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U.S. NIH’s Obesity Guidelines Part 27: Behavioral therapy for weight loss
Thursday, December 16, 2004 7:05 am Email this article
Behavioral therapies to reinforce changes in diet and exercise cause roughly a 10 percent weight loss after four to twelve months according to the U.S. NIH's Obesity Guidelines (p. 50). Behavior therapy with frequent contact cause the most weight loss
No one specific behavioral therapy appears to be superior for weight loss. (p. 50) Multimodal strategies appear to work best.
Those with the greatest intensity, that is the most frequent contact and longest duration, result in the largest weight loss. (p. 50)
Rehearsal therapy, group support, and “social pressure” conditioning most effective, cue avoidance least effective
Cognitive rehearsal, group support, and “social pressure” conditioning all caused a similar amount of weight loss, whereas cue avoidance was less effective. (p. 50)
Extended therapy increases success: 22 lbs greater weight loss in one study
Extended therapy lasting 1.4 years caused greater weight loss than therapy lasting 5-9 months. (p 50)
One study found that extended therapy increased weight loss an average of 22 pounds more than without extended therapy.
Weight regain without continued therapy
Without continued behavioral intervention a great majority of patients regain their lost weight.
Behavior therapy: Benefits lost after 3-5 years
Combining behavior therapy with other weight loss approaches helps patients lose weight for up to 1 year, however, no additional benefits are apparent after 3 to 5 years.
Roughly 30 percent of patients given behavioral therapy maintain their weight loss for one year compared to only 5 percent of those on a diet-alone, however, in a five years follow-up weight loss was similar in the two groups. (p. 49)
Diet drug plus behavior therapy causes similar weight loss as diet drug alone
Patients given the prescription diet drug Pondamin (fenfluramine, which was removed from the market in 1997) plus-behavior modification lost the same amount of weight after six months as those given fenfluramine alone, and more weight than those given behavior modification alone. (p. 49)
Diet drug group regained more lost weight after one year than behavior-only group
After one year, both groups taking fenfluramine had regained more of their lost weight than the behavior-alone group, however, the report does not say which group maintained a greater weight loss. (p. 47)
Motivation is key to losing weight
A patient’s motivation is key to successful weight loss and should be assessed by physicians helping patients lose weight.
Comment on motivational techniques
I believe that motivation techniques can help both doctors and patients to lose more weight.
Jay Piatek, MD uses motivational techniques better than anyone that I am aware of to help patients to lose weight.
I think his techniques are brilliant and would work for more than just losing weight.
Here is my understanding of what he does.
He goes beyond how much weight a person wants to lose. He asks them exactly why they want to lose the weight.
The reason might be because they are afraid of having a heart attack and not being able to watch their children grow up. Or maybe they are afraid that their children are embarrassed by them. Or maybe because they are trying to find a mate.
Whatever the reason is, he has them imagine themselves in the future having not lost the weight and having the very thing they are afraid of having happened.
He wants them to feel the pain associated with this. If the person is afraid of dying and their children growing up without a father, he wants them to imagine their children graduating from high school without a father, getting married without a father, and the family stuggling after he is dead.
He then lets these images to motivate them.
He does not have patients focus on the 30 or 40 or 50 pounds they want to lose. Instead he has them focus on the reason they want to lose the weight.
He has patients ask themselves before they put something in their mouth, “Is this going to make me feel more sexy, or more powerful, or my kids proud of me, or whatever the reason is that they want to lose weight?”
I think everybody can learn from this technique—both doctors and patients.
To read the interview with Dr. Piatek and his motivational techniques, click here and look under the section titled “PIATEK ON MOTIVATIONAL TECHNIQUES”.
Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults : the evidence report / National Heart, Lung, and Blood Institute [Bethesda, Md.] : National Institutes of Health, National Heart, Lung, and Blood Institute, . NIH publication No. 98-4083.
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