Cognitive-Behavioral Treatment of Obesity: A Clinician’s Guide

ZAFRA COOPER, CHRISTOPHER G. FAIRBURN, AND DEBORAH M. HAWKER: Cognitive-Behavioral Treatment of Obesity: A Clinician's Guide. New York: Guilford Press, 2003, 232 pp. $35.00, ISBN 1-57230-888-5. In Cognitive-Behavioral Treatment of Obesity the authors claim to present a new cognitive behavioral treatment for obesity. They deem obesity as a medical condition. The population target is patients with a body mass index (BMI) between 30 to 40; the authors disclaim experience with patients above a BMI of 40. Aimed at a professional audience, the book's goal is to serve as a manual for clinicians using cognitive behavior techniques. The book is written very clearly in 11 chapters and two appendixes which consist of patient handouts and useful websites. This clinical guide walks the reader through the characteristics of cognitivebehavioral therapy and its differences from behavioral therapy. The authors' contention is that there is a substantial body of knowledge supporting the use of behavioral therapy in the treatment of obesity. They further claim that the use of cognitive-behavioral methods result in an average initial weight loss of about 10% of weight, with a decline in loss after four to six months of trying to lose weight. In the book the authors review behavioral treatments for obesity that have evolved since the 1960s, but were relabeled cognitive-behavioral therapy with the addition of cognitive procedures. They indicate that strict cognitive behavioral-treatment looks different from how it is usually when applied to the treatment of obesity. Thus our current use of this intervention might better be called "behaviorally oriented group psycho-educational interventions." The authors claim that to their knowledge no cognitive-behavioral theories or treatments for obesity have been described or evaluated elsewhere. The difference with this treatment is that from the onset of treatment, the authors focus on the problem of maintenance and weight regain. The two long-term treatments for the prevention of weight regain is the use of drugs or long-term (or even indefinite) psychological or behavioral treatment. This is supported by evidence that suggests that extending treatment delays weight regain. Drug therapy is questionable because of the potential complications of long-term use. The authors report that their treatment takes into account the ambiguity over treatment goals such as the lack of a clear distinction between the objectives of achieving weight loss and maintaining the weight loss, as well as the contribution of cognitive factors to weight regain. The authors seem to recognize that keeping to a 1,200 to 1,500-calories-a-day diet after four to six months may be impossible to ask of most patients, and they have developed a different therapeutic approach to the prevention of posttreatment weight regain. This approach has been derived from cognitive-behavioral analysis of the processes responsible for weight regain, and it involves directing treatment of these problems. …