My younger brother Dan gradually put on weight over a decade, reaching 230 pounds two years ago, at the age of 50. Given his 5-foot-6 frame, that put him 45 pounds above the U.S. National Institutes of Health’s threshold of obesity. Accompanying this dubious milestone were a diagnosis of type 2 diabetes and multiple indicators of creeping heart disease, all of which left him on a regimen of drugs aimed at lowering his newly significant risks of becoming seriously ill and of dying at an unnecessarily early age.
He’d be in good company: a 2007 study by TheJournal of the American Medical Association found that each year, 160,000 Americans die early for reasons related to obesity, accounting for more than one in 20 deaths. The costs are not just bodily. Other studies have found that a person 70 or more pounds overweight racks up extra lifetime medical costs of as much as $30,000, a figure that varies with race and gender. And we seem to be just warming up: cardiologists who have looked at current childhood obesity rates and other health indicators predict a steep rise in heart disease over the next few decades, while a report from the Organization for Economic Cooperation and Development projected that two-thirds of the populations of some industrialized nations will be obese within 10 years.
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In a live chat with readers, David H. Freedman answers questions about weight loss strategies, teenage pot-smoking, Noam Chomsky, and other topics.
Dan had always been a gregarious, confident, life-of-the-party sort of guy, but as his weight went up, he seemed to be winding down. Then, on a family visit to Washington, D.C., early last year, he and I dropped in on the National Gallery of Art, where 10 minutes of walking left him so sore in one leg that I had to find him a wheelchair. That evening, I decided to say the obvious: He was fast heading to incapacity and an early grave. He had a family to think of. He needed to get into some sort of weight-loss program. “Got any suggestions?” he retorted. As it happened, I did.
Today, my brother weighs 165 pounds—what he weighed at age 23—and his doctor has taken him off all his medications. He has his vigor back, and a brisk three-mile walk is a breeze for him.
Sorry if this sounds like a commercial for a miracle weight-loss program. But in fact my brother did it with plain old diet and exercise, by counting calories and walking. He had no surgery, took no supplements or pills, ate no unusual foods, had no dietary restrictions, embarked on no extreme exercise regimen. He will need to work his whole life to keep the weight off, but he shows every sign of being on the right track. He has changed his eating and exercise habits, and insists he enjoys the new ones more than the old.
In short, Dan seems a lot like many of the people in the National Weight-Control Registry, the research database of those who, despite the popular wisdom that avoiding weight regain is a Herculean task, have kept off a minimum of 30 pounds for at least a year. Most of us know someone who lost weight years ago and has kept it off, and we all see celebrities who claim to have slimmed down for good using plain old diet and exercise, from Bill Clinton to Drew Carey to Jennifer Hudson. But we keep hearing that the vast majority of us—98 percent is a figure that gets thrown about—can’t expect to do the same.
Alcoholics don’t seem to face such dismal prospects, thanks to Alcoholics Anonymous and similar multistep programs, which are widely regarded as effective treatments. With obesity, we’re apparently at a loss for a clear answer. Fads like the Atkins diet slowly fade in popularity after dieters watch the weight return. We’re left with the impression that the techniques needed to permanently lose weight don’t exist, or apply to only a tiny percentage of the population, who must be freaks of willpower or the beneficiaries of exotic genes. Scientists and journalists have lined up in recent years to pronounce the diet-and-exercise regimen a nearly lost cause—a view argued in no fewer than three cover stories and another major article in The New York Times Magazine over the past 10 years, and in a cover story in this magazine two years ago.
All of which is odd, because weight-loss experts have been in fairly strong agreement for some time that a particular type of diet-and-exercise program can produce modest, long-term weight loss for most people. But this program tends to be based in clinics operated by relatively high-priced professionals, and requires a significant time commitment from participants—it would be as if the only way to get treated for alcoholism were to check into the Betty Ford Center. The problem is not that we don’t know of a weight-control approach that works; it’s that what works has historically been expensive and inconvenient.
But now that’s changing. Consider my brother, who has never been to a weight-loss clinic. His program has taken place entirely in his home, at his office, and when he’s out at restaurants or visiting friends and family—and it happens at his convenience, or even automatically, literally without his doing more than lifting a finger.
Early studies of a fast-expanding pool of electronic weight-loss aids suggest that, by allowing people like Dan to construct their own regimen on their phone and computer, these tools could be a key to reversing the obesity epidemic. Applied across the health-care spectrum—to improve senior care, fix sleep problems, and cure addiction, for example—these affordable, accessible tools could radically change the way we conceive of and administer health care, potentially saving the system billions of dollars in the process.
And the basic formula underlying Dan’s weight loss reaches well beyond health. Behavioral technology allows users to gradually and permanently alter all kinds of behavior, from reducing their energy use to controlling their spending. Now, with the help of our iPhones and a few Facebook friends, we can train ourselves to lead healthier, safer, eco-friendlier, more financially secure, and more productive lives.
Ironically, this high-tech behavioral revolution is rooted in the work of a mid-century psychologist once maligned as morally bankrupt, even fascist. But the rise of social media has reoriented our societal paranoias, and more and more people are incorporating his theories into their daily lives. As a result, psychology’s most misunderstood visionary may finally get his due.
In 1965, when Julie Vargas was a student in a graduate psychology class, her professor introduced the topic of B. F. Skinner, the Harvard psychologist who, in the late 1930s, had developed a theory of “operant conditioning.” After the professor explained the evidently distasteful, outmoded process that became more popularly known as behavior modification, Vargas’s classmates began discussing the common knowledge that Skinner had used the harsh techniques on his daughter, leaving her mentally disturbed and institutionalized. Vargas raised her hand and stated that Skinner in fact had had two daughters, and that both were living perfectly normal lives. “I didn’t see any need to embarrass them by mentioning that I was one of those daughters,” she says.
Vargas is a retired education professor who today runs the B. F. Skinner Foundation out of a one-room office in Cambridge, Massachusetts, a block away from Harvard Yard. The foundation’s purpose is largely archival, and Vargas spends three days a week poring over boxes and shelves full of lab notes, correspondence, and publications by her father, who died in 1990. A prim but engaging woman, Vargas can’t seem to help seething a bit about how her father’s work was perceived. She showed me a letter written in 1975 by the then wildly popular and influential pediatrician Benjamin Spock, who had been asked to comment on Skinner’s work for a documentary. “I’m embarrassed to say I haven’t read any of his work,” Spock wrote, “but I know that it’s fascist and manipulative, and therefore I can’t approve of it.”
Skinner’s reputation has hardly improved with time. I shared with Vargas a recent Philadelphia Inquirer article by a science reporter who passed along this assessment of “that famed rat researcher B. F. Skinner” and the behaviorists who followed him: “[They] thought homosexuality was a mental illness that could be cured, usually by giving electric shocks and other painful stimuli to try to create an aversion to homosexual thoughts.”
Vargas could only shake her head. Skinner employed punishment in one early experiment—through a device that delivered a light rap to a rat’s paw—and was so disturbed that he never used it again, arguing passionately and publicly throughout the rest of his life against the use of punishment in school, at home, and in the workplace. And he never had anything to do with trying to change sexual orientation, or any other aspect of identity. Skinner sought to shape only consciously chosen, directly observable behavior, and only with rewards; the entirely un-Skinnerian therapy to which the reporter was alluding is a form of “classical,” or “Pavlovian,” conditioning that trains a subject to reflexively associate a pleasant stimulation with an unpleasant one. The field Skinner founded, known as “behavior analysis,” has overwhelmingly hewed to the example he set in these regards. (And, for the record, “that famed rat researcher” worked, except in his earliest experiments, almost exclusively with pigeons.)
Spock and the Inquirer reporter are typical of Skinner’s critics in their ignorance of his work, yet Skinner’s theory was at its core so simple that it sounds purely commonsensical today: all organisms tend to do what the world around them rewards them for doing. When an organism is in some way prompted to perform a certain behavior, and that behavior is “reinforced”—with a pat on the back, nourishment, comfort, money—the organism is more likely to repeat the behavior. As anyone who has ever taught a dog to sit or a child to say “please” knows, if the cycle of behavior and reinforcement is repeated enough times, the behavior becomes habitual, though it might occasionally need a booster shot of reinforcement.
Skinner himself worked mostly with animals, famously training pigeons to guide missiles by pecking on a video screen placed inside the nose cone. But his followers went on to demonstrate in thousands of human studies that gentle, punishment-free behavior-modification techniques could improve learning, modify destructive habits, and generally help people lead healthier, more satisfying, more productive lives.