Step-down approach to behavioural weight loss treatment: a pilot of a randomised clinical trial

Background: In a stepped-down approach, patients begin with a more intensive treatment and are stepped down to a less intensive treatment based on achieving treatment goals. This study compared a standard behavioural weight loss programme (BWLP) to a stepped-down approach to treatment.

Methods: Fifty-two overweight/obese adults (Age: M?=?47?years, SD?=?13.5; female?=?67%) participated in an 18-week BWLP. Half of them were randomly assigned to be stepped down from weekly group meetings based on completion of weight loss goals (3%) every 6?weeks, while the other half remained in their groups regardless of weight loss.

Results: There was a significant difference favouring the BWLP in the proportion of participants who met or exceeded their 3% weight loss goal during the first six weeks. While not statistically significant by the end of treatment, the BWLP participants lost nearly 3% more body weight than stepped-down participants (SC?=?4.9% vs. BWLP?=?7.8%; p?=?.10). Greater self-monitoring was associated with increased likelihood of stepped-care eligibility and higher percent weight loss at the end of treatment (p?<?.01).

Conclusion: There was little evidence to support the efficacy of the stepped-down approach for behavioural weight loss treatment employed in this investigation.     

Methods of assessing craving to gamble: A narrative review

Although the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) does not explicitly list craving as a diagnostic criterion for pathological gambling, theories of disordered gambling and research on relapse precipitants suggest that cravings-among other factors-provoke and maintain episodes of gambling. Assessment of craving to gamble is complicated by questions regarding (a) the emotional, cognitive, behavioral, and physiological components of such craving; (b) the degree to which craving is viewed as an acute and fluctuating experience or as a relatively stable preoccupation with or inclination to gamble; (c) the threshold separating mild desire from pathological craving to gamble; and (d) the degree to which disordered gamblers are aware of, and able to report on, their experience of craving. Our literature search revealed various self-report methods that could be used to assess craving to gamble, including single-item rating scales, multi-item questionnaires, and application of the think-aloud procedure. In addition, psychophysiological reactivity (e.g., heart rate, brain activation) to gambling-related stimuli and reaction time (RT) tasks (e.g., gambling Stroop, Lexical Salience Task) may serve as proxy measures of subjective craving to gamble. Although researchers have assessed elements of reliability and validity of many measures, most require additional evaluation to examine their predictive and construct validity and their utility across different modes of gambling. The field would also benefit from further research to develop and evaluate additional self-report and proxy measures. (PsycINFO Database Record (c) 2012 APA, all rights reserved).