On obesity

THE SECTION ON "Battling obesity" (January Monitor) is better than most of the many recent special sections in the media on this issue, but it still makes the common mistake of focusing almost entirely on eating too much and devoting little attention to exercise. Certainly, many of us eat too much, and the food industry does everything it can to promote eating more. But there are several reasons (I will mention only two) to suspect that exercise, not food, is the variable that has changed most.

First, people haven't changed their food habits as much as we think. Early 19th-century travelers to America (de Tocqueville, Dickens, Mrs. Trollope and others) were impressed by the habit of wolfing down large amounts of flour, sugar and lard. Food consumption figures from the early 20th century show similar patterns.

Second, for 99 percent of our span on earth, we humans were hunters and gatherers who roamed the savanna and woods--walking many miles a day in search of food and returning laden with roots, seeds, game and anything else edible. The human body has evolved to consume a great deal of nutrients and exercise a great deal.

I would suggest that psychologists spend more time looking at how to motivate people to exercise more and at what to do about the many who live in urban environments where walking or playing outside is unsafe.


University of California, Riverside

THE ISSUE DEVOTED TO OBESITY is a useful and informative reminder of the range of applications available to psychologists. I was struck, however, by the restricted range of references in the articles. The study of eating, food disorders, nutritional deficiencies, obesity, hunger and starvation, taste, food preferences, and diet determinants have a lengthy and profound research and applied literature.

Much of [the research] was stimulated by the work of the National Academy of Sciences Committee on Food Habits in 1941.

Under the leadership of Carl Guthe and Margaret Mead, several "Bulletins of the National Research Council" included extensive bibliographies of research and practices, as well as reports of research undertaken as a result of the academy's involvement. Notable early research was also carried out by Kurt Lewin and his students on such topics as the relative effectiveness of a lecture method versus a method of group decision for changing food habits; how to present food in a cafeteria setting so that superior dietary choices are made; and, because of wartime food scarcities, how to persuade people to eat non-preferred organ meats instead of steaks and roasts. A great deal of modern social and clinical psychology took shape through the study of food habits.


University of Oregon

YOUR SERIES ON OBESITY WAS seriously flawed by the omission of articles on the medical effects of weight fluctuation and the role that dieting plays in actually producing and increasing obesity. Such topics as these were very well presented in a series of articles in the summer 1999 issue of the Journal of Social Issues (JSI), "Dying to be thin in the name of health: shifting the paradigm." Some of the points made in the JSI articles that your articles failed to include or emphasize were that weight loss through restrictive dieting has not cured obesity in a significant portion of participants, that it is unsuccessful in producing even minimal permanent weight loss in the majority of cases and that weight loss is not critical for improving health for those considered obese relative to exercise and healthful diet choices (points summarized in the JSI introductory article by J.C. Cogan and P. Ernsberger). Although the articles in JSI explored these points very well, that journal does not have the circulation of the Monitor. Thus it is very unfortunate that the Monitor did not include such topics in the recent issue.


Wheeling, W.V.

Assault on privacy and autonomy

"PROTECTING PRACTITIONERS' autonomy" (January Monitor) chronicles our profession's vigorous parrying of egregious efforts by Oxford Health Plans to invade private psychotherapy records without valid patient authorization and Oxford's assaults on patient privacy and professional autonomy.

However, this article erroneously reports that Oxford's retrospective audit targets only contracted providers. In fact, Oxford's audit has also included practitioners who sought to avoid any managed-care involvement, but whose patients submitted claims for services rendered on an "out-of-network" basis. Oxford has sought to uncover "fraud and abuse" for non-network claims already processed and paid, some dating as far back as six years earlier.

Oxford has a market share of nearly 20 percent of the health insurance business in the New York City metropolitan area. They have engaged a national firm, Audit Review Service, to conduct this "fraud and abuse" audit. Audit Review Service markets its services aggressively to insurance carriers nationwide via a periodic newsletter, "Report on Mental Health Provider Fraud," and its Web site, which alleges that "mental health care has a higher level of provider fraud and abuse than any other medical specialty." Oxford's initiatives constitute a cautionary tale for practitioners throughout the nation, pointedly including those who believe that they have shielded themselves from the abuses of the managed-care system by declining to join any provider networks.


New York, N.Y.

More on spirituality and mental health

ONE OF YOUR FEATURE STORIES on spirituality and mental health (December Monitor ) notes Dr. Jeffrey Hayes's conclusion that college students in distress may seek guidance from a "pastor, rabbi or friend because they believe that a mental health professional will misinterpret or minimize their religious beliefs" (page 53). The story notes that psychologists are less oriented to religion than the population from which their clients come. Perhaps we should also consider whether psychology tends toward a more global anti-religious attitude.

The spirituality feature called to mind the account in the October 2001 Monitor of George Albee's comments on being honored as an APA past-president. What would Albee recommend for the discipline in coming years?

It's simple. Psychology must help get rid of organized religion. "It doesn't matter which religion," he instructs. "They are all patriarchal. And that is one of the major sources of social injustice in our society and the world."

Faced with attitudes like that (at once both anti-intellectual and nativist), many clients in crisis might well be tempted to seek help elsewhere. We should understand and perhaps even applaud their instinct to do so.


Fordham University