An obesity treatment that avoids restrictive diets and weight loss drugs, but instead focuses on training individuals in developing two fundamental internal skills, has resulted in weight loss that was sustained for six years, according to a new University of California, San Francisco study. "This is the first report of a non-surgical obesity intervention to demonstrate continued weight loss after treatment ends," said Laurel Mellin, MA, RD, UCSF associate clinical professor of family and community medicine and pediatrics and the study's principal investigator. "In contrast to traditional methods of weight loss that trigger short-term weight loss followed by rapid weight regain, subjects in this study kept the weight off even six years later." Mellin will present these findings at the annual meeting of the American Dietetic Association in Denver today (October 17).
The national obesity epidemic, first recognized last year when new data published in the Journal of the American Medical Association showed a 49 percent increase in obesity rates since 1991, has intensified scientific interest in treatments demonstrating long term effectiveness, Mellin said. According to that report, obesity causes an estimated 280,000 deaths annually and diseases associated with overweight account for 6.8 percent of U.S. health care costs.
The intervention, called the Solution Method, teaches the developmental skills of self nurturing and effective limit setting. The skills are taught and practiced repeatedly in therapy until the participants use them automatically. "Our earlier research suggested that once the skills became integrated, a trend toward persistent emotional and behavioral balance followed," Mellin said. "Participants reported eating less not because they were complying with a diet but because they stopped wanting the extra food."
The research analyzed data on 27 obese participants in the group program conducted at UCSF, 19 of who were available for follow-up for six years. Investigators tracked their weight, blood pressure, exercise, depression and functioning. The group members participated in 18 weekly two-hour group sessions to practice the developmental skills, completed journal homework and made telephone "connections" with other group members for skill practice.
Each developmental skill involves asking oneself two sets of questions, Mellin said. The self-nurturing skill questions are: "How do I feel? What do I need? Do I need support?" The limit-setting questions are: "Are my expectations reasonable? Is my thinking positive and powerful? What is the essential pain and the earned reward?" The skills are designed to internalize responsive self-parenting and to create emotional balance. When one is emotionally balanced, then he or she is less likely to go to excess, Mellin said.
"With modern day stresses and so much deprivation and chaos in our lives, most of us need higher levels of these internal skills than our ancestors needed," she said. "Without the skill to access a nurturing, secure inner life, we may be at greater risk of emotional distress and of experiencing common excessive appetites, such as overeating, overworking or overdrinking," Mellin said.
On average, the participants:
· Lost weight without restrictive diets or weight loss drugs, averaging 13 pounds in the first 12 weeks of training.
· Continued to lose weight after the treatment ended and continued to lose weight at six years.
· Maintained a weight loss averaging 17 pounds for the entire group and 23 pounds for those who demonstrated mastery of the skills at the end of the treatment.
· Decreased depression scores by 60 percent at 12 weeks and by 80 percent at six years.
· Increased exercise from an average of 110 minutes weekly at the beginning of the study to a weekly average of 247 minutes at 12 weeks and 240 minutes at six years.
· Decreased blood pressure at 12 weeks and six years.
· Of the participants who used substances (smoking, drinking, or drugs) at baseline, 67 percent at one year and 83 percent at six years significantly decreased or stopped their use.
The research began 22 years ago at UCSF through a federally funded adolescent health training program. Mellin and colleagues sought to identify a safe means of turning off the drive to overeat in obese youth, a population for whom restrictive diets and weight loss drugs are avoided. When the method was shown to be effective, the program was adapted to adults. The program is described in Mellin's book, The Solution: 6 Winning Ways to Permanent Weight Loss, (Regan Books 1998) and is being used in 150 hospital groups nationwide. Information is also available on the Internet (www.weightsolution.com).
Mellin suggests caution in response to these findings. "Larger scale studies are needed to confirm these results," she said. "In addition, pilot studies for the application of developmental skills training to adult substance abuse and to school-based interventions to prevent adult emotional and behavioral imbalance are planned."
Co-investigators of the study are Mary Croughan-Minihane, PhD, UCSF associate professor of family and community medicine and epidemiology and Larry Dickey, MD, MSW, MPH, former UCSF assistant professor of family and community medicine. The implications of this study may go beyond obesity treatment, Mellin said, as the results show persistent changes in emotional and behavioral balance, suggesting the possibility that the intervention causes changes to the limbic brain.
The limbic or "feeling" brain is thought to be the seat of mammalian emotional and behavioral balance. The limbic brain is programmed early in life and is more difficult to change in adulthood. Traditional non-drug therapies for emotional and behavioral problems do not change the limbic brain, a factor that limits their effectiveness. The persistent, comprehensive changes shown in this study suggest that developmental skills training may be a practical, clinical means of altering the limbic brain and of treating depression and other compulsive behaviors, Mellin said.
Recently three UCSF psychiatric researchers postulated that limbic changes might occur in adulthood through repeated contact with a responsive environment, such as a loving relationship or long-term psychotherapy. They wrote a book on the subject: A General Theory of Love, (Random House, 2000). Practicing the skills of self-nurturing and effective limit setting may create similar changes. According to Thomas Lewis, MD, UCSF assistant clinical professor of psychiatry, and one of the book's authors: "We know that the emotional parts of a person's brain undergo substantial change as a direct result of relationships with others. Mellin's study demonstrates the remarkably powerful, long-lasting effects of limbic changes on mind and body." The other authors of the book are Fari Amini, MD, UCSF professor of psychiatry and Richard Lannon, MD, UCSF associate clinical professor of psychiatry.