Overview and the Future of Obesity Treatment

  • Lisa Terre
  • Walker S. C. Poston II
  • John P. Foreyt
Part of the Nutrition and Health book series (NH)


This chapter addresses the future of obesity treatment. To provide a foundation for discussing the future, we begin with a brief background on the importance of obesity treatment and review of current interventions. We then examine issues and controversies that we believe will affect the future of obesity treatment including the relevance of body mass index (BMI) to healthy weight, the impact of short-term weight changes and normalization of comorbid conditions on long-term health, the cost-effectiveness and feasibility of continuous care to improve weight-loss maintenance, the shift toward more comprehensive health models in obesity treatment, and promising directions in the prevention of obesity. Table 1 overviews the organization of the chapter.


Bariatric Surgery Obese Patient Gastric Bypass Eating Disorder Obesity Treatment 
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.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Flegal, KM, Carroll, MS, Ogden, CL, Johnson, CL. Prevalence and trends in obesity among US adults, 1999–2000. JAMA 2002; 288:1723–1727.CrossRefGoogle Scholar
  2. 2.
    Denke MA, Sempos CT, Grundy SM. Excess body weight: an under-recognized contributor to dyslipidemia in White American women. Arch Intern Med 1994; 154:401–410.CrossRefGoogle Scholar
  3. 3.
    Denke MA, Sempos CT, Grundy SM. Excess body weight: an under-recognized contributor to high blood cholesterol levels in White American women. Arch Intern Med 1993; 153:1093–1103.CrossRefGoogle Scholar
  4. 4.
    MacMahon S, Cutler J, Brittain E, et al. Obesity and hypertension: epidemiological and clinical issues. Eur Heart J 1987; 8(Suppl B):57–70.Google Scholar
  5. 5.
    National Task Force on the Prevention and Treatment of Obesity. Overweight, obesity, and health risk. Arch Intern Med 2000; 160:898–904.CrossRefGoogle Scholar
  6. 6.
    Pi-Sunyer FX. Medical hazards of obesity. Ann Intern Med 1993;119:655–660.Google Scholar
  7. 7.
    Solomon CG, Willett WC, Manson JE. Body weight and mortality. In: VanItallie TB, Simonpoulos AP, eds. Obesity: New directions in assessment and management. Charles Press, Philadelphia, PA, 1995, pp. 1–11.Google Scholar
  8. 8.
    Troiano RP, Frongillo EA Jr, Sobal J, et al. The relationship between body weight and mortality: a quantitative analysis of combined information from existing studies. Int J Obes Relat Metab Disord 1996; 20:63–75.Google Scholar
  9. 9.
    Manson JE, Willett WC, Stampfer MJ, et al. Body weight and mortality among women. N Engl J Med 1995; 333:677–685.CrossRefGoogle Scholar
  10. 10.
    Allison, DB, Fontaine, KR, Manson JE, et al. Annual deaths attributable to obesity in the United States. JAMA 1999; 282:1530–1538.CrossRefGoogle Scholar
  11. 11.
    Wolf A. Economic outcomes of the obese patient. Obesity Res, 2002; 10:58S–62S.Google Scholar
  12. 12.
    Finkelstein E, Fiebelkorn I, Wang G. National medical spending attributable to overweight and obesity: how much, and who’s paying? Health Affairs 2003; W3:219–226.Google Scholar
  13. 13.
    Pronk N, Goodman M, O’Connor P, Martinson B. Relationship between modifiable health risks and short-term health care charges. JAMA 1999; 282:2235–2239.CrossRefGoogle Scholar
  14. 14.
    Sjöström L, Narbro, K, Sjöström D. Costs and benefits when treating obesity. Int J Obes Relat Metab Disord 1995; 19(Suppl 6):S9–S12.Google Scholar
  15. 15.
    Sturm R. The effects of obesity, smoking, and drinking on medical problems and costs. Health Affairs 2002; 21:245–253.CrossRefGoogle Scholar
  16. 16.
    Thompson D, Wolf A. The medical-care cost burden of obesity. Obes Rev 2001; 2:189–197.CrossRefGoogle Scholar
  17. 17.
    Gortmaker SL, Must A, Perrin JM, et al. Social and economic consequences of overweight in adolescence and young adulthood. N Engl J Med 1993; 329:1008–1012.CrossRefGoogle Scholar
  18. 18.
    Enzi G. Socioeconomic consequences of obesity: the effect of obesity on the individual. Pharmaco Econom 1994; 5(Suppl 1):54–57.Google Scholar
  19. 19.
    Sarlio-Lähteenkorva S, Stunkard AJ, Rissanen A. Psychosocial factors and quality of life in obesity. Int J Obes Relat Metab Disord 1995; 19(Suppl 6):S1–S5.Google Scholar
  20. 20.
    Dattilo AM, Kris-Etherton PM. Effects of weight reduction on blood lipids and lipoproteins: a meta-analysis. Am J Clin Nutr 1992; 56:320–328.Google Scholar
  21. 21.
    Kanders BS, Blackburn GL. Reducing primary risk factors by therapeutic weight loss. In: Wadden TA, VanItallie TB, eds. Treatment of the seriously obese patient. Guilford, New York, NY, 1992, pp. 213–230.Google Scholar
  22. 22.
    Foreyt JP, Goodrick GK. Attributes of successful approaches to weight loss and control. Appl Prev Psychol 1994; 3:209–215.CrossRefGoogle Scholar
  23. 23.
    Perri MG, Fuller PR. Success and failure in the treatment of obesity: where do we go from here? Medicine, Exercise, Nutrition, and Health 1995; 4:255–272.Google Scholar
  24. 24.
    Stunkard AJ. An overview of current treatments for obesity. In: Wadden TA, VanItallie TB, eds. Treatment of the seriously obese patient. Guilford, New York, NY, 1992, pp. 33–43.Google Scholar
  25. 25.
    Wadden TA, Brownell KD, Foster GD. Obesity: Responding to the global epidemic. J Consult Clin Psychol 2002; 70:510–525.CrossRefGoogle Scholar
  26. 26.
    Kramer FM, Jeffery RW, Forster JL, et al. Long-term follow-up of behavioral treatment for obesity: patterns of weight gain among men and women. Int J Obes Relat Metab Disord 1989; 13:124–136.Google Scholar
  27. 27.
    Stalonas PM, Perri MG, Kerzner AB. Do behavioral treatments of obesity last? a five-year follow-up investigation. Addict Behav 1984; 9:175–184.CrossRefGoogle Scholar
  28. 28.
    Wadden TA, Sternberg JA, Letizia KA, et al. Treatment of obesity by very low calorie diet, behavioral therapy, and their combination: a five-year perspective. Int J Obes Relat Metab Disord 1989; 13(Suppl 2):39–46.Google Scholar
  29. 29.
    Perri MG, Nezu AM, Viegener BJ. Improving the long-term management of obesity: theory, research, and clinical guidelines. Wiley, New York, NY, 1992, pp. 3–124.Google Scholar
  30. 30.
    Lee I, Blair S, Allison D, et al. Epidemiologic data on the relationships of caloric intake, energy balance, and weight gain over the life span with longevity and morbidity. Journals of Gerontology: SERIES A 2001; 56A:7–19.Google Scholar
  31. 31.
    Perri MG, Shapiro RM, Ludwig WW, et al. Maintenance strategies for the treatment of obesity: an evaluation of relapse prevention training and posttreatment contact by mail and telephone. J Consult Clin Psychol 1984; 52: 404–413.CrossRefGoogle Scholar
  32. 32.
    Perri MG, McAdoo, WG, McAllister DA, et al. Effects of peer support and therapist contact on long-term weight loss. J Consult Clin Psychol 1987; 55:615–617.CrossRefGoogle Scholar
  33. 33.
    Perri MG, McAllister DA, Gange JJ, et al. Effects of four maintenance programs on the long-term management of obesity. J Consult Clin Psychol 1988; 56:529–534.CrossRefGoogle Scholar
  34. 34.
    Baum JG, Clark HB, Sandler J. Preventing relapse in obesity through posttreatment maintenance systems: comparing the relative efficacy of two levels of therapist support. J Behav Med 1991; 14:287–302.CrossRefGoogle Scholar
  35. 35.
    Bray GA. Use and abuse of appetite-suppressant drugs in the treatment of obesity. Ann Intern Med 1993; 119:707–713.Google Scholar
  36. 36.
    Haddock C, Poston W, Dill P, Foreyt J, Ericsson M. Pharmacotherapy for obesity: a quantitative analysis of four decades of published randomized clinical trials. Int J Obes 2002; 26:262–273.CrossRefGoogle Scholar
  37. 37.
    Abenhaim L, Moride Y, Brenot F, et al. Appetite-suppressant drugs and the risk of primary pulmonary hypertension. JAMA 1996; 335:609–616.Google Scholar
  38. 38.
    Centers for Disease Control (CDC). Cardiac valvulopathy associated with fenfluramine or dexfenfluramine: U.S. Department of Health and Human Services Interim Public Health Recommendations, November 1997. MMWR 1997; 46:1061–1066.Google Scholar
  39. 39.
    Connolly HM, Crary JL, McGoon MD, et al. Valvular heart disease associated with fenfluramine-phentermine. N Engl J Med 1997; 337:581–588.CrossRefGoogle Scholar
  40. 40.
    Stunkard AJ, Harris JR, Pederson NL, et al.The body mass of twins reared apart. N Engl J Med 1990; 322:1483–1487.CrossRefGoogle Scholar
  41. 41.
    Kahn L, Serdula M, Bowman B, Williamson D. Use of prescription weight loss pills among U.S. adults in 1996–1998. Ann Intern Med 2001; 134:282–286.Google Scholar
  42. 42.
    National Institutes of Health (National Heart, Lung, and Blood Institute in cooperation with The National Institute of Diabetes and Digestive and Kidney Disease), Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults 1998. NIH Publication No. 98-4083. US Government Printing Office, Washington, DC.Google Scholar
  43. 43.
    Phelan S, Wadden T. Combining behavioral and pharmacological treatments for obesity. Obes Res 2002; 10:560–574.Google Scholar
  44. 44.
    Frost GL, Bovill-Taylor C, Carter L, et al. Intensive lifestyle intervention combined with the choice of pharmacotherapy improves weight loss and cardiac risk factors in the obese. J Hum Nutr Diet 2002; 15:287–295.CrossRefGoogle Scholar
  45. 45.
    Finer N. Sibutramine: its mode of action and efficacy. Int J Obes Relat Metab Disord 2002; 26:S29–33.CrossRefGoogle Scholar
  46. 46.
    Wadden T, Berkowitz R, Sarwer D, Prus-Wisniewski R. Benefits of lifestyle modification in the pharmacologic treatment of obesity. Arch Intern Med 2001; 161:218–227.CrossRefGoogle Scholar
  47. 47.
    Poston W, Haddock C, Dill P, Thayer B, Foreyt J. Lifestyle treatments in randomized clinical trials of pharmacotherapies for obesity. Obes Res 2001; 9:552–563.Google Scholar
  48. 48.
    Greenway, FL, Ryan DH, Bray G, et al. Pharmaceutical cost savings of treating obesity with weight loss medications. Obes Res 1999; 7:523–531.Google Scholar
  49. 49.
    Drent ML, van der Veen EA. Lipase inhibition: a novel concept in the treatment of obesity. Int J Obes Relat Metab Disord 1993; 17:241–244.Google Scholar
  50. 50.
    Drent ML, Larsson I, William-Olsson T, et al. Orlistat (RO 18-0647), a lipase inhibitor, in the treatment of human obesity: a multiple dose study. Int J Obes Relat Metab Disord 1995; 19:221–226Google Scholar
  51. 51.
    Drent ML, van der Veen EA. First clinical studies with orlistat: a short review. Obes Res 1995; 3(Suppl 4):623S–625S.Google Scholar
  52. 52.
    Finer N, James W, Kopelman P, et al. One-year treatment of obesity: a randomized double-blind, placebo-controlled, multicentre study of orlistat, a gastrointestinal lipase inhibitor. Intern J Obes 2000; 24:306–313.CrossRefGoogle Scholar
  53. 53.
    Heymsfield S, Segal K, Hauptman J, et al. Effects of weight loss with orlistat on glucose tolerance and progression to type 2 diabetes in obese adults. Arch Intern Med 2000; 160:1321–1326.CrossRefGoogle Scholar
  54. 54.
    James W, Avenell A, Broom J, et al. A one-year trial to assess the value of orlistat in the management of obesity. Int J Obes Relat Metab Disord 1997; 21(Suppl 3):S24–S30.Google Scholar
  55. 55.
    Lindgarde F on behalf of the Orlistat Swedish Multimorbidity Study Group. The effect of orlistat on body weight and coronary heart disease risk profile in obese patients: the Swedish Multimorbidity Study. J Int Med 2000; 248:245–254.CrossRefGoogle Scholar
  56. 56.
    Sjostrom L, Rissanen A, Andersen T, et al. Randomised placebo-controlled trial of orlistat for weight loss and prevention of weight regain in obese patients. Lancet 1998: 352:167–172.CrossRefGoogle Scholar
  57. 57.
    Davidson M, Hauptman J, DiGirolamo M, Foreyt J, et al. Weight control and risk factor reduction in obese subjects treated for 2 years with orlistat. JAMA 1999; 281:235–242.CrossRefGoogle Scholar
  58. 58.
    Broom I, Wilding J, Stott P, Myers N. Randomised trial of the effect of orlistat on body weight and cardiovascular disease risk profile in obese patients: UK Multimorbidity Study. Int J Clin Pract 2002; 56: 494–499.Google Scholar
  59. 59.
    Hanefeld M, Sachse G. Diabetes, The effects of orlistat on body weight and glycaemic control in overweight patients with type 2 diabetes: a randomized, placebo-controlled trial. Diab Obes Metab 2002; 4:415–423.CrossRefGoogle Scholar
  60. 60.
    Kelley D, Bray G, Pi-Sunyer F, et al. Clinical efficacy of orlistat therapy in overweight and obese patients with type 2 diabetes: a 1 year randomized controlled trial. Diabetes Care 2002; 25:1033–1041.CrossRefGoogle Scholar
  61. 61.
    Miles J, Leiter L, Hollander, P, et al. Effect of orlistat in overweight and obese patients with type 2 diabetes treated with metformin. Diabetes Care 2002; 25:1123–1128.CrossRefGoogle Scholar
  62. 62.
    Sharma AM, Golay A. Effect of orlistat-induced weight loss on blood pressure and heart rate in obese patients with hypertension. J Hypertens 2002; 29:1873–1878.CrossRefGoogle Scholar
  63. 63.
    Snider L, Malone M. Orlistat use in type 2 diabetes. Ann Pharmacother 2002; 36:1210–1218.CrossRefGoogle Scholar
  64. 64.
    Rissanen A, Lean M, Rossner S, et al. Predictive value of early weight loss in obesity management with orlistat: an evidence-based assessment of prescribing guidelines. Int J Obes Relat Metab Dis 2003; 27:103–109.CrossRefGoogle Scholar
  65. 65.
    McDuffie J, Calis K, Uwaifo G, et al. Three-month tolerability of orlistat in adolescents with obesity-related co-morbid conditions. Obes Res 2002;10:642–650.CrossRefGoogle Scholar
  66. 66.
    Ryan DH, Kaiser P, Bray GA. Sibutramine: a novel new agent for obesity treatment. Obes Res 1995; 3(Suppl 4):553S–559S.Google Scholar
  67. 67.
    Stock MJ. Sibutramine-A review of the pharmacology of a novel anti-obesity agent. Int J Obes Relat Metab Disord 1997; 21(Suppl 1):S25–S29.Google Scholar
  68. 68.
    Bray G, Greenway F. Current and potential drugs for treatment of obesity. Endocrine Reviews 1999; 20:805–875.CrossRefGoogle Scholar
  69. 69.
    Apfelbaum M, Vague P, Ziegler O, et al. Long-term maintenance of weight loss after a very low calorie diet: a randomized blinded trial of the efficacy and tolerability of Sibutramine. Amer J Med 1999; 106:179–184.CrossRefGoogle Scholar
  70. 70.
    James WP, Astrup A, Finer N, et al. Effect of sibutramine on weight maintenance after weight loss: a randomized trial. Lancet 2000; 356:2119–2125.CrossRefGoogle Scholar
  71. 71.
    Lean MEJ: Sibutramine—a review of clinical efficacy. Int J Obes Relat Metab Disord 1997; 21(Suppl 1):S30–S36.Google Scholar
  72. 72.
    Yanovski S, Yanovski, J. Drug therapy: obesity. N Engl J Med 2002; 346:591–602.CrossRefGoogle Scholar
  73. 73.
    McMahon, F, Fujioka K, Singh, B, et al. Efficacy and safety of Sibutramine in obese white and African-American patients with hypertension: a 1-year, double blind placebo controlled, multicenter trial. Arch Int Med 2000; 160:2185–2191.CrossRefGoogle Scholar
  74. 74.
    Wadden T, Berkowitz R, Womble L, et al. Effects of sibutramine plus orlistat in obese women following one year of treatment by sibutramine alone: a placebo-controlled trial. Obes Res 2000; 8:431–437.Google Scholar
  75. 75.
    Berkowitz R, Wadden T, Tershakovec A, Cronquist J. Behavior therapy and sibutramine for the treatment of adolescent obesity. JAMA 2003; 289:1805–1812.CrossRefGoogle Scholar
  76. 76.
    Cummings D, Shannon M. Roles for ghrelin in the regulation of appetite and body weight. Arch Surg 2003; 138:389–396.CrossRefGoogle Scholar
  77. 77.
    Vastag B. Experimental drugs take aim at obesity. JAMA 2003; 289:1763–1764.CrossRefGoogle Scholar
  78. 78.
    Bray G, Tartaglia L. Medicinal strategies in the treatment of obesity. Nature 2000; 404:672–677.Google Scholar
  79. 79.
    Schwartz M, Woods S, Porte D, et al. Central nervous system control of food intake. Nature 2000; 404:661–671.Google Scholar
  80. 80.
    Woods S, Seeley R, Porte D, Schwartz M. Signals that regulate food intake and energy homeostasis. Science 1998; 280:1378–1383.CrossRefGoogle Scholar
  81. 81.
    Kojima M, Hosoda H, Dte Y, et al. Ghrelin is a growth-hormone-releasing acylated peptide from stomach. Nature 1999; 402:656–660.CrossRefGoogle Scholar
  82. 82.
    Weigle D, Cummings D, Newby P, et al. Roles of leptin and ghrelin in the loss of body weight caused by a low fat, high carbohydrate diet. J Clin Endocrinol Metab 2003; 88:1577–1586.CrossRefGoogle Scholar
  83. 83.
    Nakazato M, Murakami N, Date, Y, et al. A role for ghrelin in the central regulation of feeding. Nature 2001; 409:194–198.CrossRefGoogle Scholar
  84. 84.
    Weigle D. Pharmacological therapy of obesity: past, present, and future. J Clin Endocrinol Metab 2003; 88:2462–2469.CrossRefGoogle Scholar
  85. 85.
    Bensaid M, Gary-Bobo M, Esclangon A, et al. The cannabinoid CB1 receptor antagonist SR141716 increases Acrp30 mRNA expression in adipose tissue of obese fa/fa rats and in cultured adipocyte cells. Molec Pharmacol 2003; 63:908–14.CrossRefGoogle Scholar
  86. 86.
    Ravinet T, Arnone M, Delgorge C, et al. Anti-obesity effect of SR141716, a CB1 receptor antagonist, in diet-induced obese mice. Amer J Physiol-RegIntegrative Compar Physiol 2003; 284:R345–53.Google Scholar
  87. 87.
    Williams C, Kirkham T. Anandamide induces overeating: mediation by central cannabinoid (CB1) receptors. Psychopharmacol 1999; 143:315–317.CrossRefGoogle Scholar
  88. 88.
    Ettinger M, Littlejohn T, Schwartz S, et al. Recombinant variant of ciliary neurotrophic factor for weight loss in obese adults: a randomized, dose-ranging study. JAMA 2003; 289:1826–1832.CrossRefGoogle Scholar
  89. 89.
    Huestis M, Gorelick D, Heishman S, et al. Blockade of effects of smoked marijuana by the CB1-selective cannabinoid receptor antagonist SR141716. Arch Gen Psychiatry 2001; 58: 322–328.CrossRefGoogle Scholar
  90. 90.
    Vickers S, Webster, L, Wyatt A, et al. Preferential effects of the cannabinoid CB-sub-1 receptor antaonist, SR 141716, on food intake and body weight gain of obese (fa/fa) compared to lean Zucker rats. Psychopharmacology 2003; 167:103–111.Google Scholar
  91. 91.
    National Task Force on the Prevention and Treatment of Obesity. Very low-calorie diets. JAMA 1993; 270:967–974.CrossRefGoogle Scholar
  92. 92.
    Wadden TA, Bartlett SJ. Very low calorie diets: an overview and appraisal. In: Wadden TA, VanItallie TB, eds. Treatment of the seriously obese patient. Guilford, New York, NY, 1992, pp. 44–79.Google Scholar
  93. 93.
    Kral JG. Surgical treatment of obesity. In: Wadden TA, VanItallie TB, eds. Treatment of the seriously obese patient. Guilford, New York, NY, 1992, pp. 496–506.Google Scholar
  94. 94.
    Brolin R. Bariatric surgery and long-term control of morbid obesity. JAMA 2002; 288: 2793–2796.CrossRefGoogle Scholar
  95. 95.
    Pope G, Birkmeyer J, Finlayson S. National trends in utilization and in-hospital outcomes of bariatric surgery. J Gastrointestinal Surg 2002; 6:855–860.CrossRefGoogle Scholar
  96. 96.
    Benotti PN, Forse RA. The role of gastric surgery in the multidisciplinary management of severe obesity. Am J Surg 1995; 169:361–367.CrossRefGoogle Scholar
  97. 97.
    WHO. Obesity Preventing and Managing the Global Epidemic. World Health Organization, Geneva, Switzerland, 1998.Google Scholar
  98. 98.
    Sjostrom C, Lissner L, Wedel H, Sjostrom L. Reduction in incidence of diabetes, hypertension and lipid disturbances after intentional weight loss induced by bariatric surgery: the SOS Intervention Study. Obesity Res 1999; 7:477–484.Google Scholar
  99. 99.
    Torgerson J, Sjostrom L. The Swedish Obese Subjects (SOS) Study-rationale and results. Int J Obes 2001; 25:S2–S4.CrossRefGoogle Scholar
  100. 100.
    Greenway S, Greenway F, Klein S. Effects of obesity surgery on non-insulin-dependent diabetes mellitus. Arch Surg 2002; 137:1109–1117.CrossRefGoogle Scholar
  101. 101.
    Rubino F, Gagner M. Potential of surgery for curing type 2 diabetes mellitus. Ann Surg 2002; 236:554–559.CrossRefGoogle Scholar
  102. 102.
    Lujan J, Hernandez, Q, Frutos M, et al. Laparoscopic gastric bypass in the treatment of morbid obesity: preliminary results of a new technique. Surgical Endoscopy 2002; 16:1658–1662.CrossRefGoogle Scholar
  103. 103.
    Papasavas PK, Hayetian FD, Caushaj PF, et al. Outcome analysis of laparoscopic Roux-en-Y gastric bypass for morbid obesity: the first 116 cases. Surgical Endoscopy 2002; 16:1653–1657.CrossRefGoogle Scholar
  104. 104.
    Gould, JC, Needleman BJ, Ellison EC, et al. Evolution of minimally invasive bariatric surgery. Surgery 2002; 132:565–571.CrossRefGoogle Scholar
  105. 105.
    Dresel A, Kuhn JA. Establishing a laparoscopic gastric bypass program. Amer J Surg 2002; 184:617–620.CrossRefGoogle Scholar
  106. 106.
    Schauer P, Ikramuddin S, Hamad G, Gourash W. The learning curve for laparoscopic Roux-en-Y gastric bypass is 100 cases. Surg Endoscopy 2003; 17:212–215.CrossRefGoogle Scholar
  107. 107.
    Craig BM, Tseng DS. Cost-effectiveness of gastric bypass for severe obesity. Amer J Med 2002; 113:491–498.CrossRefGoogle Scholar
  108. 108.
    Martin LF, Tan TL, Horn JR, et al. Comparison of the costs associated with medical and surgical treatment of obesity. Surgery 1995; 118:599–607.CrossRefGoogle Scholar
  109. 109.
    Narbro K, Goran A, Jonsson E, et al. Pharmaceutical costs in obese individuals: comparison with a randomly selected population sample and long-term changes after conventional and surgical treatment: the SOS intervention study. Arch Int Med 2002; 162:2061–2069.CrossRefGoogle Scholar
  110. 110.
    Klem M, Wing R, Chang C, et al. A case-control study of successful maintenance of a substantial weight loss: individuals who lost weight through surgery versus those who lost weight through non-surgical means. Int J Obes Relat Metab Disord 2000; 24:573–579.CrossRefGoogle Scholar
  111. 111.
    Brownell KD, Wadden TA. Etiology and treatment of obesity: understanding a serious, prevalent, and refractory disorder. J Consult Clin Psychol 1992; 60:505–517.CrossRefGoogle Scholar
  112. 112.
    Foreyt JP, Poston WSC, Goodrick GK. Future directions in obesity and eating disorders. Addict Behav 1996; 21:767–778.CrossRefGoogle Scholar
  113. 113.
    Institute of Medicine. Weighing the options: criteria for evaluating weight-management programs. National Academy Press, Washington, DC, 1995, pp. 37–63.CrossRefGoogle Scholar
  114. 114.
    Bender R, Trautner C, Spraul M, et al. Assessment of excess mortality in obesity. Am J Epidemiol 1998; 147:42–48.Google Scholar
  115. 115.
    Williamson DF, Pamuk ER. The association between weight loss and increased longevity: a review of the evidence. Ann Intern Med 1993; 119:731–736.Google Scholar
  116. 116.
    Fontaine, K, Redden, D, Wang, C, et al. Years of life lost due to obesity. JAMA 2003; 289:187–193.CrossRefGoogle Scholar
  117. 117.
    Andres R, Muller DC, Sorkin JD. Long-term effects of change in body weight on all-cause mortality: a review. Ann Intern Med 1993; 119:737–743.Google Scholar
  118. 118.
    Williamson, DF, Thompson, TJ, Thun, et al. Intentional weight loss and mortality among overweight individuals with diabetes. Diabetes Care 2000; 23:1499–1504.CrossRefGoogle Scholar
  119. 119.
    Williamson DF, Pamuk ER, Thun M, et al. Prospective study of intentional weight loss and mortality in never-smoking overweight U.S. white women aged 40–64 years. Am J Epidemiol 1995; 141:1128–1141.Google Scholar
  120. 120.
    Foster GD, Sarwer DB, Wadden TA. Psychological effects of weight cycling in obese persons: a review and research agenda. Obes Res 1997; 5:474–488.Google Scholar
  121. 121.
    Blair SN, Shaten J, Brownell K, et al. Body weight change, all-cause mortality, and cause-specific mortality in the Multiple Risk Factor Intervention Trial. Ann Intern Med 1993; 119:749–757.Google Scholar
  122. 122.
    Iribarren C, Sharp DS, Burchfiel CM, et al. Association of weight loss and weight fluctuation with mortality in Japanese American men. N Engl J Med 1995; 333:686–692.CrossRefGoogle Scholar
  123. 123.
    National Task Force on the Prevention and Treatment of Obesity. Weight cycling. JAMA 1994; 272:1196–1202.CrossRefGoogle Scholar
  124. 124.
    Venditti EM, Wing RR, Jakicic JM, et al. Weight cycling, psychological health, and binge eating in obese women. J Consult Clin Psychol 1996; 64:400–405.CrossRefGoogle Scholar
  125. 125.
    Foreyt JP, Brunner RL, Goodrick GK, et al. Psychological correlates of weight fluctuation. Int J Eat Disord 1995; 17:263–275.CrossRefGoogle Scholar
  126. 126.
    Yanovski SZ. Are anorectic agents the “magic bullet” for obesity? Arch Fam Med 1993; 2:1025–1027.CrossRefGoogle Scholar
  127. 127.
    Gullo SP. Food control training as a successor to dieting: a new model for weight management. In: VanItallie TB, Simonpoulos AP, eds. Obesity: new directions in assessment and management. Charles Press, Philadelphia, PA, 1995, pp. 153–171.Google Scholar
  128. 128.
    Perri MG. Improving maintenance of weight loss following treatment by diet and lifestyle modification. In: Wadden TA, VanItallie TB, eds. Treatment of the seriously obese patient. Guilford, New York, NY, 1992, pp. 456–477.Google Scholar
  129. 129.
    Guy-Grand B. Long-term pharmacological treatment of obesity. In: Wadden TA, VanItallie TB, eds. Treatment of the seriously obese patient. Guilford, New York, NY, 1992, pp. 478–495.Google Scholar
  130. 130.
    Institute of Medicine. Weighing the options: criteria for evaluating weight-management programs. National Academy Press, Washington, DC, 1995, pp. 152–170.CrossRefGoogle Scholar
  131. 131.
    APA Practice Directorate. Website: (
  132. 132.
    Kerns R. The new health and behavior assessment and intervention CPT codes: advancing the practice of clinical health psychology. Health Psychologist 2002; 24:10–11.Google Scholar
  133. 133.
    Klem M, Viteri J, Wing R. Primary prevention of weight gain for women aged 25–34: the acceptability of treatment formats. Int J Obes 2000; 24:219–225.CrossRefGoogle Scholar
  134. 134.
    Tate D, Wing R, Winett R. Using internet technology to deliver a behavioral weight loss program. JAMA 2001; 285:1172–1177.CrossRefGoogle Scholar
  135. 135.
    Fries JF, Koop, CE, Beadle CE, et al. Reducing health care costs by reducing the need and demand for medical services. N Engl J Med 1993; 329:321–325.CrossRefGoogle Scholar
  136. 136.
    Foreyt JP, Goodrick GK. The ultimate triumph of obesity. Lancet 1995; 346:134–135.CrossRefGoogle Scholar
  137. 137.
    Curb JD, Marcus EB. Body fat and obesity in Japanese Americans. Am J Clin Nutr 1991; 53:1552S–1555S.Google Scholar
  138. 138.
    James WPT. A public health approach to the problem of obesity. Int J Obes Relat Metab Disord 1995; 19(Suppl. 3):S37–S45.Google Scholar
  139. 139.
    Lissner L, Heitman BL. Dietary fat and obesity: evidence from epidemiology. Eur J Clin Nutr 1995; 49:79–90.Google Scholar
  140. 140.
    Battle EK, Brownell KD. Confronting a rising tide of eating disorders and obesity: treatment vs. prevention and policy. Addict Behav 1996; 21:755–765.CrossRefGoogle Scholar
  141. 141.
    Institute of Medicine. Weighing the options: criteria for evaluating weight-management programs. National Academy Press, Washington, DC, 1995, pp. 102–117.CrossRefGoogle Scholar
  142. 142.
    Mokdad A, Bowman B, Ford E, et al. The continuing epidemics of obesity and diabetes in the United States. JAMA 2001; 286:1195–2000.CrossRefGoogle Scholar
  143. 143.
    Sherwood N, Jeffrey R. The behavioral determinants of exercise: implications for physical activity interventions. Annu Rev Nut 2000; 20:21–44.CrossRefGoogle Scholar
  144. 144.
    US Department of Health and Human Services (USDHHS). Physical Activity and Health: a Report of the Surgeon General. National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, 1996.Google Scholar
  145. 145.
    USDHHS. Healthy People 2010. US Government Printing Office, Washington, DC,2000. Available at Website: ( Scholar
  146. 146.
    USDHHS. Healthy people in healthy communities. Washington, DC: US Government Printing Office, 2001. Available at Website: ( Scholar
  147. 147.
    Serdula M, Mokdad A, Williamson D, et al. Prevalence of attempting weight loss and strategies for controlling weight, JAMA 1999; 282:1353–1358.CrossRefGoogle Scholar
  148. 148.
    Wee C, McCarthy E, Davis R, Phillips R. Physician counseling about exercise. JAMA 1999; 282:1583–1588.CrossRefGoogle Scholar
  149. 149.
    Grilo CM. The role of physical activity in weight loss and weight loss management. Medicine, Exercise, Nutrition, And Health 1995; 4:60–76.Google Scholar
  150. 150.
    Klem ML, Wing RR, McGuire MT, et al. A descriptive study of individuals successful at long-term maintenance of substantial weight loss. Am J Clin Nutr 1997; 66:239–246.Google Scholar
  151. 151.
    Klem M. Successful losers: The habits of individuals who have maintained long-term weight loss. Minnesota Medicine 2000; 83:43–45.Google Scholar
  152. 152.
    McGuire M, Wing R, Klem M, et al. Long-term maintenance of weight loss: do people who lose weight through various weight loss methods use different behaviors to maintain their weight? Int J Obes Relat Metab Disord 1998; 22:572–577.CrossRefGoogle Scholar
  153. 153.
    Wing R, Hill J. Successful weight loss maintenance. Ann Rev Nut 2001; 21:323–341.CrossRefGoogle Scholar
  154. 154.
    Orleans C, Kraft K, Marx J, McGinnis J. Why are some neighborhoods active and others not? charting a new course for research on the policy and environmental determinants of physical activity. Ann Behav Med 2003; 25: 77–79.CrossRefGoogle Scholar
  155. 155.
    Barlow CE, Kohl HW, Gibbons LW, et al. Physical fitness, mortality, and obesity. Int J Obes Relat Metab Disord 1995; 19(Suppl 4):S41–S44.Google Scholar
  156. 156.
    Barker DJP, Hales CN, Fall CHD, et al. Type 2 (non-insulin-dependent) diabetes mellitus, hypertension, and hyperlipidaemia (syndrome X): relation to reduced fetal growth. Diabetologia 1993; 36:62–67.CrossRefGoogle Scholar
  157. 157.
    Dorner G, Plagemann A. Perinatal hyperinsulinism as a possible predisposing factor for diabetes mellitus, obesity, and enhanced cardiovascular risk in later life. Horm Metab Res 1994; 26:213–221.Google Scholar
  158. 158.
    Fall CH, Vijayakumar M, Barker DJ, et al. Weight in infancy and prevalence of coronary heart disease in adult life. BMJ 1995; 310:17–19.Google Scholar
  159. 159.
    Bowen DJ, Tomoyasu N, Cauce AM. The triple threat: a discussion of gender, class, and race differences in weight. Women Health 1991; 17:123–143.Google Scholar
  160. 160.
    Epstein LH, Valoski A, Wing RR, et al. Ten-year outcomes of behavioral family-based treatment for childhood obesity. Health Psychol 1994; 13:373–383.CrossRefGoogle Scholar
  161. 161.
    Burke LE, Dunbar-Jacobs J. Adherence to medication, diet, and activity recommendations: from assessment to maintenance. J Cardiovasc Nurs 1995; 9:62–79.Google Scholar
  162. 162.
    Kirschenbaum DS, Fitzgibbon ML. Controversy about the treatment of obesity: criticisms or challenges? Behavior Therapy 1995; 26:43–68.CrossRefGoogle Scholar
  163. 163.
    Anonymous. Daily dietary fat and total food-energy intakes—Third National Health and Nutrition Examination Survey, Phase 1, 1988–91. MMWR 1994; 43:116–124.Google Scholar
  164. 164.
    Burkitt DP, Eaton SB. Putting the wrong fuel in the tank. Nutrition 1989; 5:189–191.Google Scholar
  165. 165.
    Eaton SB. Humans, lipids and evolution. Lipids 1992; 27:814–820.CrossRefGoogle Scholar
  166. 166.
    Whitaker RC, Wright JA, Finch AJ, et al. School lunch: a comparison of the fat and cholesterol content with dietary guidelines. J Pediatr 1993; 123:857–862.CrossRefGoogle Scholar
  167. 167.
    Chapman N, Gordon AR, Burghardt JA. Factors affecting the fat content of National School Lunch Program lunches. Am J Clin Nutr 1995; 61(Suppl 1):199S–204S.Google Scholar
  168. 168.
    Jacobson MF, Brownell, KD. Small taxes on soft drinks and snack foods to promote health. Amer J Public Health 2000; 90:854–857.CrossRefGoogle Scholar
  169. 169.
    Saelens B, Sallis J, Frank L. Environmental correlates of walking and cycling: findings from the transportation, urban design, and planning literature. Ann Behav Med 2003; 80–91.Google Scholar
  170. 170.
    Poston W, Haddock C, Hughey J, et al. (2002, April). Obesity and the environment: a tale of two Kansas cities. Presentation at the Society of Behavioral Medicine’s Twenty-Third Annual Scientific Sessions, Washington, DC (Rapid Submission).Google Scholar
  171. 171.
    Goodman WC. The invisible woman: confronting weight prejudice in America. Carlsbad, CA: Gürze Books, 1995, pp. 18–45.Google Scholar
  172. 172.
    Andersen RE, Wadden TA, Bartlett SJ, et al. Relation of weight loss to changes in serum lipids and lipoproteins in obese women. Am J Clin Nutr 1995; 62:350–357.Google Scholar
  173. 173.
    Björntorp P. Evolution of the understanding of the role of exercise in obesity and its complications. Int J Obes Relat Metab Disord 1995; 19 (Suppl 4):S1–S4.Google Scholar
  174. 174.
    Wooley SC. Maelstrom revisited. Am Psychol 1995; 50:943–944.CrossRefGoogle Scholar
  175. 175.
    Foreyt JP, Goodrick GK. Living without dieting. New York, NY: Warner Books, 1994, pp. 15–126.Google Scholar
  176. 176.
    O’Neil PM, Smith CF, Foster GD, Anderson DA. The perceived relative worth of reaching and maintaining goal weight. Int J Obes 2000; 24:1069–1076.CrossRefGoogle Scholar

Copyright information

© Humana Press Inc.,Totowa,NJ 2005

Authors and Affiliations

  • Lisa Terre
    • 1
  • Walker S. C. Poston II
    • 1
    • 2
  • John P. Foreyt
    • 3
  1. 1.Department of PsychologyUniversity of Missouri-Kansas CityKansas City
  2. 2.Mid America Heart InstituteKansas City
  3. 3.Behavioral Medicine Research Center, Department of MedicineBaylor College of MedicineHouston

Personalised recommendations