Update on Behavioral Weight Loss Treatments to Reduce Obesity and Lower Cardiometabolic Risks

Abstract

Obesity is an intractable clinical and public health problem that is associated with morbidity and mortality. This review provides an update on current and emerging behavioral weight loss interventions (BWLIs). Because lifestyle behaviors are primary determinants of weight loss success, BWLIs are front-line treatments in the clinical management of obesity. BWLIs provide guidance in dietary restriction, increased physical activity, and decreased sedentary behavior to achieve reductions in body weight. Intensive in-person comprehensive BWLIs providing 14 or more sessions over 6 months are effective in producing weight losses of 5–10% and are recommended by clinical guidelines. High-intensity BWLIs providing frequent contacts during the first 2 years have been shown to be more effective in preventing weight regain than lower intensity programs. The Medicare Diabetes Prevention Program (MDPP) is an evidence-based, federally supported translational community-based BWLI program that is being made available to communities across the US. Mindfulness-based interventions, acceptance-based interventions, and motivational interviewing are evidence-based modalities that have been recently translated into BWLIs. Current evidence suggests they can provide short-term weight loss similar to established BWLIs, but further research is needed to evaluate their effectiveness for long-term weight loss maintenance. Internet-based delivery of BWLIs offers the potential advantages of greater accessibility and reach, user anonymity, and cost-effectiveness for long-term weight loss maintenance. Comprehensive, intensive BWLIs are effective, but long-term weight maintenance is challenging and requires ongoing participant engagement. Newer translational BWLIs and Internet-based BWLIs are being developed to improve weight loss outcomes.