Personalized group cognitive behavioural therapy for obesity: a longitudinal study in a real-world clinical setting
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Severe obesity is difficult to treat, and non-surgical treatment is not supported by robust evidence. The aim of the present study was to establish the immediate and longer-term outcomes following “personalized” form of group cognitive behavioural therapy for obesity (CBT-OB)—a new treatment designed to address specific cognitive processes that have been associated with attrition, weight loss, and weight maintenance in previous studies.
Sixty-seven adult patients with obesity (body mass index (BMI) ≥ 30 kg/m2) were recruited from consecutive referrals to an Italian National Health Service obesity clinic. Each patient was offered 22 group sessions of CBT-OB (14 in the 6-month weight-loss phase and 8 in the subsequent 12-month weight-maintenance phase).
76.2% patients completed the treatment, with an average weight loss of 11.5% after 6 months (10% in the intention-to-treat analysis) and 9.9% (7.5% in the intention-to-treat analysis) after 18 months. Weight loss was associated with a significant reduction in cardiovascular risk factors, anxiety, depression, and eating disorder psychopathology, and an improvement in obesity-related quality of life.
These findings provide strong preliminary support for the use of CBT-OB for obesity in standard clinical settings, and justify its further evaluation in randomized controlled trials.
Level of evidence
Level III, longitudinal cohort study.
KeywordsObesity Lifestyle modification Cognitive behavioural therapy Group therapy Weight loss Weight maintenance Attrition
Compliance with ethical standards
Conflict of interest
Hereby authors state that they have no conflict of interest to declare.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all those who participated in the study.
- 1.Franz MJ, Boucher JL, Rutten-Ramos S, VanWormer JJ (2015) Lifestyle weight-loss intervention outcomes in overweight and obese adults with type 2 diabetes: a systematic review and meta-analysis of randomized clinical trials. J Acad Nutr Diet 115(9):1447–1463. https://doi.org/10.1016/j.jand.2015.02.031 CrossRefPubMedPubMedCentralGoogle Scholar
- 8.Wing RR Behavioral weight control. In: Wadden TA, Stunkard AJ (eds) Handbook of obesity treatment. Guildford Press, New York, pp 301–316Google Scholar
- 12.Cooper Z, Fairburn CG, Hawker DM (2003) Cognitive-behavioral treatment of obesity: a clinician’s guide. Guilford Press, New YorkGoogle Scholar
- 14.Jacob A, Moullec G, Lavoie KL, Laurin C, Cowan T, Tisshaw C, Kazazian C, Raddatz C, Bacon SL (2018) Impact of cognitive-behavioral interventions on weight loss and psychological outcomes: A meta-analysis. Health Psychol 37(5):417–432. https://doi.org/10.1037/hea0000576 CrossRefPubMedPubMedCentralGoogle Scholar
- 15.Forman EM, Butryn ML, Manasse SM, Crosby RD, Goldstein SP, Wyckoff EP, Thomas JG (2016) Acceptance-based versus standard behavioral treatment for obesity: results from the mind your health randomized controlled trial. Obesity (Silver Spring) 24(10):2050–2056. https://doi.org/10.1002/oby.21601 CrossRefGoogle Scholar
- 16.Cooper Z, Doll HA, Hawker DM, Byrne S, Bonner G, Eeley E, O’Connor ME, Fairburn CG (2010) Testing a new cognitive behavioural treatment for obesity: a randomized controlled trial with three-year follow-up. Behav Res Ther 48(8):706–713. https://doi.org/10.1016/j.brat.2010.03.008 CrossRefPubMedPubMedCentralGoogle Scholar
- 18.Dalle Grave R, Calugi S, El Ghoch M (2015) Increasing adherence to diet and exercise through cognitive behavioural strategies. In: Lenzi A, Migliaccio S, Donini LM (eds) Multidisciplinary approach to obesity. Springer International Publishing, New York, pp 327–335. https://doi.org/10.1007/978-3-319-09045-0_27 CrossRefGoogle Scholar
- 20.Fairburn CG, Beglin SJ (1994) Assessment of eating disorders: interview or self-report questionnaire? Int J Eat Disord 16(4):363–370Google Scholar
- 21.Calugi S, Milanese C, Sartirana M, El Ghoch M, Sartori F, Geccherle E, Coppini A, Franchini C, Dalle Grave R (2017) The Eating Disorder Examination Questionnaire: reliability and validity of the Italian version. Eat Weight Disord 22(3):509–514. https://doi.org/10.1007/s40519-016-0276-6 CrossRefPubMedPubMedCentralGoogle Scholar
- 23.Peterson CB, Crosby RD, Wonderlich SA, Joiner T, Crow SJ, Mitchell JE, Bardone-Cone AM, Klein M, le Grange D (2007) Psychometric properties of the eating disorder examination-questionnaire: factor structure and internal consistency. Int J Eat Disord 40(4):386–389. https://doi.org/10.1002/eat.20373 CrossRefPubMedPubMedCentralGoogle Scholar
- 26.Beck AT, Robert A, Steer RA, Gregory K, Brown GK (1996) BDI-II: beck depression inventory manual, 2nd edn. Psychological Corporation, San AntonioGoogle Scholar
- 28.Sica C, Ghisi M (2007) The Italian versions of the beck anxiety inventory and the beck depression inventory-II: psychometric properties and discriminant power. In: Lange MA (ed) Leading-edge psychological tests and testing research. NOVA Publishers, Hauppauge, pp 27–50Google Scholar
- 30.Wilson KA, De Beurs E, Palmer CA, Chambless DL (1999) Beck anxiety inventory. In: Maruish ME (ed) The use of psychological testing for treatment planning and outcomes assessment, 2nd edn. Lawrence Erlbaum, Mahwah, pp 971–992Google Scholar
- 32.Calugi S, Marchesini G, El Ghoch M, Gavasso I, Dalle Grave R (2017) The influence of weight-loss expectations on weight loss and of weight-loss satisfaction on weight maintenance in severe obesity. J Acad Nutr Diet 117(1):32–38. https://doi.org/10.1016/j.jand.2016.09.001 CrossRefPubMedPubMedCentralGoogle Scholar
- 36.Dansinger ML, Gleason JA, Griffith JL, Selker HP, Schaefer EJ (2005) Comparison of the Atkins, Ornish, Weight Watchers, and Zone diets for weight loss and heart disease risk reduction: a randomized trial. Jama 293(1):43–53. https://doi.org/10.1001/jama.293.1.43 CrossRefPubMedPubMedCentralGoogle Scholar
- 37.Fitzpatrick SL, Jeffery R, Johnson KC, Roche CC, Van Dorsten B, Gee M, Johnson RA, Charleston J, Dotson K, Walkup MP, Hill-Briggs F, Brancati FL (2014) Baseline predictors of missed visits in the Look AHEAD study. Obesity (Silver Spring) 22(1):131–140. https://doi.org/10.1002/oby.20613 CrossRefGoogle Scholar
- 40.Melchionda N, Besteghi L, Di Domizio S, Pasqui F, Nuccitelli C, Migliorini S, Baraldi L, Natale S, Manini R, Bellini M, Belsito C, Forlani G, Marchesini G (2003) Cognitive behavioural therapy for obesity: one-year follow-up in a clinical setting. Eat Weight Disord 8(3):188–193CrossRefPubMedCentralGoogle Scholar
- 41.Sasdelli AS, Petroni ML, Delli Paoli A, Collini G, Calugi S, Dalle Grave R, Marchesini G (2018) Expected benefits and motivation to weight loss in relation to treatment outcomes in group-based cognitive-behavior therapy of obesity. Eat Weight Disord 23(2):205–214. https://doi.org/10.1007/s40519-017-0475-9 CrossRefPubMedPubMedCentralGoogle Scholar
- 43.Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG, Donato KA, Hu FB, Hubbard VS, Jakicic JM, Kushner RF, Loria CM, Millen BE, Nonas CA, Pi-Sunyer FX, Stevens J, Stevens VJ, Wadden TA, Wolfe BM, Yanovski SZ (2014) 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. J Am Coll Cardiol 63(25 Pt B):2985–3023. https://doi.org/10.1016/j.jacc.2013.11.004 CrossRefPubMedGoogle Scholar