Bariatric treatments for adult obesity - Institute of Health Economics

Since the evolvement of behavioural principles for obesity treatment during the late 1960s and early1970s, behavioural treatment strategies have developed significantly in terms of improved cognitiveprocedures for relapse prevention training and correction of negative thinking. 5 The addition of suchcognitive procedures has led to the renaming of behavioural treatment as “cognitive-behaviouraltherapy.” Currently, typical behavioural therapies in the treatment of obesity include cognitivebehavioural therapy strategies. 5Behavioural therapy works primarily by enhancing dietary restraint through provision of adaptivedietary strategies and discouragement of maladaptive dietary practices, and by increasing motivationto be more physically active. 15 Cognitive behavioural therapy aims at identifying and modifyingaversive thinking patterns and mood states in order to facilitate weight loss. 15Table T.2: Behavioural modification strategiesSelf-monitoringKeeping an extended food and exercise diary to give insights into personal behaviours and to bring unrecognizedbehaviours to lightStress managementDeveloping coping strategies and meditation and relaxation techniquesStimulus controlLearning to shop carefully for healthy foods, keeping high-calorie foods out of the house, limiting the times andplaces of eating, and consciously avoiding situations in which overeating occursProblem solvingIdentifying problems choosing solutions planning and implementing evaluating the outcomeContingency managementRewarding changes in behaviorCognitive restructuringModifying negative thoughts, unrealistic goals, and inaccurate beliefs about weight loss, and preparing in advance forrelapsesSocial supportDeveloping a network of family members, friends, or colleagues who can assist in maintaining motivation andproviding positive reinforcementRelapse prevention trainingDeveloping the skills to overcome setbacks and to cope with problemsSource: Lang & Froelicher 2006 5PharmacotherapyDefinitionAntiobesity medications can reduce energy intake by decreasing the appetite or increasing satiety;reduce the absorption of nutrients; or increase energy expenditure. 16 Current available medicationswork through two mechanisms: (1) monoamines in the central nervous system, or (2) blockade oflipase digestion in the intestine 17 Pharmacotherapy for obesity should be regarded as an adjunct todietary restriction, physical exercise, and behavioural therapy. 18,19TypeApproved antiobesity medications can be divided into three broad categories:Bariatric treatments for adult obesity 67