Adult behavioral weight loss treatment.

In the United States, obesity is the second leading cause of preventable death 1,2 and associated with increased risk of developing hypertension, Type 2 diabetes, cardiovascular disease and death, stroke, as well as a variety of cancers, urinary incontinence, arthritis, and sleep apnea.3,4 Fortunately, even modest weight loss of 7-10% of body weight among obese individuals can improve blood pressure, high-density lipoprotein-cholesterol, lowdensity lipoprotein-cholesterol, triglycerides, blood glucose levels, increased cardiorespiratory fitness, and quality of life.5-8 The Diabetes Prevention Program (DPP)7 and the ongoing Look AHEAD (Action for Health in Diabetes) trial support the benefits of modest weight losses. In DPP, participants with impaired glucose tolerance (or “pre-diabetes”) were randomly assigned to receive an intensive lifestyle intervention, pharmacotherapy or placebo. Participants in the lifestyle condition achieved a 7% weight loss at 6 months and maintained a 5% weight loss at 3 years; these weight losses reduced their risk of developing Type 2 diabetes by 58%. The lifestyle intervention was nearly twice as effective as medication in reducing the incidence of diabetes.7,9 Look AHEAD, an NIH-funded clinical trial, was designed to investigate the impact of weight loss on cardiovascular morbidity and mortality in over 5000 individuals with Type 2 diabetes. Participants were randomly assigned to either a lifestyle intervention (ILI) or a diabetes education and support control (DSE) group and followed over 12 years. Although long-term data are not yet available, early findings are striking. At one year, ILI participants lost an average of 8.6% of their weight compared to 0.7% in the DSE group, and improvements in mean fitness also were significantly better in the ILI condition.10 Moreover, these changes were associated with improved diabetes control (i.e. HbA1 c levels) and CVD risk factors (i.e. blood pressure, triglycerides, HDL-cholesterol, and urine albumin / creatinine), and reduced medication use in the ILI group compared to the DSE group. These studies demonstrate that behavioral weight loss interventions consistently produce weight losses of 7-10% of initial body weight and such weight losses are associated with substantial health benefits. KEY COMPONENTS OF BEHAVIORAL WEIGHT CONTROL Behavioral weight loss treatments like those used in DPP and Look AHEAD (also referred to as “lifestyle interventions”, or “standard behavioral treatment”) focus on changing diet and physical activity to promote weight loss, and emphasize behavioral strategies and skills to implement and maintain these lifestyle changes. The goal is to produce a 10% reduction in body weight, with a weekly goal of between 0.5-1.0 kg / week.8 Treatment programs are relatively standard and are administered in a closed group format using treatment manuals; the sessions are typically led by behavioral psychologists, dieticians, and/or exercise physiologists and include structured lessons on nutrition education, physical activity, and behavioral skills. Groups have somewhere between 10 and 20 patients and meet for 6090 minutes weekly for 20-24 weeks; many programs also offer biweekly or monthly sessions for another 20-52 weeks because continued contact and accountability is associated with better long-term weight loss.11 Decades of research have identified several areas that are essential to long-term weight control, including a calorie restricted diet, engaging in high levels of physical activity, and self-monitoring of key behaviors.