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Lifestyle Management of Adult Obesity

Behavioral Strategies

Strategies based on behavioral change theories that assist patients/clients to comply with dietary or exercise therapy help achieve both weight loss and maintenance. [5] [69] The NIH Guidelines reported that behavior strategies targeted to reinforce the necessary changes in diet and physical activity produced weight losses of approximately 10% over 4 to 12 months. [5] Multimodal strategies are the most efficacious.

Motivational assessment of this client reinforced her strong desire to achieve her goals of

  1. weight loss
  2. health improvement
  3. increased energy and sense of well-being.

Key behavioral strategies include self-monitoring, cognitive restructuring, stimulus control, and social support.

Self-monitoring involves the systematic observation and recording of target behaviors. The client was asked to do daily food and physical activity (PA) records for the first two weeks, after which she was to complete food records at least two days during the week and one weekend day, as well as continue to keep a log of the frequency and duration of her exercise sessions. She agreed to purchase a pedometer to monitor daily physical activity. The Clinical Exercise Physiologist who supervised the fitness center reviewed the food and PA records every other week. She complied closely throughout the first 90 days of the weight loss program.

Cognitive restructuring involves replacing unhelpful thoughts with effective thoughts.

Many patients who attempt to lose weight have unrealistic expectations. One study found that patients who lost 10% of their bodyweight during four (4) months of treatment were disappointed with this weight loss. [70] Another study found that patients chose goals that would have required a 32% reduction in bodyweight. [71] Weight losses of 25% were considered only acceptable and a 17% weight loss was classified as disappointing and unsuccessful. This client was no exception. When asked how much weight she wanted to lose over what period, her response was “50 lbs in four months prior to a planned cruise.” This unrealistic goal was a potential barrier to her success. Therefore significant effort was devoted to helping her be more rational about expectations and to restructure thoughts to foster a more weight-independent self-concept.

To facilitate weight loss and to improve the probability of long-term weight maintenance, the client was instructed in stress management and stimulus control techniques. [5] Stimulus control is a process which involves identifying and modifying environmental cues that are associated with overeating and inactivity. Her work was moderately stressful due to declining market share at the manufacturing plant where she worked but, as a 20-year employee, she didn't feel particularly threatened. Her family situation was relatively relaxed since her third and youngest child graduated from college in engineering and accepted a position at a major company. However, stress did contribute to her overeating and was often associated with relapse.

She was instructed in diaphragmatic breathing, progressive relaxation and other stress management techniques. She also made several environmental changes to control and cue her eating and PA habits. These included removing all high fat, high calorie snacks from her house, keeping exercise clothes in her car, always keeping walking shoes by her front door, and changing her route to avoid passing a certain ice cream business.

Finally, studies show that persons with higher levels of social support tend to be more successful at achieving and maintaining weight loss. [72] She had already made a commitment to join the fitness center with members of her work group for mutual support in their individual goals. She was advised to initially solicit the support of family members and friends by informing them of her weight loss and health improvement goals. Over the first 2-3 months, the client was able to successfully incorporate all these behavioral strategies into her weight loss program.

Pertinent information

Multimodal behavioral strategies; realistic expectations.


Group exercise for increased support; support for increased lifestyle exercise.

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Last Update: March 6 2013