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The Role of Behavior Modification in Obesity Therapy
Behavior Modification
Components of Behavioral Therapy for Obesity
Wadden and Foster. Med Clin North Am 2000:84:441.
Self Monitoring
Problem Solving
Contingency Management
Cognitive Restructuring
Social Support
Stress Management
Stimulus Control
Cardinal Behaviors of Successful Long-term Weight Management National Weight Control Registry Data
Self-monitoring:
Diet: record food intake daily, limit certain foods or food quantity
Weight: check body weight >1 x/wk
Low-calorie, low-fat diet:
Total energy intake:      1300-1400 kcal/d
Energy intake from fat:  20%-25%
Eat breakfast daily
Regular physical activity: 2500-3000 kcal/wk                                            (eg, walk 4 miles/d)
Klem et al. Am J Clin Nutr 1997;66:239.
McGuire et al.Int J Obes Relat Metab Disord 1998;22:572.
Review when, where, and how behaviors will be performed
Identify behavior change goal
Have patient keep record of behavior change
Review progress at next treatment visit
Five Steps to Facilitate Behavior Change
Wadden and Foster. Med Clin North Am 2000;84:441.
1
2
5
3
4
Congratulate patient on successes (do not criticize shortcomings)
Self Monitoring:  Food Diary
Self-Monitoring Consistency and Weight Loss Weight change (lb) at 18 wk of behavior therapy
1
Baker and Kirschenbaum. Behav Ther 1993;24:377.
Self-Monitoring Index Quartiles
2
3
4
P = 0.01 for weight change among quartiles
Summary of Randomized Clinical Trials* of Behavioral Therapy for Weight Loss
*Published in 4 journals: Addictive Behaviors, Behavior Therapy,
 Behaviour Research and Therapy, and Journal of Consulting and Clinical Psychology
Adapted from Wadden and Foster. Med Clin North Am 2000;84:441.
No Active Treatment
Active Treatment
Sustained Weight Loss Can Be Achieved with Behavior Modification Therapy
0
Years
2
4
6
Men
Bj?rvell and R?ssner. Int J Obes Relat Metab Disord 1992;16:623.
Weight Loss (kg)
8
10-12
Women
Internet education (access to Internet resources) Internet behavior therapy (weekly online contact)
Internet Technology Can Be Used to Provide Effective Behavior Therapy
Weight Loss (kg)
Tate et al. JAMA 2001;285:1172.
P =0.005
Behavioral Treatment of Obesity in an Outpatient Office Practice
Provide structured, goal-oriented approach with realistic, short-term goals
Frequent patient visits (initially every 1-2 weeks) to enhance compliance
Long-term contact helps maintain motivation needed for long-term success
Identify office staff to provide brief weigh-ins and review self-monitoring
Use written educational materials and manuals
Responding to Nonadherence
Do not take patient’s behavior personally
Assume lack of planning, not motivation, is the problem
Do not criticize patient (safeguard their self-esteem)
Identify obstacles
Determine how obstacles can be handled in the future
Acknowledge the difficulty of behavior change and provide encouragement
Develop a new plan and shorten interval required for success