ABSTRACT
This chapter describes in-person lifestyle modification approaches for people with overweight and obesity. Such programs provide recommendations for diet and physical activity alongside techniques from behavior therapy that help to facilitate their adoption. High-intensity behavioral treatments that offer 14 or more individual or group counseling sessions in six months help individuals lose 5–10 kg (5–10% of initial weight), which is associated with clinically meaningful improvements in cardiometabolic risk and quality of life. Ongoing research is evaluating whether treatment adherence, which is strongly associated with weight loss, can be improved by augmenting the behavioral therapy component with strategies from cognitive-behavioral, mindfulness, acceptance-based, and motivational interventions. The most efficacious of these combined treatments typically improve weight loss by 1–2 kg in comparison to standard treatment. Using treatment enhancements in a stepped-care approach also may help poor responders to a standard lifestyle intervention to achieve clinically meaningful weight loss. Identifying methods for disseminating lifestyle modification to the millions of people who would benefit from this treatment also remains a key priority. However, to truly improve weight management at the population level, these individually-focused treatment efforts must be complemented by policy initiatives addressing the current eating and activity environment.
