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Treatment Overview

  • Riccardo Dalle Grave
  • Massimiliano Sartirana
  • Marwan El Ghoch
  • Simona Calugi
Chapter

Abstract

Cognitive behavioural therapy for obesity (CBT-OB) is a treatment that was originally designed for outpatient management of patients on a one-to-one basis. Since then, however, it has now been adapted to be administered to groups and in intensive rehabilitation units. This means that the treatment may now be delivered in several care “steps” in different settings, according to the needs of the individual patient. All CBT-OB steps associate dietary and physical activity recommendations with specific cognitive behavioural procedures, which enable further individualisation of treatment. These procedures were conceived on the basis of previous research indicating associations between cognitive processes and important factors such as treatment adherence, the amount of weight lost, and long-term weight-loss maintenance. Thus CBT-OB acts to help the patients not only to reach, accept and maintain a healthy weight loss, adopting a lifestyle centred on weight control, but also to develop a stable “weight-control mindset”. Promising results from a recent randomised controlled trial have already shown that patients suffering from morbid obesity (who are generally excluded from trials due to the high incidence of comorbidities) achieved a mean weight loss of 15% after 12 months of CBT-OB treatment. Even more encouragingly, participants showed no tendency to regain weight between months 6 and 12. Although longer-term outcome data is not yet available, it is worth mentioning that a similar treatment has been proven an effective means of managing obesity associated with binge-eating disorder (BED) over time.

References

  1. 1.
    Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG, Donato KA, et al. 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. 2014;63(25 Pt B):2985–3023.  https://doi.org/10.1016/j.jacc.2013.11.004.CrossRefPubMedGoogle Scholar
  2. 2.
    Butryn ML, Wadden TA. Behavioral treatment of obesity. In: Brownell KD, Walsh BT, editors. Eating disorders and obesity: a comprehensive handbook. 3rd ed. New York: Guilford Press; 2017. p. 512–8.Google Scholar
  3. 3.
    Cooper Z, Fairburn CG, Hawker DM. Cognitive-behavioral treatment of obesity: a clinician’s guide. New York: Guilford Press; 2003.Google Scholar
  4. 4.
    Fairburn CG. Cognitive behavior therapy and eating disorders. New York: Guilford Press; 2008.Google Scholar
  5. 5.
    Dalle Grave R. Multistep cognitive behavioral therapy for eating disorders: theory, practice, and clinical cases. New York: Jason Aronson; 2013.Google Scholar
  6. 6.
    Linehan MM. Cognitive behavioral treatment of borderline personality disorder. New York: Guilford Press; 1993.Google Scholar
  7. 7.
    Marlatt GA, George WH. Relapse prevention: introduction and overview of the model. Br J Addict. 1984;79(3):261–73.CrossRefPubMedGoogle Scholar
  8. 8.
    Unick JL, Neiberg RH, Hogan PE, Cheskin LJ, Dutton GR, Jeffery R, et al. Weight change in the first 2 months of a lifestyle intervention predicts weight changes 8 years later. Obesity (Silver Spring). 2015;23(7):1353–6.  https://doi.org/10.1002/oby.21112.CrossRefGoogle Scholar
  9. 9.
    Dalle Grave R, Sartirana M, El Ghoch M, Calugi S. Personalized multistep cognitive behavioral therapy for obesity. Diabetes Metab Syndr Obes. 2017;10:195–206.  https://doi.org/10.2147/DMSO.S139496.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Dalle Grave R, Calugi S, Compare A, El Ghoch M, Petroni ML, Tomasi F, et al. Weight loss expectations and attrition in treatment-seeking obese women. Obes Facts. 2015;8(5):311–8.  https://doi.org/10.1159/000441366.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Dalle Grave R, Melchionda N, Calugi S, Centis E, Tufano A, Fatati G, et al. Continuous care in the treatment of obesity: an observational multicentre study. J Intern Med. 2005;258(3):265–73.  https://doi.org/10.1111/j.1365-2796.2005.01524.x.CrossRefPubMedGoogle Scholar
  12. 12.
    Perri MG, Sears SF Jr, Clark JE. Strategies for improving maintenance of weight loss: toward a continuous care model of obesity management. Diabetes Care. 1993;16(1):200–9.CrossRefPubMedGoogle Scholar
  13. 13.
    Grossi E, Dalle Grave R, Mannucci E, Molinari E, Compare A, Cuzzolaro M, et al. Complexity of attrition in the treatment of obesity: clues from a structured telephone interview. Int J Obes. 2006;30(7):1132–7.  https://doi.org/10.1038/sj.ijo.0803244.CrossRefGoogle Scholar
  14. 14.
    Rogge MM, Greenwald M, Golden A. Obesity, stigma, and civilized oppression. ANS Adv Nurs Sci. 2004;27(4):301–15.CrossRefPubMedGoogle Scholar
  15. 15.
    Rudd Center for Food Policy and Obesity. Guidelines for media portrayals of individuals affected by obesity http://www.uconnruddcenter.org/files/Pdfs/Media_Guidelines.pdf.
  16. 16.
    Obesity Action Coalition (OAC). People-first language for obesity. Tampa, Florida; 2017. http://www.obesityaction.org/weight-bias-and-stigma/people-first-language-for-obesity.
  17. 17.
    Fabricatore AN. Behavior therapy and cognitive-behavioral therapy of obesity: is there a difference? J Am Diet Assoc. 2007;107(1):92–9.  https://doi.org/10.1016/j.jada.2006.10.005.CrossRefPubMedGoogle Scholar
  18. 18.
    Wing RR, Jeffery RW, Burton LR, Thorson C, Nissinoff KS, Baxter JE. Food provision vs structured meal plans in the behavioral treatment of obesity. Int J Obes Relat Metab Disord. 1996;20(1):56–62.PubMedGoogle Scholar
  19. 19.
    Middleton KM, Patidar SM, Perri MG. The impact of extended care on the long-term maintenance of weight loss: a systematic review and meta-analysis. Obes Rev. 2012;13(6):509–17.  https://doi.org/10.1111/j.1467-789X.2011.00972.x.CrossRefPubMedGoogle Scholar
  20. 20.
    Shieh C, Knisely MR, Clark D, Carpenter JS. Self-weighing in weight management interventions: a systematic review of literature. Obes Res Clin Pract. 2016;10(5):493–519.  https://doi.org/10.1016/j.orcp.2016.01.004.CrossRefPubMedGoogle Scholar
  21. 21.
    Larsen TM, Dalskov SM, van Baak M, Jebb SA, Papadaki A, Pfeiffer AF, et al. Diets with high or low protein content and glycemic index for weight-loss maintenance. N Engl J Med. 2010;363(22):2102–13.  https://doi.org/10.1056/NEJMoa1007137.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Catenacci VA, Ogden LG, Stuht J, Phelan S, Wing RR, Hill JO, et al. Physical activity patterns in the National Weight Control Registry. Obesity (Silver Spring). 2008;16(1):153–61.  https://doi.org/10.1038/oby.2007.6.CrossRefGoogle Scholar
  23. 23.
    Dalle Grave R, Calugi S, Gavasso I, El Ghoch M, Marchesini G. A randomized trial of energy-restricted high-protein versus high-carbohydrate, low-fat diet in morbid obesity. Obesity (Silver Spring). 2013;21(9):1774–81.  https://doi.org/10.1002/oby.20320.CrossRefGoogle Scholar
  24. 24.
    Calugi S, Ruocco A, El Ghoch M, Andrea C, Geccherle E, Sartori F, et al. Residential cognitive-behavioral weight-loss intervention for obesity with and without binge-eating disorder: a prospective case-control study with five-year follow-up. Int J Eat Disord. 2016;49(7):723–30.  https://doi.org/10.1002/eat.22549.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Riccardo Dalle Grave
    • 1
  • Massimiliano Sartirana
    • 1
  • Marwan El Ghoch
    • 1
  • Simona Calugi
    • 1
  1. 1.Department of Eating and Weight DisordersVilla Garda HospitalGardaItaly

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