Behavioral approaches to the treatment of obesity

Behavioral approaches to obesity are designed to help patients make lifelong changes in diet and exercise behaviors. The single best predictor of long-term weight maintenance is adoption of an exercise habit, and the combination of diet plus exercise has been shown to be most effective for long-term weight control. Frequent phone contacts and interventions focusing on decreasing sedentary activities (rather than increasing physical activity) may be ways to improve adherence to exercise programs. Encouraging restriction of dietary fat intake as well as total calories appears to be promising. Very low calorie diets may be useful for some patients, because these diets increase initial weight loss and produce dramatic improvements in glycemic control without negative psychological consequences. However, in the long term, results obtained with very low calorie diets are often not superior to those obtained with balanced low calorie regimens. Intervening early in the behavior of individuals who are overweight but do not currently have diabetes, and in the behavior of those individuals in the initial stages of diabetes, is recommended.