Mid-Term Effectiveness of Behavioral and Psychodynamic Inpatient Treatments of Severe Obesity Based on a Randomized Study

Abstract

Background: The objective of this study was to compare the effectiveness of psychodynamic and behavioral inpatient treatments of severely obese patients regarding weight and distress. Methods: In a longitudinal study obese patients (body mass index, BMI ≧35) were randomly assigned to behavioral or to psychodynamic inpatient treatment. Mostly female (n = 267; 85%) obese patients with psychiatric and somatic comorbidity (age 20–64 years, BMI 35–74) were examined with standardized self-report scales on distress (SCL-90R), interpersonal problems (Inventory of Interpersonal Problems), eating behavior (Fragebogen zum Essverhalten) and body image (Fragebogen zum Körperbild). Results: During 49 days (mean) of inpatient treatment, patients lost an average of 5.6 kg (4.4%) in the behavioral (n = 130) and 5.7 kg (4.4%) in the psychodynamic setting (n = 137). In both settings, eating behavior, well-being and body image also improved significantly. One year after discharge, return rate was 73%. Forty percent had further reduced their weight (by more than 5% compared to intake), 36% had regained weight, but were still below intake level, and another 24% had increased weight above intake. Conclusion: Behavioral and psychodynamic treatments were equally effective reducing weight and distress over 1 year.

Long-term weight loss maintenance after inpatient psychotherapy of severely obese patients based on a randomized study: Predictors and maintaining factors of health behavior

“…Behavioral treatment was considered as an evidence-based treatment approach [36], which we could therefore use as a comparison for psychodynamic treatment. As has been shown in a previous publication [20], the effects of psychodynamic and behavioral inpatient therapy on weight were comparable for midterm follow-up. Overall, results for long-term weight loss were somewhat disappointing.…”

“…Based on the former analysis of 1-year follow-up [20], we did not expect an effect of treatment setting after 3 years.…”

“…Therefore, it seems timely to compare psychodynamic and behavioral treatments of obese patients. In this paper, we report the results of a randomized prospective study [19,20] focusing on the long-term effects of inpatient treatment on weight loss (behavioral and psychodynamic) and on the prediction of weight loss and weight loss maintenance by patient characteristics. Besides weight reduction, we were interested in the long-term effects of inpatient treatment on cognitive variables (especially body image) and psychological distress.…”

Randomized Controlled Comparison of Two Cognitive Behavioral Therapies for Obese Children: Mother versus Mother-Child Cognitive Behavioral Therapy

“…Another limitation concerns the lack of information about physical activity or eating behavior of the children during the study course, although these were major topics of the treatment. Further, the follow-up period of 6 months does not satisfy the criteria of evaluating long-term efficacy as obese individuals are known to compensate for their weight loss [80]. The major limitations of this study are the small sample size and the high dropout rates, which exceed those for parent-exclusive treatments mentioned in the literature [81].…”

Tudatosság és önreflexió: A mindfulness módszerek szerepe az elhízás kezelésében

“…A visszaesésben szerepet játszó tényezőket elemezve Cooper és munkatársai (2010) arra a következtetésre jutottak, hogy az elhízás hosszútávú kezelése pszichológiai értelemben terápiarezisz tens állapotnak tekinthető, és jelenleg nem ismerjük eléggé a visszahízásban szerepet játszó tényezőket. A kutatási eredmények alapján úgy tűnik, hogy jelenleg nem mondhatjuk, hogy rendelkezünk az elhízás tartós csökkenté sére adekvát pszichológiai kezelési módszerekkel és inkább a prevencióra lenne szükséges hangsúlyt helyezni (Beutel, Dippel, Szczepanski, Thiede, & Wiltink, 2006;Nakade és mtsai, 2012;Niemeier, Leahey, Palm Reed, Brown, & Wing, 2012;Teixeira és mtsai, 2010;Werrij és mtsai, 2009). Ma már bizonyos, hogy az egészségügyi személyzet erőfeszí-tései mellett a legsikeresebb kezelés sem hoz hosszútávú eredményt a részt-vevő személyek aktív hozzáállása nélkül.…”