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Behavioral Approaches to Weight Loss


Behavioral Approaches to Weight Loss. Valerie H. Myers, PhD ... Tips cont'd. Set short and long-term goals use a step-by-step approach ... – PowerPoint PPT presentation

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Title: Behavioral Approaches to Weight Loss

Behavioral Approaches to Weight Loss
  • Valerie H. Myers, PhD
  • Pennington Biomedical Research Center

Prevalence of Overweight and Obesity Among US
Adults, Age 20-74 Years
Age-adjusted by the direct method to the year
2000 U.S. Bureau of the Census estimates using
the age groups 20-34, 35-44, 45-54, 55-64, and
65-74 years.
Impact of Effective Treatment
  • Sustained weight loss of 10
  • Fewer years of living with chronic diseases
  • Hypertension, hypercholesterolemia, type II
  • Reduces incidences of
  • stroke and heart disease
  • increase in life expectancy
  • reduces medical costs by 2,200 to 5,300
  • Oster G, Thompson D, Lifetime Health and Economic
    Benefits of Weight Loss Among Obese Persons, Am J
    Public Health, 1999891536-1542.

Impact on Other Medical Conditions
  • 5-10 weight loss
  • 5-10 total and LDL cholesterol
  • HDL
  • glycosylated hemoglobin (1-2.5)
  • blood pressure 3-8 mm HG.
  • 2-4 weight loss
  • 30-50 in diabetes incidence
  • 20 -30 in high blood pressure
  • Clinical guidelines. National Heart, Lung, and
    Blood Institute Web site. Available

Impact on Other Medical Conditions
  • Miscellaneous
  • Each kg of weight loss 1.7-2.5 mm Hg BP
  • blood glucose levels in overweight and
    obese persons without diabetes

The recommended treatments for various
NHLBI Guidelines for Management of Obesity 1998
and Bray 2003 Atlas of Obesity
Behavioral Treatment Overview
  • Lifestyle modification
  • Diet
  • Reduction in intake of 500-100 kcal/day
  • Exercise
  • 30 min/day 5-6 days/wk
  • Behavior therapy
  • Set of techniques for modifying diet exercise

Behavioral Treatment Overview
  • Weekly treatment sessions (16-26 wks)
  • Groups of 10-20 pts
  • Weigh-in, review food/fitness diaries, new
    dietetics or PA topic

Individual vs. Group Weight Loss
Renjilian et al (2001). JCCP
Behavioral Treatment Overview
  • Efficacious treatment (gt100 controlled studies)
  • Helpful with maintenance efforts
  • Successfully used with other forms of treatment
  • Short-term weight loss 8-10 over 6 months
  • Helpful for mild to moderate overweight and
  • Essential to long-term lifestyle change

Behavioral Treatment Overview
  • Overall, 10 initial wt loss
  • 80 completed tx
  • Increase in wt loss in last 3 decades
  • Weight regain is problematic
  • 30-35 regain at 1 yr
  • 50 of pts have regained all of their wt by 5th yr

Behavioral Treatment Contents
  • Goal-setting
  • Self-monitoring
  • Stimulus Control
  • Modification of Eating and Activity Patterns
  • Contingency Management
  • Cognitive Behavioral Techniques
  • Stress Management

Goal Setting
  • The initial starting point of behavioral programs
  • Involves setting goals for calories, fat,
    physical activity, and other modifiable behaviors
  • People are often unrealistic in their
  • Realistic expectations for short-term and
    long-term goals should be discussed

Goal Setting
  • Be Specific
  • Set criteria time, frequency, duration
  • Make it measurable
  • Make it realistic

Goal Setting
  • Be Specific
  • Vague Goals Specific Goals
  • I will exercise more I will walk 20
    minutes a day five days of the week
  • I will lose weight I will lose 1-2 lbs
    each week for the next 10 weeks

Goal Setting
  • Tips
  • Write it down
  • Setting goals helps keep up motivation
  • Need to plan ahead
  • If having trouble, may need to change goal
  • Dont set yourself up for failure
  • Set yourself up for success (set positive, valued

Goal Setting
  • Tips contd
  • Set short and long-term goals use a
    step-by-step approach
  • Take advantage of the skills you already have
  • Approach this as a challenge

  • The cornerstone of behavioral treatment
  • Involves daily observation and record keeping of
  • Monitoring is used to increase awareness of
    behavior patterns
  • identifying antecedents and reinforcing
    consequences that lead to faulty health patterns
  • Time, place, feelings, social situation
  • Record keeping can also be expanded to include a
    variety of information including emotions

  • Keep track of progress to know if goals are being
  • Allows you to look back at situations in which it
    was easier or more difficult to keep going
  • Gives immediate feedback
  • Reward yourself when you see change
  • Prevents false discouragement or assurance

  • Tips
  • Define specific behaviors to be monitored (steps,
    miles, calories, carbs, etc)
  • Determine how they will be recorded (pedometer,
    form, pda)
  • Start with a clear baseline for later comparison

Stimulus Control
  • Discriminative Stimulus an external or internal
    cue that signals that a given response will be
    reinforced if performed
  • People are often unaware of how their environment
    influences their behavior
  • Used to identify and then modify environmental
    antecedents that influence behavior patterns
  • Goal is to restrict environmental circumstances
    that serve as discriminative stimuli for
    maladaptive behaviors

Stimulus Control
  • Procedures are used to decrease the number of
    conditioned stimuli or situations that may
    trigger a maladaptive behavior
  • Identify and minimize stimuli that trigger target
    behaviors that you want to decrease
  • Eliminate cues that compete with what you want to
  • Avoid driving by the Krispy Kreme, smell of
    fries, commercials, out of sight out of mind)

Stimulus Control
  • Other techniques include
  • Specified number of meals and snacks to eat
  • Specified eating times or places
  • Changing serving and food storage techniques
  • Develop new stimuli to trigger new targeted
    adaptive behavior
  • Set new routines with strong associated cues
  • Wear a pedometer

Stimulus Control-Example
  • Eating Out, Party, and Holiday Tips
  • Plan ahead
  • Eat before you go
  • Eat slowly
  • Avoid buffets
  • Dont pile plate
  • Dont take a little of every item (special items)
  • Take low fat/calorie items

Modification of Maladaptive Health Patterns
  • Goal is to modify faulty health behaviors that
    may interfere with accomplishing new adaptive
    behavior by encouraging new behavior
  • slowing pace of eating, reducing portion sizes,
    measuring food intake, leaving food on plate,
    improving food choices, eliminating second
    servings, taking the stairs, parking farther from
    the building, walking or biking rather than
    driving, etc
  • Breaking the cycle

Contingency Management
  • Once a target behavior is performed, it needs to
    be strengthened by reinforcement
  • Positive reinforcement (e.g., reward) is used to
    stabilize and increase the maintenance of new
    adaptive health patterns
  • Punishment or loss of reinforcement may also be
    used to change behaviors
  • Contingency contracting
  • Self reinforcement
  • External reinforcement

Contingency Management
  • Effective rewards are
  • Immediate
  • Desirable
  • Based on meeting a specific goal
  • Eliminate all rewards centered around the
    maladaptive behavior
  • Rewards
  • Tangible (External)
  • Intangible (Internal)

Contingency Management
  • Intangible Reward Tips
  • Feeling good about yourself and what you are
  • Focus on the benefits of what you are doing
  • Watch out for pessimism or criticism (from
    yourself or others)
  • Dont wait to pat yourself on the back until you
    are 100 successful

Contingency Management
  • Tangible
  • Give yourself to keep your motivation high (like
    social activities, money, extra time for hobbies,
  • Helps to tide you over until internal rewards are

Contingency Management
  • Other tips
  • Premack Principle
  • Make your intentions known to others
  • Join others with common goals
  • Have others support you when you meet goals, and
    ignore you when you dont

Cognitive Behavioral Techniques
  • These strategies combine the traditional
    behavioral treatment components with emphasis on
    thinking patterns that may affect eating
  • Focus on perfectionistic standards, negative
    self-statements and unrealistic goals
  • Goal is to alter mood, unhelpful beliefs,
    unrealistic standards, and negative evaluations
    that affect healthful behaviors

Cognitive Behavioral Techniques
Stress Management
  • Stress Management Techniques
  • (Physiological)
  • Diaphragmatic Breathing
  • Progressive Muscle Relaxation
  • Imagery
  • Exercise
  • Sleep Hygiene
  • Reduce caffeine

Stress Management
  • Stress Management Techniques
  • (Behavioral)
  • Limit Setting
  • Time Management Training
  • Scheduling Pleasurable Events

Stress Management
  • Stress Management Techniques
  • (Cognitive)
  • Identify negative/faulty thinking
  • Cognitive Restructuring
  • Setting Realistic Expectations
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