Handbook of Psychology

208 Diabetes Mellitus

double-blind trials with serotoninergic agents (fen”uramine,
dexfen”uramine) in patients with type 2 diabetes have sug-
gested that these agents directly improve glycemic control,
irrespective of effects of food intake and body weight (e.g.,
Willey, Molyneaux, & Yue, 1994). The effects of fen”u-
ramine and phentermine, in combination with 12 months of
intensive nutrition counseling, an exercise prescription, and
instruction in behavior modi“cation, resulted in signi“cant
reductions in body weight, BMI, and HbA1c throughout
the six months of treatment in addition to decreases in dia-
betes medications, fasting plasma glucose, and triglycerides
(Redmon et al., 1999). Although fen”uramine was with-
drawn from the market in 1997 (mid-study), it is promising to
note that other drug therapies such as sibutramine, a sero-
tonin reuptake inhibitor (Meridia; Bray et al., 1996), have
been recently FDA approved and continue to be evaluated
(Jeffrey et al., 2000).
Several studies have evaluated the effects of social sup-
port, typically from spouses or signi“cant others, as a method
for enhancing motivation for weight loss (Jeffrey et al.,
2000). Wing, Marcus, Epstein, et al. (1991) did not “nd any
weight loss differences between patients treated alone and
together at posttreatment or at one-year follow-up. However,
gender differences emerged with respect to the effects of sup-
port on weight loss such that women lost more weight when
treated with their spouses and men lost more weight when
treated alone. The authors proposed that involving husbands
in a weight loss program allows women to be more conscien-
tious of food preparation and purchase for both herself and
her husband, whereas men tend to allow their wives to estab-
lish their eating patterns and are less involved in the weight
monitoring process. Gender differences have also been found
with respect to the effects of support on glycemic control,
with women achieving better control and men achieving
poorer control (Heitzman & Kaplan, 1984). Other weight
loss studies have indicated the positive effects of group
support strategies (e.g., Wing & Jeffrey, 1999) as well as
maintenance support contact (Perri et al., 1988) on weight
loss. Speci“c contributions of group or individual support
(e.g., enhanced motivation) appear to be valuable factors in
weight loss treatment. However, maintenance of behavioral
changes that produce positive results for patients again be-
come problematic following treatment.

Maintenance of Weight Loss

As reviewed previously, sustained weight loss on a long-term
basis is one of the greatest challenges for obese individuals
with diabetes, as with obese patients in general (Jeffrey et al.,
2000). One reason for this struggle is that there may be

different behavioral, cognitive, and psychological mecha-

nisms inherent in weight loss maintenance in contrast to

initial weight loss. Continued research efforts that focus on

intensifying and lengthening treatment may help to delineate

factors responsible for success in weight loss maintenance

and improved health outcomes for obese individuals (Jeffrey

et al., 2000). Researchers continue to propose lifestyle modi-

“cation strategies that seem to ef fectuate weight loss mainte-

nance and improve health status. Speci“c strategies include

implementing dietary practices, professional contact, behav-

ior modi“cation, social support strategies, and exercise on

an ongoing basis (Perri, Sears, & Clark, 1993). Thus, educat-

ing obese individuals with diabetes on how to incorporate

various long-term treatment components into their daily lives

may aid them in the dif“cult task of maintaining treatment

gains.

Summary

Because of the increased risk of medical problems associated

with the coexistence of obesity and type 2 diabetes, weight

loss continues to be the golden standard of treatment for

obese individuals with type 2 diabetes. A wealth of empirical

research has delineated speci“c behavioral strategies (e.g.,

exercise, diet), adjunctive pharmacological agents, and social

support and contingency maintenance programs that facili-

tate short-term weight loss. Similar to diabetes, obesity is a

chronic medical condition that warrants continuous health

care and lifestyle changes to maintain treatment gains and

positive behavioral patterns. As such, the challenge for re-

searchers and clinicians is to continue developing differential

intervention strategies that meet patients• complex biopsy-

chosocial needs and will contribute to long-term modi“ca-

tions of health behaviors and weight loss maintenance in type

2 diabetes patients.

ROLE OF HEALTH PSYCHOLOGY

IN DIABETES MELLITUS

As illustrated in the preceding literature review, health

psychologists can play an invaluable role in enhancing the

emotional and physical well-being of persons with diabetes.

Ideally, health psychologists function as part of the treatment

team, helping to provide comprehensive diabetes care to all

patients, not solely to those already distressed. As a member

of the treatment team, the psychologist is able to provide both

preventative services as well as problem-focused interven-

tions when needed. In addition, membership on the team fa-

cilitates the ongoing exchange of mutual feedback between