This is the 2007 version. Click here for the 2017 chapter 14 table of contents.

Behavioral Medicine

Compared to psychosomatic medicine, behavioral medicine is a relative newcomer to science. Its birth was signaled by a 1977 conference at Yale where participants defined the field. They laid plans for a new journal, and soon articles and books on behavior medicine appeared. Behavioral medicine research centers appeared at major medical centers, an Academy of Behavioral Medicine Research was founded, and there appeared a new Behavioral Medicine branch of the National Heart, Lung, and Blood Institute.

When did behavioral medicine start as a distinct discipline?

Behavioral medicine combines the behaviorist's embrace of measurable events and activities with the concerns of a medical doctor. A specialist in behavioral medicine would be unlikely to study personality or mood effects on health but might study how frequently people comply with doctor's instructions, or whether a training program can increase the accuracy with which people monitor blood glucose levels.

What is emphasized in a behavioral approach to obesity?

A good example of the behavioral approach to a medical problem is contained in the book Slim Chance in a Fat World (Stuart and Davis, 1972). Subtitled, "Behavioral Control of Obesity," this book was decades ahead of its time, because it came out well before the present obesity epidemic, yet it contains advice that is perfectly up to date. The focus is entirely upon measuring and changing the behavior of eating, with special attention to situationalcues: triggers of eating in the surrounding environment. The authors also provide necessary background information about the dieter's need for social and emotional support, benefits of exercise, the need to stay on the program, and the pros and cons of various food types. Throughout there is also a strong, bottom-line emphasis on counting calories. Charts for doing this are included with the book. Simple, practical tips are offered to make life easier for a dieter. For example:

—Always keep on hand a variety of safe foods to use as snacks. ["Safe" foods have almost no calories.]

—Once you establish how many calories per day you should eat, keep track of how much you have eaten and how much more you can eat within your diet at all times, every day

Of course, there is reinforcement:

—Build in some payoff for following every step in this program.

If this program works, why don't you hear more about it?

The program is very simple and direct and to-the-point, and it works. It has been tested on a variety of populations, and because it focuses on measuring calories, there is not much doubt about why it works. However, there is not much money to be made promoting a program that can be fully explained in a tiny little book, 4x5 inches in format and only 90 pages long, so you don't hear much about the behavioral approach to obesity, compared to more elaborate and indirect approaches.

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