Invited essayA new cognitive behavioural approach to the treatment of obesity☆
Section snippets
The effectiveness of current treatments for obesity
Obesity is a major health problem. Childhood and adult obesity are common in Western societies and their rates are rising (Prescott-Clarke & Primatesta, 1999, Flegal, Carroll, Kuczmarski & Johnson, 1998, Seidell & Rissanen, 1998). Obesity has been described by the World Health Organisation as a “global epidemic” (World Health Organisation, 1997). As a result of this increase, more people will suffer from the many weight-related medical complications, including heart disease, hypertension,
The goals of obesity treatment
Over the past 5 years it has become increasingly clear that modest weight loss is associated with significant health benefits. A 5–10% reduction in weight is accompanied by clinically important improvements in cholesterol, blood pressure, blood glucose and other health indices (Goldstein, 1992, Kanders & Blackburn, 1992, Wing & Jeffery, 1995, Tremblay et al., 1999), and there is evidence that these benefits are sustained if the lost weight is not regained (Wing & Jeffery, 1995). While the
The research on weight regain and its prevention
There has been little research on the mechanisms responsible for weight regain as opposed to weight loss. Among potential physiological mechanisms, the decrease in energy requirements which accompanies weight loss (Prentice et al., 1991, Leibel, Rosenbaum & Hirsch, 1995, Pasman, Saris & Westerterp-Plantenga, 1999) is likely to contribute as may the increase in lipoprotein lipase activity (Kern, Ong, Saffari & Carty, 1990). However, there is evidence that psychological mechanisms are also of
A cognitive behavioural analysis of weight regain
We propose that, among those with obesity, there are two interrelated reasons for patients' failure to engage in effective weight maintenance strategies. First, they do not achieve their weight loss goals, nor the anticipated benefits of achieving them. As a result, they abandon their weight loss efforts. Second, under these circumstances they neglect (or do not appreciate) the need to acquire weight maintenance skills, and thus return to their previous eating habits and hence gain weight.
The new cognitive behavioural treatment
On the basis of this cognitive behavioural analysis of weight regain, we have developed a new approach to the treatment of obesity (Cooper & Fairburn, in press). This is designed to minimise the weight regain that generally follows weight loss by overcoming psychological obstacles to the acquisition of, and long-term adherence to, effective weight-control behaviour. Three key issues are addressed: first, the treatment helps patients accept and value the weight loss that they have achieved;
Conclusion
This paper has presented a cognitive behavioural analysis of the problem of weight regain in obesity, together with a treatment derived from it. Promising initial results have led to the treatment being evaluated in an ongoing randomised controlled trial. This trial is designed to test both the efficacy of the treatment and the ideas upon which it is based. If, on the basis of the results, the treatment retains its promise, the next tasks will be to modify it to make it more suitable for
Acknowledgements
The authors and this programme of research are supported by a grant from the Wellcome Trust (046386). CGF is a Wellcome Principal Research Fellow. We are grateful to Kelly Brownell, Thomas Wadden and Rena Wing for their help with our research and to our colleagues Lynda Barnes, Gillie Bonner, Susan Byrne, Lucy Carsen, Helen Doll, Elizabeth Eeley, Paige Forbes, Deborah Lovell and Marianne O'Connor. We are also grateful to Susan Byrne, Deborah Lovell and Roz Shafran for their comments on the
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The seminal paper on the behavioural treatment of obesity was published in this journal in 1967. Stuart, R. B. (1967). Behavioural control of overeating. Behaviour Research and Therapy, 5, 357–365.