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Clinical Research

The past, present, and future of behavioral obesity treatment

International Journal of Obesity (2024)Cite this article

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Abstract

Over the last century, hundreds of evaluations have been conducted to examine weight-management interventions related to diet, physical activity, and behavior therapy. These investigations have contributed to a growing body of knowledge that has consistently advanced the field of obesity treatment, while also revealing some persistent challenges. This narrative review summarizes key findings from randomized controlled trials conducted in adults that have combined diet, physical activity, and behavior therapy, an approach variously referred to as behavioral treatment, comprehensive lifestyle modification, or intensive lifestyle intervention. The review shows that current behavioral approaches induce average reductions in baseline body weight of 5 to 10% at 6 to 12 months. Such losses have proven effective in reducing the risk of type 2 diabetes in persons with impaired glucose tolerance and in improving other obesity-related complications. These benefits have also been associated with reductions in healthcare costs. Despite these advances, behavioral treatment is challenged by the need for larger losses to achieve optimal improvements in health, by difficulties associated with maintaining weight loss, and by barriers limiting access to treatment. New anti-obesity medications, when combined with behavioral obesity treatment, hold promise of addressing the first two issues.

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Funding

Funding

AMC was supported, in part, by the National Institute of Nursing Research of the National Institutes of Health under Award Number R56NR020466 and Award Number R01NR020197. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Johns Hopkins School of Nursing, Baltimore, MD, USA

    Ariana M. Chao

  2. Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Molly Moore & Thomas A. Wadden

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  1. Ariana M. Chao
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  2. Molly Moore
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Contributions

AMC: Conceptualization, data curation, investigation, methodology, project administration, resources, supervision, validation, visualization, writing- original draft preparation, writing- review and editing. MM: Data curation, investigation, validation, writing- original draft preparation, writing-review and editing. TAW: Conceptualization, investigation, project administration, supervision, writing- original draft preparation, writing- review and editing.

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Correspondence to Ariana M. Chao.

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Competing interests

Ariana Chao has served on advisory boards to Eli Lilly and Boehringer Ingelheim and received grant support, on behalf of the University of Pennsylvania, from Eli Lilly and WW (Weight Watchers). Thomas Wadden serves on scientific advisory boards for Novo Nordisk and WW (Weight Watchers) and has received grant support, on behalf of the University of Pennsylvania, from Eli Lilly, Epitomee Medical, and Novo Nordisk. The other author has no conflicts of interest to disclose.

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Chao, A.M., Moore, M. & Wadden, T.A. The past, present, and future of behavioral obesity treatment. Int J Obes (2024). https://doi.org/10.1038/s41366-024-01525-3

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