Behavioral Approaches to Weight Loss

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Behavioral Approaches to Weight Loss

• Valerie H. Myers, PhD
• Pennington Biomedical Research Center

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Prevalence of Overweight and Obesity Among US
Adults, Age 20-74 Years
Age-adjusted by the direct method to the year
2000 U.S. Bureau of the Census estimates using
the age groups 20-34, 35-44, 45-54, 55-64, and
65-74 years.
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Impact of Effective Treatment

• Sustained weight loss of 10
• Fewer years of living with chronic diseases
• Hypertension, hypercholesterolemia, type II
  diabetes
• Reduces incidences of
• stroke and heart disease
• increase in life expectancy
• reduces medical costs by 2,200 to 5,300
• Oster G, Thompson D, Lifetime Health and Economic
  Benefits of Weight Loss Among Obese Persons, Am J
  Public Health, 1999891536-1542.

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Impact on Other Medical Conditions

• 5-10 weight loss
• 5-10 total and LDL cholesterol
• HDL
• glycosylated hemoglobin (1-2.5)
• blood pressure 3-8 mm HG.
• 2-4 weight loss
• 30-50 in diabetes incidence
• 20 -30 in high blood pressure
• Clinical guidelines. National Heart, Lung, and
  Blood Institute Web site. Available
  athttp//www.nhlbi.nih.gov/nhlbi/cardio/obes/pro
  f/guidelns/ob_gdlns.htm.

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Impact on Other Medical Conditions

• Miscellaneous
• Each kg of weight loss 1.7-2.5 mm Hg BP
• blood glucose levels in overweight and
  obese persons without diabetes

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The recommended treatments for various
BMIs
 
NHLBI Guidelines for Management of Obesity 1998
and Bray 2003 Atlas of Obesity
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Behavioral Treatment Overview

• Lifestyle modification
• Diet
• Reduction in intake of 500-100 kcal/day
• Exercise
• 30 min/day 5-6 days/wk
• Behavior therapy
• Set of techniques for modifying diet exercise

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Behavioral Treatment Overview

• Weekly treatment sessions (16-26 wks)
• Groups of 10-20 pts
• Weigh-in, review food/fitness diaries, new
  dietetics or PA topic

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Individual vs. Group Weight Loss
Renjilian et al (2001). JCCP
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Behavioral Treatment Overview

• Efficacious treatment (gt100 controlled studies)
• Helpful with maintenance efforts
• Successfully used with other forms of treatment
• Short-term weight loss 8-10 over 6 months
• Helpful for mild to moderate overweight and
  obesity
• Essential to long-term lifestyle change

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Behavioral Treatment Overview

• Overall, 10 initial wt loss
• 80 completed tx
• Increase in wt loss in last 3 decades
• Weight regain is problematic
• 30-35 regain at 1 yr
• 50 of pts have regained all of their wt by 5th yr

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Behavioral Treatment Contents

• Goal-setting
• Self-monitoring
• Stimulus Control
• Modification of Eating and Activity Patterns
• Contingency Management
• Cognitive Behavioral Techniques
• Stress Management

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Goal Setting

• The initial starting point of behavioral programs
• Involves setting goals for calories, fat,
  physical activity, and other modifiable behaviors
• People are often unrealistic in their
  expectations
• Realistic expectations for short-term and
  long-term goals should be discussed

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Goal Setting

• Be Specific
• Set criteria time, frequency, duration
• Make it measurable
• Make it realistic

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Goal Setting

• Be Specific
• Vague Goals Specific Goals
• I will exercise more I will walk 20
  minutes a day five days of the week
• I will lose weight I will lose 1-2 lbs
  each week for the next 10 weeks

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Goal Setting

• Tips
• Write it down
• Setting goals helps keep up motivation
• Need to plan ahead
• If having trouble, may need to change goal
• Dont set yourself up for failure
• Set yourself up for success (set positive, valued
  goals)

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Goal Setting

• Tips contd
• Set short and long-term goals use a
  step-by-step approach
• Take advantage of the skills you already have
• Approach this as a challenge

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Self-monitoring

• The cornerstone of behavioral treatment
• Involves daily observation and record keeping of
  behaviors
• Monitoring is used to increase awareness of
  behavior patterns
• identifying antecedents and reinforcing
  consequences that lead to faulty health patterns
• Time, place, feelings, social situation
• Record keeping can also be expanded to include a
  variety of information including emotions

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Self-monitoring

• Keep track of progress to know if goals are being
  met
• Allows you to look back at situations in which it
  was easier or more difficult to keep going
• Gives immediate feedback
• Reward yourself when you see change
• Prevents false discouragement or assurance

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Self-monitoring

• Tips
• Define specific behaviors to be monitored (steps,
  miles, calories, carbs, etc)
• Determine how they will be recorded (pedometer,
  form, pda)
• Start with a clear baseline for later comparison

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Stimulus Control

• Discriminative Stimulus an external or internal
  cue that signals that a given response will be
  reinforced if performed
• People are often unaware of how their environment
  influences their behavior
• Used to identify and then modify environmental
  antecedents that influence behavior patterns
• Goal is to restrict environmental circumstances
  that serve as discriminative stimuli for
  maladaptive behaviors

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Stimulus Control

• Procedures are used to decrease the number of
  conditioned stimuli or situations that may
  trigger a maladaptive behavior
• Identify and minimize stimuli that trigger target
  behaviors that you want to decrease
• Eliminate cues that compete with what you want to
  accomplish
• Avoid driving by the Krispy Kreme, smell of
  fries, commercials, out of sight out of mind)

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Stimulus Control

• Other techniques include
• Specified number of meals and snacks to eat
• Specified eating times or places
• Changing serving and food storage techniques
• Develop new stimuli to trigger new targeted
  adaptive behavior
• Set new routines with strong associated cues
• Wear a pedometer

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Stimulus Control-Example

• Eating Out, Party, and Holiday Tips
• Plan ahead
• Eat before you go
• Eat slowly
• Avoid buffets
• Dont pile plate
• Dont take a little of every item (special items)
• Take low fat/calorie items

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Modification of Maladaptive Health Patterns

• Goal is to modify faulty health behaviors that
  may interfere with accomplishing new adaptive
  behavior by encouraging new behavior
• slowing pace of eating, reducing portion sizes,
  measuring food intake, leaving food on plate,
  improving food choices, eliminating second
  servings, taking the stairs, parking farther from
  the building, walking or biking rather than
  driving, etc
• Breaking the cycle

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Contingency Management

• Once a target behavior is performed, it needs to
  be strengthened by reinforcement
• Positive reinforcement (e.g., reward) is used to
  stabilize and increase the maintenance of new
  adaptive health patterns
• Punishment or loss of reinforcement may also be
  used to change behaviors
• Contingency contracting
• Self reinforcement
• External reinforcement

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Contingency Management

• Effective rewards are
• Immediate
• Desirable
• Based on meeting a specific goal
• Eliminate all rewards centered around the
  maladaptive behavior
• Rewards
• Tangible (External)
• Intangible (Internal)

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Contingency Management

• Intangible Reward Tips
• Feeling good about yourself and what you are
  doing
• Focus on the benefits of what you are doing
• Watch out for pessimism or criticism (from
  yourself or others)
• Dont wait to pat yourself on the back until you
  are 100 successful

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Contingency Management

• Tangible
• Give yourself to keep your motivation high (like
  social activities, money, extra time for hobbies,
  etc.)
• Helps to tide you over until internal rewards are
  enough

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Contingency Management

• Other tips
• Premack Principle
• Make your intentions known to others
• Join others with common goals
• Have others support you when you meet goals, and
  ignore you when you dont

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Cognitive Behavioral Techniques

• These strategies combine the traditional
  behavioral treatment components with emphasis on
  thinking patterns that may affect eating
  behaviors
• Focus on perfectionistic standards, negative
  self-statements and unrealistic goals
• Goal is to alter mood, unhelpful beliefs,
  unrealistic standards, and negative evaluations
  that affect healthful behaviors

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Cognitive Behavioral Techniques
Thoughts
Feelings
Behaviors
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Stress Management

• Stress Management Techniques
• (Physiological)
• Diaphragmatic Breathing
• Progressive Muscle Relaxation
• Imagery
• Exercise
• Sleep Hygiene
• Reduce caffeine

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Stress Management

• Stress Management Techniques
• (Behavioral)
• Limit Setting
• Time Management Training
• Scheduling Pleasurable Events

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Stress Management

• Stress Management Techniques
• (Cognitive)
• Identify negative/faulty thinking
• Cognitive Restructuring
• Setting Realistic Expectations