Behavioral and Psychological Approaches to Weight Management

Abstract

Since the 1970s, behavioral weight loss approaches have been the preferred treatment for mild to moderate obesity. Patients are taught how to modify eating and exercise behaviors to meet treatment goals. Cognitive elements, such as avoidance of dichotomous thinking, reduction of negative self-talk, and improvement in coping strategies, are also emphasized. Most behavioral weight loss programs achieve a 7–10 % weight loss in 6 months. Losses of this magnitude are often sufficient to prevent or ameliorate obesity-related health concerns; however, long-term maintenance remains a significant challenge. Studies indicate that weight maintenance is associated with the continued application of behavioral modification techniques (Sarwer et al., Curr Opin Endocrinol Diabetes Obes 16(5):347–352, 2009). Initial assessment should screen for behavioral and psychological factors influencing weight control, such as eating frequency, diet quality, portion size, and activity level. Triggers, which cause the patient to eat when not hungry or to overeat, should be assessed and patients taught to avoid or manage them. Likewise, barriers to behavior change should be identified and addressed. Finally, patients should be screened for mood and/or eating disorders. Stepped-care approaches, provisions for increased patient-provider contact, and use of motivational interviewing or acceptance and commitment therapy (ACT) techniques may help improve the efficacy of behavioral interventions (Sarwer et al., Curr Opin Endocrinol Diabetes Obes 16(5):347–352, 2009; Armstrong et al., Obes Rev 12(9):709–723, 2011).