Susan C. Wooley

Confronting the failure of behavioral and dietary treatments for obesity

Abstract This review questions the appropriateness of behavioral and dietary treatments of obesity in light of overwhelming evidence that they are ineffective in producing lasting weight loss. The stigmatization of obesity, the overstatement of health risks, and the pervasive influence of the lucrative diet industry have maintained public demand for dietary treatment. However, decades of research on the biology of weight regulation make clear the unlikelihood of success with dietary treatment, information which the health professions have been slow to integrate. Recommendations are made for improving lifestyle, health risk factors, body image, and the self-esteem of the obese without requiring weight loss.

A learning theory model of chronic illness behavior: theory, treatment, and research.

&NA; Over 300 patients have been treated on an inpatient psychosomatic service employing a learning model of chronic illness behavior. This model stresses social reinforcement and avoidance of occupational and social activities in the development of a syndrome characterized by somatic complaints and care‐eliciting interpersonal behaviors. Preliminary studies showed that patients reinforced others for care‐giving responses but showed improved tolerance of experimental pain and lower rates of drug use when care‐taking responses were minimized and self‐control encouraged. Treatment was designed to involve the patient in his own care, including behavior modification techniques to reduce symptomatology, social skills training, and family therapy. One‐year follow‐up shows that most patients achieve self‐set goals, with generalization of beneficial treatment effects. Patients who return to an intact family show continuing decreases in somatic complaints and increases in achievement orientation. Treatment failures are characterized by lack of an intact family and return to the medical care system.

Obesity and women—II. A neglected feminist topic

Synopsis This second paper places these findings on obesity in a feminist context and examines the political dimension of obesity for women. It examines the possibility that in Western society females are never too thin to feel fat and looks at the ‘mass starvation of women’ in America as a possible cultural ‘equivalent to foot-binding, lip-stretching, and other forms of woman mutilation’.

Calories and sweet taste: Effects on sucrose preference in the obese and nonobese ☆

Abstract The effects of two very sweet solutions, one noncaloric (cyclamate) and one caloric (glucose, 25%), ingested orally, on preference for 2.5%–40% sucrose taste samples were studied using obese and nonobese subjects. Glucose and cyclamate were equally effective in reducing preference for sucrose samples of 10% or above, one hr after ingestion. Glucose was slightly more effective than cyclamate in reducing preference for 20% sucrose around 30 min after ingestion. The findings challenge the validity of the alliesthesia phenomenon and, therefore disconfirm the ponderostat theory of Cabanac, Duclaux, and associates.

Obesity and women—I. A closer look at the facts

Synopsis These two papers provide a new perspective on obesity. This first paper is concerne with challenging the prevailing orthodoxy that fatness is self-induced, that fat people overeat and need only to stick to a diet in order to eliminate obesity. It reviews research which indicates that ‘obese people do not, on the average, eat more than anyone else’, and that contrary to frequent medical insistence on the desirability of dieting, there are many undesirable facets, for there is an almost inevitable weight gain after dieting so that ‘the major treatment for obesity may also be the major cause of obesity’.

The Experimental Psychology of Obesity

Among the current theories purporting to explain the psychological basis of obesity in humans one of the earliest was that proposed by Hilde Bruch and summarised in her recent book1and among the first to generate experimental studies of the eating behaviour of the obese was Schachter’s2,3. The central aetiological concepts of the two theories are similar. Bruch has proposed that eating disorders (obesity and anorexia nervosa) are caused by an inability to differentiate between bodily sensations and emotional states. Obese persons are viewed as having a faulty awareness of physiological hunger, so that emotional states are mislabelled as hunger; this leads to an excessive intake of food. Schachter’s theory2–4 consists of two hypotheses. The ‘external hypothesis’ states: ...there is growing reason to suspect that the eating behavior of the obese is relatively unrelated to any internal gut state, but is, in large part, under external control; that is, eating behavior is initiated and terminated by stimuli external to the organism2.

A Behavioral Conceptualization of Psychosomatic Illness: Psychosomatic Symptoms as Learned Responses

The purpose of this chapter is to review existing theories of etiology of psychosomatic disorders and to describe a theory of psychosomatic etiology based on learning theory. This task carries with it an obligation to define what is meant by psychosomatic symptoms or psychosomatic disorders because these terms have become controversial. Some writers have proposed that the term psychosomatic be applied to all illnesses, since susceptibility to and recovery from most illnesses seem to be influenced by psychological and social variables (Wolf & Goodell, 1976). Others have proposed that the term psychosomatic be dropped as useless (Lader, 1972) because it is both misleading and too inclusive. Many contemporary writers lump together under the term psychosomatic a variety of symptoms that have traditionally been distinguished, such as conversion reactions, hypochondriacal behaviors, somatopsychic disorders, and psychological disturbances produced directly by insult to or degenerative changes in the nervous system (e.g., Wright, 1977).

IS SELF-ACCEPTANCE A REASONABLE GOAL?

For several decades evidence has accumulated on the genetic and constitutional determinants of obesity and the inefficacy of diets in producing lasting weight loss (for review see Stunkard & Penick, 1979, Wooley, Wooley & Dyrenforth, 1979; Foreyt, Goodrich & Gotto, 1981; Bennett, 1984, 1987; Garner & Wooley, 1991; Brownell, 1991; Wilson, in press). In recent years, these findings have been joined by data suggesting that weight loss and the virtually inevitable weight regain which follows not only fails to lastingly improve health but may instead risk physical and mental health (for review see Andrews, 1980, Keys, 1980; Ernsberger & Haskew, 1987; Garner & Wooley, 1991; Wooley & Garner, 1991; Prentice, this volume). Such findings, while far from conclusive, make the already perplexing question of whether to abandon dietary treatments of obesity more pressing still.