From the New York Times

[wosnes]

In the Science section today:

As Diet Ideas Abound, Is Willpower Obsolete?
By BARRON H. LERNER, M.D.

When I was growing up, the word “willpower†was used a lot. If only one was strong enough to resist sweets, according to logic of the time, one could stay thin.

Yet today, based on a series of scientific discoveries, the importance of willpower in promoting weight loss is becoming an obsolete notion. Is it worth saving?

The concept of willpower came less from scientific data than from Christian teachings about the dangers of temptation. Gluttony, after all, was one of the seven deadly sins, up there with pride, greed, extravagance, envy, wrath and sloth.

The late 19th century was perhaps the heyday of the revolt against what John C. Burnham, a historian at Ohio State University, calls “bad habits.†Groups like the Salvation Army and the Women’s Christian Temperance Union urged sinners to stop drinking, gambling and smoking.

Comparable sentiments characterized writings about obesity. In 1946, Wilson G. Smillie, a public health professor at Cornell, wrote that the physician should appeal to the obese patient’s “ability to manifest self-control.†Weight-loss programs like Overeaters Anonymous and Weight Watchers have reflected this philosophy.

Similarly, many physicians have also discouraged surgical procedures like stomach stapling or shortening of the intestines, not only because of their risks but also because they were somehow seen as quick fixes for lazy patients who do not stick to their diets.

But as critics have pointed out, while willpower can work, it usually does not. A study published in The Journal of the American Medical Association in 2005 found that regardless of the diet attempted, patients lost an average of only 5 percent of their baseline weight after one year. And dropout rates exceeded 40 percent. [A newer study is reported on this page today, in Vital Signs.]

As a result, strategies for promoting weight loss have recently begun to shift from a focus on individual behaviors to a public health approach.

As the late Dr. Donald H. Gemson of the Mailman School of Public Health at Columbia once put it, “the causes of the obesity epidemic are environmental, and the answers will be as well.†Rather than simply urging people to eat better and exercise more, experts like Dr. Gemson have increasingly argued that society has to facilitate such changes by reducing the availability of high-calorie foods, advertisements of junk food to children and reliance on automobiles, while increasing access to healthy foods and exercising.

The environmental theory of obesity is prompting governmental interventions, like New York City’s ban on most trans fats in restaurant food. And environmental strategies have successfully been used in other areas that formerly relied on moral suasion. For example, taxes on cigarettes have contributed greatly to lowered smoking rates. Legislatures have enacted laws making restaurants liable if they permit drunk patrons to drive home.

So will people necessarily lose weight if society actively discourages fattening foods? Maybe not. Consider the genetic hypothesis, the latest reassessment of the obesity problem.

Research suggesting a strong hereditary predisposition to obesity goes back several decades, but several recent findings have put this theory into the forefront. In 1994, for example, Jeffrey M. Friedman, a molecular geneticist at Rockefeller University, discovered the appetite-regulating hormone leptin. Dr. Friedman believes that people’s appetites are largely controlled by genetics, which causes them to have different “set points†at different times in their lives.

A study in The Journal of the American Medical Association in May suggested another way in which genetics might affect changes in weight. Researchers from Children’s Hospital in Boston reported that differences in how young adults secrete the hormone insulin determine how well they respond to various dietary interventions.

So maybe it is time for health professionals to stop reflexively assuming that personal sacrifice will lead to weight loss. But this will not be easy.

For one thing, there certainly are success stories of people who have dropped dozens of pounds by drastically altering their lifestyles. Moreover, watching one’s diet can have beneficial health effects beyond losing weight.

And I just cannot conceive of a session with an overweight patient that does not involve a discussion of being careful at holiday meals, controlling portion size, avoiding bedtime snacks and trying to exercise three times a week. Somehow it still seems to me that part of a doctor’s job is to push patients to try harder. Just call me old-fashioned.

Barron H. Lerner teaches medicine and public health at Columbia University Medical Center.

I think this forum proves that habits, or will power, are equally as important as what we eat; the occasional holiday splurge isn't nearly as important as what you do on a daily basis and exercising 3x/wk is just the beginning.

[brotherjohn]

Thanks for sharing the great article. It really goes to show how the American mindset is firmly entrenched that obesity is caused by everything outside of willpower and that it can be solved without willpower.

Several years ago we went on vacation to St. Louis. We went to watch the Cardinals play the Cubs, and Mark McGuire and Sammy Sosa both hit a home run in the game, if I remember correctly. My sons were little boys at the time, and they don't remember anything about the game. The only thing they remember is that "Jared" (the Subway weight-loss guy) was there and was introduced on the field!

I run into so many people who believe that Subway sandwiches will help a person lose weight. I guess I believed that, too, until I got turned on to nos. But, I see now that there is nothing intrinsically magic in a Subway sandwich. Jared drank coffee for breakfast, ate a 6 inch sub with chips and a diet drink for lunch, and a 12 inch veggie sub and a diet drink for supper.

Basically, he was eating no-sweets, no-snacks, no-seconds, no-s-days...and only two meals a day!

I would love to see how it would have turned out if he ate the plan that we are eating!

[reinhard]

What I love is how that back in the benighted days of "willpower" and other such nonsense when the author was growing up, people were thin, whereas now, with our superior scientific mindset, we are fat.

Reinhard

[kccc]

Actually, I DO think the environment is more important than we give credit for.

Yes, I can exert my willpower to eat healthily. I do. But because of the general environment, it's swimming against the current in most situations. The default, easy choice is generally the not-good one. I have to continuously exert myself to make the right choice.

In the "willpower" days, the environment was also MUCH more supportive. We've discussed that before... you had to walk more, be more active in daily life, food was less plentiful (or at least less omni=present), etc.

It does come down to habits. But your environment can support or undermine the desired habits. (Think about it - how many of us have stopped keeping junk food in the house?)

In terms of public health, making the "default choice" the better one (from a health perspective) will reap a lot of benefits. All of us don't have enough attention to go around... and "willpower" takes a lot. That's why no-s works, it helps us develop habits in place of willpower.

Rambling... but I think willpower (or habit) and environment aren't either/or choices.

[reinhard]

KCCC,

You're absolutely right -- all these things do make a difference (I'm not a science basher, my day job is writing bioinformatics software). I just thought it was an amusingly oblivious way to start an article. Plus, of course, however limited, I like to emphasize the role of willpower because that's our role -- we don't (individually) have a whole lot of control over the other stuff, and I don't want to wait around for some tectonic shift in society (which may never come) to get myself thin.

One more little caveat: while I emphasize willpower, I also emphasize it's limits. The idea is that while we have it and need it, we don't have much and need to be smart about how we allocate it. The best way to allocated it is to build habits.

Reinhard

[david]

The "war on obesity" is being turned into a public health fight because that puts money into certain party's pockets. "Willpower" can't be branded and sold over the counter. In any case, public health interventions to fight obesity have been failures, overall.

--david