Cover Story

The obesity crisis, like our nation's waistlines, is big and getting bigger. Obesity rates have soared over the last two decades: One-third of adults in the United States and 17 percent of children are now obese, according to the Centers for Disease Control and Prevention.

"Obesity is the No. 1 health challenge facing our country right now," says APA President Suzanne Bennett Johnson.

For that reason, she chose to honor two psychologists who have devoted their careers to fighting obesity: Kelly D. Brownell, PhD, director of Yale University's Rudd Center for Food Policy and Obesity, and Rena Wing, PhD, professor of psychiatry and behavior at Brown University, and director of the Weight Control and Diabetes Research Center at the Miriam Hospital in Providence, R.I.

"Brownell and Wing have each contributed greatly in different ways," says Johnson, one on the individual patient level and the other on the public policy level. They will receive the APA Award for Outstanding Lifetime Contribution to Psychology and give a keynote address at the opening ceremonies of the APA Annual Convention, Aug. 2–5, in Orlando, Fla.

Proving people can change

Wing has spent her career helping her patients overcome obesity. She's widely known for developing behavioral treatments for obesity and efforts to prevent the onset of Type-2 diabetes. 

Perhaps her most important contribution to the field has been acting as principal investigator of the Lifestyle Resource Core of the Diabetes Prevention Program, a major research study conducted at 27 clinical centers across the nation. From 1996 to 1999, Wing and her colleagues recruited more than 3,000 people with impaired glucose tolerance, a condition that put them at high risk of developing diabetes. The investigators randomly assigned participants to one of three groups: One received the diabetes drug metformin plus minimal information about diet and exercise, and a second received that same basic information plus a placebo. The third group participated in an intensive lifestyle intervention that Wing developed.

Participants in the lifestyle intervention met one-on-one with coaches 16 times in the first 24 weeks, for lessons on effective diet and exercise strategies. After the initial set of lessons, they continued to meet with counselors at least once every two months for ongoing motivational support. During the initial 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 has changed dramatically, mainly in unhealthy ways," he says, "and we are paying a predictable price."

Through his work with the Rudd Center, Brownell fights for policies that limit food companies' reach and improve nutrition for children and adults, by regulating marketing, for example. "The food industry has become ever more effective at marketing its unhealthy products, especially to children," he says.

The average U.S. child sees about 5,500 food commercials a year, according to Rudd Center statistics. The vast majority of those are for snacks and beverages filled with sugar, salt and fat. Brownell's work has raised awareness of the problem, boosting support for efforts that reduce food marketing's pull. In a recent study, for instance, Brownell and colleagues found that kids eat more unhealthy snacks and fewer fruits and vegetables after playing "adver-games" featured on food company websites (Children and Media, 2012).

The Rudd Center has also spearheaded the push for a tax on sugar-sweetened beverages to limit soda consumption. Several countries outside the United States have passed such taxes, and Brownell believes many communities and states are close to enacting soda taxes of their own. In a 2011 analysis, he and his colleagues estimated that a penny-per-ounce tax on sugar-sweetened drinks could reduce consumption by 24 percent, effectively cutting 45 to 50 calories per day from a soda drinker's diet (Preventive Medicine, 2011).

Brownell believes policies must change to curb the obesity epidemic. "Individual behavior change can be difficult when personal responsibility is overwhelmed by the environment," he says. He is encouraged by two recent pieces of legislation. The 2010 health-care reform legislation includes a mandate that chain restaurants must post calorie content on restaurant menus and menu boards. That same year, President Obama signed the Healthy, Hunger-Free Kids Act, which improves nutrition standards for any food sold in schools, whether in the lunch line or the vending machine. "We've been involved in these [initiatives], so it feels good to see that change is occurring," Brownell says.

Positive change

The picture of obesity in the United States has changed considerably since Brownell and Wing launched their careers. "In those years, there's been an explosion of obesity," Wing says. More people are overweight and obese today than ever before, and the average BMI of people enrolling in weight-loss programs has also increased, she says.

Yet our understanding of obesity has also come a long way. When Wing began her research in the 1970s, she says, "many people believed that obesity was just a cosmetic disease." Today, few would dispute that it's a medical crisis.

After a lifetime of achievement, both Wing and Brownell say work remains to be done. The good news, Brownell says, is that social norms are beginning to change. "The more citizens care about these issues, the more they can be mobilized to create social change," he says.

Interestingly, both give the same answer when asked what they're most proud of: their students and protégés who will carry on this important work in the years and decades to come.

"Both of their perspectives are important," Johnson says of Wing and Brownell. "And we should be very proud that they're both psychologists."

Learn more in Orlando: Both Brownell and Wing will be speaking about their research during the convention's opening session. Convention-goers will earn one continuing-education credit for attending.