Eating behaviors and strategies to promote weight loss and maintenance

Summary It may at times seem like we are searching for a cure for obesity with a magic diet, evidenced by past fad diets and the current attraction to low-carbohydrate diets and ketogenic diets. This chapter discusses the biologic basis of our eating behaviors and the biologic basis of health improvement with weight loss. With this understanding, we discuss the behavioral change approaches that can be used to navigate the modern food environment and lose enough weight to improve health. First, we review the evidence base for lifestyle intervention with a purpose of understanding the push by all professional societies to implement intensive behavioral therapy for obesity. The chapter discusses calorie targets and calorie deficits, episodic fasting, mindfulness, and the emergence of electronic self-monitoring tools. All of these approaches are based on our understanding of the biology of food intake. But weight loss is only the beginning; the hard part of losing weight for most patients with obesity is weight loss maintenance, and we discuss the important shift in focus to maintain lost weight, along with promising methods to achieve this goal.