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The ASMBS Textbook of Bariatric Surgery pp 147–155Cite as

Lifestyle Modification for the Treatment of Obesity

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Abstract

Despite the success of bariatric surgery in producing massive weight loss, as well as improvement in morbidity and mortality, less than 1 % of those who meet the National Institutes of Health’s criteria for bariatric surgery present for surgery each year. The remaining individuals likely could experience improvements in their health with even modest weight loss. Many of these individuals likely make efforts to lose weight, either as a result of self-motivation or physician recommendation. The most commonly practiced treatment is lifestyle modification, undertaken in a self-directed fashion, through a self-help book or program, or commercial weight-loss program. The obesity treatment literature has consistently found that individuals who engage in lifestyle modification interventions can lose approximately 7–10 % of their initial body weight and experience clinically significant improvements in weight-related health problems.

This chapter will focus on lifestyle modification approaches to treat obesity. We begin with an overview of lifestyle modification. We then summarize the main findings from the well-established scientific literature in this area and highlight the results from some of the major studies over the past decade. We conclude the chapter by discussing the use of lifestyle modification approaches to improve outcomes following bariatric surgery, as well as discuss other cognitive-behavioral approaches to weight control that are growing in popularity.

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References

  1. Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev. 1977;84(2):191–215.

    Article  PubMed  CAS  Google Scholar 

  2. Glanz K, Rimer BK, Viswanath K. Health behavior and health education: theory, research, and practice. 4th ed. San Francisco: Jossey-Bass, Inc.; 2008.

    Google Scholar 

  3. Painter JE, Borba CP, Hynes M, Mays D, Glanz K. The use of theory in health behavior research from 2000 to 2005: a systematic review. Ann Behav Med. 2008;35(3):358–62. Epub 2008 Jul 17.

    Article  PubMed  Google Scholar 

  4. Rothman AJ. Toward a theory-based analysis of behavioral maintenance. Health Psychol. 2000;19:64–9.

    Article  PubMed  CAS  Google Scholar 

  5. Kushner RF, Sarwer DB. Medical and behavioral evaluation of patients with obesity. Psychiatr Clin North Am. 2011;34(4):797–812.

    Article  PubMed  Google Scholar 

  6. Diabetes Prevention Program Research Group. The Diabetes Prevention Program: description of lifestyle intervention. Diabetes Care. 2002;25(12):2165–71.

    Article  Google Scholar 

  7. U.S. Department of Agriculture, U.S. Department of Health and Human Services. Dietary Guidelines for Americans. Washington, DC (2010). Available from: http://www.health.gov/dietaryguidelines/2010.asp.

  8. Heymsfield SB, van Mierlo CA, van der Knaap HC, Heo M, Frier HI. Weight management using a meal replacement strategy: meta and pooling analysis from six studies. Int J Obes. 2003;27(5):537–49.

    Article  CAS  Google Scholar 

  9. Blair SN, Leermakers EA. Exercise and weight management. In: Wadden TA, Stunkard AJ, editors. Handbook of obesity treatment. New York: Guilford Press; 2002. p. 283–300.

    Google Scholar 

  10. Wadden TA, Butryn ML, Byrne KJ. Efficacy of lifestyle modification for long-term weight control. Obes Res. 2004;12(Suppl):151S–62.

    Article  PubMed  Google Scholar 

  11. Jakicic JM, Winters C, Lang W, Wing RR. Effects of intermittent exercise and use of home exercise equipment on adherence, weight loss, and fitness in overweight women: a randomized trial. J Am Med Assoc. 1999;282(16):1554–60.

    Article  CAS  Google Scholar 

  12. Jeffery RW, Wing RR, Sherwood NE, Tate DF. Physical activity and weight loss: does prescribing higher physical activity goals improve outcome? Am J Clin Nutr. 2003;78(4):684–9.

    PubMed  CAS  Google Scholar 

  13. Wing RR, Hill JO. Successful weight loss maintenance. Annu Rev Nutr. 2001;21:323–41.

    Article  PubMed  CAS  Google Scholar 

  14. Wing RR. Physical activity in the treatment of the adulthood overweight and obesity: current evidence and research issues. Med Sci Sports Exerc. 1999;31(11 Suppl):S547–52.

    Article  PubMed  CAS  Google Scholar 

  15. World Health Organization. Obesity: preventing and managing the global epidemic. Geneva: World Health Organization; 1998.

    Google Scholar 

  16. National Institutes of Health/National Heart, Lung, and Blood Institute. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults. Obes Res. 1998;6:51S–210.

    Article  Google Scholar 

  17. Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393–403.

    Article  PubMed Central  Google Scholar 

  18. Diabetes Prevention Program Research Group. Effects of withdrawal from metformin on the development of diabetes in the diabetes prevention program. Diabetes Care. 2003;26(4):977–80.

    Article  Google Scholar 

  19. Look AHEAD Research Group. Long term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes: four year results of the Look AHEAD trial. Arch Intern Med. 2010;170(17):1566–75.

    Google Scholar 

  20. Wadden TA, Volger S, Sarwer DB, Vetter ML, Tsai AG, Berkowitz RI, et al. A two-year randomized trial of obesity treatment in primary care practice. N Engl J Med. 2011;365(21):1969–79.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  21. Appel L, Clark J, Yeh H, Wang NY, Coughlin JW, Daumit G, et al. Comparative effectiveness of weight-loss interventions in clinical practice. N Engl J Med. 2011;365(21):1959–68.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  22. Weinger K, Beverly EA, Lee Y, Sitnokov L, Ganda OP, Cabellero AE. The effect of a structured behavioral intervention on poorly controlled diabetes: a randomized controlled trial. Arch Intern Med. 2011;171(22):1990–9.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Perri MG, Corsica JA. Improving the maintenance of weight lost in behavioral treatment of obesity. In: Wadden TA, Stunkard AJ, editors. Handbook of obesity treatment. New York: Guilford Press; 2002. p. 357–79.

    Google Scholar 

  24. Vetter ML, Ritter S, Wadden TA, Sarwer DB. Comparison of bariatric surgical procedures on diabetes remission: efficacy and mechanisms. Diabetes Spectr. 2012;25:200–10.

    Article  PubMed  PubMed Central  Google Scholar 

  25. National Weight Control Registry. http://www.nwcr.ws/. Accessed 28 Feb 2013.

  26. Wing RR, Tate DF, Gorin AA, Raynor HA, Fava JL. A self-regulation program for maintenance of weight loss. N England J Med. 2006;355(15):1563–71.

    Article  CAS  Google Scholar 

  27. Donnelly JF, Smith BK, Dunn L, Mayo MM, Jacobsen DJ, Stewart EE, et al. Comparison of a phone vs. clinic approach to achieve 10% weight loss. Int J Obes. 2007;31:1270–6.

    Article  CAS  Google Scholar 

  28. Eakin E, Reeves M, Lawler S, Graves N, Oldenburg B, Del Mar C, et al. Telephone counseling for physical activity and diet in primary care patients. Am J Prev Med. 2009;36(2):142–9.

    Article  PubMed  Google Scholar 

  29. Perri M, Limacher M, Durning P, Janicke JM, Lutes LD, Bobroff LB, et al. Extended-Care programs for weight management in rural communities. Arch Intern Med. 2008;168(21):2347–54.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Sherwood N, Crain A, Martinson B, Hayes MG, Anderson JD, Clausen JM, et al. Keep it off: a phone-based intervention for long-term weight-loss maintenance. Contemp Clin Trials. 2011;32:551–60.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Sjostrom L, Lindroos AK, Peltonen M, Torgerson J, Bouchard C, Carlsson B, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351:2683–93.

    Article  PubMed  Google Scholar 

  32. Sjostrom L, Narbro K, Sjostrom CD, Karason K, Larsson B, Wedel H, et al. Swedish Obese Subjects Study. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357:741–52.

    Article  PubMed  Google Scholar 

  33. Sarwer DB, Dilks RJ, West-Smith L. Dietary intake and eating behavior after bariatric surgery: threats to weight loss maintenance and strategies for success. Surg Obes Relat Dis. 2011;7(5):644–51.

    Article  PubMed  Google Scholar 

  34. Bond DS, Jakicic JM, Unick JL, Vithiananthan S, Pohl D, Roye GD. Pre- to postoperative physical activity changes in bariatric surgery patients: self report vs. objective measures. Obesity. 2010;18(12):2395–7.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Bond D, Thomas J, Ryder B, Vithiananthan S, Pohl D, Wing RR. Ecological momentary assessment of the relationship between intention and physical activity behavior in bariatric surgery patients. Int J Behav Med. 2013;20(1):82–7.

    Article  PubMed  PubMed Central  Google Scholar 

  36. King W, Belle S, Eid G, Dakin GF, Inabnet WB, Mitchell JE, et al. Physical activity levels of patients undergoing bariatric surgery in the Longitudinal Assessment of Bariatric Surgery study. Surg Obes Relat Dis. 2008;4(6):721–8.

    Article  PubMed  PubMed Central  Google Scholar 

  37. King W, Hsu J, Belle S, Courcoulas AP, Eid GM, Flum DR, et al. Pre-to postoperative changes in physical activity: report from the Longitudinal Assessment of Bariatric Surgery study. Surg Obes Relat Dis. 2011;7(6):548–57.

    Google Scholar 

  38. Bond D, Phelan S, Wolfe L, Evans RK, Meador JG, Kellum JM, et al. Becoming physically active after bariatric surgery is associated with improved weight loss and health-related quality of life. Obesity. 2009;17(1):78–83.

    Article  PubMed  Google Scholar 

  39. Shah M, Snell P, Rao S, Adams-Huet B, Quittner C, Livingston EH, et al. High-volume exercise program in obese bariatric surgery patients: a randomized, controlled trial. Obesity. 2011;19:1826–34.

    Article  PubMed  Google Scholar 

  40. Dixon J, Laurie C, Anderson M, Hayden MJ, Dixon ME, O’Brien PE. Motivation, readiness to change, and weight loss following adjustable gastric band surgery. Obesity. 2009;17:698–705.

    Article  PubMed  Google Scholar 

  41. Harper J, Madan AK, Ternovits CA, Tichansky DS. What happens to patients who do not follow-up after bariatric surgery? Am Surg. 2007;73:181–4.

    PubMed  Google Scholar 

  42. Kaiser KA, Franks S, Smith A. Positive relationship between support group attendance and one-year postoperative weight loss in gastric banding patients. Obes Relat Dis. 2011;7(1):89–93.

    Article  Google Scholar 

  43. Livhits M, Mercado C, Yermilov I, Parikh JA, Dutson E, Mehran A, Ko CY, Gibbons MM. Exercise following bariatric surgery: systematic review. Obes Surg. 2010;20(5):657–65.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Papalazarou A, Yannakoulia M, Kavouras SA, Komesidou V, Dimitriadis G, Papakonstantinou A, Sidossis LS. Lifestyle intervention favorably affects weight loss and maintenance following obesity surgery. Obesity. 2010;18(7):1348–53. Epub 2009 Oct 15.

    Article  PubMed  CAS  Google Scholar 

  45. Faria S, de Oliveira KE, Lins R, Faria O. Nutritional management of weight regain after bariatric surgery. Obes Surg. 2010;20:135–9.

    Article  PubMed  Google Scholar 

  46. Kalarchian MA, Marcus MD, Courcoulas AP, Cheng Y, Levine MD, Josbeno D. Optimizing long-term weight control after bariatric surgery: a pilot study. Surg Obes Relat Dis. 2012;8(6):710–5.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Sarwer DB, Moore RH, Spitzer JC, Wadden TA, Raper SE, Williams NN. A pilot study investigating the efficacy of postoperative dietary counseling to improve outcomes after bariatric surgery. Surg Obes Relat Dis. 2012;8(5):561–8.

    Article  PubMed  Google Scholar 

  48. Tate DF, Jackvony MPH, Wing RR. Effects of internet behavioral counseling on weight loss in adults at risk for type 2 diabetes: a randomized trial. J Am Med Assoc. 2003;289(14):1833–6. doi:10.1001/jama.289.14.1833.

    Article  Google Scholar 

  49. Volpp KG, John LK, Troxel AB, Norton L, Fassbender J, Loewenstein G. Financial incentive-based approaches for weight loss: a randomized trial. J Am Med Assoc. 2008;300(22):2631–7.

    Article  CAS  Google Scholar 

  50. West DS, DiLillo V, Bursac Z, Gore SA, Greene PG. Motivational interviewing improves weight loss in women with type 2 diabetes. Diabetes Care. 2007;30(5):1081–7. Epub 2007 Mar 2.

    Article  PubMed  Google Scholar 

  51. Hayes SC, Strosahl K, Wilson KG. Acceptance and commitment therapy: the process and practice of mindful change. 2nd ed. New York: Guilford Press; 2012.

    Google Scholar 

  52. Forman EM, Herbert JD. New directions in cognitive behavior therapy: acceptance-based therapies. In: O’Donohue W, Fisher JE, editors. General principles and empirically supported techniques in cognitive behavior therapy. Hoboken: Wiley; 2009. p. 77–101.

    Google Scholar 

  53. Forman EM, Hoffman K, McGrath KB, Herbert J, Brandsma L, Lowe MR. A comparison of acceptance- and control-based strategies for coping with food cravings: an analog study. Behav Res Ther. 2007;45(10):2372–86. Epub 2007 Apr 18.

    Article  PubMed  Google Scholar 

  54. Forman E, Hoffman K, Juarascio A, Butryn M, Herbert J. Comparison of acceptance-based and standard cognitive-based coping strategies for craving sweets in overweight and obese women. Eat Behav. 2013;14(1):64–8.

    Article  PubMed  Google Scholar 

  55. Lillis J, Hayes SC, Bunting K, Masuda A. Teaching acceptance and mindfulness to improve the lives of the obese: a preliminary test of a theoretical model. Ann Behav Med. 2009;37(1):58–69. Epub 2009 Feb 28.

    Article  PubMed  Google Scholar 

  56. Niemeier HM, Leahey T, Palm Reed K, Brown RA, Wing RR. An acceptance-based behavioral intervention for weight loss: a pilot study. Behav Ther. 2012;43(2):427–35. Epub 2011 Dec 1.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Forman EM, Butryn M, Hoffman KL, Herbert JD. An open trial of an acceptance-based behavioral treatment for weight loss. Cogn Behav Prac. 2009;16:223–35.

    Article  Google Scholar 

  58. Sarwer DB, Wadden TA, Moore RH, Baker AW, Gibbons LM, Raper SE, et al. Reoperative eating behavior, postoperative dietary adherence, and weight loss after gastric bypass surgery. Surg Obes Relat Dis. 2008;4(5):640–6. Epub 2008 Jun 30.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Engstrom D. Eating mindfully and cultivating satisfaction: modifying eating patterns in a bariatric surgery patient. Bariat Nurs Surg Patient Care. 2007;2:245–50.

    Article  Google Scholar 

  60. Leahey TM, Crowther JH, Irwin SR. A cognitive-behavioral mindfulness group therapy intervention for the treatment of binge eating in bariatric surgery patients. Cogn Behav Pract. 2008;15:364–75.

    Article  Google Scholar 

  61. Weineland S, Arvidsson D, Kakoulidis TP, Dahl J. Acceptance and commitment therapy for bariatric surgery patients, a pilot RCT. Obes Res Clin Pract. 2012;6(1):e21–30.

    Article  Google Scholar 

Additional Readings

  • Bandura A. Social foundations of thought and action: a social cognitive theory. Englewood Cliffs: Prentice Hall; 1986.

    Google Scholar 

  • Brolin RE, Kenler HA, Gorman RC, Cody RP. The dilemma of outcome assessment after operations for morbid obesity. Surgery. 1989;105:337–46.

    PubMed  CAS  Google Scholar 

  • Brownell KD. The LEARN program for weight management. Dallas: American Health Publishing; 2000.

    Google Scholar 

  • Brownell KD, Horgen KB. Food fight: the inside story of America’s obesity crisis and what we can do about it. Chicago: Contemporary Books; 2003.

    Google Scholar 

  • Funnell MM, Anderson RM, Ahroni JH. Empowerment and self-management after weight loss surgery. Obes Surg. 2005;15:417–22.

    Article  PubMed  Google Scholar 

  • Green BB, McAfee T, Hindmarsh M, Madsen L, Caplow M, Buist D. Effectiveness of telephone support in increasing physical activity in primary care patients. Am J Prev Med. 2002;22(3):177–83.

    Article  PubMed  Google Scholar 

  • Hooper N, Sandoz EK, Ashton J, Clarke A, McHugh L. Comparing thought suppression and acceptance as coping techniques for food cravings. Eat Behav. 2012;13(1):62–4. Epub 2011 Oct 19.

    Article  PubMed  Google Scholar 

  • Klem ML, Wing RR, McGuire MT, Seagle HM, Hill J. A descriptive study of individuals successful at long-term maintenance of substantial weight loss. Am J Clin Nutr. 1997;66:239–46.

    PubMed  CAS  Google Scholar 

  • Leventhal H, Cameron L. Behavioral theories and the problem of compliance. Patient Educ Couns. 1987;10:117–36.

    Article  Google Scholar 

  • Leventhal H, Zimmerman R, Gutmann M. Compliance: a self-regulation perspective, Handbook of Behavioral Medicine. New York: Pergamon; 1984.

    Google Scholar 

  • National Heart, Lung, and Blood Institute (NHLBI) and the North American Association for the Study of Obesity (NAASO). The practical guide: identification, evaluation, and treatment of overweight and obesity in adults. Bethesda: National Institutes of Health; 2000.

    Google Scholar 

  • Pontiroli AE, Fossati A, Vedani P, Fiorilli M, Folli F, Paganelli M, et al. Post-surgery adherence to scheduled visits and compliance, more than personality disorders, predict outcome of bariatric restrictive surgery in morbidly obese patients. Obes Surg. 2007;17:1492–7.

    Article  PubMed  Google Scholar 

  • Poole NA, Atar AA, Kuhanendran D, Bidlake L, Fiennes A, MCluskey S, et al. Compliance with surgical after-care following bariatric surgery for morbid obesity: a retrospective study. Obes Surg. 2005;15:261–5.

    Article  PubMed  Google Scholar 

  • Shen R, Dugay G, Rajaram K, Cabrera I, Siegel N, Ren CJ. Impact of patient follow-up on weight loss after bariatric surgery. Obes Surg. 2004;14:514–9.

    Article  PubMed  Google Scholar 

  • Stevens VJ, Funk KL, Brantley PJ, Erlinger TP, Myers VH, Champagne CM, et al. Design and implementation of an interactive website to support long-term maintenance of weight loss. J Med Internet Res. 2008;10(1):e1.

    Article  PubMed  PubMed Central  Google Scholar 

  • Svetkey LP, Stevens VJ, Brantley PJ, Appel LJ, Hollis JF, Loria CM, et al. Comparison of strategies for sustaining weight loss: the weight loss maintenance randomized controlled trial. J Am Med Assoc. 2008;299(10):1139–48.

    Article  CAS  Google Scholar 

  • Tate DF, Wing RR, Winett RA. Using internet technology to deliver a behavioral weight loss program. J Am Med Assoc. 2001;285(9):1172–7.

    Article  CAS  Google Scholar 

  • U.S. Department of Agriculture, U.S. Department of Health and Human Services. Dietary Guidelines for Americans. Washington, DC (2005). Available from: http://www.health.gov/dietaryguidelines/dga2005/document/default.htm.

  • Wadden TA, Foster GD, Letizia KA, Mullen JL. Long-term effects of dieting on resting metabolic rate in obese outpatients. JAMA. 1990;264(6):707–11.

    Article  PubMed  CAS  Google Scholar 

  • Wing RR, Jakicic J, Neiberg R, Lang W, Blair SN, Cooper L, Look AHEAD Research Group, et al. Fitness, fatness, and cardiovascular risk factors in type 2 diabetes: look ahead study. Med Sci Sports Exerc. 2007;39(12):2107–16.

    Article  PubMed  Google Scholar 

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Acknowledgments

Completion of this chapter was supported, in part, by grants:

NIH Grant HL109235

NIDDK Grant 1RC1DK086132

University of Pennsylvania Diabetes Research Center Grant 2P30DK019525-36

NIH Grant R01-DK072452

NIH Grant NCT00721838

Disclosures

Disclosures Dr. Sarwer has received consulting compensation from Allergan, BAROnova, EnteroMedics, and Ethicon Endo-Surgery, which are manufacturers of products for obesity. None of these entities provided financial support for his work on this manuscript.

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Authors and Affiliations

  1. Department of Psychiatry, Director of Clinical Services Center for Weight and Eating Disorders, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

    David B. Sarwer PhD

  2. Department of Psychology, Drexel University, 3201 Chestnut Street, Philadelphia, PA, 19104, USA

    Meghan L. Butryn PhD, Evan Forman PhD & Lauren E. Bradley MS

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  1. David B. Sarwer PhD
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  2. Meghan L. Butryn PhD
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  3. Evan Forman PhD
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  4. Lauren E. Bradley MS
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Corresponding author

Correspondence to David B. Sarwer PhD .

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Editors and Affiliations

  1. GI/Nutrition, Geisinger Medical Center, Danville, Pennsylvania, USA

    Christopher Still

  2. Department of Weight and Eating Disorders, University of Pennsylvania, Philadelphia, Pennsylvania, USA

    David B. Sarwer

  3. Policy Initiatives and Advocacy, American Dietetic Association, Falls Church, Virginia, USA

    Jeanne Blankenship

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Sarwer, D.B., Butryn, M.L., Forman, E., Bradley, L.E. (2014). Lifestyle Modification for the Treatment of Obesity. In: Still, C., Sarwer, D., Blankenship, J. (eds) The ASMBS Textbook of Bariatric Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1197-4_15

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