Cognitive behavioural therapy for obesity: One-year follow-up in a clinical setting

Abstract

Cognitive behavioural therapy (CBT) is the most comprehensive means of medically treating obesity, but only few data have so far been published concerning its long-term effectiveness. We here report our experience of 1068 consecutive patients (868 females) treated with CBT at a university-based obesity centre. The patients were enrolled into three different programmes: a 14-week LEARN programme (672 patients), a 16-week MOB programme for the morbidly obese (259 patients), or a 20-week BINGE programme for subjects affected by binge eating (137 patients). Eighty-five percent of the subjects completed the weekly programmes. The percentage of patients attending the scheduled control visits during the 1-year follow-up gradually decreased, being very low in the BINGE group (10%). The percentage weight loss was an average of 6% during the weekly courses, being higher in the MOB programme; by the end of the weekly sessions, it exceeded 10% of initial body weight in 22% of cases and increased to 36% during the follow-up. The cumulative probability of follow-up was higher among the patients undergoing the MOB and LEARN programmes than among the BINGE patients (p < 0.0001), and decreased with the increasing severity of obesity. Female gender and a weight loss of > 10% i.b.w. increased compliance to follow-up. The study further demonstrates the difficulty of achieving compliance to chronic management of obesity and the critical role of binge eating disorder in the medium-term treatment of obesity. Strategies are needed to improve adherence to a follow-up protocol.

Higher body fat percentage is associated with increased cortisol reactivity and impaired cognitive resilience in response to acute emotional stress

“…The dissociation of cardiac changes support earlier experimental study specifically tying cognitive stress effects to cortisol, rather than a more general stress response, and indicates thatFin our populationFthe effects were specific to the acute stress response rather than occurring under baseline conditions. This study has direct implications for understanding the role of cognitive control with respect to behavior modification, including cognitive behavioral therapy, in the treatment of obesity, [38][39][40][41][42][43][44] and in understanding how the obese may differ cognitively from the healthy population in the application of these techniques under acute stress. Future studies, using larger participant sample sizes, more rigorous body fat indices, tasks capable of differentiating between specific cognitive functions and targeting more directly the obese population, will further enhance our understanding of the relationship between endocrine and cognitive stress resilience as a function of body fat, and will also explore the implications of these studies with respect to chronic, rather than acute, real-world stressors.…”

A physical activity program to reinforce weight maintenance following a behavior program in overweight/obese subjects

“…4,5 This was also observed in our subjects at the end of CBT and has been previously reported in an extensive revision of the results attained in our institution. 17 The fitness program promoted a further weight loss after CBT, and body weight remained on average stable during a 1-year follow-up in subjects who completed this long-term observation period.…”

“…In particular, weight balance was negative in 123 out of 200 subjects. By means of the combined approach, only one-third of subjects failed to lose weight to a specific target of 5% (37%; 95% CI, 30-44), 23% of cases lost from 5 to 10% of their initial body weight (95% CI, [17][18][19][20][21][22][23][24][25][26][27][28][29], and 40% (95% CI, 33-47) had a percentage decrease in body weight exceeding 10% of initial weight. At 1-year follow-up (nearly 3 years since the beginning of the weight reducing program), no significant weight regain was observed in subjects who completed the observation period ( þ 0.8 kg; P vs end of fitness program, 0.374; n ¼ 43).…”

“…15,16 A program of cognitive-behavioral therapy (CBT) for obesity has been operative in our unit since 1992. 17 Based on the LEARN program for weight control, 18 it includes a few notions on physical activity, but the compliance of patients to exercise has never been systematically tested. More recently, we developed a new program to stimulate further physical activity in subjects completing the LEARN course.…”

Addressing Motivation in Globesity Treatment: A New Challenge for Clinical Psychology

“…The main goal of CBT is to change how people think and react to their problems and is widely recommended both in inpatient and outpatient settings (Melchionda et al, 2003), also in technological ones (Castelnuovo et al, 2001, 2003a,b, 2005a, 2010, 2011a,b; Castelnuovo, 2008, 2010b; Molinari et al, 2012). …”