Effectiveness of cognitive-behavioral therapy based on the Mediterranean diet for the treatment of obesity

Objective: The Mediterranean dietary pattern improves cardiovascular disease factors. More research is needed on the usefulness of a Mediterranean dietary pattern in terms of weight loss. The objective of this study was to assess the effectiveness of behavioral therapy based on the Mediterranean diet for the treatment of obesity and to determine the main obstacles to weight loss. Methods: A total of 1406 obese subjects (body mass index, 31 +/- 5 kg/m(2)), aged 20-65 y, from a Mediterranean area in southeast Spain were subjected to a weight-reduction program. To evaluate effectiveness, weight loss, body fat distribution, biochemical variables, blood pressure changes, mean duration of treatment, percentage of attrition, and the ability to fulfill a Mediterranean diet pattern were assessed. To determine the main barriers to losing weight, a Barriers to Weight Loss checklist was completed. Results: The behavioral therapy program was effective for the treatment of obesity. The average weight loss was 7.7 kg. The duration of treatment was 34 wk. Eighty-nine percent of subjects fulfilled the Mediterranean principles during the program, and all the variables studied were significantly improved. Attrition was 4-9%, with the main reason being stress (37%). Main obstacles to weight loss were losing motivation, being prone to stress-related eating, and being liable to eat when bored. Recording food intake and assisting group therapy were also important tools for losing weight (P <= 0.05). Conclusions: Dietary/behavioral treatment based on Mediterranean dietary principles is effective in clinical practice. Nutrition professionals should encourage their patients to record food intake and to attend group therapy. (C) 2009 Elsevier Inc. All rights reserved.