Table 1.

Recommended components of a high-intensity comprehensive behavioral intervention to achieve and maintain a 5 to 10% reduction in body weight.

Component	Weight Loss	Weight-loss Maintenance
Counseling	≥14* in-person or telephone counseling sessions (individual or group) with a trained interventionist during a 6-mo period; recommendations for similarly structured, comprehensive Web-based interventions, as well as evidence-based commercial programs	Monthly or more frequent in-person or telephone sessions for ≥1 yr with a trained interventionist
Diet	Low-calorie diet (typically 1200–1500 kcal per day for women and 1500–1800 kcal per day for men), with macronutrient composition based on patient’s preferences and health status	Reduced-calorie diet, consistent with reduced body weight, with macronutrient composition based on patient’s preferences and health status
Physical activity	≥150 min per week of aerobic activity (e.g., brisk walking)	200–300 min per week of aerobic activity (e.g., brisk walking)
Behavior therapy	Daily monitoring of food intake and physical activity, facilitated by paper diaries or smartphone applications; weekly monitoring of weight; structured curriculum of behavioral change (e.g., DPP), including goal setting, problem solving, and stimulus control; regular feed-back and support from a trained interventionist	Occasional or frequent monitoring of food intake and physical activity, as needed; weekly-to-daily monitoring of weight; curriculum of behavioral change, including problem solving, cognitive restructuring, and relapse prevention; regular feedback from a trained interventionist

Data are from the AHA/ACC/TOS Guidelines (2013) for the Management of Overweight and Obesity in Adults (8).

^*The 2012 US Preventive Services Task Force defined high-intensity behavioral treatment as including 12 or more sessions per year. DPP = Diabetes Prevention Program.

Reprinted from Heymsfield SB, Wadden TA. Mechanisms, pathophysiology, and management of obesity. N Engl J Med 2017; 376(3):254–66, with permission of the Massachusetts Medical Society.