Looking to trim out obesity

Adults often advise young people to pick a career with growth potential. Nobody ever set out to be the last medieval armor fabricator, dodo bird veterinarian or dirigible mechanic. But unfortunately, when it comes to eating disorders and obesity research, there’s no danger the field will go extinct any time soon.

In 1976, almost half of all American adults were overweight and about 15 percent had medically significant obesity. Today, the percentage overweight is almost two-thirds, and more than 30 percent of adults are obese. It’s a growing problem in kids, too. While the obesity rate has doubled in adults during the last 30 years, it has tripled in children.

Denise E. Wilfley, Ph.D. (left), discusses research projects with Meghan Sinton, Ph.D., a postdoctoral research scholar. “My program of research indicates that interpersonal factors play a significant role in binge eating disorder among obese people,” Wilfley says. “That’s also true for other eating disorders and with childhood overweight. So if we’re going to develop more effective treatments for eating disorders or for adults and children with obesity, we need to address both individual behavior and the social context in which the problem occurs.”

When it comes to eating disorders, between 5 million and 10 million Americans suffer from anorexia nervosa, bulimia nervosa or binge eating disorder. Anorexia rates have remained pretty much constant for the past century, but bulimia and binge eating disorder seem to be increasing at roughly the same rates as obesity.

Fortunately, Denise E. Wilfley, Ph.D., director of the Weight Management and Eating Disorders Program at the School of Medicine, enjoys the challenge of finding effective treatments for significant public health problems such as obesity and eating disorders.

“I have aimed throughout my career to study the causes, characteristics and treatment of obesity and eating disorders,” says Wilfley, professor of psychiatry, medicine and pediatrics at the School of Medicine and professor of psychology in Arts & Sciences. “And since an important risk factor for the development of eating disorders is being overweight in childhood, I believe it’s important to study the whole range of problems with eating — from anorexia nervosa to obesity — across all age ranges — from childhood throughout life.”

She’s also passionate about training the next generation of clinicians and researchers in her field, and her laboratory is bustling with graduate students, fellows and junior faculty. She says her personal and professional relationships help the research to move forward, and she has found that relationships also are important to the individuals whose problems she studies and treats.

“My program of research indicates that interpersonal factors play a significant role in binge eating disorder among obese people,” she says. “That’s also true for other eating disorders and with childhood overweight. So if we’re going to develop more effective treatments for eating disorders or for adults and children with obesity, we need to address both individual behavior and the social context in which the problem occurs.”

Denise Wilfley

Born: June 29, 1960, St. Louis Mo.

Education: Bachelor of science with honors, psychology, 1982 Central Missouri State University; master’s degree, counseling psychology, 1984 and doctorate in counseling psychology with an emphasis in health psychology, 1989, University of Missouri-Columbia.

Postdoctoral training: Fellowship, 1990. Stanford University.

Family: Son Wil Welch, 7; daughters Emma and Ella Welch, 7 months; husband Robinson Welch, Ph.D.; mother Arlene Wilfley

Wilfley and her colleagues recently published a study in the Journal of the American Medical Association where she found that when overweight children lose weight, they keep it off more effectively if they also participate in a maintenance-targeted treatment program. A particularly promising maintenance approach is called social facilitation maintenance (SFM), which presumes that children need to be in a social environment that supports continued weight control. The SFM treatment guides parents to encourage their kids to be friends with physically active peers and to ensure that play dates with existing friends involve physical activity and healthful eating.

Wilfley is particularly interested in finding effective, long-term treatments for obese and overweight children because if the condition appears in childhood, the complications of obesity — from heart disease to diabetes, certain cancers, stroke, sleep apnea and high blood pressure — could begin to appear earlier in life. So instead of developing serious problems in their 50s and 60s, children who grow up obese may find themselves having heart attacks, experiencing diabetes-related vision loss or requiring treatment for colon cancer when they’re in their 30s or 40s.

“In addition, overweight children are also at risk for eating disorders because they tend to have a negative body image and more weight concerns,” she says. “If we leave kids to their own devices, they may think they should lose weight by skipping meals or eliminating certain types of food, and those unhealthy approaches can backfire and contribute to problems down the road. So we try to get families involved in positive exercise habits and food choices to improve the health of everyone in the home.”

Ongoing projects

Wilfley is a principal investigator on several large, National Institutes of Health-funded research projects. The research program provides training for undergraduate and graduate students, fellows and junior faculty members. The projects also provide much-needed treatment and prevention services to the people who take part in the studies. Not long ago, Wilfley was recognized for her laboratory’s productivity with a Midcareer Investigator Award in Patient-Oriented Research from the National Institute of Mental Health.

Her laboratory spans the spectrum of eating and weight disturbances, from helping overweight children maintain weight loss to studying psychological treatments for those who struggle with binge eating disorder to studies of family therapy and antidepressant medication in the treatment of anorexia nervosa.

Much of her research focuses on developing novel treatment and prevention approaches. For example, her team is working with an Internet-based intervention called Student Bodies that helps college-aged women with weight and shape concerns develop better emotional regulation and an improved body image. The idea is that an improved body image and better mood regulation skills should reduce the risk of eating disorders and related problems, such as depression, binge drinking and substance abuse.

“Denise brings tremendous experience and innovation to her studies of eating disorders and childhood obesity. Her work is at the leading edge of the field in terms of diagnosis, prevention and treatment,” says Charles F. Zorumski, M.D., the Samuel B. Guze Professor and head of the Department of Psychiatry and professor of anatomy and neurobiology. “Obesity represents a major contributor to health-care costs in our country and, along with depression, nicotine dependence and alcohol abuse, is one of the primary areas where behavioral and psychiatric interventions can have a large impact on public health.”

Returning home

A native St. Louisan, Wilfley returned to the area in 2002 from San Diego where she was director of the Center for Eating and Weight Disorders. After spending her early years in St. Louis, Wilfley’s family moved to Fulton in central Missouri. After earning her degrees, she spent her career on both the East and West Coasts, at Stanford University, Yale University and the University of California, San Diego/San Diego State University Joint Doctoral Program.

She decided to return to the Midwest at the suggestion of her husband, Robinson Welch, Ph.D., also a psychologist, assistant professor of psychiatry and fellow obesity and eating disorders researcher.

Denise E. Wilfley and her children at a pumpkin patch: Wil and twins Emma (left) and Ella.

“We started seriously considering it when our son, Wil, was about a year-and-a-half old,” Wilfley recalls. “We wanted him to be closer to my family. I really loved the ocean, but my husband reminded me that the beach would be there forever, but my parents wouldn’t.”

That statement took on deeper significance when Wilfley’s father, Donald, passed away several months ago. But Wilfley’s mother, Arlene, is doing well, still living near Fulton, along with all four of Wilfley’s siblings, who settled within 10 minutes of Arlene.

“My little boy has a lot of cousins to play with,” she says.

At 7 years old, he also has two new sisters to play with, Ella and Emma, both seven months old. It’s a good time for Wil because seven is his favorite number, and for a few weeks, everybody has that number in their age.

That number also would seem to be just about the number of minutes of rest that Wilfley and Welch get as they raise a young family and pursue their research. But she does find time to run with friends in Forest Park, take the kids hiking at Castlewood State Park and the river area of Grafton where they often go for family bike rides.

“We’ve even had the twins out in a bike trailer, and they seem to like it,” she says.

They also spend time at places like The Muny, the Saint Louis Zoo and at youth soccer games. And they haven’t had to give up the ocean completely. With in-laws in San Diego, body surfing and boogie boards are never too far away.