Randomized trial of Tapas Acupressure Technique for weight loss maintenance

Charles R Elder, Christina M Gullion, Lynn L Debar, Kristine L Funk, Nangel M Lindberg, Cheryl Ritenbaugh, Gayle Meltesen, Cherri Gallison, Victor J Stevens, Charles R Elder, Christina M Gullion, Lynn L Debar, Kristine L Funk, Nangel M Lindberg, Cheryl Ritenbaugh, Gayle Meltesen, Cherri Gallison, Victor J Stevens

Abstract

Background: Obesity is an urgent public health problem, yet only a few clinical trials have systematically tested the efficacy of long-term weight-loss maintenance interventions. This randomized clinical trial tested the efficacy of a novel mind and body technique for weight-loss maintenance.

Methods: Participants were obese adults who had completed a six-month behavioral weight-loss program prior to randomization. Those who successfully lost weight were randomized into either an experimental weight-loss maintenance intervention, Tapas Acupressure Technique (TAT®), or a control intervention comprised of social-support group meetings (SS) led by professional facilitators. TAT combines self-applied light pressure to specific acupressure points accompanied by a prescribed sequence of mental steps. Participants in both maintenance conditions attended eight group sessions over six months of active weight loss maintenance intervention, followed by an additional 6 months of no intervention. The main outcome measure was change in weight from the beginning of the weight loss maintenance intervention to 12 months later. Secondary outcomes were change in depression, stress, insomnia, and quality of life. We used analysis of covariance as the primary analysis method. Missing values were replaced using multiple imputation.

Results: Among 285 randomized participants, 79% were female, mean age was 56 (standard deviation (sd) = 11), mean BMI at randomization was 34 (sd = 5), and mean initial weight loss was 9.8 kg (sd = 5). In the primary outcome model, there was no significant difference in weight regain between the two arms (1.72 kg (se 0.85) weight regain for TAT and 2.96 kg (se 0.96) weight regain for SS, p < 0.097) Tests of between- arm differences for secondary outcomes were also not significant. A secondary analysis showed a significant interaction between treatment and initial weight loss (p < .036), with exploratory post hoc tests showing that greater initial weight loss was associated with more weight regain for SS but less weight regain for TAT.

Conclusions: The primary analysis showed no significant difference in weight regain between TAT and SS, while secondary and post hoc analyses indicate direction for future research.

Trial registration: ClinicalTrials.gov NCT00526565.

Figures

Figure 1
Figure 1
Study Design.
Figure 2
Figure 2
The TAT pose.
Figure 3
Figure 3
Flow of Study Participants.
Figure 4
Figure 4
Relationship of initial weight loss to weight regain, by treatment arm.

References

    1. Sharpe PA, Blanck HM, Williams JE, Ainsworth BE, Conway JM. Use of complementary and alternative medicine for weight control in the United States. J Altern Complement Med. 2007;13:217–222. doi: 10.1089/acm.2006.6129.
    1. Barnes PM, Bloom B, Nahin RL. Complementary and alternative medicine use among adults and children: United States, 2007. Natl Health Stat Report. 2008;12:1–23.
    1. McFarland B, Bigelow D, Zani B, Newsom J, Kaplan M. Complementary and alternative medicine use in Canada and the United States. Am J Public Health. 2002;92:1616–1618. doi: 10.2105/AJPH.92.10.1616.
    1. Cho SH, Lee JS, Thabane L, Lee J. Acupuncture for obesity: a systematic review and meta-analysis. [Review] [72 refs] Int J Obes (Lond) 2009;33:183–196. doi: 10.1038/ijo.2008.269.
    1. Ernst E. Acupuncture/acupressure for weight reduction? A systematic review. Wien Klin Wochenschr. 1997;109:60–62.
    1. Pittler MH, Ernst E. Complementary therapies for reducing body weight: a systematic review. Int J Obes (Lond) 2005;29:1030–1038. doi: 10.1038/sj.ijo.0803008.
    1. Evans M, Straus S. Ripe for study: complementary and alternative treatments for obesity. Crit Rev Food Sci Nutr. 2001;41:35–37. doi: 10.1080/20014091091698.
    1. Shumaker SA, Schron EB, Ockene JK, McBee WL. The handbook of health behavior change. 2. New York, NY: Springer Publishing Company, Inc; 1998.
    1. Ludwig DS, Pereira MA, Kroenke CH, Hilner JE, Van Horn L, Slattery ML, Jacobs DR Jr. Dietary fiber, weight gain, and cardiovascular disease risk factors in young adults. JAMA. 1999;282:1539–1546. doi: 10.1001/jama.282.16.1539.
    1. Tapper K, Shaw C, Ilsley J, Hill AJ, Bond FW, Moore L. Exploratory randomised controlled trial of a mindfulness-based weight loss intervention for women. Appetite. 2009;52:396–404. doi: 10.1016/j.appet.2008.11.012.
    1. Flegal KM, Carroll MD, Ogden CL, Johnson CL. Prevalence and trends in obesity among US adults, 1999-2000. JAMA. 2002;288:1723–1727. doi: 10.1001/jama.288.14.1723.
    1. Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity among US adults, 1999-2008. JAMA. 2010;303:235–241. doi: 10.1001/jama.2009.2014.
    1. Wadden TA, Butryn ML. Behavioral treatment of obesity. Endocrinol Metab Clin North Am. 2003;32:981–1003. doi: 10.1016/S0889-8529(03)00072-0. x.
    1. Jeffery RW, Drewnowski A, Epstein LH, Stunkard AJ, Wilson GT, Wing RR, Hill DR. Long-term maintenance of weight loss: current status. Health Psychol. 2000;19:5–16.
    1. Wing RR, Phelan S. Long-term weight loss maintenance. Am J Clin Nutr. 2005;82:222S–225S.
    1. Hill JO, Thompson H, Wyatt H. Weight maintenance: what's missing? J Am Diet Assoc. 2005;105:S63–S66.
    1. Wadden TA, Butryn ML, Byrne KJ. Efficacy of lifestyle modification for long-term weight control. Obes Res. 2004;12:151S–162S.
    1. Wadden TA, Crerand CE, Brock J. Behavioral treatment of obesity. Psychiatr Clin North Am. 2005;28:151–170. doi: 10.1016/j.psc.2004.09.008. ix.
    1. Dansinger ML, Tatsioni A, Wong JB, Chung M, Balk EM. Meta-analysis: the effect of dietary counseling for weight loss. Ann Intern Med. 2007;147:41–50.
    1. Turk MW, Yang K, Hravnak M, Sereika SM, Ewing LJ, Burke LE. Randomized clinical trials of weight loss maintenance: a review. J Cardiovasc Nurs. 2009;24:58–80.
    1. Svetkey LP, Stevens VJ, Brantley PJ, Appel LJ, Hollis JF, Loria CM, Vollmer WM, Gullion CM, Funk K, Smith P, Samuel-Hodge C, Myers V, Lien LF, Laferriere D, Kennedy B, Jerome GJ, Heinith F, Harsha DW, Evans P, Erlinger TP, Dalcin AT, Coughlin J, Charleston J, Champagne CM, Bauck A, Ard JD, Aicher K. Comparison of strategies for sustaining weight loss: the weight loss maintenance randomized controlled trial. JAMA. 2008;299:1139–1148. doi: 10.1001/jama.299.10.1139.
    1. Callahan RJ. Tapping the Healer Within: Using Thought Field Therapy to Instantly Conquer Your Fears, Anxieties, and Emotional Distress. Chicago, Illinois: Contemporary Books; 2001.
    1. Craig G. The EFT Manual. Santa Rosa, California: Energy Psychology Press; 2011.
    1. Fleming T. You can heal now: the Tapas Acupressure Technique (TAT) Redondo Beach, CA: TAT International; 1996.
    1. Feinstein D. Energy psychology: a review of the preliminary evidence. Psychother Theor Res Pract Train. 2008;45:199–213.
    1. Jarrett L. The Clinical Practice of Chinese Medicine. Stockbridge, MA: Spirit Press; 2003.
    1. Elder C, Ritenbaugh C, Mist S, Aickin M, Schneider J, Zwickey H, Elmer P. Randomized trial of two mind-body interventions for weight-loss maintenance. J Altern Complement Med. 2007;13:67–78. doi: 10.1089/acm.2006.6237.
    1. Elder C, Gallison C, Lindberg N, Debar L, Funk K, Ritenbaugh CK, Stevens V. Randomized Trial of Tapas Acupressure for Weight Loss Maintenance: Rationale and Study Design. J Altern Complement Med. 2010;16:683–690. doi: 10.1089/acm.2009.0454.
    1. Brantley PJ, Appel LJ, Hollis JF, Stevens VJ, Ard J, Champagne CM, Elmer PJ, Harsha DW, Myers VH, Proschan MA, Vollmer WM, Svetkey LP. Weight Loss Maintenance (WLM): Design and Rationale of a Multi-Center Trial to Sustain Weight Loss. J Soc Clin Trials. 2008;5:546–556. doi: 10.1177/1740774508096315.
    1. Svetkey LP, Harsha DW, Vollmer WM, Stevens VJ, Obarzanek E, Elmer PJ, Lin PH, Champagne C, Simons-Morton DG, Aickin M, Proschan MA, Appel LJ. Premier: a clinical trial of comprehensive lifestyle modification for blood pressure control: rationale, design and baseline characteristics. Ann Epidemiol. 2003;13:462–471. doi: 10.1016/S1047-2797(03)00006-1.
    1. Funk KL, Elmer PJ, Stevens VJ, Harsha DW, Craddick SR, Lin PH, Young DR, Champagne CM, Brantley PJ, McCarron PB, Simons-Morton DG, Appel LJ. PREMIER-a trial of lifestyle interventions for blood pressure control: intervention design and rationale. Health Promot Pract. 2008;9:271–280.
    1. Elder CR, Gullion CM, Funk KL, Debar LL, Lindberg NM, Stevens VJ. Impact of sleep, screen time, depression and stress on weight change in the intensive weight loss phase of the LIFE study. Int J Obes (Lond) 2012;36:86–92. doi: 10.1038/ijo.2011.60.
    1. Hollis JF, Gullion CM, Stevens VJ, Brantley PJ, Appel LJ, Ard JD, Champagne CM, Dalcin A, Erlinger TP, Funk K, Laferriere D, Lin PH, Loria CM, Samuel-Hodge C, Vollmer WM, Svetkey LP. Weight loss during the intensive intervention phase of the weight-loss maintenance trial. Am J Prev Med. 2008;35:118–126. doi: 10.1016/j.amepre.2008.04.013.
    1. Bastien CH, Vallieres A, Morin CM. Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Med. 2001;2:297–307. doi: 10.1016/S1389-9457(00)00065-4.
    1. Cohen S, Williamson GM. In: The social psychology of health. Spacapan S, Oskamp S, editor. Newbury Park, CA: Sage; 1988. Perceived stress in a probability sample of the United States.
    1. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24:385–396. doi: 10.2307/2136404.
    1. Kroanke K, Spitzer RL. The PHQ-9: A new depression diagnostic and severity measure. Psychiatr Ann. 2002;32:1–7.
    1. Bech P. Social functioning: should it become an endpoint in trials of antidepressants? CNS Drugs. 2005;19:313–324. doi: 10.2165/00023210-200519040-00004.
    1. Schafer JL. Analysis of incomplete multivariate data. Boca Raton, FL: Chapman & Hall/CRC; 1997.
    1. Kirk R. Experimental design: Procedures for the behavioral sciences. Belmont, CA: Brooks/Cole Publishing; 1968.
    1. Milliken GA, Johnson DE. Analysis of messy data. Boca Raton, FL: Chapman & Hall/CRC; 2002.
    1. Kleinbaum DG, Kupper LL, Nizam A, Muller KE. Applied regression analysis and other multivariable methods. Belmont, Ca: Thomson/Brooks/Cole; 2008.
    1. Kraemer HC, Kiernan M, Essex M, Kupfer DJ. How and why criteria defining moderators and mediators differ between the Baron & Kenny and MacArthur approaches. Health Psychol. 2008;27:S101–S108.
    1. Svetkey LP, Stevens V. personal communication. 2011.
    1. Koithan M, Verhoef M, Bell IR, White M, Mulkins A, Ritenbaugh C. The process of whole person healing: "unstuckness" and beyond. J Altern Complement Med. 2007;13:659–668. doi: 10.1089/acm.2007.7090.
    1. Elder C, Aickin M, Bell IR, Fonnebo V, Lewith GT, Ritenbaugh C, Verhoef M. Methodological challenges in whole systems research. J Altern Complement Med. 2006;12:843–850. doi: 10.1089/acm.2006.12.843.
    1. Ritenbaugh C, Verhoef M, Fleishman S, Boon H, Leis A. Whole systems research: a discipline for studying complementary and alternative medicine. Altern Ther Health Med. 2003;9:32–36.
    1. Stevens VJ, Obarzanek E, Cook NR, Lee IM, Appel LJ, Smith D, Milas NC, Mattfeldt-Beman M, Belden L, Bragg C, Millstone M, Raczynski J, Brewer A, Singh B, Cohen J. for the Trials of Hypertension Prevention Research Group. Long-term weight loss and changes in blood pressure: Results of the trials of hypertension prevention, phase II. Ann Intern Med. 2001;134(1):1–11.
    1. Diabetes Prevention Program Research Group. Reduction of the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393–403.
    1. Pahor M, Williamson JD, Messier SP, Loeser RF, Miller GD, Morgan TM, Rejeski WJ, Sevick MA, Ettinger WH Jr. Exercise and dietary weight loss in overweight and obese older adults with knee osteoarthritis: the Arthritis, Diet, and Activity Promotion Trial. Arthritis Rheum. 2004;50:1501–1510. doi: 10.1002/art.20256.

Source: PubMed

3
Abonner