A cognitive/behavioral group intervention for weight loss in patients treated with atypical antipsychotics. Simultaneous nutritional cognitive--behavioural therapy in obese patients. Men gain additional psychological benefits by adding exercise to a weight-loss program. Cognitive-behavioral therapy to reduce weight concerns improves smoking cessation outcome in weight-concerned women. Conceptualisation and evaluation of a cognitive-behavioural training programme for children and adolescents with obesity. Cognitive-behavioral treatment with and without response prevention for bulimia. A randomized comparison of cognitive behavioral therapy and behavioral weight loss treatment for overweight individuals with binge eating disorder. A randomized comparison of group cognitive-behavioral therapy and group interpersonal psychotherapy for the treatment of overweight individuals with binge-eating disorder. Randomized controlled comparison of two cognitive behavioral therapies for obese children: mother versus mother-child cognitive behavioral therapy.
Obesity and diabetes have caused problems for individuals with schizophrenia long before atypical antipsychotic agents. The prevalence of obesity, insulin resistance, impaired glucose tolerance, type 2 diabetes mellitus, dyslipidemia, and the Metabolic Syndrome has increased in people with schizophrenia as compared to the general population. Risk reduction studies for persons with obesity, diabetes, and cardiovascular disease indicate that cognitive/behavioral interventions that promote motivation and provide strategies to overcome the barriers in adherence to diet and activity modification are effective interventions for weight management and risk reduction. In the landmark multi-center randomized-controlled trial study, the Diabetes Prevention Project (DPP), a cognitive/behavioral intervention, was more successful in producing weight loss and preventing diabetes than the drugs metformin, troglitazone or placebo. This pilot study examined the effectiveness of a cognitive/behavioral group intervention, modified after the DPP program, in individuals with schizophrenia or schizoaffective disorder taking atypical antipsychotics in a large urban public mental health system. Outcome measures included body weight, body mass index, waist-hip ratios, and fasting glucose levels. Both groups demonstrated elevated fasting glucose levels and were obese with a mean BMI of 33. The group that received the cognitive/behavioral group intervention lost more weight than the treatment as usual group. The CB group participants lost an average of 5.4 lb or 2.9% of body weight, and those in the control group lost 1.3 lb or 0.6% body weight. The range of weight loss for the treatment group was from 1 to 20 lb. This pilot study has demonstrated that weight loss is possible with cognitive/behavioral interventions in a population with a psychotic disorder. The most important problem in cognitive-behavioural therapies for obese patients is to initiate weight loss without reinforcing the eating-behavioural disorders. We propose to assess the cognitive-behavioural therapy in obese patients suffering from eating disorders with and without combining a nutritional approach based on fat information. The patients (n = 60) have followed a group treatment of 12 weekly cognitive-behavioural therapy sessions with or without a combined nutritional approach mainly focused on fat restriction. The scores for depression (P < 0.01), anxiety (P < 0.01) and eating disorders (P < 0.001) are significantly and similarly improved with both types of treatments. The mean weight loss is significant (P < 0.001) only after a combined nutritional cognitive-behavioural approach. The Eating Disorders Inventory (EDI) subgroup 'Drive for thinness' remains only in a combined therapy (ANOVA P < 0.01), which could explain the weight loss that only occurs in this group. Finally, the association between a cognitive-behavioural therapy and a nutritional learning process improves the anxiety and depression related to eating disorders as well as the weight loss. Adding exercise to a comprehensive weight-loss program might not only attenuate any psychological distress associated with weight-loss attempts but also may provide psychological benefits. This study examined whether a diet-plus-exercise weight-loss program improved psychological outcomes more than a diet-only weight-loss program or an assessment-only control group.
                This study was part of a larger 1-year randomized weight-loss trial examining the effects of diet and exercise on cardiovascular disease risk factors in 264 overweight adults. Psychological measures specific to weight control (e.g., cognitive restraint, disinhibition, hunger, and body dissatisfaction) as well as traditional measures of psychological distress (e.g., symptoms of depression, anxiety, and stress) were obtained at baseline and 1 year.
                Men and women in either weight-loss program reported greater restraint, less disinhibition, and less hunger at 1 year than those in no program. Men in the diet-plus-exercise program experienced additional increases in restraint and decreases in hunger than did men in the diet-only program. Women in the diet-plus-exercise program did not experience additional psychological benefits specific to weight control than those in the diet-only program, despite increases in aerobic capacity.
                The pattern seen for overweight men in the diet-plus-exercise program at 1 year-greater restraint, less disinhibition, and less hunger-is similar to the pattern seen in successful weight maintainers. These results underscore the need for innovative strategies that will enhance and sustain the pattern of psychological benefits specific to weight control associated with successful weight loss, especially for overweight women. Women smokers concerned about weight gain (N = 219) were randomly assigned to 1 of 3 adjunct treatments accompanying group smoking cessation counseling: (a) behavioral weight control to prevent weight gain (weight control); (b) cognitive-behavioral therapy (CBT) to directly reduce weight concern, in which dieting was discouraged; and (c) standard counseling alone (standard), in which weight gain was not explicitly addressed. Ten sessions were conducted over 7 weeks, and no medication was provided. Continuous abstinence was significantly higher at posttreatment and at 6 and 12 months of follow-up for CBT (56%, 28%, and 21%, respectively), but not for weight control (44%, 18%, and 13%, respectively), relative to standard (31%, 12%, and 9%, respectively). However, weight control, and to a lesser extent CBT, was associated with attenuation of negative mood after quitting. Prequit body mass index, but not change in weight or in weight concerns postquit, predicted cessation outcome at 1 year. In sum, CBT to reduce weight concerns, but not behavioral weight control counseling to prevent weight gain, improves smoking cessation outcome in weight-concerned women. Obesity is common in children and adolescents with incidence rates increasing both nationally and internationally. Its causes are complex and multifaceted, and obesity is associated with high morbidity and mortality as well as psychological distress. Multidimensional programmes are necessary in the treatment of this chronic disease in order to change eating and physical activity habits. A cognitive-behavioural training programme was developed and evaluated. In combination with diet and exercise, this special group programme that includes well established behavioural methods, was expected to result in long-term weight reduction and decrease of psychological distress in connection with obesity.
                As part of the six week in-patient rehabilitation for children and adolescents at Viktoriastift in Bad Kreuznach, the three-part programme (experimental group, EG) was compared with a programme that differed only in the psychological intervention component (instead of the specific training programme they undertook muscle relaxation training, comparison group, CG).
                In total, 197 children and adolescents between 9 and 19 y-of-age were recruited into the study.
                Somatic (eg weight status), behavioural (eg eating behaviour) and psychological (eg quality of life) outcomes were assessed at five points in time: two weeks before the intervention, at the beginning and end of the programme, as well as six months and one year post-intervention. The study started in spring 1997. Main outcomes will be presented.
                Pre- vs post-intervention-tests showed significant improvements in self-reported eating behaviours for the EG compared with the CG (F=6.38, P<0.05); these changes were independent of age and sex. The weight status measured as the percentage of overweight dependent on height was reduced in both groups immediately after the intervention and at follow-up (F=16.51, P<0.01). Reduction in the prevalence of obesity tended to be higher in the EG than in the CG (15% vs 10%). Self-reported quality of life increased from before the intervention to follow-up more in the EG than in the CG (F=3.27, P=0.08). In all, the acceptance of the behavioural patient education programme was good.
                In summary, evaluation results indicate that the cognitive-behavioural training programme is a promising approach to alter obesity-related habits and to reduce somatic and psychosocial consequences. Long-term effects after two years are expected to underscore these results. We compared cognitive-behavior therapy (CBT) with and without exposure and response prevention (ERP) in the treatment of eating disorder patients who both binged and purged, and reported abnormal attitudes concerning body weight and shape. Both treatments produced significant and comparable reductions in binge-eating and purging, eating patterns, and attitudes about weight and shape at posttreatment. Treatment effects were generalized to improvements in different measures of general psychopathology, and were maintained over follow-ups of 3 and 12 months. The findings are consistent with prior research showing that CBT is an effective treatment for patients with the core features of bulimia nervosa. Furthermore, the data suggest that the addition of in-session exposure and response prevention does not enhance the effectiveness of the basic CBT program. The aim of this study was to determine the efficacy of cognitive-behavioral therapy (CBT) and behavioral weight loss treatment (BWLT) for overweight patients with binge eating disorder (BED).
                Eighty obese patients meeting criteria of BED according to DSM-IV-TR were randomly assigned to either CBT or BWLT consisting of 16 weekly treatments and 6 monthly follow-up sessions. Binge eating, general psychopathology, and body mass index (BMI) were assessed before, during, and after treatment, and at 12-month follow-up.
                At posttreatment results favored CBT as the more effective treatment. Analysis of the course of treatments pointed to a faster improvement of binge eating in CBT based on the number of self-reported weekly binges, but faster reduction of BMI in BWLT. At 12-month follow-up, no substantial differences between the two treatment conditions existed.
                CBT was somewhat more efficacious than BWLT in treating binge eating but this superior effect was barely maintained in the long term. Further research into cost effectiveness is needed to assess which treatment should be considered the treatment of choice.
                2006 by Wiley Periodicals, Inc. Cognitive-behavioral therapy (CBT) has documented efficacy for the treatment of binge eating disorder (BED). Interpersonal psychotherapy (IPT) has been shown to reduce binge eating but its long-term impact and time course on other BED-related symptoms remain largely unknown. This study compares the effects of group CBT and group IPT across BED-related symptoms among overweight individuals with BED.
                One hundred sixty-two overweight patients meeting DSM-IV criteria for BED were randomly assigned to 20 weekly sessions of either group CBT or group IPT. Assessments of binge eating and associated eating disorder psychopathology, general psychological functioning, and weight occurred before treatment, at posttreatment, and at 4-month intervals up to 12 months following treatment.
                Binge-eating recovery rates were equivalent for CBT and IPT at posttreatment (64 [79%] of 81 vs 59 [73%] of 81) and at 1-year follow-up (48 [59%] of 81 vs 50 [62%] of 81). Binge eating increased slightly through follow-up but remained significantly below pretreatment levels. Across treatments, patients had similar significant reductions in associated eating disorders and psychiatric symptoms and maintenance of gains through follow-up. Dietary restraint decreased more quickly in CBT but IPT had equivalent levels by later follow-ups. Patients' relative weight decreased significantly but only slightly, with the greatest reduction among patients sustaining recovery from binge eating from posttreatment to 1-year follow-up.
                Group IPT is a viable alternative to group CBT for the treatment of overweight patients with BED. Although lacking a nonspecific control condition limits conclusions about treatment specificity, both treatments showed initial and long-term efficacy for the core and related symptoms of BED. Parent-child treatments have been shown to be superior to child-focused treatments of childhood obesity. Yet until now, the comparative effectiveness of parent-only and parent-child approaches has been little studied.
                Fifty-six obese children and their families were randomly assigned to a 16-session cognitive behavioral therapy (CBT) for the parents only or for a combined treatment of parents and children. Children's percent overweight, the body mass index of their mothers, and behavioral and psychological problems of children and mothers were assessed.
                Both treatments reduced children's percent overweight significantly and equally by 6-month follow-up. Also both treatments provided similar results in reducing general behavior problems (externalizing and internalizing behavior problems), global and social anxiety, and depression.
                Our results point to a comparable efficacy of the two treatments. Further, psychological well-being of both mothers and children can be improved in a CBT for obese children and their parents. Future studies should focus on finding ways to improve the adherence of families to long-term treatment of obesity in childhood.
                (c) 2008 S. Karger AG, Basel.
People who are overweight or obese benefit from psychological interventions, particularly behavioural and cognitive-behavioural strategies, to enhance weight reduction. They are predominantly useful when combined with dietary and exercise strategies. The bulk of the evidence supports the use of behavioural and cognitive-behavioural strategies. Other psychological interventions are less rigorously evaluated for their efficacy as weight loss treatments.