Can CBT help type 2 diabetes and obesity patients implement lifestyle alterations?

By Shanet Susan AlexAug 9 2023Reviewed by Sophia Coveney

In an article published in Scientific Reports, researchers examine the impact of cognitive behavioral therapy (CBT) on lifestyle changes among type 2 diabetes and obesity patients.

Background

Chronic, non-communicable diseases, like diabetes, obesity, cancers, cardiovascular diseases, respiratory diseases, and chronic kidney diseases, are accountable for a significant number of global deaths.

Consuming unhealthy foods, alcohol use, physical inactivity, and tobacco use are substantial behavioral hazards for chronic diseases. Lifestyle modifications and weight loss counseling benefit greatly from CBT and behavioral treatment. Furthermore, CBT interventions are effective in weight maintenance, weight loss, and eating disorder management.

There are several studies on CBT and lifestyle modifications across chronic disease patients. Nonetheless, research comparing CBT effectiveness with non-active control cohorts is sparse.

About the study

In the present systematic literature review, the researchers evaluated the efficacy of CBT in lifestyle modification implementation in patients with chronic diseases and obesity, emphasizing the health advantages attained and the long-term improvements made.

They performed a comprehensive literature search leveraging various databases like PubMed and search terms to identify relevant studies on CBT, lifestyle modifications, and chronic diseases following preferred reporting items in systematic review and meta-analyses (PRISMA) guidelines.

Randomized controlled trials comparing CBT treatments to inactive control groups and published in English-language academic journals with adult subjects with obesity or chronic non-communicable diseases met the inclusion criteria for the present research. The systematic literature review included 86 studies that met the inclusion criteria after the screening procedure, which examined article abstracts, titles, and full texts. 

The quality of the included articles was evaluated using the Cochrane Collaboration's risk of bias tool, assessing biases associated with randomization, outcome measurement, missing outcome information, deviations from interventions, selection of documented results, and general bias. The grades of recommendation, assessment, development, and evaluation (GRADE) framework was used to determine the strength of the findings.

The team assessed health-associated outcomes such as body mass index (BMI) shifts, weight loss, glycated hemoglobin (HbA1c) level alterations, and BMI change following an active weight loss strategy (weight maintenance). Behavioral outcomes such as eating behaviors, smoking, physical activity, and treatment compliance in type 2 diabetes were examined.

A meta-analysis was performed on studies with suitable outcomes according to proper reporting, followed by subgroup analyses conducted based on individual study outcomes categorized as weight maintenance, weight loss, and diabetes management.

Results

The study excluded chronic renal disease and concentrated on type 2 diabetes and obesity. A total of 902 subjects from nine research, split into intervention and control cohorts, were included in the current research. While the control groups got no specific treatment or conventional care, the intervention group received CBT with different strategies. Further, the measured outcomes included BMI, weight, body composition, psychological variables, and diabetes control.

Although there were some issues with missing outcome information, the selection of documented results, and randomization, the trials generally performed well considering outcome assessments and deviations from interventions.

CBT interventions significantly impacted weight loss among intervention groups. Similarly, CBT improved weight maintenance in the intervention cohorts. A meta-analysis of all nine studies revealed that the general effect size of CBT interventions was medium and substantial.

In addition, CBT interventions showed positive impacts on lowering energy consumption, selecting healthier carbohydrate sources, and diet quality. Type 2 diabetes patients receiving CBT interventions showed improvements in blood glucose self-monitoring and medication adherence.

CBT resulted in improved physical activity, such as moderate to heavy daily activities and daily steps. It was also efficient in enhancing intentions to quit smoking, lowering smoking rates, and reducing depression ratings across multiple studies.

Conclusions

Overall, the current review of studies on the effectiveness of CBT in lifestyle change relative to the usual-care control cohorts demonstrated moderate effectiveness of CBT interventions in implementing lifestyle alterations and obesity treatment. Future studies are required to reach more definitive conclusions regarding the efficacy of CBT interventions for diabetes management.

Future studies on CBT therapy for weight reduction and maintenance should target long-term weight maintenance, tailor interventions for obesity control, use large sample sizes, and evaluate the length of beneficial CBT sessions. Moreover, certified CBT therapists trained in obesity management should deliver these interventions.