Reprinted from Eating Disorders Review
July/August 2003 Volume 14, Number 4
©2003 Gürze Books
(By Zafra Cooper, Christopher G. Fairburn, and Deborah M. Hawker, Guilford Press, New York, 2003; 232 pp; $35.00)
If you could pick the authors of a clinician’s manual for the cognitive-behavioral treatment of obesity, you couldn’t do better than this trio. This Oxford University team are all established authorities in cognitive-behavior therapy, empirical psychotherapy research and eating disorders, and are well situated to synthesize the background literature, reflect on theory, implement their ideas, and carry out research programs to test the validity of this specific approach. To date, the group has completed all these steps except the last one – the research to prove this model is still ongoing. However, since the rationale is well worked out, substantial research already shows value in treating obesity with behavior therapy alone (without the cognitive component elaborated here), and, importantly, these authors were urged by many clinicians and researchers to publish their treatment manual even in advance of results of their randomized controlled study, here it is.
As you would expect, the manual is very well done–it is informative and clearly written. The program focuses on treating obese patients with body mass indexes (BMIs) between 30 and 40, although it may also be useful for the overweight (BMIs 25 to 30), and, perhaps, add something useful to the treatment of those with BMIs over 40.
After describing the theory and an overview, the treatment manual presents nine specific modules that may be administered in somewhat overlapping fashion, grouped into three somewhat overlapping phases. Here’s what you’d expect to work with as a therapist. Phase one, concerning weight loss and requiring 17 sessions over 30 weeks, includes four modules aimed at: starting treatment, establishing and maintaining weight loss, addressing barriers to weight loss, and increasing activity. Phase two, usually initiated around week eight and extending through week 44, includes three specific modules aimed at body image concerns, addressing weight goals, and addressing primary goals (i.e., the goals that patients hope to achieve through weight loss, such as changing their appearance, improving their self-confidence, enhancing interpersonal functioning and enhancing fitness). Phase three consists of two modules: healthy eating (which may begin early in treatment) and weight maintenance, usually starting somewhere in the middle of the program. Liberally sprinkled throughout the manual are large numbers of worksheets, information sheets for patients, and concrete examples with instructions regarding how to conduct the treatment. The book concludes with two very useful appendices, patient handouts and useful websites.
For anyone using psychological and behavioral techniques to treat obese patients, I’d say this book is a must. The many clinical pointers provided here are well worth the price of the book. Still, we all eagerly await publication of the research studies to see how useful this treatment will prove to be through short term, and more importantly, longer-term outcome studies. How successfully these approaches instill and maintain motivation and enduring lifestyle changes remains to be seen.