Cognitive behaviour therapy of obesity
SIMOS G.

The long-term treatment of obesity seems to be a rather difficult and complex process. From the treatment processes that have a short-term evidence-based efficacy, the combination of low calorie diet, increased physical activity and behaviour therapy is the one that is usually suggested. Despite the favorable short-term results of this combination, the majority of patients regain part of the weight loss in the medium-term and often all the weight loss in the long-term.

This phenomenon may be explained by a lot of variables; prominent place among them have the patients' dissatisfaction with their new weight, since it does not correspond to their ideal for them weight, and the patients' inability to actively engage in weight maintenance strategies.

The cognitive behavioural model of obesity management (Cooper & Fairburn, 2001), suggests that the long term failure of behavioural interventions is due to the fact that the role of cognitive variables that contribute to weight regain was neglected, as well as to the relative obscurity related to the treatment goals. Weight regain is due to the patient's failure to engage in an active long-term weight management.

Patients usually underestimate the significance of the weight loss they have achieved and they also tend to ignore any other positive changes that have already occurred. As a consequence, they tend to believe that they cannot control their weight in a significant degree, they abandon any further efforts for weight loss, they abandon their weight control efforts, return to their previous eating habits, and they almost invariably regain weight.

The most important factor in determining patients' weight goals is often their belief that other personally valued objectives (primary goals) cannot be achieved without the desired weight loss. Weight loss is usually underta-ken not simply to achieve a lower weight, but because patients believe that they will also improve their appearance, feel more attractive, be able to wear more flattering and fashionable clothes, improve self-confidence and self-respect, and become socially, interpersonally and professionally more active and efficient. In practice, patients rarely achieve their weight goals and consequently do not achieve their primary goals because the achievement of these is only loosely dependent upon weight loss and because few are likely to have been addressed directly in treatment.

Patients underestimate the goal of weight maintenance and this happens because they underestimate the weight loss they have achieved, while at the same time they tend to also underestimate or deny any progress toward the achievement of their primary goals. Patients, as well as therapists sometimes, do not really understand that weight maintenance is a different process than weight loss, something that leads to a failure to appreciate the importance of acquiring and practicing effective weight control behaviours.

On the basis of their cognitive behavioural theory Cooper & Fairburn (2003) developed a new approach to the treatment of obesity that is designed to minimize the weight regain that generally follows weight loss by overcoming psychological obstacles to the acquisition of, and long-term adherence to, effective weight-control behaviour.

The cognitive begaviour therapy gives a significant emphasis both on the weight loss phase as well as on the weight maintenance phase, while at the same time manages those cognitive and behavioural factors that facilitate the achievement of those goals.

In the weight loss phase, the cognitive behaviour therapy focuses not only on diet and physical activity, but also on the achievement of cognitive and behavioural changes to other personally significant areas (e.g. appearance, self-confidence, quality of relationships, physical well-being), the patient's ability to identify and acknowledge the changes that have already been achieved in therapy, and the acceptance of those things that cannot be changed.

In the weight maintenance phase, the cognitive behaviour therapy focuses on the long-term weight maintenance and patients are discouraged to try to loose additional weight regardless of the weight loss they have achieved up to this point. Patients are also helped to become able to distinguish significant weigh changes from normal weight fluctuations and are encouraged to take corrective actions whenever it is necessary.

Key words: Obesity, cognitive behaviour therapy.