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Acceptance-based behavioral intervention aids weight loss in adults with obesity

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September 29, 2016

Adults with obesity assigned to an acceptance-based behavioral intervention were more likely to reach 10% weight loss at 1 year vs. patients assigned to a standard behavioral intervention, according to study findings published in Obesity.

In a randomized controlled trial, researchers found that patients lose more weight when assigned to the Mind Your Health program — an intervention that includes self-regulation skills adapted from acceptance and commitment therapy, dialectical behavior therapy, and relapse prevention for substance abuse — than when assigned a traditional behavior intervention.

“We developed and evaluated a new form of behavioral treatment, known as acceptance-based behavioral treatment,” Evan Forman, PhD, FTOS, co-director of the Laboratory for Innovations in Health-Related Behavior Change at Drexel University in Philadelphia, told Endocrine Today. “This treatment teaches highly specialized self-regulation skills, so individuals trying to lose weight can continue making healthful choices long after the program ends. These skills include mindful decision making, identifying and committing to big-picture life values, and a willingness to accept discomfort and reduced pleasure for the sake of those values.”

Forman and colleagues analyzed data from 190 adults with a BMI between 27 kg/m² and 50 kg/m² who had not lost more than 5% of their body weight in the 6 months leading up to the study (mean age, 52 years; 82.1% women; 70.5% white). Researchers randomly assigned patients to standard behavioral therapy (n = 90) or to an acceptance-based intervention (n = 100); assessments were completed at baseline and 6 and 12 months.

Intervention for both groups included 25 closed-group sessions of 75 minutes (16 weekly, five biweekly, two monthly and two bimonthly). The standard behavioral intervention included a traditional cognitive-behavioral model; the acceptance-based intervention combined traditional behavioral weight-loss treatments with acceptance-based models focusing on building awareness of food cues and activity-related decision making.

Patients assigned to the Mind Your Health program experienced greater weight loss at 12 months vs. those assigned to standard behavioral therapy (13.3% vs. 9.8%; P = .005). Patients assigned to the acceptance-based behavioral intervention were also more likely to reach 10% weight loss at 12 months vs. those assigned to standard intervention (64% vs. 48.9%; P = .04). Researchers found no evidence of moderation by depressive symptoms, susceptibility to food cues and disinhibited eating.

“The superiority of [acceptance-based therapy] cannot be credited to disappointing [standard behavioral therapy] results,” the researchers wrote. “In fact, [standard behavioral therapy] weight losses and weight-loss maintenance through the reduced-contact 6- to 12-month period were better than is typically reported, perhaps due to differences in delivery of the intervention (eg, continuous accountability around food records and the use of experienced, PhD-level clinicians). Thus, we can say with confidence that participants in [acceptance-based therapy] were able to achieve weight losses meaningfully greater than is typical with lifestyle modification.”

In commentary accompanying the study, Thomas A. Wadden, PhD, Albert J. Stunkard professor of psychology at the Perelman School of Medicine at the University of Pennsylvania, and Robert I. Berkowitz, MD, of the department of psychiatry and behavioral sciences at The Children’s Hospital of Philadelphia, said the added elements of acceptance and commitment therapy facilitate adherence to diet and physical activity recommendations.

“The weight loss for [acceptance-based therapy] is among the largest ever reported in the behavioral treatment literature, in the absence of using an aggressive diet or weight-loss medication,” Wadden and Berkowitz wrote. “We applaud these exciting results, which extend findings from the authors’ prior randomized trial.” – by Regina Schaffer

Disclosure: Forman and one other researcher report authorship of books on acceptance-based approaches, published by New Harbinger and Oxford University Press; another researcher reports receiving personal fees from Health Outcome Solutions outside of this study. Wadden reports serving on advisory boards for Novo Nordisk, Nutrisystem and Weight Watchers, and receiving grant support from Eisai Pharmaceuticals and Novo Nordisk. Berkowitz reports consulting for Eisai and Takeda.

AUTHORS: Forman EM, Butryn ML, Manasse SM, Crosby RD, Goldstein SP, Wyckoff EP, Thomas JG

BACKGROUND: 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) ...

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