Dietary and psychosocial intervention
All volunteers documented their eating behaviour for 3 days before intervention. Based on eating protocols, individual counselling was provided, with the recommendation of a daily calorie intake of 400-600 kcal less than the total energy expenditure. The diet was composed according to the guidelines of the German Association of Nutrition with the following distribution of macronutrients: carbohydrates 50%, fat 30% and protein 20% of the daily energy intake. Meetings for all volunteers took place over the first 6 months once a week in groups consisting of 10-12 participants with participation costs amounting to 450 €. In the first 90 minutes at the first 10 sessions, nutrition-consultants accomplished group workshops with practical cooking exercises. One workshop was provided by a physician with further hints and advise. At all dates, moderate exercise with gymnastics or aqua-fitness was performed during the last 60 minutes. The patients participated on average in 12 60- to 90-minute sessions of interactional group therapy [23]. This type of psychodynamic group therapy requires active treatment by the therapist. He or she uses supportive interventions such as giving advice, and often mirrors the acting-out of group members. Transference onto the therapist in this setting is not an explicit goal. Consequently, interactional group therapy is more adequate for these obese patients attending a weight reduction program and who mostly do not have a primarily psychotherapeutic objective.
In months 7 to 12, the participants had consultations with the nutritionists every 6-8 weeks. Anthropometry was determined in all participants before the dietary intervention and at the end of the program, after 12 months. All measurements were performed as previously described [24].
Dietary and psychosocial intervention
All volunteers documented their eating behaviour for 3 days before intervention. Based on eating protocols, individual counselling was provided, with the recommendation of a daily calorie intake of 400-600 kcal less than the total energy expenditure. The diet was composed according to the guidelines of the German Association of Nutrition with the following distribution of macronutrients: carbohydrates 50%, fat 30% and protein 20% of the daily energy intake. Meetings for all volunteers took place over the first 6 months once a week in groups consisting of 10-12 participants with participation costs amounting to 450 €. In the first 90 minutes at the first 10 sessions, nutrition-consultants accomplished group workshops with practical cooking exercises. One workshop was provided by a physician with further hints and advise. At all dates, moderate exercise with gymnastics or aqua-fitness was performed during the last 60 minutes. The patients participated on average in 12 60- to 90-minute sessions of interactional group therapy [23]. This type of psychodynamic group therapy requires active treatment by the therapist. He or she uses supportive interventions such as giving advice, and often mirrors the acting-out of group members. Transference onto the therapist in this setting is not an explicit goal. Consequently, interactional group therapy is more adequate for these obese patients attending a weight reduction program and who mostly do not have a primarily psychotherapeutic objective.
In months 7 to 12, the participants had consultations with the nutritionists every 6-8 weeks. Anthropometry was determined in all participants before the dietary intervention and at the end of the program, after 12 months. All measurements were performed as previously described [24].
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