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Behavioral Therapy for Successful Weight Loss

Behavioral Therapy for Weight Loss has evolved from the first study designed to control eating behavior,1 to a much broader strategy characterized by management of all related factors which influence our eating patterns and activity behavior.

Because these behavioral approaches to weight loss are not direct methods of weight loss, many wannabe slimmers often fail to see the relevancy behind them, instead focussing their efforts on diet or perhaps diet and exercise to lose weight.

However, the efficacy of behavior modification as a whole has been demonstrated by assessing the extra benefits of adding behavioral approaches to traditional nutrition and physical activity education and assessing the relative differences between specific behavioral approaches.

The key components of effective Behavioral Therapy include:

This may seem like a long list of behaviors to begin modifying, but many of the components are interlinked, so modifying one may have a positive impact on another.

Self Monitoring

Self-monitoring involves self-observing and recording of behaviors associated with weight management. Self-monitoring tools may include the following:

Food diaries2 to record, for example, food intake, total calories consumed, grams of fat or carbohydrate in your diet and/or number of portions of fruit and vegetables per day.

Physical activity diary2 to record which activities you have done, the level of success with those activities, how long they lasted.

Records of body weight, lean body mass or body fat.3

For increased detail and effectiveness, self monitoring could also include information about times, places and feelings associated with your eating habits, activity levels and your weight or body fat percentage.

Although you may not always be totally accurate in reporting your weight, diet and activity behaviors,4 self-monitoring is the cornerstone of behavioral treatment,5 largely because you become more aware of your behaviors and the factors that influence how you behave in ways that are helpful or harmful to your weight management efforts. These can then be modified through some of the following simple techniques.6

Both research studies and participants consistently report that self monitoring is one of the most helpful tools in weight management when they fully appreciate the connection that can be made between self monitoring and their weight. 7-10

Stimulus Control

Stimulus control techniques are designed to identify and modify the environmental cues that are associated with your overeating and inactivity.5

Some examples include shopping carefully, possibly using a pre-written list, keeping those problem snack foods out of the house, limiting the time and place of eating, laying out exercise clothes the night before as preparation for a walk or jog in the morning, learning to avoid using energy-saving techniques or devices such as the fast-food outlet, dishwasher or the car where possible, and learning alternative responses to conditioned stimuli for eating, such as only eating at the table, rather than your usual snacking habits whilst crashing out infront of the television.

By using stimulus control techniques to change your individual environments in these simple, small ways, you may be more successful in sustaining your weight management behaviors.11

Awareness and management of these small cues associated with overeating or a sedentary lifestyle can be helpful for long-term maintenance because exposure to these cues may initiate a relapse into the old ways.11

Cognitive Therapy

Approaches to cognitive restructuring, which form the backbone of cognitive–behavioral therapy, have been incorporated into the behavioral treatment of obesity over the past twenty years. 12,13

The fundamental basis on which cognitive therapy is formed, is that your thoughts (or cognitions) directly affect your feelings and behaviors.14

Negative thoughts are often followed with negative actions, such as the dieters curse of ‘Oh no I’ve blown my diet again’ and they then proceed to eat even more to deal with the feelings of failure and hopelessness.

Cognitive restructuring makes you more aware of your perceptions about yourself and your weight.

As a consequence, it is possible to learn to actively change the internal chatter (how you talk to yourself) that leads to continuing defeat in your weight loss attempts with more rational thoughts that enhance your successful efforts.15

By identifying your unhelpful self-chatter through self-monitoring you can then begin to challenge these thoughts with more rational alternatives.

The techniques that have been developed for weight management are based on those for the treatments for anxiety, depression, and bulimia nervosa,16-18 so are helpful for those who suffer these conditions as well as those with low self esteem and a tendancy towards negativity.

With help from cognitive therapy, you can learn to modify negative thinking, which in turn impacts on your eating and activity habits, helping you to meet realistic goals.19-21

Stress Management

Stress is one of the primary causes of overeating and relapse after successful weight loss,9 which makes learning various methods for reducing stress and tension crucial to your slimming success.

Tension reduction techniques which trigger the relaxation response (e.g., meditation, autogenics, progressive muscle relaxation, yoga and diaphragmatic breathing) can be used to reduce tension and associated sympathetic nervous system arousal (the fight or flight response we feel when we are put under pressure), thereby providing relief from stressful events in life.

Another useful technique to make use of is the passive response to intrusive thoughts.

These techniques are very effective for many health-related problems, including weight related issues.22

Problem Solving

Problem solving refers to self-correction of your problem areas, not just those associated with eating and physical activity, but problem solving in relation to how you deal with life issues also.

Accordingly, for weight specific issues, this includes awareness and definition your weight-specific problem, coming up with plausible solutions to this, weighing up these solutions and then selecting the most appropriate one, putting the new behavior into practice, a behavioral trial if you like, evaluating the outcome of that trial, and then re-evaluating alternative possibilities if the chosen one is not successful or adopting the new behavior as a habit by practiced repetition.23,24

A study from the 1990’s looked at formerly obese women in Oakland, California, who had successfully lost a significant amount of weight and compared three groups for their respective behaviors: relapsers, maintainers and a control group who were of stable weight.

In looking at their coping with life skills, the study showed that the women who used problem solving skills and faced their problems head on (95% of successful maintainers) were far more successful at maintaining their weight loss than the relapse group who typically avoided problems (90% of relapsers used avoidance strategies) rather than face up to their issues.9

Effective problem solving has been shown to be especially important in other studies looking at the maintenance of weight loss25 and to be more effective than a simple behavioral therapy alone for mainentance after successful weight loss.26

Social Support

Strong social support tends to lead to more success in achieving and maintaining desirable weight loss.9

In some cases this may come from a support group within a commercial weightloss program, inclusion of the family in your weight loss campaign, a friend, or a clinician.

Peer support may also come from participation in community-based programs or involvement in outside social activities (for example, evening classes at the local school, hobbies, health clubs and church-related activities) that have absolutely nothing to do with weight management, but help you to overcome the everyday stresses of daily life and consequently improve your weight loss efforts.9,11

In the prior study from Oakland California, the study showed that individuals in the three groups: relapsers, maintainers and the stable weight control group all used their own social support networks to differing extents.

The big difference was however between the relapsers and the maintainers. Within the maintainers, 70% used available social support, but within the relapsers, only 38% used support. For comparison, 80% of the stable weight control group regularly used their social support network.9

This indicates the key advantage of effective social support to the success of the maintainers over the relapsers.

Effect of Behavioral Therapy on Body Weight

Weight loss programs that include these behavioral strategies are generally effective in producing successful results. Many studies over the past twenty years have shown that the average weight loss is 0.45 kg (1 lb) per week and more than 8 kg (17.6 lb) over the total treatment period, averaging around 18 weeks. The use of multiple behavioral strategies appears to be associated with greater weight loss.24,27,28

Research programs consistently show that behavior modification techniques, prolonged treatment times and physical activity are excellent predictors of successful weight loss during treatment.9,29

This is most apparent in the study carried out by Bjorvell and Rossner, who conducted a 4 year study into the long term effects of treatment, followed up by a 6-8 years further observation.

The first six weeks involved intensive treatment comprised standard behavioral therapy (twice a week), relapse prevention, training in low energy cooking, a low energy diet, and exercise 3 times per week, all conducted in a hospital day care unit. This was followed by weekly sessions once a week for the remaining four years.

Whenever patients relapsed, they were taken into hospital day care and given a further two weeks training.

After the four years period the women had lost an average of 11.5Kg and the men had lost on average 18.4Kg.

After the 4 y of treatment, on average all subjects perfectly maintained their weight loss of approximately 15 kg in women and 20 kg in men during the follow-up period of 6 – 8 y.30,31

Bottom Line

Unfortunately, in the developed world, a weight issue is now probably best viewed as a life long problem.

However, a combined program of the behavioral techniques outlined here in combination with increased activity levels and better dietary management, with long term commitment to follow through does result in sustained loss of weight.

It is this approach that Slimmer Secrets uses to lose weight and maintain that weight loss. As I have stated in our About Us page, I have used these approaches to maintain successful weight loss for years, but I firmly believe that in the Developed World, with all its distractions and enticements, those of us who have had a weight problem in the past need to remain vigilant for life to prevent the ever possible reoccurrence. 

Sources

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