Family Behavioral Interventions

Obesity remains a complex disorder requiring a multifaceted treatment approach. Behavioral intervention is frequently referred to as behavioral weight control, behavioral treatment, and/or lifestyle [Page 256]modification. Behavioral intervention is a comprehensive approach to weight management that combines education and behavioral techniques. The Diabetes Prevention Program, one of the most impressive behavioral intervention studies, demonstrated a 7 percent decrease of initial weight. This amount concurs with the 5 to 10 percent recommended weight loss that the National Heart, Lung, and Blood Institute and the World Health Organization put forth. When treating overweight children, a family-based approach is critical.

Behavioral intervention for obesity is the first line of treatment preceding more aggressive methods such as pharmacotherapy or surgery. This method of treatment emphasizes a reduced calorie diet (e.g., 1,200 to 1,500 kilocalories per day), increased physical activity (e.g., 180 minutes per week), and modification in thoughts and behaviors. Psychoeducation is an essential adjunct in which patients are educated on the causes of overweight, energy balance, nutrition, and physical activity. The typical structure of behavioral interventions consists of 16 to 26 weeks of group or individual treatment lasting 60 to 90 minutes. Formally trained healthcare providers (e.g., dieticians, behavioral psychologists) deliver the intervention.

Key behavioral strategies include the following:

Self-monitoring: being aware of one's own behavior. For example, patients are asked to record meals, times of eating, physical activity, and weight so that they can identify difficulties or patterns and modify behavior. This is often acknowledged as the most integral technique.

Goal setting: patients learn to articulate specific, measurable, and realistic goals. Although weight loss is the primary objective, behavior goals (e.g., eating 1,300 calories/day, walking briskly for 60 minutes five times per week) are emphasized.

Stimulus control: patients learn to identify cues or triggers that are often associated with unhealthy eating habits. A classic example is going to the movies and eating popcorn or eating a snack when watching television.

Slowing the rate of eating: patients are encouraged to enjoy their food and eat less. Patients are encouraged to put their fork down or take sips of water while eating to allow their body to recognize satiation.

Regular eating: patients are instructed to eat at least three meals a day at regular times (e.g., breakfast, lunch, and dinner) as opposed to skipping meals and overeating at a later time.

Problem solving: the patient identifies difficulties and generates feasible solutions.

Relapse prevention: the patient prepares for situations that may come up in the future. The patient learns to identify high-risk situations to avoid, but is also equipped with skills to handle unavoidable difficult situations.

Nutrition education: patients are educated on healthy, well-balanced diets including items from the five basic food groups as outlined in MyPyramid.

Physical activity education: patients are educated on the benefits of exercise as well as how to increase both lifestyle activity and structured exercise.

Cognitive restructuring: patients learn to modify irrational, unrealistic, or self-deprecating thoughts. Patients identify negative cognitions and work to reframe them and adopt more positive thinking. For example, a patient may overeat and think, “I'll never be able to do this, I might as well just give up.” The patient could reframe such a thought to be more positive: “I had a lapse today, but if I keep trying, I will improve.”

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