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.
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