Misunderstanding reward and punishment in obesity and fitness

I frequently run into the contention that enlisting food--typically dessert or other treat foods--as a reward for someone who is trying to lose weight is a terrible idea because it will make the person like food more. The theory here, apparently, is that we learn to associate whatever is used as a reward with good feelings, and so it becomes more desirable. The same supposedly goes for punishment, in the opposite direction: We end up developing a strong distaste for what is used to punish us. One fitness expert I've been following on Twitter, and for whom I have tremendous respect, has been arguing lately that when gym teachers punish children for not following directions by making them, say, run laps, the kids end up being "programmed" to hate exercise.

Though almost everyone seems to accept this reasoning--apparently the notion just strikes people as intuitively obvious--there's really badly muddled thinking behind it. The basic problem is that this thinking confuses the causes and effects of reward and punishment. In general, you won't at all like something more because it's enlisted as a reward, or dislike it more because it's used as a punishment. Why would you? If your boss decided to reward your excellent performance with the honor of emptying the department trash, would you start to like emptying the trash? I doubt it. If your boss said that every time you fail to meet your annual objectives he was going to punish you by sending to Hawaii for a week, would you come to hate going to Hawaii? I don't think so. Having something enlisted as a punishment or reward doesn't in general have a big effect on how much you like or dislike it. It's the other way around: something serves as an effective punishment or reward because you already like or dislike it. If you like something that someone tries to use on you as a punishment, then it won't be a punishment, essentially by definition. The person may intend to punish you, but he's actually rewarding you. The same holds for trying to reward you with something you hate--you won't end up liking it, you'll just find it very unrewarding.

An effective reward or punishment changes how you feel about the behavior being rewarded or punished, not how you feel about the reward or punishment itself. If your boss sends you to Hawaii to reward your excellent performance, you might well feel much more motivated to perform your job well. But it won't cause you to like going to Hawaii, you already liked going to Hawaii, which is why your boss was clever to chose it as a reward. If she chooses to reward you with the job of emptying the trash, you won't be programmed into disliking emptying the trash, you already disliked it, which is why it was a really dumb choice of reward, and will not likely inspire you to work harder. The same goes for using food as a reward or running laps as a punishment. You like the food treat, so you'll work harder to get it as a reward--but it won't cause you to like the food more, you already liked it. If a kid likes running laps, then the coach is being foolish to make the kid run laps as a punishment--it won't be a punishment at all, and won't make the kid dislike running laps. If a kid already dislikes running laps, then the coach is indeed effectively punishing the kid by making her run laps--but it won't be programming the kid to hate running laps, the kid already didn't like running laps.

Now, there can be complicating circumstances that blur the picture a bit. For example, someone can turn something you like into a punishment by making you overdo it. For example, you might like running, but someone could punish you by making you run brutally long distances in the cold and rain, and that might indeed change your feelings about running. But you didn't like running brutally long distances in the cold and rain in the first place, so it's not really the same thing as being made to dislike something you liked. Also, having someone want to punish you might fill you with guilt, shame or even self-loathing, and those feelings might be intense enough to end up tainting your feelings about whatever it is that is nominally enlisted as punishment, even if it were something you liked--so in that sense, you can end up being made to dislike what's being used to punish you. But if you're feeling guilt, shame or self-loathing over your behavior, then that's the real punishment--it's an internal, self-inflicted one--and the imposed external "punishment" is really just something superfluous that you're being accidentally conditioned to associate with those feelings. (To get a bit technical, it's more Pavlovian reflexive conditioning than Skinnerian punishment, which is really a different animal. You'll know what I mean if you're familiar with the 1971 Stanley Kubrick film A Clockwork Orange, based on the novel by Anthony Burgess, where Beethoven's music becomes accidentally associated with the feelings of nausea and dread forced on the protagonist when he's exposed to violence.) And of course all this works the same way for reward, in the opposite direction. But this sort of accidental conditioning with superfluous reward and punishment isn't likely to happen in most food-treat and lap-running situations, or in most everyday situations. If you feel that badly about having done something you shouldn't have, you're probably just not going to do it very often, so no one will feel a need to tack on a misguided "punishment." If you feel great after you do a certain thing, you're probably going to do it on your own, without requiring a food treat.

Actually, food is a great reward in a weight-loss or fitness program. Behavioral experts who have studied fitness and/or obesity--in other words, real experts on reward and punishment, and who by the way tend to be in great shape themselves--routinely use food as a reward. One researcher told me about an obese, previously sedentary child who is now losing weight in part through daily walking. How did the parents get the child to take up walking? By allowing him to pick out a small, favorite food treat at the store--as long as the child walks there and back with the father. One of the top obesity-focused behavioral researchers in the country told me he rewards himself with a mango smoothie after a run, and that he finds himself thinking about that smoothie when he's about halfway through the run, which helps pull him along--and he helps others keep to their exercise plans with a similar use of food treats. I always reward myself for completing a workout with a small sundae-like treat, and absolutely find it helps get me through the last few sets of crunches or pull-ups or whatever.

Now I do happen to think conventional PE classes (where they haven't been lost to budget cuts) are a potential nightmare to lifetime fitness, and do indeed cause some kids to dislike participating in exercise. But that's not because exercise is routinely used as punishment in these classes. The exercise is usually meant to be fun and to make kids feel good, because the gym teacher herself probably always enjoyed and felt great about participating in sports and exercise. But the grueling training for fitness tests, the intensely competitive ball sports, the difficult gymnastics, the exhausting wrestling matches--this is all stuff that many kids don't like doing, so these kids are unintentionally being punished for participating. Even kids who do like this stuff aren't likely to keep it up much beyond high school. Instead, I think PE classes should emphasize establishing moderate, comfortable, enjoyable exercise as a daily lifetime habit, with the more intense, athletic, competitive stuff perhaps offered as an additional option for those who truly enjoy it. Taking it easy on kids in PE class wouldn't be promoting athletics as strongly, but we're not much of a nation of adult athletes anyway. Better off settling just to get us to not be sedentary as adults. If America were by and large a nation of walkers--or bikers, joggers, casual weightlifters, dancers, or any kind of physical-activity-doers--I firmly believe, as do many experts, that we wouldn't have an obesity crisis, and we'd be far, far healthier on average.

5 reasons why the discovery of the Fat Gene won't help you lose an ounce (and might cause you to gain weight!)

The headline: "Discovery of 'fat gene' raises hopes for fighting obesity"

The five reasons:

1) Mice! The study was conducted on mice, and most research on mice doesn't end up translating to humans.

2) Genetically engineered mice! The study was conducted on mice whose genes had been tinkered with, and findings from these studies are often even shakier, because no one really knows what these animals are. They're usually tinkered with in a way that's supposed to make their disorder more like a human disorder, but these imitation disorders rarely turn out to be good stand-ins for the real thing. And the resulting mice aren't exactly normal mice anymore, or at least breeds of mice that anyone is familiar with. So you just don't know exactly what to conclude from studies based on these critters. Very few practical treatments have come from studying these "transgenic" mice. (Which is not to say they aren't marvelous contributors to basic science, and we should all be big supporters of basic science. But basic science, by definition, won't do anything for you--not until someone figures out how to turn it into applied science.)

3) You're stuck with your genes. Even if the Fat Gene discovery translates to humans, what are we going to do with the knowledge that you have this gene? If you do have it, then presumably you're fat, but you probably knew that already, didn't you? There's gene therapy, in which you're injected with a virus carrying a gene that the virus can insert into your cells to replace the trouble-making gene. But gene therapy ran into some ugly problems in the early days just over a decade ago, and though more recent results have been encouraging, I haven't heard anyone in a position to know claim any gene therapy is likely to be widely available, or available for non-life-threatening conditions, any time soon, it's just considered too risky. The discovery of the Fat Gene might in theory lead to better diet and exercise advice based on knowing you had the gene, but that's unlikely--everything has been tried, diet-and-exercise-wise, we know what works and what doesn't, and it tends not to differ in major ways from person to person, regardless of genes. On the other hand, if a certain gene, or an overactive copy of a gene, were identified by itself as truly the major cause of being overweight, the goal would be to develop a drug that counteracts the effect of the gene. (Or if it's the absence or non-functioning of a gene causing the trouble, a drug that would work in its place.) In other words, discovery of the Fat Gene will lead to the Fat Pill! Except that...

4) ...Gene discoveries don't end up leading to good new drugs. Not so far, anyway, in spite of a few decades of trying. The problem, as many leading molecular biologists, including some who actually work for pharmaceutical companies, have told me, is that individual genes rarely cause problems by themselves, they usually work as a part of a network of hundreds of genes that work together to cause the problem. So taking a pill that counteracts the effect of the one gene wouldn't solve the problem. Even if the gene did mostly cause the problem on its own, any drug you take to try to counteract what the gene is doing would almost certainly end up interfering with the work of other genes, and with other functions that one gene is performing. In other words: side effects. That's why most drugs don't do much good for most people, and end up doing harm to some people. That's true even of drugs that make it to the market, and even of drugs that become best-sellers, let alone the thousands of experimental drugs that get washed out along the way.

5) Big gene discoveries rarely hold up. Just wait. In a couple of months, you'll see studies that show this gene doesn't seem to be a big deal after all. If you look for the studies, that is. The discovery that a previous discovery wasn't the big deal it was made out to be rarely makes headlines. Everyone either just forgets about the original big discovery, or mistakenly thinks it's still considered a big discovery. But you'll be ahead of the game, because now you know right off the bat why it's probably wrong to think of the Fat Gene as a big discovery. Although...

6) ...Maybe it really is the Fat Gene. Hey, sooner or later scientists will actually be right about one of these things. And I will have been wrong. It could be this time! Let's hope so. But in the meantime, please don't ease up on your commitment to staying healthy by eating sensibly and getting regular, enjoyable exercise in. If you do slip back to your old, unhealthy ways because you think science is going to save your butt, then all the discovery of the Fat Gene will probably have done is make you fat.

Scary cig pix are old hat elsewhere. Fried chicken next?

It's great that the FDA is trying to get gruesome, graphic, smoking-harm-related images on cigarette packaging. It's also about time, considering some other countries have been doing it for a while. I took this picture a few months ago about 60 feet outside of the US at the Canadian border crossing next to Vermont. This is a classic behavioral technique: Tweaking the environment to prompt desired behaviors, or discourage undesired behaviors. Let's get this done for cigarettes, and then move on to junk food. My whole interest in behavioral approaches to obesity was first prompted by a cancer researcher in the UK who told me he thought cans of Coca-Cola should be treated like packs of cigarettes. Enjoy!

What four new studies hint about fixing obesity

Four recent obesity-related studies have come out in the past few days that are worth taking a slightly closer look at. One reported that overweight people who have successfully taken and kept off weight tend to stick to structured exercise programs. Another found that male rats made obese and diabetic via high-fat diets tended to have diabetic female offspring, while male rats given normal diets did not--and since there was no general difference between the genes in the two groups, and because the mother rats in both groups were non-obese and non-diabetic and so couldn't have passed along anything different in utero, the explanation lies somewhere in environmental differences relating to the dad rats' different diets. (Yes, rodent studies usually don't translate well to humans, and this might well fail to translate, too, but for what it's worth it was an unusually simple and clean study, no genetic engineering or exotic behavioral manipulation or psychological interpretation involved.)

A third study found that people who live in areas where the Mediterranean diet (lots of "good" fat, lean protein, grains, vegetables and fruit, little saturated fat) is prevalent tend to keep weight off as they get older better than people in other areas--but (hallelujah!) the researchers and even (at least in this particular Reuters article) the reporter prominently note that it may well be behavioral and other environmental issues common to people who live on this diet that does the trick rather than the diet itself. The last study predicts US obesity rates have not peaked at about a third as other experts have claimed, and will continue to rise to hit 42 percent--and add that part of the problem is that hanging around with obese people tends to make it more likely that a person will herself become obese, so that the higher the obesity rate goes the more it increases the chance that it will rise further (up to a certain point).

I find all of these studies interesting in their own right, but the main reason I mention them is that all four highlight behavioral and environmental issues as being key to obesity rather than--or at least in addition to--the choice-of-food-types and the genetic issues that are often emphasized in studies. I hope I'm seeing a trend here. We can't get rolling on solving the obesity problem until we stop fixating on poorly understood physiological processes and on molecular biological factors that we can't do anything about, and start focusing on behavioral and environmental changes that we can start working on today. That's what got us into this fix, and that's what will get us out.

Is it all about the calories?

Does which foods you eat matter in weight loss?  I don't think any aspect of obesity and weight loss is more confusing, or more responsible for people's muddled thinking and poor choices in approaches to taking and keeping weight off.  Most of the answers we're given to this question fall roughly into what seem like two sharply contrasting camps.  The "it's all about the calories" camp (be warned, this link brings to you a nasty little article) suggests it doesn't really matter what you eat, you just need to eat small-enough amounts of it to not exceed the calories you're burning.  The "eat healthier foods" camp suggests that you will lose weight if you emphasize certain foods over others--some push fruits and vegetables, others "less-processed" foods, others less-calorie-dense foods, others low carbs, others low fat, and so forth.

Here's my take on it. (I've been interviewing many, many respected experts in the obesity field and reading quite a lot of studies and articles, so I'm not entirely shooting from the hip here, or at least not more than anyone else. Consider this a synthesis of what I've been finding out.)  The bottom line is that both camps are sort of right, but they're both a little misleading, too. It's true, you can lose weight eating anything if you keep portions small enough, and you can gain wait eating only vegetables if you eat enough of them. But most people are indeed more likely to keep the weight off if they lose it by emphasizing certain types of foods. That's because some foods more than others tend to push the various physiological and perhaps psychological buttons that will make it harder for you to keep control of your calorie intake. In the end, you'll still have to take in fewer calories than you're burning--but most people will find it easier to do that with some menus than with others.

So which foods should the would-be weight loser emphasize? There's a certain amount of disagreement on this question, to be sure, but a rough consensus of evidence and expert opinion favors cutting down significantly on sugar and refined carbs (like non-whole-wheat bread and pasta), taking it easy on fats (especially saturated fat, for other health reasons), eating good amounts of relatively lean protein (especially fish, chicken, and soy, prepared without much oil or butter, but beans, wheat gluten, egg whites, whey and pork can be good sources of lean protein, too), and eating lots of vegetables and reasonable amounts of fruit and other foods high in fiber.  Most experts don't advocate ultra-low-carb diets (or even counsel cutting down much on complex carbs like whole-wheat foods), and most don't think an ultra-low-fat diet is worth the trouble.  There are three main weight-control benefits to these recommended foods: They tend to be less calorie-dense, so they feel more filling per calorie and it's easier to meter how many calories you're taking in compared to a small, dense calorie-bomb like a piece of candy or fried chicken; they're less intensely stimulating to your pleasure systems, so you'll be less likely to feel compelled to pig out on them; and they tend to enter the bloodstream at reasonable rates, avoiding the blood-sugar spike-and-plummet effect you get from eating simple carbs that can lead to intense appetite swings.

Now having said all this, I'd like to point out that while eating "healthier" foods is a helpful and for most people important element of keeping weight off, I don't think it's necessarily the most important element, and it's absolutely not the only element, as is often implied by some weight-loss gurus.  Most people will not be able to keep much if any weight off just by trying to take in more healthy food, if everything else they do and everything else that's going on around them otherwise remains the same. For most people keeping weight off requires a full-court press via a "behavioral" approach, something I'll be talking a lot about here and elsewhere. Part of that approach also involves finding out which healthier foods work best for you in terms of being as satisfying as possible without pushing your appetite and cravings buttons. And it also involves being smart about the way you introduce these foods into your daily menu and make enjoyable habits out of eating them, and about how you regulate your intake of these healthier foods as well as of those less-healthy foods you may also want to take in in order to have a satisfying diet.

Does all this seem like a lot of work to figure out, put into action and maintain? Well, it can be, but if you get good guidance it shouldn't be all that hard. Even if it is a lot of work, the benefits people get out of losing excess weight in terms of their health and how they feel almost always seem worth the trouble. And if you do the behavioral approach right, losing and keeping off weight--especially if you lose it slowly, and try don't lose a large percentage of your body weight--need never be hugely demanding or uncomfortable, and in fact ought to be highly satisfying and in many ways enjoyable.