Multidimensional behavioural programmes

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366 HEALTH PSYCHOLOGY
However, it is now generally accepted that obesity is not simply a behavioural
problem and as Brownell and Steen said somewhat optimistically in 1987 ‘psychological
problems are no longer inferred simply because an individual is overweight’. Therefore,
traditional behavioural programmes make some unsubstantiated assumptions about the
causes of obesity by encouraging the obese to eat ‘normally’ like individuals of normal
weight.
Multidimensional behavioural programmes
The failure of traditional treatment packages for obesity resulted in longer periods of
treatment, an emphasis on follow-up and the introduction of a multidimensional
perspective to obesity treatment. Recent comprehensive, multidimensional cognitive–
behavioural packages aim to broaden the perspective for obesity treatment and combine
traditional self-monitoring methods with information, exercise, cognitive restructuring,
attitude change and relapse prevention (e.g. Brownell 1990). Brownell and Wadden
(1991) emphasized the need for a multidimensional approach, the importance of screening patients for entry onto a treatment programme and the need to match the individual
with the most appropriate package. State-of-the-art behavioural treatment programmes
aim to encourage the obese to eat less than they do usually rather than encouraging
them to eat less than the non-obese. Analysis of the effectiveness of this treatment
approach suggests that average weight loss during the treatment programme is 0.5 kg
per week, that approximately 60–70 per cent of the weight loss is maintained during
the first year but that follow-up at three and five years tends to show weight gains back to
baseline weight (Brownell and Wadden 1992). In a comprehensive review of the treatment interventions for obesity, Wilson (1994) suggested that although there has been an
improvement in the effectiveness of obesity treatment since the 1970s, success rates are
still poor.
Wadden (1993) examined both the short- and long-term effectiveness of both moderate and severe caloric restriction on weight loss. He reviewed all the studies involving
randomized control trials in four behavioural journals and compared his findings with
those of Stunkard (1958). Wadden (1993) concluded that, ‘Investigators have made
significant progress in inducing weight loss in the 35 years since Stunkard’s review.’ He
states that 80 per cent of patients will now stay in treatment for 20 weeks and that
50 per cent will achieve a weight loss of 20 lb or more. Therefore, modern methods of
weight loss produce improved results in the short term. However, Wadden also concludes that ‘most obese patients treated in research trials still regain their lost weight’.
This conclusion has been further supported by a systematic review of interventions for
the treatment and prevention of obesity, which identified 92 studies that fitted the
authors’ inclusion criteria (NHS Centre for Reviews and Dissemination 1997). The
review examined the effectiveness of dietary, exercise, behavioural, pharmacological and
surgical interventions for obesity and concluded that ‘the majority of the studies
included in the present review demonstrate weight regain either during treatment or
post intervention’. Accordingly, the picture for long-term weight loss is as pessimistic as
it ever was.
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