Reconceptualizing the maintenance of weight loss: a behavior pattern requiring separate treatment (obesity)
Description
Recent research indicates that although most treatment approaches for obesity can produce some temporary weight loss, few sustain long-term maintenance (Abramson, 1983: Stunkard & Penick, 1979). Brownell (1982) has recommended aggressive new approaches to weight loss which can produce medically, psychologically, and cosmetically significant weight losses. In combination with behavior therapy, he suggested the use of very low calorie diets (VLCD's) which are now proven safe and effective if patients are monitored medically (Wadden et al., 1983). Traditionally, very low calorie diets produce large weight losses, but the losses are usually poorly maintained (Van Itallie, 1980). The hope, then, would be that in conjunction with the very low calorie diet, behavior therapy might sustain the large diet-produced losses (Brownell, 1982) It may be important to conceptualize interventions to produce weight loss and weight maintenance as necessarily different learning experiences. Through this differentiation, an additional treatment strategy (i.e., a post weight loss, pre-maintenance treatment) would be required before successful maintenance can ensue This investigation evaluates the effectiveness of a premaintenance treatment in maintaining prior weight loss. All subjects in this study completed a medical weight loss regimen and achieved 'ideal weight' prior to entering treatment. One third of the subjects (N = 10) received individualized calorie training and behavior rehearsal under personalized maintenance level. One third (N = 10) were exposed to standard maintenance (booster) sessions. The remaining one third (N = 10) were monitored through weekly and then biweekly clinic weigh-ins, but no other intervention was provided. All subjects were required to keep daily logs (self-monitored records of daily weight, caloric intake, water intake) which were turned in at the time of each clinic weighing. Additionally, subjects were administered calorie proficiency tests during weeks one, four and twelve. Dependent measures were clinic measures of weight and the scores on the calorie proficiency tests The first prediction was that maintenance of weight losses for the three groups would be differentially affected by the experimental training. However, this was not substantiated. Interestingly, based on clinic standards which define weight gain as an upward deviation from the criterion of ideal weight by more than three pounds, all subjects on the whole were very successful in weight maintenance. (Abstract shortened with permission of author.)