Continuing Care and Self-Help in the Treatment of Obesity

Behavioral weight-loss (BWL) treatment, focusing on lifestyle change, remains the most widely used approach to weight control (Wadden, Butryn, & Byrne, 2004). The nature of this treatment is described in Chapters 12 and 14 of this volume. The therapeutic efficacy of BWL has been shown to be consistent across different investigators and clinical research settings. The short-term effects are uniformly positive. A typical treatment of 24 weeks reliably results in an average weight loss of about 10% of body weight. Binge eating is reduced, if not eliminated; body image is improved, self-esteem enhanced, and depressed mood decreased. Blood pressure and cholesterol level tend to drop. Long-term effects, however, are another matter. Relapse—weight regain following treatment—has proved to be a remarkably robust phenomenon (Jeffery et al., 2000). In a recent summary of the efficacy of BWL, Wadden et al. (2004) concluded that patients regain approximately “30% to 35% of their lost weight in the year after treatment. Weight regain slows after the first year, but by 5 years, 50% or more of patients are likely to have returned to their baseline weight” (p. 153S). For example, in the Diabetes Prevention Program (DPP; Diabetes Prevention Program Research Group, 2002), arguably one of the most sophisticated lifestyle interventions for obesity to date, participants gradually regained about one-third of the weight they had lost in treatment over the following 4 years. Moreover, this weight regain occurred despite an inten-