Combining CBT-OB with Weight-Loss Drugs and Bariatric Surgery
Lifestyle modification programmes based on cognitive behavioural therapy for obesity (CBT-OB) are the cornerstone of treatment for weight management. However, a subgroup of patients has difficulties adopting the lifestyle modification needed to manage their obesity, due to the powerful biological and environmental factors contrasting weight loss that promote excessive intake of food and reduced energy expenditure. In these cases, it may be useful to combine CBT-OB with weight-loss drugs or bariatric surgery (in patients with severe obesity), which have been specifically designed to address the biological obstacles to weight loss and weight maintenance. Data from some trials indicate that the association of weight-loss drugs with lifestyle modification programmes results in significantly greater weight loss than either therapy alone, because of the potentially complementary mechanisms of action of the two interventions. Similarly, some studies have shown that lifestyle modification programmes have a positive effect on weight loss following bariatric surgery. This chapter describes the rationale behind and the evidence for combining CBT-OB with weight-loss drugs or bariatric surgery and suggests practical strategies on when and how to integrate these interventions.
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