Lifestyle modification in the treatment of obesity: An educational challenge and opportunity

As many as two-thirds of adults in developed nations are overweight ( body mass index ( BMI) = 25.0-29.9 kg/m(2)) or obese ( BMI >= 30 kg/m(2)),(1) and many of these individuals suffer from weight-related comorbidities such as hypertension, hyperlipidemia, and type II diabetes.(2) On a more positive note, recent studies have demonstrated that losses as small as 5-10% of initial weight can improve these health complications.(3) For example, the Diabetes Prevention Program demonstrated that a 7% reduction in initial weight, coupled with 150 min/week of physical activity, reduced the risk of developing type II diabetes by 58% compared with placebo.(4) Behavioral treatment consistently induces weight losses in this range. This paper describes the behavioral treatment of obesity, including its short-and long-term results as well as approaches for improving the maintenance of lost weight. The terms "behavioral treatment,'' "lifestyle modification,'' and "behavioral weight control'' are often used interchangeably, as they are in this paper.(5) Lifestyle modification includes three principal components: diet, physical activity, and behavior therapy. The latter term, as applied to weight control, refers to a set of principles and techniques to help patients adopt new diet and exercise habits that can be sustained long term to promote health.