Open access peer-reviewed chapter

# Cognitive-Behavioral Therapy: Current Paths in the Management of Obesity

By Alessandro Musetti, Roberto Cattivelli, Anna Guerrini, Anna Maria Mirto, Francesco Vailati Riboni, Giorgia Varallo, Gianluca Castelnuovo and Enrico Molinari

Submitted: July 2nd 2017Reviewed: November 20th 2017Published: March 28th 2018

DOI: 10.5772/intechopen.72586

## Abstract

The treatment of obesity and its related chronic symptoms is one of the major issues that world healthcare systems are facing today. Cognitive-behavioral therapy (CBT) is one of the most effective therapies in the treatment of dysfunctional eating behaviors. In the first part of the chapter, the phenomenon of obesity will be introduced; subsequently, the role of CBT into obesity treatment will be underlined. CBT’s core strategies will be presented and analyzed: goal setting, self-monitoring, stimulus control, problem solving technique, and cognitive restructuring technique. The use of these strategies and related results is a major issue, emphasizing the need for further studies on the phenomenon of obesity, given the excellent results available in the short term, with significant weight loss, but the difficulties in keeping the results achieved in the long run. Since obesity is a chronic condition, CBT treatments must focus on different outcomes, considering weight loss as a consequence of a change in the individual’s eating style rather than as a major and only result to be pursued. Finally, we will take into account the topic of motivation in the psychological treatment of obesity since patient’s motivation assessment seems to be a major prerequisite for successful weight loss therapy.

### Keywords

• chronic care management
• overweight
• obesity
• rehabilitation
• clinical psychology
• weight management
• cognitive-behavioral therapy

## 1. Introduction

### 1.1. Obesity: a modern global epidemic

Developing new and better treatment for obesity and its related chronic clinical complications is one of the major challenge that world healthcare systems are facing today, both from a clinical and economic perspective [1]. It is well known that obesity is a worldwide chronic disease, whose treatment is complicated by its interaction with other chronic illnesses or chronic disorders [2]. In fact, as excess weight increases, so do risks of developing heart disease, type 2 diabetes, sleep apnea, osteoarthritis, and several types of cancer, among other conditions. The excessive weight gain has a relevant impact on most national health administration policies, creating a significant economic burden and requesting new strategies to be dealt with [3]. For example, evidence from the literature suggest how, in USA, obesity treatment costs have raised from 78.5 $billion, back in 1998, to 147$ billion, in 2008, affecting the annual US medical’s economic balance by 10% of its total. It seems this problem is going to increase over time, unless new health policies will be soon adopted. In recent years, the prevalence of obesity has reached epidemic proportions. Worldwide, over 1 billion people could be considered over weight, with nearly 300 million fitting the criteria for obesity (Figure 1). By 2020, nearly half of the USA population could meet the World Health Organization criteria for obesity, and it is estimated that by 2030, up to 90% of the population will be showing a body mass index (BMI) > 25.0. Generally, obesity is explained and understood through two simple factors: dysfunctional feeding and lack of proper physical activity [1]. This interpretation of the phenomenon seems, however, extremely reductive, greatly simplifying a much more complex reality. For example, the recent proliferation of genetic studies has shown that about 5–6% of the obesity’s cases can be defined as monogenic, with a single responsible mutation of the patient’s clinical picture. Otherwise, genetics determines a predisposition to weight gain that manifests itself only by interacting with environmental factors. It is calculated, however, that genetic factors are relevant in at least 70% of cases. According to Keith et al. [4], obesity treatment should be individually tailored, and realistic goals should be clearly set before starting.

Scientific literature is full of examples about how interventions exclusively aimed at weight loss results in bankruptcy over time, with a regaining of the weight lost during hospitalization within 3 years [5, 6]. It becomes clear that the multifactorial nature of this pathology requires multidisciplinary interventions, able to combine the different needs and urges of each individual, from a clinical, psychological, and social perspective. Psychological factors, in particular, influence both weight loss and, more importantly, long-term weight loss maintenance. Cognitive-behavioral therapy (CBT) appears as the treatment of choice in psychological therapies for obesity and other eating disorders (Figure 2), highlighting significant results even at longitudinal level [7]. Within this chapter, the main therapeutic components of this approach will be presented, in addition to numerous clinical examples to better understand how CBT seems to be the most effective treatment in responding to the multidimensionality of a clinical condition, such as obesity.

Specifically, CBT’s core strategies will be presented and analyzed: goal setting, self-monitoring, stimulus control, problem solving technique, and cognitive restructuring technique together with patient expectations for treatment and motivational readiness will be investigated in the context of psychological treatment of the obese subject. The application of these strategies and related results is a major issue, emphasizing the need for further studies on the phenomenon of obesity, given the excellent results achievable in the short term, with significant weight loss, but the difficulties in keeping the results obtained in the long run [7]. As already explained, obesity is a chronic condition, and CBT treatments must focus on different outcomes, considering weight loss as a consequence of a change in the individual’s eating behavior rather than as a major and only result to be pursued [7]. Researches in this field have brought to the development of different therapies for the treatment of obesity. They focused on the specific situations and other modalities characterizing the patients’ eating behavior. Typical treatments for obesity aim to help patients to change their eating behaviors throughout diets and improvements in their physical activity. They include a number of cognitive-behavioral techniques such as self-monitoring of weight and weight-related behaviors (e.g., caloric intake and physical activity), cognitive restructuring, and social support. Behavioral strategies could be aimed to change bad eating habits while cognitive restructuring and problem solving could improve emotional self-regulation and prevent stress-related relapse. Life style changing support interventions including goal setting and self-monitoring strategies and are central to improve self-control in obese and overweight individuals and are equally important in case of eating disorder to support more emotional oriented component of CBT interventions.

## Conflict of interest

The authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

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© 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution 3.0 License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Alessandro Musetti, Roberto Cattivelli, Anna Guerrini, Anna Maria Mirto, Francesco Vailati Riboni, Giorgia Varallo, Gianluca Castelnuovo and Enrico Molinari (March 28th 2018). Cognitive-Behavioral Therapy: Current Paths in the Management of Obesity, Cognitive Behavioral Therapy and Clinical Applications, Ömer Şenormancı and Güliz Şenormancı, IntechOpen, DOI: 10.5772/intechopen.72586. Available from:

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