Strategies to Improve Long-Term Outcome 133Figure 6.3 Long-term weight losses in behavioral treatments and with
extended therapist contacts. Source:Data from Perri and Corsica, 2002.
standard-length groups suggests a bene“cial impact for ex-
tended contact (i.e., 96.3% versus 66.5% of initial loss
maintained). Furthermore, the results of additional follow-
up visits conducted on average of 22 months after the initi-
ation of treatment showed that the extended treatment
groups maintained 65.8% of their initial reductions. In con-
trast, the three groups without extended contact maintained
only 38.3% of their initial reductions. Collectively, the data
in Figure 6.3 suggest that extended treatment improves
long-term outcome.
Relapse Prevention Training
Relapse prevention training (RPT) involves teaching par-
ticipants how to avoid or cope with slips and relapses
(Marlatt & Gordon, 1985). Studies of the effectiveness of
RPT on long-term weight management have revealed mixed
results. Perri, Shapiro, Ludwig, Twentyman, and McAdoo
(1984) found that the inclusion of RPT during initial treat-
ment was not effective, but combining RPT with a posttreat-
ment program of client-therapist contacts by mail and
telephone signi“cantly improved the maintenance of weight
loss. Similarly, Baum, Clark, and Sandler (1991) showed
that participants who received RPT combined with post-
treatment therapist contacts maintained their end of treat-
ment losses better than did participants in a minimal contact
condition. Recently, however, Perri and colleagues (Perri,
Nezu, et al., 2001) compared RPT and problem-solving
therapy (PST) as year-long extended treatments for weight
loss. PST showed better long-term outcome than the control
group, but RPT did not. RPT in this study was administered
as a standardized didactic program; it may be more effective
when applied as an individualized therapy (Marlatt &
George, 1998).
Telephone PromptsProviding patients with additional face-to-face treatment ses-
sions entails considerable time and effort. Therefore, it is rea-
sonable to consider whether telephone contact might be used
as a more ef“cient means of long-term care. Wing, Jeffery,
Hellerstedt, and Burton (1996) examined the impact of weekly
posttreatment calls designed to prompt self-monitoring of
body weight and food intake. The interviewers, who were not
the participants• therapists, offered no counseling or guidance.
Participation in the telephone contacts was associated with
better long-term outcome, but it did not enhance maintenance
of weight loss compared to a no-contact control condition. In
contrast, Perri, McAdoo, Spevak, and Newlin (1984) found
that client-therapist contacts by telephone and mail signi“-
cantly improved the maintenance of lost weight. In this study,
the participants• therapists actually made the phone call and
provided counseling, whereas in the Wing study, the contacts
were made by callers who were unknown to the clients and
who did not offer advice.Food Provision/Monetary IncentivesCan manipulation of the antecedents and consequences of
key behaviors improve long-term weight-loss outcome?
Jeffery and his colleagues (1993) addressed this question in
a study of the effects of food provision and monetary incen-
tives on weight loss. During initial treatment and the year
following initial treatment, participants were provided with
prepackaged, portion-controlled meals (10 per week at no
cost) or with monetary incentives for weight loss or with
both. The monetary incentives did not in”uence progress, but
the portion-controlled meals resulted in signi“cantly greater
weight losses, compared to standard behavioral treatment.
The “ndings of an additional 12-month follow-up showed a
signi“cant regaining of weight in all conditions (Jef fery &
Wing, 1995). A subsequent study (Wing et al., 1996) indi-
cated that providing participants with the •opportunityŽ to
purchase and use portion-controlled meals as a maintenance
strategy was ineffective, largely because participants did not
purchase the prepackaged meals.Peer SupportCan social support be utilized to improve long-term out-
come? The bene“ts of a peer support maintenance program
were investigated by Perri et al. (1987). After completing
standard behavioral treatment, participants were taught how
to run their own peer group support meetings. A meeting
place equipped with a scale was provided to the group, and