OBJECTIVE: To compare treatment effectiveness of psychodynamic and behavioral in-patient treatment of patients with severe obesity. DESIGN: Randomized longitudinal study of obese patients (BMI greater than or equal to 135 kg/m(2)) randomly assigned to behavioral or to psychodynamic psychosomatic rehabilitation. SUBJECTS: Ninety eight, mostly female (88%), obese patients (age 20-64y, BMI 36-74 kg/m(2)). MEASUREMENTS: Standardized self-report scales on distress (SCL-90R), eating behavior (FEV), interpersonal problems (IIP), body image (FKB-20), life satisfaction (IRES). RESULTS: During the 6 weeks of in-patient treatment patients lost an average of 5.4 kg (4.3%) in the behavioral (n = 46) and. 6.2kg (4.7%) in the psychodynamic setting (n = 52). In both settings, a significant improvement was also found for eating behavior, well-being, body image and life satisfaction. Weight reduction was more pronounced for those with a higher weight at onset, more distress in public at admission, and a longer treatment. CONCLUSION: Despite considerable differences in the behavioral vs psychodynamic treatment settings, both were equally effective. However, some common treatment elements were perceived differently by patients in the two settings. Analysis of the follow-up data will hopefully provide evidence as to which patients benefit more from which approach.
