The effectiveness of acceptance and commitment therapy upon weight management and psychological well-being of adults with overweight or obesity: A systematic review

Two-Year Results of a Five-Year Personalized Integrative Obesity Coaching Program (IBO) Based upon a Systems Health Perspective and an Evolutionary Longitudinal Study Approach

This study presents the outcomes of a 5-year personalized integrative coaching program for adults with obesity (body mass index BMI ≥ 30 kg/m2), based upon a systems health perspective, during the first 2 years. This longitudinal study, which had an evolutionary design, included all adults who enrolled in the program. Health-related quality of life (HRQoL) was measured with the Short Form-36 (SF-36), and physical outcomes included weight, waist circumference, aerobic capacity, lipid profile, and HbA1c. Subsequently, participants completed questionnaires (e.g., the Symptom Checlist-90 (SCL-90) and the Checklist Individual Strength (CIS)). Seventy-nine adults with a mean BMI of 39.5 kg/m2 (SD 5.3) were included. Forty-four participants completed 2 years in the program. Compared to baseline, there were significant improvements in the SF-36 subscales 'physical functioning' (MD 9.9 points, 95% CI: 2.1-17.5, p = 0.013) and 'general health perceptions' (MD 9.3 points, 95% CI 2.9-15.7, p = 0.006). Furthermore, significant improvements in physical outcomes and psychosocial questionnaires (e.g., weight loss (MD 3.5 kg, 95% CI: 1.2-5.7, p = 0.003), waist circumference (MD 5.1 cm, 95% CI: 2.4-7.8, p < 0.001), and CIS fatigue (MD 6.8, 95% CI: 3.1-10.5, p = 0.001) were observed. This study highlights the importance of a systems health perspective supporting the development of a personalized integrative coaching program for adults with obesity in a 'real-world' setting.

The 'Behavioral Balance Model': A new perspective on the aetiology and therapy of obesity

Obesity is a debilitating disease of global proportions that necessitates refined, concept-driven therapeutic approaches. Policy makers, the public and even health care professionals, but also individuals with obesity harbour many misconceptions regarding this disease, which leads to prejudice, negative attitudes, stigmatization, discrimination, self-blame, and failure to provide and finance adequate medical care. Decades of intensive, successful scientific research on obesity have only had a very limited effect on this predicament. We propose a science-based, easy-to-understand conceptual model that synthesizes the complex pathogenesis of obesity including biological, psychological, social, economic and environmental aspects with the aim to explain and communicate better the nature of obesity and currently available therapeutic modalities. According to our integrative 'Behavioral Balance Model', 'top-down cognitive control' strategies are implemented (often with limited success) to counterbalance the increased 'bottom-up drive' to gain weight, which is triggered by biological, psycho-social and environmental mechanisms in people with obesity. Besides offering a deeper understanding of obesity, the model also highlights why there is a strong need for multimodal therapeutic approaches that may not only increase top-down control but also reduce a pathologically increased bottom-up drive.

Integrating COM-B and the person-based approach to develop an ACT based therapy programme to raise self-determination in adolescents with obesity

BACKGROUND

This paper details the development of the Adolescent Intrinsic Motivation 'AIM2Change' intervention to support weight-management in young people previously unable to make changes whilst attending a tier 3 weight management service for children and young people. AIM2Change is an acceptance and commitment therapy based intervention that will be delivered one-to-one online over a seven-week period.

METHODS

To develop this intervention, we have triangulated results from a qualitative research study, patient and public involvement groups (PPI) and a COM-B (capability, opportunity, motivation, behaviour) analysis, in a method informed by the person-based approach.

RESULTS

The integrated development approach yielded a broad range of perspectives and facilitated the creation of a tailored intervention to meet the needs of the patient group whist remaining pragmatic and deliverable.

CONCLUSIONS

The next steps for this intervention will be in-depth co-development of the therapy sessions with service users, before implementing a proof of concept trial.

Cognitive Behavioural Therapies for Weight-Loss in Adults: A Scoping Review Protocol

Obesity and being overweight are very important public health issues due to their increasing prevalence worldwide. Third-wave cognitive behavioural therapies (3wCBT) have emerged in the last few years to promote weight loss. However, the scientific evidence identifying the most commonly used 3wCBT in weight-loss interventions in adults is still needed. The objective of this scoping review will be to identify the most widely researched 3wCBT used to facilitate weight loss in an adult population who are overweight and obese, according to the published scientific literature. The search will be carried out independently by two authors in PubMed (MEDLINE), Scopus, EMBASE, Web of Science, and PsycINFO, using search equations that contain keywords related to our search question: (1) population: adult and elderly population, (2) intervention: terms related to 3wCBT, and (3) results: weight loss or weight management. The data extraction will be performed following the indications of the Cochrane manual, and the results will be presented in three tables. The 3wCBTs have shown promising results for weight loss, but it is not yet known which of them is the most widely used to achieve weight loss in the adult population. Thus, the results of this scoping review could guide professionals in the psychological treatment of obesity and being overweight.

Psychological considerations for the holistic management of obesity

Psychological presence in multidisciplinary obesity teams has been highlighted as an important component of such teams. Although mentioned in guidelines and recommendations, there is little information regarding the extent to which this is present currently in weight management services, and in what form. Here, we discuss important ways in which psychological aspects of obesity can impact a person living with obesity and how psychology can be incorporated to provide holistic support in weight management services. Recommendations are also made to create clearer guidelines to provide a more robust reference for the inclusion of psychology in multidisciplinary teams.

Effectiveness of acceptance and commitment therapy on weight, eating behaviours and psychological outcomes: a systematic review and meta-analysis

PURPOSE

To examine the effectiveness of ACT on weight (body mass index and body mass), eating behaviours (binge eating, emotional eating, external eating and restraint eating), and psychological outcomes (quality of life [QoL], depression, psychological flexibility, and weight stigma) among adults with overweight and obesity.

METHODS

Seven electronic databases (CINAHL, EMBASE, PubMed, PsycInfo Scopus, The Cochrane Library, and Web of Science) were searched from inception through 17 June 2022. 13 studies and 48 unique effect sizes were analyzed using random-effects models. Pooled effect estimates were calculated using weighted mean differences (WMD) and standardized mean differences expressed in Hedges' g (g). Heterogeneity was assessed using Q-statistics and interpreted using I².

RESULTS

ACT was found to be effective in improving weight loss in terms of BMI (k = 6, WMD = - .50, 95% CI = - .90; - .11, t = - 3.25, p = .20, I² = .0%), psychological flexibility and weight-related stigma. However, non-significant changes were found for body mass (k = 4, WMD = - 0.33 95% CI = - 1.53; 0.87, t = - .88, p = .44, I² = .0%), binge eating (k = 4, g = - .34, 95% CI = - 1.31; 0.62, t = - 1.13, p = .34, I² = 71.1%), emotional eating (k = 6, g = - .20, 95% CI = - 0.54; 0.15, t = - 1.47, p = .20, I² = 45.0%), external eating (k = 5, g = - .40, 95% CI = 0.96; 0.16, t = - 1.99, p = .12, I² = 81.8%), restraint eating (k = 3, g = .22 95% CI = - 0.57; 1.01, t = 1.19, p = .36, I² = 69.1%), QoL (k = 3, g = .01, 95% CI = - 1.51; 1.52, t = .02, p = .99, I² = 90.2%) and depression (k = 3, g = - .55, 95% CI = - 1.78; 0.67, t = - 1.94, p = .19, I² = 79.9%).

CONCLUSION

ACT could be effective in improving weight loss but more studies are needed to ascertain its effectiveness and the underlying mechanism by which the various components influence weight-related outcomes.

LEVEL OF EVIDENCE

Evidence obtained from a systematic review and meta-analysis of existing empirical studies.

Acceptance and Commitment Therapy and Weight-Related Difficulties in Overweight and Obese Adults: A Systematic Review

Multiple studies have investigated the efficacy of acceptance and commitment therapy (ACT) in improving psychological flexibility among overweight and obese individuals. However, to date, no specific reviews have focused on ACT and weight-related difficulties in this population. This systematic review of the literature aims to identify and assemble all ACT interventions in randomized controlled trials (RCT) that address weight-related difficulties in the treatment of overweight and obese adults. The PRISMA 2020 framework was used for the systematic review, includes manual and computerized database searches. Five databases (Medline, PubMed, Scopus, PsycInfo, and Google) were utilized to gather all articles that: (a) published in English; (b) adopted the RCT design; (c) used ACT as an intervention; (d) included adult participants aged over 18 years with BMI of over 25 kg/m2, and (e) included weight-related difficulties and weight as outcome measures. The review identified seven studies comprising 698 overweight or obese participants of both genders. Improvements were reported in weight-related difficulties and percentage of weight loss in the ACT group and the non-ACT group. The present review supports ACT as an effective intervention that can help adults with weight-related difficulties and excess body weight. Further studies should be conducted in various overweight or obese populations with a more systematic RCT research design to establish the effectiveness of ACT in this area.