Handbook of Psychology

136 Obesity

changes needed to sustain weight loss (Foster et al., 1997).
Addressing unrealistic weight-loss expectations at treatment
outset may improve clients• satisfaction with the outcome of
weight-loss therapy and thereby increase the likelihood
of maintenance of weight lost.

Match Treatments to Clients

Matching long-term care to the speci“c needs of particular
subgroups of obese persons may be fostered by the develop-
ment of an empirical database (Brownell & Wadden, 1991).
Such a database might include the clinical markers known to
be associated with poor response to treatment (e.g. binge eat-
ing, depression, signi“cant life stress, and minimal weight
loss in the “rst month of treatment; Wadden & Letizia, 1992).
This database might also help to identify persons for whom
successful maintenance of weight lost might require com-
bined behavioral plus pharmacological treatment versus those
for whom behavioral management alone provides a satisfac-
tory outcome. In addition, the interaction of genetic and envi-
ronmental contributors to success and failure in the long-term
management of obesity requires investigation (Camp“eld,
Smith, Guisez, Devos, & Burn, 1995). For example, leptin as
an obesity treatment appears promising, and clinical trials
have yielded a positive dose-response effect on weight loss in
both obese and normal weight subjects (Heyms“eld et al.,
1999). Findings such as these may contribute signi“cantly to
treatment matching in patients with a potential biological dis-
position for obesity.

Test Innovative Models

Cooper and Fairburn (2001) have suggested that innovative
cognitive-behavioral interventions based on a newer concep-
tualization of the •maintenance problemŽ may improve long-
term results. These authors argue that the absence of training
in weight stabilization may hinder long-term success. They
recommend that after an active period of weight loss, it is es-
sential to provide patients with training in the maintenance of
a stable body weight. These authors are currently conducting
a randomized clinical trial to test the effects of this promising
cognitive-behavioral model.

Examine Schedules of Follow-Up Care

Research has shown that greater frequency of follow-up con-
tacts improves the success of weight loss treatment. What is
unknown is the speci“c frequency and timing of professional
contacts that are needed to sustain progress during follow-up
care. It will be important to determine the minimal and
optimal frequency of contacts needed for maintenance of

treatment effects. Importantly, the schedule in which follow-

up is generally conducted (intervals determined in advance

by the experimenters) may not provide patients with assis-

tance at critical junctures (e.g., when facing a signi“cant

stressor or after experiencing a weight gain). Whether

follow-up care should be tailored to each patient•s progress

rather than a “xed interval schedule, and whether a more

open format or drop-in approach may prove more useful for

clients should be investigated. Finally, the decline in atten-

dance at long-term follow-up sessions has proven a formida-

ble obstacle to successful maintenance treatment. Thus, we

need to develop ways to keep patients actively involved in

the long-term management of their obesity.

IMPROVING THE MANAGEMENT AND

PREVENTION OF OBESITY

In this section, we offer two sets of recommendations. The

“rst set entails suggestions to health professionals about

ways to improve the care of the obese patient. The second set

includes suggestions for the prevention of obesity.

Managing Obesity

Guidelines for a stepped-care approach for matching treat-

ments to patients based on the severity of obesity and previ-

ous response to weight-loss treatment have been described in

the recent report of the NIH (NHLBI, 1998). We offer several

additional recommendations to health care professionals who

treat obese patients.

1.Begin with a comprehensive assessment.An effective treat-

ment plan should begin with a comprehensive assessment

of the effects of obesity on the individual•s health and emo-

tional well-being (Beliard, Kirschenbaum, & Fitzgibbon,

1992). In addition to determining BMI and waist circum-

ference, the evaluation should include an assessment of the

impact of body weight on the obese person•s current health

and risk for future disease. The presence of signi“cant co-

morbidities may justify consideration of pharmacotherapy

in patients with BMIs as low as 27 and bariatric surgery

in patients with BMIs as low as 35. The obese person

should receive a thorough physical examination that

speci“cally assesses risk for diabetes, dyslipidemia, and

hypertension„conditions that are very common yet often

go undetected among obese individuals. The initial assess-

ment should also include an assessment of •behavioralŽ

risk factors, including sedentary lifestyle, consumption of

a high-fat diet, and binge eating. Quality of life indicators

including social adjustment, body image satisfaction, and