CBT for Weight Loss

Quite a bit has been written about using CBT with obesity and weight loss. It is too big a topic for me to be at all comprehensive but here are a few articles that would provide a good starting place:

Wilson, G. T. (1996). Acceptance and change in the treatment of eating disorders and obesity. Behavior Therapy, 27, 417-439. ABSTRACT - Recently it has been argued that the explicit focus on behavior change in behavior therapy must be complemented by recognition of the value of acceptance, and the importance of the relationship between these two treatment goals. The same dialectic is central to the treatment of eating disorders and obesity. Having made nutritionally sound and psychologically adaptive lifestyle changes, patients need to accept whatever shape and weight these changes produce. Treatment strategies for overcoming obstacles to acceptance are discussed. These include education, the use of the therapeutic relationship, and cognitive restructuring. Acceptance is an active process of self-affirmation rather than passive resignation to an unhappy fate. It involves emotional processing as well as cognitive and behavioral change. The focus on acceptance and the empirical evidence on the effectiveness of cognitive behavioral therapy in promoting self-acceptance in patients with eating disorders contrasts with the treatment of obesity where the value of self-acceptance has received less research attention. Aside from being important in its own right, enhancing self-acceptance might lead to more lasting changes in health-relevant eating and exercise behavior.

Elam, P. & Kimbrell, D. (1995). Size, lies, and measuring tape. Cognitive & Behavioral Practice, 2, 233-248. ABSTRACT - Outlines concepts and mistaken beliefs about eating and body image that affect clinical practice, interventions that may exacerbate eating and weight problems, and treatment strategies that encourage clients to develop a constructive self-image and effective self-control of eating and physical activity. It is suggested that the lack of awareness of the limits of dieting, dieting-related obesity, the physiological concepts related to eating and body-size regulation, or psychological overinterpretation of obesity and eating behavior can result in erroneous thinking on the clinician's part. These mistake beliefs may fuel inappropriate clinical interventions. In order to reduce the likelihood of iatrogenic complications of eating, weight, and body image problems, the authors have proposed a treatment model including assessment, psychoeducation, a plan to address food restriction and binging, and a skills training component focusing on self-nurturance, assertiveness, emotional regulation, and appropriate nutritional and activity patterns.

Tanco, S.l; Linden, W. & Earle, T. (1998). Well-being and morbid obesity in women: A controlled therapy evaluation. International Journal of Eating Disorders. 1998, 23, 325-339. ABSTRACT - Argues that morbidly obese individuals are unlikely to reach and maintain normative weights, and that interventions aimed at alleviating corollary problems (independent of attempts at weight loss) are appropriate. A cognitive group treatment program (CT) was developed which incorporated a nondieting approach, regular exercise, and use of alternative coping skills. Weight loss per se was not a focus of the intervention. The purpose of the current work was to evaluate this program in a controlled, comparative treatment outcome study. 62 obese women (aged 19 yrs and older) with a history of treatment failures were randomly assigned to the CT program, a behavior therapy weight loss program (BT), or a wait-list control group. For CT Ss, depression, anxiety, and eating-related psychopathology decreased significantly over the course of treatment while perceptions of self control increased; BT and control Ss showed no significant changes in these variables. Women in both active treatment groups lost significant amounts of weight, while control Ss showed a nonsignificant increase in weight. At 6-mo followup, treatment benefits were maintained.

Flodmark, C. (1997). Childhood obesity. Clinical Child Psychology & Psychiatry. 1997, 2, 283-295. ABSTRACT - Covers areas of today's research aimed at finding better ways of treating obesity in the future and an overview of the treatment choices available today. The cause of obesity is genetic in approximately 40-50% of adults and probably to a higher degree in children, meaning that it is possible to remain overweight without a calorie intake that exceeds that of those individuals of normal weight who lack the genetic susceptibility of obesity. Treatment is recommended from 10 yrs of age with a hypocaloric diet and a reduced fat content. Exercise is often obtained naturally by the child before this age. It is helpful to try to replace a sedentary lifestyle including television-viewing with moderate physical activities such as walking. In introducing these changes in lifestyle family therapy has been effective. Other strategies such as behavioral therapy has also been tried individually or in groups or at school with short-term benefits only. Cognitive therapy in childhood obesity gives no advantages over behavioral therapy. No reports on psychodynamic therapy have been published. Surgery is used only in rare inborn metabolic diseases. Although the treatment of children seems to give better results than does treating adults, further development of therapy for obesity is needed.

Boutelle, K. N., Kirschenbaum, D. S., Baker, R. C. & Mitchell, M. E. (1999). How can obese weight controllers minimize weight gain during the high risk holiday season? By self-monitoring very consistently. Health Psychology, 18, 364-368. ABSTRACT - This study examined the efficacy of augmenting standard weekly cognitive-behavioral treatment for obesity with a self-monitoring intervention during the high risk holiday season. Fifty-seven participants in a long-term cognitive-behavioral treatment program were randomly assigned to self-monitoring intervention or comparison groups. During 2 holiday weeks (Christmas-New Years), the intervention group's treatment was supplemented with additional phone calls and daily mailings, all focused on self-monitoring. As hypothesized, the intervention group self-monitored more consistently and managed their weight better than the comparison group during the holidays. However, both groups struggled with weight management throughout the holidays. These findings support the critical role of self-monitoring in weight control and demonstrate the benefits of a low-cost intervention for assisting weight controllers during the holidays.

James, L. C., Folen, R. A., Garland, F. N., Edwards, C., Noce, M., Gohdes, D., Williams, D., Bowles, S., Kellar, M. & Supplee, E. (1997). The Tripler Army Medical Center LEAN Program: A healthy lifestyle model for the treatment of obesity. Military Medicine, 162, 328-332. ABSTRACT - Provides an overview of the Tripler Army Medical Center LEAN Program, a multidisciplinary prevention program for overweight active duty service members. The philosophy behind the program, its major components and preliminary results are discussed. The LEAN progam is a 3-wk intensive inpatient weight-loss program coupled with a 1-yr outpatient follow-up, which emphasizes healthy lifestyles, exercise and emotions, attitudes, and nutrition. The program utilizes a team of 6 psychologists to assist patients in evaluating the relationships among food, their social environment, body image, and emotions. Teaching patients self-management techniques and cognitive coping strategies provides a common link for group and individual therapeutic interventions. Spouse and family member participation is encouraged in group activities to provide support for the patients, identify unhealthy family eating behaviors, and reduce subtle or unconscious sabotage. Re-evaluation at 6-mo intervals for an additional year and 5-yr follow-up are planned.

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