Self and external management compared with psychotherapy in the control of obesity

Seventy-four obese TOPS (Take Off Pounds Sensibly) members were assigned to one of five conditions: delayed treatment control, insight psychotherapy, self-management training plus external reinforcement, self-management training only, or external reinforcement only. The latter four groups met once per week for ten weeks and were seen at three and six months and followup. It was hypothesized that self-management plus external reinforcement would be superior to other conditions at both post-treatment and followup, and that this condition alone would produce continuing weight losses. Analysis of covariance on body weight, with pretreatment weight as covariate, indicated that self-management plus external reinforcement, self-management only, and external reinforcement only, did not differ in mean body weight at post-treatment. These three groups differed significantly from control and psychotherapy conditions, which did not differ from one another. Self-management plus external reinforcement produced better performance of techniques. At three and six month followup, differences between the four treatment conditions were no longer significant. Results are discussed in terms of evaluation of psychotherapy and behavior modification and durability of results.