Obesity is a chronic condition, meaning it is unlikely to be cured, so behavioral interventions are needed to help people change their habits and improve their quality of life and their psychological functioning. The goal of weight management for obese people is to help them improve their unhealthful dietary and sedentary habits.
Behavioral change interventions typically include a number of specific strategies, including self-monitoring, stimulus control, cognitive restructuring, stress management, social support, rewards, problem solving, physical activity, and relapse prevention. These interventions make it easier for people to stay on a healthful eating plan and a regular exercise program.
The most important behavioral strategy for obese people to follow is self-monitoring—the observing and recording of behavioral patterns, followed by feedback on the behaviors. The obese person should keep a written notebook of all food that is ingested. This is best done on a regular basis, with entries written in a log as soon as possible after the food is eaten. Feedback means looking up and recording the number of calories that each food contained. In addition, it is also helpful to record the time of day that food is eaten, as well as one's mood, location, and other people present.
The number of minutes engaged in brisk walking or other physical activity should be recorded in the same notebook. In addition, a bathroom scale should be used to record one's weight on a daily basis. The primary goal of self-monitoring is to serve as a reminder of one's eating and exercise patterns. Results of such record keeping are clear: people who self-monitor lose more weight than those who do not. If a person uses only one weight-management strategy, it should be self-monitoring.
Stimulus control involves identifying the major barriers that are associated with unhealthful eating habits and sedentary patterns. Modifying these barriers by controlling environmental stimuli can help persons manage their weight-control behaviors. For example, one of the most common barriers to weight loss is a lack of time to exercise. Strategies to help persons find time during the day to exercise, such as setting their alarm clock to wake them up 45 minutes earlier and laying out exercise clothes and shoes before going to bed, are therefore important. When people get up earlier and exercise for even a few days, they tend to feel good about themselves and slowly develop the exercise habit. Other common stimulus-control strategies include avoiding high-risk places (such as a donut shop or fast-food restaurant), parking at the far end of the supermarket parking lot, and cleaning out the refrigerator and throwing out all high-calorie foods.
Cognitive restructuring means changing the way people think about themselves. For example, some people think that they can lose a lot of weight quickly, such as thirty pounds in thirty days. Cognitive restructuring involves helping people set more realistic goals, such as losing about one pound a week and focusing on quality of life and improved health, not just cosmetic goals such as looking better.
Stress is one of the major predictors of abandoning a weight-loss or weight-control regimen. It triggers unhealthful eating
Good friends, family members, education classes, community programs, and other social activities can serve as good social-support
Rewards for behavior change can help motivate people and reinforce healthful diets and exercise. Rewarding weight loss should be discouraged, however, because some people tend to use unhealthy strategies to achieve their goals. It is better to encourage specific behaviors, such as a certain number of minutes of exercise per day. Small rewards for small behavior changes make good sense for most people.
Problem solving involves identifying and correcting high-risk situations involving one's eating and exercise habits. High-risk situations are usually emotional or social. For example, being invited to a new restaurant may make a person feel anxious. A problem-solving approach may involve calling the restaurant ahead of time and asking for healthful, calorie-controlled suggestions. Bringing a low-calorie vegetable plate to a party may make it easier to stay away from the high-calorie fried chicken wings. Problem solving means planning ahead for high-risk situations.
John P. Foreyt
Perri, Michael, and Foreyt, John P. (2003). "Preventing Weight Regain after Weight Loss." In Handbook of Obesity, edited by George Bray and Claude Bouchard. New York: Marcel Dekker.
Poston, Walker, S. C.; Hyder, M. L.; O'Bryne, K. K.; and Foreyt, John P. (2000). "Where Do Diets, Exercise, and Behavior Modification Fit in the Treatment of Obesity?" Endocrine 13:187–192.
Wadden, Thomas A., and Stunkard, Albert J., eds. (2002). Handbook of Obesity Treatment. New York: Guildford Press.