Behavior Therapy

Additional Benefits Beyond Other Weight Loss Approaches

Thirty-six RCT articles were reviewed to evaluate whether behavior therapy provides additional benefit beyond other weight loss approaches. Of the 36, 4 were accepted and 32 were not considered.

The 36 trials were: (350, 373, 376, 379, 395, 399, 400, 412, 414, 415, 436-438, 443, 444, 469, 470, 473, 476, 478, 490, 510, 677, 679, 688, 700, 708, 709, 730-736).

Four RCT articles that compared behavior therapy plus another weight loss strategy to that weight loss strategy without behavior therapy, and that met the inclusion criteria, were accepted.  Three of the accepted studies compared behavior therapy to a dietary intervention (436, 476, 477). No studies were found that compared behavior therapy to either exercise or to a combination of diet and exercise. One study was found that compared behavior therapy to drug therapy (478).

Thirty-two of the articles were not considered because:

• Either behavior therapy was not used or it was not possible to ascertain whether it was used (412, 490, 677, 730);
• Behavior therapy was used either alone or as part of an intervention, but the comparison groups used did not allow for determining the unique effect of behavior therapy (350, 373, 376, 399, 400, 414, 415, 444, 470, 700, 732, 735); or
• Behavior therapy was integrated into all of the intervention groups, making it impossible to detect the unique effect of behavior therapy (379, 395, 437, 438, 443, 469, 473, 510, 679, 688, 708, 709, 731, 733, 734, 736).

Comparison of Behavior Therapy Strategies

Another way to examine the efficacy of behavior therapy in the treatment of obesity is to evaluate studies that compare various behavioral techniques to one another. These studies are primarily from the behavioral psychology literature.

Thirty-one RCT articles were reviewed that compared one or more behavioral interventions (367, 445, 476, 479-495, 632, 680, 694, 737-744).  Most of the trials used a group format and followed subjects over time; three included booster sessions (484, 487, 491). Twelve of the studies provided 1 year or more of follow-up weights. Most studies lacked a pure, no-treatment, control group. There were limited intervention data on special populations, including various ethnic groups and populations with low income and education. Men and women were well represented. The majority of patients were young and middle-aged adults. Nine of the trials studied special patient populations: subjects with type 2 diabetes (482, 485, 489, 490, 492, 493, 739); subjects at high risk for coronary artery disease (484); and subjects with binge eating disorder (494).

Trials with subjects with type 2 diabetes used behavioral approaches to increase adherence to the American Diabetes Association diet and improve glycemic control, rather than to lose weight as the primary objective (although all reported an effect on weight).

Of the 31 articles reviewed, 19 were accepted and the following 12 were not included because:

• The results were not presented by treatment group (694);
• The dropout rate was more than 35 percent (445, 632, 742, 744);
• Self-reported body weight was used (741);
• There was no control group (680);
• The treatment duration was less than 12 weeks (737-739, 743); or
• The population was not overweight.