1. The Role of Behavior Modification in Obesity Therapy

2. Behavior Modification

3. Components of Behavioral Therapy for Obesity Wadden and Foster. Med Clin North Am 2000:84:441. Self Monitoring Problem Solving Contingency Management Cognitive Restructuring Social Support Stress Management Stimulus Control

4. Cardinal Behaviors of Successful Long-term Weight Management National Weight Control Registry Data Self-monitoring: – Diet: record food intake daily, limit certain foods or food quantity – Weight: check body weight >1 x/wk Low-calorie, low-fat diet: – Total energy intake: 1300-1400 kcal/d – Energy intake from fat: 20%-25% Eat breakfast daily Regular physical activity: 2500-3000 kcal/wk (eg, walk 4 miles/d) Klem et al. Am J Clin Nutr 1997;66:239. McGuire et al.Int J Obes Relat Metab Disord 1998;22:572.

5. Review when, where, and how behaviors will be performed Identify behavior change goal Have patient keep record of behavior change Review progress at next treatment visit Five Steps to Facilitate Behavior Change Wadden and Foster. Med Clin North Am 2000;84:441. 1 2 5 3 4 Congratulate patient on successes (do not criticize shortcomings)

6. Self Monitoring: Food Diary TimeFoodAmountPlaceCaloriesMood 9:15 amCoffee1 cupBedroom0Neutral 12:15 pmBagel1 wholeCar250Rushed 12:15 pmCream cheese1 ozCar100Rushed 12:15 pmCoffee1 cupCar0Rushed 3:30 pmOreo cookies12Den640Stressed 6:30 pmFried chicken3 ozKitchen435Neutral 6:30 pmJuice8 ozKitchen120Neutral 6:30 pmRoll w/butterKitchen125Neutral 6:30 pmMashed potatoes½ cupKitchen170Neutral 8:30 pmYogurt1 cupKitchen100Bored 8:30 pmApple1 largeKitchen140Bored Total for the Day2080

7. Self-Monitoring Consistency and Weight Loss Weight change (lb) at 18 wk of behavior therapy 1 Baker and Kirschenbaum. Behav Ther 1993;24:377. Self-Monitoring Index Quartiles 234 P = 0.01 for weight change among quartiles

8. Summary of Randomized Clinical Trials* of Behavioral Therapy for Weight Loss 197419841990-951996-99 Number of trials15 149 Treatment duration (wk)8132621 Rate of weight loss (kg/wk)0.5 0.40.5 Weight loss (kg)3.86.99.09.6 Length of follow-up (wk)6584074 Weight loss at follow-up (kg)4.04.45.26.0 *Published in 4 journals: Addictive Behaviors, Behavior Therapy, Behaviour Research and Therapy, and Journal of Consulting and Clinical Psychology Adapted from Wadden and Foster. Med Clin North Am 2000;84:441.

9. No Active TreatmentActive Treatment Sustained Weight Loss Can Be Achieved with Behavior Modification Therapy 0 Years 246 Men Björvell and Rössner. Int J Obes Relat Metab Disord 1992;16:623. Weight Loss (kg) 810-12 Women

10. Internet education (access to Internet resources) Internet behavior therapy (weekly online contact) Internet Technology Can Be Used to Provide Effective Behavior Therapy Weight Loss (kg) Tate et al. JAMA 2001;285:1172. Baseline3 months6 months P =0.005

11. Behavioral Treatment of Obesity in an Outpatient Office Practice Provide structured, goal-oriented approach with realistic, short-term goals Frequent patient visits (initially every 1-2 weeks) to enhance compliance Long-term contact helps maintain motivation needed for long-term success Identify office staff to provide brief weigh-ins and review self-monitoring Use written educational materials and manuals

12. Responding to Nonadherence Do not take patient’s behavior personally Assume lack of planning, not motivation, is the problem Do not criticize patient (safeguard their self-esteem) Identify obstacles Determine how obstacles can be handled in the future Acknowledge the difficulty of behavior change and provide encouragement Develop a new plan and shorten interval required for success