Outlook: A Quarterly Newsletter of the Society of Behavorial Medicine
Fall 2008 Return to Outlook Main page >>


Bonnie Spring
Bonnie Spring, PhD, ABPP

Some of you know that I am an inveterate traveler. Asia has been my favorite destination for more than 30 years. Never have I been happier than when trekking (usually literally) through Japan, India, China, Cambodia, Vietnam, Indonesia, Thailand, Myanmar, or Singapore. At least initially, my fascination with Asia reflected its exoticism, relative to my U.S. life experiences. Meeting others with vastly different values, priorities, beliefs and fears expanded my own horizons. Seeing how things really are different elsewhere helped me to envision how they could be different where I am.

After a hiatus of several years, I returned to Japan this past August 2008 to attend the International Congress of Behavioral Medicine. Re-orienting to Tokyo I was struck, as usual, by much that is different. Where in the U.S. could one ever encounter: …a luggage attendant who bows formally to each departing airport bus..... a breakfast buffet containing (adjacently) iceberg lettuce, fruit loops, congee, pickles, scrambled eggs, seaweed, hotdogs, olives, sashimi…..a device that automatically sheaths in plastic the wet umbrellas of entering customers …orderly subway lines….heated toilet seats with rushing water acoustics…..white gloved, capped train attendants?

Yet in the midst of so much foreignness, a vague feeling of familiarity also crept over me. Compared to most Americans, the Japanese are very slight in build. More than once I've given a gift of extra-large Japanese size clothing that failed to close around an American frame. I'd always attributed the apparent absence of Japanese weight control problems to a mixture of felicitous genes and healthy lifestyle. Having a car is a distinct liability in Tokyo, where food portion sizes also tend to be sensible. The ubiquitous Japanese vending machine has for many years offered the micro-packages of soft drinks and Haagen-Dazs that calorie-conscious Westerners can now purchase. On this visit, my Japanese companions at the breakfast buffet still decorated their plates elegantly with tiny food servings. But something was askew…..Could my fellow patrons actually have grown slightly larger than I'd remembered?

The change was subtle, nearly imperceptible, but born out by a Google search. Fearing the economic costs of obesity in a rapidly aging society, the Japanese government passed a new law this past April 2008. The so-called "Metabo Law" aims to shrink by 10 percent over the next four years and 25 percent over the next seven years the number of Japanese whose waist circumference exceeds government limits. The national law forbids waist lines larger than 33.5 inches for men and 35.4 inches for women. Companies and local governments must now measure the waistlines of all employees and citizens between the ages of 40 and 74 as part of an annual check-up. Companies whose employees fail to meet weight loss targets will face hefty fines.

Which shall we consider more astonishing: the Japanese approach to the "metabo" problem or the fact that the obesity epidemic has now struck the lithe Japanese? Clearly, the world has entered a global era in which our problems are our neighbors' and our neighbors' problems are ours. Let us hope that the expanded human capital now applied to solve our shared health challenges will yield better solutions…and soon.

In that same spirit we can look forward to hearing fresh perspectives when SBM 2009 meets in Montréal, Canada this coming April. Nearly 150 annual meeting submissions this year have come from Canada - a new record. Meeting attendees are ensured of an international perspective on behavioral medicine in a world-class city.


I have spent much of the past two years learning about a different kind of boundary: the sort that separates the health professions. My education has been contributed by the mentoring souls who co-populate the Council on Evidence-Based Behavioral Practice (EBBP), supported by the National Institutes of Health's Office of Behavioral and Social Science Research (OBSSR). Council members hail from medicine (Evelyn Whitlock), social work (Edward Mullen), nursing (Robin Newhouse), public health (Ross Brownson), psychology (Jason Satterfield), and information sciences (Kristin Hitchcock).

The EBBP Council is trying to decipher how practitioners can utilize behavioral medicine research to help people engage in healthier behaviors. Our process of mutual education has been alternately head-spinning and eye-popping, hair-pulling and uplifting. In other words, our process is quite reminiscent of the one that affects those of you who work on interdisciplinary teams. The core, ineluctable challenge has been the one to which SBM introduced me: that of integrating behavioral medicine interventions at the individual, community, and population levels of the ecological model. With alternating exhilaration and gnashing of teeth, Council was able to develop a model of the evidence based behavioral practice process that appears to us to apply at all levels of the ecological model. A set of three free on-line learning modules on searching for evidence, systematic reviews, and engaging the EBBP practice process for individuals and communities was just released at www.ebbp.org/training. The EBBP Council would very much welcome your input on how we're doing: bspring@northwestern.edu

Much can be learned by craning one's neck to assume the perspective of a sister discipline whose members engage in behavioral medicine. Acquiring the new viewpoint takes time and practice. The developmental process is akin to that needed to perform Piaget's Three Mountain Task. There the challenge is to depart from egocentrism well enough to envision how things look from a different vantage point. The undertaking is puzzling, enlightening, and eminently worthwhile. It affords the kind of deep, broad perspective that becomes possible when SBM's many member professional disciplines gather for the annual meeting.


In many respects, the boundary of greatest importance for SBM to cross is the one that involves translating research findings into practical implementation and practical questions into meaningful, useful research. Four SBM working groups have been working diligently and creatively to address that challenge. Their efforts are beginning to bear fruit, and you can expect to hear more about their accomplishments in the next issue of Outlook. In the meanwhile, most sincere thanks go to Paul Jacobsen for chairing the Guidelines working group, Barbara Resnick for chairing the Practice journal working group, Jeff Goodie for chairing the group on practice research networks, and Amanda Graham for chairing the consumer demand working group.