Obesity Treatment 185success rates are still poor. In 1993, Wadden also examined both the short-
and long-term effectiveness of both moderate and severe caloric restriction
on weight loss (Wadden, 1993). He examined all the studies involving
randomized controlled trials in four behavioral journals and compared his
findings to those of Stunkard (1958). Wadden concluded that “Investigators
have made significant progress in inducing weight loss in the 35 years since
Stunkard’s review.” He stated that 80 percent of patients will now stay in
treatment for 20 weeks and that 50 percent will achieve a weight loss of
20 lbs or more. Therefore, modern methods of weight loss produce improved
results in the short term. Wadden also concluded, however, that “most obese
patients treated in research trials still regain their lost weight.” This
conclusion has been further supported by a systematic review of interventions
for the treatment and prevention of obesity, which identified 92 studies
which fitted the authors’ inclusion criteria (NHS Centre for Reviews and
Dissemination, 1997). The review examined the effectiveness of dietary,
exercise, behavioral, pharmacological, and surgical interventions for obesity,
and concluded that “the majority of the studies included in the present
review demonstrate weight regain either during treatment or post interven-
tion.” Further, Fabricatore and Wadden in 2006 argued that the weight losses
achieved with nonsurgical approaches “have remained virtually unchanged
over the past 20 years.” In real terms, between 90 percent and 95 percent
of those who lose weight regain it within several years (Garner and Wooley,
1991). Accordingly, the picture for long-term weight loss remains a pes-
simistic one.
Problems with weighingIntrinsic to the definition and treatment of both obesity and eating disorders
is the process of weighing. An individual is weighed in order to compare
their weight with that recommended by the health professionals, and
repeated weighing is used in order to provide both negative and positive
feedback during a treatment program. Weighing is also used by many
normal-weight individuals to facilitate their own weight control. Underly-
ing the use of weighing is the assumption that the individual will benefit
from being weighed, as this practice will encourage them to adhere to any
treatment recommendations. It also assumes that even if weighing has no
actual benefits, it can do no harm. The focus on weighing, however, shifts
the desired outcome of any treatment program from improved health
and well-being to actual weight loss defined by the number on the scale.