Fifty Years of Behavioral/Lifestyle Interventions for Overweight and Obesity: Where Have We Been and Where Are We Going?

OBJECTIVE: This paper reviews the literature pertaining to the structure and content of intensive lifestyle interventions (ILIs) for overweight/obesity since Richard Stuart described this new treatment approach in 1967. A consensus opinion has formed that behavioral/lifestyle treatment of overweight and obesity should be viewed as a mainstream intervention for the treatment and prevention of type 2 diabetes and medical complications associated with obesity.

METHODS: The development of modern ILIs and demonstration of their efficacy are compared by structure, content, and efficacy of four major randomized controlled trials: Diabetes Prevention Program (DPP), Look AHEAD, POUNDS Lost, and CALERIE.

RESULTS: The results of these studies indicated that modification of lifestyle behaviors related to nutrition and physical activity can yield weight loss and prevention or improvement of a variety of medical conditions associated with obesity in a variety of subpopulations.

CONCLUSIONS: Recommendations for the structure and length of behavioral/lifestyle interventions have been recently adopted by agencies and institutions that approve reimbursement for medical services. These recommendations represent a giant step in the effort to recognize ILIs as a mainstream approach for the treatment of obesity and comorbid medical conditions. Nevertheless, they do not adequately represent advances made since the publication of the DPP results.