Improving the Management and Prevention of Obesity 137emotional status (i.e., the presence of anxiety and depres-
sive symptomatology) ought to be included as well. A care-
ful individualized assessment will often reveal important
behavioral and psychological targets for intervention such
as binge eating, body image disparagement, anxiety, de-
pression, or poor social adjustment„problems that need to
be addressed regardless of whether weight loss itself be-
comes an objective of treatment (Perri, Nezu, & Viegener,
1992; Wadden & Foster, 1992).2.Discuss treatment expectations.Virtually all obese clients
begin weight-loss therapy with unrealistically high expec-
tations about the amount of weight loss they can achieve
(Foster et al., 1997). These faulty expectations may lead
patients to discount the bene“cial impact of modest
weight losses. Treatment of faulty weight-loss expecta-
tions may improve the patient•s satisfaction with the out-
come of weight-loss therapy and thereby foster better
maintenance of weight loss. In some situations, it may be
particularly important to address the internalized aesthetic
standards that produce faulty weight-loss expectations.
Teaching patients to resist the social pressure to achieve
an •idealŽ body, to adopt nonderogatory self-statements
about large body size, and to uncouple the association be-
tween body weight and self-esteem should represent sig-
ni“cant objectives for therapy (Foster & Kendall, 1994).
3.Focus on behavior change.Obese persons do not have di-
rect control over how much weight they lose. Therefore,
treatment goals should be framed in terms of behaviors
that they can control, such as the quantity and quality of
food they consume and the amounts and types of physical
activity they perform. Moreover, obese persons should be
informed that signi“cant health bene“ts can be derived
from even modest weight losses of 5% to 10%. The main-
tenance of stable weight and the prevention of weight gain
should be recognized as a legitimate treatment option for
some obese persons, particularly since the natural course
of obesity entails weight gain.
4.Include multiple indicators of “success.”Successful out-
come in the care of the obese person should not be viewed
solely in terms of weight change. Bene“cial changes in risk
factors for disease and improvements in quality of life
(Atkinson, 1993) represent important indicators of success.
Improvements in the quality of diet should be a component
of care independent of whether weight reduction is an iden-
ti“ed objective of care (Hill, Drougas, & Peters, 1993). Re-
ductions in amounts of dietary fats, particularly saturated
fats, can improve health as well as assist in weight loss
(Insull et al., 1990). Similarly, increased physical activity
and a decrease in sedentary lifestyle can represent bene“-
cial components of long-term care irrespective of the
impact of exercise on weight loss (Lee, Blair, & Jackson,
1999; Leermakers, Dunn, & Blair, 2000; Paffenbarger &
Lee, 1996). Finally, self-acceptance, independent of
weight body, may also be a signi“cant indicator of success
(Wilson, 1996).
5.Adopt a lifelong perspective.We believe that obesity
should be viewed as a chronic condition requiring long-
term, if not lifelong, care. The clinical challenge is not to
convince the obese person that they need to be in treat-
ment forever. Rather the challenge is to convince the over-
weight person that successful management of weight
will require constant vigilance and ongoing efforts at self-
management of eating and exercise behaviors. Although
weight management may become somewhat easier over
time, it is always likely to entail conscious efforts to main-
tain behavioral control of one•s energy balance. In a com-
passionate manner, health providers must communicate
to their obese patients not merely a recognition of the
chronicity of problem, but also an empathic understanding
of the emotional aspects of what it means to be obese in a
culture that values thinness. Finally, clinicians need to as-
sure obese patients of their ready availability to assist in
the long-term management of weight and related issues.Prevention of ObesityClinical treatment of obesity will not resolve the current epi-
demic of overweight in the United States. Serious public
health efforts are needed to counter the ominous trend of in-
creasing body weights in our country. Accordingly, a number
of far-reaching initiatives are warranted. We describe four
sets of recommendations:1.Develop a national plan to prevent and treat obesity.The
increasing prevalence of obesity and obesity-related disor-
ders demands serious attention from policymakers as well
as the general public. As Mokdad and colleagues (2000)
have noted, •The time has come to develop a national,
comprehensive plan to prevent and treat the obesity epi-
demicŽ(p. 1650). The overarching objective of such a plan
would be to identify and implement effective educational,
behavioral, and environmental approaches to control and
prevent obesity. The development of a national plan would
require the collaborative efforts of both the public and the
private sectors including scientists, physicians, public
health of“cials, educators, and leaders from the agricul-
tural and food industries (Nestle & Jacobson, 2000).
2.Intervene in the schools.Schools are in a unique position
to support the promotion of healthy lifestyles. Interven-
tions in the school environment can result in bene“cial
changes in both diet and physical activity (Sallis et al.,