Behavior therapy for obesity: An evaluation of treatment outcome

The long-term evidence on the behavioral treatment of obesity, including both experimentally controlled outcome studies and uncontrolled clinical trials, is critically reviewed. Results of the controlled studies show that weight loss at post-treatment (a mean of 10-11 lbs) is generally maintained at a one year follow-up. However, there is little evidence of continued weight loss during follow-up. The few studies with follow-ups of more than one year show less satisfactory maintenance of treatment effects. Other findings include marked variability in weight loss, the failure to find prognostic indicators, the absence of negative side-effects, and greatly reduced attrition. Ten of the 17 controlled studies included specific maintenance strategies, booster sessions being the preferred strategy despite the lack of supporting data. Findings from the controlled clinical trials are largely consistent with those of the controlled studies. Suggestions for improving the efficiency of behavioral treatment programs are made, with specific emphasis on changing treatment format, emphasizing physical activity, and incorporating improved maintenance strategies. The outcome evidence is summarized in an extended discussion of the question, what treatment method(s), administered by whom, for which populations, has what effects, on what measures, and at what cost.