The science behind BodMinSou

BodMinSou is the result of over three years research into the most effective ways to lose and maintain a healthy weight. The resulting solution is a holistic approach to weight management and healthy living that uses approaches from different scientific fields.

Before we began, we analysed current approaches for weight loss and referenced their success rates against scientific studies from around the world. Our findings revealed that no one single approach was effective in long term weight loss or weight management. Our research revealed that existing commercial weight loss solutions worked short term by focusing on diet restriction, calorie counting or exercise intensity. These however were not sustainable long term. One to one counselling solutions worked well on associated mental and behavioural therapies but often failed to offer cost effective long term support. Additionally we looked at the effectiveness of long term habit formation for related conditions and our research revealed a number of approaches with high success rates. We wondered could we combine the best existing approaches, techniques and methodologies together?

It seemed like a simple proposition, on paper, but it took three long years to develop and refine this solution, and we’re not done yet. During that time we conducted trials in various countries, refined and tested our findings. BodMinSou has completed initial trials and we believe will benefit people in providing a sustainable long term solution to weight loss and healthy living. Since we are a new service and our approach is different we will continue to test, innovate and improve but we’re finally ready to come out of the lab.

We will continue to evaluate BodMinSou but we are very pleased with the results from our first studies. But remember, BodMinSou is not intended to address any medical problem. If you have any reason to believe you are suffering from a pre-existing medical condition, or are pregnant, then please consult your doctor before starting a BodMinSou program. You can also see if BodMinSou is suitable for you here.

Our approach

Cognitive Behavioral Therapy (CBT for weight loss)

Cognitive behavioural therapy or CBT for weight loss is a form of treatment that focuses on examining the relationships between thoughts, feelings and behaviours. CBT for weight loss focuses on changing how you think about yourself, your actions and the circumstances around your actions. CBT is what is referred to as an ‘evidence-based therapy’, meaning that it has been shown to be effective in controlled scientific clinical studies. CBT research goes back more than 30 years, with several decades of evidence available showing it as an effective treatment for a wide range of problems, including weight loss.

Key to it is its focus on making changes and sticking to them. CBT for weight loss also works to help overcome the worry and other negative emotions that can be associated with weight.

CBT for weight loss normally occurs as a face-to-face session with a trained therapist, who teaches techniques that can be used at home. Now online programs such as BodMinSou allow people to access these same proven techniques and receive continuous support.

Further Reading
CBT For Weight Loss

  1. Cognitive Behavioral Therapy (CBT)?
  2. Prevention of Eating Disorders in At-risk College-Age Women
  3. Computer-delivered cognitive behavioural therapy: effective and getting ready for dissemination
  4. Bringing more effective tools to the weight-loss table
  1. Australian Bureau of Statistics: National Survey of Mental Health and Wellbeing 2007: Summary of Results; 23 October 2008.
  2. Butler AC, Chapman JE, Forman EM, Beck AT. The empirical status of cognitive behavioural therapy: a review of meta-analyses. Clin Psychol Rev. 2006
  3. Andrews G, Issakidis C, Sanderson K, Corry J, Lapsley H. Utilising survey data to inform public policy: comparison of the cost-effectiveness of treatment of ten mental disorders. Br J Psychiatry. 2004
  4. Marks I, Cavanagh K, Gega L. Hands-On Help: Computer-Aided Psychotherapy. New York, NY: Psychology Press; 2007.
  5. Marks I, Cavanagh K. Computer-aided psychological treatments: evolving issues. Annu Rev Clin Psychol. 2009
  6. Barak A, Klein B, Proudfoot JG. Defining internet-supported therapeutic interventions. Ann Behav Med.2009
  7. Andersson G, Cuijpers P. Internet-based and other computerized psychological treatments for adult depression: a meta-analysis. Cogn Behav Ther. 2009
  8. Vernmark K, Lenndin J, Bjärehed J, Carlsson M, Karlsson J, Öberg J, Carlbring P, Eriksson T, Andersson G. Internet administered guided self-help versus individualized e-mail therapy: a randomized trial of two versions of CBT for major depression. Behav Res Ther. 2010
  9. Ruwaard J, Schrieken B, Schrijver M, Broeksteeg J, Dekker J, Vermeulen H, Lange A. Standardized web-based cognitive behavioural therapy of mild to moderate depression: a randomized controlled trial with a long-term follow-up. Cogn Behav Ther. 2009
  10. Warmerdam L, van Straten A, Twisk J, Riper H, Cuijpers P. Internet-based treatment for adults with depressive symptoms: randomized controlled trial. J Med Internet Res. 2008
  11. Meyer B, Berger T, Caspar F, Beevers CG, Andersson G, Weiss M. Effectiveness of a novel integrative online treatment for depression (Deprexis): randomized controlled trial. J Med Internet Res. 2009;11:e15. doi: 10.2196/jmir.1151.
  12. Titov N, Andrews G, Robinson E, Schwencke G, Johnston J, Solley K, Choi I. Clinician-assisted Internet-based treatment is effective for generalized anxiety disorder: a randomized controlled trial. Aust N Z J Psychiatry. 2009
  13. Kiropoulos LA, Klein B, Austin DW, Gilson K, Pier C, Mitchell J, Ciechomski L. Is internet-based CBT for panic disorder and agoraphobia as effective as face-to-face CBT? J Anxiety Disord. 2008
  14. Shandley K, Austin DW, Klein B, Pier C, Schattner P, Pierce D, Wade V. Therapist-assisted, Internet-based treatment for panic disorder: can general practitioners achieve comparable patient outcomes to psychologists? J Med Internet Res. 2008
  15. Berger T, Hohl E, Caspar F. Internet-based treatment for social phobia: a randomized controlled trial. J Clin Psychology. 2009
  16. Carlbring P, Gunnarsdóttir M, Hedensjö L, Andersson G, Ekselius L, Furmark T. Treatment of social phobia: randomised trial of internet-delivered cognitive-behavioural therapy with telephone support. Br J Psychiatry. 2007
  17. Titov N, Andrews G, Choi I, Schwencke G, Mahoney A. Shyness 3: randomized controlled trial of guided versus unguided Internet-based CBT for social phobia. Aust N Z J Psychiatry. 2008
  18. Titov N, Andrews G, Choi I, Schwencke G, Johnston L. Internet-based cognitive behavior therapy for social phobia without clinical input is effective: a pragmatic RCT of two types of reminders. Aust N Z J Psychiatry. 2009
  19. Titov N, Andrews G, Schwencke G, Solley K, Johnston L, Robinson E. An RCT comparing effect of two types of support on severity of symptoms for people completing Internet-based cognitive behavior therapy for social phobia. Aust N Z J Psychiatry. 2009
  20. Cuijpers P, Marks IM, van Straten A, Cavanagh K, Gega L, Andersson A. Computer-aided psychotherapy for anxiety disorders: a meta-analytic review. Cogn Behav Ther. 2009 F1000 Factor 3.0 Recommended Evaluated by Perminder Sachdev 4 May 2010
  21. Carlbring P, Nordgren LB, Furmark T, Andersson G. Long term outcome of Internet delivered cognitive-behavioural therapy for social phobia: a 30-month follow-up. Behav Res Ther. 2009
  22. Titov N, Andrews G, Kemp A, Robinson E. Characteristics of adults with anxiety or depression treated at an Internet clinic: comparison with a national survey and an outpatient clinic. PLoS ONE. 2010
  23. Kaltenthaler E, Sutcliffe P, Parry G, Beverley C, Rees A, Ferriter M. The acceptability to patients of computerized cognitive behaviour therapy for depression: a systematic review. Psychol Med. 2008
  24. Computerised Cognitive Behavioural Therapy (cCCBT) Implementation Guidance. London, UK: Department of Health; Improving Access to Psychological Therapies (IAPT) Program. 1 April 2007.
  25. National Institute for Health and Clinical Excellence Computerised cognitive behavioural therapy for depression and anxiety (Review of Technology Appraisal 51; Technology Appraisal 97)
  26. Learmonth D, Trosh J, Rai S, Sewell J, Cavanagh K. The role of computer-aided psychotherapy within an NHS CBT specialist service. Couns Psychother Res. 2008
  27. de Graaf LE, Huibers MJH, Riper H, Gerhards SAH, Arntz A. Use and acceptability of unsupported online computerized cognitive behavioural therapy for depression and associations with clinical outcome. J Affect Disord. 2009
  28. Steinfeld BI, Coffman SJ, Keyes JA. Implementation of evidence-based practice in a clinical setting: what happens when you get there? Prof Psychol Res Pr. 2009
  29. VirtualClinic homepage. [ http://www.virtualclinic.org.au]

Long Term Habit Formation

On a daily basis we execute hundreds of habits without even a thought. These are habits that have grown and evolved over time from infancy. In fact, research shows that nearly half of our actions can be linked to our habits. If we look at habits in relation to weight gain, it’s easy to see how many bad habits are established.

A common myth about habit formation is that twenty one days of repetitive tasks can form a new habit. Unfortunately, this is a distortion of the truth and a misinterpretation of Dr. Maxwell Maltz’s work on self-image. Dr. Maxwell did not find that 21 days of task completion forms a habit but the idea began to grow in popularity and became a reality. The truth is that it’s more like 90 days or more. A study from the University College of London set the number of days to 66 days until an action becomes something you do without thinking. Whilst this is a more realistic time frame it’s different for all of us and a happy medium is more likely 60 to 90 days.

Take Small Steps

Our approach uses the best practices of habit formation and utilises the principals of “Small Steps” or “Tiny Habits”. We all know that when we give ourselves big goals these often seem over whelming. For example, introducing a workout routine. Instead of giving yourself the Herculean task of doing this every day, you could do what Stephen Guise recommends, one push up a day. The task is so small that you’ll feel ridiculous for not completing it. Then, over time the small action becomes part of your daily routine. Once the absurdly tiny becomes “normal”, then you are well on your way to a new routine and to establishing a long term habit.

The critical part is to not fool yourself into doing lots of push ups because you can, but to force yourself to complete only one. Do it every day. And watch what happens. Stanford psychologist B.J. Fogg, has done extensive research into lazy-smart habit formation. If a habit is so tiny such as flossing one tooth you’ll feel ridiculous for not getting it into your day. Then, over time, that minuscule becomes a part of your day.

It’s these principals we use to establish long term sustainable healthy habits. If the secret to developing new habits is to do them every day, then the secret to beginning that process is to start with small steps.

  1. Aarts, H., & Dijksterhuis, A. (2000). Habits as knowledge structures: Automaticity in goal-directed behavior. Journal of Personality and Social Psychology, 78, 53–63.
  2. Bargh, J.A., Chen, M., & Burrows, L. (1996). Automaticity of social behavior: Direct effects of trait construct and stereotype activation on action. Journal of Personality and Social Psychology, 71, 230– 244.
  3. Barnes, T.D., Kubota, Y., Hu, D., Jin, D.Z., & Graybiel, A.M. (2005). Activity of striatal neurons reflects dynamic encoding and recoding of procedural memories. Nature, 437, 1158–1161.
  4. Daw, N.D., Niv, Y., & Dayan, P. (2005). Uncertainty-based competition between prefrontal and dorsolateral striatal systems for behavioral control. Nature Neuroscience, 8, 1704–1711.
  5. Dickinson, A., & Balleine, B. (1995). Motivational control of instrumental action. Current Directions in Psychological Science, 4, 162– 167.
  6. Ji Song, M., & Wood, W. (2006). Habitual purchase and consumption: Habits and intentions guide behavior. Manuscript submitted for publication.
  7. Neal, D.T., & Wood, W. (2006). Ego-depletion and habits in everyday life. Unpublished manuscript, Duke University.
  8. Quinn, J.M., & Wood, W. (2005).Habits across the lifespan. Unpublished manuscript, Duke University.
  9. Schultz, W., Dayan, P., & Montague, P.R. (1997). A neural substrate of prediction and reward. Science, 275, 1593–1599.
  10. Verplanken, B., & Wood, W. (2006). Breaking and creating habits: Consequences for public policy interventions. Journal of Public Policy & Marketing, 25, 90–103.
  11. Vohs, K.D., Baumeister, R.F., & Ciarocco, N.J. (2005). Self-regulation and self-presentation: Regulatory resource depletion impairs impression management and effortful self-presentation depletes regulatory resources. Journal of Personality and Social Psychology, 88, 632–657.
  12. Webb, T.L., & Sheeran, P. (2006). Does changing behavioral intentions engender behavior change? A meta-analysis of the experimental evidence. Psychological Bulletin, 132, 249–268.
  13. Wood, W., Quinn, J.M., & Kashy, D. (2002). Habits in everyday life: Thought, emotion, and action. Journal of Personality and Social Psychology, 83, 1281–1297.
  14. Wood, W., Tam, L., & Guerrero Witt, M. (2005). Changing circumstances, disrupting habits. Journal of Personality and Social Psychology, 88, 918–933.
  15. Yeung, N., Botvinick, M.M., & Cohen, J.D. (2004). The neural basis of error detection: Conflict monitoring and the error-related negativity. Psychological Review, 111, 931–959.

Tiered Support And Motivation

It’s easier to stick with a weight loss plan when you have support and can share tips on diet say researchers. BodMinSou provides a tiered support structure that offers various forms of support catering to the many needs of a diverse group of participants. Whilst we have found some people like a hands on approach with lots of support others require infrequent support and motivation.

Tiered Approach

1. Professional Support
Most commercial solutions have a fixed approach involving set times for support whereby a participant must attend a physical session or online web session. We differ in that we monitor continuous progress and launch proactive support as needed. This utilises technological algorithms to understand when you might need us. Our approach also understands who should reach out to you, for example a fitness instructor may be more relevant to you than one of our general support staff. This makes a difference as you will always be able to get the right advice when you need it.

In the study, 415 obese men and women, who had an average age of 54 and at least one cardiovascular risk factor, were assigned to two programs: one combined phone, online, e-mail and group and individual coaching sessions and the second lacked the in-person support component. A third group met with a weight-loss coach at the beginning of the study and had the option of meeting with them at the end but didn’t receive any regular counseling in between besides referrals to online resources and brochures. The Checkup blog reports:

At 24 months, those in the remote-support-only group had lost a mean of 10.12 pounds; those in the remote-plus-in-person support group lost a mean of 11.22 pounds; and those in the control group lost a mean of 1.76 pounds.While 38.2 percent of the remote-only group lost 5 percent or more of their starting weight, 41.4 percent of those in the remote-plus-in-person group did so; only 18.8 percent of the control group achieved that 5-percent weight loss, a widely accepted benchmark at which health benefits of weight loss start to kick in. In short, those receiving only remote support lost nearly as much as those also receiving in-person support.

2. Group Support
There is considerable evidence that having a support group more than doubles the chances of long term weight loss. At BodMinSou we match participants into small teams of 12 based on their health goals, profile information, gender and geolocation information. The result is a team that is on the same path as you and one that will offer you the best social support.

Teams are intentionally small to create a better social bond and experience. Participants are also free to change teams in the event that a suitable match hasn’t occurred.

3. Community Support
Online forums are well established within the weight loss community. Evidence suggests that online community support is as effective as offline meetings. At BodMinSou each program integrates community feedback where participants can discuss relevant topics based on their health program.

  1. House JS. Work Stress and Social Support. Reading, MA: Addison-Wesley; 1981.
  2. Verheijden MW, Bakx JC, van Weel C, Koelen MA, van Staveren WA. Role of social support in lifestyle-focused weight management interventions. Eur. J. Clin. Nutr. 2005;59 S1:S179–S186.
  3. Williams P, Barclay L, Schmied V. Defining social support in context: a necessary step in improving research, intervention, and practice. Qual. Health Res. 2004;14(7):942–960.
  4. Coulson NS, Buchanan H, Aubeeluck A. Social support in cyberspace: a content analysis of communication within a Huntington’s disease online support group. Patient Educ. Couns. 2007;68(2):173–178.
  5. Mo PKH, Coulson NS. Exploring the communication of social support within virtual communities: a content analysis of messages posted to an online HIV/AIDS support group. CyberPsychol. Behav. 2008;11(3):371–374.
  6. Elfhag K, Rossner S. Who succeeds in maintaining weight loss? A conceptual review of factors associated with weight loss maintenance and weight regain. Obes. Rev. 2005;6(1):67–85.
  7. Gallagher KI, Jakicic JM, Napolitano MA, Marcus BH. Psychosocial factors related to physical activity and weight loss in overweight women. Med. Sci. Sports Exerc. 2006;38:971–980.
  8. Gorin A, Phelan S, Tate D, Sherwood N, Jeffery R, Wing R. Involving support partners in obesity treatment. J. Consult. Clin. Psychol. 2005;73:341–343.
  9. Wing RR, Jeffery RW. Benefits of recruiting participants with friends and increasing social support for weight loss and maintenance. J. Consult. Clin. Psychol. 1999;67:132–138.
  10. Blixen CE, Singh A, Thacker H. Values and beliefs about obesity and weight reduction among African American and Caucasian women. J. Transcult. Nurs. 2006;17(3):290–297.
  11. Lynch C, Chang J, Ford A, Ibrahim S. Obese African-American women’s perspectives on weight loss and bariatric surgery. J. Gen. Intern. Med. 2007;22(7):908–914.
  12. Kruger J, Blanck H, Gillespie C. Dietary and physical activity behaviors among adults successful at weight loss maintenance. Int. J. Behav. Nutr. Phys. Act. 2006;3(1):17.
  13. Sarasohn-Kahn J. The wisdom of patients: Health care meets online social media. [Accessed August 21, 2008]. available at http://www.chcf.org/documents/chronicdisease/HealthCareSocialMedia.pdf.
  14. Idriss SZ, Kvedar JC, Watson AJ. The role of online support communities: benefits of expanded social networks to patients with psoriasis. Arch. Dermatol. 2009;145(1):46–51.
  15. Malik SH, Coulson NS. Computer-mediated infertility support groups: an exploratory study of online experiences. Patient Educ. Couns. 2008;73(1):105–113.
  16. White M, Dorman SM. Receiving social support online: implications for health education. Health Educ. Res. 2001;16(6):693–707.
  17. Wright KB, Bell SB. Health-related support groups on the Internet: linking empirical findings to social support and computer-mediated communication theory. J. Health Psychol. 2003;8(1):39–54.
  18. Tate DF, Jackvony EH, Wing RR. Effects of internet behavioral counseling on weight loss in adults at risk for type 2 diabetes: a randomized trial. JAMA. 2003;289:1833–1836.
  19. Tate DF, Wing RR, Winett RA. Using internet technology to deliver a behavioral weight loss program. JAMA. 2001;285:1172–1177.
  20. Micco N, Gold B, Buzzell P, Leonard H, Pintauro S, Harvey-Berino J. Minimal in-person support as an adjunct to internet obesity treatment. Ann. Behav. Med. 2007;33(1):49–56.
  21. Tate DF, Jackvony EH, Wing RR. A randomized trial comparing human e-mail counseling, computer-automated tailored counseling, and no counseling in an internet weight loss program. Arch. Intern. Med. 2006;166(15):1620–1625.
  22. Womble LG, Wadden TA, McGuckin BG, Sargent SL, Rothman RA, Krauthamer-Ewing ES. A randomized controlled trial of a commercial Internet weight loss program. Obes. Res. 2004;12(6):1011–1018.
  23. Gold BC, Burke S, Pintauro S, Buzzell P, Harvey-Berino J. Weight loss on the web: a pilot study comparing a structured behavioral intervention to a commercial program. Obes. Res. 2007;15(1):155–164.
  24. SparkPeople, SparkPeople’s Rankings. [Accessed March 31, 2009]. Available at http://www.sparkpeople.com/about/stats.asp.
  25. Creswell JW. Research Design: Qualitative, Quantitative and Mixed Methods Approaches. Thousand Oaks, California: Sage Publications, Inc.; 2003.
  26. MacQueen KM, McLelland E, Kay K, Milstein B. Codebook development for team-based qualitative research. Cult. Anthropol. Methods. 1998;10(2):31–36.
  27. Buchanan H, Coulson NS. Accessing dental anxiety online support groups: an exploratory qualitative study of motives and experiences. Patient Educ. Couns. 2007;66(3):263–269.
  28. Fogel J, Ribisl KM, Morgan PD, Humphreys K, Lyons EJ. Underrepresentation of African Americans in online cancer support groups. J. Natl. Med. Assoc. 2008;100(6):705–712.
  29. Fox S. The Social Life of Health Information. Pew Internet & American Life Project. 2009. Jun 11 [on 17 June 2009]. accessed at http://www.pewinternet.org/~/media//Files/Reports/2009/PIP_Health_2009.pdf.
  30. Hwang KO, Farheen K, Johnson CW, Thomas EJ, Barnes AS, Bernstam EV. Quality of weight loss advice on internet forums. Am. J. Med. 2007;120(7):604–609.
  31. Esquivel A, Meric-Bernstam F, Bernstam EV. Accuracy and self correction of information received from an internet breast cancer list: content analysis. BMJ. 2006;332(7547):939–942.
  32. Nelson S, Hwang KO, Bernstam EV. Comparing clinician knowledge and online information regarding Alli (Orlistat) Int. J. Med. Inform. 2009;78(11):772–777.
  33. Hesse BW, Nelson DE, Kreps GL, Croyle RT, Arora NK, Rimer BK, Viswanath K. Trust and sources of health information: the impact of the internet and its implications for health care providers: findings from the first health information national trends survey. Arch. Intern. Med. 2005;165(22):2618–2624.
  34. Granovetter MS. The strength of weak ties. Am. J. Sociol. 1973;78(6):1360–1380.
  35. Huang J, Yu H, Marin E, Brock S, Carden D, Davis T. Physicians’ weight loss counseling in two public hospital primary care clinics. Acad. Med. 2004;79(2):156–161.
  36. Yarnall KSH, Pollak KI, Ostbye T, Krause KM, Michener JL. Primary care: is there enough time for prevention? Am. J. Public Health. 2003;93:635–641.
  37. Park ER, Wolfe TJ, Gokhale M, Winickoff JP, Rigotti NA. Perceived preparedness to provide preventive counseling: reports of graduating primary care residents at academic health centers. J. Gen. Intern. Med. 2005;20:386–391.
  38. Moore H, Summerbell CD, Greenwood DC, Tovey P, Griffiths J, Henderson M, Hesketh K, Woolgar S, Adamson AJ. Improving management of obesity in primary care: cluster randomised trial. BMJ. 2003;327(7423):1085.
  39. Jackson JE, Doescher MP, Saver BG, Hart LG. Trends in professional advice to lose weight among obese adults 1994 to 2000. J. Gen. Intern. Med. 2005;20:814–818.

Personal Health Education

Research has shown that teaching how to modify lifestyles can have a major role in reducing weight and BMI. Training accompanied by continual follow up could lead to long term sustainable results. Teaching healthy habits and the basics of nutritional, sports science have the advantage of self-empowering the participant to be more proactive in their own decision making towards their own health.

Learning Visually

In using the “Small Steps” approach to education BodMinSou takes larger goals and breaks those goals into bite sized pieces of information. Additionally we teach through imagery and with 65 percent of the population being visual learners, images are an effective way to engage people.

According to Dr. Lynell Burmark,“…unless our words, concepts, ideas are hooked onto an image, they will go in one ear, sail through the brain, and go out the other ear. Words are processed by our short-term memory where we can only retain about seven bits of information (plus or minus 2) […]. Images, on the other hand, go directly into long-term memory where they are indelibly etched.”

One study found that participants retained only 10-20 percent of written or spoken information but almost 65 percent retained visual information. Another study showed that illustrated text was 9 percent more effective than text alone when testing immediate comprehension and 83 percent more effective when the test was delayed.

Personal Programs

Group and team support are critical components to BodMinSou but as each individual may be on a different point in their health journey we provide each participant with their own individual program.

Participants are more in control of the speed, duration and time committed, by having their own program. Having this self-control additionally allows participants to develop habits at a pace that suits them, this increases the potential for sustained longer term health change.

  1. Joo NS, Kim SM, Kim KM, Kim CW, Kim BT, Lee DJ. Changes of body weight and inflammatory markers after 12-Week intervention trial: results of a double-blind, placebo control pilot study. Yonsei Medical Journal. 2011;52(2):242-248.
  2. Huang TT, Harris KJ, Lee RE, Nazir N, Born W, Kaur H. Assessing overweight, obesity, diet, and physical activity in college students. J Am Coll Health. 2003;52(2):83-6.
  3. Adiels M, Taskinen MR, Packard C, Caslake MJ, Soro-Paavonen A, Westerbacka J, et al. Overproduction of large VLDL particles is driven by increased liver fat content in man. Diabetologia. 2006;49(4):755-65.
  4. Despres JP, Lemieux I. Abdominal obesity and metabolic syndrome. Nature. 2006;444(7121):881-7.
  5. Malekzadeh R, Mohamadnejad M, Merat S, Pourshams A, Etemadi A. Obesity pandemic: an Iranian perspective. Arch Iranian Med. 2005;8(1):1-7.
  6. Hofbauer KG, Nicholson JR, Boss O. The obesity epidemic: current and future pharmacological treatments. Annu Rev Pharmacol Toxicol. 2007;47:565-92.
  7. Goodpaster BH, Delany JP, Otto AD, Kuller L, Vockley J, South-Paul JE, et al. Effects of diet and physical activity interventions on weight loss and cardiometabolic risk factors in severely obese adults: a randomized trial. JAMA. 2010;304(16):1795-802.
  8. Appel LJ, Clark JM, Yeh HC, Wang NY, Coughlin JW, Daumit G, et al. Comparative effectiveness of weight-loss interventions in clinical practice. N Engl J Med. 2011;365(21):1959-68.
  9. Hill JO, Hauptman J, Anderson JW, Fujioka K, O’Neil PM, Smith DK, et al. Orlistat, a lipase inhibitor, for weight maintenance after conventional dieting: a 1-y study. Am J Clin Nutr. 1999;69(6):1108-16.
  10. Wadden TA, West DS, Delahanty L, Jakicic J, Rejeski J, Williamson D, et al. The Look AHEAD study: a description of the lifestyle intervention and the evidence supporting it. Obesity (Silver Spring). 2006;14(5):737-52.
  11. Pi-Sunyer F. Clinical guidlines on the identification, evaluation, and treatment of overweight and obesity in adults. National Institutes of Health; 1996.
  12. Lau DC, Douketis JD, Morrison KM, Hramiak IM, Sharma AM, Ur E. 2006 Canadian clinical practice guidelines on the management and prevention of obesity in adults and children [summary]. CMAJ. 2007;176(8):S1-13.
  13. Wadden TA, Volger S, Sarwer DB, Vetter ML, Tsai AG, Berkowitz RI, et al. A two-year randomized trial of obesity treatment in primary care practice. N Engl J Med. 2011;365(21):1969-79.
  14. Wadden TA, Berkowitz RI, Womble LG, Sarwer DB, Phelan S, Cato RK, et al. Randomized trial of lifestyle modification and pharmacotherapy for obesity. N Engl J Med. 2005;353(20):2111-20.