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Abstract

Obesity is a prevalent disorder associated with myriad psychological and physiological problems. Dietary restraint alone is ineffective in treating obesity and can instead exacerbate the problem. Regular physical exercise is fundamental to successful management of weight problems as well as to generalized physical and psychological well-being. In Study 1, demographic and psychometric variables from obese women, referred over an eight year period to a hospital psychology department for weight management, were reviewed. Findings suggest that such obese women are mildly depressed, anxious, perceive themselves as lacking in self-control and have elevated levels of eating-related psychopathology. In addition to such psychological distress, morbidly obese women are also at risk physiologically. As morbidly obese individuals are unlikely to maintain weights at normative levels, goals and treatments aimed at alleviating these problems, independent of attempts at significant weight loss, seem appropriate. A group treatment programme (CT), based, in part, on the principals of cognitive therapy was developed. The programme incorporated a nondieting approach, encouraged nonchaotic eating and regular exercise, and promoted the use of alternative coping skills; weight loss per se was not a focus of the intervention. Study 2 presents pre- and post-treatment results from a group of 15 morbidly obese women completing this programme. Following treatment, these women were significantly less depressed and anxious and showed lower levels of eating-related psychopathology. By the end of treatment, significantly more of the women were exercising regularly. Given the promising nature of these results, a controlled, comparative treatment outcome study (Study 3) was embarked upon. Sixty-two women, each with a body mass index of at least 30 kg/m 2, were randomly assigned to either the above-described CT programme, a behaviour therapy weight loss programme (BT) or a wait-list control group. Women in both active treatment groups lost significant amounts of weight, while members of the control group had a nonsignificant increase in weight. For CT participants, depression, anxiety, and eating-related psychopathology decreased significantly over the course of treatment while perceptions of self control increased significantly. In contrast, BT and control subjects showed no significant changes in these psychological variables. Relative to control subjects, significantly greater proportions of CT and BT subjects were exercising regularly by the end of treatment. At six month follow-up, data from approximately half the original CT and BT participants were obtained. Statistically, these subjects did not show significant changes across time in terms of weight or psychometric variables. Variables possibly mediating the differential effects of the two treatments are discussed, as are limitations to the current work and directions for future research.