Behavioral treatment of obesity

The behavioral treatment of obesity consists of a set of principles and techniques to help overweight individuals modify inappropriate eating and activity habits. As provided in University and hospital clinics, this approach produces an average loss of 8.5 kg (9% of initial weight) in approximately 20 weeks. The maintenance of weight loss is facilitated by the provision of long-term patient-provider contact as well as by the use of weight-loss medications. The most promising results are likely to be obtained when behavioral and pharmacologic approaches are combined. The article concludes with a discussion of the importance of treating obese individuals with respect and compassion.     

Too big to be seen: Weight‐based discrimination among nursing students

An educational intervention was conducted to determine the efficacy of an obesity sensitivity program to determine nursing students’ attitudes toward obese clients. As part of the clinical curriculum, nursing students (N = 103) received weekly obesity sensitivity education on weight‐based discrimination. Students’ completed a preproject and postproject attitudes toward obese persons scale (Barra, 2015) to evaluate discriminatory beliefs and actions. All clinical groups had a significant positive change in their own weight prejudices postobesity education intervention. Chi‐square analysis was utilized as a measure of association between pre‐ and postobesity education with clinical application concerning obesity size, body odor, appearance, and lifestyle, along with provider fear of a back injury. Promoting nursing student awareness of obese client bias can dissipate negative stigmas to promote a therapeutic patient–provider relationship.     

Safe and effective management of the obese patient

The prevalence of overweight and obesity has increased dramatically in the recent decades, and obesity is now a major public health problem. Obesity negatively influences an individual's health by increasing mortality and raising the risk for multiple medical conditions such as type 2 diabetes mellitus, hypertension, dyslipidemia, and coronary heart disease. In addition, the obese individual is often the brunt of social discrimination. Weight loss has been shown to reduce the risk for many of these comorbid conditions. A multifaceted approach to the obese patient should include identifying potential causes for weight gain, outlining medical conditions that would benefit by weight loss, and tailoring a weight loss program that is safe and effective for the individual. Components of a successful weight loss program include dietary intervention, recommendations for physical activity, behavior modification, and, in a select group of patients, pharmacologic or surgical intervention.     

The lifestyle challenge program: a multidisciplinary approach to weight management

BACKGROUND: The increasing prevalence of overweight and obesity in the US has received widespread attention and is highlighted in recent government-issued health priorities. While there are many weight loss programs in different settings, few include pharmacist involvement in spite of pharmacists' recognized easy accessibility to the public. OBJECTIVE: To provide insight into a successful, collaborative, multidisciplinary approach to weight management and to encourage pharmacists and other healthcare professionals to adopt a similar approach to patient management. METHODS: Adult patients >18 years of age were recruited from an outpatient university-based setting to participate in a weight management program. The principles of the program included diet, exercise, and behavior modification. The program was conducted through weekly one-hour group sessions held over a 20-week period. Faculty involved in the program included an attending physician specializing in nutrition, a pharmacist, and a behavioral psychologist. All data are expressed as mean +/- SD unless otherwise specified. RESULTS: Ninety participants (74 female, mean age 48 +/- 10 y) entered the program between April 2001 and April 2004. Participants had multiple obesity-related comorbid diseases. The weight of completers (n = 59) decreased from 100.9 +/- 20 kg at baseline to 97.3 +/- 19.5 kg at 10 weeks and 95.9 +/- 20 kg at 20 weeks. Thirty-nine patients completed both baseline and final assessments, which showed improvement in health-related quality of life, binge-eating behavior, and depressive symptoms (p < 0.05). CONCLUSIONS: This program is a successful multidisciplinary model for the management of overweight and obese patients in an outpatient-based hospital setting.     

The impact of significant weight loss on resting energy expenditure in obese youth.

BACKGROUND: The prevalence of obesity in American youth is increasing and treating the condition is difficult. METHODS: We have developed a multidisciplinary weight-reduction program that includes a very low calorie diet followed by a hypocaloric diet, exercise, and behavior modification. Based on data collected at baseline and at the end of the acute intervention phase (10 weeks), we assessed the impact of the weight loss that resulted from participation in this weight reduction program on the resting energy expenditure and body composition of obese children and adolescents. RESULTS: There was a significant decrease in body weight and body fat as assessed by weight determinations and skin-fold measurements after 10 weeks. The body mass index decreased significantly from 33.8 on entry to 29.6 (P < 0.0001). Despite the significant weight loss, resting energy expenditure and lean body mass remained constant from entry until the completion of the acute phase. CONCLUSION: We conclude that a multidisciplinary weight-reduction program that combines a very low calorie diet followed by a balanced hypocaloric diet, with a moderate-intensity progressive exercise program and behavior modification is an effective means for weight-reduction in obese children and adolescents. Furthermore, fat mass is significantly reduced while lean body mass and resting energy expenditure are unaltered.     

Obesity: assessment and management in primary care.

Obesity is a complex, multifactorial condition in which excess body fat may put a person at health risk. National data indicate that the prevalence of obesity in the United States is increasing in children and adults. Reversing these trends requires changes in individual behavior and the elimination of societal barriers to healthy lifestyle choices. Basic treatment of overweight and obese patients requires a comprehensive approach involving diet and nutrition, regular physical activity, and behavioral change, with an emphasis on long-term weight management rather than short-term extreme weight reduction. Physicians and other health professionals have an important role in promoting preventive measures and encouraging positive lifestyle behaviors, as well as identifying and treating obesity-related comorbidities. Health professionals also have a role in counseling patients about safe and effective weight loss and weight maintenance programs. Recent evidence-based guidelines from the National Heart, Lung, and Blood Institute, as well as recommendations from the American Academy of Pediatrics, American Association of Clinical Endocrinologists/American College of Endocrinology, American Obesity Association, U.S. Clinical Preventive Services Task Force, Institute of Medicine, and World Health Organization can be consulted for information and guidance on the identification and management of overweight and obese patients.     

Effects of a weight-loss program for obese children: a "mix of attributes" approach

Childhood obesity is an important global public health issue. There is a need for more effective, low cost and child-centered intervention programs for reducing body weight. In response to this need, we developed a mix of attributes approach (including content, interactivity, control, channel, and objectivity) to help obese children (weight-for-length index, WLI >/= 1.20) reduce their body weight and improve their knowledge, attitude, and behavior. The prevalence of obesity in our sample was 15.9 % (140 obese children out of 882 children studying in the fourth grade) . An experimental, randomized research design was conducted in this study. Anthropometric measurements (including Body Mass Index [BMI] , WLI, body fat percentage, triceps, and subscapular skinfold thickness) and questionnaires (including the Scale of Obesity and Body Weight Loss Knowledge, Attitude, and Practice) were evaluated at baseline (pretest) and after one month of the intervention (posttest) for all obese children. Of 140 obese children, 118 completed this study (66 in the experimental group, 52 in the control group). The mix of attributes approach significantly reduced the degree of obesity revealed in anthropometric measurements. (p < .05). This approach also significantly improved obese children ' s knowledge (p < .001) and slightly improved their behaviors (p = .057); however, this program did not change the children ' s attitudes so easily (p = .597). To more effectively lose weight, we suggest an additional attribute, " individuality, " as a means of increasing efforts to change attitudes in obese children.     

Treatment of diabetes in patients with severe obesity.

Besides genetic predisposition, obesity is the most important risk factor for the development of diabetes mellitus, and weight reduction has been shown to markedly improve blood glucose control in obese subjects with type 2 diabetes. Therapeutic strategies for the obese diabetic patient include: 1) promoting weight loss through lifestyle modifications (hypocaloric diet and exercise) and anti-obesity drugs (orlistat, sibutramine, etc.); 2) improving blood glucose control, essentially through the reduction of insulin resistance (metformin, eventually thiazolidinediones) or insulin need (alpha-glucosidase inhibitors) and, at a later stage, the correction of defective insulin secretion (sulphonylureas, repaglinide) or low circulating insulin levels (exogenous insulin); and 3) treating common associated risk factors, such as arterial hypertension and dyslipidaemias, to improve cardiovascular prognosis. When morbid obesity is present, both restoring a good glycemic control and correcting associated risk factors can only be obtained through marked and sustained weight loss. This primary objective justifies more aggressive weight reduction programmes, including very low-calorie diets and bariatric surgery, but only within a multidisciplinary approach and in well-selected patients.     

Treatment of obesity

For primary care physicians, obesity is one of the most challenging problems confronted in office practice. The disorder is Increasing in prevalence despite the efforts of both patients and physicians. Treatment requires a multimodality approach that addresses diet, physical activity, and behavioral issues. Medication and surgical approaches may be appropriate as well. This review outlines the evidence for each approach, suggests how primary care physicians can best help obese patients, and provides practical tips for weight loss.     

fMRI reactivity to high-calorie food pictures predicts short- and long-term outcome in a weight-loss program

Behavioral studies have suggested that food cues have stronger motivating effects in obese than in normal-weight individuals, which may be a risk factor underlying obesity. Previous cross-sectional neuroimaging studies have suggested that this difference is mediated by increased reactivity to food cues in parts of the reward system in obese individuals. To date, however, only a few prospective neuroimaging studies have been conducted to examine whether individual differences in brain activation elicited by food cues can predict differences in weight change. We used functional magnetic resonance imaging (fMRI) to investigate activation in reward-system as well as other brain regions in response to viewing high-calorie food vs. control pictures in 25 obese individuals before and after a 12-week psychosocial weight-loss treatment and at 9-mo follow-up. In those obese individuals who were least successful in losing weight during the treatment, we found greater pre-treatment activation to high-calorie food vs. control pictures in brain regions implicated in reward-system processes, such as the nucleus accumbens, anterior cingulate, and insula. We found similar correlations with weight loss in brain regions implicated by other studies in vision and attention, such as superior occipital cortex, inferior and superior parietal lobule, and prefrontal cortex. Furthermore, less successful weight maintenance at 9-mo follow-up was predicted by greater post-treatment activation in such brain regions as insula, ventral tegmental area, putamen, and fusiform gyrus. In summary, we found that greater activation in brain regions mediating motivational and attentional salience of food cues in obese individuals at the start of a weight-loss program was predictive of less success in the program and that such activation following the program predicted poorer weight control over a 9-mo follow-up period.     

Overweight and Obesity Among Youth Entering Residential Care: Prevalence and Correlates

Little is known about the prevalence of clinical weight problems for youth living in residential care. Therefore, this study examined the prevalence and correlates of overweight and obesity in a large sample of youth (N = 1709) entering a residential care program. Results indicated that 48% of youth were overweight or obese at the time of intake, which is much higher than national pediatric rates. Females had higher rates of overweight/obesity, as did youth referred from moderately restrictive placements such as foster care. Youth who were overweight/obese had greater internalizing symptoms at intake. Clinical and research implications are discussed.     

Parental perceptions of the preschool obese child

Childhood obesity is a serious public health problem today with many potential complications and adverse outcomes for children. How parents view their children's weight is an important consideration for nurses. The purpose of this study was to increase staff understanding of parents' views so that interventions could be developed to achieve improved outcomes in attenuating the rate of weight gain in obese children. A questionnaire was administered to 200 parents, mostly Hispanic, of obese children to determine the parents' perceptions of their child's obesity. The study revealed that 35% of parents did not believe their obese child was overweight and 53% had no problem controlling what their child eats. However, 78% of parents expressed concern about heart disease as a consequence of childhood obesity. The study demonstrated that parents acknowledge some health risks of obesity but that interventions in treating childhood obesity need to begin with the understanding of parents' perceptions of their own child's obesity.     

Integrating the transtheoretical model into the management of overweight and obese adults

PURPOSE: To show how the nurse practitioner (NP) can incorporate stage-specific interventions from the transtheoretical model in the management of overweight and obese adults. DATA SOURCES: Research articles, clinical articles, and government guidelines pertaining to the management of overweight and obesity in adults. CONCLUSIONS: Overweight and obesity are complex and chronic conditions that require lifelong management. The NP can help clients to safely and successfully lose weight by developing stage-specific interventions, by using an expert multidisciplinary team, and by providing ongoing monitoring and motivation. IMPLICATIONS FOR PRACTICE: The prevalence of overweight and obesity continues to increase at an alarming rate and is a major public health concern. The NP has an important role in the assessment and management of clients with this condition.     

Understanding obesity in the older person: prevalence and risk factors

District nurses deal with many overweight and obese clients on their caseloads. Many of these people have various co-morbities; their weight issues are often glossed over, prioritizing more pressing clinical issues. This however is a mistake, in this article the issue of obesity in the elderly is mapped out. It starts with looking at the reasons behind the epidemic and looking at individual factors. The elderly suffer from sarcopenia as a result of ageing which leads to changes in body morphology. If not tackled early, such changes lead to considerable increases in cardiometabolic risk. Widespread increases in BMI have been shown to promote CHD, hypertension, type 2 diabetes and certain types of cancers. Clinical depression can be a manifestation of obesity. An overview of the prevalence and non-conservative clinical management is given.     

Implications of the biology of weight regulation and obesity on the treatment of obesity

PURPOSE: The purposes of this article are to provide a brief review of the complex biology of weight regulation and obesity, to explain some of the effects of diet and exercise on the biology of weight regulation and obesity, and to propose a coherent way to assess and treat people related to weight and obesity. DATA SOURCES: Scientific publications, clinical guidelines, and government sources. CONCLUSIONS: Obesity is a complex problem requiring an understanding of how interventions interact with the biology of weight regulation in people who are obese. Promoting health in obese people requires a focus on improving insulin sensitivity. IMPLICATIONS FOR PRACTICE: Helping individuals maintain normal weight throughout life is important in order to keep the long- and short-term weight signals in balance and reflective of true energy requirements. Exercise is associated with loss of total and abdominal adipose tissue and improved insulin sensitivity. Diets inducing gradual weight loss are less likely to stimulate appetite. Diets should include antioxidants to neutralize the increase in free radical production associated with obesity and exercise. Other interventions in the treatment of obesity may include treating sleep deficits and the dysregulated endocannabinoid system.     

Self-efficacy targeted treatments for weight loss in postmenopausal women

Matching behavioral treatment programs to different types of obese clients is a rarely studied strategy, thus guidelines for identifying who might benefit most from which program remain elusive. This study categorized the weight control self-efficacy beliefs of obese, postmenopausal women, and determined the effects of self-efficacy targeted versus non-targeted (control) treatment on weight loss outcomes (body habitus, physical conditioning, affect, and eating behaviors). Obese (BMI 33 +/- 5), postmenopausal (60 +/- 6 years old) women (n = 59) participated in a 6-month weight loss program. The 37 women categorized by Q methodology as Assured (self-confident, independent) were randomized to Assured (AT) or Non-Targeted (NT) treatment; the 22 Disbelievers (doubtful, wavering) were randomized to Disbeliever (DT) or NT treatment. At baseline, the Assureds had significantly smaller body girths and reported significantly greater self-esteem, fewer symptoms of binge eating, and less negative affect overeating than the Disbelievers. Improvement in these variables with weight loss erased significant differences between the groups and was a desired outcome. Treatment delivery type may have influenced attrition rate, since significantly more Assureds dropped from NT than AT and significantly more Disbelievers dropped from DT than NT. Thus, the self-efficacy type may serve as a means to identify different types of treatment needs (flexible vs. rigid) to sustain women's adherence and success in the program. The significant weight loss outcomes for women in all groups argues for the incorporation of strategies to enhance self-efficacy but not the need for specific treatments that directly target self-efficacy types.     

Research aimed at improving both mood and weight (RAINBOW) in primary care: A type 1 hybrid design randomized controlled trial

Effective interventions targeting comorbid obesity and depression are critical given the increasing prevalence and worsened outcomes for patients with both conditions. RAINBOW is a type 1 hybrid design randomized controlled trial. The objective is to evaluate the clinical and cost effectiveness and implementation potential of an integrated, technology-enhanced, collaborative care model for treating comorbid obesity and depression in primary care. Obese and depressed adults (n = 404) will be randomized to usual care enhanced with the provision of a pedometer and information about the health system's services for mood or weight management (control) or with the Integrated Coaching for Better Mood and Weight (I-CARE) program (intervention). The 12-month I-CARE program synergistically integrates two proven behavioral interventions: problem-solving therapy with as-needed intensification of pharmacotherapy for depression (PEARLS) and standardized behavioral treatment for obesity (Group Lifestyle Balance™). It utilizes traditional (e.g., office visits and phone consults) and emerging care delivery modalities (e.g., patient web portal and mobile applications). Follow-up assessments will occur at 6, 12, 18, and 24 months. We hypothesize that compared with controls, I-CARE participants will have greater improvements in weight and depression severity measured by the 20-item Depression Symptom Checklist at 12 months, which will be sustained at 24 months. We will also assess I-CARE's cost-effectiveness and use mixed methods to examine its potential for reach, adoption, implementation, and maintenance. This study offers the potential to change how obese and depressed adults are treated—through a new model of accessible and integrative lifestyle medicine and mental health expertise—in primary care.     

Management of obesity

We live in an overweight society. Although food consumption has not increased dramatically over the last two decades, physical activity has markedly diminished. However, recent studies suggest that weights up to 20% above ideal body weight do not carry a significant risk of increased mortality in the absence of other chronic diseases. A team approach helps maintain patient motivation, the key to an effective weight-loss program. An efficient weight-loss and weight-maintenance program in the moderately obese patient includes modification of eating patterns, an individualized balanced fuel-source diet, and an exercise program to allow caloric deficit of approximately 500 calories a day. We must realize that for morbidly obese patients in whom the amount of caloric restriction necessary to reach and maintain a desirable body weight may be incompatible with a reasonable quality of life, surgery is warranted. The aggressiveness of our therapeutic regimen should always depend on the risk of morbidity and mortality associated with the patient's degree of obesity.     

Psychosocial factors in obesity

Obese people as a group have similar mental health as normal weight people, and there are no psychiatric features characteristic of obesity in general. However, small subgroups of obese individuals may have psychiatric abnormalities which are specific for obesity, such as body image disturbance or periodic compulsive overeating (bulimia). Obesity is strongly related to sociocultural factors. In western countries obesity is commoner in lower than in higher social classes. Thus, the development of obesity is influenced by social status. However, also the converse is true: recent observations suggest that obese people lose social status. This is probably due to prejudice and discrimination against obese persons in the modern western society.     

Lifestyle modification in the treatment of obesity: an educational challenge and opportunity

As many as two-thirds of adults in developed nations are overweight (body mass index (BMI)=25.0-29.9 kg/m2) or obese (BMI>or=30 kg/m2), and many of these individuals suffer from weight-related comorbidities such as hypertension, hyperlipidemia, and type II diabetes. On a more positive note, recent studies have demonstrated that losses as small as 5-10% of initial weight can improve these health complications. For example, the Diabetes Prevention Program demonstrated that a 7% reduction in initial weight, coupled with 150 min/week of physical activity, reduced the risk of developing type II diabetes by 58% compared with placebo. Behavioral treatment consistently induces weight losses in this range. This paper describes the behavioral treatment of obesity, including its short- and long-term results as well as approaches for improving the maintenance of lost weight. The terms "behavioral treatment," "lifestyle modification," and "behavioral weight control" are often used interchangeably, as they are in this paper. Lifestyle modification includes three principal components: diet, physical activity, and behavior therapy. The latter term, as applied to weight control, refers to a set of principles and techniques to help patients adopt new diet and exercise habits that can be sustained long term to promote health.