Description of Treatment/Procedure:

Recent guidelines from the National Heart, Lung, and Blood Institute (NHLBI) have defined overweight as a body mass index (BMI) of 25 kg/m2 to 29 kg/m2 and obesity as a BMI of 30 kg/m2 or higher. It is estimated that the overall prevalence of obesity is greater than 30% in adults. Obesity has been found to be associated with a number of disease conditions including type 2 diabetes mellitus, coronary heart disease, high blood pressure, osteoarthritis, and gallbladder disease. A poor diet and physical inactivity is the second leading cause of death in the United States. A 10% reduction in body weight has been found to decrease risk factors for diabetes and cardiovascular disease.

Committee Summary

With regard to behavioral therapy programs for weight loss in adults, the ICSI Technology Assessment Committee finds:

1. Behavioral therapy programs are generally safe unless the patient has an underlying psychological condition.
   
2. Successful behavioral therapy programs have typically been conducted in academic settings and generally include the following components: a) an active phase (typically 6 months) during which modest weight loss can be expected, b) an on-going maintenance phase, and c) cognitive behavioral therapy (with sufficient time for individuals to learn these approaches).
   
3. Behavioral therapy programs in a community setting are largely unregulated with no specific credentialing for program leaders.
   
4. Individuals enrolled in behavioral therapy programs without incentives or food provision typically experienced weight losses of 2.5% to 10% of baseline weight following an active treatment phase of from 8 weeks to 6 months. (Conclusion Grade II) There are limited post-treatment follow-up data but the available evidence suggests that weight loss may be maintained or furthered at 6 to 12 months following treatment. (Conclusion Grade III)
   
5. In programs involving incentives or food provision in addition to behavioral therapy, individuals typically experienced weight losses of 6.6% to 13.7% after 6 months. In programs that actively continued treatment for 18 months, further weight losses were not observed. At 12 months post-treatment, weight losses had been reduced to 1.7% to 8.6% of original body weight. (Conclusion Grade II)
   
6. Many of the behavioral therapy programs did not choose to assess health outcomes. The available evidence indicates that blood pressure and lipid levels are improved following treatment. State anxiety, trait anxiety, and depression scores have typically improved but differences between treatment groups or between treatment and control groups have generally not been significant.