Table 3 The main procedures of the six CBT-OB modules

Module 1 - Monitoring food Intake, physical activity and body weight

• Initiating weekly weighing

• Explaining what the treatment will involve

• Educating on energy balance

• Establishing real-time monitoring of food intake and physical activity

• Initiating weekly weighing

Module 2 - Changing eating

• Creating an energy deficit of 500–1000 kcal per day produce a variable weight loss of about 0.5–1 kg a week.

• Planning ahead when, what and where to eat

• Eating consciously

Module 3 - Developing an active lifestyle

• Assessing the patient’s eligibility for exercise

• Assessing the patient’s functional exercise capacity

• Motivating the patient to exercise

• Developing an active lifestyle, reducing sedentary activities and increasing the daily step count

• Improving physical fitness

• Continuing or commencing formal exercise (in selected cases)

Module 4 - Addressing obstacles to weight loss

• Educating the patients on cognitive-behavioural weight-loss obstacles (antecedent stimuli, positive consequences, problematic thoughts)

• Introducing the Weight-Loss Obstacles Questionnaire

• Creating the Personal Formulation

• Addressing weight-loss obstacles

- Reducing environmental stimuli

- Addressing events influencing eating and exercise habits

- Addressing impulses and emotions influencing eating and exercise habits

- Addressing problematic thoughts

- Addressing the use of food as a reward, and the patient’s rational excuses for not adopting an active lifestyle

Module 5 - Addressing weight-loss dissatisfaction

• Detecting weight-loss dissatisfaction and its reasons

• Addressing unrealistic weight goals

• Addressing dysfunctional primary goals for losing weight

• Addressing negative body image

Module 6: Addressing the obstacles to weight maintenance

• Reviewing the changes achieved through weight loss

• Educating the patient on weight maintenance

• Involving the patient actively in the decision to start weight maintenance

• Introducing the procedures for weight maintenance

- Establishing weekly self-weighing and a weight-maintenance range

- Adopting eating habits and physical activity habits conducive to weight maintenance

- Constructing a weight-maintenance mindset

- Identifying and addressing high-risk situations and

- Addressing weight regain

• Discontinuing real-time monitoring of food intake

• Evaluating possible future weight-loss attempts

• Preparing a weight-maintenance plan

• Bringing the treatment to a close