The mind your health project: A randomized controlled trial of an innovative behavioral treatment for obesity

Abstract

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

An initial evaluation of a weight loss intervention for individuals who engage in emotional eating

“…For instance, although the findings of the current pilot study do not suggest that the EBT skills offered any additional benefit beyond those provided in the SBT condition over 20 weeks, it is possible that a longer trial or larger sample size may have produced different results. Importantly, the current study included a larger proportion of AfricanAmerican women (79 %) than the previously described studies of similar interventions or samples (e.g., Niemeier et al, 2012;Forman et al, 2013;Alberts et al, 2012;Daubenmier et al, 2011), which may also account for some of the differences between study findings, particularly given potential differences in weight loss outcomes among African American women (Wingo et al, 2014). There is some evidence to suggest that eating in response to emotions such as feeling stressed, overwhelmed and lonely is a relatively common phenomenon in African-American women with obesity (James 2013), and stressors such as discrimination, occupational stress, and caregiving responsibilities contribute to emotional eating and weight control difficulties in African-American women (Befort et al, 2008;Walcott-McQuigg, 1995).…”

“…While there are no previous randomized trials comparing weight loss interventions for this type of population, the absence of group differences in weight loss in the current study is consistent with findings from several brief randomized trials of weight loss interventions for women with other forms of problematic eating (Alberts et al, 2012;Daubenmier et al, 2011;Manzoni et al, 2009). However, a longer randomized trial with overweight women (not selected for problematic eating) provided some preliminary evidence that an acceptance-based weight loss intervention may be more effective for producing weight loss as compared to a SBT (Forman et al, 2013), suggesting that these types of skills may have a more noticeable effect after longer period of time. Thus, it is possible that mindfulness-and acceptancebased skills are more likely to facilitate successful outcomes in weight-maintenance, an area in which standard behavioral weight loss treatments have historically produced less successful outcomes.…”

“…Two uncontrolled studies of women who were high in emotional or disinhibited eating demonstrated that these types of treatment approaches (i.e., DBT; ACT-informed behavioral weight loss) were associated with decreases in problematic eating and weight (Roosen et al, 2012;Niemeier et al, 2012). Randomized controlled trials of these approaches, or treatments which incorporate strategies consistent with these approaches, have produced reductions in binge eating (e.g., DBT for BED, Robinson & Safer, 2012;MB-EAT, Kristeller et al, 2014) and emotional eating (Robinson & Safer, 2012) in individuals with BED, as well as weight loss in individuals with obesity (i.e., ACT-informed behavioral weight loss, Forman et al, 2013). However, these studies did not directly test these effects in people who are high in emotional eating.…”

Introduction to SMART designs for the development of adaptive interventions: with application to weight loss research

“…Specifically, for individuals who have a history of binge or emotional eating at baseline, the first-stage decision rule recommends 10 weekly sessions on IBT; whereas, for individuals who do not have such a history, the decision rule recommends offering only 5 weekly sessions of IBT. Such baseline tailoring is based on the conjecture that to achieve a meaningful long-term reduction in weight, those who have a history of binge or emotional eating may require more time and treatment; whereas, for those who do not have such a history, it may be better to offer short duration IBT and move them more quickly to a second-stage treatment if they do not respond [51]. Concerning the second-stage decision rule, responders to 5 or 10 weekly sessions of initial IBT are continued on IBT.…”

The Impact of Self-Criticism and Self-Reassurance on Weight-Related Affect and Well-Being in Participants of a Commercial Weight Management Programme

“…Recent relapse prevention models [26,27,28] now include third-wave psychotherapeutic approaches (e.g., Acceptance and Commitment Therapy [29], Mindfulness-Based Cognitive Therapy [30] and Compassion-Focused Therapy (CFT) [31]) because there is growing evidence that learning to accept and manage emotional responses to stresses associated with relapse can create opportunities for behavioural self-regulation [32,33,34,35,36,37]. Self-regulation of behaviour for weight management may be supported by strategies that promote stress management and emotion regulation inter alia through self-reassuring compassionate abilities [8,18,23,33,34,35,38,39,40]. Third-generation behavioural approaches seek to help individuals change their relationship to difficult thoughts, emotions or bodily sensations, rather than trying to change or control them, while engaging in adaptive actions towards effective and sustained behavioural change and well-being [41].…”