Treatment matching for obesity: identifying mediators of psychosocial and behavioral intervention components

In light of the limited long-term success of obesity treatments, it is tempting to consider the elusive goal of 'treatment matching', in which characteristics of individuals are optimally matched to targeted treatments to improve success. Previous frameworks for treatment matching in obesity have primarily focused on basic physiological characteristics, such as initial degree of overweight, and on treatment intensity, such as stepped-care alternatives (self-help manuals, group support, medication and surgery). Few studies have empirically evaluated the success of these frameworks. Given recent advances in genomics, neuroscience and other fields, both the breadth of domains and combinations of individuals' characteristics that could be used for treatment matching have increased markedly. Although the obesity field seems poised to build on these advances, a crucial challenge remains regarding the treatments themselves. Ultimately, the success of treatment matching will rely on identifying treatment intervention components with well-differentiated and empirically supported mediators, that is, clear insights into how intervention components work. Here we examine the scope of this challenge specifically for the design of efficacious psychosocial and behavioral intervention components, and identify areas for future research.