Abstract
Cognitive behavioural therapy (CBT) is the most comprehensive means of medically treating obesity, but only few data have so far been published concerning its long-term effectiveness. We here report our experience of 1068 consecutive patients (868 females) treated with CBT at a university-based obesity centre. The patients were enrolled into three different programmes: a 14-week LEARN programme (672 patients), a 16-week MOB programme for the morbidly obese (259 patients), or a 20-week BINGE programme for subjects affected by binge eating (137 patients). Eighty-five percent of the subjects completed the weekly programmes. The percentage of patients attending the scheduled control visits during the 1-year follow-up gradually decreased, being very low in the BINGE group (10%). The percentage weight loss was an average of 6% during the weekly courses, being higher in the MOB programme; by the end of the weekly sessions, it exceeded 10% of initial body weight in 22% of cases and increased to 36% during the follow-up. The cumulative probability of follow-up was higher among the patients undergoing the MOB and LEARN programmes than among the BINGE patients (p<0.0001), and decreased with the increasing severity of obesity. Female gender and a weight loss of >10% i.b.w. increased compliance to follow-up. The study further demonstrates the difficulty of achieving compliance to chronic management of obesity and the critical role of binge eating disorder in the medium-term treatment of obesity. Strategies are needed to improve adherence to a follow-up protocol.
Similar content being viewed by others
References
Brownell K.D., Wadden T.A.: Etiology and treatment of obesity: understanding a serious, prevalent, and refractory disorder. J. Consult. Clin. Psychol., 60, 505–517, 1992.
Rossner S.: Long-term intervention strategies in obesity treatment. Int. J. Obes. Relat. Metab. Disord.,19 (Suppl 7) S29–S33, 1995.
Wooley S.C., Garner D.M.: Dietary treatments for obesity are ineffective. BMJ., 309, 655–656, 1994.
Muls E., Kempen K., Vansant G., Saris W.: Is weight cycling detrimental to health? A review of the literature in humans. Int. J. Obes. Relat. Metab. Disord., 19 (Suppl 3) S46–S50, 1995.
Williamson D.A., Martin C.K.: Binge eating disorder: a review of the literature after publication of DSM-IV. Eat. Weight Disord., 4, 103–114, 1999.
American Psychiatry Association. Diagnostic and Statistical Manual of Mental Disorders. Washington DC, American Psychiatry Association, 2000.
Foreyt J.P., Poston W.S., 2nd: What is the role of cognitive-behavior therapy in patient management? Obes. Res., 6 (Suppl 1) 18S–22S, 1998.
Bennett G.A.: Cognitive-behavioural treatments for obesity. J. Psychosom. Res., 32, 661–665, 1988.
Fitzgibbon M.L., Kirschenbaum D.S.: Distressed binge eaters as a distinct subgroup among obese individuals. Addict. Behav., 16, 441–451, 1991.
Ricca V., Mannucci E., Zucchi T., Rotella CM., Faravelli C: Cognitive-behavioural therapy for bulimia nervosa and binge eating disorder. A review. Psychother. Psychosom., 69, 287–295, 2000.
Kramer F.M., Jeffery R.W., Forster J.L., Snell M.K.: Long-term follow-up of behavioral treatment for obesity: patterns of weight regain among men and women. Int. J. Obes., 13, 123–136, 1989.
Wadden T.A., Frey D.L.: A multicenter evaluation of a proprietary weight loss program for the treatment of marked obesity: a five-year follow-up. Int. J. Eat. Disord., 22, 203–212, 1997.
Latner J.D., Stunkard A.J., Wilson G.T., Jackson M.L., Zelitch D.S., Labouvie E.: Effective long-term treatment of obesity: a continuing care model. Int. J. Obes. Relat. Metab. Disord., 24, 893–898, 2000.
Gormally J., Block S., Daston S., Rardin D.: The assessment of binge eating severity among obese persons. Addict. Behav., 7, 47–55, 1982.
Stunkard A.J., Messick S.: The three-factor eating questionnaire to measure dietary restraint, disinhibi-tion and hunger. J. Psychosom. Res., 29, 71–83, 1985.
Beck AT.: Depression Inventory. Philadelphia, Centre for Cognitive Therapy, 1978.
Derogatis L.R., Rickels K., Rock A.F.: The S.C.L. 90 and the M.M.P.I.: a step in the validation of a new self-report scale. Br. J. Psychiatry, 128, 280–289, 1976.
Fairburn C.G., Cooper Z.: The eating disorder examination, 12th Ed. In: Fairburn C.G., Wilson G.T., Cooper Z. (Eds.), Binge eating. New York & London, Guilford Press, 1993, pp. 317–360.
Brownell K.D.: The LEARN program for weight control. Dallas, American Health, 1991.
Fairburn C.G., Marcus M.D., Wilson G.T.: Cognitive-behavioral therapy for binge eating and bulimia nervosa. A comprehensive treatment manual. In: Fairburn C.G., Wilson G.T. (Eds.), Binge Eating: Nature, Assessment and Treatment. New York, Guildford Press, 1993, pp. 361–404.
Rossner S.: Defining success in obesity management. Int. J. Obes. Relat. Metab. Disord., 21 (Suppl 1), S2–S4, 1997.
Wing R.R., Koeske R., Epstein L.H., Nowalk M.P., Gooding W., Becker D.: Long-term effects of modest weight loss in type II diabetic patients. Arch. Intern. Med., 147, 1749–1753, 1987.
Finer N., James W.P., Kopelman P.G., Lean M.E., Williams G.: One-year treatment of obesity: a randomized, double-blind, placebo-controlled, multicentre study of orlistat, a gastrointestinal lipase inhibitor. Int. J. Obes. Relat. Metab. Disord., 24, 306–313, 2000.
Smith I.G., Goulder M.A.: Randomized placebo-controlled trial of long-term treatment with sibutramine in mild to moderate obesity. J. Fam. Pract. 50, 505–512, 2001.
Wirth A., Krause J.: Long-term weight loss with sibutramine: a randomized controlled trial. JAMA, 286, 1331–1339, 2001.
Agren G., Narbro K., Naslund I., Sjostrom L., Peltonen M.: Long-term effects of weight loss on pharmaceutical costs in obese subjects. A report from the SOS intervention study. Int. J. Obes. Relat. Metab. Disord., 26, 184–192, 2002.
DeMaria E.J., Sugerman H.J., Meador J.G., Doty J.M., Kellum J.M., Wolfe L., Szucs R.A., Turner M.A.: High failure rate after laparoscopic adjustable silicone gastric banding for treatment of morbid obesity. Ann. Surg., 233, 809–818, 2001.
Wing R.R., Jeffery R.W.: Outpatient treatments of obesity: a comparison of methodology and clinical results. Int. J. Obes., 3, 261–279, 1979.
Bennett W.: Dietary treatments of obesity. Ann. N. Y. Acad. Sci. 499, 250–263, 1987.
Apolone G., De Carli G., Brunetti M., Garattini S.: Health-related quality of life (HR-QOL) and regulatory issues. An assessment of the European Agency for the Evaluation of Medicinal Products (EMEA) recommendations on the use of HR-QOL measures in drug approval. Pharmacoeconomics 19, 187–195, 2001.
Prochaska J.O.: Strong and weak principles for progressing from precontemplation to action on the basis of twelve problem behaviors. Health Psychol., 13, 47–51, 1994.
Prochaska J.O., Velicer W.F.: The transtheoretical model of health behavior change. Am. J. Health Promot., 12, 38–48, 1997.
Wadden T.A.: Treatment of obesity by moderate and severe caloric restriction. Results of clinical research trials. Ann. Intern. Med., 119, 688–693, 1993.
Wadden T.A., Berkowitz R.I., Vogt R.A., Steen S.N., Stunkard A.J., Foster G.D.: Lifestyle modification in the pharmacologic treatment of obesity: a pilot investigation of a potential primary care approach. Obes. Res., 5, 218–226, 1997.
Jeffery R.W., Drewnowski A., Epstein L.H., Stunkard A.J., Wilson G.T, Wing R.R., Hill D.R.: Long-term maintenance of weight loss: current status. Health Psychol., 19, 5–16, 2000.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Melchionda, N., Besteghi, L., Di Domizio, S. et al. Cognitive behavioural therapy for obesity: One-year follow-up in a clinical setting. Eat Weight Disord 8, 188–193 (2003). https://doi.org/10.1007/BF03325012
Published:
Issue Date:
DOI: https://doi.org/10.1007/BF03325012