Molding the Social Environment

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We have seen that cognitive behavioral therapy comes in several flavors and that it can be quite successful in promoting behavioral change by breaking negative behavior cycles and restructuring harmful patterns. Appetitive traits are vulnerabilities linked to eating behavior, and these vulnerabilities can slow progress or cancel it out altogether.

One problem can be a person’s impaired responsiveness to internal satiety signals — the signals that say “You have been fed, now stop eating.” Another appetitive trait is extreme responsiveness to external food cues. When the ice cream truck drives slowly by with its tinkly music, she or he gets up and starts fishing in the pockets for change. Pair up extreme responsiveness to external food cues with extreme impulsivity, and you’ve got a person whose arm does not need to be twisted one little bit.

“High motivation to eat” is a tough one, the grand-daddy of all appetitive traits. Possibly the only thing that can replace it is an even higher motivation toward something else. Here’s the problem with helping a person switch to a higher motivation track: the satisfaction of eating is a known quantity, a dependable reward, and a proven consolation for the pains of life. A 6-year-old knows what he likes. Even with a known commodity, delayed gratification is a difficult concept to master.

One marshmallow now seems like a much better deal than two marshmallows tomorrow. When he has never experienced the joy of winning a basketball game or dating a prom queen, change is a very, very hard sell. The idea that he should quit drinking soda pop for the sake of some incomprehensible far-future goal is just ludicrous. And even when people, children or adults, do the work and make changes, backsliding and recidivism are right around the corner. Far too often, change doesn’t last.

We are told that appetitive traits arise from both genetic and environmental influences, and that the environment includes both the built environment and the social environment — in other words, the world. Negative influences are everywhere, in the family, among a child’s peers, at school, in the media, and in the larger community. Fortunately, some health care professionals possess a skill set whose purpose is to change the social environment.

One such person is Denise Wilfley, Ph.D., a professor of psychiatry, medicine, pediatrics, and psychology at Washington University in St. Louis. Wilfley knows that elements of the built environment “may determine which families particularly need weight loss maintenance treatment and how much of it.” She headed a team consisting of basic and behavioral scientists, urban design experts, and public health professionals to determine what should follow a four-month, family-based behavioral weight loss treatment.

Working with kids in the 7- to 11-year range, they evaluated the built environment to objectively assess environmental factors and determine the most effective ways to help children stay on track. They came up with an eight-month program called social facilitation maintenance, or SFM. Journalist Erin Fults writes:

The goal of the SFM intervention is to make the healthy choice the easy choice by building social support and routines for healthy behaviors across the home, peer, and community environments…. Such a change for a child requires that family members are also on board.

Next: More about enforcing long-term weight loss.

Your responses and feedback are welcome!

Source: “Dr. Denise Wilfley: Successful Interventions for Curbing Pediatric Obesity,”, 11/23/11
Image by James Emery

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