ObjectiveTo determine whether acceptance-based behavioral treatment (ABT) would result in greater weight loss than standard behavioral treatment (SBT), and whether treatment effects were moderated by interventionist expertise or participants’ susceptibility to eating cues. Recent research suggests that poor long-term weight control outcomes are due to lapses in adherence to weight control behaviors, and that adherence might be improved by enhancing SBT with acceptance-based behavioral strategies.Design and MethodsOverweight participants (n = 128) were randomly assigned to 40 weeks of SBT or ABT.ResultsBoth groups produced significant weight loss and, when administered by experts, weight loss was significantly higher in ABT than SBT at post-treatment (13.17% v. 7.54%) and 6-month follow-up (10.98% v. 4.83%). Moreover, 64% of those receiving ABT from experts (v. 46% for SBT) maintained at least a 10% weight loss by follow-up. Moderation analyses revealed a powerful advantage, at follow-up, of ABT over SBT in those potentially more susceptible to eating cues. For participants with greater baseline depression symptomology, weight loss at follow-up was 11.18% in ABT vs. 4.63% in SBT; other comparisons were 10.51% vs. 6.00% (emotional eating), 8.29% v. 6.35% (disinhibition) and 9.70% v. 4.46% (responsivity to food cues). Mediation analyses produced partial support for theorized food-related psychological acceptance as a mechanism of action.ConclusionsResults offer strong support for the incorporation of acceptance-based skills into behavioral weight loss treatments, particularly among those with greater levels of depression, responsivity to the food environment, disinhibition and emotional eating, and especially when interventions are provided by weight control experts.Trial Registrationclinical trials.gov identifier: NCT00746265

The results indicate that ACT approaches have the potential to promote short-term increases in physical activity.

Weight suppression, the difference between highest past weight and current weight, is a robust predictor of clinical characteristics of bulimia nervosa; however, the influence of weight suppression in anorexia nervosa (AN) has been little studied, and no study to date has investigated the ways in which the relevance of weight suppression in AN may depend upon an individual’s current body mass index (BMI). The present study investigated weight suppression, BMI, and their interaction as cross-sectional and prospective predictors of psychological symptoms and weight in AN. Women with AN completed depression (Beck Depression Inventory-II) and eating disorder symptomatology measures (Eating Disorder Examination Questionnaire and Eating Disorders Inventory-3) at residential treatment admission (N = 350) and discharge (N = 238). Weight suppression and BMI were weakly correlated (r = −.22). At admission, BMI was positively correlated with all symptom measures except Restraint and depression scores. Weight suppression was also independently positively correlated with all measures except Weight Concern and Body Dissatisfaction subscale scores. In analyses examining discharge scores (including admission values as covariates), the admission weight suppression X BMI interaction consistently predicted post-treatment psychopathology. Controlling for weight gain in treatment and age, higher admission weight suppression predicted lower discharge scores (less symptom endorsement) among those with lower BMIs; among those with higher BMIs, higher weight suppression predicted higher discharge scores. These results are the first to demonstrate that absolute and relative weight status are joint indicators of AN severity and prognosis. These findings may have major implications for conceptualization and treatment of AN.

Objective Weight stigma is a chronic stressor that may increase cardiometabolic risk. Some individuals with obesity self-stigmatize (i.e., weight bias internalization; WBI). No study to date has examined whether WBI is associated with metabolic syndrome. Methods Blood pressure, waist circumference, and fasting glucose, triglycerides, and HDL cholesterol were measured at baseline in 178 adults with obesity enrolled in a weight-loss trial. Medication use for hypertension, dyslipidemia, and pre-diabetes was included in criteria for metabolic syndrome. One hundred fifty-nine participants (88.1% female, 67.3% black, mean BMI=41.1kg/m2) completed the Weight Bias Internalization Scale and Patient Health Questionnaire (PHQ-9, to assess depressive symptoms). Odds ratios and partial correlations were calculated adjusting for demographics, BMI, and PHQ-9 scores. Results Fifty-one participants (32.1%) met criteria for metabolic syndrome. Odds of meeting criteria for metabolic syndrome were greater among participants with higher WBI, but not when controlling for all covariates (OR=1.46, 95% CI=1.00–2.13, P=.052). Higher WBI predicted greater odds of having high triglycerides (OR=1.88, 95% CI=1.14–3.09, P=0.043). Analyzed categorically, high (versus low) WBI predicted greater odds of metabolic syndrome and high triglycerides (Ps<.05). Conclusions Individuals with obesity who self-stigmatize may have heightened cardiometabolic risk. Biological and behavioral pathways linking WBI and metabolic syndrome require further exploration.

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