Behavioral Treatment of Obesity

Abstract

SynopsisBehavioral treatment should be the first line of intervention for overweight and obese individuals. This paper provides an overview of the structure and principles of behavioral weight loss treatment. The short-and long-term effectiveness of this approach is reviewed. Strategies for improving weight loss maintenance are described, including prolonging contact between patients and providers (either in the clinic or via Internet or telephone), facilitating high amounts of physical activity, and combining lifestyle modification with pharmacotherapy. Finally, innovative programs that can be used to disseminate behavioral approaches beyond traditional academic settings are discussed. Keywords obesity; weight loss; dieting; lifestyle; behavioral Weight loss treatment is recommended for adults with a body mass index (BMI) of 30 kg/m 2 or higher, as well as those with BMI of 25 kg/m 2 or higher who have weight-related comorbidities. 1 Behavioral treatment should be the first line of intervention for overweight and obese individuals. 1 This paper first provides an overview of the structure and principles of behavioral weight loss treatment. Second, the short-and long-term effectiveness of this approach is reviewed. Third, strategies for improving weight loss maintenance are described. Finally, dissemination of behavioral treatment is addressed. Structures and principles of behavioral treatmentThe lifestyle modification interventions delivered in the Diabetes Prevention Program and Look AHEAD research studies are exemplars of behavioral treatment programs. 2,3 The intervention materials from both of these programs are in the public domain and may be used for educational or research purposes. Behavioral weight loss treatment also has been described in detail in other publications. [4][5][6] The structure and three key components of this © 2011 Elsevier Inc. All rights reserved. Meghan L. Butryn, Ph.D., mlb34@drexel.edu. Mailing address: Drexel University, 245 N. 15 th St., MS 626, Philadelphia, PA 19102. Phone: 215-762-3567. Fax: 215-762-7441. Victoria Webb, B.A., vwebb@mail.med.upenn.edu. Mailing address: Center for Weight and Eating Disorders, University of Pennsylvania, 3535 Market St., Philadelphia, PA 19104. Phone: 215-898-4793. Fax: 215-898-2878. Thomas A. Wadden, Ph.D., wadden@mail.med.upenn.edu. Mailing address: Center for Weight and Eating Disorders, University of Pennsylvania, 3535 Market St., Philadelphia, PA, 19104. Phone: 215-898-7315. Fax: 215-898-2878. Disclosures: The authors have no financial disclosures or conflicts of interest to declare.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 ...

The maintenance of treatment effects in the long-term management of obesity.

“…However, the clinical significance of an 8.5 kg reduction in body weight is also determined by whether the weight loss is maintained over the long run. Reviews of randomized clinical trials of behavior therapy for obesity show that over the course of the year following behavioral treatment participants regain typically 30–40% of their lost weight (Brownell & Wadden, 1992; Perri & Fuller, 1995; Wadden & Sarwer, in press). The actual percentage of weight regain following behavior therapy may be somewhat higher than 30–40% because participants in some of the studies reviewed received additional treatment or maintenance therapy during the period immediately subsequent to initial treatment.…”

“…More than 150 studies have evaluated the effectiveness of behavior therapy for obesity. Recent reviews (Brownell & Wadden, 1992; Perri & Fuller, 1995; Wadden & Sarwer, in press) of randomized trials conducted in the past decade show that behavioral treatment, typically delivered in 15–24 weekly groups sessions, produced an average weight loss of approximately 8.5 kg, an amount that represented a mean body weight reduction of 9%. This degree of weight loss is associated with significant improvements in blood pressure and blood glucose (Kanders & Blackburn, 1992; Wing et al, 1987; Wing & Jeffery, 1995), and psychological well-being (Wadden & Stunkard, 1993).…”

Weight regain after total meal replacement very low‐calorie diet program with and with‐out anti‐obesity medications

“… 17 However, without follow‐up treatment, individuals often experience weight regain of 40%–50% within 1–2 years. 18 , 19 Transitioning individuals from a pro‐obesogenic lifestyle to a healthy one is crucial in obesity management as it involves modifying the habits and environment that contributed to the severity of obesity in the first place. Studies have indicated that combining VLCD therapy with intensive lifestyle changes leads to longer‐term weight reduction, which is more successful than VLCD therapy alone.…”

Evaluation of an exercise programme for post‐bariatric surgery patients: views of participants

“…Long‐term weight loss, with or without bariatric surgery, is most effective in interventions that are the focused on behaviour change . To this end, obesity is influenced by learned behaviours . Post‐operative interventions such as BELT strive for long‐term success in promoting lifestyle modification for patients following bariatric surgery through inclusion of behavioural interventions.…”