Changing routine behavior is painstaking and slow, Frechman says. She asks clients to start by focusing on one small habit. For example, instead of going to the vending machine for candy at 3 o'clock each afternoon, she advises them to go to the office cafeteria and buy fruit.
"It's hard," she says. "I sometimes work with people for years to get them to change one little thing."
Louise Paziak, 54, of Burbank says she had some success losing weight only after she began keeping a food diary. "I would think, 'Well, I'm not eating that much.' But what I found out was that I was nibbling a lot," she says.
She has lost 20 pounds over the last two years through nutritional counseling, strict shopping rules that prohibit snacks and eating only half of what she is served in a restaurant.
"I'm so aware of it now, I notice what other people are eating too," she says with a laugh.
Whether individuals can buck their environment is hotly debated. Some experts think it's just too hard for most people.
"It's not that people can't think about what they're doing. Of course they can," Wood says. "That's one of the things that makes this so complex. If you ask people to limit their diet and eat healthful, everyone can do that for a short amount of time. It's when you have to inhibit a response over a long period of time, that is where we have difficulty. It involves not just a decision to do something new, it also involves inhibiting the old one. If people rely on willpower alone, they are expecting too much of themselves."
It's easier to change the environment than it is to change people, Cohen says. In her paper, she says people need protection from the "toxic environment" and calls on governments, communities and organizations to solve the obesity problem. She advocates downsizing portions, limiting access to ready-to-eat foods and curbing food advertising.
"We've created an environment that has resulted in our being overweight and obese and now we have to create an environment that helps us be healthy," she says.
The antismoking campaign is a good model, Cohen says. Smoking rates have been reduced by restricting where cigarettes can be sold and used, by taxing them and by media campaigns depicting smoking as harmful.
Eckel, the past president of the American Heart Assn., agrees that an out-of-control environment, along with the biological propensity to retain weight, has caused Americans to gain weight. But he doubts change through legislation is necessary.
