in Behavioral Treatment
MICHAEL G. PERRI
Poor maintenance of treatment-induced weight loss represents a critical problem in the management of obesity (see Chapter 94). Individuals who complete behavioral weight loss programs lose on average about 9% of their body weight but regain about half of the lost weight within 1 year and nearly all of it within 5 years. Nonetheless, a significant proportion of participants in behavioral programs (approximately 20%) succeed in sustaining 50% or more of their lost weight over 4 years. Moreover, an increasing number of studies provide data about the effectiveness of specific methods to enhance maintenance (see Chapter 106). Knowledge of the research on maintenance strategies can provide the clinician with useful information for long-term treatment planning in the care of obese clients.
The “maintenance problem” in obesity treatment stems from a complex interaction of physiological, environmental, and psychological variables. Physiological factors such as reduced metabolic rate, resulting from sustained dieting, prime the obese person to regain lost weight. Continuous exposure to an environment rich in tasty, high-calorie foods, combined with a dieting-induced, heightened sensitivity to palatable foods, further predisposes the individual to setbacks in dietary control (see Chapter 78). Most obese persons cannot sustain the substantial degree of psychological control needed to cope effectively with this unfriendly combination of environment and biology (see Chapter 83). Furthermore, following weight loss treatment, there are fewer reinforcers to help patients maintain adherence to changes in diet and activity. The most reward-