Acceptance-based versus standard behavioral treatment for obesity: Results from the mind your health randomized controlled trial

Evan M Forman, Meghan L Butryn, Stephanie M Manasse, Ross D Crosby, Stephanie P Goldstein, Emily P Wyckoff, J Graham Thomas, Evan M Forman, Meghan L Butryn, Stephanie M Manasse, Ross D Crosby, Stephanie P Goldstein, Emily P Wyckoff, J Graham Thomas

Abstract

Objective: To evaluate the efficacy, as well as potential moderators and mediators, of a revised acceptance-based behavioral treatment (ABT) for obesity, relative to standard behavioral treatment (SBT).

Methods: Participants with overweight and obesity (n = 190) were randomized to 25 sessions of ABT or SBT over 1 year. Primary outcome (weight), mediator, and moderator measurements were taken at baseline, 6 months, and/or 12 months, and weight was also measured every session.

Results: Participants assigned to ABT attained a significantly greater 12-month weight loss (13.3% ± 0.83%) than did those assigned to SBT (9.8% ± 0.87%; P = 0.005). A condition by quadratic time effect on session-by-session weights (P = 0.01) indicated that SBT had a shallower trajectory of weight loss followed by an upward deflection. ABT participants were also more likely to maintain a 10% weight loss at 12 months (64.0% vs. 48.9%; P = 0.04). No evidence of moderation was found. Results supported the mediating role of autonomous motivation and psychological acceptance of food-related urges.

Conclusions: Behavioral weight loss outcomes can be improved by integrating self-regulation skills that are reflected in acceptance-based treatment, i.e., tolerating discomfort and reduction in pleasure, enacting commitment to valued behavior, and being mindfully aware during moments of decision-making.

Conflict of interest statement

Dr. Forman reports grants from the National Institute for Diabetes and Digestive and Kidney Diseases (award # R01 DK095069), during the conduct of the study. Dr. Crosby reports personal fees from Health Outcome Solutions, outside the submitted work. None of the remaining authors report a conflict of interest.

© 2016 The Obesity Society.

Figures

Figure 1
Figure 1
CONSORT Diagram
Figure 2
Figure 2
Percent weight loss by treatment condition over time
Figure 3
Figure 3
Session-by-session percent weight loss, with time modeled as the independent variable

References

    1. Butryn ML, Webb V, Wadden TA. Behavioral treatment of obesity. The Psychiatric clinics of North America. 2011;34(4):841–859.
    1. Klem ML, et al. A descriptive study of individuals successful at long-term maintenance of substantial weight loss. Am J Clin Nutr. 1997;66(2):239–246.
    1. Brownell KD, Jeffery R. Improving long-term weight loss: Pushing the limits of treatment. Behavior Therapy. 1987;18(4):353–374.
    1. Wilson G. Behavioral treatment of obesity: Thirty years and counting. Advances in Behaviour Research & Therapy. 1994;16(1):31–75.
    1. Weinsier RL, et al. Do adaptive changes in metabolic rate favor weight regain in weight-reduced individuals? An examination of the set-point theory. American Journal of Clinical Nutrition. 2000;72(5):1088–1094.
    1. Lowe MR. Self-Regulation of Energy Intake in the Prevention and Treatment of Obesity: Is It Feasible? Obesity research. 2003;11(S10):44S–59S.
    1. Forman EM, Butryn ML. A new look at the science of weight control: How acceptance and commitment strategies can address the challenge of self-regulation. Appetite. 2015;84:171–180.
    1. Hayes SC, Strosahl KD, Wilson KG. Acceptance and commitment therapy. New York: Guilford Press; 1999.
    1. Robins CJ, Ivanoff AM, Linehan MM. Dialectical behavior therapy. Handbook of personality disorders: Theory, research, and treatment. 2001:437–459.
    1. Marlatt GA, George WH. Relapse prevention: introduction and overview of the model. Br J Addict. 1984;79(3):261–73.
    1. Forman EM, Butryn ML. Mindfulness and Acceptance Approaches to Treatment of Eating Disorders and Weight Concern, in. In: Haynos AF, Lillis J, Forman EM, Butryn ML, editors. Incorporating acceptance approaches into behavioral weight loss treatment. New Harbinger; Oakland, CA: In Press.
    1. Forman EM, et al. A randomized controlled effectiveness trial of acceptance and commitment therapy and cognitive therapy for anxiety and depression. Behavior Modification. 2007;31(6):772–799.
    1. Forman EM, et al. Comparison of acceptance-based and standard cognitive-based coping strategies for craving sweets in overweight and obese women. Eating behaviors. 2013;14(1):64–68.
    1. Hooper N, et al. Comparing thought suppression and acceptance as coping techniques for food cravings. Eat Behav. 2012;13(1):62–4.
    1. Niemeier HM, et al. An acceptance-based behavioral intervention for weight loss: a pilot study. Behav Ther. 2012;43(2):427–35.
    1. Forman EM, et al. An open trial of an acceptance-based behavioral treatment for weight loss. Cognitive and Behavioral Practice. 2009;16:223–235.
    1. Butryn ML, et al. A pilot study of acceptance and commitment therapy for promotion of physical activity. Journal of Physical Activity and Health. 2009;8(4):516–522.
    1. Goodwin CL, et al. A pilot study examining the initial effectiveness of a brief acceptance-based behavior therapy for modifying diet and physical activity among cardiac patients. Behavior modification. 2011:119–217.
    1. Lillis J, et al. Teaching acceptance and mindfulness to improve the lives of the obese: a preliminary test of a theoretical model. Annals of behavioral medicine: a publication of the Society of Behavioral Medicine. 2009;37(1):58–69.
    1. Tapper K, et al. Exploratory randomised controlled trial of a mindfulness-based weight loss intervention for women. Appetite. 2009;52(2):396–404.
    1. Katterman SN, et al. Efficacy of an acceptance-based behavioral intervention for weight gain prevention in young adult women. Journal of Contextual Behavioral Science. 2014;3(1):45–50.
    1. Forman EM, et al. The mind your health project: a randomized controlled trial of an innovative behavioral treatment for obesity. Obesity. 2013;21(6):1119–1126.
    1. Look AHEAD Research Group. The Look AHEAD study: a description of the lifestyle intervention and the evidence supporting it. Obesity (Silver Spring, Md) 2006;14(5):737–752.
    1. Diabetes Prevention Program Research Group. The Diabetes Prevention Program (DPP) description of lifestyle intervention. Diabetes care. 2002;25(12):2165–2171.
    1. Hayes SC, Strosahl KD, Wilson KG. Acceptance and commitment therapy: An experiential approach to behavior change. New York, NY: Guilford Press; 1999.
    1. Levesque CS, et al. Validating the theoretical structure of the Treatment Self-Regulation Questionnaire (TSRQ) across three different health behaviors. Health education research. 2007;22(5):691–702.
    1. Juarascio AS, et al. The development and validation of the food craving acceptance and action questionnaire (FAAQ) Eating Behaviors. 2011:182–187.
    1. Dozois DJA, Dobson KS, Ahnberg JL. A psychometric evaluation of the Beck Depression Inventory - II. Psychological Assessment. 1998;10(2):83–89.
    1. Cappelleri JC, et al. Evaluating the Power of Food Scale in obese subjects and a general sample of individuals: development and measurement properties. International Journal of Obesity. 2009;33(8):913–922.
    1. Lowe MR, et al. The Power of Food Scale. A new measure of the psychological influence of the food environment. Appetite. 2009;53(1):114–118.
    1. Shearin EN, et al. Construct validity of the three-factor eating questionnaire: Flexible and rigid control subscales. International Journal of Eating Disorders. 1994;16(2):187–198.
    1. Stunkard AJ, Messick S. The three-factor eating questionnaire to measure dietary restraint, disinhibition and hunger. J Psychosom Res. 1985;29(1):71–83.
    1. Yeomans MR, Leitch M, Mobini S. Impulsivity is associated with the disinhibition but not restraint factor from the Three Factor Eating Questionnaire. Appetite. 2008;50(2):469–476.
    1. Jensen MD, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. Journal of the American College of Cardiology. 2014;63(25):2985–3023.
    1. Hayes AF. The PROCESS macro for SPSS and SAS. 2015
    1. Franz MJ, et al. Weight-loss outcomes: a systematic review and meta-analysis of weight-loss clinical trials with a minimum 1-year follow-up. Journal of the American Dietetic Association. 2007;107(10):1755–1767.
    1. Butryn ML, et al. A pilot study of acceptance and commitment therapy for promotion of physical activity. J Phys Act Health. 2011;8(4):516–22.
    1. Gregg JA, et al. Improving Diabetes Self-Management Through Acceptance, Mindfulness, and Values: A Randomized Controlled Trial. Journal of Consulting and Clinical Psychology. 2007;75(2):336–343.
    1. Webber KH, et al. Motivation and its relationship to adherence to self-monitoring and weight loss in a 16-week Internet behavioral weight loss intervention. Journal of nutrition education and behavior. 2010;42(3):161–167.
    1. Williams GC, et al. Motivational predictors of weight loss and weight-loss maintenance. Journal of personality and social psychology. 1996;70(1):115–126.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir