Weight Loss Interventions in Psychology - Literature review Example

Literature Review on Weight Loss interventions in Psychology Introduction This paper will review research literature on weight loss treatments and importantly, how successful they are in the long term while considering any ethical issues that need to be taken into account in weight-loss approaches. Precisely, this paper will follow a qualitative research methodology in reviewing the current state of research evidence on effectiveness of weight loss approaches over an extended follow-up period in women while identifying recommendations that can be effective in the case of Elizabeth, a 38-year-old woman of over healthy weight in need of help with weight-loss. Specifically, this paper will highlight the public health problem of obesity, its prevalence, as well as public health costs of the obesity epidemic while the broad focus of the paper will be on research and interventions in the public health problem of obesity. Defining obesity There is a global consensus on the classification of overweight and obesity on the basis of BMI (Rippe Crossley & Ringer 1998); the WHO and the National Institutes of Health (NIH) classify BMI of 25-29.9 as overweight, BMI of 30-39.9 as obese, and BMI of beyond 40 as severe obesity. Obesity is generally defined as a body mass index (BMI) that exceeds 27, measured as a ratio of an individual’s weight in kilograms to their height in square meters, and is classified as one of the most pressing concerns of public health all over the world (Douketis et al. 1999). Echoing their perspective, Mehta and Chang (2009) point out that obesity is one of the leading causes of premature mortality not only in the U.S. alone, but also across the world. Precisely, overweight and obesity pose a significant public health challenge in Australia, and regular monitoring is imperative to determine shifts in their incidences and the most at risk groups in order to monitor and focus target preventive interventions (Flood et al. 2000). Aetiology of obesity Obesity has been conceptualized as a multifactorial disorder that is caused by genetic, metabolic as well as environmental, socioeconomic and behavioral factors; according to this view, the specific contribution of each of these factors to the overall obesity epidemic varies significantly (Marin-Guerrero et al., 2008). Expert opinions hold that unlike behavioral factors, which have undergone significant modifications, genetic factors and their perceived influence on energy balance have remained constant over the years, thus, cannot account for the rise in the obesity epidemic. In support of this perspective, Rippe, Crossley and Ringer (1998) also conceptualize obesity as a chronic health disorder with a broad multifactorial aetiology ranging from genetics to environment to metabolism to lifestyle to behavioral factors. The rising prevalence of overweight and obesity in the Australian population like in the rest of the developed world can be attributable to the increasing levels of physical inactivity as well as the shifts in food consumption patterns (Banwell, Hinde, Dixon, & Sibthorpe, 2005). Other studies further support this claim by attributing the prevalence of the obesity epidemic in low-income and middle-income countries to new dietary habits and sedentary lifestyles, which further aggravate the risk of chronic diseases and premature mortality in populations (Cecchini et al., 2010). Further still, a recent study by Cheong et al, (2010) also implicates socio-economic status, lifestyle habits, as well as psychosocial factors in the rising prevalence of both obesity and overweight on a global scale; precisely, socio-demographic and psychosocial factors as well as working hours of individuals are more likely to contribute to obesity of particular individuals in the populations. Prevalence of obesity The prevalence of overweight and obesity in Australian children in particular is on rising trend of nearly one percentage point per year, which equates to nearly 40000 more children becoming overweight on a yearly basis (Sanigorski, Bell, Kremer & Swinburn, 2007). Furthermore, it is argued that Australian children rank highest in global estimations of highly at risk of obesity and while girls are more likely to be obese than boys, children of lower socioeconomic status are even at a much greater risk of overweight and obesity. It is evident that the global prevalence of childhood obesity has gone up in recent years and the epidemic of childhood obesity poses greater public health challenge since obesity in childhood is more likely to persist into adulthood thereby predisposing individuals to the heightened risk of disease burden in later life (Jurgen, Wolfenstetter & Wenig, 2012). Overweight and obesity cases in the Australian population were on a rising trend during the 1990s and given the country’s progressively worsening obesogenic environment in contemporary times, the risk of obesity for the more recently born cohorts in the country is further aggravated (Allman-farinelli et al., 2008). Walls et al, (2012) project the progression of the incidence of obesity in Australia drawing from measures of overweight and obesity prevalence derived from a national longitudinal study. Their findings support the thesis that if the rates of weight gain remain constant, then the prevalence of obesity will rise by 65% while the proportion of normal-weight adults will be less than a third of the Australian population by 2025. History of interventions The global healthcare community in general as well as the physician community in particular did not regard obesity as a chronic disease, given that there is little or no evidence at all of clinical interventions such as counselling for overweight and obese patients regarding the adverse health consequences of their rising weight gain (Rippe, Crossley, & Ringer, 1998). The lack of incentive for physician involvement in the treatment of obesity is attributable to numerous factors including the lack of reimbursement for obesity-related therapies in most insurance plans, high skepticism of the effectiveness of the prevailing therapies, as well as the persistence of negative societal prejudices that attribute obesity to a lack of discipline. Evidence for long-term interventions and maintenance It has been established that weight-loss interventions that follow a reduced energy diet as well as exercise are more likely to result to a moderate weight loss after six months, and despite the likelihood of regaining weight, weight loss can be maintained since the addition of weight-loss medications to some extent improves maintenance of weight-loss (Franz et al., 2007). This systemic review dispels the conflicting views among professionals and the public concerning the efficacy of interventions for losing weight, especially given that tackling obesity and overweight among populations is the single most effective strategy not only in the primary but also in the secondary prevention of diseases. Recent studies have proposed an overweight and obesity treatment model comprising of lifestyle interventions coupled with additional medical therapies delivered by an interdisciplinary team of health professionals such as physicians, dieticians, exercise specialists as well as behavior therapists in appropriate situations. It is further argued that severely obese individuals with Type 2 diabetes can achieve significant outcomes in weight loss following behavioral weight loss programs while underscoring the notion that a severely obese individual can benefit from conservative weight loss and weight maintenance treatments (Unick et al., 2011). There is convincing evidence of the effectiveness of the TAKE 5 weight-loss intervention among the adults with intellectual disabilities and obesity population; it has been established that this group is highly receptive of energy-deficit diets within the multi-component intervention (Melville et al., 2011). Besides that, there is adequate proof of not only the feasibility and acceptance, but also of the effectiveness of family based behavioral treatment of obesity in clinical settings, which has been tried in Britain (Edwards et al., 2006); these findings underpin the proposal that family-based behavioral treatment for obesity does result to significant weight loss without adverse psychological consequences for the patients. Centrality of long-term maintenance in interventions For obesity interventions to be successful in resulting to significant positive outcomes in weight-loss, they should be able to yield a longer-term maintenance of weight-loss while preventing post treatment weight regain. The fact that it is not easy for people with obesity to maintain a new lower weight after successfully losing weight sustains the notion that obesity resists psychological interventions if a long term perspective is not undertaken (Cooper et al., 2010. The implication of this finding is that it is not ethically sound to reinforce the perceived effectiveness of psychological treatments for obesity in the absence of data that supports the longer-term effects of these particular interventions. This conclusion derives from the central observation that despite the successful weight-loss in most people that seek obesity treatment, only a few of them succeed to sustain the significant behavioral changes that are essential in preventing subsequent weight gain. In that respect, it is evident that most people might succeed in losing weight in the short term but may eventually regain a vast proportion of the lost weight, thereby highlighting the need for a paradigm shift in psychological research on obesity from treatment to prevention. In the same breath, Latner, Stunkard, Wilson and Jackson (2006) argue that despite the heightened risk of the obesity epidemic and its adverse health implications on populations, professional long-term treatment is not available for a vast proportion of the obese patients. Similarly, a number of recent studies express skepticism concerning obesity and weight-loss interventions by arguing that community-based obesity prevention methods are highly ineffective (Douketis et al., 1999); these studies further contend that except in a negligible proportion of obese patients who receive dietary and surgical treatments, obesity treatments are generally ineffective in the longer term, that is, over two years durations. In that case, there is no doubt that despite the effectiveness of intensive and regular physical exercise in preventing weight-gain, this strategy does not work for the entire populations since it is only effective in the short-term given the counteractive effect of societal forces that promote obesity (Anand, 2006). Prevailing Interventions The major clinical interventions in the treatment of overweight and obesity include pharmacological, behavioral, motivational interviewing, as well as cognitive behavioral therapies; each of these therapies have been tried with varying success levels in the treatment of obesity as discussed below. Pharmacological Therapy Clearly, significant advances have been made in the contemporary understanding of pharmacological treatments for eating disorders (Kotler & Walsh, 2000); clinical tests point out the short-term effectiveness of antidepressants in cases of bulimia nervosa while highlighting the lack of evidence for the effectiveness of this treatment in severe cases. It has been proven that anti-obesity drugs work through varied mechanisms both in the central as well as in the peripheral nervous system tissues, and this treatment should be considered for patients that failed to achieve significant weight-loss outcomes through lifestyle change programs, diet and physical exercising (Hainer, 2011). In as much as ephedrine and phenylpropanolamine stimulants were commonly recommended as weight loss supplements, there is insufficient evidence of both short and long term clinical trials of their weight-loss efficacy (Tek, Ratliff & Chwastiak, 2011). Furthermore, studies recommend that pharmacological treatments for obesity are more likely to yield positive outcomes when combined with appropriate behavioral or nutritional programs. For instance, Mersebach et al., (2004) establish a significant weight-loss through the combined effect of a sibutramine diet alongside exercise in obese hypo-pituitary patients but there is no evidence of longer-term maintenance of outcomes. According to Astrup & Toubro (2004), topiramate is effective in promoting weight-loss in obese patients and the weight-loss is more likely to continue for a long time; furthermore they highlight that topiramate is generally tolerated due to its mild to moderate side effects. Behavioral Therapy There is significant evidence of the prevalent use of very-low-energy diets (VLED) alongside behavior therapy as a clinical strategy in the treatment of morbid obesity; this finding underscores the notion that combining VLED with BT is more likely to yield enhanced 5-year maintenance than BT when used singly, particularly in men (Pekkarinen & Mustajoki, 1997). It has been suggested that treatment of obese individuals exclusively on training does not result to any significant outcomes in weight-loss if it is not combined with diet as well as behavior modification therapy (Soderlund, Fischer & Johansson, 2009); nevertheless, training does help in preventing both additional weight gain as well as weight regain. Motivational Interviewing According to Low et al (2013), motivational interviewing (MI) is a client-centered, directive approach that is used to enhance an individual’s intrinsic motivation to alter their behavior by exploring as well as resolving ambivalence concerning changing behavior. It has been established that low-intensity MI counseling interventions might result to positive outcomes in terms of significant weight loss in the short term, but the weight loss cannot be maintained over the longer term (Hardcastle et al., 2013). These findings underscore the implication that low-intensity MI counselling interventions may not be effective in resulting to longer-term changes in all health-related outcomes. In support of this view, Hardcastle, Blake and Hagger (2012) further reiterate that motivational interviewing is merely an effective strategy for promoting physical activity amongst the socioeconomically disadvantaged groups in the short term. Cognitive behavior Therapy (CBT) It has been suggested that recent advances in the area of eating disorders can shade more light on the problem of weight regain given the rising incidence of psychological treatments that result to long lasting outcomes in patients eating habits (Cooper et al., 2010). Recent studies point out a remarkable finding of a highly effective intervention, cognitive behavior therapy (CBT-BN), in the area of a serious eating disorder known as bulimia nervosa, which is characterized by recurrent binge eating. Cognitive behavior therapy has been credited for resulting to a significant decrease in the regularity of binge eating and its allied habits, and a total cessation of the mannerisms altogether; besides that, the outcomes of this treatment have been found to endure into the long term in a vast majority of the patients. Cognitive behavior therapy in the treatment of obesity targets the patients’ overeating tendencies and high physical inactivity to prevent weight post-treatment weight regain; nonetheless, CBT does not result to any positive outcomes in weight maintenance. Summary of evidence Overall, there is little evidence of clinicians involvement in treatment of obesity since it was not regarded as a chronic disease; in the words of Rippe, Crossley, & Ringer (1998), physicians were not involved in the treatment of obesity due to the lack of reimbursement for obesity-related therapies in most insurance plans. Besides that, the lack of incentive for physician involvement can be attributable to the high skepticism of the effectiveness of the prevailing therapies, as well as the persistence of negative societal prejudices that attribute obesity to a lack of discipline. Nevertheless, there is significant evidence of numerous weight-loss interventions in the treatment of weight-loss and obesity in contemporary times, though with various success levels, especially in the short-term. Franz et al., (2007) present an optimistic perspective that weight-loss interventions following a reduced energy diet as well as exercise are more likely to result to a moderate weight loss after six months and weight loss can be maintained since the addition of weight-loss medications to some extent improves maintenance of weight-loss. Nonetheless, there is little evidence of interventions that result to successful weight-loss maintenance in the longer-term; as Cooper et al., 2010 suggest, people with obesity may not easily maintain a new lower weight after successfully losing weight since it requires a strong long term commitment to lifestyle change, dietary and rigorous excise routine. Conclusion Ultimately, the research literature reviewed is highly inconclusive on whether or not the prevailing interventions of weight-loss could potentially yield significant weight-loss maintenance in the longer term, despite prevalence of evidence drawn from clinical trials of the perceived effectiveness of interventions in the short term. References Allman-farinelli, M., Chey, T., Bauman, A. E., Gill, T., et al. (2008). Age, period and birth cohort effects on prevalence of overweight and obesity in australian adults from 1990 to 2000. European Journal of Clinical Nutrition, 62(7), 898-907.  Anand, S. S. (2006). 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Projected progression of the prevalence of obesity in Australia. Obesity, 20(4), 872-878.  Read More