to greater weight loss than similar programs that focus on
kids alone (Health Psychology, 1994).
According to Wilfley, the trick is to help parents engineer
healthy home environments — removing TVs from
bedrooms, limiting computer time, making physical activity
a routine for the entire family, and teaching parents how to
find and prepare nutritious foods on a budget. “There’s a lot
of room for making healthy fruits and vegetables a default
choice, but it takes a lot of conscious decision-making and
going out of your way,” she says.
Simply teaching people the healthy basics isn’t enough.
“It’s unrealistic to feel we can have people completely
change habits and behaviors with just education alone,”
Wilfley says. Behavioral interventions lasting up to a year are
necessary to help most families implement changes that will
last in the long run.
She’s developed a program to help kids and families keep
weight off after they’ve done the hard work of losing it. Her
intervention, which she calls social facilitation maintenance
treatment, helps build social support and routines for
healthy behaviors by extending the intervention across the
home, peer and community environments (Journal of the
American Medical Association, 2007).
Early interventions are also key. A variety of studies have
shown that overweight babies are more likely to become
overweight kids, and overweight kids are more likely to
become overweight and obese adults. Among low-income
families, one in seven children is already obese by the time
he or she enters preschool. “If we’re going to get our arms
around this, we should start early,” Black says.
Helping families is well and good, but a one-by-one
approach presents an obvious challenge in reaching all 12. 5
million American children and adolescents who are obese.
Schools — where most kids spend most of their days — are
Schools can make sweeping changes and reach huge
numbers of young people with relative ease, says Gary
Foster, PhD, who directs the Center for Obesity Research and
Education at Temple University. “Clinic-based approaches
are incredibly important, but from a public-health
perspective, it’s easier to work with 3,000 individual families.
You can make structural changes in a school just because the
principal said so,” he says.
Kids consume 35 percent to 50 percent of their total
calories at school, according to Jamie Chriqui, PhD, a senior
research scientist at the University of Illinois at Chicago’s
Institute for Health Research and Policy, who presented her
findings on school foods at APA’s 2012 Annual Convention
in August. Many of those calories come from so-called
“competitive foods” — vending machines, school stores and à
la carte cafeteria offerings that typically include cookies, candy
When it comes to preventing and managing
diabetes (and the obesity that often goes along
with it), most of the hard work is in the patient’s
“Very little of what happens in managing
these conditions happens in the clinical office.
Most of it happens out there in the patients’
day-to-day lives,” says Gareth Dutton, PhD, an
associate professor of preventive medicine at the
University of Alabama at Birmingham and APA’s
representative to the National Diabetes Education
Program (NDEP). “APA has such an important
role to play at the table. We have expertise in
helping individuals navigate the challenges of
That’s why APA has joined forces with NDEP,
a federally funded program sponsored by the
National Institutes of Health and the Centers for
Disease Control and Prevention. The program,
established in 1997, includes more than 200
partners working together to provide prevention
and treatment resources and materials to
diabetes patients and health-care providers.
Researchers have a long way to go in
deciphering where best to help patients (in
schools, libraries, other community settings?) and
who can best deliver the programs (community
health workers, lay professionals, peer support
networks?). But two things are clear to Dutton
and his colleagues at NDEP: “One, the patient
and his or her family have to be at the center of
the team,” he says. “Ninety-nine percent of the
work must be done by the patient.”
Two, he says, experts are increasingly realizing
the importance of patient-centered outcomes.
Physicians may fret over a patient’s blood
pressure or blood-glucose level. “But it’s things
like quality of life, emotional well-being, social
relationships, that patients care about on a day-
to-day basis,” he says. “If we can help patients
see improvement in those outcomes, we may see
better outcomes overall.”
Driving down rates of diabetes will
undoubtedly be difficult, but things are moving
in the right direction, says Dutton. “There’s a
long way to go and multiple pieces that have to
fall into place, but we’re starting to get a better
recognition of what we have to do and how to