Table 2.
CBT-OB strategies and procedures for minimising attrition, enhancing weight loss and improving weight-loss maintenance
| Strategies and procedures for minimising attrition: | |
| • Addressing patient’s difficulties attending the sessions | |
| - Scheduling the sessions at times compatible with a patient’s work commitments | |
| - Routinely asking the patients whether they are experiencing any difficulties as regards attending the sessions, and devoting time to understanding and/or overcoming them. | |
| • Showing interest in each patient as a person, irrespective of their weight and/or other issues | |
| - Adopting a “people first” policy—putting individuals before the disability or disease when describing persons affected by obesity (e.g., “person with obesity” instead of “obese person” | |
| - Avoiding any use of potentially pejorative adjectives or adverbs, or any language that implies moral judgements or highlights patients’ “character flaws” regarding their weight | |
| • Addressing unrealistic weight loss expectations | |
| - Encouraging patients to pursue and be satisfied with achievable short-term weight-loss goals (i.e., a weight loss of between 0.5 kg and 1.0 kg/week) and not disputing unrealistic goals at the beginning of treatment | |
| - Addressing unrealistic goals only when patients have achieved some success in reaching a healthy weight, but manifest dissatisfaction with the weight loss achieved | |
| • Maintaining therapeutic momentum | |
| - Identifying with the patients the best time to start the treatment | |
| - Stressing the importance of avoiding any interruptions in treatment, especially during the first 8 weeks | |
| - Explaining to the patients in advance that another therapist will take the place of the primary therapist in the event of their absence | |
| • Developing a protocol for dealing with late attendance or non-attendance | |
| - Encouraging patients to arrive a little early for session (e.g., 10–15 min) in order to relax and mentally prepare themselves | |
| - If patients are running late for an appointment, calling them after 15 min to express concern about their absence, and to try to reschedule the appointment as soon as possible | |
| Strategies and procedures for enhancing weight loss | |
| • Increasing dietary restraint and decreasing dietary disinhibition | |
| - Eating regularly (i.e., three planned meals and two snacks, and refraining from eating in the intervals between) | |
| - Planning meals in advance (when, what and where to eat) on a specific monitoring record, making reference to a structured meal plan | |
| - Supplying patients with grocery lists, menus and recipes | |
| - Monitoring food intake in real time | |
| - Training patients to eat consciously (i.e., “think while you are eating”) | |
| - Training patients to “ride out” the desire for food, educating them that any impulses will be transitory and can be tolerated | |
| - Encouraging patients to consider their efforts to control eating as a necessary condition for achieving healthy weight loss and benefiting from its associated physical and psychological advantages | |
| - Involving patients actively in identifying processes hindering weight loss using the “Weight-Loss Obstacles Questionnaire” | |
| - Developing collaboratively with the patients their personal formulation of the processes that are hindering weight loss | |
| - Designing personalized procedures aimed at addressing the specific obstacles encountered by each patient | |
| - Involving, with the consent of patients, their significant others in treatment to create the optimal environment for facilitating patients attempts efforts to change their eating habits | |
| • Strategies and procedures for improving weight-loss maintenance | |
| - Addressing weight-loss satisfaction before starting weight-loss maintenance | |
| - Dedicating one or two sessions to preparing patients for weight maintenance, and collaboratively developing a weight maintenance plan | |
| - Encouraging patients to suspend any attempts to lose weight while learning weight-maintenance skills (i.e., at least 12 months) | |
| - Creating a list of personal reasons to maintain weight | |
| - Adopting a mindset with a constant focus on weight control, and keeping a constant but flexible focus on weight control and self-awareness regarding diet and physical activity | |
| - Identifying and addressing high-risk weight- regain situations, preventing lapses from becoming relapses, and addressing any weight regain | |
| - Implementing weekly self-weighing and ensuring patients maintain weight within a specific range of 4 kg | |
| - Encouraging patients to follow a high-protein, low-glycaemic-index diet with moderate fat content, and to practice at least 30 min of moderate-intensity activity daily |