle behavior change was more effective than medication or placebo in the prevention of diabetes. The lifestyle behavior change intervention was developed by Dr. Wing.
The future of psychology will involve an expanded role in integrated health care. Given the economic and personal costs associated with chronic physical conditions, and the overwhelming evidence in support of a biopsychosocial approach to health promotion and illness prevention, psychologists need to be fully informed about the most effective ways to help support the nation’s health.
Accordingly, APA Divs. 38 (Health), 12 (Society of Clinical Psychology) and 54 (Society of Pediatric Psychology) all strongly support APA’s efforts to identify the evidence bases and best practices for the treatment of obesity.
On behalf of Div. 38
Elizabeth A. Klonoff, PhD, president
Christopher R. France, PhD, past president
Annette L. Stanton, PhD, president-elect
On behalf of Div. 12
J. Gayle Beck, PhD, president
Danny Wedding, PhD, past president
Mark Sobell, PhD, president-elect
On behalf of Div. 54
Tonya M. Palermo, PhD, president
Gerald P. Koocher, PhD, past resident
Mike Rapoff, PhD, president-elect
Sustainability and B.F. Skinner
Kudos to Tori DeAngelis for her article “Going green” in the February Monitor. As shown in the article, APA demonstrates it can “talk the talk and walk the walk” regarding environmental stability.
Interestingly, the frequency of use of the term “sustainability” was approximately 12 in the article. One of Webster’s meanings of “sustainability” is “the ability to keep going, as an action or process.”
Recall that in operant conditioning principles, sustainability deals with the maintenance of behavior, a property specialized in experimental research of B.F. Skinner (1957) as illustrated in his classic text “Schedules of Reinforcement” co-authored with C.B. Ferster. The task of “sustainability” of concerted effort aimed at the mitigation of global climate change and its damaging consequences should not overlook basic laboratory principles of behavior. That is, Skinner showed that under varied environmental conditions, intermittent reinforcement leads to greater “resistance to extinction” (e.g., sustainability) of operant behavior compared to behavior following continuous reinforcement.
To the degree that global climate change is a profound problem for the survival of a wide range of species, including humans, over immediate and distant time frames — we should not neglect any tools, whether from applied or laboratory research, that may solve effective behavior change.
William F. Vitulli, PhD
University of South Alabama
Due to a staff error, the “President’s column” on the topic “Increasing psychology’s role in integrated care” did not run in the March Monitor as scheduled. To read the column, go to the digital edition. The column will also appear in the May issue.