Physicians' Academy for Cardiovascular Education

Cognitive behavioral group therapy not better at preventing weight regain after dieting in T2DM

EASD 2017 - Lisbon, Portugal

Sep. 13, 2017 - news

Presented by Kirsten Berk (ErasmusMC, Rotterdam, The Netherlands) at the European Association for the Study of Diabetes (EASD) Annual Meeting in Lisbon, Portugal (11-15 September).

Cognitive behavioral group therapy (CBGT) is no better than standard care at preventing weight regain after dieting in people with type 2 diabetes (T2DM).

According to the International Diabetes Federation (IDF), 80% of people with T2DM are overweight or obese at the time of diagnosis. Losing weight can reduce the risk of long-term cardiovascular illness and even death. However, current weight loss programs for overweight and obese people with T2DM have not been shown to be effective in the long-term. CBGT, which aims to change thought patterns and behaviors, is an effective treatment for anxiety and depression, and is useful for other mental and physical health problems, like eating disorders.

In this study, Dr Kirsten Berk from the ErasmusMC, Rotterdam, the Netherlands and colleagues examined whether CBGT could help people with T2DM ‘keep the weight off’ after dieting. The Prevention of Weight Regain (POWER) trial recruited 206 overweight or obese adults (BMI ≥27 kg/m2) with T2DM from the outpatient diabetes-clinic at the ErasmusMC in the Netherlands. All participants were put on a very low-calorie diet. After 8 weeks, 158 participants had achieved at least 5% weight loss and were randomised to either continue with usual care provided by their physician and diabetes nurse, or to receive CBGT (17 sessions over 18 months) in addition to usual care.

CBGT involved an experienced psychological therapist working with the group to identify and modify unhelpful thought patterns and behaviors around lifestyle, weight, body perception and relapse. The researchers compared the difference in body weight, weight regain, blood glucose, HbA1c, insulin dose, lipids, depression and anxiety between the groups over 2 years.

Two years after the start of treatment, weight regain was similar between the CBGT and usual care groups (control group regained an average 4.7 kg, CBGT group regained an average 4.0 kg). The results also showed that CBGT was no better than standard care at improving cardiovascular risk factors or psychological wellbeing.

The authors conclude: “Negative trials matter because they tell us what doesn’t work, which is as important as what does. Our results provide no scientific justification to offer cognitive behavioral group therapy on top of usual care to optimize the effect of weight loss dieting in obese patients with type 2 diabetes. We urgently need to identify better approaches for long-term weight loss and weight maintenance in people with type 2 diabetes.”

- Our reporting is based on the information provided by the EASD press service -