The use and effectiveness of behavioural modification techniques in achieving and maintaining normal weight and fitness : the lifestyle changes for adults in Cyprus

Background and aim: Research showed that behavioural modification techniques were the most effective way to achieve and maintain a healthy weight compared to diet and exercise alone. If behavioural modification was the most effective technique, then at least the two thirds of the candidates (Weight Loss Candidate with Behaviour Modification-WLCB) who used the specific behavioural modification techniques regarding eating and physical activity would achieve a weight loss of average ½ -1kg per week for the 18 weeks of the treatment and then maintain it or continue to lose after treatment termination with a total treatment period of 36 weeks. The treatment was efficient and long-lasting compared to the control candidates who followed a diet plan only. Furthermore, if the use of behavioural modification was the most effective way for diet and exercise, then the weight loss and maintenance would be more efficient and long-lasting. The principal aim of this project was to develop behaviour modification techniques (protocol and guidelines) in order to promote effective weight management for sedentary and active Cypriot adults, concentrating on nutrition and exercise. Study design: The study was quantitative and qualitative in nature using an action research approach. Furthermore, it was observational and longitudinal using structured methods and a representative sample of adults 19-50 years of age is investigated for 36 weeks. Methods: Anthropometric data and health and diet history were taken using standard methods from 315 (the control and intervention group (1:1) Cypriot adults from rural and urban areas. Individualised diet plans, personalised physical activities as well as behavioural modification parameters were assessed with the aid of a questionnaire, interview, food and exercise diary and behavioural checklist. Obesity and overweight were defined using the current International Obesity Task Force definition. The validated questionnaires for Physical Activity (IPAQ) and the nutritional assessment (National Integrated Health Associates) were used for initial assessment and the behavioural checklists were used for the follow up. Behavioural checklists were completed by the candidates on a bi-weekly basis along with the food and exercise diary. The questionnaire reliability (test-retest), internal consistency and ability to differentiate obese vs. normal-weight adult behaviours were tested using a pilot population of 50 adults not enrolled in a formal weight loss programme. Its reliability (checklists, food and exercise diary) and predictive validity were tested using a selective population: 265 adults of the observational group enrolled in behavioural modification treatment vs. diet. OBJECTIVES OF THE STUDY: Τhe objectives of the research were a) The study of every aspect of weight management and thus be capable of making suggestions for the development of guidelines and protocols for behavioural modification to health professionals working with the public. b) The identification and adjustment of eating and exercise behaviour related to body weight in order to achieve an efficient weight management in Cypriot overweight/obese adults. c) The evaluation of the effectiveness of the modest lifestyle changes in weight management induced by short-term energy/calorie restriction and behaviour modification in overweight and obese Greek Cypriots with Body Mass Index (BMI) above 25 or 30 respectively, or body weight 20% or above of Ideal Body weight (IBW), or body fat above normal levels. d) The development of education and counselling protocols and guidelines for professionals for weight management protocols based on the Mediterranean Diet and the eating and exercise habits of Cypriot Adults. e) The implementation of the protocols to intervention groups in order to identify the efficiency. Outcomes: The outcomes of the project was the development of an education and counselling protocol/manual which included teaching tools and guidelines for professionals for weight management with the title “Protocol and Guidelines for professional users for weight management for Adults: assessment, categorization, therapy/ follow up of overweight and obesity”. The development of an eating behaviour and physical activity protocol/manual based on the Mediterranean Diet and the demonstrated eating and exercise habits of Cypriot Adults can be used by the stakeholders and the public for efficient and effective weight management. RESULTS: The average length of weight loss treatment was 18 weeks for the intervention and the control groups, and the average weight loss for the intervention group was 11.96kg (t-test, p-value ≤ 0.001) and for the control group was 5.56kg (t-test, p-value≤ 0.002). During the 18 weeks of the maintenance period the 50% of the intervention group continued to lose while, an additional 48% of them maintained the weight and only 2% of them gained weight. Conclusions: To conclude, the prevalence of obesity worldwide has reached epidemic proportions. Physical inactivity and poor diet have been identified as primary contributors to the leading causes of death in developed countries including Cyprus. It is unfortunate that more emphasis is given to calorie restriction dieting rather than behavioural modification for diet and physical activity in achieving and maintaining weight loss. The fact is that incorporating appropriate behavioural modification techniques for diet and sufficient physical activity into one’s life is an essential component of achieving a healthy body weight. The research project aimed at developing a behavioural approach and behavioural modification techniques for the treatment of obesity and weight management adjusted to the needs of the Cypriot adult population. The difference of this approach underlines the emphasis that has to be given to the follow-up programme for the maintenance of the weight loss through behavioural modification. This approach evolved from the environmental control of eating behaviour to a broader approach characterized by systematic manipulation of all factors associated with eating and exercise patterns. The need for the project derives from the fact that obesity is a chronic condition with a substantial potential for relapse; therefore long–term treatments are needed. The expected outcomes of this project are the development of guidelines and protocols to be used by health professionals. The ultimate goal is the reduction of the obesity epidemic in Cyprus.