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

Abstract

This article reviews the efficacy of strategies designed t o improve the maintenance of treatment effects in the long-term management of obesity. Included are the results from controlled trials that evaluated strategies such as extended therapy, relapse prevention training, monetary incentives, food provision, and peer support as well as the use of very-low-calorie diets and pharmacotherapy. Improved maintenance of weight loss was observed in behavior therapy extended beyond 6 months and in long-term pharmacotherapy (dexfenfluramino or the combination of fenfluramine + phentermine) used in conjunction with behavior therapy or dietary counseling. Following the termlnation of longterm therapy, a regaining of weight was observed across all treatment modalities. These findings are discussed in terms of a "continuous-care" model of obesity management.

"A Comparison of Eating Patterns Across Two Obesity Treatments: Behavior Therapy vs. Behavioral Choice Treatment"

“…From a historical perspective, the short-term success of weight loss itself via conventional behavioral therapy is impressive (Perri & Fuller 1995;Stunkard, 1958;Wadden, 1993), however, results remain temporary (Perri, 1998). Across behavioral dieting treatments, the observed pattern of weight change has been consistent: initial weight loss is rapid then declines; weight is regained and eventually plateaus close to baseline weight (Cooper & Fairburn, 2002;Jeffery et al, 2000).…”

“…Few studies to date have examined the mechanisms involved in successful weight loss and weight loss maintenance across treatments for obesity. From research over the last several decades, it is clear that dieting treatments, although effective in producing initial weight loss, fail to maintain or promote further weight loss over the long-term (Perri, 1998). BCT has shown improved weight maintenance over traditional behavioral approaches (Sbrocco et al, 1999).…”

“…Despite the significant improvements in weight loss, however, these losses were short-term with most of the weight lost during treatment regained within 2 years of follow up (Brownell, 1982;Perri, 1998).…”

"The Impact of a Low-Fat Diet and the Use of Fat Substitutes on Fat Preferences Among Overweight Women Seeking Weight Loss Treatment"

“…Unfortunately, the maintenance of these losses are rather dismal, with more than 30-40% of lost weight regained within one year for men and women who underwent behavioral treatment of obesity (Perri, 1998). Two to five-year follow-up of behavioral treatments for obesity indicate a gradual, but nearly certain return to baseline weights (Kramer, Jeffery, Forster, & Snell, 1989;Stalonas, Perri, & Kerzner, 1984;Wadden, Sternberg, Letizia, Stunkard, & Foster, 1989).…”

“…Two to five-year follow-up of behavioral treatments for obesity indicate a gradual, but nearly certain return to baseline weights (Kramer, Jeffery, Forster, & Snell, 1989;Stalonas, Perri, & Kerzner, 1984;Wadden, Sternberg, Letizia, Stunkard, & Foster, 1989). Perri (1998) reviewed the efficacy of techniques added to improve maintenance of losses achieved by traditional behavior therapy, and concluded that weight regain still remains probable upon program termination. As depicted in Table 1, weight regain occurs despite longer programs and new program components (Wing, 1999).…”