Future Research Directions 135condition, which received a home-based exercise regimen,
showed superior maintenance of weight loss at follow-up
compared to all other conditions. These results corroborate
the “ndings of Perri et al. (1997) regarding the bene“ts of
home-based exercise in the management of obesity.
Short Bouts and Home Exercise Equipment
Jakicic, Winters, Lang, and Wing (1999) showed that the
bene“ts of home exercise may be enhanced by providing
participants with exercise equipment and by allowing them
to exercise in brief bouts. Jakicic et al. tested the effects of
intermittent exercise (i.e., four 10-min bouts per day versus
one 40-min bout per day) and the use of home exercise
equipment on adherence and weight loss, and “tness. The
researchers provided half of the subjects in the short-bout
condition with motorized treadmills for home use. The ben-
e“ts from exercise in short or long bouts were equivalent.
However, participantswiththe home exercise equipment
maintained signi“cantly higher levels of long-term exercise
adherence and weight loss compared to subjectswithout
exercise equipment.
Exercise-Focused Maintenance Program
Finally, Leermakers, Perri, Shigaki, and Fuller (1999) exam-
ined whether a posttreatment program focused exclusively
on exercise might improve long-term outcome in obesity
treatment. These researcher compared the effects of exercise-
focused and weight-focused posttreatment programs. The
components of exercise-focused program included supervised
exercise, incentives for exercise completion, and relapse pre-
vention training aimed at the maintenance of exercise. The
weight-focused maintenance program included problem solv-
ing of barriers to weight-loss progress. The results of a long-
term follow-up showed that participants in the weight-focused
program had signi“cantly greater decreases in fat intake and
signi“cantly better maintenance of lost weight, compared to
subjects in the exercise-focused condition. These results high-
light the necessity of focusing on dietary intake as well exer-
cise in the long-term management of obesity.
Multicomponent Posttreatment Programs
A number of investigations have studied the impact of
posttreatment programs with multiple components. Perri,
McAdoo, et al. (1984) tested the effects of a multicomponent
program that included peer group meetings combined
with ongoing client-therapist contacts by mail and telephone.
The multicomponent program produced signi“cantly better
maintenance of weight loss, compared to a control group.
These “ndings were replicated in a later study (Perri,
McAdoo, McAllister, Lauer, & Yancey, 1986) that employed
a longer initial treatment (20 rather than 14 weeks), included
aerobic exercise, and achieved larger weight losses at post-
treatment and at follow-ups.
Finally, Perri and colleagues (1988) examined the effects
of adding increased exercise and a social in”uence program
(or both) to a posttreatment therapist contact program con-
sisting of 26 biweekly group sessions. Compared to a control
condition that received behavioral therapy without posttreat-
ment contact, all four posttreatment programs produced sig-
ni“cantly greater weight losses at an 18-month follow-up
evaluation. The four maintenance groups succeeded in sus-
taining on average 83% of their initial weight losses, com-
pared to 33% for the group without a posttreatment program.SummaryA review of strategies designed to improve long-term out-
come in obesity treatment reveals an interesting pattern of
“ndings. The use of VLCDs, relapse prevention training, peer
group meetings, telephone prompts by nontherapists, mone-
tary incentives for weight loss, supervised group exercise, the
assistance of personal trainers, and the availability of portion-
controlled meals do not appear effective in improving long-
term outcome. On the other hand, there is evidence suggesting
that extending treatment beyond six months through the use of
weekly or biweekly sessions and providing multicomponent
programs with ongoing patient-therapist contact improves the
maintenance of lost weight. In addition, home-based exercise
programs and the use of home exercise equipment may en-
hance adherence and may contribute to improved long-term
outcome.FUTURE RESEARCH DIRECTIONSSeveral areas for clinical research appear promising. Some of
these are discussed next.Address Unrealistic Weight-Loss ExpectationsMost obese clients enter weight-loss treatment with unre-
alistically high expectations about the amount of weight
loss they can reasonably achieve (Foster, Wadden, Vogt, &
Brewer, 1997). The discrepancy between clients• expecta-
tions and actual outcome may cause them to discount the
bene“cial impact of modest weight losses and lead ultimately
to demoralization and dif“culty maintaining the behavior