Table 2 CBT-OB strategies and procedures for minimising attrition, enhancing weight loss and improving weight-loss maintenance

Strategies and procedures for minimising attrition:

• Addressing patient’s difficulties attending the sessions

- Scheduling the sessions at times compatible with a patient’s work commitments

- Routinely asking the patients whether they are experiencing any difficulties as regards attending the sessions, and devoting time to understanding and/or overcoming them.

• Showing interest in each patient as a person, irrespective of their weight and/or other issues

- Adopting a “people first” policy—putting individuals before the disability or disease when describing persons affected by obesity (e.g., “person with obesity” instead of “obese person”

- Avoiding any use of potentially pejorative adjectives or adverbs, or any language that implies moral judgements or highlights patients’ “character flaws” regarding their weight

• Addressing unrealistic weight loss expectations

- Encouraging patients to pursue and be satisfied with achievable short-term weight-loss goals (i.e., a weight loss of between 0.5 kg and 1.0 kg/week) and not disputing unrealistic goals at the beginning of treatment

- Addressing unrealistic goals only when patients have achieved some success in reaching a healthy weight, but manifest dissatisfaction with the weight loss achieved

• Maintaining therapeutic momentum

- Identifying with the patients the best time to start the treatment

- Stressing the importance of avoiding any interruptions in treatment, especially during the first 8 weeks

- Explaining to the patients in advance that another therapist will take the place of the primary therapist in the event of their absence

• Developing a protocol for dealing with late attendance or non-attendance

- Encouraging patients to arrive a little early for session (e.g., 10–15 min) in order to relax and mentally prepare themselves

- If patients are running late for an appointment, calling them after 15 min to express concern about their absence, and to try to reschedule the appointment as soon as possible

Strategies and procedures for enhancing weight loss

• Increasing dietary restraint and decreasing dietary disinhibition

- Eating regularly (i.e., three planned meals and two snacks, and refraining from eating in the intervals between)

- Planning meals in advance (when, what and where to eat) on a specific monitoring record, making reference to a structured meal plan

- Supplying patients with grocery lists, menus and recipes

- Monitoring food intake in real time

- Training patients to eat consciously (i.e., “think while you are eating”)

- Training patients to “ride out” the desire for food, educating them that any impulses will be transitory and can be tolerated

- Encouraging patients to consider their efforts to control eating as a necessary condition for achieving healthy weight loss and benefiting from its associated physical and psychological advantages

- Involving patients actively in identifying processes hindering weight loss using the “Weight-Loss Obstacles Questionnaire”

- Developing collaboratively with the patients their personal formulation of the processes that are hindering weight loss

- Designing personalized procedures aimed at addressing the specific obstacles encountered by each patient

- Involving, with the consent of patients, their significant others in treatment to create the optimal environment for facilitating patients attempts efforts to change their eating habits

• Strategies and procedures for improving weight-loss maintenance

- Addressing weight-loss satisfaction before starting weight-loss maintenance

- Dedicating one or two sessions to preparing patients for weight maintenance, and collaboratively developing a weight maintenance plan

- Encouraging patients to suspend any attempts to lose weight while learning weight-maintenance skills (i.e., at least 12 months)

- Creating a list of personal reasons to maintain weight

- Adopting a mindset with a constant focus on weight control, and keeping a constant but flexible focus on weight control and self-awareness regarding diet and physical activity

- Identifying and addressing high-risk weight- regain situations, preventing lapses from becoming relapses, and addressing any weight regain

- Implementing weekly self-weighing and ensuring patients maintain weight within a specific range of 4 kg

- Encouraging patients to follow a high-protein, low-glycaemic-index diet with moderate fat content, and to practice at least 30 min of moderate-intensity activity daily