This document describes a new cognitive behavioral therapy for obesity called CBT-OB. CBT-OB combines traditional behavioral strategies for obesity treatment with specific cognitive strategies to address cognitive processes associated with treatment dropout, amount of weight lost, and long-term weight maintenance. The treatment is highly personalized based on an individual patient's needs and formulation. It aims to help patients achieve and maintain a healthy weight loss through lifestyle changes and developing a stable "weight-control mindset". Research has found CBT-OB to be effective in achieving significant weight loss and preventing weight regain at 12 months for patients with severe obesity.
The document discusses the emerging role of diet coaching in obesity treatment and weight management. It notes that while dietitians receive training in nutrition science, they often lack skills in behavior change and coaching needed to help clients maintain long-term weight loss and lifestyle changes. The document argues that dietitians should receive additional training in techniques like cognitive behavioral therapy, neuro-linguistic programming, and health coaching in order to more effectively promote sustainable behavior change and wellness among clients.
This study aims to evaluate the effectiveness of peer health coaching in improving clinical outcomes for low-income patients with poorly controlled diabetes. The study will randomize 400 patients from 6 primary care clinics in San Francisco to either receive peer coaching (n=200) or usual care (n=200) over 6 months. The primary outcome is change in HbA1c levels. Secondary outcomes include changes in blood pressure, BMI, LDL cholesterol, diabetes self-care activities, medication adherence, quality of life, self-efficacy, and depression. Clinical values and self-reported measures will be assessed at baseline and 6 months. The study also seeks to understand the perspectives of peer coaches providing this support.
Dietary Strategies for Weight Loss MaintenanceMARKETDIGITALBN
Weight regain after a successful weight loss intervention is very common. Most studies
show that, on average, the weight loss attained during a weight loss intervention period is not
or is not fully maintained during follow-up. We review what is currently known about dietary
strategies for weight loss maintenance, focusing on nutrient composition by means of a systematic
review and meta-analysis of studies and discuss other potential strategies that have not been studied
so far. Twenty-one studies with 2875 participants who were overweight or obese are included in
this systematic review and meta-analysis
This document discusses the treatment of obesity through a multidisciplinary approach combining bariatric endoscopic procedures, pharmacotherapy, and lifestyle interventions. It notes obesity affects 1/3-1/2 of the population and is the second leading preventable cause of disease and death. While lifestyle changes alone often fail to achieve sustained weight loss, bariatric endoscopic procedures and drugs can help patients lose 10% or more of their body weight. The approach involves an evaluation by a dietitian and psychologist before trials of lifestyle changes and potential additional treatments. The goal is long-term management through a stepped-care model using multiple treatment cycles tailored to the individual.
Alive pd protocol and descriptive paperGladys Block
Alive-PD is a fully automated tailored diabetes prevention program. This journal article describes its features, and describes the protocol of the randomized controlled trial.
Alive-PD protocol and descriptive paperGladys Block
The document describes a randomized controlled trial protocol to evaluate the effectiveness of a fully automated 1-year diabetes prevention program called Alive-PD. 340 subjects with pre-diabetes were randomized to either the Alive-PD intervention group (n=164) or a delayed-entry control group (n=176). The primary outcomes are changes in HbA1c and fasting glucose levels from baseline to 6 months. Secondary outcomes include changes in additional biometric measures at 3, 6, 9, and 12 months. The intervention involves weekly tailored goal setting, challenges, and other online interactions to encourage diet and physical activity changes to prevent diabetes progression. The trial will provide evidence on the efficacy of this web-based program in reducing gly
Weight loss strategies
that really work
With your guidance, sustained weight loss is possible—
even for the severely obese. These tips and tools will help.
Adopting weight loss
strategies needn’t be
too time-consuming;
evidence suggests that
physicians can provide
basic counseling about
healthy behaviors in
fewer than 5 minutes.
Most clinically
obese patients
are told to lose
weight, but not
given any advice
on how to do so.
Receiving
weight
management
advice from
a physician
is strongly
associated with
patient efforts
to lose weight.
Patients who
sleep too little
or too much
have been
shown to gain
more weight
compared with
those who sleep
for 8 hours.
Urge patients to
keep a record of
their food and
beverage intake
and exercise,
an activity that
helps create
awareness and
accountability.
Bariatric surgery
provides greater
sustained
weight loss
and metabolic
improvements
for severely
obese patients
than other
conventional
weight
management
treatments.
The document discusses the emerging role of diet coaching in obesity treatment and weight management. It notes that while dietitians receive training in nutrition science, they often lack skills in behavior change and coaching needed to help clients maintain long-term weight loss and lifestyle changes. The document argues that dietitians should receive additional training in techniques like cognitive behavioral therapy, neuro-linguistic programming, and health coaching in order to more effectively promote sustainable behavior change and wellness among clients.
This study aims to evaluate the effectiveness of peer health coaching in improving clinical outcomes for low-income patients with poorly controlled diabetes. The study will randomize 400 patients from 6 primary care clinics in San Francisco to either receive peer coaching (n=200) or usual care (n=200) over 6 months. The primary outcome is change in HbA1c levels. Secondary outcomes include changes in blood pressure, BMI, LDL cholesterol, diabetes self-care activities, medication adherence, quality of life, self-efficacy, and depression. Clinical values and self-reported measures will be assessed at baseline and 6 months. The study also seeks to understand the perspectives of peer coaches providing this support.
Dietary Strategies for Weight Loss MaintenanceMARKETDIGITALBN
Weight regain after a successful weight loss intervention is very common. Most studies
show that, on average, the weight loss attained during a weight loss intervention period is not
or is not fully maintained during follow-up. We review what is currently known about dietary
strategies for weight loss maintenance, focusing on nutrient composition by means of a systematic
review and meta-analysis of studies and discuss other potential strategies that have not been studied
so far. Twenty-one studies with 2875 participants who were overweight or obese are included in
this systematic review and meta-analysis
This document discusses the treatment of obesity through a multidisciplinary approach combining bariatric endoscopic procedures, pharmacotherapy, and lifestyle interventions. It notes obesity affects 1/3-1/2 of the population and is the second leading preventable cause of disease and death. While lifestyle changes alone often fail to achieve sustained weight loss, bariatric endoscopic procedures and drugs can help patients lose 10% or more of their body weight. The approach involves an evaluation by a dietitian and psychologist before trials of lifestyle changes and potential additional treatments. The goal is long-term management through a stepped-care model using multiple treatment cycles tailored to the individual.
Alive pd protocol and descriptive paperGladys Block
Alive-PD is a fully automated tailored diabetes prevention program. This journal article describes its features, and describes the protocol of the randomized controlled trial.
Alive-PD protocol and descriptive paperGladys Block
The document describes a randomized controlled trial protocol to evaluate the effectiveness of a fully automated 1-year diabetes prevention program called Alive-PD. 340 subjects with pre-diabetes were randomized to either the Alive-PD intervention group (n=164) or a delayed-entry control group (n=176). The primary outcomes are changes in HbA1c and fasting glucose levels from baseline to 6 months. Secondary outcomes include changes in additional biometric measures at 3, 6, 9, and 12 months. The intervention involves weekly tailored goal setting, challenges, and other online interactions to encourage diet and physical activity changes to prevent diabetes progression. The trial will provide evidence on the efficacy of this web-based program in reducing gly
Weight loss strategies
that really work
With your guidance, sustained weight loss is possible—
even for the severely obese. These tips and tools will help.
Adopting weight loss
strategies needn’t be
too time-consuming;
evidence suggests that
physicians can provide
basic counseling about
healthy behaviors in
fewer than 5 minutes.
Most clinically
obese patients
are told to lose
weight, but not
given any advice
on how to do so.
Receiving
weight
management
advice from
a physician
is strongly
associated with
patient efforts
to lose weight.
Patients who
sleep too little
or too much
have been
shown to gain
more weight
compared with
those who sleep
for 8 hours.
Urge patients to
keep a record of
their food and
beverage intake
and exercise,
an activity that
helps create
awareness and
accountability.
Bariatric surgery
provides greater
sustained
weight loss
and metabolic
improvements
for severely
obese patients
than other
conventional
weight
management
treatments.
This document provides a summary of the American Dietetic Association's position on weight management. It endorses lifelong commitment to healthful lifestyle behaviors through sustainable eating and daily physical activity for successful weight management. It discusses goals of weight management, which go beyond numbers to also include prevention of weight gain and improvements in health. It also covers assessment of obesity, which involves measuring BMI, waist circumference, medical history, psychological factors, and nutrition intake to develop a care plan.
To maintain your weight, you must balance the calories you consume through diet and exercise. Dieting should start with a low calorie but nutritionally balanced diet, and weight can be managed by reducing calories or increasing exercise. Weight loss programs can be non-clinical like commercial chains or self-guided, or medical programs in healthcare settings involving professionals and focusing on nutrition, fitness, and behavior change therapies. Some medical programs use weight loss drugs or bariatric surgery for extreme obesity cases.
This document summarizes 10 key points for the management of overweight and obesity in adults. It addresses evaluating patients' BMI and waist circumference, counseling on weight loss benefits, recommending calorie-restricted diets and lifestyle programs for weight loss and maintenance, and the role of bariatric surgery. The points cover best practices for identifying patients who need weight loss, targeting modest 3-5% weight loss for health improvements, prescribing 6 month lifestyle programs including reduced calorie diets and exercise, and maintaining weight loss through long-term programs. Bariatric surgery is recommended for adults with a BMI ≥40 or ≥35 with comorbidities who have not achieved weight loss through other means.
RESEARCH Open AccessTelecoaching plus a portion control pl.docxsyreetamacaulay
RESEARCH Open Access
Telecoaching plus a portion control plate
for weight care management: a
randomized trial
Jill M. Huber1, Joshua S. Shapiro2, Mark L. Wieland1, Ivana T. Croghan1, Kristen S. Vickers Douglas3,
Darrell R. Schroeder4, Julie C. Hathaway5 and Jon O. Ebbert1,6*
Abstract
Background: Obesity is a leading preventable cause of death and disability and is associated with a lower health-
related quality of life. We evaluated the impact of telecoaching conducted by a counselor trained in motivational
interviewing paired with a portion control plate for obese patients in a primary care setting.
Methods: We conducted a randomized, clinical trial among patients in a primary care practice in the midwestern
United States. Patients were randomized to either usual care or an intervention including telecoaching with a
portion control plate. The intervention was provided during a 3-month period with follow-up of all patients
through 6 months after randomization. The primary outcomes were weight, body mass index (BMI),waist
circumference, and waist to hip ratio measured at baseline, 6, 12, 18, and 24 weeks. Secondary outcomes included
measures assessing eating behaviors, self-efficacy, and physical activity at baseline and at 12 and 24 weeks.
Results: A total of 1,101 subjects were pre-screened, and 90 were randomly assigned to telecoaching plus portion
control plate (n = 45) or usual care (n = 45). Using last-value carried forward without adjustment for baseline
demographics, significant reductions in BMI (estimated treatment effect -0.4 kg/m2, P = .038) and waist to hip ratio
(estimated treatment effect -.02, P = .037) at 3 months were observed in the telecoaching plus portion control plate
group compared to usual care. These differences were not statistically significant at 6 months. In females, the
telecoaching plus portion control plate intervention was associated with significant reductions in weight and BMI
at both 3 months (estimated treatment effect -1.6 kg, P = .016 and -0.6 kg/m2, P = .020) and 6 months (estimated
treatment effect -2.3 kg, P = .013 and -0.8 kg/m2, P = .025). In males, the telecoaching plus portion control
intervention was associated with a significant reduction in waist to hip ratio at 3 months (estimated treatment
effect -0.04, P = .017), but failed to show a significant difference in weight and BMI.
Conclusion: Telecoaching with a portion control plate can produce positive change in body habitus among obese
primary care patients; however, changes depend upon sex.
Trial registration: ClinicalTrials.gov NCT02373878, 13 February 2015. https://clinicaltrials.gov/ct2/show/
NCT02373878.
Keywords: Obesity, Telecoaching, Portion control plate, Primary care, Patient-centered medical home
* Correspondence: [email protected]
1Division of Primary Care Internal Medicine, Department of Medicine,
Rochester, MN 55905, USA
6Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
Full list of author information is ...
American Heart Association Lifestyle Recommendations to Reduce.docxjesuslightbody
American Heart Association Lifestyle Recommendations to Reduce Obesity
Jane Doe
University
Project and Practicum
Summer 2022
Abstract
The prevalence of obesity and sedentary lifestyle complications are increasing at alarming rates, representing a common but preventable cause of severe medical complications like diabetes, cardiovascular diseases, and early mortality. This chronic condition has been for a long time a public health concern and social determinant. The Fitbit app offers a unique opportunity to enhance the efficacy of weight loss plans as it is used to track activity, monitor steps, heart rate, energy expenditure, sleep, and sedentary behavior. The integrative review focused on how the American Heart Association (AHA) Diet and Lifestyle recommendations and the Fitbit app are used as innovative solutions to reduce obesity in adult patients.
Research Methodology: A systematic review was conducted to identify research articles completed in the preceding 4-5 years centered on obesity care, diet, physical activity, activity trackers, and lifestyle implications.
Results and Discussion: The databases searched were Chamberlain Library, PubMed, and CINHAL. Initial searches yielded over 2000 articles, of which 45 were chosen and examined because they fit the integrative review's theme. The 15 papers most relevant to the PICOT question were studied in further detail and appraised using the Johns Hopkins Evidence Appraisal table. The studies reported positive physical activity outcomes.
Conclusions and Further Recommendations:This systematic review supported the effectiveness of the AHA Diet and Lifestyle recommendations to reduce obesity, and clinical use generalization is recommended. Fitbit app provides new ways to improve physical activity habits, and the easy availability of electronic devices may enhance their generalizability use.
Keywords: Obesity care; Obesity complications; Lifestyle recommendations; Obesity management; Physical activity intervention using Fitbit activity trackers.
Dedication
Thanks to my family for their unwavering support of this project; their cooperation means a lot to me. To my husband Armando, thank you for your love, understanding, and patience during this time. I credit my achievement to all of you for your unwavering love and belief in me.
Acknowledgments
First, I must acknowledge the help of all my professors who inspired, encouraged, and supported me throughout the DNP program. My heartfelt thanks to my teammates, without whom I would never have completed this phase in my life. Their encouragement has had a significant influence on my strong determination during this trip.
Contents
American Heart Association Lifestyle Recommendations to Reduce Obesity 1
Abstract 2
Introduction Error! Bookmark not defined.
Dedication 3
Acknowledgments 4
American Heart Association Lifestyle Recommendations to Reduce Obesity 6
Problem Statement 6
S.
Responsed to colleagues posting that addressed different trends tha.docxzmark3
Responsed to colleague's posting that addressed different trends than those you described. Agree or disagree with the colleague's position on the current and future trends in the treatment of addiction.
Colleague #1
Current trends:
There are a number of trends within the addiction recovery and treatment field. One of the most utilized modalities within the field of addiction recovery may be cognitive behavioral therapy (CBT). CBT seeks to teach those recovering from addiction and other mental illness to find connections between their thoughts, feelings and even their actions or behaviors (Kiluk & Carroll, 2013). The cognitive behavioral approach often encourages those participating in the treatment to identify, and challenge potential thinking errors that may be contributing to their current addiction, or even mental illness.
Another widely used treatment trend is the 12-step program. This program is one that is based on peer support groups that meet together regularly to provide support, guidance and care as each individual works the program as a whole (AAWS, 2012). The basic assumption of the intervention model is that people can help one another achieve and maintain abstinence from substances, and healing cannot come about until one surrenders to a higher power (AAWS, 2012). This is a widely spread program that is estimated to be used by the majority of treatment centers throughout the country (Doweiko, 2019).
Future trends:
There have been a number of developments and shifts within the field of addiction recovery therapy. It seems that societal trends, to a certain extent, may have some sort of impact on the trends as they develop as well. For example, there has been more of an emphasis placed on holistic health, and holistic treatment in a number of fields. This trend may be seen being implemented into the field of substance abuse treatment, and recovery as well.
Drake (2020) suggests that holistic care should be integrated into a multidisciplinary approach within the substance abuse field. The concept of incorporating a registered dietician to the multidisciplinary approach supports the “moniker” of providing a holistic approach to those in substance abuse disorder treatment. Implementing this style of holistic care is said to improve the overall quality of treatment and recovery. It has been reported that those with substance use disorders have become well quicker, fewer symptoms, and sustain recovery longer when they follow principles of quality nutrition (Drake, 2020).
Similarly, there have been various studies implementing the Integrative Body Mind Spirit (I-BMS) intervention among those with substance use disorders. This intervention utilizes Western practices in congruence with Eastern philosophies, as well as techniques (Rentala et al., 2020) There are a number of specific interventions utilized within this particular program that all seek to foster a deeper connection between body, mind and spirit. One of the most com.
power point presentation on obesity by Rajeshwaree Netha (Doctor of pharmacy).
contents included are Introduction,pathophyisiology,clinical presentation (signs and symptoms of obesity disorder) ,Treatment,goals of treatment, general approach, Pharmacological treatment, and Evaluation of therapeutic outcomes.
The role of Occupational Therapy in public health and health promotionAccra School of Hygiene
More recently, the American Occupational Therapy Association (AOTA) articulated a role for occupational therapists in health promotion (AOTA Commission on Practice, 2001), charging practitioners to promote health and wellness in both individuals and communities through engagement in human occupation to promote healthy lifestyles.
Although occupational therapy practice traditionally focuses on individuals, to evaluate the impact of occupational therapy health promotion programs, the profession will need to assume a greater public health focus.
The American Gastroenterological Association Obesity Practice GuideDr. Robert M. Webman
Between 2000 and 2018, the percentage of American adults who are obese increased from 30 percent to over 40 percent. The rate of severely obese individuals doubled within the same period.
Obesity is linked with the onset of several chronic conditions, including diabetes and heart disease. Researchers have also noted that people who are obese have a greater chance of developing gastrointestinal problems, such as fatty liver disease, gastric cancer, and chronic acid reflux. In response, the American Gastroenterological Association (AGA) created the Practice guide on Obesity and Weight management, Education, and Resources (POWER), a guide for treating patients with obesity.
This document discusses the evaluation and management of obesity by gastroenterologists. It covers assessing a patient's readiness to change, obtaining a medical history and physical exam, evaluating lifestyle factors, screening for psychological issues, and the potential role of endoscopy in initial and postoperative evaluation of bariatric surgery patients. Key aspects include using the stages of change model, motivational interviewing techniques, evaluating diet and exercise habits, screening for eating disorders, and being familiar with normal and abnormal postoperative anatomy after different bariatric procedures.
Obesity- Tipping Back the Scales of the Nation 19th April, 2017mckenln
Dr. Rebecca Beeken presented on inspiring behavioral change through various techniques. She discussed traditional approaches focusing on information alone are often ineffective for behavior change. The COM-B model identifies capability, motivation, and opportunity as necessary conditions for behavior. Successful interventions incorporate self-monitoring and other self-regulation techniques. Commercial weight loss programs that emphasize lifestyle changes over dieting and use behavior change techniques and cognitive behavioral therapy have shown promising results. Habit formation through repetition can help establish healthy behaviors long-term. Health professionals, teachable moments, and nudging in appropriate settings can also influence behavior change. A multifaceted approach is needed to inspire lasting behavior change.
The document outlines the 5 A's approach to obesity management, which includes asking permission to discuss weight, assessing risks, advising on risks and options, agreeing on goals and expectations, and assisting by addressing barriers and referring to other providers. It provides guidance on setting SMART behavioral goals focused on sustainable lifestyle changes rather than weight targets alone. The document also discusses following up to support patients in achieving their goals as obesity requires long-term management.
Community ProblemThe community issue addressed is the high preva.docxtemplestewart19
Community Problem
The community issue addressed is the high prevalence rates of obesity and overweight. In this regard, the challenge is comprehensive, owing to categorizing the aspect as a lifestyle condition. Subsequently, other factors, such as nutrition, inadequate physical exercise, and sedentary lives contribute to the issue. The problem is significant, owing to substantial correlations between obesity, overweight, and other comorbidities. The implication is that obesity is a risk factor for other illnesses, including cardiovascular diseases, obesity, cancer, and other issues. In such a case, programs and initiatives implemented to reduce prevalence should be adequate. Accurate evaluation is critical in attaining the best outcomes, including follow-up, adherence, and addressing elements that require a change to meet emerging needs.
Structure
The evaluation structure follows a pre-and post-intervention approach. In this regard, the emphasis is on the initiatives and their ability to meet the set goals. According to the CDC (2016), obesity evaluation measures often employ baseline data to compare progress at the post-implementation phase. In this regard, the structure entails collecting baseline data of the metrics, such as BMI, waistline, and weight, among other anthropometric factors. After the intervention, such as a community education program sensitizing users on the risk factors associated with obesity and overweight, the evaluation will compare the baseline measures to assess any progress. To illustrate, evaluating how the BMI changed after a participant implements recommended steps will help determine efficacy. As a result, the suggested structure focuses on a pre-and post-intervention approach.
Process
The evaluation process will be goal-based. Subsequently, the procedure will focus on specific objectives determined by the set metrics. According to Seral-Cortes et al. (2021), an effective evaluation process should emphasize knowing the goals and project outcomes, testing them against set results. Additionally, precise objectives and measurable data are also vital in promoting an effective process of assessment. Other components or steps incorporate using a logic model to describe the intervention or program, formulating the project's acceptability criteria, and developing required questions. In the proposed process, a goal-based method will apply. Subsequently, post-intervention, goals will be formulated or indicators of success, such as reducing the prevalence levels by 25% in the first three months. Behavioral changes, including nutritional awareness assessed by selecting at least three healthy diets after four weeks of community education, will be helpful.
Outcome Standards
The outcomes will focus on behavior and prevalence levels in the long-term from the example of community education and awareness. As described, after three months, disease prevalence at the community level will reduce by 25%. Additionally, behavioral.
Community ProblemThe community issue addressed is the high preva.docxjanthony65
The document discusses evaluating a community program aimed at addressing high rates of obesity and overweight. It describes the evaluation structure as using a pre-and post-intervention approach to collect baseline data on metrics like BMI before the program and compare to post-program. The evaluation process will focus on specific, measurable goals set in advance. Outcome standards will focus on reducing prevalence levels, improving behaviors like exercise and nutrition, and decreasing BMI and weight.
Duke Integrative Medicine offers several professional training programs to healthcare organizations and businesses to support patient-centered care and health behavior change. They provide online courses on value-based care, health behavior change, and integrative health coaching. The courses teach skills like patient engagement, preventive health visits, documentation, and coding. They aim to increase patient engagement in health goals and behaviors through techniques like personal health planning. The integrative health coaching certification trains providers in health behavior change and patient-centered care using motivational methods to facilitate lifestyle changes.
Duke Integrative Medicine offers several professional training programs to healthcare organizations and businesses to support patient-centered care and health behavior change. They provide online courses on value-based care, health behavior change, and integrative health coaching. The courses teach skills like patient engagement, preventive health visits, documentation, and coding. They aim to increase patient engagement in health goals and behaviors through techniques like personal health planning. The integrative health coaching certification trains providers in health behavior change and patient-centered care using motivational methods to facilitate lifestyle changes.
This document outlines the aims and objectives of a training course on nutrition, physical activity, and obesity in primary care settings. The course will cover five themes split into three sections: services overview, communication skills training, and developing local facilities. It will help participants understand public health context, explore WHO guidance, highlight evidence, review local resources, identify barriers and enablers, and devise work plans. The communication skills training will focus on positive conversations, identifying at-risk groups, conveying advice, understanding behavior, and setting goals. Participants will also reflect on resources and set priorities and goals to address gaps.
This document provides a segmentation, targeting, positioning, and marketing strategy for Metabical, a new prescription weight loss drug. It segments the market into doctors, patients, and insurance companies. The target audience is males and females aged 50+ with a BMI of 25-30. The positioning positions Metabical as providing a credible way to lose weight and live healthily. The marketing strategy includes medical journal articles, conferences, an online support program, competitions, and endorsements. It allocates most of the $20 million budget to convincing doctors followed by promotional activities and advertising.
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler Community Health Nursing A Canadian Perspective, 5th Edition TEST BANK by Stamler Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Study Guide Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Studocu Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Course Hero Community Health Nursing A Canadian Perspective, 5th Edition Answers Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Course hero Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Studocu Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Study Guide Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Ebook Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Questions Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Studocu Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Stuvia
This document provides a summary of the American Dietetic Association's position on weight management. It endorses lifelong commitment to healthful lifestyle behaviors through sustainable eating and daily physical activity for successful weight management. It discusses goals of weight management, which go beyond numbers to also include prevention of weight gain and improvements in health. It also covers assessment of obesity, which involves measuring BMI, waist circumference, medical history, psychological factors, and nutrition intake to develop a care plan.
To maintain your weight, you must balance the calories you consume through diet and exercise. Dieting should start with a low calorie but nutritionally balanced diet, and weight can be managed by reducing calories or increasing exercise. Weight loss programs can be non-clinical like commercial chains or self-guided, or medical programs in healthcare settings involving professionals and focusing on nutrition, fitness, and behavior change therapies. Some medical programs use weight loss drugs or bariatric surgery for extreme obesity cases.
This document summarizes 10 key points for the management of overweight and obesity in adults. It addresses evaluating patients' BMI and waist circumference, counseling on weight loss benefits, recommending calorie-restricted diets and lifestyle programs for weight loss and maintenance, and the role of bariatric surgery. The points cover best practices for identifying patients who need weight loss, targeting modest 3-5% weight loss for health improvements, prescribing 6 month lifestyle programs including reduced calorie diets and exercise, and maintaining weight loss through long-term programs. Bariatric surgery is recommended for adults with a BMI ≥40 or ≥35 with comorbidities who have not achieved weight loss through other means.
RESEARCH Open AccessTelecoaching plus a portion control pl.docxsyreetamacaulay
RESEARCH Open Access
Telecoaching plus a portion control plate
for weight care management: a
randomized trial
Jill M. Huber1, Joshua S. Shapiro2, Mark L. Wieland1, Ivana T. Croghan1, Kristen S. Vickers Douglas3,
Darrell R. Schroeder4, Julie C. Hathaway5 and Jon O. Ebbert1,6*
Abstract
Background: Obesity is a leading preventable cause of death and disability and is associated with a lower health-
related quality of life. We evaluated the impact of telecoaching conducted by a counselor trained in motivational
interviewing paired with a portion control plate for obese patients in a primary care setting.
Methods: We conducted a randomized, clinical trial among patients in a primary care practice in the midwestern
United States. Patients were randomized to either usual care or an intervention including telecoaching with a
portion control plate. The intervention was provided during a 3-month period with follow-up of all patients
through 6 months after randomization. The primary outcomes were weight, body mass index (BMI),waist
circumference, and waist to hip ratio measured at baseline, 6, 12, 18, and 24 weeks. Secondary outcomes included
measures assessing eating behaviors, self-efficacy, and physical activity at baseline and at 12 and 24 weeks.
Results: A total of 1,101 subjects were pre-screened, and 90 were randomly assigned to telecoaching plus portion
control plate (n = 45) or usual care (n = 45). Using last-value carried forward without adjustment for baseline
demographics, significant reductions in BMI (estimated treatment effect -0.4 kg/m2, P = .038) and waist to hip ratio
(estimated treatment effect -.02, P = .037) at 3 months were observed in the telecoaching plus portion control plate
group compared to usual care. These differences were not statistically significant at 6 months. In females, the
telecoaching plus portion control plate intervention was associated with significant reductions in weight and BMI
at both 3 months (estimated treatment effect -1.6 kg, P = .016 and -0.6 kg/m2, P = .020) and 6 months (estimated
treatment effect -2.3 kg, P = .013 and -0.8 kg/m2, P = .025). In males, the telecoaching plus portion control
intervention was associated with a significant reduction in waist to hip ratio at 3 months (estimated treatment
effect -0.04, P = .017), but failed to show a significant difference in weight and BMI.
Conclusion: Telecoaching with a portion control plate can produce positive change in body habitus among obese
primary care patients; however, changes depend upon sex.
Trial registration: ClinicalTrials.gov NCT02373878, 13 February 2015. https://clinicaltrials.gov/ct2/show/
NCT02373878.
Keywords: Obesity, Telecoaching, Portion control plate, Primary care, Patient-centered medical home
* Correspondence: [email protected]
1Division of Primary Care Internal Medicine, Department of Medicine,
Rochester, MN 55905, USA
6Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
Full list of author information is ...
American Heart Association Lifestyle Recommendations to Reduce.docxjesuslightbody
American Heart Association Lifestyle Recommendations to Reduce Obesity
Jane Doe
University
Project and Practicum
Summer 2022
Abstract
The prevalence of obesity and sedentary lifestyle complications are increasing at alarming rates, representing a common but preventable cause of severe medical complications like diabetes, cardiovascular diseases, and early mortality. This chronic condition has been for a long time a public health concern and social determinant. The Fitbit app offers a unique opportunity to enhance the efficacy of weight loss plans as it is used to track activity, monitor steps, heart rate, energy expenditure, sleep, and sedentary behavior. The integrative review focused on how the American Heart Association (AHA) Diet and Lifestyle recommendations and the Fitbit app are used as innovative solutions to reduce obesity in adult patients.
Research Methodology: A systematic review was conducted to identify research articles completed in the preceding 4-5 years centered on obesity care, diet, physical activity, activity trackers, and lifestyle implications.
Results and Discussion: The databases searched were Chamberlain Library, PubMed, and CINHAL. Initial searches yielded over 2000 articles, of which 45 were chosen and examined because they fit the integrative review's theme. The 15 papers most relevant to the PICOT question were studied in further detail and appraised using the Johns Hopkins Evidence Appraisal table. The studies reported positive physical activity outcomes.
Conclusions and Further Recommendations:This systematic review supported the effectiveness of the AHA Diet and Lifestyle recommendations to reduce obesity, and clinical use generalization is recommended. Fitbit app provides new ways to improve physical activity habits, and the easy availability of electronic devices may enhance their generalizability use.
Keywords: Obesity care; Obesity complications; Lifestyle recommendations; Obesity management; Physical activity intervention using Fitbit activity trackers.
Dedication
Thanks to my family for their unwavering support of this project; their cooperation means a lot to me. To my husband Armando, thank you for your love, understanding, and patience during this time. I credit my achievement to all of you for your unwavering love and belief in me.
Acknowledgments
First, I must acknowledge the help of all my professors who inspired, encouraged, and supported me throughout the DNP program. My heartfelt thanks to my teammates, without whom I would never have completed this phase in my life. Their encouragement has had a significant influence on my strong determination during this trip.
Contents
American Heart Association Lifestyle Recommendations to Reduce Obesity 1
Abstract 2
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Dedication 3
Acknowledgments 4
American Heart Association Lifestyle Recommendations to Reduce Obesity 6
Problem Statement 6
S.
Responsed to colleagues posting that addressed different trends tha.docxzmark3
Responsed to colleague's posting that addressed different trends than those you described. Agree or disagree with the colleague's position on the current and future trends in the treatment of addiction.
Colleague #1
Current trends:
There are a number of trends within the addiction recovery and treatment field. One of the most utilized modalities within the field of addiction recovery may be cognitive behavioral therapy (CBT). CBT seeks to teach those recovering from addiction and other mental illness to find connections between their thoughts, feelings and even their actions or behaviors (Kiluk & Carroll, 2013). The cognitive behavioral approach often encourages those participating in the treatment to identify, and challenge potential thinking errors that may be contributing to their current addiction, or even mental illness.
Another widely used treatment trend is the 12-step program. This program is one that is based on peer support groups that meet together regularly to provide support, guidance and care as each individual works the program as a whole (AAWS, 2012). The basic assumption of the intervention model is that people can help one another achieve and maintain abstinence from substances, and healing cannot come about until one surrenders to a higher power (AAWS, 2012). This is a widely spread program that is estimated to be used by the majority of treatment centers throughout the country (Doweiko, 2019).
Future trends:
There have been a number of developments and shifts within the field of addiction recovery therapy. It seems that societal trends, to a certain extent, may have some sort of impact on the trends as they develop as well. For example, there has been more of an emphasis placed on holistic health, and holistic treatment in a number of fields. This trend may be seen being implemented into the field of substance abuse treatment, and recovery as well.
Drake (2020) suggests that holistic care should be integrated into a multidisciplinary approach within the substance abuse field. The concept of incorporating a registered dietician to the multidisciplinary approach supports the “moniker” of providing a holistic approach to those in substance abuse disorder treatment. Implementing this style of holistic care is said to improve the overall quality of treatment and recovery. It has been reported that those with substance use disorders have become well quicker, fewer symptoms, and sustain recovery longer when they follow principles of quality nutrition (Drake, 2020).
Similarly, there have been various studies implementing the Integrative Body Mind Spirit (I-BMS) intervention among those with substance use disorders. This intervention utilizes Western practices in congruence with Eastern philosophies, as well as techniques (Rentala et al., 2020) There are a number of specific interventions utilized within this particular program that all seek to foster a deeper connection between body, mind and spirit. One of the most com.
power point presentation on obesity by Rajeshwaree Netha (Doctor of pharmacy).
contents included are Introduction,pathophyisiology,clinical presentation (signs and symptoms of obesity disorder) ,Treatment,goals of treatment, general approach, Pharmacological treatment, and Evaluation of therapeutic outcomes.
The role of Occupational Therapy in public health and health promotionAccra School of Hygiene
More recently, the American Occupational Therapy Association (AOTA) articulated a role for occupational therapists in health promotion (AOTA Commission on Practice, 2001), charging practitioners to promote health and wellness in both individuals and communities through engagement in human occupation to promote healthy lifestyles.
Although occupational therapy practice traditionally focuses on individuals, to evaluate the impact of occupational therapy health promotion programs, the profession will need to assume a greater public health focus.
The American Gastroenterological Association Obesity Practice GuideDr. Robert M. Webman
Between 2000 and 2018, the percentage of American adults who are obese increased from 30 percent to over 40 percent. The rate of severely obese individuals doubled within the same period.
Obesity is linked with the onset of several chronic conditions, including diabetes and heart disease. Researchers have also noted that people who are obese have a greater chance of developing gastrointestinal problems, such as fatty liver disease, gastric cancer, and chronic acid reflux. In response, the American Gastroenterological Association (AGA) created the Practice guide on Obesity and Weight management, Education, and Resources (POWER), a guide for treating patients with obesity.
This document discusses the evaluation and management of obesity by gastroenterologists. It covers assessing a patient's readiness to change, obtaining a medical history and physical exam, evaluating lifestyle factors, screening for psychological issues, and the potential role of endoscopy in initial and postoperative evaluation of bariatric surgery patients. Key aspects include using the stages of change model, motivational interviewing techniques, evaluating diet and exercise habits, screening for eating disorders, and being familiar with normal and abnormal postoperative anatomy after different bariatric procedures.
Obesity- Tipping Back the Scales of the Nation 19th April, 2017mckenln
Dr. Rebecca Beeken presented on inspiring behavioral change through various techniques. She discussed traditional approaches focusing on information alone are often ineffective for behavior change. The COM-B model identifies capability, motivation, and opportunity as necessary conditions for behavior. Successful interventions incorporate self-monitoring and other self-regulation techniques. Commercial weight loss programs that emphasize lifestyle changes over dieting and use behavior change techniques and cognitive behavioral therapy have shown promising results. Habit formation through repetition can help establish healthy behaviors long-term. Health professionals, teachable moments, and nudging in appropriate settings can also influence behavior change. A multifaceted approach is needed to inspire lasting behavior change.
The document outlines the 5 A's approach to obesity management, which includes asking permission to discuss weight, assessing risks, advising on risks and options, agreeing on goals and expectations, and assisting by addressing barriers and referring to other providers. It provides guidance on setting SMART behavioral goals focused on sustainable lifestyle changes rather than weight targets alone. The document also discusses following up to support patients in achieving their goals as obesity requires long-term management.
Community ProblemThe community issue addressed is the high preva.docxtemplestewart19
Community Problem
The community issue addressed is the high prevalence rates of obesity and overweight. In this regard, the challenge is comprehensive, owing to categorizing the aspect as a lifestyle condition. Subsequently, other factors, such as nutrition, inadequate physical exercise, and sedentary lives contribute to the issue. The problem is significant, owing to substantial correlations between obesity, overweight, and other comorbidities. The implication is that obesity is a risk factor for other illnesses, including cardiovascular diseases, obesity, cancer, and other issues. In such a case, programs and initiatives implemented to reduce prevalence should be adequate. Accurate evaluation is critical in attaining the best outcomes, including follow-up, adherence, and addressing elements that require a change to meet emerging needs.
Structure
The evaluation structure follows a pre-and post-intervention approach. In this regard, the emphasis is on the initiatives and their ability to meet the set goals. According to the CDC (2016), obesity evaluation measures often employ baseline data to compare progress at the post-implementation phase. In this regard, the structure entails collecting baseline data of the metrics, such as BMI, waistline, and weight, among other anthropometric factors. After the intervention, such as a community education program sensitizing users on the risk factors associated with obesity and overweight, the evaluation will compare the baseline measures to assess any progress. To illustrate, evaluating how the BMI changed after a participant implements recommended steps will help determine efficacy. As a result, the suggested structure focuses on a pre-and post-intervention approach.
Process
The evaluation process will be goal-based. Subsequently, the procedure will focus on specific objectives determined by the set metrics. According to Seral-Cortes et al. (2021), an effective evaluation process should emphasize knowing the goals and project outcomes, testing them against set results. Additionally, precise objectives and measurable data are also vital in promoting an effective process of assessment. Other components or steps incorporate using a logic model to describe the intervention or program, formulating the project's acceptability criteria, and developing required questions. In the proposed process, a goal-based method will apply. Subsequently, post-intervention, goals will be formulated or indicators of success, such as reducing the prevalence levels by 25% in the first three months. Behavioral changes, including nutritional awareness assessed by selecting at least three healthy diets after four weeks of community education, will be helpful.
Outcome Standards
The outcomes will focus on behavior and prevalence levels in the long-term from the example of community education and awareness. As described, after three months, disease prevalence at the community level will reduce by 25%. Additionally, behavioral.
Community ProblemThe community issue addressed is the high preva.docxjanthony65
The document discusses evaluating a community program aimed at addressing high rates of obesity and overweight. It describes the evaluation structure as using a pre-and post-intervention approach to collect baseline data on metrics like BMI before the program and compare to post-program. The evaluation process will focus on specific, measurable goals set in advance. Outcome standards will focus on reducing prevalence levels, improving behaviors like exercise and nutrition, and decreasing BMI and weight.
Duke Integrative Medicine offers several professional training programs to healthcare organizations and businesses to support patient-centered care and health behavior change. They provide online courses on value-based care, health behavior change, and integrative health coaching. The courses teach skills like patient engagement, preventive health visits, documentation, and coding. They aim to increase patient engagement in health goals and behaviors through techniques like personal health planning. The integrative health coaching certification trains providers in health behavior change and patient-centered care using motivational methods to facilitate lifestyle changes.
Duke Integrative Medicine offers several professional training programs to healthcare organizations and businesses to support patient-centered care and health behavior change. They provide online courses on value-based care, health behavior change, and integrative health coaching. The courses teach skills like patient engagement, preventive health visits, documentation, and coding. They aim to increase patient engagement in health goals and behaviors through techniques like personal health planning. The integrative health coaching certification trains providers in health behavior change and patient-centered care using motivational methods to facilitate lifestyle changes.
This document outlines the aims and objectives of a training course on nutrition, physical activity, and obesity in primary care settings. The course will cover five themes split into three sections: services overview, communication skills training, and developing local facilities. It will help participants understand public health context, explore WHO guidance, highlight evidence, review local resources, identify barriers and enablers, and devise work plans. The communication skills training will focus on positive conversations, identifying at-risk groups, conveying advice, understanding behavior, and setting goals. Participants will also reflect on resources and set priorities and goals to address gaps.
This document provides a segmentation, targeting, positioning, and marketing strategy for Metabical, a new prescription weight loss drug. It segments the market into doctors, patients, and insurance companies. The target audience is males and females aged 50+ with a BMI of 25-30. The positioning positions Metabical as providing a credible way to lose weight and live healthily. The marketing strategy includes medical journal articles, conferences, an online support program, competitions, and endorsements. It allocates most of the $20 million budget to convincing doctors followed by promotional activities and advertising.
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Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
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2. they have learned and thereby preventing weight regain
in the long term [2, 3]. It has been postulated that there
are specific cognitive processes acting in these individ-
uals, helping them maintain long-term adherence to life-
style modification [4].
However, the treatments traditionally offered to patients
with obesity mainly aim to counter the biological and be-
havioural factors hindering weight loss and maintenance,
with very little regard to the cognitive processes that may
be at play. Failure to address a patients’ ability to adhere
to lifestyle modification over time may therefore be one of
the reasons why biological and behavioural treatments
have limited effectiveness in promoting long-term weight
loss [5]. This theory has been lent weight by recent indica-
tions that there are several cognitive factors associated
with treatment attrition, weight loss and weight mainten-
ance, respectively [4], suggesting that success rates may be
improved by developing new treatments to address these
cognitive processes; even existing treatments for obesity
could be enhanced by integrating specific cognitive strat-
egies and procedures.
With this in mind, we describe here the theory and main
strategies and procedures of a new cognitive behavioural
therapy for obesity (CBT-OB), a treatment designed to
help patients to achieve and maintain a healthy weight loss
through personalized combinations of strategies and pro-
cedures from traditional behavioural therapy for obesity
(BT-OB) with others addressing some specific cognitive
processes that the evidence suggests can influence attri-
tion, weight loss and weight-loss maintenance.
Cognitive processes associated with attrition, weight loss
and weight maintenance
Basic research clearly indicates that cognitive processes
play an important role in maintaining excessive and dys-
regulated eating habits, making healthy eating difficult
[6]. Moreover, several clinical studies in real-world set-
tings have found significant associations between specific
cognitive factors and treatment attrition, as well as the
amount of weight patients are able to lose and maintain
(Table 1) [14]. These findings have been the basis upon
which CBT-OB has been designed, with a view to over-
coming some of the shortcomings of traditional behav-
ioural therapy for obesity (BT-OB) [15].
From BT-OB to CBT-OB
BT-OB was originally based on learning theory (i.e., behav-
iourism), and the idea that education, and the recognition
and modification of environmental stimuli (antecedents)
and consequences of food intake (reinforcements), can
prompt patients to change their dietary and physical activity
habits with a view to reaching and maintaining a healthy
weight [7, 14] . The treatment was subsequently integrated
with social cognitive theory (e.g., goal setting, modelling
and self-efficacy) [8] and basic cognitive strategies (e.g.,
problem solving and cognitive restructuring) [9], as well as
specific recommendations on diet and exercise [10]. BT-
OB is an effective means of helping some patients achieve
weight loss in the short term; after one year, about 25 and
30% manage to lose and maintain 5–9.9% and ≥ 10% of
their body weight, respectively [11] with a mean drop-out
rate of about 20% [12]. This rate of weight loss is associated
with a significant reduction in the incidence of type 2 dia-
betes, not to mention improvements in other weight-
related medical comorbidities, psychosocial problems and
quality of life [13].
However, patients tend to achieve peak weight loss at
around six months, and at five-year follow-up roughly
50% of BT-OB patients have returned to their original
weight [16]. Indeed, even in its latest iteration, BT-OB is
poorly individualized; it is generally administered to
groups, and there is a prescribed order of sessions to fol-
low, irrespective of each patient’s actual progress [5].
This may be due to the main goal of the treatment, help-
ing patients achieve behavioural change (i.e., of eating
healthily and exercising), falling short. With this in
mind, we have developed a new form of treatment, inte-
grating strategies and procedures that can help to bring
about cognitive change—the aim of standard CBT [5]—
and thereby improve long-term outcomes.
To this end, CBT-OB involves not only the four main
core strategies of BT-OB [15], namely (i) using a specific
model of the disorder maintenance; (ii) actively involving
patients with a collaborative therapeutic style; (iii) using a
problem-solving approach focused on the present; and (iv)
Table 1 Specific cognitive factors associated with treatment
discontinuation, amount of weight lost and weight-loss
maintenance
Cognitive factors associated with treatment discontinuation:
• Higher expected 1-year BMI loss at baseline [7, 8]
• Primary goal for weight loss based on appearance at baseline [8]
• Acceptable or disappointing weight with respect to personal
expectations [9]
• Dissatisfaction with weight loss obtained through treatment [10]
Cognitive factors associated with amount of weight lost:
• Increase in dietary restraint and reduction in disinhibition [11]
• Higher expected weight loss at baseline [12]
Cognitive factors associated with weight-loss maintenance:
• Satisfaction with the results achieved [7]
• Weight-loss satisfaction [12]
• Confidence in the ability to lose additional weight without professional
help [7]
• Greater weight-loss satisfaction from week 15 or 19 of the weight-loss
phase (a decline is associated with weight regain) [13]
From Dalle Grave et al. [15] p. 9. Reprinted with the permission of
Springer Nature
Dalle Grave et al. BioPsychoSocial Medicine (2020) 14:5 Page 2 of 8
3. assessing treatment efficacy and updating the strategies
and procedures involved in response to clinical and re-
search findings, but also integrates CBT-based strategies
and procedures. In short, CBT-OB differs from BT-OB in
the following key aspects [15]: (i) rather than solely pursu-
ing behavioural change, it aims to produce cognitive
change to influence the long-term maintenance of lifestyle
modification; (ii) it is based on a personalized “cognitive
conceptualisation”, also called a “personal formulation”
(see Fig. 1), of the main mechanisms known to negatively
influence weight loss and maintenance, tackling them by
means of specific cognitive-behavioural strategies and pro-
cedures introduced according to the needs of the individ-
ual patient; (iii) it can be used to treat even patients with
severe obesity and disability (usually not treated with
standard BT-OB) via the adoption of intensive forms of
the treatment (e.g., residential programmes).
Goals, general strategies and procedures of CBT-OB
The main goals of CBT-OB are to help patients to (i)
reach, accept and maintain a healthy amount of weight
loss (i.e., 5–10% of their starting body weight) [13]; (ii)
adopt and maintain a lifestyle conducive to weight control;
and (iii) develop a stable “weight-control mind-set”. CBT-
OB therapists adopt a therapeutic style designed to de-
velop and nurture a collaborative working relationship
(the therapist and patient(s) work together as a team). The
treatment combines specific recommendations for a pa-
tient’s diet and exercise habits with procedures from both
behavioural and cognitive forms of therapy. In addition to
some of the procedures adopted by BT-OB (i.e., self-
monitoring, goal setting, stimulus control, contingency
management, behavioural substitution, skills for increasing
social support, problem solving and relapse prevention)
[17], the treatment includes specific cognitive strategies
and procedures, some of which have been adapted from
‘enhanced’ CBT (CBT-E) for eating disorders [18] (i.e., en-
gaging patients to make the treatment a priority and to
play an active role in changing their own habits; organiz-
ing the agenda of the sessions; self-monitoring in real
time; doing the strategically planned “homework; estab-
lishing a pattern of regular eating; identifying setbacks and
respond promptly to them), and Cooper et al. CBT [5]
(i.e., drawing distinction between weight loss and weight
maintenance; addressing during the weight loss phase po-
tential obstacles to the acceptance of weight maintenance
such as unrealistic weight goals, primary goals, and body
image concerns), and some of which have been developed
by our team. However, CBT-OB differs from Copper et al.
CBT [5] in the following main aspects: (i) it actively in-
volves, with the patients’ agreement, significant other(s) to
creating an environment that promotes positive changes
in eating and physical activity habits; (ii) it provides patient
a structured meal plan based on the food exchange lists;
(iii) it trains patients to assess their energy expenditure
and to develop not only an active lifestyle, but also an im-
provement of their physical fitness; (iv) it develops collab-
oratively with the patients their personal formulation of
the processes that are hindering weight loss; (v) it encour-
age patients to fill in weekly the Weight-Loss Obstacles
Questionnaire to identify not only the behaviours but also
the cognitive processes that might hinder weight loss; (vi)
it has a longer maintenance phase (48 weeks vs. 24 weeks);
and (vii) it includes two intensive steps of care (i.e., day-
hospital and residential CBT-OB) for patients with severe
and disabling obesity. These integrations enable the treat-
ment to be personalized, and help patients address with
specific strategies and procedures the processes that our
previous research has found to be respectively associated
with drop-out, the amount of weight lost, and maintaining
a lower weight in the long term (see Table 2).
As such, CBT-OB places great emphasis on engaging
the patients in the treatment, partly by encouraging them
to prioritize treatment and play an active role in replacing
their unhealthy habits with those conducive to weight
control. To this end, the generic CBT strategies of real-
Fig. 1 An example personal formulation featuring a patient’s main obstacles to weight loss
Dalle Grave et al. BioPsychoSocial Medicine (2020) 14:5 Page 3 of 8
4. time self-monitoring and carrying out strategic homework
tasks are adopted, although other elements of generic
CBT, such as formal thought records, schemas, assump-
tions, and automatic thoughts, are not introduced. Al-
though CBT-OB does address some aspects of cognitive
bias, such as generalization and dichotomous thinking, as
CBT-E [18], it does not often rely on complex cognitive
restructuring, but instead seeks to promote cognitive
change (i.e., a change of their frame of mind) with simpler
means by encouraging patients to analyse the effects and
implications of strategic and achievable modifications to
their behaviour. Both in and outside sessions, patients are
asked to observe their own behaviour and seek to identify
anything that is standing in the way of their adopting a
lifestyle that will help them lose, and subsequently main-
tain, weight. The therapist aims to stimulate a patient’s
interest in the effects and implications of trying different
ways of behaving. Then, when they consistently imple-
ment the new eating and physical activity habits and dem-
onstrate a persistent “weight-control mindset”, they are
helped to identify triggers that are likely to reactivate their
“weight-gain mindset”, to recognize the first signs that this
is occurring, and to take preventative action straight away
(to “do the right thing”, generally the opposite of the be-
haviour driven by the weight-gain mindset). In this way,
Table 2 CBT-OB strategies and procedures for minimising
attrition, enhancing weight loss and improving weight-loss
maintenance
Strategies and procedures for minimising attrition:
• Addressing patient’s difficulties attending the sessions
- Scheduling the sessions at times compatible with a patient’s work
commitments
- Routinely asking the patients whether they are experiencing any
difficulties as regards attending the sessions, and devoting time to
understanding and/or overcoming them.
• Showing interest in each patient as a person, irrespective of their
weight and/or other issues
- Adopting a “people first” policy—putting individuals before the
disability or disease when describing persons affected by obesity (e.g.,
“person with obesity” instead of “obese person”
- Avoiding any use of potentially pejorative adjectives or adverbs, or any
language that implies moral judgements or highlights patients’
“character flaws” regarding their weight
• Addressing unrealistic weight loss expectations
- Encouraging patients to pursue and be satisfied with achievable short-
term weight-loss goals (i.e., a weight loss of between 0.5 kg and 1.0 kg/
week) and not disputing unrealistic goals at the beginning of
treatment
- Addressing unrealistic goals only when patients have achieved some
success in reaching a healthy weight, but manifest dissatisfaction with
the weight loss achieved
• Maintaining therapeutic momentum
- Identifying with the patients the best time to start the treatment
- Stressing the importance of avoiding any interruptions in treatment,
especially during the first 8 weeks
- Explaining to the patients in advance that another therapist will take
the place of the primary therapist in the event of their absence
• Developing a protocol for dealing with late attendance or non-
attendance
- Encouraging patients to arrive a little early for session (e.g., 10–15 min)
in order to relax and mentally prepare themselves
- If patients are running late for an appointment, calling them after 15
min to express concern about their absence, and to try to reschedule
the appointment as soon as possible
Strategies and procedures for enhancing weight loss
• Increasing dietary restraint and decreasing dietary disinhibition
- Eating regularly (i.e., three planned meals and two snacks, and
refraining from eating in the intervals between)
- Planning meals in advance (when, what and where to eat) on a
specific monitoring record, making reference to a structured meal plan
- Supplying patients with grocery lists, menus and recipes
- Monitoring food intake in real time
- Training patients to eat consciously (i.e., “think while you are eating”)
- Training patients to “ride out” the desire for food, educating them that
any impulses will be transitory and can be tolerated
- Encouraging patients to consider their efforts to control eating as a
necessary condition for achieving healthy weight loss and benefiting
from its associated physical and psychological advantages
- Involving patients actively in identifying processes hindering weight
loss using the “Weight-Loss Obstacles Questionnaire”
Table 2 CBT-OB strategies and procedures for minimising
attrition, enhancing weight loss and improving weight-loss
maintenance (Continued)
- Developing collaboratively with the patients their personal formulation
of the processes that are hindering weight loss
- Designing personalized procedures aimed at addressing the specific
obstacles encountered by each patient
- Involving, with the consent of patients, their significant others in
treatment to create the optimal environment for facilitating patients
attempts efforts to change their eating habits
• Strategies and procedures for improving weight-loss maintenance
- Addressing weight-loss satisfaction before starting weight-loss
maintenance
- Dedicating one or two sessions to preparing patients for weight
maintenance, and collaboratively developing a weight maintenance
plan
- Encouraging patients to suspend any attempts to lose weight while
learning weight-maintenance skills (i.e., at least 12 months)
- Creating a list of personal reasons to maintain weight
- Adopting a mindset with a constant focus on weight control, and
keeping a constant but flexible focus on weight control and self-
awareness regarding diet and physical activity
- Identifying and addressing high-risk weight- regain situations, prevent-
ing lapses from becoming relapses, and addressing any weight regain
- Implementing weekly self-weighing and ensuring patients maintain
weight within a specific range of 4 kg
- Encouraging patients to follow a high-protein, low-glycaemic-index
diet with moderate fat content, and to practice at least 30 min of
moderate-intensity activity daily
Dalle Grave et al. BioPsychoSocial Medicine (2020) 14:5 Page 4 of 8
5. patients learn to manipulate their own frame of mind [19],
and thereby deal more effectively with weight gain by im-
mediately averting setbacks that might otherwise develop
into full-scale relapses.
Other adaptations include a higher frequency of ses-
sions in the first weeks of treatment, when the focus is
on helping patients to “start well” placing great emphasis
on establishing and maintaining therapeutic momentum
(i.e., identifying the best time for patients to start CBT-
OB, stressing the importance of avoiding any interrup-
tions during the treatment, and planning one session a
week for the first eight weeks of the treatment) as early
weight loss has been shown to be a good predictor of
long-term weight loss [20]. In addition, a subgroup of
patients with severe and disabling obesity may begin
treatment in intensive settings, such as day-hospital or
residential CBT-OB units [21], to boost their chances of
success.
Further details of CBT-OB, together with a compre-
hensive description of the treatment and its implementa-
tion, can be found in the main treatment guide [15]. In
addition to reading the manual, the therapist delivering
the treatment should attend a workshop given by an ex-
pert in CBT-OB providing an overview of the interven-
tion and its strategies and procedures. However, it is
also advisable that therapists receive supervision in
implementing the treatment from someone proficient in
it.
The versions of CBT-OB
CBT-OB has been designed to treat all classes of obesity
within a stepped-care approach involving three levels of
care (outpatient, day-hospital and residential). Out-
patient CBT-OB can be delivered individually by a single
therapist or in group by two therapists. It includes the
following phases (see Fig. 2):
Preparatory Phase. This is delivered in one or two
sessions, and has the aims of assessing the nature
and severity of a patient’s obesity, as well as any
associated medical and psychosocial comorbidities,
as well as engaging the patient(s) in the treatment.
Phase 1. This has been designed to help patients
achieve a healthy rate of weight loss and be satisfied
with the resulting weight. It lasts about 24 weeks
and is delivered across 16 sessions, the first eight of
which are held once a week, and the remaining eight
on a two-weekly basis.
Phase 2. This has the aim of helping patients to
develop a lifestyle and mindset conducive to long-
term weight maintenance. It usually lasts 48 weeks
Fig. 2 The map of cognitive behavioural therapy for obesity (CBT-OB) From Dalle Grave et al. [15], 20. Reprinted with the permission of
Springer Nature
Dalle Grave et al. BioPsychoSocial Medicine (2020) 14:5 Page 5 of 8
6. and is delivered across 12 sessions that are held at
four-weekly intervals.
CBT-OB is delivered in six modules (see Table 3),
each including specific strategies and procedures that
may be adapted to the patient’s individual progress and
barriers; the six modules are introduced in a flexible and
individualized way, according to the patient’s needs,
across Phase 1 and Phase 2. In general, however, Module
1 is introduced in the first session, Module 2 and 3 in
the second session, Module 4 in the third session, Mod-
ule 5 when the patient reports dissatisfaction with
weight loss unrelated to poor adherence to the diet and
exercise programme, and Module 6 at the beginning of
Phase 2.
Each session lasts 45 min (90 min when the treatment
is delivered in group), and is divided into five parts, each
with a distinct objective, specifically:
1. In-session collaborative weighing (up to 5 min)
2. Reviewing self-monitoring and other homework (up
to 10 min)
3. Collaboratively setting the session agenda (about 2
min)
4. Working through the agenda and agreeing on
homework tasks (up to 30 min).
5. Concluding the session (about 3 min). This includes
summarizing what has been addressed in session,
confirming the homework assignment(s), and
scheduling the next appointment.
Day-hospital and residential CBT-OB, on the other
hand, which are indicated for patients with severe and
disabling obesity with no upper limit of body mass index
(BMI) [22], last 21 days. A distinctive characteristic of
these intensive versions is they are delivered by a multi-
disciplinary CBT-OB-trained team of physicians, dieti-
cians, psychologists, physiotherapists and nurses, all
acting in concert. Relying on the same principles as out-
patient CBT-OB, intensive versions of the treatment in-
clude the following main procedures [23]: (i) a low-
energy diet; (ii) a motor/functional rehabilitation
programme; and (iii) a daily group CBT-OB session in
which patients are actively trained to use the procedures
outlined in Modules 1–3 (as in outpatient CBT-OB).
Day-hospital CBT-OB is similar to residential CBT-E,
but the patients sleep in their home. After discharge, pa-
tients are advised to continue CBT-OB treatment in the
outpatient setting. Since such patients have already im-
plemented the procedures of Modules 1–3 (generally de-
livered during the first two sessions of outpatient CBT-
OB) during the intensive CBT-OB phase, these can be
omitted from the “post-intensive” outpatient CBT-OB
(see Fig. 1).
Table 3 The main procedures of the six CBT-OB modules
Module 1 - Monitoring food Intake, physical activity and body weight
• Initiating weekly weighing
• Explaining what the treatment will involve
• Educating on energy balance
• Establishing real-time monitoring of food intake and physical activity
• Initiating weekly weighing
Module 2 - Changing eating
• Creating an energy deficit of 500–1000 kcal per day produce a variable weight
loss of about 0.5–1 kg a week.
• Planning ahead when, what and where to eat
• Eating consciously
Module 3 - Developing an active lifestyle
• Assessing the patient’s eligibility for exercise
• Assessing the patient’s functional exercise capacity
• Motivating the patient to exercise
• Developing an active lifestyle, reducing sedentary activities and increasing the
daily step count
• Improving physical fitness
• Continuing or commencing formal exercise (in selected cases)
Module 4 - Addressing obstacles to weight loss
• Educating the patients on cognitive-behavioural weight-loss obstacles (ante-
cedent stimuli, positive consequences, problematic thoughts)
• Introducing the Weight-Loss Obstacles Questionnaire
• Creating the Personal Formulation
• Addressing weight-loss obstacles
- Reducing environmental stimuli
- Addressing events influencing eating and exercise habits
- Addressing impulses and emotions influencing eating and exercise habits
- Addressing problematic thoughts
- Addressing the use of food as a reward, and the patient’s rational excuses for
not adopting an active lifestyle
Module 5 - Addressing weight-loss dissatisfaction
• Detecting weight-loss dissatisfaction and its reasons
• Addressing unrealistic weight goals
• Addressing dysfunctional primary goals for losing weight
• Addressing negative body image
Module 6: Addressing the obstacles to weight maintenance
• Reviewing the changes achieved through weight loss
• Educating the patient on weight maintenance
• Involving the patient actively in the decision to start weight maintenance
• Introducing the procedures for weight maintenance
- Establishing weekly self-weighing and a weight-maintenance range
- Adopting eating habits and physical activity habits conducive to weight
maintenance
- Constructing a weight-maintenance mindset
- Identifying and addressing high-risk situations and
- Addressing weight regain
• Discontinuing real-time monitoring of food intake
• Evaluating possible future weight-loss attempts
• Preparing a weight-maintenance plan
• Bringing the treatment to a close
Dalle Grave et al. BioPsychoSocial Medicine (2020) 14:5 Page 6 of 8
7. CBT-OB may be also associated with weight loss drugs
and/or bariatric surgery in selected cases [24], or in
some cases followed by these interventions if there is a
need of further weight loss, and can also be adapted for
patients with obesity associated with binge-eating dis-
order (BED) [25].
Finally, CBT-OB is contraindicated for patients who
are pregnant or lactating, take medication affecting body
weight, have medical comorbidities associated with
weight loss or have severe psychiatric disorders (e.g.,
major depression, acute psychotic disorders, substance
use disorders, and bulimia nervosa).
CBT-OB effectiveness
A randomized control trial has assessed the effectiveness
of CBT-OB in 88 patients with severe obesity, allocated ei-
ther a high-protein diet (HPD) or a high-carbohydrate diet
(HCD) [26]. The treatment studied in this trial included 3
weeks of residential CBT-OB followed by outpatient CBT-
OB. Encouragingly, the attrition rate observed in the both
HPD (25.6%) and HCD (17.8%) groups was far lower than
the 50% attrition rate commonly observed in the commu-
nity after standard biomedical prescriptive weight-loss
treatments [27] and similar to that reported by research
trials of BT-OB [12]. Furthermore, weight loss at 43 weeks
in completers (n = 69) was 15% for HPD and 13.3% for
HCD, a percentage weight loss which was much higher
than the mean 8% in 6 months reported by conventional
lifestyle-modification programmes based on BT-OB [26].
No significant difference between the two arms was ob-
served throughout the trial, and both diets produced simi-
lar improvements in cardiovascular risk factors and
psychological profiles; what is more, no tendency to regain
weight was observed in either group between 6 and 12
months [26].
Another study, conducted in an Italian National Health
Service obesity clinic, assessed the effectiveness of group
CBT-OB in 67 patients with severe obesity. In this case the
treatment was less intensive than recommended by the
CBT-OB protocol, including only 22 group sessions (14 in
the 6-month weight-loss phase and 8 in the subsequent 12-
month weight-maintenance phase) [21]. Nevertheless,
76.2% patients completed the treatment, displaying an aver-
age weight loss of 11.5% after 6 months and 9.9% after 18
months. This weight loss was associated with a significant
reduction in cardiovascular risk factors, anxiety, depression
and eating-disorder psychopathology, and an improvement
in obesity-related quality of life [21].
Another study compared the long-term effects of resi-
dential CBT-OB in 54 patients with severe obesity with or
without binge-eating disorder (BED) [28]. Even though
patients did not receive outpatient CBT-OB after dis-
charge, at 5-year follow-up, 51.5% of the former group no
longer met the diagnostic criteria for BED. Moreover, no
difference was observed between the two groups in terms
of mean weight loss (6.3 kg in BED vs. 7.4 kg in non-BED).
Finally, one observational outpatient study on CBT-
OB delivered individually in a real-world clinical setting
is ongoing.
Conclusions
CBT-OB is an innovative treatment designed to help pa-
tients maintain long-term weight loss by addressing
some limitations of traditional BT-OB, namely the poor
personalization of the intervention and the prevalent
focus on helping the patients to reach behavioural
change (i.e., eating and exercise habits) rather than a
cognitive change oriented to long-term weight control.
As such, CBT-OB includes the main procedures of trad-
itional BT-OB, but includes new strategies and proce-
dures, introduced according to the individual patient’s
needs, to address specific cognitive processes that previ-
ous research has found to be associated with treatment
discontinuation, weight loss and weight maintenance.
Moreover, it can be delivered in a stepped-care ap-
proach, including three levels of care (i.e., outpatient,
day-hospital, and residential) to treat patients with se-
vere and disabling obesity. If the promising results dis-
played by CBT-OB so far are confirmed by future
randomized controlled trials comparing CBT-OB with
BT-OB, the treatment has the potential to improve on
the outcomes achievable by traditional lifestyle-
modification weight-loss treatments.
Abbreviations
BT-OB: Behavioural-therapy for obesity; CBT: Cognitive-behavioural therapy;
CBT-E: Enhanced-cognitive behavioural therapy for eating disorders; CBT-
OB: Cognitive-behavioural therapy for obesity; OB: Obesity
Acknowledgements
Not applicable.
Authors’ contributions
RDG was the major contributor in writing the manuscript, SC and MS
reviewed the manuscript. All authors read and approved the final
manuscript.
Funding
None.
Availability of data and materials
Not applicable.
Ethics approval and consent to participate
Not applicable.
Consent for publication
Not applicable.
Competing interests
The authors declare that they have no competing interests.
Author details
1
Department of Eating and Weight Disorders, Villa Garda Hospital, Via Monte
Baldo 89 37016 Garda (VR), Verona, Italy. 2
Associazione Disturbi Alimentari,
Via Sansovino 16, 37016 Verona, Italy.
Dalle Grave et al. BioPsychoSocial Medicine (2020) 14:5 Page 7 of 8
8. Received: 19 December 2019 Accepted: 2 March 2020
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