Cognitive Behavioural Therapy (CBT) provides obese individuals with a set of principles and techniques to change their dietary habits and encourage an active lifestyle and regular physical activity. The idea began to circulate in the sixties in the United States, and is the most closely monitored type of treatment/cure for obesity in randomised controlled trials [
31]-[
33]. CBT was initially developed based on the premise that learning principles could be a valid tool to correct the dysfunctional behaviour patterns of individuals with weight problems [
34],[
35]. However, after their initial enthusiasm scientists agreed that factors such as genetic predisposition and the biological mechanisms (as cognitive processes) associated with obesity hindered weight loss maintenance and the behaviour acquired during therapy. Some studies have underscored the need to couple the CBT programme with strategies aimed at producing suitable cognitive changes and encouraging achievement of the obesity treatment goals,
i.e., weight loss and weight loss maintenance. Obesity applied CBT focuses on education and involves not only teaching a patient how to eat, but also encouraging him to have an active lifestyle; this will make him aware of the biological, psychological and environmental obstacles to weight loss and weight maintenance; the aim of the programme is to make him his own
therapist. In fact the therapist does not teach the patient how to solve a particular problem, instead he asks him questions with open answers to encourage the patient to find the most appropriate solutions (as part of a Socratic dialogue). Treatment is generally divided into two stages: at the beginning the goal is to loose weight and tackle the obstacles preventing weight loss and weight loss maintenance, then, after 5–6 months, the patient moves to the second stage where the goal is to help patients assume the approach and behaviour best suited to maintaining the results they have achieved. The tools include: self-monitoring of food intake (counting calories), physical exercise (with a pedometer), and weight (weight log). Moreover treatment includes a procedure to identify and discuss possible dysfunctional thoughts, which might induce the patient to drop out of the weight loss programme. In particular during the first sessions, the patient is asked to keep a “Diary of the obstacles to weight loss” to help him understand events, thoughts, emotions and behaviour, and
restructure the thoughts which cause him to overeat. Scientific research on
lifestyle modification to treat obesity has produced positive results as showed by Wadden
et al.[
36]. CBT could be used to make breakfast a daily habit. The reasons why people skip breakfast could be examined using a questionnaire highlighting the obstacles which occurred “often” or “always” (
i.e., lack of time or appetite in the morning), and for which specific solutions could be provided. Strategies to overcome these obstacles could include, for example, education, and mechanical feeding to re-establish normal signs of hunger or fullness or even so-called problem solving. Education can help increase awareness about the importance of breakfast, the prevention of weight problems and insulin resistance, and the improvement of cognitive performance. The best solution is a limited number of short and simple messages encouraging and explaining the importance of breakfast as a way to regulate calorie intake during the day. Mechanical feeding could be one way to solve the problem of appetite loss in the morning (often cited by individuals who skip breakfast). The cognitive behavioural strategy consists in asking the patient to “mechanically” plan his meals ahead of time, either by himself or with a therapist, as if it were a medicine; he should disregard his physiological stimuli, thoughts about food, and ambient situation. Clinically speaking this helps to normalize the often-erratic hunger and fullness mechanisms of an individual with bad eating habits: it also helps to manage his thoughts about food and to collect data about the effects of food intake on weight swings. Problem solving can also be used as a backup to mechanical feeding in order to overcome the obstacles preventing individuals from eating breakfast. This strategy primarily involves identification and specification of the problem, implementation of solutions, and finally analysis of the entire process to establish the consequences of all possible solutions.