One-year behavioral treatment of obesity: Comparison of moderate and severe caloric restriction and the effects of weight maintenance therapy.

Compared the weight losses of 49 obese women (mean age 39.31 yrs) randomly assigned to a 52-wk behavioral program combined with either moderate or severe caloric restriction. Ss in the balanced deficit diet (BDD) condition were prescribed a 1,200-kcal/day diet throughout treatment, and those in the very-low-calorie diet (VLCD) condition were given a 420-kcal/day liquid diet for 16 wks and a 1,200-kcal/day diet thereafter. The VLCD Ss lost significantly more weight than the BDD Ss at all periods through Week 26, at which time mean losses were 21.45 and 11.86 kg, respectively. VLCD Ss, however, regained weight during the next 26 wks of weekly therapy and during a 26-wk weight maintenance program that provided biweekly meetings. Mean weight losses at the end of the maintenance program were 10.94 and 12.18 kg, respectively. Reports of binge eating declined in both groups, and no relationship was observed between binge eating and weight loss or attrition. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavioral treatment of obese binge eaters: do they need different care?

This study investigated the relationship between binge eating and the outcome of weight loss treatment. Participants in a 48-week trial of a structured diet combined with exercise and behavior therapy were classified into one of four groups: no overeating; episodic overeating; subthreshold binge-eating disorder(BED); and BED. Binge eating status was not associated with either dropout or adherence to the diet, but did affect weight loss and mood. The BED group lost significantly more weight at the end of treatment than all other groups, even when adjusting for initial weight. At 1-year follow-up, there were no differences among groups in weight loss or weight regain. The BED group began treatment with significantly higher BDI scores, but improvement in mood occurred by week 5. On the basis of these findings, and a review of the recent literature, we conclude that obese binge eaters respond as favorably to standard dietary and behavioral treatments as do obese nonbingers.     

An evaluation of a television-delivered behavioral weight loss program: Are the ratings acceptable?

This experiment evaluated the efficacy of television delivery of a behavioral weight reduction program. Seventy-one overweight adults were randomly assigned to a live-contact weight loss group that was videotaped for viewing by other groups, a live-contact group that was not videotaped, a television-delivered group that observed the videotaped weight loss sessions, or a waiting-list control group. Participants in all 3 treatment groups lost significantly more weight during the 8-week treatment program than those in the waiting-list control group. There were no significant weight loss differences among the 3 treatment groups during the program. These weight changes were maintained at 3-month follow-up. At 15-month follow-up, the television-delivered group and the live-contact group maintained their weight losses, whereas the videotaped group did not. Cost-effectiveness analyses indicated that the television-delivered group received the most cost-effective treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Lifestyle intervention in overweight individuals with a family history of diabetes

OBJECTIVE: To assess the effect of lifestyle intervention over 2 years on changes in weight, coronary heart disease (CHD) risk factors, and incidence of diabetes in overweight individuals with a parental history of diabetes. RESEARCH DESIGN AND METHODS: Participants (n = 154), who were 30-100% over ideal body weight, had one or both parents with diabetes, and were currently nondiabetic, were randomly assigned to 2-year treatments focused on diet (decreasing calories and fat intake), exercise (goal of 1,500 kcal/week of moderate activity), or the combination of diet plus exercise or to a no-treatment control group. Subjects were reassessed at 6 months, 1 year, and 2 years. RESULTS: At 6 months, the groups differed significantly on measures of eating, exercise, and fitness; weight losses in the diet and diet-plus-exercise groups were significantly greater than in the exercise and control conditions. Weight losses were associated with positive changes in CHD risk factors. After 6 months, there was gradual deterioration of behavioral and physiological changes, so that at 2 years, almost no between-group differences were maintained. Differences between groups in risk of developing diabetes were of borderline significance (P = 0.08). Strongest predictors were impaired glucose tolerance at baseline, which was positively related to risk of developing diabetes, and weight loss from baseline to 2 years, which was negatively related; in all treatment groups, a modest weight loss of 4.5 kg reduced the risk of type 2 diabetes by approximately 30% compared with no weight loss. CONCLUSIONS: Although initially successful, the interventions studied here were not effective in producing long-term changes in behavior, weight, or physiological parameters. However, weight loss from 0 to 2 years reduced the risk of developing type 2 diabetes. Since modest weight loss significantly reduced risk of type 2 diabetes, further research is needed to determine how best to increase the percentage of subjects achieving at least a modest weight loss.     

Maintenance following a very-low-calorie diet.

The authors posed 2 questions in this randomized study of maintenance procedures in which participants were followed for 15 mo after completion of a very-low-calorie diet: Would stimulus narrowing during the reintroduction of solid food, achieved by the use of prepackaged foods, improve weight losses and the maintenance of those losses as compared with the use of regular food? Would reintroduction of foods dependent on progress in losing or maintaining weight be superior to reintroduction on a time-dependent basis? Neither the stimulus narrowing condition nor the reintroduction procedure enhanced either maximum weight loss or maintenance of those losses. The stimulus narrowing condition appeared to be poorly tolerated; compliance and attendance were poorer in this condition than in the regular food condition. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Long-term relationship between weight and aerobic-fitness change in children.

The relationship between changes in relative weight and fitness was assessed 5 years after children began treatment for obesity. Multivariate regression analysis showed that two factors were independently related to fitness change: (a) maintenance of weight loss from the end of 6 months of treatment to the 5-year follow-up and (b) initial fitness level. Children who showed the largest long-term changes in relative weight and the lowest initial fitness showed the largest improvements in fitness. Short-term weight loss was not related to long-term fitness change. These results show that weight loss and fitness are related over 5 years. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effect of increasing initial weight loss with the Scarsdale Diet on subsequent weight loss in a behavioral treatment program.

20 overweight Ss (aged 20–65 yrs) who participated in a behavioral weight control program that included 2 wks on the Scarsdale diet lost more weight during that period than did 19 Ss in a behavioral group without the diet. The experimental manipulation of initial weight loss did not significantly affect subsequent or overall weight loss. At 1 yr, the average weight losses of the Scarsdale and behavioral conditions were not significantly different. (3 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Obese binge eaters: Affect, cognitions, and response to behavioral weight control.

The present study compared obese female binge eaters and nonbinge eaters of comparable age and weight on mood, diet behavior, and responses to a standard versus modified behavioral weight-control program. The modified behavioral program emphasized meal regularity, intake of complex carbohydrates, and activity as an alternate to overeating. Binge eaters reported significantly more depressive symptomatology, psychological distress, and maladaptive diet behavior than nonbinge eaters at pretreatment and at all subsequent assessments. Furthermore, binge eaters were more likely to drop out of treatment. No differences in weight loss at posttreatment occurred between binge eaters and nonbinge eaters, but binge eaters regained significantly more weight than nonbinge eaters at 6-month follow-up. Differences in weight loss between the groups were not significant at the 1-year follow-up, and no significant differences between the standard and modified treatment conditions were observed. Marked differences between binge eaters and nonbinge eaters in affect and cognitions appeared to persist despite behavioral treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Motivational predictors of weight loss and weight-loss maintenance.

Self determination theory proposes that behavior change will occur and persist if it is autonomously motivated. Autonomous motivation for a behavior is theorized to be a function both of individual differences in the autonomy orientation from the General Causality Orientations Scale and of the degree of autonomy supportiveness of relevant social contexts. We tested the theory with 128 patients in a 6-month, very-low-calorie weight-loss program with a 23-month follow-up. Analyses confirmed the predictions that (a) participants whose motivation for weight loss was more autonomous would attend the program more regularly, lose more weight during the program, and evidence greater maintained weight loss at follow-up, and (b) participants' autonomous motivation for weight loss would be predicted both by their autonomy orientation and by the perceived autonomy supportiveness of the interpersonal climate created by the health-care staff. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Controlled trial of very low calorie diet, behavior therapy, and their combination in the treatment of obesity.

Assessed the effectiveness of a combined program of low calorie diet (400–500 kcal) and behavior therapy in treating obesity. 50 women (average age 43.9 yrs) and 9 men (average age 44.7 yrs), averaging 89% overweight, were randomly assigned to 1 of 3 conditions: (a) low calorie diet alone, (b) behavior therapy alone, or (c) low calorie diet plus behavior therapy (combined treatment). Mean weight losses for the 3 conditions at the end of treatment were 14.1, 14.3, and 19.3 kg, respectively; losses for combined treatment were significantly greater than those for the other 2 conditions. At 1-yr follow-up, mean weight losses for the diet alone, behavior therapy alone, and combined-treatment conditions were 4.6, 9.5, and 12.9 kg, respectively; and losses for combined treatment were significantly greater than for the diet alone condition. 29% of the combined-treatment and 44% of the behavior therapy alone Ss maintained weight losses within 2 kg of their end-of-treatment weight; none of the diet-alone Ss met this criterion. Ss in all 3 conditions achieved significant reductions in blood pressure at posttreatment, but only those receiving behavior therapy alone and combined treatment showed significant decreases in depression. (36 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A randomized comparison of two weight-reducing diets. Calorie counting versus low-fat carbohydrate-rich ad libitum diet

We compared the importance of rate of initial weight loss for long term outcome in obese patients and the efficacy of two different dietary weight maintenance programmes. An initial weight loss of 12.6 kg was achieved either by eight weeks low energy diet (2 MJ/day) (n = 21) or 17 weeks conventional hypocaloric, high protein diet (5 MJ/day) (n = 22) both supported by an anorectic compound (ephedrine 20 mg and caffeine 200 mg thrice daily). Weight loss rate had no effect on long-term weight maintenance. Randomisation to one year weight maintenance of either an ad lib, low fat, high carbohydrate diet or a fixed energy diet (< 8 MJ/day), both supported by reinforcement sessions 2-3 times monthly, resulted in a maintenance of 13.2 of initial 13.5 kg weight loss in the ad lib group versus 9.7 of 13.8 kg in the fixed energy intake group. At follow-up two years after the initial weight loss, 65% of the ad lib group and only 40% of the fixed energy intake group had maintained a weight loss of > 5 kg.     

Behavior therapy for obesity: A comparative investigation of long-term efficacy.

Both individual and group behavior therapies were compared to a stringent social pressure program in the treatment of 72 obese females (mean age, 41.5 yrs) with a long-standing history of obesity (mean, 15.9 yrs) and inability to lose weight or maintain a weight loss. Following an 8-wk treatment phase, half of each treatment condition received 4 additional booster sessions and the remaining half simply reported for regularly scheduled follow-up weigh-ins at 3, 6, 9, and 12 mo, respectively. Both behavioral treatments were significantly superior to the social-pressure therapy at posttreatment. However, whereas the 2 group treatments resulted in successful maintenance of treatment-produced weight reduction, Ss treated with individual behavior therapy showed substantial relapse at long-term follow-up. It is hypothesized that initial treatment success and subsequent maintenance of weight loss are governed by partially different processes. (32 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effects of health beliefs on weight loss in individuals at high risk for NIDDM

OBJECTIVE: To determine whether perceived risk and other health beliefs held by individuals at high risk for developing NIDDM predict weight loss and behavior change during a behavioral weight loss program to reduce the risk of NIDDM. RESEARCH DESIGN AND METHODS: Health beliefs and objective risk factors for diabetes were examined in 154 overweight men and women with a family history of NIDDM. The effects of these factors on adherence, dietary intake, weight loss, and changes in glucose levels were examined in a subset of 79 of these subjects who participated in a 2-year behavioral weight control program. RESULTS: Those subjects who perceived themselves at highest risk of developing diabetes had a stronger family history of the disease and were more likely to be women than subjects considering themselves at more moderate risk. These participants also rated diabetes as a more serious disease, but were less likely to believe that weight loss would lower their risk. None of these health beliefs were related to attendance at meetings, dietary intake, weight loss, or fasting glucose, but higher perceived seriousness predicted larger reductions in BMI at 1 year. Of the objective risk factors for NIDDM, higher baseline BMI predicted larger weight losses throughout the program, and a stronger family history of diabetes was related to greater weight regain after an initial weight loss. CONCLUSIONS: Perceived risk of developing diabetes and other health beliefs did not predict performance in a behavioral weight loss program. These data suggest that efforts to modify health beliefs by educating high-risk individuals about their risk and benefits of weight loss may not be effective in improving long-term weight loss results.     

A pilot investigation of a behavioral weight control program with mentally retarded adolescents and adults: Effects on weight, fitness, and knowledge of nutritional and behavioral principles.

Examined the long- and short-term effects of a behavioral weight control program for 10 mentally retarded Ss (mean age 22.7 yrs, mean IQ 52.5) that incorporated teaching about diet, emphasizing exercise, using positive reinforcement, providing periodic weighings, involving parents and group home leaders, and teaching skills to encourage continuing or maintaining weight loss after the end of the program. Weight loss, changes in knowledge of behavioral and nutritional principles, and measures of aerobic fitness and body size were assessed using a nutrition and self-management test. Results indicate significant changes on all measures but arm girth for all Ss at the end of the program, but weight losses were no longer significant at 1-yr follow-up. Ss who were withdrawn from the program by their group home managers showed significant weight gains over the year. Ss' IQ scores were significantly correlated with posttest and follow-up weight losses, and those residing with parents rather than in group homes tended to remain in the program and to lose weight. (8 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Maintenance strategies for the treatment of obesity: An evaluation of relapse prevention training and posttreatment contact by mail and telephone.

129 21–57 yr old moderately obese volunteers who averaged 57% over ideal weight were randomly assigned to 1 of 6 experimental conditions in a 3?×?2 factorial design. Three treatment conditions (nonbehavioral therapy, behavior therapy, or behavior therapy plus relapse prevention training) were crossed with 2 posttreatment conditions (posttreatment client–therapist contact by telephone and mail or no posttreatment contact). All treatments produced substantial initial weight losses, but Ss tended to regain weight during the follow-up period. Posttreatment client–therapist contact by mail and telephone significantly enhanced the maintenance of weight loss for groups that received nonbehavioral treatment or behavior therapy plus relapse prevention training, but it did not improve maintenance for groups that received behavior therapy only. At 12-mo follow-up, the only condition that maintained its mean posttreatment weight loss was the one that received behavior therapy plus relapse prevention training and posttreatment contact. (29 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Outcome of multimodal day treatment for children with severe behavior problems: a five-year follow-up

OBJECTIVE: To evaluate the long-term outcome of a multimodal day treatment program for children with severe behavior problems and to identify factors that may predict a positive outcome. METHOD: Thirty-three children who completed a day treatment program were assessed using a prospective, single-cohort design tested at intake, discharge, and 5-year follow-up. The child's functioning was assessed using the Revised Child Behavior Profile (RCBP), Hare Self-Esteem Scale, Depression Self-Rating Scale, Hopelessness Scale for Children, Index of Peer Relations, and a 5-point ordinal scale for scholastic reintegration. RESULTS: Repeated-measures analyses of variance showed that improvement was maintained on all measures between intake and 5-year follow-up. A stepwise multiple regression showed that 92% of the adjusted variance in the behavioral functioning of the children at 5-year follow-up, as assessed by the RCBP, was explained by parental cooperation, initial RCBP total and externalizing scores, and history of problem pregnancy. CONCLUSIONS: Children who were admitted to a day treatment setting appear to function well globally, even 5 years after discharge. Parental cooperation was the most important variable in predicting positive outcome.     

A comparison of weight control and weight control plus body image therapy for obese men and women.

Participants were 65 obese men and women who were randomly assigned to either weight control or weight control plus cognitive–behavioral body image therapy. Both conditions showed clinically significant improvements in body image at posttreatment and 1-year follow-up. Adding body image therapy to weight control did not result in greater psychological improvements and did not result in better maintenance of body image change when participants regained weight after treatment. Weight loss and maintenance were equivalent between groups. Adding body image therapy did not improve or detract from weight loss. Although body image therapy has been shown to be effective in obese persons, it appears that a well-rounded cognitive–behavioral weight control program is effective as well. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavior change, weight loss, and physiological improvements in Type II diabetic patients.

53 obese 30–70 yr olds with Type 2 diabetes treated by diet only or oral medication were assigned to a behavior-modification, nutrition-education, or standard-care treatment condition to investigate whether behavior modification would improve short- and long-term results of weight control programs for Ss. The behavior-modification and nutrition-education groups met weekly for 16 wks and were given the same information on nutrition, exercise, and diabetes; however, strategies to change eating behavior were used in the behavior-modification condition. The standard-care condition was identical to the nutrition-education condition except that Ss met only 4 times over the 16-wk treatment period. Results indicate that behavior-modification Ss lost more weight than either the nutrition-education or standard-care Ss during the 16-wk treatment period. However, at 16-mo follow-up, differences in weight loss across treatment conditions were not significant. Physiological parameters and mood improved with initial weight loss, but these changes were not maintained. Physiological changes appeared more directly related to weight loss than to treatment condition. Changes in weight were related to improved eating and exercise habits, and modest weight losses of 4.6–23.6 kg produced significant improvements in blood-sugar control. (46 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Three-year follow-up of the treatment of obesity by very low calorie diet, behavior therapy, and their combination.

This study investigated the long-term efficacy of the treatment of obesity by very low calorie diet, behavior therapy, and their combination. Mean weight losses at the end of treatment for the three conditions were 14.09, 14.26, and 19.25 kg, respectively. Forty-five of 50 subjects were successfully contacted 3 years after treatment, at which time mean weight losses had declined to 3.76, 4.76, and 6.53 kg, respectively. Differences between groups were not significant. More than 40% of subjects reported having sought additional therapy prior to the 3-year follow-up evaluation and reported having lost an average of 3.42 kg. When weight losses for the three conditions were recalculated to correct for the effects of additional therapy, they declined further to 2.20, 3.54, and 5.11 kg, respectively (differences, again, were not significant). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Long-term effects of family-based treatment of childhood obesity.

This study was a 5-year follow-up of obese children who participated in a family-based behavioral weight-control program targeting and reinforcing children and parents for weight loss (Epstein, Wing, Koeske, Andrasik, & Ossip, 1981). Children in the parent-plus-child group showed significantly greater weight reductions after 5 years (–22.7% overweight) than did children in a child-alone target group or in a no-target control group (4.3% and 8.2% overweight, respectively). One third of children in the parent-plus-child group were within 20% of normal weight in comparison with 5% of the children in the no-target control group. Height percentile decreased from the 72nd to the 60th percentile; these changes were negatively related to weight change. These children remained taller than the average child after weight loss, and children of short and medium-height parents were still relatively taller than their parents after 5 years. (23 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)