Lifestyle Modification for the Management of Obesity
Section snippets
Diabetes Prevention Program
The Diabetes Prevention Program provides an excellent example of the components of behavioral treatment and of the benefits of this approach.5 This study examined more than 3200 overweight individuals with impaired glucose tolerance who were randomly assigned to 1 of 3 treatment conditions: (1) placebo, (2) metformin (ie, 850 mg twice a day), or (3) a lifestyle intervention designed to induce a loss of 7% of initial weight and to increase physical activity. The lifestyle intervention provided
Structure of Behavioral Treatment
In academic medical centers, lifestyle modification is typically provided on a weekly basis for an initial period of 16 to 26 weeks, similar to the Diabetes Prevention Program.11, 12 This time-limited approach provides a clear starting and finishing line that helps participants pace their efforts. Treatment is usually provided to groups of 10 to 20 individuals (during 60- to 90-minute sessions) by registered dietitians, behavioral psychologists, exercise specialists, or related health
Short-Term Results of Treatment
Table 2 summarizes the results of a sample of randomized controlled trials published between 1974 to 2002. The studies selected were all published in Addictive Behaviors, Behaviour Research and Therapy, Behavior Therapy, and Journal of Consulting and Clinical Psychology. Studies were included if the intervention was representative of standard behavioral treatment and did not prescribe a diet of <900 kcal per day. The table is adapted from an earlier publication11 and updated.17, 18, 19, 20, 21,
Dietary Options for Weight Loss
Participants in behavioral programs are usually encouraged to consume a high-carbohydrate, low-fat diet (ie, fewer than 30% of calories from fat) that emphasizes consumption of fruits, vegetables, and whole grains.6, 14 This diet is consistent with recommendations of the U.S. Department of Agriculture.26 Lifestyle modification, however, can be combined with a variety of other dietary approaches, several of which have been designed to produce greater initial weight losses, which are so desired
Physical Activity for Cardiovascular Health and Weight Management
Physical activity plays a critical role in improving cardiovascular health, particularly in persons with obesity and its related health complications.71 Regular bouts of aerobic activity may reduce lipid levels, blood pressure, and the risk of osteoporosis71 and, in patients with type 2 diabetes, improve insulin sensitivity, abdominal adiposity, and glycemic control.72 The extent to which physical fitness reduces obesity-related mortality is less clear. Lee et al73, 74 examined more than 21,000
Long-Term Weight Management
Weight regain is a problem following virtually all dietary and behavioral interventions.91 As shown in Table 2, patients treated by behavior therapy for 20 to 30 weeks typically regain about 30% to 35% of their lost weight in the year following treatment. Weight regain slows after the first year but by 5 years 50% or more of patients are likely to have returned to their baseline weight.92
Summary and Conclusions
This review has shown that a comprehensive program of lifestyle modification is effective in inducing and maintaining losses of approximately 10% of initial weight. Losses of this size are associated with the prevention and amelioration of obesity-related health complications including type 2 diabetes and hypertension. Research is now needed to identify methods of making lifestyle modification available to the millions of people who would benefit from it. Moreover, far greater efforts and
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Preparation of this article was supported, in part, by grant DK065018 from the National Institute of Diabetes, Digestive, and Kidney Disease.