of 38
7/28/2019 Behavioral Treatment of Obesity.pdf
1/38
Behavioral Treatment of Obesity inChildren and Adults:
v ence- ase n erven ons
Hollie Raynor, Ph.D., R.D., L.D.N.Hollie Raynor, Ph.D., R.D., L.D.N.
Associate ProfessorAssociate ProfessorDepartment of NutritionDepartment of Nutrition
Obesity Research CenterObesity Research Center
Objectives
Define evidenceDefine evidence--based treatmentbased treatment
--based childhood obesity interventionsbased childhood obesity interventions
Describe the components of evidenceDescribe the components of evidence--based adult obesity interventionsbased adult obesity interventions
en y e ec ve e ary nerven onsen y e ec ve e ary n erven onsused in adult behavioral weight controlused in adult behavioral weight controlinterventionsinterventions
7/28/2019 Behavioral Treatment of Obesity.pdf
2/38
What is Evidence-based? The focus on using evidenceThe focus on using evidence--basedbased
n erven ons comes rom concerns an erven ons comes rom concerns apatients/clients receive treatment that ispatients/clients receive treatment that isgrounded in tradition and/or outdated training,grounded in tradition and/or outdated training,rather than scientific evidencerather than scientific evidence
esearc commun y encourage oesearc commun y encourage oscrutinize and evaluate interventions in orderscrutinize and evaluate interventions in orderto ascertain their efficacyto ascertain their efficacy
What is Evidence-based?
Accumulation of researchAccumulation of research
Quality of researchQuality of research Experimental vs. Observational designsExperimental vs. Observational designs
MethodsMethods
Measures (selfMeasures (self--report vs. objective)report vs. objective)
Randomized Controlled TrialsRandomized Controlled Trials
MetaMeta--analysesanalyses
7/28/2019 Behavioral Treatment of Obesity.pdf
3/38
What is Evidence-based? --
Current best evidence for making clinicalCurrent best evidence for making clinicaldecisions about the care of patients/clientsdecisions about the care of patients/clients
Incorporates best research evidence,Incorporates best research evidence,clinical expertise, and patient valuesclinical expertise, and patient values
Currentl used to im rove the ualit ofCurrentl used to im rove the ualit ofcare, and can provide objective criteria forcare, and can provide objective criteria for
decisions regarding the allocation of healthdecisions regarding the allocation of healthcare resourcescare resources
What is Evidence-based?
LimitationsLimitations
Understanding efficacy (emphasis onUnderstanding efficacy (emphasis oninternal validity) vs. effectivenessinternal validity) vs. effectiveness(emphasis on external validity)(emphasis on external validity)
Type of population studiedType of population studied
Geographic settingsGeographic settings
Health care settingHealth care setting
Will change over timeWill change over time
7/28/2019 Behavioral Treatment of Obesity.pdf
4/38
Overweight/Obese - definition
Definitions of overweight and obese are based uponDefinitions of overweight and obese are based upon bodybodymass index (BMI):mass index (BMI): weight (kg)/height (mweight (kg)/height (m22))
In children,In children, BMI percentileBMI percentile for age and gender is thefor age and gender is thepreferred measure for detecting overweight in childrenpreferred measure for detecting overweight in childrenand adolescentsand adolescents
Overweight (at risk for overweight):Overweight (at risk for overweight): 8585thth to 94to 94thth ercentile BMIercentile BMI
Obese (overweight):Obese (overweight): >>9595thth percentile BMIpercentile BMI
7/28/2019 Behavioral Treatment of Obesity.pdf
5/38
Overweight/Obese - definition
,,classified by BMIclassified by BMI
BMIBMI >>25 = overweight25 = overweight
BMIBMI >>30 = obese30 = obese
BMIBMI >>40 = extreme obesity40 = extreme obesity
Body Mass Index Table
BMI =25BMI =25 BMI =30BMI =30
InchesInches Body weight (lbs)Body weight (lbs)
6060 129129 153153
6161 133133 158158
6262 137137 164164
6363 142142 169169
6464 146146 174174
6565 151151 180180
6666 155155 186186
6767 160160 191191
6868 165165 197197
6969 170170 203203
7070 175175 209209
7171 180180 215215
7/28/2019 Behavioral Treatment of Obesity.pdf
6/38
Goals of Behavioral Lifestyle
Interventions
Behavioral lifestyle interventions focus onBehavioral lifestyle interventions focus onc angngc angng ea ngea ng anan e suree sure-- me ac v yme ac v ybehaviorsbehaviors
Goal is to:Goal is to:
Improve weight statusImprove weight status Weight loss in adultsWeight loss in adults
Maintain weight statusMaintain weight status
Long term weight loss maintenanceLong term weight loss maintenance Weight gain preventionWeight gain prevention
Behavioral Lifestyle Interventions
LeisureLeisure--time activity goalstime activity goals
Behavioral modification techniquesBehavioral modification techniques
7/28/2019 Behavioral Treatment of Obesity.pdf
7/38
Behavioral Theory
EvidenceEvidence--based childhood and adult obesitybased childhood and adult obesity
Antecedents Behaviors ConsequencesAntecedents Behaviors Consequences
The interventions use behavior modificationThe interventions use behavior modification
-2
0
2
-8
-6
-4
Weightloss(kg) vce uca on
Diet (behavioral intervention)
Diet +exercise (behavioral
intervention)
-10
0 6-mo 12-mo 24-mo
Months
Franz MJ et al. Weight-loss outcomes: a systematic review and meta-analysis of weight loss clinical
trials with a minimum 1-year follow-up. JADA 2007;107:1755-67.
7/28/2019 Behavioral Treatment of Obesity.pdf
8/38
ADA-Evidence Analysis Library Pediatric weight managementPediatric weight management
Using behavioral counseling as part of aUsing behavioral counseling as part of amultimulti--component pediatric weightcomponent pediatric weightmanagement (PWM) program to treatmanagement (PWM) program to treatoverweight results in significant reductionsoverweight results in significant reductionsin weight status and adiposity in childrenin weight status and adiposity in childrenan a o escen s.an a oescen s.
Rating: Grade I (good)Rating: Grade I (good)
ADA-Evidence Analysis Library
pediatric obesity in children andpediatric obesity in children andadolescent obesity treatmentadolescent obesity treatment
Family participationFamily participation Children (6Children (6--12 yrs)12 yrs) Rating: Strong (Imperative)Rating: Strong (Imperative)
Rating: Fair (conditional)Rating: Fair (conditional)
7/28/2019 Behavioral Treatment of Obesity.pdf
9/38
ADA-Evidence Analysis Library
What about younger children?What about younger children?
No ratin s as ver little research has beenNo ratin s as ver little researchhas beenconducted in this age groupconducted in this age group
Given the evidence for children aged 6 to 12 yrs,Given the evidence for children aged 6 to 12 yrs,most likely intervention should be familymost likely intervention should be family--basedbased
Effectiveness aside, weight loss (in contrast toEffectiveness aside, weight loss (in contrast toweight management) in this population may beweight management) in this population may beappropra e ony un er cer an crcums ances.appropra e ony un er cer an crcums ances.However, these circumstances have not beenHowever, these circumstances have not been
identified in the research.identified in the research.
ADA-Evidence Analysis Library
-- ,,kcal per day) as part of a clinicallykcal per day) as part of a clinicallysupervised, multisupervised, multi--component weightcomponent weight--loss program is associated with bothloss program is associated with bothshortshort--term and longerterm and longer--term reduction interm reduction inadi osit amon sixadi osit amon six-- to 12to 12-- eaea --oldoldchildren.children. Rating: Grade I (good)Rating: Grade I (good)
7/28/2019 Behavioral Treatment of Obesity.pdf
10/38
ADA-Evidence Analysis Library
component of a clinically supervised,component of a clinically supervised,multimulti--component childhood weightcomponent childhood weight--management intervention program.management intervention program.
Rating: Grade I (good)Rating: Grade I (good)
Childhood Obesity Interventions
> 85> 85thth percentile BMI, but not greaterpercentile BMI, but not greaterthan 100% overweightthan 100% overweight
Conducted in research settingsConducted in research settings
7/28/2019 Behavioral Treatment of Obesity.pdf
11/38
Behavioral Targets
EvidenceEvidence--based interventions targetbased interventions targetbehaviors that reduce energy intake andbehaviors that reduce energy intake andincrease energy expenditureincrease energy expenditure
LowLow--calorie diet (900calorie diet (900--1200 kcals/day)1200 kcals/day) Most widely studied is the Traffic Light Diet (Epstein andMost widely studied is the Traffic Light Diet (Epstein and
colleagues)colleagues)
Categorizes food into Green, Yellow, Red (based uponCategorizes food into Green, Yellow, Red (based uponenergyenergy--density and nutrient quality)density and nutrient quality)
e uce n a e o ase uce na e o as -- oo , so a, swee an sa y snacoo , so a, swee an sa y snacfoodsfoods
Generally does not cause an increase in F&V and dairyGenerally does not cause an increase in F&V and dairyproducts unless specifically targeted in treatmentproducts unless specifically targeted in treatment
Behavioral Targets
--
Increase in physical activity (60 minutes/day),Increase in physical activity (60 minutes/day),with focus on play and family activitieswith focus on play and family activities
Reduction in TV watching (Reduction in TV watching (
7/28/2019 Behavioral Treatment of Obesity.pdf
12/38
Riley et al., 2008
FamilyFamily--based is not just includingbased is not just includingparents/caregivers in the treatment ofparents/caregivers in the treatment of
''
Changing the context of the family (home)Changing the context of the family (home)environment to help support the change aenvironment to help support the change achild is making:child is making:
ParentingParenting
CommunicationCommunication
SupportSupport
EnvironmentEnvironment
7/28/2019 Behavioral Treatment of Obesity.pdf
13/38
Behavioral Parenting Program Strategies for Antecedents:Strategies for Antecedents:
-- aren a mo e ngaren a mo e ng Parent makes all of the same changes in behaviors asParent makes all of the same changes in behaviors as
childchild
-- Change the home environment (stimulus control)Change the home environment (stimulus control) EatingEating
-- Overt and covert restrictionOvert and covert restriction
--
-- ProblemProblem--solving and presolving and pre--planningplanning
Behavioral Parenting Program
Strategies for behaviors:Strategies for behaviors: --
Goals of programGoals of program Kcals, Red Foods, F&VKcals, Red Foods, F&V Physical ActivityPhysical Activity TV WatchingTV Watching WeightWeight
ParentParent--child meetingschild meetings
Tie weight change to behavior change toTie weight change to behavior change to
weightweight Feedback on selfFeedback on self--monitoring is importantmonitoring is important
7/28/2019 Behavioral Treatment of Obesity.pdf
14/38
Behavioral Parenting Program Strategies for consequences:Strategies for consequences:
Positive reinforcementPositive reinforcement
PraisePraise
Contingency contractingContingency contracting
Point systemPoint system
Reduction of negative reinforcementReduction of negative reinforcement
Increase use of extinction for problematicIncrease use of extinction for problematic
behaviorsbehaviors
FamilyFamily--based:based:
Group processGroup process
Treatment Structure
CogntveCogntve-- e avorae avora
Social learning (Interventionist serves as model ofSocial learning (Interventionist serves as model ofparenting behaviors)parenting behaviors)
Sessions:Sessions:
Review of assigned homework (group process andReview of assigned homework (group process and
Presentation and discussion of new topic (cognitivePresentation and discussion of new topic (cognitivebehavioralbehavioral parenting behaviors/practices)parenting behaviors/practices)
Assignment of new homeworkAssignment of new homework
7/28/2019 Behavioral Treatment of Obesity.pdf
15/38
Treatment Structure 66--months of treatment (Parent + child)months of treatment (Parent + child)
Weekly sessions for 12 to 16 weeksWeekly sessions for 12 to 16 weeks Group session for parentsGroup session for parents
Group session for childrenGroup session for children
15 minute individual parent15 minute individual parent--child meeting with anchild meeting with aninterventionistinterventionist
For remaining 2 to 3 months of treatment,For remaining 2 to 3 months of treatment,frequency of sessions drops to either one or twofrequency of sessions drops to either one or twomeetings/monthmeetings/month
Assessments at 0, 6, 12 months (DV =Assessments at 0, 6, 12 months (DV =
percent overweight or zBMI)percent overweight or zBMI)
Childhood Obesity Treatment
These evidenceThese evidence--based interventions targetingbased interventions targetingc ren age o years pro ucesc ren age o years pro ucessignificant reductions in percent overweightsignificant reductions in percent overweight((--15 to15 to --20%), with 1020%), with 10--year followyear follow--up showingup showingalmost 1/3 of treated children no longeralmost 1/3 of treated children no longeroverweight and a mean reduction in percentoverweight and a mean reduction in percent
-- ,,Paluch, & Raynor, 2002; Epstein, Paluch, Kilanowski, Raynor,Paluch, & Raynor, 2002; Epstein, Paluch, Kilanowski, Raynor,2004; Raynor,2004; Raynor, Kilanowski, Esterlis, & Epstein, 2002 )Kilanowski, Esterlis, & Epstein, 2002 )
7/28/2019 Behavioral Treatment of Obesity.pdf
16/38
Maternal and Child Health Bureau
Recommendations for Treatment in a
Primary Care Setting
..
years of ageyears of age
2. Apply a family2. Apply a family--based model in treatmentbased model in treatment
3. Use behavior modification techniques3. Use behavior modification techniques
4. Help families make small changes4. Help families make small changes
5. Target changing 2 or 3 eating and activity5. Target changing 2 or 3 eating and activity
behaviors at a timebehaviors at a time
Childhood Interventions Behaviors recommended to target in primary careBehaviors recommended to target in primary care
settingssettings
FastFast--food intake (limit)food intake (limit)
Sweetened drink intake (limit)Sweetened drink intake (limit)
Sweet and salty snack foods (limit)Sweet and salty snack foods (limit)
LowLow--fat dairy (2 servings per day)fat dairy (2 servings per day)
Fruits & vegetables (1.5 c fruits & 2.5 c vegetables/day)Fruits & vegetables (1.5 c fruits & 2.5 c vegetables/day)
Physical activity (60 minutes per day)Physical activity (60 minutes per day) TV watching (< 2 hrs/day)TV watching (< 2 hrs/day)
7/28/2019 Behavioral Treatment of Obesity.pdf
17/38
Childhood Interventions
Will these recommendations beWill these recommendations beeffective at treating young children whoeffective at treating young children whoare overweight?are overweight?
ANDAND
What are the best behaviors to target?What are the best behaviors to target?
Pediatric Obesity Treatment Child HELP and Kids CANChild HELP and Kids CAN
Two research programs funded by theTwo research programs funded by theAmercan D a etes Assoc aton an t eAmercan D a etes Assoc aton an t eNational Institutes of HealthNational Institutes of Health
For children between the ages of 4 to 9For children between the ages of 4 to 9years,years, >>8585thth percentile BMI, with at leastpercentile BMI, with at least
one problematic eating or activity behaviorone problematic eating or activity behavior
7/28/2019 Behavioral Treatment of Obesity.pdf
18/38
Pediatric Obesity Treatment Both programs randomly assign families toBoth programs randomly assign families to
one o ree, mon n erven onsone o ree, mon n erven ons
Behavioral parenting program (2 differentBehavioral parenting program (2 differentparenting programs in each study)parenting programs in each study)
NewsletterNewsletter
Anthropometric assessments conductedAnthropometric assessments conducted--
feedback to families and pediatricianfeedback to families and pediatrician
Child HELP
IncreaseIncrease
Fruits and VegetablesFruits and Vegetables
(2 servings fruit and 3(2 servings fruit and 3servings vegetables/day)servings vegetables/day)
LowLow--fat dairyfat dairy
(2 servings/day)(2 servings/day)
LowLow--energyenergy--dense foodsdense foods
Sweet/salty snack foodsSweet/salty snack foods
((
7/28/2019 Behavioral Treatment of Obesity.pdf
19/38
2
2.2
2.4
2.6
2.8
0.4
0.6
0.8
1
1.2
1.4
1.6
1.8
zBMI Newsletter
Increase
Decrease
0
0.2
0 6 12
Months
Kids CAN
Physical ActivityPhysical Activity
(60 min/day)(60 min/day)
Sweetened drinksSweetened drinks
((
7/28/2019 Behavioral Treatment of Obesity.pdf
20/38
1.8
2
2.2
2.4
2.6
0.4
0.6
0.8
1
1.2
1.4
1.6
zBMI Newsletter
Traditional
Substitute
0
0.2
0 6 12
Months
Important Components of Treatment Measures of weight statusMeasures of weight status
Provides regulatory feedbackProvides regulatory feedback
Children that do better have parents that are doingChildren that do better have parents that are doing
betterbetter SelfSelf--monitoringmonitoring ModelingModeling Stimulus controlStimulus control PrePre--planning, problemplanning, problem--solvingsolving
Pro rams that tar et arents onl also show oodPro rams that tar et arents onl also show oodoutcomesoutcomes
Caloric prescription appears to be needed toCaloric prescription appears to be needed toproduce clinically relevant weight statusproduce clinically relevant weight statusimprovementsimprovements
7/28/2019 Behavioral Treatment of Obesity.pdf
21/38
ADA-Evidence Analysis Library
Weight loss and weight maintenanceWeight loss and weight maintenance
therapy should be based on atherapy should be based on acomprehensive weight managementcomprehensive weight managementprogram including diet, physical activity,program including diet, physical activity,and behavior therapy. The combinationand behavior therapy. The combination
erapy s more success u an usng anyerapy s more success u an usng anyone intervention alone.one intervention alone. Rating: StrongRating: Strong
ADA-Evidence Analysis Library
A com rehensive adult wei ht mana ement ro ramA com rehensive adult wei ht mana ement ro ramshould make maximum use of multiple strategies forshould make maximum use of multiple strategies forbehavior therapy (e.g. self monitoring, stressbehavior therapy (e.g. self monitoring, stressmanagement, stimulus control, problem solving,management, stimulus control, problem solving,contingency management, cognitive restructuring,contingency management, cognitive restructuring,and social support). Behavior therapy in addition toand social support). Behavior therapy in addition todiet and physical activity leads to additional weightdiet and physical activity leads to additional weightloss. Continued behavioral interventions ma beloss. Continued behavioral interventions ma benecessary to prevent a return to baseline weight.necessary to prevent a return to baseline weight. Rating: StrongRating: Strong
7/28/2019 Behavioral Treatment of Obesity.pdf
22/38
Adult Obesity Treatment ,,
treatments achieve a mean weight loss of 10treatments achieve a mean weight loss of 10kg over 6 months of treatment, but have akg over 6 months of treatment, but have aweightweight--loss regain of 38% over a mean f/u ofloss regain of 38% over a mean f/u of18 months (Wing, 2002)18 months (Wing, 2002)
How can weight loss maintenance beHow can weight loss maintenance be
improved?improved?
Adult Obesity Interventions
LowLow--calorie diet (1200calorie diet (1200--1500 kcals/day)1500 kcals/day)
LowLow--fat diet (20% to 30% kcals/fat)fat diet (20% to 30% kcals/fat)
Strong focus on increasing structure of the dietStrong focus on increasing structure of the diet
Physical activityPhysical activity
--10,000 steps/day10,000 steps/day
7/28/2019 Behavioral Treatment of Obesity.pdf
23/38
Behavior Modification Strategies for Antecedents:Strategies for Antecedents:
-- ange e ome envronmen s muusange e ome envronmen s muuscontrol)control)EatingEating
LeisureLeisure--time behaviorstime behaviors
-- ProblemProblem--solving and presolving and pre--planningplanning
--
-- Cognitive restructuringCognitive restructuring
-- RelaxationRelaxation
7/28/2019 Behavioral Treatment of Obesity.pdf
24/38
7/28/2019 Behavioral Treatment of Obesity.pdf
25/38
7/28/2019 Behavioral Treatment of Obesity.pdf
26/38
Behavior Modification Strategies for behaviors:Strategies for behaviors:
SelfSelf--monitoringmonitoringGoals of programGoals of program
Kcals, fatKcals, fat
Physical ActivityPhysical Activity
WeightWeight
Tie weight change to behavior change toTie weight change to behavior change toemonstrate reatons p etweenemonstrate reatons p etween
behaviors and weightbehaviors and weight
Feedback on selfFeedback on self--monitoring is importantmonitoring is important
7/28/2019 Behavioral Treatment of Obesity.pdf
27/38
7/28/2019 Behavioral Treatment of Obesity.pdf
28/38
Behavior Modification Strategies for consequences:Strategies for consequences:
Positive reinforcementPositive reinforcement
Weight loss vs. maintenanceWeight loss vs. maintenance
Reinforcing value of foodReinforcing value of food
Structure of Treatment
outcomes, standard length of intervention isoutcomes, standard length of intervention is18 months18 months
Weight loss interventionsWeight loss interventions Weekly for 6 monthsWeekly for 6 months 60 minute group sessions60 minute group sessions
2 times/month for months 72 times/month for months 7--1818 -- 60 minute group60 minute group
sessonssessons Assessments at 0, 6, 12, 18 months (DV =Assessments at 0, 6, 12, 18 months (DV =
wt)wt)
7/28/2019 Behavioral Treatment of Obesity.pdf
29/38
Important Components of
Treatment Measures of wei ht statusMeasures of wei ht status
Provides regulatory feedbackProvides regulatory feedback
Regular and longRegular and long--term followterm follow--upup AccountabilityAccountability
Habit changeHabit change
SelfSelf--monitoringmonitoring
Dietary structureDietary structure Meal plans, meal replacements, portion controlled foodsMeal plans, meal replacements, portion controlled foods
Variety?Variety?
Lots of physical activity!Lots of physical activity!
Materials from DPP
. . .. . .p_part.htmlp_part.html
7/28/2019 Behavioral Treatment of Obesity.pdf
30/38
Macronutrient Content
of the Diet
7/28/2019 Behavioral Treatment of Obesity.pdf
31/38
Macronutrient Composition
and Weight Loss Maintenance 800 artici ants800 artici ants Randomly assigned to 1 of 4 diets:Randomly assigned to 1 of 4 diets: the targeted
percentages of energy derived from fat, protein,and carbohydrates in the four diets were 20, 15,and 65%; 20, 25, and 55%; 40, 15, and 45%; and40, 25, and 35% - diets consisted of similar foodsand met guidelines for cardiovascular health
Received behavior modification, and had a
physical activity goal of 90 min/week
7/28/2019 Behavioral Treatment of Obesity.pdf
32/38
7/28/2019 Behavioral Treatment of Obesity.pdf
33/38
Dietary Structure
7/28/2019 Behavioral Treatment of Obesity.pdf
34/38
Do meal replacements help with
weight loss?
Foods of fixed calorie and nutrient contentFoods of fixed calorie and nutrient contentthat are designed to take the place of a mealthat are designed to take the place of a mealor snackor snack
PortionPortion--controlled and nutritionally balancedcontrolled and nutritionally balanced
, , ,, , ,prepared mealsprepared meals
Typical recommendation is to replace 2Typical recommendation is to replace 2meals with a meal replacementmeals with a meal replacement
Do meal replacements help withweight loss?
Purpose: To examine whether using mealPurpose: To examine whether using mealreplacements improves weight loss in adultsreplacements improves weight loss in adultsenrolled in a weight loss program.enrolled in a weight loss program.
Participants: 100 overweight and obese menParticipants: 100 overweight and obese men
diet groups.diet groups.
Length of weight loss program: 27 monthsLength of weight loss program: 27 months
7/28/2019 Behavioral Treatment of Obesity.pdf
35/38
Do meal replacements help
with weight loss?
Diet A: 1200Diet A: 1200--1500 calories/day, with1500 calories/day, withparticipants eating regular foodsparticipants eating regular foods
Diet B: 1200Diet B: 1200--1500 calories/day, with1500 calories/day, withparticipants using meal replacements for 2participants using meal replacements for 2meals and 2 snacks each daymeals and 2 snacks each day
as mon s:as mon s:
Both groups followed the same 1200Both groups followed the same 1200--15001500kcals/day diet and used meal replacementskcals/day diet and used meal replacementsfor 1 meal and 1 snack per dayfor 1 meal and 1 snack per day
Weight Loss Maintenance Using
Meal Replacements0
ight
4
6
8
ereductionininitialw Standard then
Meal
Replacement
10
12Percentag
TimeDitschuneit et al., AJ CN; 1999; 69: 198-204
Meal
Replacement
0 2 4 6 8 10 12 14 16 18 20 22 24 26 28
7/28/2019 Behavioral Treatment of Obesity.pdf
36/38
Why are meal replacements
effective for weight loss?
ConvenientConvenient
PortionPortion--controlledcontrolled
Removes work of estimating portion size andRemoves work of estimating portion size andcaloriescalories
Widely availableWidely available
Easy to selfEasy to self--monitormonitor
Dietary Variety
with increased intake, weight, and bodywith increased intake, weight, and bodyfat in animals (for a review Raynor &fat in animals (for a review Raynor &Epstein, 2001, Psychological Bulletin)Epstein, 2001, Psychological Bulletin)
Increased variet within a meal isIncreased variet within a meal isassociated with increased consumptionassociated with increased consumptionin humansin humans
7/28/2019 Behavioral Treatment of Obesity.pdf
37/38
HFF
20
30
40
50
60
70
Percentvariety
Before intervention
After intervention
Registry
FOS
20
30
40
50
60
70
Percentvariety
LFM
20
30
40
50
60
70
Percentvariety
0 0
10
0
10
LFB
10
20
30
40
50
60
70
Percentvariety
LFV
10
20
30
40
50
60
70
Percentvariety
0 0
Mean percent variety in 5 food groups for recent successful weight losers before and after a standard
weight loss intervention (n=96), and registry participants (n =2237) (M +SEM).
Raynor, H. A., J effery, R. W., Phelan, S., Hill, J . O., & Wing, R.R. (2005). Amount of foodgroup variety consumed in the diet and long-term weight loss maintenance. Obesity Research, 13, 883-890.
Food Group Variety andObesity Treatment
different foods, particularly energydifferent foods, particularly energy--densedensefoods, in the diet may help with successfulfoods, in the diet may help with successfulweight loss and longweight loss and long--term weight lossterm weight lossmaintenancemaintenance
Limiting variety may be especially helpfulLimiting variety may be especially helpfulduring maintenance, when selfduring maintenance, when self--monitoring ofmonitoring ofintake is less consistentintake is less consistent
7/28/2019 Behavioral Treatment of Obesity.pdf
38/38
Dietary Variety Prescription 18 month trial testin the effectof limitin snack food18 month trial testin the effectof limitin snackfood
variety (R01variety (R01 -- NIDDK)NIDDK)
2 groups: Standard vs. Standard + variety2 groups: Standard vs. Standard + varietyprescriptionprescription Can this prescription be adhered to over the longCan this prescription be adhered to over the long--term?term?
Will a greater length of time of limiting variety effect weightWill a greater length of time of limiting variety effect weightloss?loss?
control)?control)?
200 participants200 participants
Research TeamProvidence, RIProvidence, RI Knoxville, TNKnoxvi lle, TN
Rena Wing, Ph.D.Rena Wing, Ph.D. Betsy Anderson, M.S., R.D. L.D.N.Betsy Anderson, M.S., R.D. L.D.N.
Chantelle Hart, Ph.D.Chantelle Hart, Ph.D. Ashlee SchochAshlee Schoch
Elissa Jelalian, Ph.D.Elissa Jelalian, Ph.D. Lusi MartinLusi Martin
Patrick Vivier, M.D.Patrick Vivier, M.D. Shannon Looney, M.P.H.Shannon Looney, M.P.H.
Kathrin Osterholt, M.S.Kathrin Osterholt, M.S. Christen Mullane, M.A.Christen Mullane, M.A.
Amanda FineAmanda Fine J ess Bachman, M.S., R.D., L.D.N.J ess Bachman, M.S., R.D., L.D.N.
Allison MartirAllison Martir Emily Van Walleghen, Ph.D.Emily Van Walleghen, Ph.D.
Patty TellierPatty Tellier Andrew CarberryAndrew Carberry
Holly ManiganHolly Manigan Adriana ColettaAdriana Coletta