More than 40% of American adults are obese — the highest rate ever observed, according to the Centers for Disease Control (National Center for Health Statistics Data Brief No. 360opens in new window, Feb. 2020).
“Obesity continues to increase, relatively unchecked, and the human and societal costs are staggering,” says Carlos Grilo, PhD, professor of psychiatry and psychology and director of the Program for Obesity Weight and Eating Researchopens in new window at the Yale School of Medicine.
Knowing obesity can be a major risk factor for more severe cases of COVID-19, it’s an especially important time for psychologists to turn to new research and evidence-based practices (Kass, D.A., et al., The Lancetopens in new window, Vol. 395, No. 10236, 2020).
Experts from the fields of medicine, public health and beyond have mobilized to address the problem. And psychologists — who are now building on decades of research on behavior change and the maladaptive thoughts and behaviors that contribute to obesity, along with underlying genetic and medical factors — are getting increasingly creative in their contributions.
The February/March edition of American Psychologist, a special issue entitled “Obesity: Psychosocial and Behavioral Aspects of a Modern Epidemic,” highlights the breadth of research psychologists are conducting. Eleven articles on child, adolescent and adult obesity summarize some of the most important emerging knowledge about obesity derived from rigorous science and lay the foundation for the roles psychologists can play in addressing obesity in the future.
“Psychologists have done valuable research ranging from basic biology to public policy and have an important voice in how this issue might be addressed,” says psychologist Kelly Brownell, PhD, director of the World Food Policy Centeropens in new window at Duke University’s Sanford School of Public Policy, who was not involved with the special issue. “The special issue brings together some of the most creative people working on obesity into a coherent picture of what might be done in the future.”
A toxic brew
Part of what’s hard about treating obesity is the “toxic food environment” that pervades America, says David Sarwer, PhD, associate dean for research and director of the Center for Obesity Research and Educationopens in new window at the College of Public Health at Temple University in Philadelphia.
“How do we effectively change our eating behaviors when calorically dense, high-fat, high-sugar foods are readily available and often far less expensive than healthier choices?” says Sarwer, who with Grilo served as guest editors for the special issue.
The answer may involve applying principles from behavioral economics to the food environment, as explored in the American Psychology article “How Psychological Insights Can Inform Food Policies to Address Unhealthy Eating Habits,” by psychologist Christina Roberto, PhD, an assistant professor of medical ethics and health policy at the University of Pennsylvania’s Perelman School of Medicine.
For example, we make most of our eating decisions using what behavioral economists call “system 1,” a fast and instinctive process that often leads to unhealthy choices, rather than “system 2,” a slower and more logical approach. Roberto argues that idea should determine how we package, market and regulate food (American Psychologistopens in new window, Vol. 75, No. 2, 2020).
“These insights can inform policies that incentivize healthier behaviors — including everything from clear nutritional labeling to beverage taxes in major metropolitan areas,” Sarwer says.
But tweaking the food environment is just one piece of the puzzle. In “Weight Stigma as a Psychosocial Contributor to Obesity,” psychologists Rebecca Puhl, PhD, deputy director of the Rudd Center for Food Policy & Obesityopens in new window at the University of Connecticut, Mary Himmelstein, PhD, of Kent State University in Ohio and Rebecca Pearl, PhD, of the University of Pennsylvania’s Perelman School of Medicine, summarize the evidence showing that people who experience weight stigma often display psychological distress, unhealthy eating behaviors and further weight gain (American Psychologistopens in new window, Vol. 75, No. 2, 2020). For example, several studies have shown that adults with obesity who experience weight discrimination have elevated cortisol levels.
“Despite being one of the country’s top public health problems, obesity continues to trigger stigma and discrimination,” Grilo says.
Other articles in the special issue include a randomized controlled trial of a new intervention for binge-eating disorder, enhanced developmental models of childhood obesity, a review of psychosocial and behavioral issues in bariatric surgery, an examination of how cognitive deficits are linked to weight gain and obesity, and more.
Maintaining results
Looking ahead, psychologists say a top priority is to develop and deliver evidence-based interventions that both promote weight loss and help people maintain the results they achieve.
“We know that a variety of different approaches to weight loss can promote clinically significant improvements in health within just a few months,” Sarwer says. “The challenge is maintaining those behaviors and benefits over the long term.”
Practitioners, even those who don’t specialize in weight management, are likely to increasingly treat patients with obesity and can therefore benefit from a general understanding of the psychological factors at play — which the special issue provides, Sarwer adds.
“The scope of America’s obesity problem has become so large and so daunting that health-care providers — regardless of their discipline — should, at a minimum, be able to provide patients with evidence-based guidance for healthy eating and physical activity,” he says. “It’s going to take individuals across the health-care professions working together to slow the growth of this epidemic and eventually reverse it.”
