Behavioral approaches to obesity are usually employed in the context of short-term (10-20 wk) treatment interventions. These programs produce weight losses averaging 10 kg at the end of the program and 6.6 kg at 1-y follow-up. Improvements in long-term results may depend on a shift to a chronic disease model of obesity treatment, in which patients remain in ongoing care for extended periods of time. Highly structured diets and supervised exercise warrant further investigation as components of such a chronic disease approach to the treatment of severe obesity.