Treatment of Obesity Through Changes in Lifestyle

  • Rena R. Wing
Part of the Contemporary Biomedicine book series (CB, volume 15)


Obesity is a major health problem that now affects over 58 million Americans (1). The most effective treatment for this disease involves the combination of diet, exercise, and behavior modification (2, 3). Most individuals who enroll in such lifestyle intervention programs will initially succeed in losing weight, but the long-term maintenance of weight loss remains difficult to achieve (2, 4). This chapter will review the recent research on lifestyle approaches to the treatment of obesity and suggest strategies that the clinician may find helpful in working with overweight individuals to achieve long-term weight loss.


Binge Eating Binge Eating Disorder Weight Loss Program Initial Weight Loss Behavioral Program 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Kuczmarski RJ, Flegal KM, Campbell SM, Johnson CL. Increasing prevalence of overweight among U.S. adults. The national health and nutrition examination surveys, 1960 to 1991. JAMA 1994; 272: 205–211.Google Scholar
  2. 2.
    Wadden TA. The treatment of obesity: an overview. In: Obesity Theory and Therapy. Stunkard AJ, Wadden TA, eds. New York: Raven, pp. 197–218, 1993.Google Scholar
  3. 3.
    Wing RR. Behavioral treatment of severe obesity. Am i Clin Nutr 1992; 55: 545S - 551S.Google Scholar
  4. 4.
    Wing RR Behavioral treatment of obesity: its application to type II diabetes. Diabetes Care 1993; 16: 193–199.Google Scholar
  5. 5.
    Brownell KD, Wadden TA. Behavior therapy for obesity: modern approaches and better results. In: Handbook of Eating Disorders: Physiology, Psychology, and Treatment of Obesity, Anorexia and Bulimia. Brownell KB, Foreyt JP, eds. New York: Basic Books, p. 180–198, 1986.Google Scholar
  6. 6.
    Marcus MD. Binge eating in obesity. In: Binge Eating. Nature, Assessment, and Treatment. Fairburn CG, Wilson GT, eds. New York: The Guilford Press, pp. 77–96, 1993.Google Scholar
  7. 7.
    Spitzer RL, Devlin M, Walsh BT, Hasin D, Wing R, Marcus M, Stunkard A, Yanovski S, Agras S, Mitchell J, Nonas C. Binge eating disorder: a multisite field trial of the diagnostic criteria. Int J Eating Disord 1992; 11: 191–203.CrossRefGoogle Scholar
  8. 8.
    Wing RR. Behavioral strategies for weight reduction in obese type II diabetic patients. Diabetes Care 1989; 12: 139–144.PubMedCrossRefGoogle Scholar
  9. 9.
    Craighead LW, Blum MD. Supervised exercise in behavioral treatment for moderate obesity. Behav Ther 1989; 20: 49–59.CrossRefGoogle Scholar
  10. 10.
    Wing RR, Epstein LH, Paternostro-Bayles M, Kriska A, Nowalk MP, Gooding W. Exercise in a behavioural weight control programme for obese patients with type 2 (non-insulin-dependent) diabetes. Diabetologia 1988; 31: 902–909.PubMedCrossRefGoogle Scholar
  11. 11.
    Brownell KD. The LEARN Program for Weight Control. Dallas, TX: American Health Publishing Company, 1991.Google Scholar
  12. 12.
    Brownell KD, Jeffery RW. Improving long-term weight loss: pushing the limits of treatment. Behav Ther 1987; 18: 353–374.CrossRefGoogle Scholar
  13. 13.
    Wadden TA, Sternberg JA, Letizia KA, Stunkard AJ, Foster GD. Treatment of obesity by very low calorie diet, behaviour therapy, and their combination: a five-year perspective. Int J Obes 1989; 13: 39–46.PubMedGoogle Scholar
  14. 14.
    Stalonas PM, Kirschenbaum DS. Behavioral treatment for obesity: eating habits revisited. Behav Ther 1985; 16: 1–14.CrossRefGoogle Scholar
  15. 15.
    Kramer FM, Jeffery RW, Forster JL, Snell MK. Long-term follow-up of behavioral treatment for obesity: patterns of weight regain among men and women. Int J Obes 1989; 13: 123–136.PubMedGoogle Scholar
  16. 16.
    Blackburn GL, Read JL. Benefits of reducing-revisted. Postgrad Med J 1984; 60: 13–18.PubMedGoogle Scholar
  17. 17.
    Wing RR, Koeske R, Epstein LH, Nowalk MP, Gooding W, Becker D. Long-term effects of modest weight loss in type II diabetic patients. Arch Intern Med 1987; 147: 1749–1753.PubMedCrossRefGoogle Scholar
  18. 18.
    Wing RR, Jeffery RW. Effect of modest weight loss on changes in cardiovascular risk factors: Are there differences between men and women or between weight loss and maintenance? Int J Obes 1995; 19: 67–73.Google Scholar
  19. 19.
    Jeffery RW, Hellerstedt WL, French SA, Baxter JE. A randomized trial of counseling for fat restriction versus calorie restriction in the treatment of obesity. Int J Obes 1995; 19: 132–137.Google Scholar
  20. 20.
    Schlundt DG, Hill JO, Pope-Cordle J, Arnold D, Virts KL, Katahn M. Randomized evaluation of a low fat ad libitum carbohydrate diet for weight reduction. Int J Obes 1993; 17: 623–629.Google Scholar
  21. 21.
    Pascale RW, Wing RR, Butler BA, Mullen M, Bononi P. Effects of a behavioral weight loss program stressing calorie restriction versus calorie plus fat restriction in obese individuals with NIDDM or a family history of diabetes. Diabetes Care 1995; 18 (9): 1241–1248.PubMedCrossRefGoogle Scholar
  22. 22.
    Shah M, Jeffery RW. Is obesity due to overeating and inactivity, or to a defective metabolic rate? A review. Ann Behav Med 1991; 13: 73–81.Google Scholar
  23. 23.
    Dreon DM, Frey-Hewitt B, Ellsworth N. Dietary fat: carbohydrate ratio and obesity in middle-aged men. Am J Clin Nutr 1988; 47: 995–1000.PubMedGoogle Scholar
  24. 24.
    Romieu I, Willett WC, Stampfer MJ, Colditz GA, Sampson L, Rasner B, Hennekens CH, Speizer FE. Energy intake and other correlates of relative weight. Am J Clin Nutr 1988; 47: 406–412.PubMedGoogle Scholar
  25. 25.
    Wadden TA, Stunkard AJ, Brownell KD. Very low calorie diets: their efficacy, safety, and future. Ann Intern Med 1983; 99: 675–684.PubMedGoogle Scholar
  26. 26.
    National Task Force on the Prevention and Treatment of Obesity. Very low-calorie diets. JAMA 1993; 270 (8): 967–974.CrossRefGoogle Scholar
  27. 27.
    Wadden TA, Stunkard AT. Controlled trial of very low calorie diet, behavior therapy, and their combination in the treatment of obesity. J Consult Clin Psychol 1986; 54: 482–488.PubMedCrossRefGoogle Scholar
  28. 28.
    Wing RR, Marcus MD, Salata R, Epstein LH, Miaskiewicz S, Blair EH. Effects of a very-lowcalorie diet on long-term glycemic control in obese type 2 diabetic subjects. Arch Intern Med 1991; 151: 1334–1340.PubMedCrossRefGoogle Scholar
  29. 29.
    Miura J, Arai K, Tsukahara S, Ohno M, Ikeda Y. The long term effectiveness of combined therapy by behavior modification and very low calorie diet: 2 years follow-up. Int J Obes 1989; 13: 73–77.PubMedGoogle Scholar
  30. 30.
    Wadden TA, Foster GD, Letizia KA. One-year behavioral treatment of obesity: comparison of moderate and severe caloric restriction and the effects of weight maintenance therapy. J Consult Clin Psychol 1994; 62: 165–171.PubMedCrossRefGoogle Scholar
  31. 31.
    Wing RR, Blair E, Marcus M, Epstein LH, Harvey J. Year-long weight loss treatment for obese patients with Type II diabetes: Does inclusion of an intermittent very low calorie diet improve outcome ? Am J Med 1994; 97: 354–362.PubMedCrossRefGoogle Scholar
  32. 32.
    Wing RR. Don’t throw out the baby with the bathwater: a commentary on very-low-calorie diets. Diabetes Care 1992; 15: 293–296.PubMedGoogle Scholar
  33. 33.
    Foster GD, Wadden TA, Peterson FJ, Letizia KA, Bartlett SJ, Conill AM. A controlled comparison of three very-low-calorie diets; effects on weight, body composition, and symptoms. Am J Clin Nutr 1992; 55: 811–817.PubMedGoogle Scholar
  34. 34.
    Jeffery RW, Wing RR, Thorson C, Burton LR, Raether C, Harvey J, Mullen M. Strengthening behavioral interventions for weight loss: a randomized trial of food provision and monetary incentives. J Consul Clin Psychol 1993; 61: 1038–1045.CrossRefGoogle Scholar
  35. 35.
    Wing RR, Jeffery RW, Burton LR, Thorson C, Sperber Nissinoff K, Baxter JE. Food provision vs. structured meal plans in the behavioral treatment of obesity. Int J Obes 1996; 20: 56–62.Google Scholar
  36. 36.
    Pronk NP, Wing RR. Physical activity and long-term maintenance of weight loss. Obes Res 1994; 2: 587–599.PubMedGoogle Scholar
  37. 37.
    Colvin RH, Olson SB. Winners revisited: an 18-month follow-up of our successful weight losers. Addict Behav 1984; 9: 305, 306.Google Scholar
  38. 38.
    Miller PM, Sims KL. Evaluation and component analysis of a comprehensive weight control program. Int J Obes 1981; 5: 57–66.PubMedGoogle Scholar
  39. 39.
    Jeffery RW, Bjornson-Benson WM, Rosenthal BS, Lindquist RA, Kurth CL, Johnson SL. Correlates of weight loss and its maintenance over two years of follow-up among middle-aged men. Prey Med 1984; 13: 155–168.CrossRefGoogle Scholar
  40. 40.
    Kayman S, Bruvold W, Stern JS. Maintenance and relapse after weight loss in women. Behavioral aspects. Am J Clin Nutr 1990; 52: 800–807.PubMedGoogle Scholar
  41. 41.
    Dahlkoetter J, Callahan EJ, Linton J. Obesity and the unbalanced energy equation: exercise versus eating habit change. J Consult Clin Psychol 1979; 47: 898–905.PubMedCrossRefGoogle Scholar
  42. 42.
    Pavlou KN, Krey S, Steffee WP. Exercise as an adjunct to weight loss and maintenance in moderately obese subjects. Am J Clin Nutr 1989; 49: 1115–1123.PubMedGoogle Scholar
  43. 43.
    Stalonas PM, Johnson WG, Christ M. Behavior modification for obesity: the evaluation of exercise, contingency management, and program adherence. J Consult Clin Psychol 1978; 46: 463–469.PubMedCrossRefGoogle Scholar
  44. 44.
    Hill JO, Sparling PB, Shields TW, Heller PA. Effects of exercise and food restriction on body composition and metabolic rate in obese women. Am J Clin Nutr 1987; 46: 622–630.PubMedGoogle Scholar
  45. 45.
    Lemons AD, Kreitzman SN, Coxon A, Howard A. Selection of appropriate exercise regimes for weight reduction during VLCD and maintenance. Int J Obes 1989; 13 (Supp12): 119–123.PubMedGoogle Scholar
  46. 46.
    Donnelly JE, Pronk NP, Jacobsen DJ, Pronk SJ, Jakicic JM. Effects of a very-low-calorie diet and physical-training regimens on body composition and resting metabolic rate in obese females. Am J Clin Nutr 1991; 54: 56–61.PubMedGoogle Scholar
  47. 47.
    Donnelly JE, Jakicic J, Gunderson S. Diet and body composition: effects of very low calorie diets and exercise. Sports Med 1991; 12: 237–249.PubMedCrossRefGoogle Scholar
  48. 48.
    Wood PD, Stefanick ML, Williams PT, Haskell WL. The effects on plasma lipoproteins of a prudent weight-reducing diet, with or without exercise, in overweight men and women. New Engl J Med 191; 325: 461–466.Google Scholar
  49. 49.
    Andersen RE, Wadden TA, Bartlett SJ, Vogt RA, Weinstock RS. Relation of weight loss to changes in serum lipids and lipoproteins in obese women. Am J Clin Nutr 1995; 62: 350–357.PubMedGoogle Scholar
  50. 50.
    Jakicic JM, Wing RR, Butler BA, Robertson RJ. Prescribing exercise in multiple short bouts versus one continuous bout: effects on adherence, cardiorespiratory fitness, and weight loss in overweight women. Int J Obes 1995; 19: 893–901.Google Scholar
  51. 51.
    Martin JE. Strategies to enhance patient exercise compliance. In: Exercise in Modern Medicine. Franklin BA, Gordon S, Timmis GC, eds. Baltimore. Williams and Wilkins, pp. 280–291, 1989.Google Scholar
  52. 52.
    Epstein LH, Wing RR, Koeske R, Valoski A. A comparison of lifestyle exercise, aerobic exercise, and calisthenics on weight loss in obese children. Behav Ther 1985; 16: 345–356.CrossRefGoogle Scholar
  53. 53.
    Epstein LH, Valoski A, Wing RR, McCurley J. Ten year outcomes of behavioral family based treatment for childhood obesity. Health Psychol 1994; 13: 373–383.PubMedCrossRefGoogle Scholar
  54. 54.
    Wadden TA, Letizia KA. Predictors of attrition and weight loss in patients treated by moderate and severe caloric restriction. In: Treatment of the Seriously Obese Patient. Wadden TA, VanItallie TB, eds. New York: The Guilford Press, pp. 383–410, 1992.Google Scholar
  55. 55.
    Jeffery RW, Wing RR, Stunkard AJ. Behavioral treatment of obesity: the state of the art. Behav Ther 1978; 9: 189–199.CrossRefGoogle Scholar
  56. 56.
    Wadden TA, Bartlett S, Letizia KA, Foster GD, Stunkard AJ, Conill A. Relationship of dieting history to resting metabolic rate, body composition, eating behavior and subsequent weight loss. Am J Clin Nutr 1992; 56: 2065–2115.Google Scholar
  57. 57.
    Wing RR, Jeffery RW, Hellerstedt WL. A prospective study of effects of weight cycling on cardiovascular risk factors. Arch Intern Med 1995; 155: 1416–1422.PubMedCrossRefGoogle Scholar
  58. 58.
    Marcus MD, Wing RR, Ewing L, Kern E, Gooding W, McDermott M. Psychiatric disorders among obese binge eaters. Int J Eating Disord 1990; 9: 69–77.CrossRefGoogle Scholar
  59. 59.
    Yanovski SZ. Binge eating disorder: current knowledge and future directions. Obes Res 1993; 1 (4): 306–324.PubMedGoogle Scholar
  60. 60.
    Marcus MD, Wing RR, Hopkins J. Obese binge eaters: affect, cognitions, and response to behavioral weight control. J Consult Clin Psychol 1988; 56: 433–439.PubMedCrossRefGoogle Scholar
  61. 61.
    Yanovski SZ, Gormally JF, Leser MS, Gwirtsman HE, Yanovski JA. Binge eating disorder affects outcome of comprehensive very-low-calorie diet treatment. Obes Res 1994; 2: 205–212.PubMedGoogle Scholar
  62. 62.
    Kumanyika SK, Obarzanek E, Stevens VJ, Hebert PR, Whelton PK. Weight-loss experience of black and white participants in NHLBI-sponsored clinical trials. Am J Clin Nutr 1991; 53: 1631–1638.Google Scholar
  63. 63.
    Kumanyika S. Obesity in black women. Epidemiol Rev 1987; 9: 31–50.PubMedGoogle Scholar
  64. 64.
    McNabb WL, Quinn MT, Rosing L. Weight loss program for inner-city black women with noninsulin-dependent diabetes mellitus: PATHWAYS. J Am Diet Assoc 1993; 93: 75–77.PubMedCrossRefGoogle Scholar
  65. 65.
    Harris JK, French SA, Jeffery RW, McGovern PG, Wing RR. Dietary and physical activity correlates of long-term weight loss. Obes Res 1994; 2 (4): 307–313.PubMedGoogle Scholar
  66. 66.
    Holden JH, Darga LL, Olson SM, Stettner DC, Ardito EA, Lucas CP. Long-term follow-up of patients attending a combination very-low calorie diet and behaviour therapy weight loss programme. Int J Obesity 1992; 16: 605–613.Google Scholar
  67. 67.
    Guare JC, Wing RR, Marcus MD, Epstein LH, Burton LR, Gooding WE. Analysis of changes in eating behavior and weight loss in type II diabetic patients. Diabetes Care 1989; 12: 500–503.PubMedCrossRefGoogle Scholar

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© Springer Science+Business Media New York 1997

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  • Rena R. Wing

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