Behavioral Treatment of Obesity

F R Quale: A Behaviour Contracting Approach to Weight Control. Saand J Behav Ther, 4, 117-124, 1975. A weight control program employing behaviour modification techniques is presented. In the first phase the clients were trained to use different techniques to achieve weight loss. A weight control contract, specifying a penalty for weight gain or lack of weight loss, was established. In the second phase, the goal was maintenance of weight loss during the following year. The success rate reported was 62 % in Phase I and 91 % in Phase II.C Botella & L Wadelius: Behavioural and Traditional Treatment of Obesity. SaandJ Behav Ther, 4, 125-136, 1975. After a summarized background to the overweight problem the literature on behavioural treatment of obesity is reviewed. An experimental comparison between behavioural treatment of obesity and traditional medical treatment is reported. Both treatment groups lost weight significantly. At the one-year follow-up, only the behaviourally treated group had maintained a significant weight loss, although less than immediately after the end of treatment. H Fries: Anorectic Behaviour: Nosological Aspects and Introduction of a Behaviour Scale. Saand J Behav Ther, 4, 137-148, 1975. The anorectic behaviour is typical for patients with primary or "true" anorexia nervosa. It may also be of a more unspecific character, as in mitigated forms of anorexia nervosa or "pseudo-anorectic" conditions. A valid and easily applicable anorectic behaviour scale is introduced, which seems well suitable for diagnostic purpose and routine evaluation of therapeutic effects.T Aim & L-G Kall: Anorexia Nervosa and Behaviour Therapy. Saand J Behav Ther, 4, 159–163, 1975. The historical development of the treatment of anorexia nervosa is reviewed. Experimental evaluations of active components in therapy, by means of single—subject designs are discussed. Some concluding remarks are given pointing at the importance of including the patient's natural environment in the treatment.M Lindquist & K G Gotestam: Self—Control over Eating. Saand J Behav Ther, 4, 159–163,. 1975. The effect of environmental planning and self—administration of consequences was studied in an A-B-C design in the treatment of a client with incorrect eating habits. The combination of the techniques proved to be effective for this problem.

Practices Associated with Weight Loss Versus Weight-Loss Maintenance: Results of a National Survey

Recent analyses of population data reveal that obesity rates continue to rise, and are projected to reach unprecedented levels over the next decade 1. Despite concerted efforts to impede obesity progression, as of today, weight loss and weight maintenance strategies remain at best partially successful endeavours. Regardless of the observation that weight loss strategies can produce significant weight loss 2 and substantial improvements of the determinants of the metabolic risk profile 3, 4, it is clear that actual weight loss tends to be lower than the anticipated weight loss, and most individuals who achieve weight loss will likely regain some weight 5 and even overshoot 6 their pre-intervention body weight. As such, an improved understanding of the factors that contribute to lower than expected weight loss, and poor weight maintenance would improve the effectiveness of weight loss interventions.

Lifestyle Modification for the Management of Obesity

Let’s get serious about promoting physical activity

Few individuals with overweight/obesity maintain weight loss. Executive function (EF) and socioeconomic status (SES) contribute to weight loss maintenance (WLM). This study examined whether the relationship between EF and WLM differs across SES. Forty-four participants between 32-78 years of age were assessed ≥ 1-year post- behavioral obesity intervention. Those who achieved >5% weight loss during the program were recruited for the present study. Participants (N = 44) previously lost >5% of initial body weight. Hierarchical regressions tested the moderating role of SES in the relationship between performance-based EF [Iowa Gambling Task (IGT)] or self-report EF [Behavior Rating Inventory of Executive Function (BRIEF-A)] and %WLM. The relationship between performance-based EF and %WLM varied across SES (p < .05). For those with high SES, a 1-point T-score increase on IGT corresponded with 4.5% greater %WLM (β = .52, p = .03). No association was observed for those with low SES (β = -.12, p = .54). For those with low SES, greater EF may not benefit WLM. For those with high SES, greater EF may benefit WLM. Personalized WLM interventions accounting for levels of SES and EF may best facilitate WLM. Keywords: executive function, weight loss maintenance, socioeconomic status, obesity

Behavioral weight loss interventions have achieved success in primary care; however, to our knowledge, pragmatic implementation of a fully automated treatment that requires little researcher oversight has not been tested. Moreover, weight loss maintenance remains a challenge. To evaluate the long-term effectiveness of an automated, online, behavioral obesity treatment program (Rx Weight Loss [RxWL]) at 12 months (primary end point) and 24 months when delivered pragmatically in primary care and to compare the effectiveness of 3 weight loss maintenance approaches. This randomized clinical trial of RxWL, an online weight loss program, recruited patients from a Rhode Island primary care network with approximately 60 practices and 100 physicians. Eligible participants were primary care patients aged 18 to 75 years with overweight or obesity who were referred by their nurse care manager and enrolled between 2018 and 2020. All participants were included in the intention-to-treat analysis, whereas only those who engaged with maintenance intervention were included in the per-protocol analysis. Data were analyzed from August 2022 to September 2023. All participants were offered the same 3-month weight loss program, with randomization to one of three 9-month maintenance programs: control intervention (monthly online newsletters), monthly intervention (9 monthly video lessons and 1 week of self-monitoring per month), or refresher intervention (an introductory session and two 4-week periods of lessons and self-monitoring at 7 and 10 months). The primary outcome was weight change at 12 months using height and weight data collected from electronic medical records through 24 months. Among the 540 participants (mean [SD] age, 52.8 [13.4] years; 384 females [71.1%]) in the intention-to-treat analysis, mean estimated 3-month weight loss was 3.60 (95% CI, -4.32 to -2.88) kg. At the 12-month primary end point, the amount of weight regained in the monthly (0.37 [95% CI, -0.06 to 0.81] kg) and refresher (0.45 [95% CI, 0.27 to 0.87] kg) maintenance groups was significantly less than that in the newsletter control maintenance group (1.28 [95% CI, 0.85 to 1.71] kg; P = .004). The difference in weight regain between the monthly and refresher maintenance groups was not statistically significant. This pattern persisted at 24 months. In the per-protocol analysis of 253 participants, mean weight loss at the end of the initial 3-month intervention was 6.19 (95% CI, -7.25 to -5.13) kg. Similarly, at 12 months there was less weight regain in the monthly (0.61 kg) and refresher (0.96 kg) maintenance groups than in the newsletter control maintenance group (1.86 kg). Results of this randomized clinical trial indicate that pragmatic implementation of a 12-month automated, online, behavioral obesity treatment that includes 9 months of active maintenance produces clinically significant weight loss over 2 years in primary care patients with overweight or obesity. These findings underscore the importance of providing ongoing maintenance intervention to prevent weight regain. ClinicalTrials.gov Identifier: NCT03488212.

Background: Musculoskeletal problems contribute to nurse attrition, which compromises patient safety and costs healthcare organizations millions of dollars. Recent research describes a physical activity paradox in which high amounts of work-related physical activity may be detrimental to health; however, there is a lack of evidence on the physical activity paradox with respect to musculoskeletal health in nurses. The purpose of this study was to examine the relationship between musculoskeletal symptoms (MSSs) and high amounts of physical activity at work in nurses. Methods: This was a 7-day observational design using direct measurement of physical activity and self-reported MSSs in nurses. Physical activity was measured in step counts using a wearable accelerometer and MSSs were reported using ecological momentary assessment. Step counts and MSSs were compared between work days and days off, and a regression model analyzed the combined effect of physical activity and work days on MSSs while controlling for age, exercise, and body mass index. Results: Musculoskeletal symptoms and step counts were significantly higher on work days compared to days off. Higher step counts on work days resulted in significantly higher expected MSS ratings than the same number of steps taken on a day off. Conclusions: This study supports the existence of a physical activity paradox in nurses with respect to MSSs. Understanding this paradox in the nursing workforce can translate to interventions that reduce the detrimental health effects of high levels of physical activity at work, which can minimize nurse attrition, improve patient outcomes, and reduce costs in healthcare organizations.

Individuals successful at weight loss maintenance engage in high amounts of physical activity (PA). Understanding how and when weight loss maintainers accumulate PA within a day and across the week may inform PA promotion strategies and recommendations for weight management. We compared patterns of PA in a cohort of weight loss maintainers (WLM, n = 28, maintaining ≥13.6 kg weight loss for ≥1 year, BMI 23.6 ± 2.3 kg/m2), controls without obesity (NC, n = 30, BMI similar to current BMI of WLM, BMI 22.8 ± 1.9 kg/m2), and controls with overweight/obesity (OC, n = 26, BMI similar to pre-weight loss BMI of WLM, 33.6 ± 5.1 kg/m2). PA was assessed during 7 consecutive days using the activPALTM activity monitor. The following variables were quantified; sleep duration, sedentary time (SED), light-intensity PA (LPA), moderate-to-vigorous intensity PA (MVPA), and steps. Data were examined to determine differences in patterns of PA across the week and across the day using mixed effect models. Across the week, WLM engaged in ≥60 min of MVPA on 73% of days, significantly more than OC (36%, p < 0.001) and similar to NC (59%, p = 0.10). Across the day, WLM accumulated more MVPA in the morning (i.e., within 3 h of waking) compared to both NC and OC (p < 0.01). WLM engaged in significantly more MVPA accumulated in bouts ≥10 min compared to NC and OC (p < 0.05). Specifically, WLM engaged in more MVPA accumulated in bouts of ≥60 min compared to NC and OC (p < 0.05). WLM engage in high amounts of MVPA (≥60 min/d) on more days of the week, accumulate more MVPA in sustained bouts, and accumulate more MVPA in the morning compared to controls. Future research should investigate if these distinct patterns of PA help to promote weight loss maintenance.

A new causal chain model positing theory- and research-based interrelationships among psychosocial and behavioral variables leading to weight loss and its maintenance was assessed. Two samples of women participating in community-based cognitive-behavioral obesity treatments were assessed over either 6months (weight loss phase; N=103), or additionally including Months 6-12 (weight-loss maintenance phase; N=101). Analyses first evaluated whether baseline physical, demographic, behavioral (physical activity, fruit/vegetable intake), and/or psychosocial (self-regulation, self-efficacy, negative mood) variables significantly predicted weight change. Further analyses assessed whether changes in model-based behavioral and psychosocial variables significantly differed by groupings of participants based on their short-term weight loss and weight-loss maintenance/further loss. The predictive value of changes in the psychosocial variables on behavioral changes was next assessed, also accounting for group. Finally, mediation, moderation, and moderated mediation analyses tested proposed causal chain-based interrelationships among variables. Of the 12 variables assessed at baseline, only weight was inversely associated with lost weight, and only fruit/vegetable intake was positively associated with effects during the weight-loss maintenance phase. Overall improvements in behavioral and psychosocial variables were significantly greater in participant groupings with better weight loss and weight-loss maintenance results. Changes in self-regulation, self-efficacy, and mood significantly predicted the weight-loss behavior changes, unaffected by group. Results from the five mediation, moderation, and moderated mediation analyses supported hypotheses based on the new causal chain model. The field testing indicated adequacy of the new causal chain model and informed architectures of behavioral obesity treatments concerned with long-term reductions in excess weight.

Study protocol for a randomized controlled trial comparing two low-intensity weight loss maintenance interventions based on acceptance and commitment therapy or self-regulation

The relation of grit to weight loss maintenance outcomes

Reprint: 2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults.

The prevalence of obesity has increased substantially in the past 3 decades and is projected to increase further in the years ahead. It increases the risk of diabetes mellitus, dyslipidemia, hypertension, cardiovascular disease, sleep apnea, nonalcoholic hepatic steatosis, gallbladder disease, osteoarthritis, and cancer. The prevention and treatment of obesity is, therefore, a leading challenge facing public health and medicine in the 21st century. Two stereotypes have dominated thinking in public health, medicine, and the media about obesity. The first stereotype is that the recent surge in prevalence of obesity reflects almost entirely environmental and psychological factors and excludes an important contribution of genetic biological factors. The second stereotype is that obesity should and can be treated primarily by diet and behavioral modification. In this review, I challenge these tenets. I summarize evidence for a strong genetic neurobiological contribution to adiposity and body weight and assert that common human obesity is, like essential hypertension, a complex multifactorial disease where genetic factors promote sensitivity or resistance to obesity in a toxic environment. This concept of a genetic resistance versus sensitivity to obesity helps explain why many people remain thin in a toxic environment whereas others develop profound obesity. I then discuss evidence that dietary therapy for obesity generally fails to achieve weight loss maintenance. There is mounting indication that the high rate of relapse from weight loss during dietary therapy occurs because of compensatory biological adaptations that promote lack of compliance and effectiveness. Relapse from weight loss during dietary therapy is not caused simply by lack of discipline and will power. Finally, I briefly discuss the alternatives to dietary and behavioral therapy, namely bariatric surgery and pharmacotherapy. As a prelude to my critique of dietary therapy, I begin with a discussion of the role of genetic neurobiological factors in obesity. The surge …

To investigate weight loss and reasons for attrition in obese patients on long-term continuous care. Observational study with 36 months of follow-up. Setting. Fifteen Italian obesity centres applying a continuous care model of medical treatment. One thousand treatment-seeking obese subjects (785 females, median age 45.1 years, median BMI 37.4 kg m(-2)). Weight loss expectations were systematically recorded at baseline. An initial intensive treatment period (3-6 months) was followed by a less intensive continuous care (a follow-up control every 2-4 months). Main outcome measures. Attrition, reasons for treatment interruption and BMI change. Data were recorded by telephone interview in dropouts. Only 157 patients (15.7%) were in continuous treatment at 36 months. The main reasons of attrition were logistics, unsatisfactory results and lack of motivation. The only basal predictor for continuous care was lower Expected One-Year BMI Loss (P = 0.016). The probability of dropout increased systematically for any 5% expected BMI loss (Hazard ratio, 1.05; 96% confidence interval, 1.01-1.09). The mean percentage weight loss was greater in continuers (5.2% vs. 3.0% in dropouts; P = 0.016). However, the dropouts satisfied with the results or confident to lose additional weight without professional help reported a mean weight loss of 9.6% and 6.5% respectively. Continuous care produces long-term weight loss only in a subgroup of obese patients seeking treatment in medical centres. The finding that subgroups of dropouts report long-term weight loss has implication for the treatment of obesity.