The Psychology of Eating: From Healthy to Disordered Behavior

182 Obesity Treatment

nonobese patients may find the term obesityupsetting, those patients who
are obese prefer this more medical term to the use of a euphemism (Tailor
and Ogden, 2009). Therefore, although many obese people come into contact
with doctors, particularly GPs, for help with their obesity, much evidence
indicates that GPs do not necessarily believe that the patients’ weight
problem lies within their domain, often feel skeptical about the potential
effectiveness of available interventions, and hold conflicting models of obesity
to patients focusing on behavioral rather than medical causes and solutions.

Dietary Interventions

When obese people do seek help, the first and most common solution will
involve some form of dietary intervention which ranges from relatively
simple traditional approaches, contemporary specific approaches, to more
recent complex multidimensional packages. The effectiveness of these
approaches will now be described.

Traditional treatment approaches

The traditional treatment approach to obesity was a corrective one, and
encouraged the obese to eat “normally.” This consistently involved putting
them on a diet. Stuart (1967) and Stuart and Davis (1972) developed a
behavioral program for obesity involving monitoring food intake, modi-
fying cues for inappropriate eating, and encouraging self-reward for
appropriate behavior, which was widely adopted by hospitals and clinics.
The program aimed to encourage eating in response to physiological
hunger, and not in response to mood cues such as boredom or depression
or external cues such as the sight and smell of food or other people eat-
ing. In 1958, Stunkard concluded his review of the past 30 years’ attempts
to promote weight loss in the obese with the statement, “Most obese per-
sons will not stay in treatment for obesity. Of those who stay in treatment,
most will not lose weight, and of those who do lose weight, most will regain
it.” More recent evaluations of their effectiveness indicate that although
traditional behavioral therapies may lead to initial weight losses of on aver-
age 0.5 kg per week (Brownell and Wadden, 1992), “weight losses achieved
by behavioural treatments for obesity are not well maintained” (Stunkard
and Penick, 1979).