RESEARCH FINDINGS USING GUIDED IMAGERY FOR

WEIGHT LOSS

AUGUST, 2006


Prevalence and Costs

In the early 1990s, Americans spent $33 billion annually on weight loss services and products (Curtis, 1999). Most of these products failed, since at least 64% of all American adults are now clinically overweight or obese – an all-time high (Finkelstein, Fiebelkorn & Wang, 2004).

The total number of overweight American children has tripled in the last twenty years (Curtin, Bandini, et al, 2005). The numbers have been rising since 1960, with the largest increase occurring since 1990. Obesity causes 280,000 deaths annually (Allison, Fontaine, et al, 1999).

Direct costs of weight problems amounted to $51.6 billion in 1995 (Wolf, & Colditz, 1998). By 2003, that amount had risen to $75 billion (Finkelstein, Fiebelkorn & Wang, 2004). This amount does not take into account costs of treating Type 2 diabetes, heart disease, hypertension, stroke, and arthritis related to obesity. In 1994, as a result of weight-related problems, Americans lost 39.3 million workdays, spent $62.7 million dollars on office visits, and resulted in lost productivity costs to the U.S. economy of $3.93 billion (Allison, Fonataine, et al, 1999).

What is overweight and obesity?

Today’s standard for measuring healthy weight is the use of the Body Mass Index, or BMI (weight in kilograms divided by height in meters, squared). People are defined as overweight if their BMI is 25 or more; obesity is defined as having a BMI of 30 or above.

Carrying too much weight is a known risk factor for diabetes, heart disease, stroke, hypertension, gall bladder disease, arthritis, respiratory problems including sleep apnea, and some cancers. Obesity can affect menstruation, stress incontinence, pregnancy, cholesterol levels, and often contributes to psychological conditions such as depression.

Obesity is caused by many factors. Certainly, genetics plays a role, but other major contributors are lifestyle, diet, and psychological factors (depression, anxiety, etc. leading to emotional eating). Additionally, weight gain can be caused by diseases such as hypothyroidism, Cushing’s Syndrome, depression, and neurological problems. Steroids can result in weight gain. In an ironic Catch-22, the antidepressants prescribed for emotional eating can, in themselves, cause weight gain.

Medical treatment of Weight Problems

Pharmacologic treatment of weight problems includes appetite suppressants (Orlistat and Sibutramine) and, often, anti-depressants. Morbid obesity, defined as weighing at least twice ideal weight and when weight interferes with normal physiological functioning, can be treated with gastrointestinal surgery (Bariatric surgery).

Non-pharmacologic treatment including imagery

Behavior modification has traditionally been the first recommendation in weight control: diet, exercise, nutritional education, and other behavior modification techniques. Individual and/or group psychology is often recommended, especially for obesity. Weight loss is often attained; sustained weight loss is usually not.

Mind/body approaches are also being used, often as part of a comprehensive program. Hypnosis has often proven effective in sustained weight loss in a number of studies (Anderson, 1985; Barabasz & Spiegel, 1989; Cochrane & Friesen, 1986; Johnson, 1997), while authors of another study report small, sustained losses only when the hypnosis included stress reduction (Stradling, Roberts, et al, 1998).

Behavior therapy has also been effective, especially when combined with hypnosis (Bolocosky, Spinler & Coulthard-Morris, 1985). Sustained weight loss has been achieved with Cognitive Behavioral Therapy (CBT) (Braet, Tanghe, et al, 2004; Braet, Van Winckel & Van Leeuwen, 1997; Dalle Grave, Todesco, et al, 2004; Dornelas, Wylie-Rosett & Swencionis, 1998; Mellin, Slinkard, & Irwin, 1987; Rapoport, Clark & Wardle, 2000), and its effectiveness has been increased with the addition of hypnosis (Kirsch, 1996).

In one study, adding guided imagery to a general behavior/education weight loss program increased weight loss by a factor of two (Rossman, undated). One group of clinically obese people who used a multi-component program CBT with relaxation, along with nutrition and exercise, achieved long-term weight loss (Golay, Buclin, et al, 2004).

Overweight adolescents often respond to peer pressure as motivation for losing weight. One program, which combined CBT with "peer-enhanced adventure therapy," was four times as successful as a program that combined CBT with exercise alone (Jelalian, Mehlenbeck, et al, 2006).

Guided imagery reduced binge eating by 74% and reduced vomiting by 73% in one group of patients with bulimia nervosa (Esplen, Garfinkle, et al, 1998). CBT has also proven successful in cases of binge eating (Devlin, Goldfein, et al, 2005; Fossati, Amati, et al, 2004; Gluck, Geliebter, et al, 2004; Grilo, Masheb, et al, 2005).

Conclusion

A low-cost imagery intervention may improve not only overweight patients’ weight and lower their anxiety about food, but may mitigate or prevent ancillary diseases, improve patients’ general health, and reduce patients’ utilization of medical services.

REFERENCES

Allison DB, Fontaine KR, Manson JE, Stevens J, VanItallie TB. Annual deaths attributable to obesity in the United States. JAMA. 1999;282(16):1530-1538.

Anderson MS. Hypnotizability as a factor in the hypnotic treatment of obesity. Int J of Clin and Exp Hyp. 1985;33:150-59.

Barabasz M, Spiegel D. Hypnotizability and weight loss in obese subjects. Int J of Eating Disorders. 1989;8(3):335-41.

Bolocosky DN, Spinler D, Coulthard-Morris L. Effectiveness of hypnosis as an adjunct to behavioral weight management. J Clin Psychol. 1985;Jan;41(1):35-41.

Braet C, Tanghe A, Decaluwe V, Moens E, Rosseel Y. Inpatient treatment for children with obesity: weight loss, psychological well-being, and eating behavior. J Pediatr Psychol. 2000;Oct;29(7):519-29.

Braet C, Van Winckel M, Van Leeuwen K. Follow-up results of different treatment programs for obese children. Acta Paediatr. 1997;Apr;86(4):397-402.

Cochrane G, Friesen J. Hypnotherapy in weight loss treatment. J Consult Clin Psycho. 1986;54:489-92.

Curtin C, Bandini LG, Perrin EC, Tybor DJ, Must A. Prevalence of overweight in children and adolescents with attention deficit hyperactivity disorder and autism spectrum disorders: a chart review. MBC Pediatr. 2005;Dec 21;5(1):48 [Epub ahead of print].

Curtis, Leslie. Weight-loss Providers Agree to Help Consumers Make Better Choices . NIDDK Summer, 1999.
http://win.niddk.nih.gov/notes/summer99/PG4.html
Accessed August, 2006.

Dalle Grave R, Todesco T, Banderali A, Guardini S. Cognitive-behavioural guided self-help for obesity: a preliminary research. Eat Weight Disord. 2004; Mar;9(1):69-76.

Devlin MJ, Goldfein JA, Petkova E, Jiang H, Raizman PS, Wolk S, Mayer L, Carino J, Bellace D, Kamenetz C, Dobrow I, Walsh BT. Cognitive behavioral therapy and fluoxetine as adjuncts to group behavioral therapy for binge eating disorder. Obes Res. 2005;Jun;13(6):1077-88.

Dornelas EA, Wylie-Rosett J, Swencionis C. The DIET study: long-term outcomes of a cognitive-behavioral weight-control intervention in independent-living elders. Dietary Intervention: Evaluation Technology. J Am Diet Assoc. 1998;Nov;98(11):1276-1281.

Esplen MJ, Garfinkel PE, Olmsted M, Gallop RM, Kennedy S. A randomized controlled trial of guided imagery in bulimia nervosa. Psychol Med 1998 Nov;28(6):1347-57.

Finkelstein EA, Fiebelkorn IC, Wang G. State-level estimates of annual medical expenditures attributable to obesity. Obes Res. 2004;Jan;12(1):18-24.

Fossati M, Amati F, Painot D, Reiner M, Haenni C, Golay A. Cognitive-behavioral therapy with simultaneous nutritional and physical activity education in obese patients with binge eating disorder. Eat Weight Disord. 2004;Jun;9(2):134-8.

Gluck ME, Geliebter A, Lorence M. Cortisol stress response is positively correlated with central obesity in obese women with binge eating disorder (BED) before and after cognitive-behavioral treatment. Ann N Y Acad Sci. 2004; Dec;1032:202-7.

Golay A, Buclin S, Ybarra J, Toti F, Pichard C, Picco N, de Tonnac N, Allaz AF. New interdisciplinary cognitive-behavioural-nutritional approach to obesity treatment: a 5-year follow-up study. Eat Weight Disord. 2004; Mar;9(1):29-34.

Grilo CM, Masheb RM. A randomized controlled comparison of guided self-help cognitive behavioral therapy and behavioral weight loss for binge eating disorder. Behav Res Ther. 2005; Nov;43(11):1509-25.

Jelalian E, Mehlenbeck R, Lloyd-Richardson EE, Birmaher V, Wing RR. 'Adventure therapy' combined with cognitive-behavioral treatment for overweight adolescents. Int J Obes (Lond). 2006 Jan;30(1):31-9.

Johnson DL. Weight loss for women: studies of smokers and nonsmokers using hypnosis and multicomponent treatments with and without overt aversion. Psychol Rep. 1997; Jun;80(3 Pt 1):931-3.

Kirsch I. Hypnotic enhancement of cognitive-behavioral weight loss treatment – another meta-re-analysis. J Consult Clin Psychol. 1996; June;64(3):517-9.

Mellin LM, Slinkard LA, Irwin CE Jr. Adolescent obesity intervention: validatin of the SHAPEDOWN program. J Am Diet Assoc. 1987; Mar;87(3):333-338.

Rapoport L, Clark M, Wardle J. Evaluation of a modified cognitive-behavioural programme for weight management. Int J Obes Relat Metab Disord. 2000; Dec;24(12):1726-1737.

Rossman, J. Director of Behavioral Medicine at Canyon Ranch. Unpublished study.

Stradling J, Roberts D, Wilson A, Lovelock F. Controlled trial of hypnotherapy for weight loss in patients with obstructive sleep apnoea. International Journal of Obesity and Related Metabolic Disorders. 1998 Mar; 22(3):278-81.

Third National Health & Nutrition Examination Survey (NHANES III) 1999. Centers for Disease Control. National Center for Health Statistics. Hyattsville, MD.

Wolf AM, Colditz GA. Current estimates of the economic cost of obesity in the United States. Obes Res. 1998; Mar;6(2):97-106.