The anti-obesity messages are becoming mind-numbingly familiar: smaller portions. Less fried food. Fewer sodas. It’s all true, but it has become mere background noise. Yes, fast-food companies have spectacular ad budgets (even as I write this article about horrifying obesity trends, I want that $10 Pizza Hut dinner box, the one that comes with a medium pizza and no fewer than 16 bread sticks). We live in a nation that can turn a lint-roller into an infomercial juggernaut. So why can’t we sell healthy eating?
A study appearing this week in the Archives of Internal Medicine suggests a new idea. Maybe we should stop asking people to change — or even limit — their diets. Let’s admit that no one really wants edamame more than Pizza Hut, and that when the Pizza Hut guy gets to the door, no one wants to see him carrying anything smaller than a Dinner Box. Instead, let’s start with a simpler suggestion: just don’t eat more than you do now.
This strategy won’t solve the obesity problem, but it could help us to keep from getting any bigger. For two years, Gary Bennett of Duke University’s Psychology & Neuroscience department and eight colleagues followed 365 obese patients who had already developed hypertension. The researchers chose not only a physically unhealthy population but one that was also struggling socioeconomically. Bennett says no participant in his study was earning more than $25,000 a year. The Duke team wanted to work with the poor because those with money can already afford to pick halibut and asparagus over hamburger and fries. For the poor, getting fresh fish and vegetables can mean a long bus ride and a week’s pay — making health not only psychologically but also financially difficult.
The 365 patients were recruited from community-health centers and then randomly divided into two groups. The first group received whatever usual weight-loss care was provided at the center: typically a combination of one-on-one advice and then some take-home material that might include steps to follow on how to exercise more and eat better. Those in the first group also had the opportunity to schedule future appointments to talk about weight loss. Most did not.
The participants in the other group got roughly the same amount of time with a counselor and similar advice on how to lose weight. But they were also given the opportunity to receive monthly counseling calls from educators trained in the principles of motivational interviewing — a well-studied method of cognitive therapy. And the participants in the second group were given the option of attending a monthly group session where they could share personal stories. But in order to keep the program inexpensive, the participants weren’t given specific diets. They didn’t have to follow calorie counts or avoid certain foods, although they were repeatedly asked — during the phone calls and in the group meetings — not to eat more than they already did.
After two years, those in the second group had lost more weight—an average of 2.2 lbs (1 kg) more—than those in the first group. That’s not much, but it’s a shift in the right direction. They also showed significant improvement in their blood-pressure scores compared to those in the control group. “People in this population tend to gain weight year after year, typically one to three pounds per year,” says Bennett. “It’s very hard for anyone to lose weight, but we seem to have found a strategy that can help people at least not to put on more weight.”
The blood-pressure figures suggest that even if participants weren’t choosing salad over fries, they were making choices on the margins that mattered — fries without melted cheese, say, or a double Whopper instead of a triple. Psychologically speaking, the participants were probably beginning to retrain their reward systems to recognize when they are full — when eating another order of fries isn’t having fun but flirting with diabetes. Plenty of research shows that the feeling of being full — researchers use the term satiety — is determined far more by how you think and feel than by how much is actually in your stomach.
The new study is small and needs to be replicated, but it does suggest that public-health messages about obesity might work better if they were more subtle. If the choice is between the Dinner Box and a spinach salad, there isn’t much of a choice at all. It’s depressing, but the best way to begin slowing the obesity crisis may be to ask people to eat just 16 bread sticks, not 17.
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