Behavioral treatment of obesity

Abstract

This review has shown that behavioral treatment is effective in inducing a 10% weight loss, which is sufficient to significantly improve health. Weight loss maintenance is challenging for most patients. Long-term outcomes have the potential to be improved through various methods including prolonging contact between patients and providers (either in the clinic or via Internet or telephone), facilitating high amounts of physical activity, or combining lifestyle modification with pharmacotherapy. Innovative programs also are being developed to disseminate behavioral approaches beyond traditional academic settings.

Figure 1

Mean weight change per quartile of monitoring index (i.e., frequency of recording weight and eating within a behavioral treatment program). Higher quartiles indicate more often frequently engaging in self-monitoring behaviors. Figure reproduced from: Baker RC, Kirschenbaum DS. Self-monitoring may be necessary for successful weight control. Behav Ther 1993;24:377–394.

Figure 2

An example of a self-monitoring record. Participants record the times, amounts, and calories of foods consumed and the physical activity they engage in. The extra column can be used to monitor additional contextual information (e.g., places, feelings). Reprinted from: Butryn ML, Clark VL, Coletta MC. Behavioral Approaches to the Treatment of Obesity. In: Akabas SR, Lederman SA, Moore BJ, editors. Understanding obesity: biological, psychological and cultural influences. New York: Wiley; in press.

Figure 3

Mean percent of initial body weight lost at 1 year following involvement in a behavioral weight loss program. Data adapted from: Christian JG, Tsai AG, Bessesen DH. Interpreting weight losses from lifestyle modification trials: Using categorical data. Int J Obes 2010;34:207–209.

Figure 4

Percent change in weight for participants in the intensive lifestyle intervention (ILI) and diabetes support and education (DSE) groups of the Look AHEAD (Action for Health in Diabetes) trial during 4 years of follow-up. Reprinted from: Look AHEAD Research Group, Wing RR. Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus: four-year results of the Look AHEAD trial. Arch Intern Med 2010;170:1566–75.

Figure 5

Weight changes during five years following treatment by very low calorie diet (VLCD), behavior therapy (BMOD), or a combination of VLCD and BMOD. Reprinted from: Wadden TA, Sternberg JA, Letizia KA, et al. Treatment of obesity by very low calorie diet, behavior therapy, and their combination: a five-year perspective. Int J Obes 1989;13 Suppl 2:39–46.

Figure 6

Key interactive website features. Reproduced from: Funk KL, Stevens VJ, Bauck A, et al. Development and implementation of a tailored self-assessment tool in an internet-based weight loss maintenance program. Clinical Practice & Epidemiology in Mental Health 2011; 7: 67–73.

Figure 7

Percentage weight loss by minutes per week of physical activity. Reprinted from: Jakicic JM, Marcus BH, Lang W, et al. Effect of Exercise on 24-Month Weight Loss Maintenance in Overweight Women. Arch Intern Med 2008;168:1550–1559.

Figure 8

Weight changes by physical activity level at 30 months. Main effect of sex, P = 0.04; main effect of exercise group, P = 0.003; sex x exercise group interaction, P = 0.29 (NS). Error bars are ± 1 SD. Reprinted from: Tate DF, Jeffery RW, Sherwood NE, et al. Long-term weight losses associated with prescription of higher physical activity goals. Are higher levels of physical activity protective against weight regain? Am J Clin Nutr 2007;85: 954–959.