ArticlePDF Available

Acceptance-Based Versus Standard Behavioral Treatment for Obesity: Results from the Mind Your Health Randomized Controlled Trial


Abstract and Figures

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.
Content may be subject to copyright.
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
, and J. Graham Thomas
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 (n5190) were randomized to 25 sessions of ABT or
SBT over 1 year. Primary outcome (weight), mediator, and moderator measurements were taken at base-
line, 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% 6
0.83%) than did those assigned to SBT (9.8% 60.87%; P50.005). A condition by quadratic time effect
on session-by-session weights (P50.01) 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%; P50.04). 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.
Obesity (2016) 24, 2050–2056. doi:10.1002/oby.21601
Behavioral weight loss interventions produce weight losses averaging
about 5% to 8% at the end of a 12-month intervention (1). While these
outcomes are robust, a substantial proportion of participants do not
achieve clinically significant benefits, and participants lose consider-
ably less weight than individuals whose adherence to dietary prescrip-
tions is ensured via a controlled environment (2,3). The suboptimal
outcomes of behavioral weight control programs are primarily attrib-
utable to an inability to meet and/or maintain prescribed dietary intake
and physical activity goals, i.e., to inadherence (4,5).
Adherence to healthy eating and physical activity goals depends on the
ability to self-regulate in the face of biological predispositions (e.g., a
drive to consume high-calorie food) and the pervasive cues (e.g., the
presence of food, television, cravings, anxiety, boredom) that facilitate
overeating and sedentary behavior (6). Standard behavioral interventions
for weight loss do not intensively focus on developing skills that teach
individuals how to override drives and urges for pleasure or comfort,
which may help explain why most individuals lose less weight than
desired. Given the pervasive obesogenic food environment, urges and
desires to consume calorie-dense, palatable food likely persist for most
individuals seeking weight loss.
Acceptance-based behavioral interventions infuse behavioral treat-
ment with strategically chosen self-regulation skills that are adapted
primarily from Acceptance and Commitment Therapy (ACT) (7) but
also from Dialectical Behavior Therapy (8) and Relapse Prevention
for Substance Abuse (9). These self-regulation skills include an
Department of Psychology, Drexel University, Philadelphia, Pennsylvania, USA. Correspondence: Evan M. Forman (
Neuropsychiatric Research Institute, Fargo, North Dakota, USA
Department of Psychiatry and Behavioral Science, University of North Dakota School of
Medicine and Health Sciences, Fargo, North Dakota, USA
Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown
University, Providence, Rhode Island, USA.
See commentary, pg 2029.
Funding agencies: The Mind Your Health project was funded by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases (award R01
DK095069) (to EMF).
Disclosure: EMF and MLB report authorship of books on acceptance-based approaches, published by New Harbinger and Oxford University Press. RDC reports
personal fees from Health Outcome Solutions, outside the submitted work. The other authors declared no conflict of interest.
Author contributions: EMF, MLB, RDC, and JGT designed the study. EMF, MLB, SMM, SPG, and EPW collected data. RDC and SMM conducted data analysis. EMF, MLB,
SMM, SPG, and EPW wrote the initial draft of the paper. All authors were involved in revising the paper and had final approval of the submitted and published versions.
Clinical trial registration: identifer NCT01854320.
Received: 2 March 2016; Accepted: 1 June 2016; Published online 27 September 2016. doi:10.1002/oby.21601
2050 Obesity |VOLUME 24 | NUMBER 10 | OCTOBER 2016
Original Article
ability to tolerate uncomfortable internal states (e.g., urges, cravings,
and negative emotions) and a reduction of pleasure (e.g., choosing
to exercise instead of watch TV), behavioral commitment to clearly
defined values (which is posited to increase motivation to persist in
difficult weight control behaviors), and metacognitive awareness of
decision-making processes (6,10). This collection of skills is meant
to facilitate adherence to behavioral recommendations for weight
loss despite the challenges posed by biological predispositions and
cues that push individuals to engage in unhealthy behaviors (or
nonbehaviors) that impede weight control.
Treatments based on acceptance-based principles have shown prom-
ise in analog studies [e.g., abstaining from craved, high-calorie foods
(11,12)] and uncontrolled trials (13-16). Several randomized con-
trolled trials also provide support. In one study, individuals complet-
ing a self-selected weight loss program who were randomized to an
ACT-based 1-day workshop intervention continued to lose weight in
the months that followed, whereas those randomized to a wait list
control experienced weight regain (17). In another trial, women
randomized to ACT-based workshops lost more weight than partici-
pants assigned to a control condition (18). In addition, university
students at risk for weight gain assigned to 8 h of acceptance-based
behavioral intervention experienced weight loss, but those assigned
to a control exhibited weight gain (19).
Only one published trial to date has compared acceptance-based
behavioral treatment (ABT) of obesity to a gold standard behavioral
weight loss intervention. The Mind Your Health (MYH) project (20)
randomized 128 participants with overweight or obesity to receive
30 sessions of group-based ABT or standard behavioral treatment
(SBT) over the course of 40 weeks. Both interventions included the
core components of behavioral treatment, e.g., prescriptions for
calorie intake and physical activity, self-monitoring of food intake,
stimulus control, and problem solving. At post-treatment and at a
6-month follow-up, the advantage of ABT was only statistically
significant for participants who received the treatment from weight
loss experts (vs. student trainees) and for participants with particular
vulnerabilities to internal and external cues for overeating, i.e.,
mood disturbance, elevated responsivity to food cues, and high
disinhibition. For example, in the expert-led groups, mean ABT
weight loss at follow-up was 11% versus 4.8% for SBT. Participants
with greater baseline depressive symptomology lost 11.2% of body
weight in ABT versus 4.6% in SBT.
Despite the promise demonstrated in early studies of ABT for weight
control, a number of questions remain unanswered. First, virtually all of
the evidence supporting ABT for weight control comes from analog
studies, open trials, or trials with a weak control; only one randomized
controlled trial comparing ABT with a gold standard treatment exists at
this time. Moreover, the original MYH trial obtained reliable evidence
for the superiority for ABT over SBT only under certain conditions.
Additional investigation is needed to establish whether ABT confers a
benefit over SBT when delivered by experienced clinicians and to
ensure that the previous effect was not attributable to idiosyncratic
effects of clinicians in the MYH trial. Furthermore, the findings that the
benefit of ABT are more pronounced among those with specific vulner-
abilities requires replication in a sample that receives the treatment
from experienced clinicians. In addition, clinician and supervisor feed-
back indicated that the ABT protocol was problematic in certain regards
(e.g., a missing unifying framework, sometimes lacking integration of
acceptance and behavioral skills, overemphasis on tolerating
discomfort and not enough on tolerating reduction of pleasure), thus
raising the possibility that a revised protocol would produce better
results. Finally, initial evidence suggested that the ability to accept psy-
chological experiences of reduced pleasure and discomfort related to
food choices mediated the effect of ABT. However, no previous study
has examined whether the values component of ABT also mediates the
effect of ABT for weight control. Thus, it is necessary to test whether
these postulated unique mechanisms of action underlie ABT.
In order to investigate the questions posed above, this study random-
ized 190 participants with overweight or obesity to either a standard
behavioral or an acceptance-based behavioral weight loss intervention.
Both interventions were delivered in 25 group sessions over 1 year and
were delivered by experienced weight control clinicians. We hypothe-
sized that ABT would produce greater weight loss at 12 months com-
pared with SBT, and, consistent with previous findings, the effect of
ABT would be most pronounced for those with the particular vulner-
abilities described above (i.e., mood disturbance, responsivity to food
cues, and disinhibited eating). Lastly, we hypothesized that food-
related psychological acceptance and autonomous motivation would
mediate the effect of ABT given that these are posited to be two of the
central mechanisms of action of the treatment.
Participants (n5190) had a body mass index (BMI) between 27
and 50 kg/m
and were between 18 and 70 years of age. Participants
were excluded if they had a medical or psychiatric condition that
limited their ability to comply with the behavioral recommendations
of the program or posed a risk to the participant during weight loss,
were unable to engage in the program’s exercise plan, changed the
dosage of weight-affecting medication within the past 3 months,
were pregnant or planned to become pregnant during the study
period, had lost more than 5% of their weight in the past 6 months,
or met criteria for binge eating disorder.
Recruitment for this study was conducted in four waves of 38 to 45
participants (making up approximately four treatment groups). Poten-
tial participants were recruited through referrals from local primary
care physicians and advertisements in newspapers and radio stations.
Initial screens for eligibility were conducted via telephone. Partici-
pants who appeared eligible were invited for two in-person appoint-
ments to complete screening and baseline assessment procedures. All
participants provided informed consent. Once enrolled, participants
were randomly assigned to SBT (n590) or ABT (n5100). Random-
ization was stratified by gender and ethnicity. Assessments were com-
pleted at months 0 (baseline), 6 (midpoint), and 12 (post-treatment).
See Figure 1 for a CONSORT diagram. The study protocol was
approved by the Drexel University Institutional Review Board.
Participants attended 25 treatment groups in total. Treatments were
manualized and groups were held weekly for 16 sessions, biweekly
for 5 sessions, monthly for 2 sessions, and bimonthly for 2 sessions.
Treatment was delivered in 75-minute, small (10-14 participants),
closed-group sessions. Groups typically consisted of brief individual
Original Article Obesity
check-ins (35 min), skill presentation, and a skill building exercise.
If a participant was absent from group, a 20-minute individual
makeup session was scheduled to cover material that was missed.
Interventionists were doctoral-level clinicians with an average of 4.8
years of experience delivering behavioral weight loss treatment. All
interventionists delivered an equal number of SBT and ABT groups.
Trainees functioned as group co-leaders.
Treatment. Shared treatment components. Behavioral com-
ponents of both treatments (e.g., daily self-monitoring of calorie
intake, prescriptions for a balanced-deficit diet and physical activity,
stimulus control, problem solving) were similar to those used in Look
AHEAD and the Diabetes Prevention Program protocols (21,22). See
Table 1 for a description of components for all treatments.
SBT-only components. Components of SBT not included in ABT
were introduction of the traditional cognitive-behavioral model, which
indicates that changing the content of one’s thoughts can produce behav-
ior change; cognitive restructuring; building self-efficacy and positive
self-esteem; and learning to cope with food cravings through distraction.
Acceptance-based treatment components. The ABT materi-
als [For the full clinician and participant manuals, see Forman & Butryn,
2016 (23, 24)] were adapted from those used in the first clinical trial test-
ing the MYH protocol, i.e., MYH I, which themselves represented a syn-
thesis of traditional behavioral weight loss treatment and several ABTs,
i.e., Dialectical Behavior Therapy (8), Marlatt’s Relapse Prevention
Model (9), and especially ACT (25). The ABT sessions used for this
study largely emphasized the following principles: (1) participants must
choose goals that emanate from freely chosen, personal life values (e.g.
living a long and healthy life; being a present, loving, active grand-
mother); (2) participants must recognize that, in the context of the obeso-
genic environment, weight control behaviors will inevitably produce dis-
comfort (urges to eat, hunger, cravings, feelings of deprivation, fatigue)
and a reduction of pleasure (choosing an apple instead of ice cream,
choosing a walk instead of watching TV); and (3) participants will
Figure 1 CONSORT diagram.
TABLE 1 Components of standard behavioral (SBT) and acceptance-based (ABT) behavioral treatments
Shared components of SBT and ABT Included only in SBT Included only in ABT
Nutritional education, 1,200- to 1,800-calorie goal
(depending on weight and personal preferences)
Distraction and
Values clarification;
ongoing commitment
Physical activity education, gradual increases up to Identification of cognitive Mindful decision-making training
250 min per week of aerobic activity distortions
Setting specific, reasonable, actionable, and time-limited
goals related to eating or activity behavior
Cognitive restructuring Psychological acceptance of and
willingness to experience less
pleasurable or comfortable states
Self-monitoring of caloric intake and physical activity
Stimulus control (e.g., removal of problematic foods from home/work)
Behavior analysis (e.g., reviewing factors leading to
a lapse in eating or activity goals)
Relapse prevention (e.g., identifying triggers for overeating/
sedentary behavior, creating plan for small weight gains)
Problem solving (e.g., identifying barriers to healthy eating and
activity and developing solutions to overcome)
Social support (e.g., communicating needs, building positive support)
Obesity An RCT of Acceptance-Based Behavioral Treatment Forman et al.
2052 Obesity |VOLUME 24 | NUMBER 10 | OCTOBER 2016
benefit from increased awareness of how cues impact their eating and
activity-related decision-making.
Based on feedback from clinicians and clinicians’ supervisors, the
MYH I manual was adapted in several ways. For example, a “Control
What You Can and Accept What You Can’t” framework was used to
orient participants to the aspects of their experience that can and
should be directly modified (their personal food environment and their
behaviors) and those aspects of their experience which are not under
voluntary control (e.g., thoughts, emotions, urges) and towards which
direct attempts to control will result in wasted effort or even paradoxi-
cal magnification. Acceptance-based skills were also more tightly inte-
grated within behavioral weight loss principles by framing behavioral
skills and challenges within the context of ABT. For example, partici-
pants who avoided self-weighing were taught to be willing to accept
difficult thoughts (“I am never going to lose this weight”) and emo-
tions (shame) while simultaneously stepping on the scale. (In contrast,
the SBT condition would help participants recognize the maladaptive
thinking style producing the thought, and utilize cognitive restructur-
ing to reduce shame and produce a more adaptive behavioral choice.)
Additionally, acceptance of loss of pleasure (the ability to make the
less hedonically rewarding choice, like an apple instead of ice cream
after dinner) and willingness to choose a behavior despite internal
experience were emphasized while acceptance of aversive experience
(e.g., the ability to accept the experience of a craving for ice cream)
was deemphasized.
Treatment fidelity. Group sessions were audio recorded and four
psychologists (including EF and MLB) independently rated 25% of
sessions on a scale of 1 (poor) to 10 (perfect) adherence to each sec-
tion of the specific session manual. Likewise, avoidance of treat-
ment contamination was rated from 1 (total) to 10 (no) contamina-
tion. Neither rating differed by condition (Ps50.83, 0.79). Any
adherence issues noted were immediately addressed in ongoing
Outcomes. Weight loss (taken at each session and all assessment
points) was measured with the participant in street clothes (without
shoes) using a standardized SecaV
Rscale accurate to 0.1 kg. Height
was measured with a stadiometer to establish BMI (kg/m
Mediators (measured at baseline and midpoint). Autonomous
regulation of health behaviors was measured with the Treatment Self-
Regulation Questionnaire. The 15-item Treatment Self-Regulation
Questionnaire has adequate reliability (a50.76-0.93; current sample
a50.71-0.74) and predicts health behaviors such as fruit and vegeta-
ble intake, exercise, and smoking cessation (26). Psychological accep-
tance of food cravings was measured using the 10-item Food Craving
Acceptance and Action Questionnaire (FAAQ), which has adequate
reliability (a50.93; current sample a50.58-77) and validity (27).
Moderators (measured at baseline). Mood disturbance was
assessed via the Beck Depression Inventory-II, a 21-item self-report
measure with excellent internal consistency and validity (current sample
a50.88) (28). Susceptibility to food cues was measured using the
15-item Power of Food Scale. The Power of Food Scale has adequate
reliability (a50.81-0.91; current sample a50.93) and predictive valid-
ity (29,30). The 20-item Disinhibition subscale of the Eating Inventory,
which has good reliability (a50.91; current sample a50.79) and
validity (31-33), was used to measure disinhibited eating.
Statistical analyses
Treatment groups were compared on demographic and clinical char-
acteristics at baseline using a v
test for categorical variables and
independent sample t-tests for continuous measures. The primary
and secondary outcomes were percent of initial body weight lost at
post-treatment (12 months), and reaching 10% weight loss at post-
treatment, a well-established marker of success in behavioral weight
loss interventions (34). Means and effects are reported 6standard
error (not standard deviation) of the mean.
All outcome analyses were based on an intention-to-treat (21,22)
approach, and were conducted in SPSS version 23. Missing data
were imputed using maximum likelihood estimation to account for
the dependencies of missingness on other variables in the dataset.
We repeated analyses using only data from those who completed
assessments; results were equivalent, and so are not reported. Treat-
ments were compared using a general linear mixed model, which
included an autocorrelation term to account for serial dependency
among within-person observations based on a first-order autoregres-
sive component. Two time points (mid- and post-treatment) were
included in the model reflecting percent of baseline weight lost. The
secondary outcome was evaluated using logistic regression. Modera-
tors were examined in separate (grand-mean centered) models via
the addition of a main effect for moderator and a moderator 3treat-
ment condition interaction term. We also compared treatment groups
on the trajectories of session-by-session weight, with time (i.e.,
week) as the independent variable, using a mixed-effects model with
linear, quadratic, and cubic effects.
Hayes boostrapping simple mediation analyses PROCESS macro for
SPSS (35) evaluated whether changes from baseline to mid-treatment
in psychological acceptance and autonomous motivation mediated the
effect of treatment condition on 12-month weight loss. As a check,
we repeated mediation analyses using residualized change scores from
baseline to mid-treatment in psychological acceptance of food-related
urges and cravings; results were equivalent, and so are not reported.
TABLE 2 Baseline sample characteristics
Mean SD Mean SD tdfP
Age 51.61 9.97 51.67 10.16 0.04 188 0.97
Body mass index 36.50 5.41 37.40 6.21 1.06 188 0.29
BDI 7.10 6.07 8.07 6.77 1.04 188 0.30
PFS 41.06 12.41 41.67 13.76 0.32 184 0.75
EI-DIs 8.06 2.50 8.01 2.52 20.14 184 0.89
FAAQ 40.23 7.53 37.97 6.40 22.20 184 0.03
TSRQ-AM 6.46 0.73 6.55 0.53 0.92 184 0.36
BDI, Beck Depression Inventory; EI-Dis, Eating Inventory–Disinhibition subscale;
FAAQ, Food Acceptance and Action Questionnaire; PFS, Power of Food Scale;
TSRQ-AM, Treatment Self-Regulation Questionnaire-Autonomous Motivation.
Original Article Obesity
Baseline characteristics
The sample was 82.1% female, and primarily Caucasian (70.5%;
African American: 24.7%; Asian: 1.1%; Hispanic: 3.7%) with a
mean age of 51.64 60.73 years and mean starting BMI of 36.93 6
0.42 kg/m
. The groups were equivalent in gender (v
df 51, P50.97) and ethnicity (v
51.05, df 53, P50.79), and
on all outcome and process measures at baseline with the exception
of higher FAAQ scores in ABT (Tables 2 and 3).
Attendance and attrition
Treatment attendance (with inclusion of makeup sessions) was in excess
of 84% of expected sessions, and there were no differences between the
two treatments in terms of the average number of sessions attended
521.26 65.85, M
520.88 65.46; t(189) 520.46, P5
0.65). Overall, 84.2% of the ABT participants and 85.6% of SBT partic-
ipants attended the majority (i.e., 18 or more) of the 25 scheduled groups
50.07, df 51, P50.79). A total of 142 participants (74%) com-
pleted the mid-treatment assessment and 149 participants (78%) com-
pleted the post-treatment assessment.
Weight loss
ABT yielded a significantly greater percent weight loss than did SBT
across mid- (M
512.9% 60.83, M
510.3% 60.87) and post-
treatment (M
513.3% 60.83, M
59.8% 60.87; b53.44
SE 51.21, P50.005; Figure 2). No time by treatment condition inter-
action was evident (b520.92, SE 50.71, P50.20). Additionally,
ABT participants were more likely (64.0%) than SBT participants
(48.9%) to reach 10% weight loss at 12 months [Wald v
df 51, P50.04, OR 51.86, 95% CI (1.04-3.23)]. Given differences
in FAAQ between groups at baseline, we repeated outcome analyses
with FAAQ as a covariate, and results were equivalent.
Session-by-session weight change is depicted in Figure 3. Nonlinear
analyses revealed a condition by time quadratic effect (b50.003,
SE 50.001, P50.01). Specifically, SBT showed a shallower trajec-
tory of weight loss compared with ABT with upward deflection
(weight regain) by 12 months, while ABT maintained weight losses
through 12 months.
After adding a main effect for moderator and a moderator 3treat-
ment condition interaction term to the general linear model, no evi-
dence was detected for the moderating effects of depressive symp-
toms (b520.18, SE 50.19, P50.28), susceptibility to food cues
(b520.02, SE 50.09, P50.58), or disinhibited eating (t
20.97, b520.48, SE 50.49, P50.69).
The superior effect of ABT (relative to SBT) on 12-month weight loss
was mediated by psychological acceptance of food-related urges and
cravings [b
51.55, SE 50.55, 95% CI (2.65-7.81)] and autono-
mous motivation [b
50.47, SE 50.33, 95% CI (0.03-1.37)].
TABLE 3 Mediator variable descriptive statistics
Baseline Mid-treatment
Mean SD Mean SD df t P Mean SD Mean SD
FAAQ 40.23 7.53 37.97 6.40 184 22.20 0.03 51.03 9.02 43.70 6.99
TSRQ-AM 6.46 0.73 6.55 0.53 184 0.92 0.36 6.77 0.35 6.59 0.53
FAAQ, Food Acceptance and Action Questionnaire; TSRQ-AM, Treatment Self-Regulation Questionnaire-Autonomous Motivation.
Figure 2 Percent weight change by treatment condition over time.
Figure 3 Session-by-session percent weight change, with time modeled as the
independent variable.
Obesity An RCT of Acceptance-Based Behavioral Treatment Forman et al.
2054 Obesity |VOLUME 24 | NUMBER 10 | OCTOBER 2016
During the 12-month treatment period, participants who were random-
ized to ABT demonstrated significantly greater weight loss than those
who received SBT. In particular, SBT weight loss was 9.8%, whereas
ABT weight losses were 13.3%, which represents a clinically signifi-
cant 36% improvement. In addition, the likelihood of maintaining a
10% weight loss at 12 months was one-third greater for ABT, i.e.,
64% versus 49% for SBT. A strength of the study is that the superior-
ity of ABT cannot be credited to disappointing SBT results. In fact,
SBT weight losses and weight loss maintenance through the reduced-
contact 6- to 12-month period were better than is typically reported
(36), perhaps due to differences in delivery of the intervention (e.g.,
continuous accountability around food records and the use of experi-
enced PhD-level clinicians). Thus, we can say with confidence that
participants in ABT were able to achieve weight losses meaningfully
greater than is typical with lifestyle modification (1,3). These findings
are consistent with a large body of literature demonstrating that ABT
can produce clinically significant weight losses (13,14,16,18,37,38).
Moreover, this study, while one of the first of its kind, offers prelimi-
nary evidence that weight control outcomes can be improved by infus-
ing behavioral treatments with skills related to acceptance of discom-
fort and reduced pleasure, clarification of and commitment to life
values, and mindful decision-making.
The advantage of ABT over SBT was more pronounced in this study
relative to the first MYH Trial. Several potential explanations exist for
this difference including the use of experienced clinicians (who could
perhaps better integrate behavioral and ABT-specific skills), and the
fact that the revised ABT protocol focused more on general willingness
and accepting a loss in pleasure, and less on coping with emotional dis-
tress, cravings, and hunger. These same changes to treatment focus
may have been responsible for improving the efficacy of ABT for all
participants, such that the benefit of ABT was no longer limited to a
subset of participants as it was in the previous trial (20).
This study replicated the results of the original MYH Study (20) in that
changes from baseline to 6 months in food-related psychological
acceptance mediated the effect of condition on weight loss. Addition-
ally, it extended this work by detecting a mediating role of autonomous
motivation, which is consistent with other research demonstrating that
higher amounts of autonomous motivation early in weight loss treat-
ment are predictive of greater total weight loss (39,40). These findings
support the theory underlying ABT, which proposes that participants
are better able to adopt and maintain changes in weight control behav-
iors (such as meeting a daily calorie goal) if they learn specialized
self-regulation skills.
Our session-by-session analyses indicated that the advantage of ABT
became increasingly evident starting about session 16 (also week 16;
see Figure 3), i.e., when treatment frequency transitioned to biweekly
(and eventually, monthly and bimonthly). It is possible that ABT
enhances skills or characteristics (e.g., autonomous motivation) that
augment participants’ ability to better sustain weight control behaviors
(and thus prevent weight regain) even when the frequency of group
sessions lessens and external accountability diminishes. Future
research should continue to investigate the ideal number of weekly ses-
sions before transitioning to less frequent sessions.
This study has several limitations. Perhaps most importantly, assess-
ments were not available after treatment contact ended.
Generalizability is another concern given that treatment to motivated
participants was delivered by expert clinicians who were trained and
supervised by the treatment developers. Future studies could examine
outcomes under conditions that more closely resemble typical clinical
care, e.g., a community setting, with lower intensity interventions
delivered by nonpsychologists. Outcomes might also have been
affected by the choice of BMI ceiling, participant attrition, and vari-
ability in makeup sessions experienced. Finally, additional research
must be conducted to better understand ABT mechanisms of action,
for instance by using a more comprehensive battery (including behav-
ioral measures). In conclusion, study results suggest that the efficacy
of behavioral weight loss treatment can be improved by integrating
self-regulation skills that are reflected in ABT models. Learning to tol-
erate discomfort or reduction in pleasure, enact commitment to valued
behavior, and be mindfully aware during moments of decision-making
may position participants to adhere to recommendations for lifestyle
modification in the face of powerful biological and environmental
challenges. This is the first randomized clinical trial to demonstrate
that ABT for obesity produced greater weight losses than the gold
standard, traditional form of behavioral treatment. Discovering ways
to improve the efficacy of behavioral therapy is a key priority in the
obesity treatment field; as such, the clinical and research impact of
these findings is notable.O
C2016 The Obesity Society
1. Butryn ML, Webb V, Wadden TA. Behavioral treatment of obesity. Psychiatr Clin
2. 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;66:239-246.
3. Wilson G. Behavioral treatment of obesity: thirty years and counting. Adv Behav
Res Ther 1994;16:31-75.
4. 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. Am J Clin Nutr 2000;72:1088-
5. Lowe MR. Self-regulation of energy intake in the prevention and treatment of
obesity: is it feasible? Obes Res 2003;11:44S-59S.
6. 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.
7. Hayes SC, Strosa hl KD, Wilson KG. Acceptance and Commitment Therapy. New
York: Guilford Press; 1999.
8. Robins CJ, Ivanoff AM, Linehan MM. Dialectical behavior therapy. In: Livesley
WJ, ed. Handbook of Personality Disorders: Theory, Research, and Treatment .
New York: Guilford Press; 2001:437-459.
9. Marlatt GA, George WH. Relapse prevention: introduction and overview of the
model. Br J Addict 1984;79:261-273.
10. Forma n EM, Butryn, ML. Incorporating acceptance approaches into behavioral
weight loss treatment. In: Haynos AF, Lillis J, Forman EM, Butryn ML, eds.
Mindfulness and Acceptance for Treating Eating Disorders and Weight Concern.
Oakland, CA: New Harbinger Publications; 2016.
11. Forman EM, Hoffman KL, Juarascio AS, Butryn ML, Herbert JD. Comparison of
acceptance-based and standard cognitive-based coping strategies for craving sweets
in overweight and obese women. Eat Behav 2013;14:64-68.
12. Hooper N, Sandoz EK, Ashton J, Clarke A, McHugh L. Comparing thought
suppression and acceptance as coping techniques for food cravings. Eat Behav
13. Niemeier HM, Leahey T, Palm Reed K, Brown RA, Wing RR. An acceptance-
based behavioral intervention for weight loss: a pilot study. Behav Ther 2012;43:
14. Forman EM, Butryn ML, Hoffman KL, Herbert JD. An open trial of an acceptance-
based behavioral treatment for weight loss. Cognit Behav Pract 2009;16:223-235.
15. 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
Activity Health 2009;8:516-522.
16. Goodwin CL, Forman EM, Herbert JD, Butryn ML, Ledley GS. A pilot study
examining the initial effectiveness of a brief acceptance-based behavior therapy for
Original Article Obesity
modifying diet and physical activity among cardiac patients. Behav Modif 2011;36:
17. 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;37:58-69.
18. 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
19. Katterman SN, Goldstein SP, Butryn ML, Forman EM, Lowe MR. Efficacy of an
acceptance-based behavioral intervention for weight gain prevention in young adult
women. J Contextual Behav Sci 2014;3:45-50.
20. Forman EM, Butryn ML, Juarascio AS, et al. The Mind Your Health project: a
randomized controlled trial of an innovative behavioral treatment for obesity.
Obesity (Silver Spring) 2013;21:1119-1126.
21. Look AHEAD Research Group. The Look AHEAD study: a description of the lifestyle
intervention and the evidence supporting it. Obesity (Silver Spring) 2006;14:737-752.
22. Diabetes Prevention Program Resea rch Group. The Diabetes Prevention Program
(DPP) description of lifestyle intervention. Diabetes Care 2002;25:2165-2171.
23. Forman EM, Butryn ML. Effective Weight Loss: An Acceptance-based Behavioral
Approach (Treatments that Work series). New York: Oxford University Press; 2016.
24. Forman EM, Butryn ML. Effective Weight Loss: A Companion Workbook
(Treatments that Work series). New York: Oxford University Press; 2016.
25. Hayes SC, Strosahl KD, Wilson KG. Accepta nce and Commitment Therapy: An
Experiential Approach to Behavior Change. New York: Guilford Press; 1999.
26. Levesque CS, Williams GC, Elliot D, Pickering MA, Bodenhamer B, Finley PJ.
Validating the theoretical structure of the Treatment Self-Regulation Questionnaire
(TSRQ) across three different health behaviors. Health Educ Res 2007;22:691-702.
27. Juarascio AS, Forman EM, Timko CA, Butryn M, Goodwin CL. The development
and validation of the food craving acceptance and action questionnaire (FAAQ). Eat
Behav 2011;182-187.
28. Dozois DJA, Dobson KS, Ahnberg JL. A psychometric evaluation of the Beck
Depression Inventory - II. Psychol Assess 1998;10:83-89.
29. Cappell eri JC, Bushmakin AG, Gerber RA, et al. Evaluating the Power of Food
Scale in obese subjects and a general sample of individuals: development and
measurement properties. Int J Obes (Lond) 2009;33:913-922.
30. 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;53:114-118.
31. Shearin EN, Russ MJ, Hull JW, Clarkin JF, Smith GP. Construct validity of the
three-factor eating questionnaire: flexible and rigid control subscales. Int J Eat
Disord 1994;16:187-198.
32. Stunkard AJ, Messick S. The three-factor eating questionnaire to measure dietary
restraint, disinhibition and hunger. J Psychosom Res 1985;29:71-83.
33. Yeomans MR, Leitch M, Mobini S. Impulsivity is associated with the disinhibition
but not restraint factor from the Three Factor Eating Questionnaire. Appetite 2008;
34. Jensen MD, Ryan DH, Donato KA, et al. 2013 Guidelines (2013) for managing
overweight and obesity in adults. Obesity (Silver Spring) 2014;22:S1-S410.
35. Hayes AF. The PROCESS Macro for SPSS and SAS. 2015.
36. Franz MJ, VanWormer JJ, Crain AL, et al. Weight-loss outcomes: a systematic
review and meta-analysis of weight-loss clinical trials with a minimum 1-year
follow-up. J Am Diet Assoc 2007;107:1755-1767.
37. Butryn ML, Forman EM, Hoffman K, Shaw J, Juarascio A. A pilot study of
acceptance and commitment therapy for promotion of physical activity. J Phys Act
Health 2011;8:516-522.
38. Gregg JA, Callaghan GM, Hayes SC, Glenn-Lawson JL. Improving diabetes self-
management through acceptance, mindfulness, and values: a randomized controlled
trial. J Consult Clin Psychol 2007;75:336-343.
39. Webb er KH, Tate DF, Ward DS, Bowling JM. Motivation and its relationship to
adherence to self-monitoring and weight loss in a 16-week Internet behavioral
weight loss intervention. J Nutr Educ Behav 2010;42:161-167.
40. Williams GC, Grow VM, Freedman ZR, Ryan RM, Deci EL. Motivational
predictors of weight loss and weight-loss maintenance. J Pers Soc Psychol 1996;70:
Obesity An RCT of Acceptance-Based Behavioral Treatment Forman et al.
2056 Obesity |VOLUME 24 | NUMBER 10 | OCTOBER 2016
... Since then, several studies have been conducted comparing ABT with standard behavioral treatment (SBT) in randomized controlled trials Forman et al., 2016;Forman et al., 2019). Greater weight loss was found in ABT (10.9%) than SBT (8.7%), although this was not statistically significant, and no differences were found during a follow-up. ...
... First, changes in BMI were detected both at the end of the intervention and during a 9-month follow-up, which may support the hypothesis that the intervention could be useful in reducing one's BMI. It should be noted that the amount of weight lost is low with respect to other interventions, especially those with a larger sample size and in which a randomized clinical trial was conducted , Forman et al., 2016, Forman et al., 2019. However, the results are in line with those found by Lillis et al. (2017), where the weight loss did not reach 5%. ...
... Food-related acceptance increased after the intervention, as we hypothesized. This finding is consistent with previous research , Forman et al., 2016, Lillis et al., 2017. One of the main goals of these interventions is to increase acceptance of the internal experiences that may appear in the process of losing weight, which would in turn lead to a change in the individual's relationship with their context and food. ...
Full-text available
Current behavioral interventions for weight loss in overweight and obesity present problems in maintaining long-term weight loss results. Acceptance and commitment therapy (ACT) could be a suitable approach to promote long-term weight loss. The aim of this pilot study is to evaluate the efficacy of an ACT-based intervention on body weight change at the end of the intervention and after a 9-month follow-up, in addition to analyzing the effects of the intervention on several variables of interest. Nine women (Mage= 44.11 years; SD= 5.82) attended a group intervention of 10 weekly sessions, addressing contents of eating habits, physical activity, and ACT. At the end of the intervention, the average weight loss was 2.8%, and after a 9-month follow-up, it was 3.9%. Based on the results, it can be concluded that the study provides evidence in favor of the suitability of ACT to help promote weight loss.
... Posteriormente, se han realizado varios estudios comparando ABT con terapia conductual estándar en ensayos experimentales aleatorizados , Forman et al., 2016Forman et al., 2019). Se encontró mayor pérdida de peso en ABT (10,9%) que en la condición estándar (8,7%), aunque no resultó estadísticamente significativa y tampoco se encontraron diferencias en el seguimiento. ...
... En primer lugar, se detectaron cambios en el IMC tanto al finalizar la intervención como en el seguimiento a los nueve meses, lo que apoyaría la hipótesis de que la intervención podría resultar útil para reducir el IMC. Cabe señalar que la cantidad de peso perdido es baja respecto a otras intervenciones, especialmente aquellas con un mayor tamaño muestral y en las que se realizó un ensayo clínico aleatorizado , Forman et al., 2016, Forman et al., 2019. No obstante, se encuentra en la línea de los resultados de Lillis et al. (2017), donde el porcentaje de peso perdido no alcanzó el 5%. ...
... La aceptación relacionada con la comida, según nuestras hipótesis, aumentó tras la intervención. Este dato consistente con trabajos previos , Forman et al., 2016, Lillis et al., 2017. Uno de los objetivos principales de estas intervenciones es generar una mayor aceptación de las experiencias internas que pueden aparecer en un proceso de pérdida de peso, lo que conllevaría a su vez un cambio de la relación de la persona con su contexto y la comida. ...
En la actualidad, las intervenciones conductuales para pérdida de peso en sobrepeso y obesidad presentan problemas para mantener los resultados de pérdida de peso a largo plazo. La terapia de aceptación y compromiso (ACT) podría ser un enfoque adecuado para favorecer la pérdida de peso a largo plazo. El objetivo de este estudio piloto es evaluar la eficacia de una intervención basada en ACT en el cambio del peso corporal al finalizar la intervención y en el seguimiento a los 9 meses, además de analizar los efectos de la intervención en diversas variables de interés. Nueve mujeres (edad: M= 44,11 años; DT= 5,82) participaron en una intervención grupal de 10 diez sesiones semanales, abordando contenidos de hábitos alimentarios, actividad física y ACT. Al finalizar la intervención, la pérdida de peso promedio fue de 2,8%, y en el seguimiento a los 9 meses, fue de 3,9%. A tenor de los resultados, podemos afirmar que el estudio ofrece datos a favor de ACT en las intervenciones de pérdida de peso.
... 7,8 The ABT has led to weight loss in groups diverse in race and ethnicity, sex, and education. [10][11][12][13] Clinically meaningful weight loss is defined as a loss of 5%-10% of body weight. 14 Notably, in one study, participants randomized to an ABT intervention lost 13.3% over the course of a year, which is higher than the 5%-8% body weight loss observed in other studies. ...
... 14 Notably, in one study, participants randomized to an ABT intervention lost 13.3% over the course of a year, which is higher than the 5%-8% body weight loss observed in other studies. 13,15,16 Acceptance-based interventions have been used to treat chronic pain, risky sexual behavior, anorexia, and mental well-being among adolescents. [17][18][19][20][21][22] The ABT is a particularly relevant intervention for obesity as it focuses on self-regulatory skills and teens with obesity exhibit worse self-regulatory skills compared with teens without obesity. ...
Background: Obesity prevalence among adolescent girls continues to rise. Acceptance-based therapy (ABT) is effective for weight loss in adults and feasible and acceptable for weight loss among adolescents. This pilot randomized controlled trial (RCT) assessed effectiveness of an adolescent-tailored ABT intervention on decreasing weight-related outcomes and improving psychological outcomes compared with enhanced care. Methods: In this 6-month, two-arm pilot RCT, participants were randomized to the ABT intervention or to enhanced care. The ABT intervention condition attended 15 virtual, 90-minute group sessions. The enhanced care comparison received 15 healthy lifestyle handouts and virtually met twice with a registered dietitian. The primary outcome assessed was change in BMI expressed as a percentage of the 95th percentile (%BMIp95). Results: Participants included 40 girls (ages 14-19) assigned to ABT (n = 20) or enhanced care (n = 20). A decrease in %BMIp95 was observed within the ABT intervention [d = -0.19, 95% confidence interval, CI: (-0.36 to -0.02)], however, not within the enhanced care comparison [d = -0.01, 95% CI: (-0.09 to 0.07)]. The ABT group showed slight changes in psychological flexibility [d = -0.34, 95% CI: (-0.62 to -0.06)] over enhanced care [d = -0.11, 95% CI: (-0.58 to 0.37)]. There was no significant intervention effect noted between groups. Conclusion: In this pilot RCT, the ABT intervention was as effective as enhanced care for weight loss. However, previous ABT studies occurred in person, and this study was conducted virtually due to COVID-19. Thus, future research investigating the potential effectiveness of ABT in-person among adolescents and optimization of virtual interventions is needed.
... 27 Eight studies made head-to-head intervention comparisons between BWMPs. [27][28][29][30][31][32][33][34] At programme-end, one study found reduced depression after a self-guided leaflet-based intervention (top 10 tips) compared to an intervention focussed on increasing behavioural flexibility by breaking daily habits ( Figure S2L). 31 Another study found reduced depression after a cognitive behavioural therapy (CBT) versus behavioural weight loss treatment, which persisted to between 7 and 12 months after programme-end ( Figure S2N). ...
Full-text available
Behavioural weight management programmes (BWMPs) lead to weight loss but subsequent weight regain may harm mental health outcomes. We searched for randomised trials of BWMPs in adults with overweight/obesity with follow‐up ≥12 months from baseline that measured weight change both at and after programme‐end. We included only studies reporting mental health at or after programme‐end. We meta‐analysed changes in various mental health outcomes using a random‐effects model by nature of the comparator group and by time since programme end. Subgroup analysis explored heterogeneity. We used mixed models and meta‐regression to analyse the association between change in weight and change in depression and/or anxiety over time, with higher scores indicating greater depression and/or anxiety. We included 47 studies. When comparing BWMPs (diet and/or exercise) to control, most estimates included the possibility of no difference, but pooled estimates for psychological wellbeing, self‐esteem and mental‐health composite scores at programme‐end, anxiety at 1–6 months, and depression at 7–12 months after programme‐end suggested improvements in intervention arms relative to control, with 95% CIs excluding no difference. Pooled estimates found no evidence that BWMPs harmed mental health at programme end or beyond. Mental health composite scores at programme‐end favoured diet and exercise interventions over diet alone, with 95% CIs excluding no difference. All other measures and timepoints included the possibility of no difference or could not be meta‐analysed due to high heterogeneity or a paucity of data. Mixed models and meta‐regression of the association between change in depression and/or anxiety scores over time, and change in weight, were inconclusive. Despite weight regain after BWMPs, our meta‐analyses found no evidence of mental health harm and some evidence that BWMPs may improve some dimensions of mental health at and after programme‐end.
Behavioral interventions delivered via one-on-one telephone coaching (hereafter referred to as telehealth) for weight loss have had great population-level reach but to date limited efficacy. Acceptance and Commitment Therapy (ACT) has promise to improve behavioral weight loss treatment efficacy by addressing the fundamental challenges of weight loss and maintenance: overeating in response to internal (stress) and external (high calorie foods) cues. Here we describe the Weight Loss, Nutrition, and Exercise Study (WeLNES) randomized controlled trial that is testing the efficacy of an ACT-based telehealth coaching intervention for weight loss in comparison to a Standard Behavioral Therapy (SBT)-based telehealth coaching intervention. A total of 398 adults with overweight or obesity are being recruited and randomized to either ACT or SBT telehealth coaching. Participants in both arms are offered twenty-five telehealth coaching sessions in year one and nine booster sessions in year two. All participants receive a Bluetooth-enabled scale to self-monitor weight and a Fitbit Inspire + Fitbit app for tracking diet and physical activity. The primary aim is to determine whether a greater proportion of ACT participants will achieve a clinically significant weight loss of ≥10% compared with SBT participants at 12-months. Secondary outcomes include change in weight from baseline to 6, 12, and 24-months. Whether the effect of ACT on weight loss is mediated by ACT processes and is moderated by baseline factors will also be examined. If ACT proves efficacious, ACT telehealth coaching will offer an effective, broadly scalable weight loss treatment-thereby making a high public health impact.
Objective: Although altered reward processing is proposed to play a key role in obesity maintenance, the role of food enjoyment and enjoyment of non-food naturally rewarding activities ("non-food enjoyment") in obesity maintenance remains unknown. This study examined how food and non-food enjoyment were associated with baseline body mass index (BMI) and weight loss (WL) following year-long behavioral WL treatment. Methods: At baseline, participants (MAge = 51.81; 73.8 % White, N = 279) with overweight/obesity completed a 7-day ecological momentary assessment (EMA) protocol inquiring about pleasure/enjoyment derived from eating and non-food activities over the past few hours. Participants also completed retrospective self-report measures of food/non-food enjoyment. With linear regressions, associations between EMA food/non-food enjoyment and BMI and post-treatment WL were examined. Race was included as a covariate. Results: EMA and retrospective food/non-food enjoyment measures had modest concordance, providing preliminary psychometric support for the EMA measures. Partially consistent with hypotheses, greater EMA food enjoyment was associated with lower BMI (B = -1.03, p = .01) and with greater WL, though the latter association was not statistically significant (B = 1.15, p = .07). Exploratory analyses suggested that race was associated with food enjoyment (non-White participants had greater food enjoyment than White participants, d = 0.81, p = .005), and that race may have affected associations between food enjoyment and weight outcomes. Associations between non-food enjoyment and weight outcomes were small and nonsignificant (ps > .93). Conclusions: Results suggest enjoyment from food, but not from non-food domains, is associated with weight outcomes.
Obesity is a worldwide epidemic with unknown etiology. It is now accepted as a state of chronic low-grade inflammation. Several genetic and environmental factors like diet, stress, and lifestyle play key roles in obesity onset and progression. Obesity also causes further complications like cardiovascular complications, metabolic syndrome, and type 2 diabetes. Current treatment options for obesity include lifestyle modifications, cognitive behavioral therapy, and pharmacological interventional options. Recent studies show that disturbances in gut microbiome also play a role in obesity and has opened up several new frontiers in obesity research. Current inquiries into gut microbiome have led to new treatment options for obesity including fecal microbiota transplant (FMT) and vagal nerve block. These treatments show that they might be effective, however more research are needed to evaluate their long-term effects on obesity and associated comorbidities. This chapter details on current state of knowledge on prevalence in obesity epidemic, their etiology, current interventional options, and the role of gut microbiota in shaping future of obesity and associated comorbidities intervention using innovative approaches.
Cognitive behavior therapy (CBT) has been the dominant psychotherapeutic paradigm in the Western world, enjoying this status for a few decades. To date, managed care and third-party payers have favored its emphasis on scientific validation, short-term efficient treatment, and relatively easy to learn techniques (often in treatment manuals). In practice, CBT also attained a wide range of applicability: from childhood problems, such as functional enuresis and oppositional defiant disorder, to problems of adults, such as depression, anxiety disorders, chronic pain and so on. As such, it is important to understand CBT paradigm, particularly for those entering the field. To understand CBT and to make intelligent therapeutic choices as well as research questions, one needs to understand waves of CBT as well as their relative strengths and weaknesses. While taking the agnotology of CBT into consideration, this volume will help readers do this by having experts in the field of CBT write key chapters on the key component issues in CBT.
Third Wave treatments for obesity propose that standard cognitive and behavioral strategies for obesity are necessary yet insufficient, given the unprecedented challenge of our biological predispositions combined with the modern-day environment. In particular, our biological predispositions (to prefer high calorie foods and conserve energy) and modern environment (in which highly palatable calorie-dense foods are ubiquitous and the need for physical activity is low) are proposed to inevitably give rise to a host of challenging thoughts, feelings, and sensations (e.g., cravings and urges) that require special psychological skills to manage. Given the hyperpalatability of foods in the modern-day environment, difficulties being mindful while eating and being in tune with one’s hunger, taste satisfaction, and satiety cues, may lead individuals to eat based upon immediate desires rather than true biological hunger, thus fueling overeating. Third Wave treatments for obesity provide individuals with mindfulness- and/or acceptance-based strategies for managing the challenges of both external cues (e.g., the presence of delicious foods) and internal cues (e.g., cravings to eat fatty foods). In so doing, these treatments help individuals intentionally choose behaviors in line with biological hunger signals, goals, or values, even amidst such challenges. This chapter presents the theoretical framework for Third Wave treatments for obesity, provides a description of the treatments, and offers suggestions for future research. We review two primary types of treatments: (1) mindfulness-based interventions, which focus on cultivating mindfulness in daily life and eating through meditation and mindfulness practices; and (2) acceptance-based behavioral treatments, which supplement traditional behavioral and cognitive lifestyle modification strategies with mindfulness- and acceptance-based strategies. Third Wave treatments for obesity provide theoretical and applied contributions to the field by incorporating novel applications of acceptance- and mindfulness-based strategies, and by offering viable alternative treatment approaches for individuals with overweight. Yet, little is still known about how to produce enduring weight loss, emphasizing the need for an improved understanding of active treatment ingredients, contextual factors, and the mechanisms underlying effects.
Full-text available
The National Weight Control Registry (NWCR) is, to the best of our knowledge, the largest study of individuals successful at long-term maintenance of weight loss. Despite extensive histories of overweight, the 629 women and 155 men in the registry lost an average of 30 kg and maintained a required minimum weight loss of 13.6 kg for 5 y. A little over one-half of the sample lost weight through formal programs; the remainder lost weight on their own. Both groups reported having used both diet and exercise to lose weight and nearly 77% of the sample reported that a triggering event had preceded their successful weight loss. Mean (+/-SD) current consumption reported by registry members was 5778 +/- 2200 kJ/d, with 24 +/- 9% of energy from fat, Members also appear to be highly active: they reported expending approximately 11830 kJ/wk through physical activity. Surprisingly, 42% of the sample reported that maintaining their weight loss was less difficult than losing weight. Nearly all registry members indicated that weight loss led to improvements in their level of energy, physical mobility, general mood, self-confidence, and physical health. In summary, the NWCR identified a large sample of individuals who were highly successful at maintaining weight loss. Future prospective studies will determine variables that predict continued maintenance of weight loss.
An ACT Approach Chapter 1. What is Acceptance and Commitment Therapy? Steven C. Hayes, Kirk D. Strosahl, Kara Bunting, Michael Twohig, and Kelly G. Wilson Chapter 2. An ACT Primer: Core Therapy Processes, Intervention Strategies, and Therapist Competencies. Kirk D. Strosahl, Steven C. Hayes, Kelly G. Wilson and Elizabeth V. Gifford Chapter 3. ACT Case Formulation. Steven C. Hayes, Kirk D. Strosahl, Jayson Luoma, Alethea A. Smith, and Kelly G. Wilson ACT with Behavior Problems Chapter 4. ACT with Affective Disorders. Robert D. Zettle Chapter 5. ACT with Anxiety Disorders. Susan M. Orsillo, Lizabeth Roemer, Jennifer Block-Lerner, Chad LeJeune, and James D. Herbert Chapter 6. ACT with Posttraumatic Stress Disorder. Alethea A. Smith and Victoria M. Follette Chapter 7. ACT for Substance Abuse and Dependence. Kelly G. Wilson and Michelle R. Byrd Chapter 8. ACT with the Seriously Mentally Ill. Patricia Bach Chapter 9. ACT with the Multi-Problem Patient. Kirk D. Strosahl ACT with Special Populations, Settings, and Methods Chapter 10. ACT with Children, Adolescents, and their Parents. Amy R. Murrell, Lisa W. Coyne, & Kelly G. Wilson Chapter 11. ACT for Stress. Frank Bond. Chapter 12. ACT in Medical Settings. Patricia Robinson, Jennifer Gregg, JoAnne Dahl, & Tobias Lundgren Chapter 13. ACT with Chronic Pain Patients. Patricia Robinson, Rikard K. Wicksell, Gunnar L. Olsson Chapter 14. ACT in Group Format. Robyn D. Walser and Jacqueline Pistorello
Human beings use language to shape their world: to structure it and give it meaning. Language builds our skyscrapers, imparts the strength to our steel, creates the elegance of our mathematics, and forms our art’s depiction of beauty. Language has been the source of so much human achievement that it is only natural that we look to it first to identify a problem and craft a solution. But it is precisely because language can be so useful that it can also be problematic. Language not only enables human achievements, but also our ability to project fearsome futures, to compare ourselves to unrealistic ideals and find ourselves wanting, or to torment our souls with the finitude of life itself. Language is at the core of the remarkable human tendency to suffer in the midst of plenty.
Young adult women, particularly those attending college, may be at risk for future weight gain. The current study examined the efficacy of a brief acceptance-based behavioral approach in facilitating weight gain prevention in female college students with a body mass index between 23 and 32 kg/m2. Fifty-eight participants were randomized to an intervention group who attended eight group sessions over 16 weeks (n=29), or an assessment-only control group (n=29) and completed assessments at baseline, six weeks, post-intervention, and one year. Group sessions taught behavioral (e.g., monitor weight, calories, and exercise) and acceptance-based (e.g., distress tolerance, acceptance of cravings) strategies that could be applied for weight loss or weight gain prevention. The intervention resulted in a decrease in weight and body mass index of 1.57 kg and 0.52 kg/m2 (respectively) at 16 weeks that was maintained at one year follow up (M=−2.24 kg, M=−0.74 kg/m2) whereas the control group gained 1.07 kg and 0.34 kg/m2 over the year. Results indicate that a brief acceptance-based behavioral intervention may be effective for a group who appears to be at risk for future weight gain and further research is needed to determine mechanisms of change.
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.
Existing strategies for coping with food cravings are of unknown efficacy and rely on principles that have been shown to have paradoxical effects. The present study evaluated novel, acceptance-based strategies for coping with craving by randomly assigning 48 overweight women to either an experimental psychological acceptance-oriented intervention or a standard cognitive reappraisal/distraction intervention. Participants were required to carry a box of sweets on their person for 72h while abstaining from any consumption of sweets. Results suggested that the acceptance-based coping strategies resulted in lower cravings and reduced consumption, particularly for those who demonstrate greater susceptibility to the presence of food and report a tendency to engage in emotional eating.
This article provides psychometric information on the second edition of the Beck Depression Inventory (BDI–II; A. T. Beck, R. A. Steer, & G. K. Brown, 1996), with respect to internal consistency, factorial validity, and gender differences. Both measures demonstrated high internal reliability in the full student sample. Significant differences between the mean BDI and BDI-II scores necessitated the development of new cutoffs for analogue research on the BDI–II. Results from exploratory and confirmatory factor analyses indicated that a 2-factor solution optimally summarized the data for both versions of the inventory and accounted for a cumulative 41% and 46% of the common variance in BDI and BDI–II responses, respectively. These factor solutions were reliably cross-validated, although the importance of each factor varied by gender. The authors conclude that the BDI–II is a stronger instrument than the BDI in terms of its factor structure. (PsycINFO Database Record (c) 2012 APA, all rights reserved)