Evaluation of a modified cognitive–behavioural programme for weight management

Abstract

OBJECTIVE: To evaluate a modi®ed cognitive ± behavioural treatment (M-CBT) for weight management which addresses both the psychosocial costs and the physiological health risks of obesity, without a focus on weight loss. DESIGN: Randomized controlled trial comparing M-CBT with standard cognitive ± behavioural therapy (S-CBT). SUBJECTS: Sixty-three overweight women with body mass index (BMI) ! 28 kgam 2 , mean age 47.5 and mean BMI 35.4. MEASURES: Weight, waist and hip circumference, blood lipids, blood glucose, blood pressure, psychological wellbeing, depression, self esteem, stress, binge eating, eating style, body image, nutrient intake, aerobic ®tness, activity levels, patient satisfaction with treatment. RESULTS: Both M-CBT and S-CBT achieved improvements in a broad range of physical, psychological and behavioural variables. Weight loss in the S-CBT group was greater than in the M-CBT group immediately after treatment, but both groups lost weight. Participants in the M-CBT group continued to lose weight up to the 1 y follow-up. M-CBT was evaluated positively by participants. CONCLUSIONS: Both M-CBT and S-CBT programmes were successful at inducing modest weight loss, as well as improving emotional well-being, reducing distress, increasing activity and ®tness, improving dietary quality and reducing cardio-vascular disease risk factors. The improvements were maintained or continued at 1 y follow-up. These results suggest that treatment based on the new weight-control paradigm which emphasizes sustained lifestyle change without emphasis on dieting, can produce modest bene®ts to health and well-being.

Exploratory randomised controlled trial of a mindfulness-based weight loss intervention for women

“…However, the current programme was considerably briefer, amounting to a total of just 8 hours. This contrasts with the 20-40 hours generally employed in CBT programmes (e.g., Nauta et al, 2001;Rapoport et al, 2000). Increasing the duration of the current programme may therefore help increase its efficacy.…”

“…Indeed, experts are increasingly recognising the need to address the psychological aspects of obesity (e.g., Byrne, 2002;Cooper & Fairburn, 2001;House of Commons Health Committee, 2004). Although a growing number of interventions are now incorporating components aimed at this (e.g., Cooper & Fairburn, 2001;Rapoport, Clark & Wardle, 2000), the development of these still falls far short of that achieved in areas such as nicotine and alcohol dependence to which obesity has been compared (House of Commons Health Committee, 2004). …”

“…Such interventions generally incorporate both behavioural elements such as cue avoidance, and cognitive elements such as challenging dysfunctional thoughts (e.g., Nauta, Hosers & Jansen, 2001;Rapoport, Clark & Wardle, 2000). Most recently motivational interviewing techniques have been included to increase the efficacy of traditional weight loss programmes (e.g., Carels et al, 2007).…”

Dietary restraint and self-regulation in eating behavior

“…Where interventions that focus on relaxation of restraint (a so-called 'undieting' approach) have been compared with those promoting restraint, the inclusion of restraint produces better weight loss results. [49][50][51][52] Longitudinal studies overwhelmingly show that increases in restraint over time are associated with greater weight loss, 45,[53][54][55] and also with better weight maintenance after weight loss. [56][57][58][59][60] Studies of long-term weight suppressors (people who have successfully maintained a weight loss) show that this group have high levels of restraint together with low levels of disinhibition 42,[61][62][63] and report vigilant self-monitoring of eating behaviors and weight.…”

Current Trends in Weight Management: What Advice Do We Give to Patients?

“…As was expected, the TBT group lost weight more quickly; however, at the 6-and 12-month measures, the nondiet group contin-ued to lose weight, whereas the TBT group began to regain weight. This weight pattern was also reflected in a study by Rapoport et al 44 At the end of 10 weeks, participants who were randomized to the modified cognitive behavior therapy group (the nondiet group that focused on physical activity and healthy eating rather than energy restriction) lost 1.3 kg, and the standard cognitive behavior therapy group (advised to follow a 1,200-calorie meal plan) lost 8.6 lb. At the end of 1 year, the gap between the groups closed as the standard group gained a little weight (mean weight loss 7.9 lb), while the nondiet group continued to lose (mean weight loss 4.4 lb).…”