Effectiveness of acceptance and commitment therapy on weight, eating behaviours and psychological outcomes: a systematic review and meta-analysis

Abstract

Purpose To examine the effectiveness of ACT on weight (body mass index and body mass), eating behaviours (binge eating, emotional eating, external eating and restraint eating), and psychological outcomes (quality of life [QoL], depression, psychological flexibility, and weight stigma) among adults with overweight and obesity. Methods Seven electronic databases (CINAHL, EMBASE, PubMed, PsycInfo Scopus, The Cochrane Library, and Web of Science) were searched from inception through 17 June 2022. 13 studies and 48 unique effect sizes were analyzed using random-effects models. Pooled effect estimates were calculated using weighted mean differences (WMD) and standardized mean differences expressed in Hedges’ g (g). Heterogeneity was assessed using Q-statistics and interpreted using I2. Results ACT was found to be effective in improving weight loss in terms of BMI (k = 6, WMD = − .50, 95% CI = − .90; − .11, t = − 3.25, p = .20, I2 = .0%), psychological flexibility and weight-related stigma. However, non-significant changes were found for body mass (k = 4, WMD = − 0.33 95% CI = − 1.53; 0.87, t = − .88, p = .44, I2 = .0%), binge eating (k = 4, g = − .34, 95% CI = − 1.31; 0.62, t = − 1.13, p = .34, I2 = 71.1%), emotional eating (k = 6, g = − .20, 95% CI = − 0.54; 0.15, t = − 1.47, p = .20, I2 = 45.0%), external eating (k = 5, g = − .40, 95% CI = 0.96; 0.16, t = − 1.99, p = .12, I2 = 81.8%), restraint eating (k = 3, g = .22 95% CI = − 0.57; 1.01, t = 1.19, p = .36, I2 = 69.1%), QoL (k = 3, g = .01, 95% CI = − 1.51; 1.52, t = .02, p = .99, I2 = 90.2%) and depression (k = 3, g = − .55, 95% CI = − 1.78; 0.67, t = − 1.94, p = .19, I2 = 79.9%). Conclusion ACT could be effective in improving weight loss but more studies are needed to ascertain its effectiveness and the underlying mechanism by which the various components influence weight-related outcomes. Level of evidence Evidence obtained from a systematic review and meta-analysis of existing empirical studies.

Cognitive Behavioural Therapies for Weight-Loss in Adults: A Scoping Review Protocol

“…Sixteen articles were included in this systematic review, half of which showed that acceptance and commitment therapy effectively addressed health behaviours related to weight control. The results found in the systematic review by Iturbe et al are supported by those found in a very recently published review by Chew et al [ 24 ]. These authors included thirteen studies in their recent systematic review and meta-analysis and showed that acceptance and commitment therapy was effective in achieving weight loss in terms of body mass index.…”

“…In the weight-management context, acceptance and commitment therapy could improve the ability to cope with the negative effects of food cravings and the ability to engage in healthy behaviours that are consistent with one’s values [ 59 ]. Scientific evidence has shown that acceptance and commitment therapy is one of the most effective 3wCBTs for weight loss in the adult population [ 15 ] and, in particular, for the reduction in body mass index [ 24 ]. In contrast, according to some authors, one of the most difficult 3wCBTs to research is functional analytic psychotherapy [ 60 ].…”

“…Currently, there are several published reviews on 3wCBT in patients who are overweight and/or obese [ 13 , 15 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ]. Most of them are aimed at describing the effectiveness of one of the 3wCBTs on weight loss [ 22 , 23 , 24 , 27 ].…”

“…Currently, there are several published reviews on 3wCBT in patients who are overweight and/or obese [ 13 , 15 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ]. Most of them are aimed at describing the effectiveness of one of the 3wCBTs on weight loss [ 22 , 23 , 24 , 27 ]. Sosa-Cordobés et al [ 22 ] carried out a systematic review and meta-analysis aimed at determining the efficacy of mindfulness-based interventions for stress and weight reduction.…”

Occupational Health of Health-Care Workers with Overnutrition: Scoping Review with Meta-Analysis

“…This is similar to the article by Hilbert et al [52], which concluded that group cognitive remediation therapy did not improve weight loss in adults with obesity in comparison with no treatment prior to behavioral therapy for weight loss. However, a current meta-analysis of the effectiveness of acceptance and commitment therapy showed that it may be effective in improving weight loss in terms of BMI [53].…”