Nonclinical programs are popular commercial enterprises that have a structure created by a parent company and weekly meetings conducted by variably trained counselors, supplemented by instructional and guidance materials prepared in consultation with health care professionals. The effectiveness of commercial programs is hard to evaluate because they publish few statistics and have high dropout rates. Nevertheless, their ready availability has made them popular. Physicians can assist patients by helping them select programs with sensible low-fat diets and an emphasis on physical activity. Clinical programs are provided by licensed health care professionals, often as part of a commercial weight loss enterprise but also in solo or group private practice.
Most programs teach clients how to make safe, sensible, and gradual changes in eating patterns.
It is based on behavioral analysis, which considers the behavior to be changed, its antecedents, and its consequences. The primary behavior to be changed is eating, with efforts to slow the rate of eating. The third step is reinforcing these behaviors. Self-monitoring, with detailed record keeping, is used to determine which behaviors should be modified and reinforced. Nutrition education is increasingly important in these programs, as are measures to increase physical activity.