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Low-intensity obesity treatments can reduce z-BMI and may be more feasible in primary care.

This article provides an overview of research regarding adult behavioral lifestyle intervention for obesity treatment. We first describe two trials using a behavioral lifestyle intervention to induce weight loss in adults, the Diabetes Prevention Program (DPP) and the Look AHEAD (Action for Health in Diabetes) trial. We then review the three main components of a behavioral lifestyle intervention program: behavior therapy, an energy- and fat-restricted diet, and a moderate- to vigorous-intensity physical activity prescription. Research regarding the influence of dietary prescriptions focusing on macronutrient composition, meal replacements, and more novel dietary approaches (such as reducing dietary variety and energy density) on weight loss is examined. Methods to assist with meeting physical activity goals, such as shortening exercise bouts, using a pedometer, and having access to exercise equipment within the home, are reviewed. To assist with improving weight loss outcomes, broadening activity goals to include resistance training and a reduction in sedentary behavior are considered. To increase the accessibility of behavioral lifestyle interventions to treat obesity in the broader population, translation of efficacious interventions such as the DPP, must be undertaken. Translational studies have successfully altered the DPP to reduce treatment intensity and/or used alternative modalities to implement the DPP in primary care, worksite, and church settings; several examples are provided. The use of new methodologies or technologies that provide individualized treatment and real-time feedback, and which may further enhance weight loss in behavioral lifestyle interventions, is also discussed.

Research shows a positive relationship between dietary energy density (ED) and body mass index (BMI), but dietary ED of weight loss maintainers is unknown. This preliminary investigation was a secondary data analysis that compared self-reported dietary ED and food group servings consumed in overweight adults (OW: BMI = 27 -45 kg/m 2 ), normal weight adults (NW: BMI = 19 -24.9 kg/m 2 ), and weight loss maintainers (WLM: current BMI = 19 -24.9 kg/m 2 [lost ≥ 10% of maximum body weight and maintained loss for ≥ 5 years]) participating in 2 studies, with data collected from July 2006 and March 2007. Three 24-hr phone dietary recalls from 287 participants (OW = 97, NW = 85, WLM = 105) assessed self-reported dietary intake. ED (kcal/g) was calculated by three methods (food + all beverages except water [F + AB], food + caloric beverages [F + CB], and food only [FO]). Differences in self-reported consumption of dietary ED, food group servings, energy, grams of food/beverages, fat, and fiber were assessed using one-way MANCOVA, adjusting for age, sex, and weekly energy expenditure from self-reported physical activity. ED, calculated by all three methods, was significantly lower in WLM than in NW or OW (FO: WLM = 1.39 ± 0.45 kcal/g; NW = 1.60 ± 0.43 kcal/g; OW = 1.83 ± 0.42 kcal/g). Selfreported daily servings of vegetables and whole grains consumed were significantly higher in WLM compared to NW and OW (vegetables: WLM = 4.9 ± 3.1 servings/day; NW = 3.9 ± 2.0 servings/day; OW = 3.4 ± 1.7 servings/day; whole grains: WLM = 2.2 ± 1.8 servings/day; NW = 1.4 ± 1.2 servings/day; OW = 1.3 ± 1.3 servings/day). WLM self-reported consuming significantly less energy from fat and more fiber than the other two groups. Self-reported energy intake per day was significantly lower in WLM than OW, and WLM self-reported consuming significantly more grams of food/beverages per day than OW. These preliminary findings suggest that consuming a diet lower in ED, characterized by greater intake of vegetables and whole grains, may aid with weight loss maintenance and should be further tested in prospective randomized controlled trials. © 2010 Elsevier Ltd. All rights reserved.Corresponding author and requests for reprints: Hollie Raynor, Ph.D., R.D.; 1215 W. Cumberland Ave., JHB 229, Knoxville, TN, 37996; phone: 1-865-974-6259; fax: 1-865-974-3491; hraynor@utk.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. DISCLOSUREThe authors have no conflict of interest to declare. NIH Public Access INTRODUCTIONGiven the current prevalence of overweight and obesity among adults in the United States and th...