The Psychology of Eating: From Healthy to Disordered Behavior

184 Obesity Treatment

Brownell and Wadden (1991) emphasized the need for a multidimensional
approach and also highlighted the importance of screening patients for entry
onto a treatment program, and argued that each patient should be
matched to the most appropriate package. This can involve using motiva-
tional interviewing, which is derived from the stages of change theory, as
a means to assess whether an individual is ready to change their behavior
and to evaluate their degree of motivation (Prochaska and DiClemente, 1984;
and see figure 11.2 in chapter 11). Further, the concept of a reasonable
weight which is negotiated by the patient and the therapist is used, and
such approaches focus on long-term lifestyle change rather than short-term
“quick fixes” (Brownell and Wadden, 1991; Brownell, 1998, 1999). A multi-
dimensional approach to obesity treatment is illustrated in figure 9.1.
Some individual studies show that multidimensional long-term interven-
tions including components such as relapse prevention, problem-solving
therapy, motivation, behavioral skills training, and group support produce
good initial weight losses and some degree of weight maintenance (e.g.,
Sherman et al., 2000; Perri et al., 2001). A broader analysis of the effectiveness
of multidimensional treatment approaches suggests that average weight loss
during the treatment program is 0.5 kg per week and that approximately
60 to 70 percent of the weight loss is maintained during the first year
(Brownell and Wadden, 1992). At 3- and 5-year follow-ups, however, the
data tend to show weight gains back to baseline weight (Brownell and
Wadden, 1992). In a comprehensive review of the treatment interventions
for obesity, Wilson (1995) suggested that there has been an improvement
in the effectiveness of obesity treatment since the 1970s. However, long-term

cognitive

restructuring

relapse

prevention

screening

patients

Weight

loss

reasonable

weights

exercise

nutritional

information

self-

monitoring

lifestyle

changes

Figure 9.1 Multidimensional packages for obesity.