Obesity and the unbalanced energy equation: Exercise versus eating habit change.

Compared the relative effectiveness of exercise and eating habit change individually and in combination for weight loss and physical conditioning. 44 female volunteers aged 17–46 yrs were randomly assigned to 1 of 4 groups: exercise, eating habits, combination, and delay-of-treatment control. Each group met for 8 1-hr sessions. Ss were assessed at pretreatment, posttreatment, and follow-up using measures of weight, physical fitness, and personal adjustment. After the 1 8-wk period, the control group was treated using the same procedures as employed for the combination group. Results indicate significant improvement for all treatment groups in comparison with the delay-of-treatment control on body weight and most measures of physical fitness and personal adjustment. Groups who exercised showed the most improvement in physical fitness. The combination group demonstrated the most improvement in weight and body circumference. At 8-wk follow-up, only the combination group continued to lose weight. Once treated, the delay-of-treatment control group demonstrated results similar to those of the combination group. Results suggest the necessity of combining exercise and eating habit change in dealing with obesity. (24 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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)     

Weight loss and maintenance and changes in diet and exercise for behavioral counseling and nutrition education.

100 out of 112 women who initially were at least 20 lb overweight, but did not weigh over 220 lb completed a 16-wk program of either behavioral counseling or nutrition education. Initial weight losses were similar for both groups, but behavioral Ss (BEs) consumed significantly fewer calories and changed more on 2 of 4 exercise measures than did nutrition education Ss (NEs). Reviews of daily eating records indicated that BEs more often used diets that were nutritionally unsound. The exercise changes in both conditions were modest and highly variable. Seven-month follow-up indicated that BEs maintained significantly more weight loss than did NEs. Interviews with 92 Ss indicated that regular monitoring of eating, an exercise routine, and problem solving were associated with maintenance. (27 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sequencing of behavior therapy and pharmacotherapy for obesity.

Investigated 2 sequences of combining behavior therapy and pharmacotherapy to determine if anorexic medication could be used effectively to facilitate initial weight loss without compromising the long-term effects of behavior therapy. 91 18–30 yr old women, averaging 31% overweight, participated in a 16-wk treatment program with follow-up assessments scheduled 4 mo and 1 yr later. Anorexic medication, fenfluramine HCl, enhanced weight loss whenever it was introduced, but it was more effective when introduced 8 wks into the behavior therapy program rather than initially. Ss in this sequence (later medication) had lost the most weight (9.3 kg) by the end of treatment, significantly more than those receiving either medication or behavior therapy only. These Ss, however, regained weight once treatment was terminated so that by the 1-yr follow-up, the conditions were not significantly different. Ss in the other sequence (initial medication) maintained their weight loss after medication was terminated as long as they continued to receive behavior therapy; however, they too regained weight once all treatment was terminated. Thus, anorexic medication demonstrated a surprisingly strong effect when introduced midway through a behavior therapy program, when the rate of loss typically slows, but this initially beneficial effect was not maintained during the follow-up period. A post hoc exploration of the data indicates that medication was particularly helpful to Ss who did not initially respond well to behavior therapy. (13 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Enhancing the efficacy of behavior therapy for obesity: Effects of aerobic exercise and a multicomponent maintenance program.

Tested whether the efficacy of behavior therapy for obesity might be improved by the programmatic additions of an aerobic exercise regimen during treatment and a multicomponent maintenance program following treatment. 14 male and 76 female obese 22–60 yr olds were randomly assigned to 2 treatment conditions (behavior therapy or behavior therapy plus aerobic exercise) and 2 posttreatment conditions (no further contact or a multicomponent maintenance program). The exercise regimen consisted of 80 min/week of brisk walking or stationary cycling. The maintenance program included therapist contact by telephone and mail and peer self-help group meetings. At posttreatment, Ss in the behavior therapy plus aerobic exercise condition lost significantly more weight than those who received behavior therapy only. Over an 18-mo follow-up period, maintenance program participants demonstrated significantly better weight-loss progress than Ss in the no-further-contact condition. (29 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Correlates of successful response to a behavioral weight control clinic.

Attempted to identify what types of persons successfully respond to a behavioral weight control clinic. The 40 participants of the study were physically healthy, 25–45 yrs old, and weighed 150–200 lbs. Measures of psychological functioning during preclinic testing indicated that participants experienced no extreme distress. The treatment was conducted over 4 mo by professional behavioral counselors and resulted in an average weight loss of 12.1 lbs. A prediction model based on problem severity and a model using behavior change both accounted for 25% of the variance in weight loss. Initial weight-loss success was correlated with 2 of the 3 severity variables; Ss reporting frequent binge eating and histories of previous dieting weight loss tended to lose the most weight. Successful weight loss also correlated with decreases in problem eating habits and high-calorie snacking but not with increased activity level. Interviews at the end of 7-mo follow-up were used to compare the 8 Ss who successfully maintained losses with the 13 Ss who showed signs of relapse. Ss who were successful at maintenance used frequent exercise, whereas those who relapsed reported high levels of stress during the follow-up. Implications of these correlates for obesity treatment and the importance of viewing unsuccessful weight control as evidence of negative change are discussed in terms of preventing relapse during follow-up. (40 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Influence of aerobic exercise on depression.

43 depressed undergraduate women were randomly assigned to either an aerobic exercise treatment condition in which they participated in strenuous exercise, a placebo treatment condition in which they practiced relaxation exercises, or a no-treatment condition. Aerobic capacity was assessed before and after a 10-wk treatment period. Self-reported depression was assessed before, during, and after the treatment period. Results show that Ss in the aerobic exercise condition had reliably greater increases in aerobic capacity and reliably greater decreases in depression than did Ss in the placebo or no-treatment condition. There was a reduction in depression that was independent of treatment; it is suggested that a no-treatment control condition is a necessity in research on depression. It is concluded that findings provide clear evidence that participation in a program of strenuous aerobic exercise is effective for reducing depression. (20 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Role of the therapist in the self-control of obesity.

The role of the therapist was varied in a weight reduction program with 24 male and 24 female graduate students. When meetings with the therapist were "faded out" over the duration of the 10-wk treatment period, Ss lost significantly more weight compared to Ss who met with the therapist on a regular basis. A follow-up conducted 6 mo after therapy showed that Ss who had regularly met with the therapist during the treatment period had gained back all the weight they had lost during treatment; they no longer differed from controls. Ss who had had the therapist faded out, however, maintained their losses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive and behavioral therapy for musical-performance anxiety.

Compared the efficiency of cognitive-behavioral therapy, emphasizing self-instruction and attention-focusing techniques, with behavior rehearsal and with a waiting-list control in the treatment of debilitating musical-performance anxiety. Ss were 53 pianists (aged 12–53 yrs old) who experienced extreme anxiety in performing situations. Therapy sessions were conducted over a 3-wk period; Ss met 3 times in small groups for 1?–2 hrs and also completed homework assignments. Self-report (e.g., Subjective Stress Scale, Expectations of Personal Efficacy Scale for Musicians), behavioral, and physiological indexes of anxiety were collected at baseline, treatment termination, and follow-up intervals. Multivariate analyses indicated that both the cognitive-behavioral therapy and behavior-rehearsal programs were effective in reducing musical-performance anxiety in comparison to the control condition at the follow-up assessment, although there were no differences among groups at treatment termination. Cognitive therapy was more effective than the behavior-rehearsal program on several measures. (40 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A self-control behavior therapy program for depression.

A behavior therapy program based on a self-control model of depression was evaluated against a nonspecific group therapy condition and a waiting list control group, 28 depressed volunteer female Ss ages 18–48 were administered a psychological test battery including the Beck Depression Inventory and the MMPI and randomly assigned to 1 of the 3 experimental conditions. The experimental therapy procedure consisted of a 6-wk group treatment program that sequentially focused on modifying self-monitoring, self-evaluation, and self-control skills. In each phase specific self-control principles were discussed in conjunction with behavioral homework assignments involving activity schedules. The self-control therapy Ss showed significantly greater reduction in depression on self-report and behavioral measures. Self-control Ss also showed greater improvement in overall pathology on the MMPI. There was some evidence that self-control Ss improved on specific measures of self-control behavior. A 6-wk follow-up generally confirmed maintenance of improvement. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Weight loss and behavior change 1 year after behavioral treatment for obesity.

Reports a 1-yr follow-up study of 88 of the 1st 108 clients to complete a behavioral weight reduction program at Stanford University's Eating Disorders Clinic. On the average, Ss maintained their in-treatment weight loss over the follow-up period, but there was marked variability and a low correlation between in-treatment and posttreatment performance. Ss reported significant changes in their eating behavior after treatment, but these changes were only weakly related to weight changes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of degree of obesity, food deprivation, and palatability on eating behavior of humans.

Monitored the eating behavior of 20 obese and 20 normal weight Ss in the context of tasting tests. Intake was measured following a solid food preload and following a period of food deprivation. All Ss participated in both conditions. Under all experimental conditions obese Ss ate more than normal weight Ss. The effect of a preload was similar in both groups. Obese Ss, however, were more responsive to their preference functions than were normal weight Ss. The fruitfulness of using brief exposure tests for determining differential modes of eating behavior is discussed. (24 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of a short-term exercise program on caloric consumption.

33 women (aged 18–32 yrs) were randomly assigned to either a high-intensity exercise group, a low-intensity exercise group, or a waiting-list control group. All Ss recorded food intake during specified weeks before, during, and following the 7-wk exercise program. Results suggest that exercisers do not compensate for energy expenditure by increasing caloric intake and that choosing between low- and high-intensity exercise does not differentially alter caloric intake. Nevertheless, maximization of negative energy balance or weight loss may be best achieved by exercise programs of high frequency and intensity. (28 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

One-year follow-up of cognitive-behavioral therapy for obese individuals with binge eating disorder.

The results of a 1-year posttreatment follow-up of 93 obese women diagnosed as having binge eating disorder (BED) and treated with group cognitive–behavior therapy (CBT) followed by weight loss treatment are described. The group as a whole maintained both reductions in binge eating and abstinence rates fairly well. However, they regained the weight lost during treatment. Those who stopped binge eating during CBT maintained a weight lost of 4.0 kg over the follow-up period. In contrast, those who continued to binge gained 3.6 kg. Twenty-six percent of those abstinent after CBT met criteria for BED at follow-up and had gained weight, whereas the remaining 74% had lost weight. Stopping binge eating appears critical to sustained weight loss. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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)     

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)     

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)     

Weight gain through self-control procedures.

21 underweight (at least 10%) undergraduates were assigned to either a self-reinforcement condition, a self-punishment condition, or to a discussion-reflection control condition. Ss received 1 weekly treatment session over a 5-wk period. Following treatment, the self-reinforcement groups gained significantly more pounds (kilograms) than either the self-punishment or the control group. This effect was maintained at a 12-wk follow-up. The punishment and control groups did not differ significantly at posttest or at follow-up. Similar results were obtained when percentage of weight change was analyzed, with the treatment effect significant at follow-up. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparison of a self-control approach and an emotional coping approach to the treatment of obesity.

Compared the relative effectiveness of a self-control program that emphasized modification of external environmental-eliciting cues for eating behavior with an induced affect program aimed at decreasing eating behavior as a response to emotional states. Data from 40 female Ss indicate that although the self-control group lost significantly more of their proportion overweight than any of the other groups and significantly more pounds than the control groups at posttreatment assessment, they did not demonstrate continued treatment superiority during the follow-up period. It appears that some continued treatment contact may be critical for continued weight loss by self-control Ss. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Covert modeling-hypnosis in the treatment of obesity.

Investigated the efficacy of a covert modeling/hypnosis treatment package in the control of obesity. 48 overweight female volunteers (who had been administered the Harvard Group Scale of Hypnotic Susceptibility, Eating Patterns Questionnaire, and Rotter's Internal–External Locus of Control Scale) were randomly assigned to 1 of the following groups: (a) covert modeling/hypnosis, (b) covert modeling, (c) no-model scene control, and (d) minimal treatment (where Ss received a shortened version of the covert modeling/hypnosis procedure following an 8-wk no-treatment period). Results indicate a significant effect for weight loss from pretreatment to follow-up across all groups combined. Proportion weight loss measures indicated significantly greater weight loss only for the covert modeling/hypnosis group as compared to the no-model controls. Implications for combining behavior therapy and hypnotic techniques are discussed. (30 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)