Scaling Science-Based Approaches Beyond the Clinic

Abstract

The behavioral treatment of obesity, alone or in combination with pharmacotherapy or bariatric surgery, is the cornerstone of effective weight management and recommended as the first line of treatment. Expert panels, including the United States Preventive Services Task Force (USPSTF), the American Heart Association (AHA), the American College of Cardiology (ACC), and The Obesity Society (TOS), have developed a list of specific criteria for effective comprehensive behavioral weight management programs. These guidelines recommend that physicians offer such treatments or refer to programs that meet empirically based criteria. The reality, however, is that remarkably few providers or other healthcare professionals are able to overcome the barriers of lack of time, reimbursement, and training, to effectively provide the kind of empirically based treatment described by the panels. Specialized clinics and providers can help, but their number pales in comparison to the number of patients seeking effective solutions. Given the prevalence of overweight and obesity, the potential of commercial behavioral weight management programs lies in their scalability through standardized programs, multiple community locations, and costs that compare favorably to clinic-based approaches. Not all programs are created equal, however, and while many commercial weight management programs incorporate behavioral content, remarkably few have empirical support from randomized controlled trials. This chapter reviews widely available commercial behavioral weight management programs, both face-to-face and app-based, with an emphasis on those with empirical support. Such empirical evidence can help providers and patients make sense of countless programs that often overpromise and under deliver.