Effectiveness of Cognitive Behaviour Therapy Targeting Eating Behaviour for Patients with Abdominal Obesity in an Ordinary Primary Health Care Setting

Abstract

The purpose of this study is to explain how Cognitive Behavioural Therapy Targeting Eating Behavior (CBT-TEB) was applied and to assess the therapy's short-term efficacy in lowering abdominal obesity and body mass index (BMI) in routine primary care settings. Obesity is a serious public health issue and associated with an increased risk of cardiovascular disease events and mortality. The risk of cardiovascular complications is directly related to excess body fat mass and ectopic fat deposition, but also other obesity-related complications such as pre-type 2 diabetes, obstructive sleep apnoea, and non-alcoholic fatty liver diseases.
A screening questionnaire was given to consecutive patients and after that a health dialogue, blood pressure and plasma glucose check were offered. Eighty- three persons aged 18-69 years consented to participate in the CBT-TEB intervention. Inclusion criteria were the combination of abdominal obesity and BMI \(\ge\) 25. Primary outcome measures were changes from baseline to six months after end of therapy in waist circumference (WC), waist-to-hip ratio (WHR), weight, and BMI. Changes in eating behaviours: cognitive restraint eating, emotional eating and uncontrolled eating. Obesity related psychosocial problems as well as patients´ and group leaders´ experiences of the CBT-TEB programme were also assessed. Pulse, systolic and diastolic blood pressure, total cholesterol, high-density lipoproteins (HDL-C), low-density lipoproteins (LDL-C) and triglycerides were measured.
Mean reductions after six months (total sample, last observation carried forward): WC 4.8 (sd 7.0) cm, WHR 0.027 (sd 0.04), weight 4.4 (sd 4.9) kg, BMI 1.6 (sd 1.8) kg/m2. Mean reductions after six months in therapy completers: WC 5.5 (7.3) cm, WHR 0.031 (0.05), weight 5.0 (5.0) kg, BMI 1.8 (1.8) kg/m2. Cognitive restraint eating increased and uncontrolled eating, emotional eating and obesity-related psychosocial problems decreased significantly during therapy. Patients´ experiences of the therapy exceeded their expectations. Group leaders´ experiences were positive. After a brief training period, it was possible to deploy CBT-TEB in primary care using district nurses and health educators as group leaders. Both patients and staff responded favorably to the treatment. The CBT-TEB program's short-term success in reducing weight and abdominal obesity in patients receiving primary care was pleasing and seems to be superior to the majority of other reported CBT-based programs.