Obesity A Theoretical Overview

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The behavioral approach to obesity grew out of Learning Theory (1,2) and was first applied to the treatment of obesity between 1960 and 1970 (3,4). The primary assumptions of the behavioral approach are that (1) eating and exercise behaviors affect body weight; by changing eating and exercise behaviors it is possible to change body weight; (2) eating and exercise patterns are learned behaviors and, like other learned behaviors, can be modified; and (3) to modify these behaviors long term, it is necessary to change the environment that influences them.

The behavioral approach does not deny that an individual's genetic background may have a strong influence on their body weight. However, despite a predisposition to be a certain weight, changes in energy balance (i.e., decreases in energy intake and/or increases in energy expenditure) will produce weight loss.

Likewise, the behavioral approach recognizes the importance of an individual's past history. The individual's family and cultural background influence body weight by determining food preferences, food choices, and the preferred level of physical activity. However, while accepting the importance of historical antecedents, the focus of a behavioral approach is on current behaviors and the environmental factors controlling these current behaviors.

The essence of the behavioral approach to obesity is the functional analysis of behavior, delineating the association between eating and exercise behaviors and environmental events such as time of day, presence of other people, mood, and other activities (5,6). Patients are asked to monitor their eating and exercise behaviors to determine specific problem areas that should be targeted in treatment. The environment controlling these behaviors is then restructured to modify these problem behaviors.

A key technique in behavioral approaches is self-monitoring (7), which involves writing down exactly what is eaten and what type of physical activity is performed. This record allows the patient and therapist to identify problem behaviors that might be changed. For example, the self-monitoring record may reveal that a large percentage of an individual's calories is consumed in the form of desserts, that between-meal eating constitutes a major problem, or that an individual's portion sizes are unusually large. Alternatively, the individual may consume relatively few calories but lead a very sedentary lifestyle. These different behavior patterns would lead to different targets for the behavior change intervention.

Often in changing overall behavior, it is necessary to break the target behavior into several components, and then to work on each part in turn (i.e., ''shape'' the behavior). For example, to lower calorie intake in an overweight individual, a therapist might work first on

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