Objective: To describe the implementation of Cognitive Behavioural Therapy Targeting Eating Behaviour (CBT-TEB) and to determine the short-term effectiveness in reducing abdominal obesity and body mass index (BMI) where the therapy was provided in ordinary primary care centres.
Methods: A screening questionnaire was given to consecutive patients and after that a health dialogue, blood pressure and plasma glucose check were offered. Eightythree persons aged 18-69 years consented to participate in the CBT-TEB intervention. Inclusion criteria were the combination of abdominal obesity and BMI ≥ 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: 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.
Results: 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.
Conclusions: It was feasible to implement CBT-TEB in primary care with health educators and district nurses as group leaders after short training. The therapy was well accepted by patients and staff. The short-term effectiveness of CBT-TEB was satisfying and seems to surpass most or all published CBT-based programmes for reduction of weight and abdominal obesity in patients attending primary care.
Lisbeth Stahre, Ann Blomstrand and Tore Hallstrom
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