types of foods, teaching when and under what con-
ditions to eat, encouraging regular exercise, and
maintaining modified eating patterns after the pro-
gram has ended. Finally, pharmacologic and surgical
treatments for obesity are on the increase (Wadden
et al., 2002).
Again, however, early prevention may be the
best and safest road to weight control. An excellent,
classic example of such an approach is the Stanford
Adolescent Obesity Project (Coates & Thoresen,
1981). A variety of strategies were used with ado-
lescents in the hope that weight control at this age
would lead to the prevention of obesity in adult-
hood. The strategies used were self-observation,
cue elimination, and social and family support.
These interventions were noticeably more effective
when parents were involved. Many investigators are
also exploring the possibility of using peer group
discussion. A 10-year outcome study of a family-
based behavioral treatment for childhood obesity
suggests that early intervention in childhood can
effect important and lasting changes in weight con-
trol (Epstein, Valoski, Wing, & McCurley, 1994).
Two recent meta-analyses of school-based
obesity prevention programs suggested that the fol-
lowing components appear most likely to benefit
children and youth: (a) modifying the home envi-
ronment to limit food access, to increase access to
physical activity, and to provide good behavior
models for appropriate eating; (b) reducing televi-
sion viewing; (c) modifying school policies and the
school physical environment to support improved
dietary practices (e.g., outlawing soft drinks) and
encourage physical activity; and (d) providing class-
room instruction on good dietary practices (Katz,
O’Connell, Njike, Yeh, & Nawaz, 2008; Kropski,
Keckley, & Jensen, 2008).
OTHER APPLICATIONSTreatment and preventive initiatives must be sup-
plemented with techniques that encourage patients
to cope with medical procedures and follow medi-
cal advice.
Coping with Medical Procedures
The prospect of facing surgery, a visit to the dentist,
or a variety of medical examinations can be enough
to strike fear into the heart of even the strongest.
Faced with such procedures, many patients delay
their visits or even forgo them entirely. Health
and pediatric psychologists specializing in behav-
ioral medicine have developed interventions to
help patients deal with the stress surrounding such
procedures.Medical Examinations and Procedures. Some
medical examinations or procedures are especially
stressful. Without them, however, the patient may
not be properly diagnosed and may miss out on a
health-saving intervention. A good example is sig-
moidoscopy, a fairly common procedure designed
to examine the mucous lining of the bowel to
discover the presence of any pathological growths
in the last 10 inches of the colon. This in turn can
aid in the early detection and prevention of colon
cancer. For many patients, however, the procedure
is very stressful. It involves inserting a scope into
the colon, with some stretching of the bowel.
Although all of this is not very painful or dangerous,
it does unnerve many people, and they perceive it
as a humiliating procedure. Interventions have been
developed that help patients cope with the stress of
this and other procedures. For example, brief
instructions might be given to prepare the patient
for what to expect.
What kind of information is most likely to help
patients cope with stressful medical procedures?
Often, a distinction is made betweenprocedural infor-
mation(descriptions of what will occur) andsensory
information(descriptions of the sensations that will be
felt). Reviews of relevant studies indicate that
although procedural preparation was superior to sen-
sory preparation in reducing negative affect, pain
reports, and other distress, combined procedural-
sensory preparation was the most effective method
(e.g., Jaaniste, Hayes, & von Baeyer, 2007; Suls &
Wan, 1989).
In addition to informational interventions, evi-
dence supports the use of behavioral interventions502 CHAPTER 17