Clinical Psychology and Medicine for the Treatment of Obesity in Out-patient Settings: The TECNOB Project,

In 2005, about 1.6 billion adults (above 15 years of age) were estimated to be overweight, whereas about 400 million people were obese. Obesity is a condition with such an increasing prevalence that it can be defined as a global epidemic. In 2015, approximately 2.3 billion adults will be overweight and more than 700 million will be obese (WHO, 2006). Obesity increases the risk of many health complications such as cardiovascular diseases, some types of cancer, osteoarthritis, hypertension, dyslipidemia, and hypercholesterolemia, and is associated with early death (Flegal, Graubard, Williamson, & Gail, 2005; Whitlock, et al., 2009). Obesity is a strong risk factor for the development of type 2 diabetes (Klein, et al., 2004a, 2004b). Indeed, as BMI (Body Mass Index) increases, the risk of developing type 2 diabetes increases in a "dose-dependent" manner (Colditz, et al., 1990; Must, et al., 1999). The prevalence of type 2 diabetes is 3–7 times higher in obese than in normal-weight adults, and those with a BMI >35 are 20 times more likely to develop type 2 diabetes than those with a BMI between 18.5 and 24.9 (Field, et al., 2001; Mokdad, et al., 2003). Obesity-related medical complications weigh heavily on public health care costs and developing effective interventions for substantially reduce weight, maintain weight loss and prevent or manage associated diseases like type 2 diabetes in cost-effective manner is a priority. Stand-alone and combined treatment options (dietetic, nutritional, physical, behavioral, cognitive-behavioral, pharmacological, surgical) are available, but clinical practice and research have shown significant difficulties with regard to availability, costs, treatment adherence and long-term efficacy (Weinstein, 2006). These procedures imply high costs both for the obese individuals and the public health system, overall within an enduring care setting. Indeed, the main challenge in the treatment of obesity is to maintain weight loss in the long term (Hill, Thompson, & Wyatt, 2005). Most overweight and obese individuals regain about one third of the weight lost with treatment within 1 year, sometimes even before the end of the intervention, and they are typically back to baseline in 3 to 5 years (Jeffery, et al., 2000; Katan, 2009; Wing, Tate, Gorin, Raynor, & Fava, 2006). Similarly, few