Effects of cognitive behavioural therapy targeting eating behaviour (CBT-TEB) : a novel obesity treatment

Detta är en avhandling från Stockholm : Karolinska Institutet, Dept of Clinical Neuroscience

Sammanfattning: Objective. The overall objective was to evaluate the outcome of the 10-week (20/30 h) CBTTEB treatment programme for persons with obesity. The evaluation took place in three studies. Paper I (Study I): Method. One hundred and five obese women from an obesity unit`s waiting list participated in a randomised controlled study. Of these, 62 took part in the CBT-TEB programme and 43 served as controls. Follow-up was 6-,12- and 18-months post-treatment, without any booster treatment. Results. Weight change for the CBT-TEB patients after therapy was - 8.5 kg (SD 16.1) (per-protocol). Weight change at the follow-up for the CBT-TEB patients 18 months after the end of therapy was - 10.4 kg (SD 10.8) (per-protocol) and - 5.7 kg (SD 9.5) (ITT). Weight change (per-protocol) for the controls at the 18-month follow-up was + 2.3 kg (SD 7.0) and +1.6 kg (SD 6.0) (ITT). About two thirds still fulfilled the widely held success criterion of having lost 5% or more of initial weight at 1.5 years after the end of therapy. Paper II (Study II): Method. Fifty-four obese women from a child care centre participated in a randomised controlled trial involving the CBT-TEB programme and a conventional weight loss programme. Of these, 16 women took part in the CBT-TEB programme and 26 in the control programme. Follow-up was 6-,12- and 18-months post-treatment, without any booster treatment. Results. Weight change for the CBT-TEB patients after therapy was -8.6 kg (SD 2.9) (per-protocol) and -7.7 kg (SD 3.8) (ITT). Weight change for the CBT-TEB patients 18 months after the end of therapy was – 5.9 kg (SD 5.4) (per-protocol) and -5.5 kg (SD 5.5) (ITT). Weight change for the participants in the control programme after the end of therapy was -0.7 kg (SD 1.2) (per-protocol) and -1.4 kg (SD 1.6) (ITT). Weight change for the participants in the control programme at follow-up 18 months after end of therapy was +0.3 kg (SD 4.3) (per-protocol) and -0.6 kg (SD 5.5) (ITT). Paper III (Study III): Method. Eighty-three primary care patients (74 females and nine males) started the CBT-TEB programme. Follow-up was at 6 months. An objective in this study was also to evaluate change in waist circumference (WC) and waist-to-hip ratio (WHR) after therapy. Eating behaviour was determined by the Three Factor Eating Questionnaire and obesity-related problems by the Obesity-Related Problems Scale. Results. Weight change (ITT) for the CBTTEB patients after therapy was -4.5 kg (SD 3.9), and at 6 months -4.4 kg (SD 4.9). Emotional and uncontrolled eating decreased and cognitive control increased during therapy. Obesityrelated problems decreased. Conclusions: The results demonstrate a very satisfactory efficacy for the CBT-TEB programme. It was feasible to implement the programme in primary healthcare, using ordinary personnel as group leaders after a short period of training.

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