Continuation of weight loss treatment is associated with the number of self-selected treatment modalities.

Abstract

Abstract Behavior therapy is a cornerstone of weight loss treatment and behaviorists help direct patients' treatment. A novel design was used that allowed participants to choose different treatment modalities during behavioral weight loss treatment. The association between the selection of different treatment modalities and program completion was examined (N=58). Participants could choose five additional treatments options (two medications with or without meal replacements, or meal replacements alone). Participants changed treatments 3.5 times on average. Participants who completed the study changed treatments significantly more times than dropouts. Dropouts, however, tried more treatment options early in treatment compared to completers. Over time, participants chose more effective treatments. The results provide behaviorists with data on the benefits and costs of patients changing treatment modalities during treatment. Keywords: Behavior therapy, Phenylpropanolamine, Caffeine, Ephedrine, Meal replacement, treatment preference. ********** The guidelines for the treatment of obesity suggest that behavior therapy, diet, and increased physical activity are cornerstones of weight loss treatment (NHLBI, 1998). Behavioral psychologists play a critical role in delivering and directing weight loss treatment in multidisciplinary settings. Therefore, behavioral psychologists must consider the benefits and costs of patients' desires to add various treatment modalities to behavior therapy. Other treatment modalities include meal replacements and medication. There is substantial variability of weight loss in response to these treatments and predicting weight loss success remains difficult (Martin, 2002). Nevertheless, patients who seek fee-for-service weight loss services must consider a number of treatment modalities and few studies have examined if patient preference for, and choice of, treatment modalities affects outcome. Providing patients with the best possible care involves entering into a partnership with the patient, in which the patient and provider review treatment options and arrive at treatment strategies together. It appears that engaging the patient in treatment and fostering the patient's commitment contributes to a positive treatment outcome (e.g., motivational interviewing) (Ingersoll et al., 2005). Few studies, however, have studied the effects of treatment preference on weight loss. In a randomized trial, Renjilian et al. (2001) found that weight loss was not affected by assigning participants to their preferred or non-preferred treatment modality (group vs. individual therapy), and Burke et al. (2006) describe the design of a randomized trial that assigns participants to a preferred dietary approach, though weight loss data were not reported. To our knowledge, no study has examined: 1) the degree to which participants would change treatment modalities, if given the choice, 2) whether the number of times that people self-select different treatment options is associated with program continuation and completion, and 3) if participants choose more effective treatment options as treatment progresses. The primary aim of this study was to conduct a unique group-based weight loss program that allowed participants to choose freely among a number of treatment options on a weekly basis, and to observe the number of times that treatments were changed. All participants were provided with behavior therapy and they had the choice to add treatment options to this standard treatment regimen. It was hypothesized that participants who tried more treatment options would be more likely to complete treatment. This hypothesis was based on the following assumptions: 1) the efficacy of weight loss treatments will vary among participants, and participants who try more treatment options have a greater chance of finding one that works for them, thus increasing satisfaction with therapy and decreasing the likelihood of dropping out of treatment, 2) most participants will experience set-backs during treatment and those participants who are willing to try additional treatment options will be less likely to become discouraged and discontinue treatment, and 3) vicarious or social learning (Bandura, 1965) will allow participants to learn from the success and failure of other group members; therefore, participants will choose more successful weight loss treatments over time. …