Role of Behavioral Therapy in the Management of Obesity

LIBER8 design and methods: an integrative intervention for loss of control eating among African American and White adolescent girls

Loss of control (LOC) eating affects a significant number of adolescents of all racial and ethnic backgrounds and is associated with numerous psychosocial problems, including depression, anxiety, low self-esteem, body dissatisfaction, and weight concerns. However, empirically validated, culturally sensitive treatments for adolescents with these disordered eating behaviors are not available. This pilot project involved designing a developmentally and culturally appropriate treatment for LOC eating for adolescent girls. We intend to conduct multiple focus groups with adolescent girls who engage in LOC eating, and their primary caregivers. Data from these groups will inform the subsequent creation of a manualized treatment protocol. We will then evaluate the efficacy of this intervention (LIBER8-Linking Individuals Being Emotionally Real) to reduce LOC eating. This intervention will integrate components of dialectical behavior therapy, such as mindfulness and distress tolerance skills training, and cognitive-behavioral therapy. We will also integrate text-messaging, a key adolescent communication strategy, as a means of self-monitoring. Participants meeting study criteria will be offered participation in this 12-week randomized controlled trial comparing LIBER8 to a weight management control condition (2BFit). We hypothesize that this intervention will serve to reduce LOC eating, as well as improve psychosocial functioning as evidenced by decreased depression, anxiety, eating disorder cognitions, emotional eating, impulsivity, and improved quality of life. The feasibility and acceptability of this intervention will be extensively evaluated with the explicit intent of informing a subsequent larger randomized controlled trial.

Obesity: prevalence, theories, medical consequences, management, and research directions

Obesity and its associated disorders are a growing epidemic across the world. Many genetic, physiological, and behavioral factors play a role in the etiology of obesity. Diet and exercise are known to play a valuable role in the treatment and prevention of obesity and associated disorders such as hypertension, heart disease, and diabetes. Therefore, the purpose of this review is to examine the prevalence, etiology, consequences, and treatment of obesity.

Obesity

Obesity is a chronic disease, which similar to diabetes and hypertension, requires long-term treatment. The patient must be willing to make major changes in eating habits, lifestyle, and physical activity to achieve long-lasting results.

Long-Term Pharmacologic Treatment of Morbid Obesity in a Community Practice

OBJECTIVE

To determine the safety, efficacy, and metabolic changes in patients with morbid obesity treated with d,l-fenfluramine and phentermine in an open-label trial.

METHODS

In patients with a body mass index (BMI) =40.0 kg/m 2 (N = 298) who sought assistance at a private medical practice for treatment of obesity, 60 mg of d,l-fenfluramine and 15 to 30 mg of phentermine resin were administered daily in an open-label trial, without placebo controls, for up to 24 months. The setting was a community-based private practice. Study subjects were given instructions for a 1,200 to 1,400 kcal/day diet, exercise, and behavior modification. Follow-up included a monthly medical visit, behavior modification group attendance, quarterly laboratory evaluation, and electrocardiographic monitoring.

RESULTS

BMI decreased from 45.8 kg/m2 to 37.4 kg/m2 (P<0.0001) in those who completed 12 months of treatment and to 38.2 kg/m2 (P<0.0001) in those who continued the protocol for 24 months. Statistically significant decreases in fasting blood glucose, total and high-density lipoprotein cholesterol, triglycerides, systolic and diastolic blood pressures, and fasting insulin concentrations were noted. The dropout rate was 42.3% at 12 months and 69.8% at 24 months. The most common reason given for discontinuing participation in the study was "success" with the program (mean BMI loss of 7.8 kg/m2). Five patients discontinued treatment because of side effects. No laboratory or electrocardiographic abnormalities were noted that could be attributed to the medications. No statistically significant regain of weight occurred in those who completed 12 or 24 months of treatment.

CONCLUSION

In this study, treatment of morbid obesity with d,l-fenfluramine and phentermine was safe and efficacious in promoting and maintaining weight loss. Moreover, statistically significant changes were noted in metabolic variables associated with risk of heart disease. Future efforts must focus on methods to improve long-term compliance.