Suchen und Finden
Preface
6
The Book’s Outline
7
The Story of the Book
8
Acknowledgments
9
Contents
11
Part 1: Mismanaging the Obesity Threat
17
Like Boiled Frogs
18
How the Problem Sneaked Up on Us
18
The Temperature Is Rising
20
The Heavy Burden of Obesity
22
For Older Americans, The Future Is Now
24
The Sociocultural Burden
25
‘‘Globesity’’
26
A Bucket Half-Empty?
27
The Leverage (or the Impediment) Is with the People
28
It Is Not Easy Becoming a Top Gun
29
States In Mind
31
Emotions Play a Role
35
Failure to Learn from Failure
37
Single-Loop vs. Double-Loop Learning
37
Barriers to Learning
42
What Is to Be Done?
43
Metanoia
43
Synthesis, Not Analysis
43
What Is Feedback?
47
Circles, Not Straight Lines
47
Dynamic, Not Static
51
Obliterating, Not Automating
53
Notes
55
Part 2: How We Changed Our Environment, and Now Our Environment Is Changing Us
65
Unbalanced Act
66
‘‘For every complex problem there is an [explanation] that is simple, direct, and hellip wrong.’’
67
Moving Beyond Individual-Centric Explanations
69
‘‘Civilization is but a filmy fringe on the history of man.’’
69
Evolved Asymmetry of Our Physiology
72
How Asymmetry Is Achieved by Our Physiology
73
Asymmetry in Energy Intake
73
Asymmetry in Energy Expenditure
77
Asymmetry in Energy Storage
78
Conclusion
80
Human-Environment Interactions: Not One Way hellip and Not One-Way
81
Human Behavior Is Not Expressed in a Vacuum
83
It Is Not Just Physical
84
We shape our environment, and then our environment shapes us.
86
A Symphony Out of Tune?
87
Tilting the Energy Balance: More Energy In
88
The Quantity of Food We Eat
89
The Causes Behind the Cause
91
How America’s Eating Habits Started to Change
91
The First Mechanism: The Time We Eat
97
Soft Drinks: The Liquid Snack
99
The Second Mechanism: Where We Eat
101
Fast Food: Eat Anywhere, Everywhere
102
The Qualitative Dimension
103
The Quantity Dimension
106
Events Give Birth to Trends, But What Escalates Them Are Self-Reinforcing Processes
111
Demand-Pull
114
Supply-Push
116
Putting It All Together
119
Hurricane Obesa
120
Tilting the Energy Balance: Less Energy Out
121
The Water Is Boiling!
121
Work: Engineering Energy Expenditure Out of the Workplace
123
Moving About: Transport and Urban Design
125
Play and Leisure
128
The Burden Is Cumulative
130
Dr. Jekyll and Mr. Hyde, or Changing the Vicious to Virtuous
131
Individual Differences
134
Some Are ‘‘Squares,’’ and Some Are Not
134
Deciphering the Code, One Gene at a Time
135
Genes and Individual Susceptibility to Weight Gain: The Experimental Findings
137
The Pimas
139
Genetic x Environmental Interactions: Conclusion
141
Is Ad-Lib Behavior Killing Us?
143
A (Mis-)Match Made in America
143
Like Our Genes, Our Mental Models Did Not Change
145
Turning-Off Automatic Control and Asserting Cognitive Control
146
It Can Be Done
148
The Allure of the ‘‘Silver Bullet’’
150
Looking Ahead
152
Notes
153
Part 3: We Can’t Manage What We Don’t Understand
175
The Energy Balance Equation: Reigning Intellectual Paradigm or Straitjacket?
176
The Magic Number
177
From the Experts’ Mouths to the Journalists’ Ears to the Public’s Mind
178
We Like to Believe that We Are in Full Control
180
What We Know that Ain’t So
182
Looking Back Versus Looking Forward
182
The First Trap: Linear Thinking
184
A Plumbing Analogy
187
A Second Trap: Energy as a Single Currency
189
We Need a Better ‘‘Map’’
191
Closing the Loops on Energy Balance: Energy Output Side
192
Tip of a Physiological Iceberg!
192
‘‘Under-the-Surface’’ Determinants of Energy Expenditure
193
The System in Action: ‘‘Under the Surface’’ Responses to Energy Imbalance
198
Implications for Treatment
200
Failure to Account for Individual Differences
200
How an Energy Deficit Is Induced Also Matters
202
Seeing Through the Complexity
203
Revisiting the Bathtub Analogy
204
Learning to ‘‘Squint’’
206
Closing the Loops on Energy Balance: Energy Input Side
209
Body Defenses on the Second Energy Front
209
Two-Tier System: Short-Term and Long-Term
210
Short-Term Component
211
Long-Term Component
212
Two Asymmetries, Not One
214
A Homeostatic System with a Difference
216
Beyond Physiology: Closing the Behavior-Physiology Loop
220
Not Only Do We Eat Food, We Also Think About It
220
Which Requires More Effort: To Do or Not to Do?
221
Strength (and Weakness) Model of Human Self-Regulation
222
A First Course in Managing Stocks and Flows
224
The Evidence: To Use It Is to Lose It, at Least Temporarily
226
A Challenge for the Self: How to Accomplish a Lot with a Little
227
Why Goals Matter, and How More May Be Less
229
Weight Cycling: Not Once, Not Twice
235
Understanding How Cycles Happen
236
Longer-Term Risks
240
Less Is More
241
Looking Back and Looking Forward
243
Looking Back
243
Understanding Is a First Step, But Far from Sufficient
244
Looking Forward
247
Notes
249
Part 4: We Can’t Manage What We Mis-Predict
266
Learning by Doing
267
How Hard Can It Be?
268
Trying Your Hand at Predicting Dynamics
269
The Bathtub Exercise
270
The Answer
272
What Do These Results Tell Us?
273
Beyond Bathtubs
276
‘‘Give Us the Tools, and We Will Finish the Job’’
278
Sources of Complexity in Systems
278
The KISS Acronym: ‘‘Keep It Simple, Stupid’’
280
Argument for a Calculus
282
Leveraging Computer Technology
283
A Microworld for Weight and Energy Regulation
284
Telescopes for the Mind
284
Simulation Models Are Operational Models
285
Overview of Model Structure
288
Energy Intake (EI) Subsystem
290
Energy Expenditure (EE) Subsystem
291
Energy Metabolism and Regulation Subsystem
292
Glucose and Free Fatty Acid Metabolism
293
Protein/Amino Acid Metabolism
297
Exercise Metabolism
298
Body Composition Subsystem
299
Fat Mass (FM)
300
Fat-Free Mass (FFM)
302
Taking Off
302
Experiment 1: Assessing Weight Loss-Reality Versus Fiction
304
The Experiment
306
Experimental Results
307
Looking Inside a White Box
309
It Is Not Academic
311
Experiment 2: Going Ballistic-On a Diet
312
Chasing a Moving Target
312
The Experiment
313
It Is No Passive Tool
315
Experiment 3: Understanding Why 250 Pounds Does Not Equal 250 Pounds
317
Individual Differences: More than Meets the Eye
317
The Experiment
318
Phase 1: Overfeeding
318
Phase 2: Dieting
320
One Size Does Not Fit All
322
Experiment 4: Trading Treatment Options-Diet Versus Exercise
324
Energy Is Not a Single Currency
324
Diet Versus Exercise: Do 500 kcal = 500 kcal?
325
Trading Exercise Intensity for Exercising Time
329
Manipulating Diet Composition
331
Don’t Trade hellip Integrate
333
PhDs for the Masses? (That’s Personal Health Decision support)
334
Notes
336
Part 5: Prevention and Beyond
349
The Fat Lady hellip Models
350
The Third Path: Prevention
354
Can’t Unscramble an Egg
354
The Buck Starts Here
355
Make Healthy Choices the Easy Choices
358
Public Works to Level the Playing Field
359
Energy Input
360
‘‘Thought for Food’’
361
Economic Incentives
362
Energy Output
364
Often Preventable But Rarely Prevented
366
Location, Location, Location: Places to Intervene in Systems
368
Behavior Change Cannot Be Legislated
368
Lessons from Managing America’s Other Energy Problem
369
Leverage Points
374
Leveraging Paradigms hellip and Succeeding
376
Back in the United States: A Challenge and an Opportunity
380
It Will Take More Than Food Pyramids
383
‘‘Educate Them and They Will Change’’
383
Half a Century of Government Education
383
It Is Not Working
385
It Is Deeper Than Just That
387
Information Is Not Enough to Change Mental Models
389
Learning from Experience: A Bad Second Option
394
Lessons from Business: Learning About Risky Stuff Without Experiencing the Risk
396
Transforming Prevention from a Spectator Sport to a Contact Sport
400
‘‘Virtual to Your Health’’
404
Microworlds YAcy Us
405
Child’s Play
407
Learning About Healthy Behavior by Playing, Not by Lecturing
408
Double-Loop Playing
410
(Almost) Never Too Young to Think Systematically
410
At Home, the Real Risk Is in Expecting Too Little
413
Shifting the Burden and Its Risks
414
Keeping the Burden
417
Teaching Children to Fish
418
Balance of Powers and Responsibilities
420
Beyond Prevention
421
Wellness Does Not Mean Only a Lack of Disease
421
Beyond Prevention of Disease
423
Health Potential Programs for People?
425
The Second Flowering
427
Advances in Molecular Biology: The Know-How
429
Computational Modeling of Physiological Processes: The Models
429
Ubiquitous Computing and Intelligent Sensors: The Personal Specs
430
The Internet: The Information Infrastructure
433
Not Automating,hellip Obliterating
433
Notes
437
Subject Index
459
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