The Weight Loss Profile: A Biopsychosocial Approach to Weight Loss
The utility of an intervention strategy that first identifies potential obstacles to weight loss and then specifically modifies these problem areas using personalized interventions within a generic cognitive-behavioral weight loss program is demonstrated.
Abstract
Obesity is a common complicating condition in a variety of medical problems. Often effective consultation liaison involves recommendations to overweight patients involving lifestyle and health risk modification. Factors that need to be addressed include exercise, nutritional counseling/caloric restriction, and attitude and behavioral change regarding eating. Patients requiring weight loss typically seek various commercial programs that are readily accessible. One major problem associated with such programs is the high attrition rate within the first six weeks of initiation. Therefore, attempts to facilitate longer-term retention and associated weight loss are warranted. One approach is the identification of factors associated with problems in short-term retention and weight loss followed by the implementation of brief interventions to potentially reverse the influence of these factors on retention and weight loss. The present investigation was conducted to determine the effects of such a strategy on short-term retention and weight loss in a commercial weight loss program. Two groups (n = 66 per group) of female participants with a mean age of thirty-eight years, mean initial weight of 184.6 lbs, mean height of 64.3 inches, mean goal weight of 147.3 lbs, mean Body Mass Index of 31.4 kg/m2 were recruited for the study. Groups were matched for age, initial weight, height, goal weight, and body mass index. One group (controls) received a standard thirteen-week group cognitive-behavioral intervention that emphasized the teaching of self-management strategies for weight reduction. The second group (personalized intervention) received the same thirteen-week cognitive-behavioral intervention. This group also completed a questionnaire (Weight Loss Profile) that identifies factors associated with poor retention and minimal weight loss. Targeted interventions were implemented to modify specific problem areas identified on the Weight Loss Profile. The problem areas were based upon previous research which identified predictors of retention and weight loss. The problem areas included job stress, social comfort, self-consciousness regarding weight and eating behaviors, concern with physical appearance, Type A behavior pattern, social support, motivation, and expectation of success. Both groups also received 1,000 calorie/day prepackaged foods, instruction in mild exercise, and nutritional counseling. Weekly weights and attendance were recorded across the thirteen consecutive week period. The group receiving the personalized intervention lost significantly more weight than the control group (30 lbs vs. 11 lbs, respectively). The personalized program was associated with significantly higher retention rates through week ten (90.6%) in contrast to the control group (74.6%). From week eleven through week thirteen the differences in retention rates were minimal. These findings were observed despite higher pretreatment levels of motivation and social support in the control group. This study demonstrates the utility of an intervention strategy that first identifies potential obstacles to weight loss and then specifically modifies these problem areas using personalized interventions within a generic cognitive-behavioral weight loss program. This approach represents a specific application of the biopsychosocial model and illustrates the impact of such an intervention on health behavior. The results suggest the potential utility of the intervention strategy for other problems seen in consultation liaison psychiatry in which health behavior change is required.