Skip to main content

Advertisement

Log in

Lifestyle modification in the management of obesity: achievements and challenges

  • Review
  • Published:
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity Aims and scope Submit manuscript

Abstract

Lifestyle modification therapy for overweight and obese patients combines specific recommendations on diet and exercise with behavioral and cognitive procedures and strategies. In completers it produces a mean weight loss of 8–10 % in about 30 weeks of treatment. However, two main issues still to be resolved are how to improve dissemination of this approach, and how to help patients maintain the healthy behavioral changes and avoid weight gain in the long term. In recent years, several strategies for promoting and maintaining lifestyle modification have been evaluated, and promising results have been achieved by individualising the treatment, delivering the intervention by phone and internet or in a community setting, and combining lifestyle modification programs with residential treatment and bariatric surgery. These new strategies raise optimistic expectations for the effective management of obesity through lifestyle modification.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Wadden TA, Butryn ML, Byrne KJ (2004) Efficacy of lifestyle modification for long-term weight control. Obes Res 12(Suppl):151S–162S

    Article  PubMed  Google Scholar 

  2. Ferster CB, Nurberger JI, Levitt EE (1962) The control of eating. J Math 1:87–109

    Google Scholar 

  3. Stuart RR (1967) Behavioral control of overeating. Behav Res Ther 5:357–365

    Article  Google Scholar 

  4. Wadden TA, McGuckin BG, Rothman RA, Sargent SL (2003) Lifestyle modification in the management of obesity. J Gastrointest Surg 7:452–463

    Article  PubMed  Google Scholar 

  5. Sbraccia P, Vettor R (2012) SIO, Società Italiana dell’Obesità e ADI, Associazione Dietetica Italiana. Standard italiani per la cura dell’obesità 2012–2013. Società Italiana dell’Obesità, Roma

  6. National Heart, Lung, and Blood Institute (NHLBI) and the North American Association for the Study of Obesity (NAASO) (2000) The practical guide: identification, evaluation, and treatment of overweight and obesity in adults. National Institutes of Health, Bethesda

    Google Scholar 

  7. National Institutes of Health (1998) Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults—the evidence report. Obes Res 6(Suppl 2):51S–209S

    Google Scholar 

  8. Wadden TA, Berkowitz RI, Womble LG, Sarwer DB, Phelan S, Cato RK, Hesson LA, Osei SY, Kaplan R, Stunkard AJ (2005) Randomized trial of lifestyle modification and pharmacotherapy for obesity. N Engl J Med 353:2111–2120

    Article  PubMed  CAS  Google Scholar 

  9. Diabetes Prevention Program (DPP) Research Group (2002) The Diabetes Prevention Program (DPP): description of lifestyle intervention. Diabetes Care 25:2165–2171

    Article  Google Scholar 

  10. Willaing I, Ladelund S, Jorgenson T, Simonsen T, Nielsen LM (2004) Nutritional counselling in primary care: a randomized comparison of an intervention by general practitioner or dietician. Eur J Cardiovasc Prev Rehabil 11:513–520

    Article  PubMed  Google Scholar 

  11. Dalle Grave R, Calugi S, Gavasso I, El Ghoch M, Marchesini G (2013) A randomized trial of energy-restricted high-protein versus high-carbohydrate, low-fat diet in morbid obesity. Obesity. doi:10.1002/oby.20320

    PubMed  Google Scholar 

  12. Heshka S, Anderson JW, Atkinson RL, Greenway FL, Hill JO, Phinney SD, Kolotkin RL, Miller-Kovach K, Pi-Sunyer FX (2003) Weight loss with self-help compared with a structured commercial program: a randomized trial. JAMA 289:1792–1798

    Article  PubMed  Google Scholar 

  13. Ryan DH, Espeland MA, Foster GD, Haffner SM, Hubbard VS, Johnson KC, Kahn SE, Knowler WC, Yanovski SZ (2003) Look AHEAD (Action for Health in Diabetes): design and methods for a clinical trial of weight loss for the prevention of cardiovascular disease in type 2 diabetes. Control Clin Trials 24:610–628

    Article  PubMed  Google Scholar 

  14. Donini LM, Cuzzolaro M, Spera G, Badiali M, Basso N, Bollea MR, Bosello O, Brunani A, Busetto L, Cairella G, Cannella C, Capodaglio P, Carbonelli MG, Castellaneta E, Castra R, Clini E, Contaldo F, Dalla Ragione L, Dalle Grave R, D’Andrea F, Del Balzo V, De Cristofaro P, Di Flaviano E, Fassino S, Ferro AM, Forestieri P, Franzoni E, Gentile MG, Giustini A, Jacoangeli F, Lubrano C, Lucchin L, Manara F, Marangi G, Marcelli M, Marchesini G, Marri G, Marrocco W, Melchionda N, Mezzani B, Migliaccio P, Muratori F, Nizzoli U, Ostuzzi R, Panzolato G, Pasanisi F, Persichetti P, Petroni ML, Pontieri V, Prosperi E, Renna C, Rovera G, Santini F, Saraceni V, Savina C, Scuderi N, Silecchia G, Strollo F, Todisco P, Tubili C, Ugolini G, Zamboni M (2010) Obesity and eating disorders. Indications for the different levels of care. An Italian Expert Consensus Document. Eat Weight Disord 15 (1–2 Suppl):1–31

  15. Bellentani S, Dalle Grave R, Suppini A, Marchesini G (2008) Behavior therapy for nonalcoholic fatty liver disease: the need for a multidisciplinary approach. Hepatology 47:746–754

    Article  PubMed  Google Scholar 

  16. Dalle Grave R, Calugi S, Centis E, Marzocchi R, El Ghoch M, Marchesini G (2010) Lifestyle modification in the management of the metabolic syndrome: achievements and challenges. Diabetes Metab Syndr Obes 3:373–385

    PubMed  Google Scholar 

  17. Kushner RF (2003) Roadmaps for clinician practice: case studies in disease prevention and health promotion—assessment and management of adult obesity: a primer for physicians. American Medical Association, Chicago

    Google Scholar 

  18. Fabricatore AN (2007) Behavior therapy and cognitive-behavioral therapy of obesity: is there a difference? J Am Diet Assoc 107:92–99

    Article  PubMed  Google Scholar 

  19. Baker RC, Kirschenbaum DS (1993) Self-monitoring may be necessary for successful weight control. Behav Ther 24:377–394

    Article  Google Scholar 

  20. O’Neil PM (2001) Assessing dietary intake in the management of obesity. Obes Res 9(Suppl):S361–S366

    Google Scholar 

  21. Jakicic JM (2003) Exercise in the treatment of obesity. Endocrinol Metab Clin North Am 32:967–980

    Article  PubMed  Google Scholar 

  22. Kraemer HC, Wilson GT, Fairburn CG, Agras WS (2002) Mediators and moderators of treatment effects in randomized clinical trials. Arch Gen Psychiatry 59:877–883

    Article  PubMed  Google Scholar 

  23. Foster GD, Makris AP, Bailer BA (2005) Behavioral treatment of obesity. Am J Clin Nutr 82(1 Suppl):230S–235S

    PubMed  CAS  Google Scholar 

  24. Brownell KD (2000) The LEARN manual for weight management. American Health Publishing Co, Dallas

    Google Scholar 

  25. Cooper Z, Fairburn CG, Hawker DM (2003) Cognitive-behavioral treatment of obesity: a clinician’s guide. Guilford Press, New York

    Google Scholar 

  26. Wadden TA, West DS, Delahanty L, Jakicic J, Rejeski J, Williamson D, Berkowitz RI, Kelley DE, Tomchee C, Hill JO, Kumanyika S (2006) The Look AHEAD study: a description of the lifestyle intervention and the evidence supporting it. Obesity 14:737–752

    Article  PubMed  Google Scholar 

  27. Fairburn CG, Cooper Z, Shafran R, Bohn K, Hawker DM, Murphy R, Straebler S (2008) Enhanced cognitive behavior therapy for eating disorders: The core protocol. In: Fairburn CG (ed) Cognitive behavior therapy and eating disorders. Guilford Press, New York, pp 45–193

    Google Scholar 

  28. Fairburn CG (2008) Cognitive behavior therapy and eating disorders. Guilford Press, New York

    Google Scholar 

  29. Bravata DM, Smith-Spangler C, Sundaram V, Gienger AL, Lin N, Lewis R, Stave CD, Olkin I, Sirard JR (2007) Using pedometers to increase physical activity and improve health: a systematic review. JAMA 298:2296–2304

    Article  PubMed  CAS  Google Scholar 

  30. Rooney B, Smalley K, Larson J, Havens S (2003) Is knowing enough? Increasing physical activity by wearing a pedometer. WMJ 102:31–36

    PubMed  Google Scholar 

  31. O’Neil PM, Brown JD (2005) Weighing the evidence: benefits of regular weight monitoring for weight control. J Nutr Educ Behav 37:319–322

    Article  PubMed  Google Scholar 

  32. Wing RR, Tate DF, Gorin AA, Raynor HA, Fava JL, Machan J (2007) STOP regain: are there negative effects of daily weighing? J Consult Clin Psychol 75:652–656

    Article  PubMed  Google Scholar 

  33. Dalle Grave R, Melchionda N, Calugi S, Centis E, Tufano A, Fatati G, Fusco MA, Marchesini G (2005) Continuous care in the treatment of obesity: an observational multicentre study. J Intern Med 258:265–273

    Article  PubMed  CAS  Google Scholar 

  34. Dalle Grave R, Calugi S, Molinari E, Petroni ML, Bondi M, Compare A, Marchesini G, the QSG (2005) Weight loss expectations in obese patients and treatment attrition: an observational multicenter study. Obes Res 13:1961–1969

    Article  PubMed  Google Scholar 

  35. Foster GD, Phelan S, Wadden TA, Gill D, Ermold J, Didie E (2004) Promoting more modest weight losses: a pilot study. Obes Res 12:1271–1277

    Article  PubMed  Google Scholar 

  36. Wadden TA, Crerand CE, Brock J (2005) Behavioral treatment of obesity. Psychiatr Clin North Am 28:151–170, ix

    Google Scholar 

  37. Wing RR, Jeffery RW (1999) Benefits of recruiting participants with friends and increasing social support for weight loss and maintenance. J Consult Clin Psychol 67:132–138

    Article  PubMed  CAS  Google Scholar 

  38. Avenell A, Broom J, Brown TJ, Poobalan A, Aucott L, Stearns SC, Smith WC, Jung RT, Campbell MK, Grant AM (2004) Systematic review of the long-term effects and economic consequences of treatments for obesity and implications for health improvement. Health Technol Assess 8:iii–iv, 1–182

    Google Scholar 

  39. D’Zurilla TJ, Goldfried MR (1971) Problem solving and behavior modification. J Abnorm Psychol 78:107–126

    Article  PubMed  Google Scholar 

  40. Perri MG, Nezu AM, McKelvey WF, Shermer RL, Renjilian DA, Viegener BJ (2001) Relapse prevention training and problem-solving therapy in the long-term management of obesity. J Consult Clin Psychol 69:722–726

    Article  PubMed  CAS  Google Scholar 

  41. Perri MG, Nezu AM, Patti ET, McCann KL (1989) Effect of length of treatment on weight loss. J Consult Clin Psychol 57:450–452

    Article  PubMed  CAS  Google Scholar 

  42. Wadden TA, Webb VL, Moran CH, Bailer BA (2012) Lifestyle modification for obesity: new developments in diet, physical activity, and behavior therapy. Circulation 125:1157–1170

    Article  PubMed  Google Scholar 

  43. Latner JD, Stunkard AJ, Wilson GT, Jackson ML, Zelitch DS, Labouvie E (2000) Effective long-term treatment of obesity: a continuing care model. Int J Obes Relat Metab Disord 24:893–898

    Article  PubMed  CAS  Google Scholar 

  44. Cooper Z, Fairburn CG (2001) A new cognitive behavioural approach to the treatment of obesity. Behav Res Ther 39:499–511

    Article  PubMed  CAS  Google Scholar 

  45. Stahre L, Tarnell B, Hakanson CE, Hallstrom T (2007) A randomized controlled trial of two weight-reducing short-term group treatment programs for obesity with an 18-month follow-up. Int J Behav Med 14:48–55

    Article  PubMed  Google Scholar 

  46. Cooper Z, Doll HA, Hawker DM, Byrne S, Bonner G, Eeley E, O’Connor ME, Fairburn CG (2010) Testing a new cognitive behavioural treatment for obesity: a randomized controlled trial with three-year follow-up. Behav Res Ther 48:706–713

    Article  PubMed  Google Scholar 

  47. Wing RR, Phelan S (2005) Long-term weight loss maintenance. Am J Clin Nutr 82(1 Suppl):222S–225S

    PubMed  CAS  Google Scholar 

  48. Jeffery RW, Wing RR, Sherwood NE, Tate DF (2003) Physical activity and weight loss: does prescribing higher physical activity goals improve outcome? Am J Clin Nutr 78:684–689

    PubMed  CAS  Google Scholar 

  49. Rosenbaum M, Hirsch J, Gallagher DA, Leibel RL (2008) Long-term persistence of adaptive thermogenesis in subjects who have maintained a reduced body weight. Am J Clin Nutr 88:906–912

    PubMed  CAS  Google Scholar 

  50. Linde JA, Jeffery RW, French SA, Pronk NP, Boyle RG (2005) Self-weighing in weight gain prevention and weight loss trials. Ann Behav Med 30:210–216

    Article  PubMed  Google Scholar 

  51. Butryn ML, Phelan S, Hill JO, Wing RR (2007) Consistent self-monitoring of weight: a key component of successful weight loss maintenance. Obesity 15:3091–3096

    Article  PubMed  Google Scholar 

  52. Wadden TA, Butryn ML (2003) Behavioral treatment of obesity. Endocrinol Metab Clin North Am 32:981–1003, x

    Google Scholar 

  53. Expert Panel on the Identification, Evaluation, and Treatment of Overweight in Adults (1998) Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: executive summary. Am J Clin Nutr 68:899–917

    Google Scholar 

  54. World Health Organization (2000) Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser 894:i–xii, 1–253

  55. Christian JG, Tsai AG, Bessesen DH (2010) Interpreting weight losses from lifestyle modification trials: using categorical data. Int J Obes 34:207–209

    Article  CAS  Google Scholar 

  56. Diabetes Prevention Program Research Group (2002) Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 346:393–403

    Article  Google Scholar 

  57. Wing RR, Epstein LH, Marcus MD, Kupfer DJ (1984) Mood changes in behavioral weight loss programs. J Psychosom Res 28(3):189–196

    Article  PubMed  CAS  Google Scholar 

  58. Fontaine KR, Barofsky I, Bartlett SJ, Franckowiak SC, Andersen RE (2004) Weight loss and health-related quality of life: results at 1-year follow-up. Eat Behav 5(1):85–88

    Article  PubMed  Google Scholar 

  59. Dalle Grave R, Cuzzolaro M, Calugi S, Tomasi F, Temperilli F, Marchesini G (2007) The effect of obesity management on body image in patients seeking treatment at medical centers. Obesity 15:2320–2327

    Article  PubMed  Google Scholar 

  60. Perri MG, Corsica JA (2002) Improving maintenance of weight lost in behavioral treatment of obesity. In: Wadden T, Stunkard A (eds) Handbook of obesity treatment. Guilford Press, New York, pp 357–379

    Google Scholar 

  61. Look AHEAD Research Group (2013) Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med 369:145–154

    Article  Google Scholar 

  62. Wing RR (2010) Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus: four-year results of the Look AHEAD trial. Arch Intern Med 170:1566–1575

    PubMed  CAS  Google Scholar 

  63. Gerstein HC (2013) Do lifestyle changes reduce serious outcomes in diabetes? N Engl J Med 369:189–190

    Article  PubMed  CAS  Google Scholar 

  64. Nijamkin MP, Campa A, Sosa J, Baum M, Himburg S, Johnson P (2012) Comprehensive nutrition and lifestyle education improves weight loss and physical activity in Hispanic Americans following gastric bypass surgery: a randomized controlled trial. J Acad Nutr Diet 112:382–390

    Article  PubMed  Google Scholar 

  65. Shang E, Hasenberg T (2010) Aerobic endurance training improves weight loss, body composition, and co-morbidities in patients after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis 6(3):260–266

    Article  PubMed  Google Scholar 

  66. Tsai AG, Wadden TA (2009) Treatment of obesity in primary care practice in the United States: a systematic review. J Gen Intern Med 24:1073–1079

    Article  PubMed  Google Scholar 

  67. Ashley JM, St Jeor ST, Schrage JP, Perumean-Chaney SE, Gilbertson MC, McCall NL, Bovee V (2001) Weight control in the physician’s office. Arch Intern Med 161:1599–1604

    Article  PubMed  CAS  Google Scholar 

  68. Perri MG, Limacher MC, Durning PE, Janicke DM, Lutes LD, Bobroff LB, Dale MS, Daniels MJ, Radcliff TA, Martin AD (2008) Extended-care programs for weight management in rural communities: the treatment of obesity in underserved rural settings (TOURS) randomized trial. Arch Intern Med 168:2347–2354

    Article  PubMed  Google Scholar 

  69. Radcliff TA, Bobroff LB, Lutes LD, Durning PE, Daniels MJ, Limacher MC, Janicke DM, Martin AD, Perri MG (2012) Comparing costs of telephone vs face-to-face extended-care programs for the management of obesity in rural settings. J Acad Nutr Diet 112:1363–1373

    Article  PubMed  Google Scholar 

  70. Harvey-Berino J, West D, Krukowski R, Prewitt E, VanBiervliet A, Ashikaga T, Skelly J (2010) Internet delivered behavioral obesity treatment. Prev Med 51:123–128

    Article  PubMed  Google Scholar 

  71. Daumit GL, Dickerson FB, Wang NY, Dalcin A, Jerome GJ, Anderson CA, Young DR, Frick KD, Yu A, Gennusa JV 3rd, Oefinger M, Crum RM, Charleston J, Casagrande SS, Guallar E, Goldberg RW, Campbell LM, Appel LJ (2013) A behavioral weight loss intervention in persons with serious mental illness. N Engl J Med 368:1594–1602

    Article  PubMed  CAS  Google Scholar 

Download references

Conflict of interest

All authors declare no conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Riccardo Dalle Grave.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Dalle Grave, R., Calugi, S. & El Ghoch, M. Lifestyle modification in the management of obesity: achievements and challenges. Eat Weight Disord 18, 339–349 (2013). https://doi.org/10.1007/s40519-013-0049-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40519-013-0049-4

Keywords

Navigation