Behavioral Weight Loss Treatment
for Obesity and Pediatric Overweight
Status: Strong Research Support
Behavioral Weight Loss Treatment (BWL) for obesity is a short-term intervention designed to achieve acute weight reduction as well as establish new behavioral patterns to increase the likelihood of sustained maintenance of weight loss. A well-studied version of BWL for adults is the LEARN (Lifestyle, Exercise, Attitudes, Relationships, and Nutrition) Program. As the components of its acronym suggest, LEARN promotes change in multiple domains to synergistically yield weight loss. An emphasis of LEARN is the benefit of small, lifestyle-oriented changes (e.g., getting off a bus at an earlier stop and walking the remainder of the distance to one’s destination) that can cumulatively achieve a negative energy balance. LEARN encourages reasonable weight goals and moderation in food choices (no food is completely forbidden). LEARN consists of 12 lessons, which can be conducted in individual or group therapy sessions. BWL for children similarly corrects maladaptive eating and activity patterns and food choices by targeting nutrition, diet, and exercise, and a reduction in sedentary activities such as television viewing. In most adaptations of BWL for children, parents are enlisted to facilitate and support family-level lifestyle changes that promote healthy weight. The development of better problem solving skills for children and parents is an additional part of some protocols. For children, weight loss is frequently less of a goal than weight maintenance during a period of growth, the net effect of which is a reduction in BMI-for-age percentile. BWL typically yields modest short-term weight loss or BMI-for-age percentile reduction in adults and children, respectively. Children typically maintain their weight loss following BWL while adults often experience weight regain, consistent with the data from other weight loss interventions for the adult population.
Key References (in reverse chronological order)
- Golan, M., Kaufman, V., & Shahar, D.R. (2006). Childhood obesity treatment: targeting parents exclusively v. parents and children. British Journal of Nutrition, 95, 1008-1015.
- Wadden, T.A., & The Look AHEAD Research Group. (2006). The Look AHEAD study: A description of the lifestyle intervention and the evidence supporting it. Obesity, 14, 737-752.
- Wadden, TA, Berkowitz, RI, Womble, LG, et al (2005) Randomized trial of lifestyle modification and pharmacotherapy for obesity. N Engl J Med. 353, 2111-2120.
- Berkowitz, RI, Wadden, TA, Tershakovec, AM, Cronquist, JL. (2003) Behavior therapy and sibutramine for treatment of adolescent obesity. JAMA 289, 1805-1812.
- Diabetes Prevention Program Research Group. (2002). Reduction in the incidence of Type 2 diabetes with lifestyle interventions or metformin. New England Journal of Medicine, 346, 393–403.
- Epstein, L.H., Paluch, R.A., Kilanowski, C.K. & Raynor, H.A. (2004). The effect of reinforcement or stimulus control to reduce sedentary behavior in the treatment of pediatric obesity. Health Psychology, 23, 371-380.
- Jeffery, R. W., & Wing, R. R. (1995). Long-term effects of interventions for weight loss using food provision and monetary incentives. Journal of Consulting and Clinical Psychology, 65, 793–796.
- Wadden, TA, Foster, GD, Letizia, KA. (1994) One-year behavioral treatment of obesity: comparison of moderate and severe caloric restriction and the effects of weight maintenance therapy. J Consult Clin Psychol. 62, 165-171.
- Wing, RR, Blair, E, Marcus, M, Epstein, LH, Harvey, J. (1994) Year-long weight loss treatment for obese patients with type II diabetes: does including an intermittent very-low-calorie diet improve outcome? Am J Med. 97, 354-362.
- Hypertension Prevention Trial Research Group. (1990). The hypertension prevention trial: Three-year effects of dietary changes on blood pressure. Archives of Internal Medicine, 150, 153–162.
- Full reference list
- Brownell, K.D. (2004). The LEARN Program for Weight Management (10th Ed.). Dallas: American Health Publishing Company.
- Contact the LEARN Institute for Lifestyle Management http://www.thelifestylecompany.com/lccp/lccp.htm (adults)
- Leonard Epstein, PhD (State University of New York at Buffalo) (children and adolescents)