Behavioral Weight Control Treatments

Basic Philosophy of Treatment

Lifestyle behavior modification for obesity is based upon changing eating habits and physical activity to yield negative energy balance, that is, burning more energy than is consumed via eating. During the initial phase of treatment, weight loss occurs at a rate of approximately 1 to 2 pounds (.5 to 1 kg) per week. After this initial phase, the goal of treatment is weight maintenance.

Components of Behavioral Weight Control Interventions

Self-Monitoring. One feature of behavioral weight control interventions is self-monitoring of eating and exercise habits. Self-monitoring involves recording food intake and intentional efforts to increase physical activity. Self-monitoring also involves recording environmental events associated with eating and exercise, for example, place and time of day; cognitive and emotional reactions, such as eating in response to stress; and hunger ratings before and after eating. Self-monitoring enhances awareness of habits and can provide a record of behavior that can be used to evaluate progress and to set goals for reinforcement. Also, the dietary record can be analyzed for the adequacy of the person's nutritional intake across time.

Stimulus Control. Stimulus control procedures alter the relationship between environmental events and eating and exercise habits. Commonly used stimulus control procedures are (a) eating at the same time and place at each meal, (b) slowing eating by putting utensils down between bites, (c) eating on small plates, (d) resisting the urge to have seconds, (e) eating while seated, (f) leaving a small amount of food on one's plate, (g) serving small portions of food, and (h) exercising at the same time each day.

Reinforcement/Shaping. The natural consequences of eating (e.g., the good taste of food and reduction of hunger) facilitate the development of overeating habits, whereas the natural consequences of exercise (e.g., fatigue and muscle soreness) facilitate the development of a sedentary lifestyle. As a person gains weight, the natural consequences of exercise become even more aversive, resulting in less physical activity as obesity increases. Unfortunately, alteration of the natural consequences of eating is essentially impossible without pharmacological or surgical intervention. On a more positive note, the development of healthy physical activity habits makes some of the natural consequences of exercise less aversive over time. Nevertheless, because these natural consequences are so difficult to modify, behavioral programs have typically tried to modify other reinforcers, for example, social reinforcement or material rewards for behavior change. The principle of shaping is generally employed when reinforcement contingencies are formulated. Shaping refers to setting small but reasonable goals at first, and then gradually making them more challenging over the course of treatment.

Goal Setting. Behavioral weight control programs are very goal oriented. These goals might include things such as cessation of eating certain types of foods (e.g., soft drinks), walking up stairs instead of using elevators, or modification of snacks (e.g., eating fruit instead of ice cream).

Behavioral Contracting. To enhance the person's motivation for achieving these goals, a procedure called behavioral contracting is used. Behavioral contracting involves clearly specifying behavioral goals (e.g., “I agree to walk at least 30 minutes per day for at least 5 days per week”). A behavioral contract generally includes some type of reinforcement contingency for successful attainment of the goal (e.g., “if [Page 168]I meet my exercise goal for this week, I will reward myself by purchasing a copy of my favorite magazine”).

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