Obesity: Main Treatment Recommendations & Cognitive Behavioral Therapy

Diagnosis

Obesity is a chronic metabolic disease characterized by an increase of body fat stores. In clinical practice the body mass index (BMI) is still used to categorize overweight and obese individuals and the most common definition of obesity is BMI ≥30 Kg / m ^ 2

(For, 2007; Yumuk et al., 2015)


Main Treatment Recommendations


  • Dietary Interventions:

A calorie deficit of 500 kcal/d produces a weekly deficit of ≈3500 kcal which is equivalent to 0,45Kg weight loss. However weight loss is not linear, is curvilinear, usually with more rapid weight loss at the initial stage. Calories are crucial for the energy balance but we must remember that food consists of more than calories and the quality in a diet is essential. Note that it is out of most importance to enjoy your diet. Interventions such as “very low calorie” diets only under medical supervision.


  • Physical Activity:

Initially at least 150 min/week moderate aerobic exercise combined with 1-3 sessions/week resistance exercise.


  • Pharmacological Interventions:

May be used in patients with BMI>30 Kg/m^2 or BMI>27 with co-morbidities.


  • Surgical (Bariatric) Interventions:

BMI>35 Kg/m^2 with comorbid conditions

BMI>40 Kg/m^2

Consider if other weight loss attempts fail/ requires lifelong medical monitoring.


  • Behavior Interventions:

Cognitive Behavioral Therapy

Motivational Interviewing

“Increase motivation for change /Improve self-efficacy, and self-regulatory capabilities”


(Bray et al., 2018; Cardoso, Regina and Passos, 2018)



(Yumuk et al., 2015)


Cognitive Behavioral Therapy:


Cognitive behavioral therapy (CBT) aims to help a patient change his insight and understanding of thoughts and beliefs concerning weight regulation, obesity and its consequences. In addition, CBT marks behaviors that need to be changed for successful weight loss and weight loss maintenance (Yumuk et al., 2015).


CBT postulates that therapeutic strategies designed to change dysfunctional cognitions can lead to improvements in behaviours. CBT: Commonly used to maintain behaviour change, utilizing prominent strategies around relapse prevention and self-regulation (Barrett et al., 2018).


Components of CBT:


  • Self-monitoring: recording type/amount/calories of food-beverage consumed. Helps to identify eating patterns and select targets for reducing calorie intake.

  • Stimulus control: Patients are taught how to manage external cues (e.g smell of food, places/events associate with food)

  • Goal Setting: S.M.A.R.T. goals (specific, measurable, achievable, realistic, time able).

  • Problem Solving: Patients are taught how to analyze and overcome various challenges regarding the adherence to their diet/goals. They learn how to identify possible solutions, pick the most promising one and implement it.

  • Cognitive and Relaxation Techniques


These components should form part of routine dietary management or a structured program intervention


(Yumuk et al., 2015; Bray et al., 2018)


Interestingly:

A common misconception among patients and clinicians is that weight loss is simply a matter of willpower. Many obese patients regard themselves as failures (no willpower), but sound data indicate that the ability to delay gratification involves more than willpower. Rather than thinking of resisting temptation as willpower, it should be considered a matter of managing where one focuses one’s attention.

Mischel et al conducted a series of experiments in children spanning more than 30 years. On the basis of this research, they suggest 3 strategies for managing one’s attention: avoidance, distraction, and reframing (eg, shifting attention from a tempting aspect of the stimulus to its long-term consequences). Distractions such as going for a walk before dinner or working on an interesting hobby before bedtime, may help patients avoid dietary indiscretions. Focusing on the temptation and trying to fight it (“I won’t have that donut!”) is ineffective (For, 2007).


The table summarizes behavioral therapy techniques for weight loss (For, 2007).




References:

Barrett, S. et al. (2018) ‘Integrated motivational interviewing and cognitive behaviour therapy for lifestyle mediators of overweight and obesity in community-dwelling adults : a systematic review and meta-analyses’. BMC Public Health.

Bray, G. A. et al. (2018) ‘The Science of Obesity Management : An Endocrine Society Scienti fi c Statement’, (December 2017), pp. 79–132. doi: 10.1210/er.2017-00253.

Cardoso, E., Regina, S. and Passos, L. (2018) ‘Quality assessment of clinical guidelines for the treatment of obesity in adults : application of the AGREE II instrument Avaliação da qualidade das diretrizes clínicas para o tratamento da obesidade em adultos : aplicação do instrumento AGREE II Evaluación de la calidad de guías clínicas para el tratamiento de la obesidad en adultos : aplicación del instrumento AGREE II’, 34(6). doi: 10.1590/0102-311X00050517.

For, C. R. (2007) ‘Treatment of Obesity’, 82(January), pp. 93–102. doi: 10.4065/82.1.93.

Yumuk, V. et al. (2015) ‘European Guidelines for Obesity Management in Adults’, pp. 402–424. doi: 10.1159/000442721.


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