design of the Diabetes Prevention Program, says Wing, many of
the program’s investigators argued that diet and exercise training
was a waste of time, since people have so much trouble losing
weight and keeping it off. But Wing fought for it, arguing that
behavior contributes to obesity — and that behavior change can
lead to successful weight loss and, she hoped, prevent diabetes.
Her critics were wrong. “The main study was actually stopped
early because the results were so dramatic,” Wing says. The diet
and exercise program was almost twice as effective as drug-treatment intervention, reducing the risk of developing diabetes
by a remarkable 58 percent (New England Journal of Medicine,
2002). “It was effective in all age groups, all ethnic groups, both
genders and in all BMI [body-mass index] categories,” she says.
Several factors contributed to the program’s success, Wing
says. For one, the program was more intensive than other
approaches, requiring patients to meet with coaches frequently
over the course of the study. The program also benefited from
a vast knowledge base, Wing says. She and her colleagues drew
on decades of behavioral weight-loss research to design a
curriculum backed by solid evidence.
The Diabetes Prevention Program is now being offered in
medical centers and YMCAs throughout the country, Wing
says. Following that success, she’s now working on a similar
project testing whether an intensive behavioral intervention can
decrease the risk of heart disease and heart attacks in people
with Type- 2 diabetes.
Wing is proud of the Diabetes Prevention Program’s success
and encouraged by the results. Treating obesity may require
intensive interventions, she says, but the study is proof that
they can work.
“One thing we’ve shown is that obesity needs to be treated
like a chronic disease,” she adds. “You can’t just teach people in
a couple of sessions and then send them off on their own.”
Taking on the food industry
Like Wing, Brownell knows the difficulty of changing people’s
eating and exercise habits. He began his career researching
treatments for obesity. “It was interesting, but somewhat
discouraging,” he says. He soon shifted his attention from
treatment to prevention. In the decades since, he’s focused on
food policy and public health.
When it comes to food and physical activity, we live in an
increasingly toxic environment, Brownell says. He believes food
manufacturers deserve significant blame. “The food industry
has systematically trained people in the U.S. to eat a diet high
in sugar, fat and salt, and increasingly, has spread this negative
influence to every corner of the world,” he says.
These days we think nothing of eating fast food for breakfast,
snacking between meals and consuming dinner while still in the
car. Our portion perceptions have also changed. Eight-ounce
cans were once the norm, but today we’re accustomed to seeing
soda in 20-ounce bottles — or larger. “The food environment
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