Current practice guidelines for management of overweight and obesity recommend a program of diet, exercise, and behavior therapy for all persons with a body mass index (calculated as kg/m2) of at least 30 (and those with body mass index ≥25 plus two weight-related comorbidities). In this tripartite treatment—often referred to as lifestyle modification—behavior therapy provides a structure that facilitates meeting goals for energy intake and expenditure. Although standard behavior therapy reliably induces mean weight losses of approximately 10% of initial weight, these reductions are difficult to maintain. Some authors argue that a shift in focus from behavior change to cognitive change will improve long-term results of lifestyle modification programs. This review describes, in detail, the standard behavioral treatment of obesity and compares it with an alternative treatment model that is based in a cognitive conceptualization of weight control. A review of the literature suggests that the differences between standard behavior therapy and cognitive-behavioral therapy of obesity lie more in their underlying theories than in their implementation. Empirical comparisons of the long-term effects of these approaches are needed.
Section snippets
Standard Behavior Therapy of Obesity
Historically, behavioral weight-loss programs included weekly sessions of 60 to 90 minutes each, for approximately 6 months, and induced mean weight losses of approximately 10% of initial weight (19). Without continued treatment, however, participants usually regained approximately one third of their lost weight within the first 6 months after treatment ended and returned to their baseline weights within 5 years (20). Perri and colleagues found that weight regain could be minimized by offering
Conclusions
The question of whether cognitive change precedes and causes behavior change or vice versa has been the subject of theoretical debate and empirical scrutiny for several decades. Current research methods are unlikely to settle this issue definitively in laboratory settings and much less likely to identify whether cognitive or behavioral change is primary in the successful maintenance of a weight loss achieved in lifestyle modification. Randomized controlled trials of standard and CBT-based
A. N. Fabricatore is an assistant professor of Psychology in Psychiatry, Center for Weight and Eating Disorders, University of Pennsylvania School of Medicine, Philadelphia.
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Poor lifestyle behaviors impact (pre)pregnant women by affecting pregnancy outcomes and offspring health. This systematic review provides an overview of psychological therapies to support lifestyle behavior changes among (pre)pregnant women.
Scientific databases were searched from their inception to 20 December 2020 for studies investigating the effects of psychological therapies on improvements in lifestyle behaviors.
Studies were eligible if they included (pre)pregnant women, examined the effects of a psychological therapy on at least one lifestyle behavior and used a control group receiving usual pregnancy care or a non-psychological intervention. Lifestyle behaviors of interest were dietary intake, physical activity, smoking, alcohol consumption, drug use, body weight loss and body weight gain during pregnancy. Pregnancy complications were included as outcome measures.
Motivational interviewing (MI) (n = 21), cognitive behavioral therapy (CBT) (n = 8), incentive-based contingency management (IBCM) (n = 9), mindfulness (n = 1) and hypnosis (n = 1) were investigated as lifestyle behavior interventions. The findings revealed that MI was effective in reducing (self-reported) smoking and alcohol consumption and restricting gestational weight gain (GWG). CBT was only studied as an intervention to restrict GWG and the results predominantly confirmed its effectiveness. IBCM showed the strongest effect on reducing smoking and substance use. The studies using hypnosis or mindfulness to reduce smoking or restrict GWG, respectively, showed no associations.
The use of psychological therapies to improve lifestyle behaviors among (pre)pregnant women is new and the scientific proof is promising. Before wide implementation is legitimated, more evidence is needed on the consequences of lifestyle change for pregnancy outcomes.
This patient guideline is intended for all patients at risk of or living with non-alcoholic fatty liver disease (NAFLD). NAFLD is the most frequent chronic liver disease worldwide and comes with a high disease burden. Yet, there is a lot of unawareness. Furthermore, many aspects of the disease are still to be unravelled, which has an important impact on the information that is given (or not) to patients. Its management requires a close interaction between patients and their many healthcare providers. It is important for patients to develop a full understanding of NAFLD in order to enable them to take an active role in their disease management. This guide summarises the current knowledge relevant to NAFLD and its management. It has been developed by patients, patient representatives, clinicians and scientists and is based on current scientific recommendations, intended to support patients in making informed decisions.
Malgré l’importante prévalence de la symptomatologie dépressive chez les femmes en surpoids ou en situation d’obésité, le rôle de la stigmatisation et des attributions causales dans l’expression de ces symptômes chez des femmes françaises a été jusqu’ici largement sous-exploré.
Cette recherche a pour objectif d’étudier le rôle de la stigmatisation intériorisée, des expériences stigmatisantes et de l’attribution causale dans l’intensité des symptômes dépressifs chez des femmes françaises en surpoids ou en situation d’obésité.
Ces quatre variables ont été mesurées auprès de 160 femmes françaises en surpoids ou en situation d’obésité.
Nos analyses mettent en évidence des corrélations positives entre expériences stigmatisantes, stigmatisation intériorisée et symptomatologie dépressive. Il est important de relever que les expériences stigmatisantes semblent jouer un rôle plus prépondérant que la stigmatisation intériorisée dans l’expression des symptômes dépressifs.
Pour les femmes présentant une symptomatologie dépressive élevée, il apparaît essentiel d’intégrer à leurs prises en charge des interventions visant à réduire leur niveau de stigmatisation. En outre, dans une perspective préventive, il semble également primordial d’engager des campagnes en France visant à réduire la stigmatisation à l’encontre de cette population.
Despite the high prevalence of depressive symptoms among women being overweight or having obesity, the role of stigma and causal attributions in the expression of these symptoms in French women has been largely under-explored to date.
The aim of this research is to study the role of internalized stigmatization, stigmatizing experiences and causal attribution in the intensity of depressive symptoms in overweight and obese French women.
These four variables were measured in 160 French women being overweight or having obesity.
Our analyses highlight positive correlations between stigmatizing experiences, internalized stigmatization and depressive symptomatology. It is important to note that stigmatizing experiences seem to play a more preponderant role than internalized stigmatization in the expression of depressive symptoms.
For women with significant depressive symptoms, it appears essential to integrate interventions aimed at reducing their level of stigma. Moreover, from a preventive perspective, it also seems essential to promote campaigns in France aimed at reducing the stigmatization in this population.
2019, Diabetes and Metabolic Syndrome: Clinical Research and Reviews
Besides physical consequences, obesity has negative psychological effects, thereby lowering human life quality. Major psychological consequences of this disorder includes depression, impaired body image, low self-esteem, eating disorders, stress and poor quality of life, which are correlated with age and gender. Physical interventions, mainly diet control and energy balance, have been widely applied to treat obesity; and some psychological interventions including behavioral therapy, cognitive behavioral therapy and hypnotherapy have showed some effects on obesity treatment. Other psychological therapies, such as relaxation and psychodynamic therapies, are paid less attention. This review aims to update scientific evidence regarding the mental consequences and psychological interventions for obesity.
A. N. Fabricatore is an assistant professor of Psychology in Psychiatry, Center for Weight and Eating Disorders, University of Pennsylvania School of Medicine, Philadelphia.
