Behavioral Approaches to Obesity

Abstract

Obesity is extremely prevalent in developed countries, affecting about 36 percent of people in the United States alone. Advisory panels recommend a 5-10% reduction in initial weight for adults with obesity, or for those who are overweight, with a weight-related comorbidity. This loss can significantly reduce the development of type 2 diabetes and improve other cardiovascular disease (CVD) risk factors, as seen in the Diabetes Prevention Program and Look AHEAD trials. Greater reductions in weight produce even greater improvements in CVD risk factors. Weight loss can be achieved with a comprehensive lifestyle program that consists of dietary change, increased physical activity, and behavior therapy, provided in individual or group sessions. Behavioral treatment can be combined with diets of varying macronutrient composition as long as they induce a caloric deficit. Physical activity should be gradually increased over a period of 6 months, and although it is not effective for inducing weight loss, it is very important for facilitating weight maintenance. Principles of behavioral treatment include self-monitoring, stimulus control, and goal setting. Weight regain is common, but frequent follow up with an interventionist, which includes at least monthly counseling, can mitigate it. Treatment delivered by telephone, internet, and smartphone offer promising approaches that can be disseminated to larger populations. For complete coverage of all related areas of Endocrinology, please visit our on-line FREE web-text, WWW.ENDOTEXT.ORG.