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

E M Forman, M L Butryn, A S Juarascio, L E Bradley, M R Lowe, J D Herbert, J A Shaw, E M Forman, M L Butryn, A S Juarascio, L E Bradley, M R Lowe, J D Herbert, J A Shaw

Abstract

Objective: To 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 methods: Overweight participants (n = 128) were randomly assigned to 40 weeks of SBT or ABT.

Results: Both groups produced significant weight loss, and when administered by experts, weight loss was significantly higher in ABT than SBT at post-treatment (13.17% vs. 7.54%) and 6-month follow-up (10.98% vs. 4.83%). Moreover, 64% of those receiving ABT from experts (vs. 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 versus 4.63% in SBT; other comparisons were 10.51% versus 6.00% (emotional eating), 8.29% versus 6.35% (disinhibition), and 9.70% versus 4.46% (responsivity to food cues). Mediation analyses produced partial support for theorized food-related psychological acceptance as a mechanism of action.

Conclusions: Results 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 registration: ClinicalTrials.gov NCT00746265.

Conflict of interest statement

Note: The first author had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. In addition, the authors declared no conflict of interest.

Copyright © 2013 The Obesity Society.

Figures

Figure 1
Figure 1
Participant recruitment, withdrawals, and collection of weight measurements through 6- month follow-up N/A
Figure 2
Figure 2
Weight loss by treatment group when treatment provided by expert clinicians N/A
Figure 3
Figure 3
Weight loss at 6-month follow-up among those at higher levels of hypothesized moderators Note: * indicates statistical significance at the p < .05 level.

References

    1. Klem ML, Wing RR, McGuire MT, Seagle HM, Hill JO. 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 RW. 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. Butryn ML, Webb V, Wadden TA. Behavioral treatment of obesity. Psychiatr Clin North Am. 2011;34(4):841–859.
    1. Weinsier RL, Nagy TR, Hunter GR, Darnell BE, Hensrud DD, Weiss HL. 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. Abramowitz JS, Tolin DF, Street GP. Paradoxical effects of thought suppression: a meta-analysis of controlled studies. Clinical Psychology Review. 2001;21(5):683–703.
    1. Osman M. An evaluation of dual-process theories of reasoning. Psychonomic bulletin & review. 2004;11(6):988–1010.
    1. Ward A, Mann T. Don’t mind if I do: disinhibited eating under cognitive load. Journal of personality and social psychology. 2000;78(4):753–763.
    1. Linehan MM. Cognitive-behavioral treatment of borderline personality disorder. Guilford Press; New York: 1993.
    1. Marlatt GA, George WH. Relapse prevention: introduction and overview of the model. British journal of addiction. 1984;79(3):261–273.
    1. Hayes S, Strosahl K, Wilson K. Acceptance and commitment therapy: An experiential approach to behavior change. Guilford Press; New York: 1999.
    1. Forman E, Herbert J. New directions in cognitive behavior therapy: Acceptance-based therapies. In: O’Donohue W, Fisher JE, editors. General principles and empirically supported techniques in cognitive behavior therapy. Wiley; Hoboken: 2009. pp. 77–101.
    1. Wansink B. Mindless Eating: Why We Eat More Than We Think. Bantam; New York: 2006.
    1. Metcalfe J, Mischel W. A hot/cool-system analysis of delay of gratification: dynamics of willpower. Psychological review. 1999;106(1):3–19.
    1. Forman EM, Hoffman K, McGrath KB, Herbert J, Brandsma L, Lowe MR. A comparison of acceptance- and control-based strategies for coping with food cravings: An analog study. Behav Res Ther. 2007;45(10):2372–2386.
    1. Forman E, Hoffman K, Juarascio A, Butryn M, Herbert J. Comparison of acceptance-based and standard cognitive-based coping strategies for craving sweets in overweight and obese women. Under review.
    1. Hooper N, Sandoz EK, Ashton J, Clarke A, McHugh L. Comparing thought suppression and acceptance as coping techniques for food cravings. Eating behaviors. 2012;13(1):62–64.
    1. Lillis J, Hayes SC, Bunting K, Masuda A. Teaching acceptance and mindfulness to improve the lives of the obese: a preliminary test of a theoretical model. Ann Behav Med. 2009;37(1):58–69.
    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(2):396–404.
    1. Niemeier HM, Leahey T, Palm Reed K, Brown RA, Wing RR. An acceptance-based behavioral intervention for weight loss: a pilot study. Behavior therapy. 2012;43(2):427–435.
    1. Forman EM, Butryn M, Hoffman KL, Herbert JD. An open trial of an acceptance-based behavioral treatment for weight loss. Cognitive and Behavioral Practice. 2009;16:223–235.
    1. Butryn ML, Forman EM, Hoffman KL, Shaw JA, Juarascio AS. A pilot study of acceptance and commitment therapy for promotion of physical activity. J Phys Act Health. 2011;8(4):516–522.
    1. Arch JJ, Eifert GH, Davies C, Vilardaga JC, Rose RD, Craske MG. Randomized Clinical Trial of Cognitive Behavioral Therapy (CBT) Versus Acceptance and Commitment Therapy (ACT) for Mixed Anxiety Disorders. Journal of consulting and clinical psychology. 2012
    1. Forman EM, Chapman JE, Herbert JD, Goetter EM, Yuen EK, Moitra E. Using session-by-session measurement to compare mechanisms of action for acceptance and commitment therapy and cognitive therapy. Behavior therapy. 2012;43(2):341–354.
    1. Brownell KD. The LEARN program for weight management. American Health; Dallas: 2000.
    1. University of Pittsburgh. [Accessed November 8, 2007]; .
    1. Deci E, Ryan RM. Intrinsic motivation and self-determination in human behavior. Plenum; New York: 1985.
    1. Marlatt GA, Kristeller JL. Mindfulness and meditation. In: Miller WR, editor. Integrating Spirituality in Treatment. American Psychological Association; Washington, DC: 1999. pp. 67–84.
    1. Frisch MB, Cornell J, Villanueva M, Retzlaff P. Clinical validation of the Quality of Life Inventory. Psychological Assessment. 1992;4:92–101.
    1. Lowe MR, Butryn ML, Didie ER, 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. Steer RA, Cavalieri TA, Leonard DM, Beck AT. Use of the Beck Depression Inventory for Primary Care to screen for major depression disorders. Gen Hosp Psychiatry. 1999;21(2):106–111.
    1. Arnow B, Kenardy J, Agras WS. The Emotional Eating Scale: the development of a measure to assess coping with negative affect by eating. The International journal of eating disorders. 1995;18(1):79–90.
    1. Cappelleri JC, Bushmakin AG, Gerber RA, et al. Psychometric analysis of the Three-Factor Eating Questionnaire-R21: results from a large diverse sample of obese and non-obese participants. Int J Obes (Lond) 2009;33(6):611–620.
    1. Juarascio A, Forman E, Timko CA, Butryn M, Goodwin C. The development and validation of the food craving acceptance and action questionnaire (FAAQ) Eating behaviors. 2011;12(3):182–187.
    1. Wing RR, Tate DF, Gorin AA, Raynor HA, Fava JL. A self-regulation program for maintenance of weight loss. The New England journal of medicine. 2006;355(15):1563–1571.
    1. Hayes A. An analytic primer and computational tool for observed variable moderation, mediation, and conditional process modeling. 2012. Manuscript submitted for publication.
    1. Timmerman GM, Brown A. The effect of a mindful restaurant eating intervention on weight management in women. Journal of nutrition education and behavior. 2012;44(1):22–28.
    1. Gifford EV, Lillis J. Avoidance and inflexibility as a common clinical pathway in obesity and smoking treatment. Journal of health psychology. 2009;14(7):992–996.
    1. Niemeier HM, Phelan S, Fava JL, Wing RR. Internal disinhibition predicts weight regain following weight loss and weight loss maintenance. Obesity (Silver Spring) 2007;15(10):2485–2494.
    1. Butryn ML, Thomas JG, Lowe MR. Reductions in internal disinhibition during weight loss predict better weight loss maintenance. Obesity (Silver Spring) 2009;17(5):1101–1103.

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren