Letters

Treatment guidelines

I am concerned about APA's plans to write treatment guidelines for obesity ("Treatment guideline development now under way," December Monitor). Since when is obesity, per se, a psychological disorder? Why are we not writing treatment guidelines for eating disorders?

As far as I am aware, the literature (scientific literature in general, not just ours) shows that obese people are no different psychologically than so-called "normal-weight" people except insofar as they have symptoms resulting from their being victims of discrimination. In that case, by the way, no psychological measurement is able to differentiate overweight people from, say, African-Americans who've suffered discrimination.

More importantly, there is also research data to support the theory that weight is generally not a variable that people can control, whereas healthy habits (e.g., good nutrition, active lifestyle) are, and furthermore that it is perfectly possible—and pretty common—for obese people to be healthy via good habits while more slender people (not to mention the too-thin) can and frequently do have lifestyle-related cancers, high cholesterol, high blood sugar, and/or high blood pressure due to poor habits or simply bad genes. So why would we write treatment plans based on weight?

I would refer anyone who wants to know more about this to Linda Bacon's and Lucy Aphramor's article for an excellent review of the issues.

Virginia S. Wood, PsyD
Woodstock, Ga.

APA's response

The Advisory Steering Committee (ASC) considered a wide range of factors in determining the most suitable topics for APA's initial treatment guidelines, including the functional and societal impact of the disorder and the potential for APA guidelines to improve the quality of care and health of those affected. On all criteria, depression and obesity ranked highest. 

The ASC is impressed by the evidence that psychological interventions have a positive impact on a range of health and mental health conditions, as well as by the pressing need for psychologists to work in partnership with other health-care providers to address these public health problems.

However, the existing research evidence on effective treatments for obesity and their health benefits has not been adequately synthesized for widespread dissemination to psychologists. It is precisely because of the divergent viewpoints noted by Dr. Wood that evidence-based treatment guidelines are needed for obesity.

As experts in behavior change, psychologists have been instrumental in developing, testing, and disseminating many of the most effective interventions for obesity. Behavior change is difficult, but treatments that use proven psychological techniques to address nutrition and exercise habits, as well as individual barriers to change, can help people manage their weight and prevent many of the health conditions that accompany obesity. Given the epidemic of obesity in modern society, targeting this area with guidelines to promote effective long-term behavior change is important and timely.

For more information on APA's work developing treatment guidelines, please visit APA Clinical Treatment Guidelines Development.

Steven D. Hollon, PhD
Chair, Advisory Steering Committee

Exercise and mental health

The December article "The exercise effect," was decent, but I found it somewhat lacking. The implication in my reading is that there hasn't been much research, while research goes back to the 1960s.

When tested against antidepressants, there are a number of studies showing exercise was just as effective, and some studies showing it has more lasting benefits. Another omission was not mentioning John Ratey's book published last year, "Spark: The Revolutionary New Science of Exercise and the Brain," which documents studies in different chapters for depression, anxiety, addiction, ADHD and stress. I highly recommend this book for anyone interested in this topic.

I also give testimony that running/walking—"rulking"—is greatly benefitting me while a family member is experiencing major psychiatric issues.

Mike Miller, PhD
North Olmsted, Ohio


Please send letters to Sara Martin, Monitor  Editor. Letters should be no more than 250 words and may be edited for space and clarity.