ACTonFood. Acceptance and Commitment Therapy-Based Group Treatment Compared to Cognitive Behavioral Therapy-Based Group Treatment for Weight Loss Maintenance: An Individually Randomized Group Treatment Trial

Abstract

The purpose of this Individually Randomized Group Treatment Trial was to compare an Acceptance and Commitment Therapy-based (ACT) group intervention and a Cognitive Behavioral Therapy-based (CBT) group intervention for weight loss maintenance in a sample of adult patients with obesity seeking treatment for weight loss. One hundred and fifty-five adults (BMI: Kg/m2 = 43.8 [6.8]) attending a multidisciplinary rehabilitation program for weight loss were randomized into two conditions: ACT and CBT. Demographical, physical, and clinical data were assessed at the beginning of the program (t0), at discharge (t1), and at 6-month follow-up (t2). The following measures were administered: The Acceptance and Action Questionnaire-II (AAQ-II) and the Clinical Outcome in Routine Evaluation-Outcome Measure (CORE-OM). Generalized linear mixed models were performed to assess differences between groups. Moderation effects for gender and Eating Disorders (ED) have been considered. From baseline to discharge, no significant differences between interventions were found, with the only exception of an improvement in the CORE-OM total score and in the CORE-OM subjective wellbeing subscale for those in the CBT condition. From discharge to follow-up, ACT group participants showed significant results in terms of weight loss maintenance, CORE-OM total score, and CORE-OM and AAQ-II wellbeing, symptoms, and psychological problems subscales. Gender moderated the effects of time and intervention on the CORE-OM subscale reporting the risk for self-harm or harm of others. The presence of an eating disorder moderated the effect of time and intervention on the CORE-OM total score, on the CORE-OM symptoms and psychological problems subscales, and on the AAQ-II. Patients who received the ACT intervention were more likely to achieve a ≥ 5% weight loss from baseline to follow-up and to maintain the weight loss after discharge. The ACT intervention was thus effective in maintaining weight loss over time.

Weight stigma in patients with overweight and obesity: validation of the Italian Weight Self-Stigma Questionnaire (WSSQ)

“…Despite multidisciplinary interventions have been developed to improve weight loss and to reduce IWS [30][31][32][33][34], the extent to which weight self-stigma affects health outcomes is still unclear [26,27]. To fill the knowledge gaps in the particular field, the Weight Self-Stigma Questionnaire (WSSQ), was shown to be a reliable and valid tool to assess IWS and to detect the impact of effective interventions targeting weight-related stigma [17].…”

The Mediating Role of Psychological Inflexibility in the Relationship Between Anxiety, Depression, and Emotional Eating in Adult Individuals With Obesity

“…Preliminary evidence collected in non-clinical samples suggested that psychological inflexibility and experiential avoidance-the unwillingness to remain in contact and consequently, avoid internal states such as unpleasant thoughts, feelings, sensations-played a key role in the relationship between negative emotional states and the onset of emotional eating (Litwin et al, 2017). Among clinical samples the study of the linkage between negative internal states as anxiety and depression, psychological inflexibility, and emotional eating is increasing (Lillis et al, 2011;Niemeier et al, 2012;Schaumberg et al, 2016;Cattivelli et al, 2021;Guerrini Usubini et al, 2021a,b;Di Sante et al, 2022). Within this perspective, the present study was conceived to replicate and extend literature concerning the role of psychological inflexibility on the relationship between negative internal states, and emotional eating in a clinical sample of inpatient adult individuals with obesity seeking for obesity rehabilitation.…”

Efficacy of eHealth interventions to reduce depression symptoms in individuals with obesity: a systematic review of randomized controlled trials

“…Interventions that integrate elements of cognitive behavioural therapy (CBT) have been shown to lead to positive outcomes in improving mental health ( 22 ). In general, most mental health interventions for individuals with obesity aim to increase knowledge about potential difficulties associated with dieting by simultaneously providing psychoeducation about weight biology, increased self-esteem and mental health, improved health and eating behaviours, and physical activity, rather than focusing predominantly on weight loss ( 23 , 24 ).…”