Four weight loss researchers discussed the value of intensive lifestyle interventions, behavioral therapy, and pharmacotherapy during the Scientific Sessions symposium Maximizing Weight Loss Maintenance—Ingredients for the Secret Sauce on Sunday, June 5. The session was livestreamed and can be viewed on-demand by registered meeting participants at ADA2022.org. If you haven’t registered for the 82nd Scientific Sessions, register today to access the valuable meeting content.
Hollie Raynor, PhD, RD, LDN, Associate Dean and Professor in the Department of Nutrition at the University of Tennessee, reviewed several dietary strategies, physical activity goals, and the latest counseling and behavior-change approaches.
Behavioral therapy strategies include identifying personal triggers and changing the environment to control stimulus. But the real key to success is self-monitoring of weight, calorie consumption, and physical activity, she said.
“There’s quite a bit of evidence showing that individuals who self-monitor over time generally are the best in terms of maintenance of behaviors and weight,” Dr. Raynor said. “Whatever the goals are, the idea is that we’re helping individuals develop self-regulation skills.”
Linda M. Delahanty, MS, RDN, Director of Nutrition and Behavioral Research and the Path to Lifestyle Change Program at Massachusetts General Hospital Diabetes Center, presented data from the STOP Regain study, which found that participants did best at maintaining weight loss when they stepped on a scale every day, took quick action when they regained 3 or 4 pounds, and restarted full weight loss efforts as soon as they regained more than that.
Behavioral therapy, she said, should promote self-regulatory processes, skills to adjust food intake in response to weight gain and episodes of overeating, and self-confidence by setting small, realistic goals that allow participants to succeed. She provided a framework for motivational interviewing, which has been used successfully in weight loss counseling. Her series of questions can be individually tailored with language to motivate participants to change their behavior.
“Everybody needs the flexibility to find their own way,” Delahanty said. “Each person learns what works best for them and is a livable, sustainable recipe for success.”
Angela Forfia, Associate Director of Diabetes Education and Prevention at the Association of Diabetes Care & Education Specialists (ADCES), reviewed real-world lessons learned from the U.S. National Diabetes Prevention Program (National DPP).
About 10 years ago, ADCES partnered with the Centers for Disease Control and Prevention to take the National DPP’s lifestyle interventions into communities across the country. The initiative built upon an existing infrastructure of accredited diabetes self-management education and support programs but shifted the focus from costly, one-on-one counseling sessions at research hospitals to small group interventions in health care and community settings.
To date, 2,755 people have participated in the programs and 85% have participated in more than four sessions. Of those who showed up for more than four sessions, 28% lost 5% or more of their body weight in the first six months, with an average weight loss of 3.4%, Forfia said. At the end of the first year, 24% had lost 5% or more body weight, with an average of 3.8% weight loss.
Scott Kahan, MD, MPH, Director of the National Center for Weight and Wellness, discussed the combination of behavioral therapy and pharmacotherapy to treat obesity.
He cited a recent study comparing intensive behavioral counseling alone versus behavioral counseling in combination with pharmacotherapy. Behavioral counseling alone resulted in an average weight loss of 7.5% among study participants. When medication was added, the average jumped to 12% of body weight, and 50% more people lost weight, he said.
Other studies have shown that naltrexone/bupropion combined with the behavioral therapy resulted in a weight loss of 5% or more in 80% of study participants. While the studies prove that pharmacotherapy can be beneficial, they also demonstrate that the intensity of counseling matters, he said.
“You do a little bit of counseling, you get a little bit of benefit. You do a lot more counseling, you get a lot more benefit,” Dr. Kahan said. “So it’s both an example of the benefit of pairing behavioral therapy and pharmacotherapy, but also an example of these gradations of intensifying counseling and getting more benefit.”