Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Clinical nutrition

Effects of cognitive behavioral therapy on weight maintenance after successful weight loss in women; a randomized clinical trial

European Journal of Clinical Nutrition volume 74, pages 436–444 (2020)Cite this article

Subjects

Abstract

Background/Objectives

Weight regain after weight loss is a main challenge in obesity management. Cognitive behavioral therapy (CBT) has been introduced as an option for achieving weight loss but not tested for weight maintenance. The aim of this study was to evaluate the effects of CBT on weight maintenance after successful weight loss.

Subjects/Methods

Female adults [n = 113, BMI = 23–30 kg/m²; age = 18–45 years], who had lost at least 10% of their body weight by using a weight loss program, were randomly allocated to either CBT or control group for a further 24-week weight-maintenance period.

Results

Compared with control group, CBT treatment improved weight loss maintenance (mean difference, −2.2 kg [95% CI, −3.50, −0.94]; P = 0.001), BMI (mean difference, −0.77 kg/m²; [95% CI, −1.25, −0.28]; P = 0.002), and waist circumference (mean difference, −2.08 cm; [95% CI, −3.31, −0.844]; P = 0.001) at the end of the 24-week period intervention. Estimated energy intake showed a significant reduction over time in CBT group, while it increased in control group (P < 0.001). There was also a significant group × time interaction for mean daily steps over the 24-week period with CBT having a higher level (P < 0.001). However, changes in lipid profiles and carbohydrate metabolism were not significantly different between the groups.

Conclusion

Cognitive behavioral therapy is an effective tool for weight maintenance over a 24-week period in successful weight losers, with corresponding maintenance of a reduced energy intake and doing more physical activity which may helpful for weight maintenance in the long term.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Jeffery R, Epstein L, Wilson G, Drewnowski A, Stunkard A, Wing R. Long-term maintenance of weight loss: current status. Health Psychol. 2000;19(1S):5.

    Article  CAS  Google Scholar 

  2. Wing RR, Phelan S. Long-term weight loss maintenance. Am J Clin Nutr. 2005;82:222S–5S.

    Article  CAS  Google Scholar 

  3. Loveman E, Frampton G, Shepherd J, Picot J, Cooper K. The clinical effectiveness and cost-effectiveness of long-term weight management schemes for adults: a systematic review. Health Technol Assess. 2011;15:182.

    Article  Google Scholar 

  4. Kassirer JP, Angell M. Losing weight—an ill-fated new year’s resolution. New Engl J Med. 1998;338:52–4.

    Article  CAS  Google Scholar 

  5. Montani JP, Schutz Y, Dulloo AG. Dieting and weight cycling as risk factors for cardiometabolic diseases: who is really at risk? Obes Rev. 2015;16:7–18.

    Article  Google Scholar 

  6. Strohacker K, Carpenter KC, McFarlin BK. Consequences of weight cycling: an increase in disease risk? Int J Exerc Sci. 2009;2:191–201.

    PubMed  PubMed Central  Google Scholar 

  7. Foster GD, Makris AP, Bailer BA. Behavioral treatment of obesity. Am J Clin Nutr. 2005;82:230S–5S.

    Article  CAS  Google Scholar 

  8. Tsiros MD, Sinn N, Brennan L, Coates AM, Walkley JW, Petkov J, et al. Cognitive behavioral therapy improves diet and body composition in overweight and obese adolescents. Am J Clin Nutr. 2008;87:1134–40.

    Article  CAS  Google Scholar 

  9. Palavras MA, Hay P, dos Santos Filho CA, Claudino A. The efficacy of psychological therapies in reducing weight and binge eating in people with bulimia nervosa and binge eating disorder who are overweight or obese—a critical synthesis and meta-analyses. Nutrients. 2017;9:299.

    Article  Google Scholar 

  10. Rodriguez-Hernandez H, Morales-Amaya UA, Rosales-Valdéz R, Rivera-Hinojosa F, Rodriguez-Moran M, Guerrero-Romero F. Adding cognitive behavioural treatment to either low-carbohydrate or low-fat diets: differential short-term effects. Br J Nutr. 2009;102:1847–53.

    Article  CAS  Google Scholar 

  11. Vranešić Bender D, Krznarić Ž. Nutritional and behavioral modification therapies of obesity: facts and fiction. Dig Dis. 2012;30:163–7.

    Article  Google Scholar 

  12. Ash S, Reeves M, Bauer J, Dover T, Vivanti A, Leong C, et al. A randomised control trial comparing lifestyle groups, individual counselling and written information in the management of weight and health outcomes over 12 months. Int J Obes. 2006;30:1557–64.

    Article  CAS  Google Scholar 

  13. Svetkey LP, Stevens VJ, Brantley PJ, Appel LJ, Hollis JF, Loria CM, et al. Comparison of strategies for sustaining weight loss: the weight loss maintenance randomized controlled trial. JAMA. 2008;299:1139–48.

    Article  CAS  Google Scholar 

  14. Cresci B, Tesi F, La Ferlita T, Ricca V, Ravaldi C, Rotella C, et al. Group versus individual cognitive-behavioral treatment for obesity: results after 36 months. Eat Weight Disord-Stud Anorex, Bulim Obes. 2007;12:147–53.

    Article  CAS  Google Scholar 

  15. Van Dorsten B, Lindley EM. Cognitive and behavioral approaches in the treatment of obesity. Med Clin North Am. 2011;95:971–88.

    Article  Google Scholar 

  16. Beck AT, Beck RW. Screening depressed patients in family practice: a rapid technic. Postgrad Med. 1972;52:81–5.

    Article  CAS  Google Scholar 

  17. Ferguson B. ACSM’s guidelines for exercise testing and prescription 9th ed. 2014. J Can Chiropr Assoc. 2014;58:328.

    PubMed Central  Google Scholar 

  18. Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG, Donato KA, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults. A Rep Am Coll Cardiol/Am Heart Assoc Task Force Pract Guidel Obes Soc. 2014;129:S102–S38.

    Google Scholar 

  19. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2014;37:S81–S90.

    Article  Google Scholar 

  20. Mason C, Katzmarzyk PT. Effect of the site of measurement of waist circumference on the prevalence of the metabolic syndrome. Am J Cardiol. 2009;103:1716–20.

    Article  Google Scholar 

  21. Matthews D, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and β-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985;28:412–9.

    Article  CAS  Google Scholar 

  22. Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972;18:499–502.

    Article  CAS  Google Scholar 

  23. Ramage S, Farmer A, Apps Eccles K, McCargar L. Healthy strategies for successful weight loss and weight maintenance: a systematic review. Appl Physiol Nutr Metab. 2013;39:1–20.

    Article  Google Scholar 

  24. Dombrowski SU, Knittle K, Avenell A, Araujo-Soares V, Sniehotta FF. Long term maintenance of weight loss with non-surgical interventions in obese adults: systematic review and meta-analyses of randomised controlled trials. BMJ. 2014;348:g2646.

    Article  CAS  Google Scholar 

  25. Goldstein DJ. Beneficial health effects of modest weight loss. Int J Obes. 1992;16:397–415.

    CAS  Google Scholar 

  26. Mann T, Tomiyama AJ, Westling E, Lew A-M, Samuels B, Chatman J. Medicare’s search for effective obesity treatments: diets are not the answer. Am Psychol. 2007;62:220.

    Article  Google Scholar 

  27. Kellett E, Smith A, Schmerlaib Y. The Australian guide to healthy eating. Canberra, ACT: Commonwealth Department of Health and Family Services; 1998.

  28. Donnelly JE, Blair SN, Jakicic JM, Manore MM, Rankin JW, Smith BK. Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults. Med Sci Sports Exerc. 2009;41:459–71.

    Article  Google Scholar 

  29. Rossini R, Moscatiello S, Tarrini G, Di Domizio S, Soverini V, Romano A, et al. Effects of cognitive-behavioral treatment for weight loss in family members. J Am Diet Assoc. 2011;111:1712–9.

    Article  Google Scholar 

  30. Rapoport L, Clark M, Wardle J. Evaluation of a modified cognitive-behavioural programme for weight management. Int J Obes. 2000;24:1726–37.

    Article  CAS  Google Scholar 

  31. Cooper Z, Doll HA, Hawker DM, Byrne S, Bonner G, Eeley E, et al. Testing a new cognitive behavioural treatment for obesity: a randomized controlled trial with three-year follow-up. Behav Res Ther. 2010;48:706–13.

    Article  Google Scholar 

Download references

Acknowledgements

We thank the staff of NovinDiet Clinic, Mansoureh Pahlevani, Rahil Ahmadi, for their assistance in data collection, Elham Zamani and Sahar Shahemi for doing dietary consultation and CBT and Masoud Solaymani for his statistical consultation. Thanks also go to Asadi at Jaam e Jam Laboratory for the analysis of blood samples. The authors’ responsibilities were as follows—AM, and HRF: contributed to the initial study design, study protocol setup, and data collection; AM: provided data analysis and wrote the first draft of the manuscript; HRF: designed the research, conducted the research, contributed to data interpretation, revised the manuscript, and provided medical supervision; MAT and IAM: refined the study design and contributed to data interpretation and redrafting of the manuscript; AD and RM: provided advice and consultation for the study design and conducted the research; and all authors: read and approved the final manuscript.

Funding

Funding

This study was supported by The School of Life Sciences, The University of Nottingham, UK and The Digestive Disease Research Institute (DDRI), affiliated to Tehran University of Medical Sciences (TUMS).

Author information

Authors and Affiliations

  1. MRC/ARUK Centre for Musculoskeletal Ageing Research, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, School of Life Sciences, University of Nottingham Medical School, Nottingham, NG7 2UH, UK

    Ameneh Madjd, Moira A. Taylor, Ian A. Macdonald & Hamid R. Farshchi

  2. NovinDiet Clinic, Tehran, Iran

    Ameneh Madjd & Hamid R. Farshchi

  3. Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran

    Alireza Delavari, Reza Malekzadeh & Hamid R. Farshchi

Authors
  1. Ameneh Madjd
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Moira A. Taylor
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alireza Delavari
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Reza Malekzadeh
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ian A. Macdonald
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hamid R. Farshchi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Ameneh Madjd or Hamid R. Farshchi.

Ethics declarations

Conflict of interest

IAM is a member of the UK Scientific Advisory Committee on Nutrition, Joint Editor of the International Journal of Obesity, a member of the Mars Scientific Advisory Council, of Scientific Advisory boards for Nestle Research, Novozymes, a Scientific Adviser to the Waltham Centre for Pet Nutrition. None of the other authors declares that they have no conflict of interest.

Additional information

Publisher’s note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Madjd, A., Taylor, M.A., Delavari, A. et al. Effects of cognitive behavioral therapy on weight maintenance after successful weight loss in women; a randomized clinical trial. Eur J Clin Nutr 74, 436–444 (2020). https://doi.org/10.1038/s41430-019-0495-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41430-019-0495-9

This article is cited by

Search

Advanced search

Quick links