Behavioral Treatment for Obesity
G. TERENCE WILSON
KELLY D. BROWNELL
Behavioral weight loss (BWL) treatment has as its primary goals the modification of people’s eating habits and level of physical activity. The emphasis is on changing behavior to restrict caloric consumption and increase energy expenditure through physical exercise, thereby producing a negative energy balance and consequent weight loss. BWL treatment has been more intensively researched, and its effects more thoroughly documented, than any other intervention for obesity. Treatment principles and procedures have been clearly specified in “user friendly” treatment manuals for professionals and the public alike. As a result, BWL treatment has been widely disseminated and accepted. Behavioral treatment has for some time now been regarded as a necessary component of any adequate obesity treatment program (see Chapters 91 and 92).
BWL programs are typically administered on a group basis. Current duration of treatment ranges from 4 to 6 months of weekly sessions. A core feature of BWL treatment is self-monitoring, the detailed, daily recording of food intake and the circumstances under which it occurs. This assessment guides selection and implementation of behavioral interventions. Self-monitoring is also part of the behavior change process. Patients use this self-monitoring of performance to evaluate their progress against realistic weight loss goals. Attaining these goals motivates continued adherence to treatment procedures. By learning to identify the personal and environmental influences that regulate their eating, patients can take specific actions to break unhealthy habits. The same behavioral principles are used to encourage increased physical activity (see Chapter 93). Other self-regulatory strategies include stimulus control, which is designed to limit exposure to cues that prompt overeating. For example, patients are instructed to do nothing else while eating