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Munialo CD, Mellor DD. A review of the impact of social disruptions on food security and food choice. Food Sci Nutr 2024; 12:13-23. [PMID: 38268897 PMCID: PMC10804122 DOI: 10.1002/fsn3.3752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 07/06/2023] [Accepted: 09/29/2023] [Indexed: 01/26/2024] Open
Abstract
At times of severe social disruption, be that war, conflict, pandemic, or economic downturn, both the availability and consumption of healthy dietary patterns can be adversely affected with any effects often outlasting the initial social disruption. For instance, when the COVID-19 pandemic hit and lockdown restrictions followed, households were reported to consume unhealthy diets. In some cases, this seemed to be a response to the situation and a coping mechanism. In contrast, in other cases, it was a consequence of limited food availability or access, with some communities finding that fresh foods became difficult to source due to the disruption in global supply chains. The example presented by the impact of conflict in Ukraine, which has also disrupted global food supply chains, at a macrolevel, food systems and at a microlevel, individual and community shows that food choices may respond to different global events in similar ways. Therefore, in this review, a range of events/disruptions are considered, beyond pandemics and wars, including climate disasters (e.g., fire, famine, and floods) that have been shown to impact food supply and consequently, food security. The importance of this can be seen as inadequate and nutritionally poor diets have a concomitant effect on health, which extends beyond the initial period of societal stress and disruption of food supply chains. Hence, the impact of such disruptions on consumer behavior which includes food choice needs to be corroborated. Therefore, this review aims to discuss the impact of such disruptions on consumer behavior and food choices. Additionally, this review provides some practical strategies that can be used to ensure the availability of healthy diets.
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Affiliation(s)
- Claire D. Munialo
- Food, Land and Agribusiness ManagementHarper Adams UniversityNewportUK
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Kudlek L, Mueller J, Eustacio Colombo P, Sharp SJ, Griffin SJ, Ahern A. The moderating and mediating role of eating behaviour traits in acceptance and commitment therapy-based weight management interventions: protocol for an individual participant data meta-analysis. BMJ Open 2023; 13:e076411. [PMID: 38081662 PMCID: PMC10729174 DOI: 10.1136/bmjopen-2023-076411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 11/27/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Precision medicine approaches to obesity aim to maximise treatment effectiveness by matching weight management interventions (WMIs) to characteristics of individuals, such as eating behaviour traits (EBTs). Acceptance and commitment therapy (ACT)-based WMIs may address EBTs such as emotional and uncontrolled eating more effectively than standard interventions, and might be most effective in people with high levels of these traits. However, few studies have examined this directly. We will examine (a) whether ACT-based interventions are more effective for people with certain levels of EBTs (ie, moderation) and (b) whether ACT-based interventions operate through changes in EBTs (ie, mediation). METHODS AND ANALYSIS This individual participant data (IPD) meta-analysis will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses of Individual Participant Data guidance. We will include studies on ACT-based WMIs that assessed EBTs in people with a body mass index ≥25 kg/m2. We identified studies by screening studies included in a previous review of third wave cognitive behavioural interventions, and updating the search to 20 June 2022. We will request IPD from eligible published and unpublished studies. We will harmonise and re-analyse data using a two-stage random effects meta-analysis pooling within-trial interactions to investigate moderating effects and using a one-stage simultaneous equation model to examine mediating effects. We will assess the risk of bias in included studies using the Cochrane Risk of Bias tool 2 and the Risk of Bias in Non-randomised Studies of Interventions tool. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Cambridge Psychology Research Ethics Committee (Application No: PRE.2023.121). Data sharing will follow data transfer agreements and coauthorship will be offered to investigators contributing data. Findings will be disseminated through peer-reviewed journals and conferences and will contribute to the lead author's PhD thesis. PROSPERO REGISTRATION NUMBER CRD42022359691.
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Affiliation(s)
- Laura Kudlek
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Julia Mueller
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | | | - Stephen J Sharp
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Simon J Griffin
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
- Primary Care Unit, University of Cambridge, Cambridge, UK
| | - Amy Ahern
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
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Benbaibeche H, Saidi H, Bounihi A, Koceir EA. Emotional and external eating styles associated with obesity. J Eat Disord 2023; 11:67. [PMID: 37131270 PMCID: PMC10152697 DOI: 10.1186/s40337-023-00797-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 04/24/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Obesity is related to eating habits. Overeating is the most behavioural trait implicated in obesity; emotional, external and rigid restrained eating are three maladaptive eating habits that are associated to overeating. OBJECTIVES The current study assesses the eating styles of Algerian adults. It identifies and analyses differences in eating styles in a sample from adults with normal BMI and who have obesity. The study examines the relationship between eating styles and BMI. METHODS The sample consisted of 200 volunteers aged from 31 to 62 years old, 110 with obesity and 90 having normal BMI. The participants were recruited from hospital and university employees. They were questioned about their eating habits. The participants did not receive any treatment. To assess eating styles, participants completed the DEBQ. RESULTS The prevalence of women was in the majority, representing 61% (n = 122) in the total sample (63.63% (n = 70) with obesity, and 55.77% (n = 52) with normal BMI). The prevalence of men represents 39% (n = 78) in the total sample (36.36% (n = 40) with obesity, and 42.22% (n = 38) with normal BMI). Participants with obesity showed pathological eating styles. They scored higher on emotional and external eating styles than to normal BMI group. However, restraint eating showed a slight no significant increase. The mean scores ± standard deviations observed in each eating styles were: emotional eating (2.88 ± 0.99** vs. 1.71 ± 0.32), external eating (3.31 ± 0.68** vs. 1.96 ± 0.29), and retrained eating (1.81 ± 0.7ns vs. 1.3 ± 0.30). The linear regression analysis showed an effect of emotional and external eating on BMI. CONCLUSION These results could be used to provide clinical information at the initial screening for obesity criteria, obesity prevention and treatment.
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Affiliation(s)
- Hassiba Benbaibeche
- Faculté des sciences, département des sciences de la nature et de la vie, Université Alger 1, Alger, Algérie.
| | - Hamza Saidi
- University of Sciences and Technology Houari Boumediene, Algiers, Algeria
| | - Abdenour Bounihi
- Ecole Supérieure des Sciences de l'Aliment et des Industries Agroalimentaires, Alger, Algérie
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Ahlich E, Rancourt D. Boredom proneness, interoception, and emotional eating. Appetite 2022; 178:106167. [PMID: 35843373 DOI: 10.1016/j.appet.2022.106167] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/24/2022] [Accepted: 07/11/2022] [Indexed: 11/02/2022]
Abstract
Emotional eating is associated with weight gain and difficulty losing weight during weight loss interventions. Theoretical and empirical work suggest boredom may be an important predictor of problematic eating behaviors. Yet, little work has examined the role of boredom in emotional eating. Further, individual differences in the ability to recognize internal cues (i.e., interoception) may alter the impact of boredom on emotional eating. This study hypothesized that boredom proneness would predict unique variance in emotional eating after accounting for negative and positive affect, and that the association between boredom proneness and emotional eating would be stronger among those with poorer interoceptive ability compared to those with better interoceptive ability. Hypotheses were tested in two large samples using multiple linear regression. Participants aged 18-65 were recruited from MTurk (n = 365; 59.2% female) and an undergraduate research pool (n = 461; 52.9% female). Participants completed self-report measures: Boredom Proneness Scale; Dutch Eating Behavior Questionnaire- Emotional Eating; Multidimensional Assessment of Interoceptive Awareness-2; Intuitive Eating Scale-2- Reliance on Hunger and Satiety Cues; and Positive and Negative Affect Schedule. Boredom proneness was a significant predictor of emotional eating in both samples, even accounting for the broad dimensions of negative and positive affect (ps < .001). Interoception did not moderate the association between boredom proneness and emotional eating in either sample (ps > .05), but was an independent predictor of emotional eating (ps < .001). Boredom proneness and interoceptive ability may warrant attention as targets in the prevention and treatment of emotional eating. Future work should continue exploring different emotion categories and different facets of interoception in emotional eating, as well as examine novel mechanisms that could inform intervention efforts.
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Kinsey AW, Phillips J, Desmond R, Gowey M, Jones C, Ard J, Clark JM, Lewis CE, Dutton GR. Factors Associated with Weight Loss Maintenance and Weight Regain Among African American and White Adults Initially Successful at Weight Loss. J Racial Ethn Health Disparities 2022; 9:546-565. [PMID: 33544328 PMCID: PMC8339173 DOI: 10.1007/s40615-021-00985-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Providing ongoing treatment through extended care programs can improve weight loss maintenance (WLM), but the effectiveness of these programs for African Americans (AA) are mixed and may be due to unique cultural factors. PURPOSE To identify, prioritize, and organize factors associated with WLM as experienced by AA and White adults initially successful with weight loss. METHODS Adults identified their greatest amount of lifetime weight loss, and those achieving ≥5% weight loss were classified as maintainers (continued >5% weight reduction for ≥1 year) or regainers (≤5% weight reduction) based on current weight. The nominal group technique was conducted to identify and rank WLM facilitators and barriers. Online card sorting tasks and hierarchical clustering were performed to illustrate conceptual relationships between facilitators (maintainers only) and barriers (regainers only). RESULTS Participants (maintainers, n = 46; regainers, n = 58; 81.7% women, 48.1% AA) identified known factors associated with successful weight management (daily weighing, self-monitoring, regular physical activity, mindful eating). However, the perceived importance of these factors differed between groups (maintainer vs. regainers; AA vs. Whites). Unique factors affecting WLM were also identified (refresher groups recommended by White maintainers and regainers; self-accountability identified by AA maintainers). Salient facilitators and barriers were best represented in 2-3 clusters; each group had ≥1 unique cluster(s) revealing group-specific higher-order domains associated with successful WLM. CONCLUSIONS As lifestyle interventions for WLM (particularly for AA) are developed, attention to the preferences, and lived experiences of these groups is recommended. Strategies targeting physical activity maintenance and autonomy-supportive approaches may improve WLM among AA.
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Affiliation(s)
- Amber W Kinsey
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, 1717 11th Avenue South, Medical Towers 615, Birmingham, AL, 35205, USA
| | - Janice Phillips
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, 1717 11th Avenue South, Medical Towers 615, Birmingham, AL, 35205, USA
| | - Renee Desmond
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, 1717 11th Avenue South, Medical Towers 615, Birmingham, AL, 35205, USA
| | - Marissa Gowey
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Catherine Jones
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jamy Ard
- Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC, USA
| | - Jeanne M Clark
- Division of General Internal Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Cora E Lewis
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gareth R Dutton
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, 1717 11th Avenue South, Medical Towers 615, Birmingham, AL, 35205, USA.
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Chwyl C, Berry MP, Manasse SM, Forman EM. Rethinking emotional eating: Retrospective and momentary indices of emotional eating represent distinct constructs. Appetite 2021; 167:105604. [PMID: 34293393 PMCID: PMC8435005 DOI: 10.1016/j.appet.2021.105604] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 05/27/2021] [Accepted: 07/15/2021] [Indexed: 11/18/2022]
Abstract
Emotional eating (EE) has been proposed as a key weight loss barrier. However, most investigations of EE rely on retrospective self-reports, which may have poor construct validity. This study evaluated concordance between a common self-report EE measure and a novel method for assessing momentary EE using ecological momentary assessment (EMA). We further assessed the utility of both measures for predicting both BMI and weight outcomes. Participants with overweight or obesity enrolled in a weight loss trial (N = 163) completed a self-report measure of EE and underwent an EMA protocol that assessed momentary emotions and eating behaviors. Momentary EE was derived from EMA data using generalized linear mixed-effects models. Linear regression models examined associations between both EE measures and concurrent BMI as well as weight losses over 30 months. Retrospectively self-reported EE and momentary EE were negatively correlated with one another (r = -0.27). Higher momentary EE and higher retrospectively reported EE both predicted higher concurrent BMI, and higher retrospectively reported EE predicted poorer weight loss outcomes at all time points (p < 0.05). By contrast, higher momentary EE predicted improved weight outcomes at 1-year and 2-year follow-up (p < 0.05). Our findings extend prior research suggesting that retrospective self-report EE measures capture a different construct than intended and suggest that momentary EE could predict improved weight loss outcomes.
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Affiliation(s)
- Christina Chwyl
- Center for Weight, Eating, and Lifestyle Sciences (WELL Center), Drexel University, Philadelphia, PA, USA.
| | - Michael P Berry
- Center for Weight, Eating, and Lifestyle Sciences (WELL Center), Drexel University, Philadelphia, PA, USA.
| | - Stephanie M Manasse
- Center for Weight, Eating, and Lifestyle Sciences (WELL Center), Drexel University, Philadelphia, PA, USA.
| | - Evan M Forman
- Center for Weight, Eating, and Lifestyle Sciences (WELL Center), Drexel University, Philadelphia, PA, USA.
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Thomas JG, Goldstein CM, Bond DS, Lillis J, Hekler EB, Emerson JA, Espel-Huynh HM, Goldstein SP, Dunsiger SI, Evans EW, Butryn ML, Huang J, Wing RR. Evaluation of intervention components to maximize outcomes of behavioral obesity treatment delivered online: A factorial experiment following the multiphase optimization strategy framework. Contemp Clin Trials 2020; 100:106217. [PMID: 33197609 DOI: 10.1016/j.cct.2020.106217] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 11/06/2020] [Accepted: 11/11/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Behavioral lifestyle intervention (BLI) is recommended as a first-line treatment for obesity. While BLI has been adapted for online delivery to improve potential for dissemination while reducing costs and barriers to access, weight losses are typically inferior to gold standard treatment delivered in-person. It is therefore important to refine and optimize online BLI in order to improve the proportion of individuals who achieve a minimum clinically significant weight loss and mean weight loss. STUDY DESIGN Five experimental intervention components will be tested as adjuncts to an established 12-month online BLI: virtual reality for BLI skills training, interactive video feedback, tailored intervention to promote physical activity, skills for dysregulated eating, and social support combined with friendly competition. Following the Multiphase Optimization Strategy (MOST) framework, the components will first be refined and finalized during Preparation Phase pilot testing and then evaluated in a factorial experiment with 384 adults with overweight or obesity. A priori optimization criteria that balance efficacy and efficiency will be used to create a finalized treatment package that produces the best weight loss outcomes with the fewest intervention components. Mediation analysis will be conducted to test hypothesized mechanisms of action and a moderator analysis will be conducted to understand for whom and under what circumstances the interventions are effective. CONCLUSION This study will provide important information about intervention strategies that are useful for improving outcomes of online BLI. The finalized treatment package will be suitable for testing in a future randomized trial in the MOST Evaluation Phase.
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Affiliation(s)
- J Graham Thomas
- Weight Control and Diabetes Research Center, The Miriam Hospital, 196 Richmond St., Providence, RI 02903, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, 222 Richmond St., Providence, RI 02903, USA.
| | - Carly M Goldstein
- Weight Control and Diabetes Research Center, The Miriam Hospital, 196 Richmond St., Providence, RI 02903, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, 222 Richmond St., Providence, RI 02903, USA
| | - Dale S Bond
- Weight Control and Diabetes Research Center, The Miriam Hospital, 196 Richmond St., Providence, RI 02903, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, 222 Richmond St., Providence, RI 02903, USA
| | - Jason Lillis
- Weight Control and Diabetes Research Center, The Miriam Hospital, 196 Richmond St., Providence, RI 02903, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, 222 Richmond St., Providence, RI 02903, USA
| | - Eric B Hekler
- Department of Family Medicine and Public Health, University of California, San Diego (UCSD), Center for Wireless and Population Health Systems, Qualcomm Institute at UCSD, 9500 Gilman Ave., San Diego, CA 92093, USA
| | - Jessica A Emerson
- Weight Control and Diabetes Research Center, The Miriam Hospital, 196 Richmond St., Providence, RI 02903, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, 222 Richmond St., Providence, RI 02903, USA
| | - Hallie M Espel-Huynh
- Weight Control and Diabetes Research Center, The Miriam Hospital, 196 Richmond St., Providence, RI 02903, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, 222 Richmond St., Providence, RI 02903, USA
| | - Stephanie P Goldstein
- Weight Control and Diabetes Research Center, The Miriam Hospital, 196 Richmond St., Providence, RI 02903, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, 222 Richmond St., Providence, RI 02903, USA
| | - Shira I Dunsiger
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 S Main St., Providence, RI 02903, USA
| | - E Whitney Evans
- Weight Control and Diabetes Research Center, The Miriam Hospital, 196 Richmond St., Providence, RI 02903, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, 222 Richmond St., Providence, RI 02903, USA
| | - Meghan L Butryn
- Department of Psychology, Drexel University, 3141 Chestnut St, Philadelphia, PA 19104, USA
| | - Jeff Huang
- Department of Computer Science, Brown University, 115 Waterman St., Providence, RI 02906, USA
| | - Rena R Wing
- Weight Control and Diabetes Research Center, The Miriam Hospital, 196 Richmond St., Providence, RI 02903, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, 222 Richmond St., Providence, RI 02903, USA
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Paans NPG, Bot M, Brouwer IA, Visser M, Gili M, Roca M, Hegerl U, Kohls E, Owens M, Watkins E, Penninx BWJH. Effects of food-related behavioral activation therapy on eating styles, diet quality and body weight change: Results from the MooDFOOD Randomized Clinical Trial. J Psychosom Res 2020; 137:110206. [PMID: 32798835 DOI: 10.1016/j.jpsychores.2020.110206] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 07/14/2020] [Accepted: 07/26/2020] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Depression and obesity are bi-directionally related, eating styles and diet quality are two important factors associated with both. It remains uncertain if and how these two factors can be modified. Therefore the current study aims to investigate whether food-related behavioral activation therapy (F-BA), targeting mood, dietary habits and food related behavior, can improve eating styles, and diet quality and reduce body weight in adults with overweight or obesity and subsyndromal depressive symptoms. METHODS Data were derived from the MooDFOOD prevention trial, a 2x2 factorial RCT investigating the effect of nutritional strategies on prevention of depression. Changes in emotional, uncontrolled, and cognitive restrained eating (Three Factor Eating Questionnaire Revised), Mediterranean Diet Score (MDS), and body weight were analyzed among 1025 adults who either received F-BA or no intervention for 12 months. Intervention effect was tested by longitudinal analysis of covariance using mixed model analysis. RESULTS The F-BA group showed a small decrease in emotional (β=-5.68, p<.001) and uncontrolled eating (β=-4.05, p=.03), and increase in cognitive restrained eating (β=5.53, p<.01), compared to no F-BA. The effect of the F-BA therapy on emotional and uncontrolled eating was stronger in those with higher baseline depressive symptoms (IDS-SR). The F-BA did also lead to small improvements in MDS (β=1.95, p<.001), but not to change in body weight. CONCLUSION Our trial showed no reduction in bodyweight, but provides support for the possibility to improve both unhealthy eating styles and diet quality using an intervention targeting these specifically, although effects were small [Trial registration: clinicaltrials.gov NCT02529423].
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Affiliation(s)
- Nadine P G Paans
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands.
| | - Mariska Bot
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Ingeborg A Brouwer
- Department of Health Sciences, Faculty of Science, and Amsterdam Public Health research institute, Vrije Universiteit, Amsterdam, The Netherlands
| | - Marjolein Visser
- Department of Health Sciences, Faculty of Science, and Amsterdam Public Health research institute, Vrije Universiteit, Amsterdam, The Netherlands
| | - Margalida Gili
- Institut Universitari d' Investigació en Ciències de la Salut (IUNICS/IDISBA), Rediapp, University of Balearic Islands, Carretera de Valldemosssa km 7,5, 07071 Palma de Mallorca, Spain
| | - Miquel Roca
- Institut Universitari d' Investigació en Ciències de la Salut (IUNICS/IDISBA), Rediapp, University of Balearic Islands, Carretera de Valldemosssa km 7,5, 07071 Palma de Mallorca, Spain
| | - Ulrich Hegerl
- Department of Psychiatry, Psychosomatic and Psychotherapy, Senckenberg Distinguished Professorship, Goethe-University Frankfurt, Frankfurt A.M., Germany
| | - Elisabeth Kohls
- Department of Psychiatry and Psychotherapy, University Leipzig, Medical Faculty, Leipzig, Germany
| | - Matthew Owens
- Department of Psychology, University of Exeter, Exeter, UK
| | - Ed Watkins
- Department of Psychology, University of Exeter, Exeter, UK
| | - Brenda W J H Penninx
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
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Pickett S, Burchenal CA, Haber L, Batten K, Phillips E. Understanding and effectively addressing disparities in obesity: A systematic review of the psychological determinants of emotional eating behaviours among Black women. Obes Rev 2020; 21:e13010. [PMID: 32067355 DOI: 10.1111/obr.13010] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 12/21/2019] [Accepted: 01/17/2020] [Indexed: 11/28/2022]
Abstract
Emotional eating may be a particularly important contributor to differences in body weight and weight loss response to behavioural interventions among non-Hispanic Black women. We performed a systematic review on the impact of psychological factors (stress, anxiety, depression, and discrimination) upon emotional eating and weight among non-Hispanic Black women, applying the Preferred Reporting Items for Systematic Reviews and Meta-analysis for relevant studies. The initial search yielded 4593 articles with 15 accepted for review. Based on this review, there is a suggestion that negative emotions, in particular, perceived stress, may be predictive of emotional eating among non-Hispanic Black women. Results from the only two longitudinal studies identified by the review indicate that stress influences emotional eating, and emotional eating predicts weight gain over time. Findings from this review highlight the need for more studies that examine various negative emotions that may lead to emotional eating and weight gain among non-Hispanic Black women. Findings from this review also highlight the need for more rigorous studies to differentiate the effects of emotional eating from that of the physiologic (ie, activation of the hypothalamic-pituitary axis) responses to stress and its impact on high-risk groups.
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Affiliation(s)
- Stephanie Pickett
- School of Nursing, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Clare A Burchenal
- School of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Leora Haber
- School of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Kendra Batten
- School of Health and Human Sciences, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Erica Phillips
- Division of General Internal Medicine, Weill Cornell Medical College, New York, NY, USA
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Paixão C, Dias CM, Jorge R, Carraça EV, Yannakoulia M, de Zwaan M, Soini S, Hill JO, Teixeira PJ, Santos I. Successful weight loss maintenance: A systematic review of weight control registries. Obes Rev 2020; 21:e13003. [PMID: 32048787 PMCID: PMC9105823 DOI: 10.1111/obr.13003] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/09/2020] [Accepted: 01/10/2020] [Indexed: 12/25/2022]
Abstract
Weight loss maintenance is a major challenge for obesity treatment. Weight control registries can be useful in identifying psychological and behavioural factors that could contribute to better long-term success. The objective of this study is to describe the existing weight control registries and their participants and identify correlates of weight loss maintenance. A comprehensive search of peer-reviewed articles published until November 2018 was conducted in PubMed, Web of Science, and Scopus. Studies that reported results from weight control registries were considered. Fifty-two articles, corresponding to five registries (the United States, Portugal, Germany, Finland, and Greece), were included. Registries differed in inclusion criteria and procedures. Of 51 identified weight loss and maintenance strategies, grouped in 14 domains of the Oxford Food and Activity Behaviors taxonomy, the following were the most frequently reported: having healthy foods available at home, regular breakfast intake, increasing vegetable consumption, decreasing sugary and fatty foods, limiting certain foods, and reducing fat in meals. Increased physical activity was the most consistent positive correlate of weight loss maintenance. To our knowledge, this is the first systematic review of information about successful weight loss maintenance obtained from weight control registries. Key common influential characteristics of success were identified, which can inform future prospective studies and weight management initiatives.
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Affiliation(s)
- Catarina Paixão
- Centro Interdisciplinar para o Estudo da Performance Humana, Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz Quebrada Dafundo, Portugal
| | - Carlos M Dias
- Centro de Investigação em Saúde Pública (CISP), NOVA-Escola Nacional de Saúde Pública, Lisbon, Portugal.,Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - Rui Jorge
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz, Almada, Portugal.,Unidade de Investigação do Instituto Politécnico de Santarém, Escola Superior Agrária, Instituto Politécnico de Santarém, Santarém, Portugal
| | - Eliana V Carraça
- Centro Interdisciplinar para o Estudo da Performance Humana, Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz Quebrada Dafundo, Portugal
| | - Mary Yannakoulia
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
| | - Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Sirpa Soini
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
| | - James O Hill
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, Alabama
| | - Pedro J Teixeira
- Centro Interdisciplinar para o Estudo da Performance Humana, Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz Quebrada Dafundo, Portugal
| | - Inês Santos
- Centro Interdisciplinar para o Estudo da Performance Humana, Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz Quebrada Dafundo, Portugal.,Laboratório de Nutrição, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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11
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Naets T, Vervoort L, Tanghe A, De Guchtenaere A, Braet C. Maladaptive Eating in Children and Adolescents With Obesity: Scrutinizing Differences in Inhibition. Front Psychiatry 2020; 11:309. [PMID: 32425824 PMCID: PMC7212434 DOI: 10.3389/fpsyt.2020.00309] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 03/27/2020] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION In order to grasp the complex etiology of childhood obesity, we aim to clarify the relationship between external eating and weight. Based on theory and empirical evidence, we claim that inhibition is an important moderator in this association. In our first research question we expected that high external eating would be related to a higher weight status, especially for those with high inhibition problems. Secondly, we explored the moderating role of inhibition in the association between external eating and weight change after a multidisciplinary obesity treatment. METHOD We investigated n=572 participants (51% boys, aged 7-19) with moderate to extreme obesity recruited in a Belgian inpatient treatment center. At intake, parents reported on inhibition (BRIEF), while the children and adolescents reported on their eating behavior (DEBQ). Weight and length were objectively measured pre and post treatment (ADJUSTED BMI). Two hierarchical linear regression models were built to scrutinize the influence of inhibition on the association between external eating and both baseline weight and weight change. RESULTS First, predicting baseline weight, we found no significant moderating effect of inhibition problems. Second, predicting weight loss, inhibition turned out to be a substantial moderator, specifically in adolescents. Some unexpected gender differences occurred in favor of adolescent boys, in a way that those with high external eating and low inhibition problems lost most weight. CONCLUSION Inhibition problems act as a moderator explaining weight loss, but this only holds for adolescents. This suggests that external eating and inhibition play a complex role in weight loss in certain age and gender categories, and stresses the importance of identifying subgroups for tailoring interventions. For those with high inhibition problems, interventions aimed at increasing inhibition skills might be needed to optimize treatment outcomes.
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Affiliation(s)
- Tiffany Naets
- Clinical Child and Adolescent Psychology (CCAP) Lab, Department of Developmental, Personality and Social Psychology, Ghent University, Ghent, Belgium
| | - Leentje Vervoort
- Clinical Child and Adolescent Psychology (CCAP) Lab, Department of Developmental, Personality and Social Psychology, Ghent University, Ghent, Belgium
| | - Ann Tanghe
- Obesity Department, Zeepreventorium vzw, De Haan, Belgium
| | | | - Caroline Braet
- Clinical Child and Adolescent Psychology (CCAP) Lab, Department of Developmental, Personality and Social Psychology, Ghent University, Ghent, Belgium
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12
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Pickett S, McCoy TP, Odetola L. The Influence of Chronic Stress and Emotions on Eating Behavior Patterns and Weight among Young African American Women. West J Nurs Res 2020; 42:894-902. [PMID: 31941424 DOI: 10.1177/0193945919897541] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
This study examines the influence of chronic stress, varied positive and negative emotions on eating behaviors, and weight among 91 community-dwelling African American women 18-40 years old. Study measures include hair cortisol, Differential Emotional Scale IV, Eating Behavior Pattern Questionnaire, demographic form, waist circumference, and Body Mass Index (BMI). Analysis revealed positive emotions of interest (rs = .27, p = .011) and surprise (rs = .23, p = .029) were associated with low fat eating. Negative emotions of anger (rs = .23, p = .035), shyness (rs = .29, p = .006), and guilt (rs = .24, p = .022) were positively associated with emotional eating. Mediation analysis suggests that emotional eating mediates anger (indirect effect = 0.136), shyness (0.144), guilt (0.187), and BMI among young African American women. Chronic stress and positive and negative emotions impact eating behaviors and should be considered for successful weight management among African American women.
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Affiliation(s)
- Stephanie Pickett
- School of Nursing, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Thomas P McCoy
- School of Nursing, Statistician, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Love Odetola
- School of Public Health Education, University of North Carolina at Greensboro, Greensboro, NC, USA
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13
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Abstract
One of the biggest challenges in the management of obesity is the prevention of weight regain after successful weight loss. Weight regain after weight loss has large interindividual variation. Although many factors probably contribute to this variation, we hypothesize that variability in biological responses associated with weight loss-induced shrinking of subcutaneous adipocytes has an important role. In this Review, we show that weight loss-induced variations in cellular stress, extracellular matrix remodelling, inflammatory responses, adipokine secretion and lipolysis seem to be associated with the amount of weight that is regained after successful weight loss. Weight regain could therefore, at least in part, depend on a combination of these factors. Further research on the causality of these associations could aid the development of effective strategies to prevent weight regain after successful weight loss.
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Affiliation(s)
- Marleen A van Baak
- NUTRIM School for Nutrition and Translational Research in Metabolism, Department of Human Biology, Maastricht University, Maastricht, Netherlands.
| | - Edwin C M Mariman
- NUTRIM School for Nutrition and Translational Research in Metabolism, Department of Human Biology, Maastricht University, Maastricht, Netherlands
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14
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Carpenter KM, Vickerman KA, Salmon EE, Javitz HS, Epel ES, Lovejoy JC. A Randomized Pilot Study of a Phone-Based Mindfulness and Weight Loss Program. Behav Med 2019; 45:271-281. [PMID: 28985151 PMCID: PMC8462129 DOI: 10.1080/08964289.2017.1384359] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This study evaluated the feasibility and efficacy of integrating mindfulness training into a phone-based weight loss program to improve outcomes in those with high levels of emotional eating. Participants were 75 enrollees into an employer-sponsored weight loss program who reported high levels of overeating in response to thoughts and feelings. Seventy-five overweight and obese participants (92% female, 65% Caucasian, aged 26 to 68 years) were randomized to the new mindfulness weight loss program (n = 50) or the standard behavioral weight loss program (n = 25). Both programs consisted of 11 coaching calls with health coaches and registered dietitians with supplemental online materials. Satisfaction, engagement, and percent weight lost did not significantly differ for intervention vs. control at six months. Intervention participants had significantly better scores at six-month follow-up on mindful eating, binge eating, experiential avoidance, and one mindfulness subscale. Exploratory analyses showed that improvements on several measures predicted more weight loss in the intervention group. This pilot study found that integrating mindfulness into a brief phone-based behavioral weight loss program was feasible and acceptable to participants, but did not produce greater weight loss on average, despite hypothesized changes in mindful eating. Only one third of intervention participants reported participating in mindfulness exercises regularly. Mechanisms of change observed within the intervention group suggest that for adults with high levels of emotional eating those who embrace mindful eating and meditation may lose more weight with a mindfulness intervention.
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Affiliation(s)
| | | | - Erica E Salmon
- Center for Wellbeing Research, Alere Wellbeing, Seattle, WA USA
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15
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Neumann M, Holzapfel C, Müller A, Hilbert A, Crosby RD, de Zwaan M. Features and Trajectories of Eating Behavior in Weight-Loss Maintenance: Results from the German Weight Control Registry. Obesity (Silver Spring) 2018; 26:1501-1508. [PMID: 30230246 DOI: 10.1002/oby.22270] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 06/22/2018] [Accepted: 07/03/2018] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Eating behaviors such as dietary restraint and disinhibition caused by emotional and external cues play a relevant role in weight-loss maintenance. METHODS Four hundred forty individuals with successful weight-loss maintenance included in the prospective German Weight Control Registry completed the Dutch Eating Behavior Questionnaire. Participants were categorized into the following two weight groups: stable weight trajectory (WS) (n = 280) and unstable weight trajectory (WUS) (n = 160) over the 2-year assessment period. RESULTS Those with successful weight-loss maintenance had significantly higher scores on the restrained and emotional eating subscales compared with a general population (GP) sample. At baseline, the WS individuals had lower restrained, emotional, and external eating scores compared with the WUS individuals. Over the 2-year follow-up period, the trajectories of the restraint scores decreased in both groups but stayed elevated compared with the GP sample. Scores of the emotional and external eating subscales remained stable in the WS group but increased in the WUS group. CONCLUSIONS A certain degree of restraint seems to be necessary for successful weight-loss maintenance; however, high emotional and external eating may counteract this effect, resulting in weight regain in the long run.
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Affiliation(s)
- Maria Neumann
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Christina Holzapfel
- Institute for Nutritional Medicine, Technical University of Munich, University Hospital "Klinikum rechts der Isar,", Munich, Germany
| | - Astrid Müller
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Anja Hilbert
- Integrated Research and Treatment Center AdiposityDiseases, Department of Medical Psychology and Medical Sociology, Leipzig University Medical Center, Leipzig, Germany
| | - Ross D Crosby
- Neuropsychiatric Research Institute, Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota, USA
| | - Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
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16
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Paans NPG, Bot M, Brouwer IA, Visser M, Roca M, Kohls E, Watkins E, Penninx BWJH. The association between depression and eating styles in four European countries: The MooDFOOD prevention study. J Psychosom Res 2018; 108:85-92. [PMID: 29602330 DOI: 10.1016/j.jpsychores.2018.03.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 03/07/2018] [Accepted: 03/07/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Depression, one of the most prevalent and disabling disorders in Europe, is thought to be associated with unhealthy eating styles. As prevalence of depression and eating styles potentially differ across Europe, the current study aimed to investigate in a large, European sample, the associations of history of major depressive disorder and depression severity with unhealthy eating styles. METHODS Baseline data of the MooDFOOD prevention study was used. The current analysis included 990 participants of four European countries (The Netherlands, United Kingdom, Germany, Spain). Analyses of Covariance and linear regression analyses were performed with depression history or depression severity as determinants, and emotional, uncontrolled, and cognitive restrained eating (Three Factor Eating Questionnaire Revised, 18 item) as outcomes. RESULTS Depression history and severity were associated with more emotional and uncontrolled eating and with less cognitive restrained eating. Mood, somatic, and cognitive symptom clusters were also associated with more emotional and uncontrolled eating, and with less cognitive restrained eating. The somatic depressive symptoms "increased appetite" and "increased weight" were more strongly associated to unhealthy eating styles compared to other symptoms. No differences in associations between depression and unhealthy eating were found between European countries. CONCLUSION Our results suggest that depression is related to more unhealthy eating styles. Diminishing unhealthy eating styles in subthreshold depressed persons could potentially reduce adverse health consequences like weight gain, unhealthy dietary patterns and weight-related diseases. It is also possible that interventions that decrease depressive symptoms can lead to a decrease in unhealthy eating styles.
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Affiliation(s)
- Nadine P G Paans
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.
| | - Mariska Bot
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Ingeborg A Brouwer
- Department of Health Sciences, Faculty of Earth and Life Sciences, Amsterdam Public Health Research Institute, VU University, Amsterdam, The Netherlands
| | - Marjolein Visser
- Department of Health Sciences, Faculty of Earth and Life Sciences, Amsterdam Public Health Research Institute, VU University, Amsterdam, The Netherlands; Department of Internal Medicine, Nutrition and Dietetics, VU University Medical Center, Amsterdam Public Health Research Institute, VU University, Amsterdam, The Netherlands
| | - Miquel Roca
- Institut Universitari d' Investigació en Ciències de la Salut (IUNICS/IDISPA), Rediapp, University of Balearic Islands, Carretera de Valldemosssa km 7,5, Palma de Mallorca 07071, Spain
| | - Elisabeth Kohls
- Department of Psychiatry and Psychotherapy, University Leipzig, Medical Faculty, Leipzig, Germany
| | - Ed Watkins
- Department of Psychology, University of Exeter, Exeter, UK
| | - Brenda W J H Penninx
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
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17
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Frayn M, Livshits S, Knäuper B. Emotional eating and weight regulation: a qualitative study of compensatory behaviors and concerns. J Eat Disord 2018; 6:23. [PMID: 30221002 PMCID: PMC6137864 DOI: 10.1186/s40337-018-0210-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 08/14/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Emotional eating, or overeating in response to negative emotions, is a behavior endorsed by both normal weight and people with overweight/obesity. For some individuals, emotional eating contributes to weight gain and difficulties losing weight. However, there are also many who engage in emotional eating who maintain a normal weight. Little is known about the mechanisms by which these individuals are able to regulate their weight. METHODS The present study seeks to gain insight into the behaviors of individuals of normal weight who engage in emotional eating through a series of one-on-one, 1-h long, qualitative interviews. Interviews were semi-structured and guided by questions pertaining to participants' compensatory behaviors used to regulate weight and concerns regarding their emotional eating. All interviews were transcribed and then objected to a thematic analysis of their content. RESULTS The results of this analysis showed that participants endorsed using physical activity, controlling their eating behaviors, and engaging in alternative stress reduction and coping strategies to mitigate the effects of their emotional eating. They reported concern over the effects of emotional eating on their weight, body image, and health and saw this behavior as an unhealthy coping mechanism that was difficult to control. CONCLUSIONS These results suggest that programs promoting exercise, mindful eating, emotion regulation, and positive body image could have a positive effect on emotional eaters who struggle to maintain a healthy weight.
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Affiliation(s)
- Mallory Frayn
- Department of Psychology, McGill University, 2001 McGill College, Montreal, Quebec H3A 1G1 Canada
| | - Simone Livshits
- Department of Psychology, McGill University, 2001 McGill College, Montreal, Quebec H3A 1G1 Canada
| | - Bärbel Knäuper
- Department of Psychology, McGill University, 2001 McGill College, Montreal, Quebec H3A 1G1 Canada
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18
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Niemeier HM, Lillis J, Wing RR. Characteristics of adults with overweight/obesity and high internal disinhibition: do they fit with targets for acceptance-based interventions? Obes Sci Pract 2017; 3:311-318. [PMID: 29071107 PMCID: PMC5598016 DOI: 10.1002/osp4.93] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Revised: 11/21/2016] [Accepted: 11/22/2016] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE Adults with overweight/obesity reporting high levels of internal disinhibition (ID) tend to do poorly in standard behavioural weight loss programmes. The current study sought to compare a sample of individuals with overweight/obesity selected on the basis of high ID with an unselected treatment-seeking sample of adults with overweight/obesity on characteristics that might make acceptance-based treatments particularly appropriate for those with high ID. METHODS Sample 1 included 162 treatment-seeking adults with overweight/obesity who were selected for high ID; sample 2 included 194 unselected treatment-seeking adults with overweight/obesity. First, the two samples were compared on levels of general and weight-related experiential avoidance, and values-consistent behaviour, both of which are targeted in acceptance-based treatments, and on other general psychological characteristics. Next, the unselected sample was split into two groups, those meeting criteria for high (N = 105; sample 2/high ID) vs. low (N = 89; sample 2/low ID) ID, and the three groups were compared on the same characteristics. RESULTS Sample 1 reported higher levels of both general and weight-related experiential avoidance as well as less values-consistent behaviour than sample 2. They reported greater psychological impairment in quality of life, depression and anxiety. Within sample 2, 54% met the criteria for high ID. Both sample 1 and sample 2/high ID reported higher levels of experiential avoidance and less values-consistent behaviour than did the sample 2/low ID. The two high ID samples also reported greater psychological impairment in quality of life, depression and anxiety than sample 2/low ID. CONCLUSIONS Adults with overweight/obesity who report high levels of ID were characterized by higher levels of experiential avoidance, lower levels of values-consistent behaviour, and more psychosocial impairment as compared with other adults with overweight/obesity. As these are important targets of acceptance-based approaches, this subgroup may benefit from the integration of such approaches into behavioural weight loss programmes.
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Affiliation(s)
- H M Niemeier
- Department of Psychology University of Wisconsin-Whitewater Whitewater WI USA
| | - J Lillis
- Department of Psychiatry and Human Behavior Alpert Medical School of Brown University, Weight Control and Diabetes Research Center of The Miriam Hospital Providence RI USA
| | - R R Wing
- Department of Psychiatry and Human Behavior Alpert Medical School of Brown University, Weight Control and Diabetes Research Center of The Miriam Hospital Providence RI USA
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19
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Exploring process variables through which acceptance-based behavioral interventions may improve weight loss maintenance. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2017; 6:398-403. [PMID: 29230381 DOI: 10.1016/j.jcbs.2017.07.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Objective A previously published randomized trial with individuals reporting high internal disinhibition showed significant differences in post-treatment weight change favoring Acceptance-Based Behavioral Intervention (ABBI) when compared to standard behavioral treatment (SBT). This paper examines process variables that might contribute to the observed differences in weight change. Methods Participants were 162 adults with overweight or obesity (mean BMI 37.6) randomly assigned to ABBI or SBT. Both interventions provided the same calorie intake target, exercise goal, and self-monitoring skills training. SBT incorporated current best practice interventions for addressing problematic thoughts and emotions. ABBI utilized acceptance-based techniques based on Acceptance and Commitment Therapy. ABBI and SBT were compared on process measures hypothesized to be related to outcome in ABBI and SBT and their association with weight loss outcomes using linear and non-linear mixed models methods and exploratory correlational analyses. Results Both the SBT and the ABBI groups showed significant changes over time on all process variables. The only significant between group difference was for values consistent behavior, with the ABBI group improving more as compared to SBT (t=2.45, p=.016); however, changes in values consistent behavior did not mediate weight change. Exploratory analyses suggest the possibility that changes in process variables were less associated with weight change in ABBI than in SBT after treatment was discontinued. Conclusions Both conditions produced significant changes in process variables, however there was little difference between groups. Thus, the results do not provide an adequate process account for the observed weight change differences between ABBI and SBT, leaving important questions that need to be addressed by future research.
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20
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Sawamoto R, Nozaki T, Nishihara T, Furukawa T, Hata T, Komaki G, Sudo N. Predictors of successful long-term weight loss maintenance: a two-year follow-up. Biopsychosoc Med 2017; 11:14. [PMID: 28592990 PMCID: PMC5460352 DOI: 10.1186/s13030-017-0099-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 05/09/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Weight regain is a common problem following weight loss intervention, with most people who seek treatment for obesity able to lose weight, but few able to sustain the changes in behavior required to prevent subsequent weight regain. The identification of factors that predict which patients will successfully maintain weight loss or who are at risk of weight regain after weight loss intervention is necessary to improve the current weight maintenance strategies. The aim of the present study is identify factors associated with successful weight loss maintenance by women with overweight or obesity who completed group cognitive behavioral treatment (CBT) for weight loss. METHODS Ninety women with overweight or obesity completed a 7-month weight loss intervention. The data of 86 who completed follow-up surveys 12 and 24 months after the end of the treatment was analyzed. Depression, anxiety, binge eating, food addiction, and eating behaviors were assessed before and after the weight loss intervention. Participants who lost at least 10% of their initial weight during the weight loss intervention and had maintained the loss at the month 24 follow-up were defined as successful. RESULTS The intervention was successful for 27 participants (31.3%) and unsuccessful for 59 (68.6%). Multiple logistic regression analysis extracted larger weight reduction during the weight loss intervention, a lower disinhibition score, and a low food addiction score at the end of the weight loss intervention as associated with successful weight loss maintenance. CONCLUSION The results suggest that larger weight reduction during the weight loss intervention and lower levels of disinhibition and food addiction at the end of the weight loss intervention predicted successful weight loss maintenance. TRIAL REGISTRATION Trial registry name: Development and validation of effective treatments of weight loss and weight-loss maintenance using cognitive behavioral therapy for obese patients. Registration ID: UMIN000006803 Registered 1 January 2012. URL: https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000008052.
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Affiliation(s)
- Ryoko Sawamoto
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 Japan
| | - Takehiro Nozaki
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 Japan
| | - Tomoe Nishihara
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 Japan
| | - Tomokazu Furukawa
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 Japan
| | - Tomokazu Hata
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 Japan
| | - Gen Komaki
- School of Health Sciences, Fukuoka, International University of Health and Welfare, Okawa, Japan
| | - Nobuyuki Sudo
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 Japan
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22
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Gettens KM, Gorin AA. Executive function in weight loss and weight loss maintenance: a conceptual review and novel neuropsychological model of weight control. J Behav Med 2017; 40:687-701. [PMID: 28160229 DOI: 10.1007/s10865-017-9831-5] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 01/18/2017] [Indexed: 02/07/2023]
Abstract
Weight loss maintenance is a complex, multifaceted process that presents a significant challenge for most individuals who lose weight. A growing body of literature indicates a strong relationship between cognitive dysfunction and excessive body weight, and suggests that a subset of high-order cognitive processes known as executive functions (EF) likely play an important role in weight management. Recent reviews cover neuropsychological correlates of weight status yet fail to address the role of executive function in the central dilemma of successful weight loss maintenance. In this paper, we provide an overview of the existing literature examining executive functions as they relate to weight status and initial weight loss. Further, we propose a novel conceptual model of the relationships between EF, initial weight loss, and weight loss maintenance, mapping specific executive functions onto strategies known to be associated with both phases of the weight control process. Implications for the development of more efficacious weight loss maintenance interventions are discussed.
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23
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Lillis J, Niemeier HM, Thomas JG, Unick J, Ross KM, Leahey TM, Kendra KE, Dorfman L, Wing RR. A randomized trial of an acceptance-based behavioral intervention for weight loss in people with high internal disinhibition. Obesity (Silver Spring) 2016; 24:2509-2514. [PMID: 27804255 PMCID: PMC5125828 DOI: 10.1002/oby.21680] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 09/07/2016] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To determine whether an acceptance-based behavioral intervention (ABBI) produces better weight losses than standard behavioral treatment (SBT) among individuals reporting high internal disinhibition. METHODS Participants were 162 adults with overweight or obesity (mean BMI 37.6 kg/m2 ) randomly assigned to ABBI or SBT. Both interventions provided the same calorie intake target, exercise goal, and self-monitoring skills training. SBT incorporated current best practice interventions for addressing problematic thoughts and emotions. ABBI utilized acceptance-based techniques based on Acceptance and Commitment Therapy. ABBI and SBT were compared on weight change and internal disinhibition change over 24 months. RESULTS Mixed models analysis showed mean weight loss at 24 months was -4.1% (SE = 0.88) for ABBI and -2.4% (SE = 0.87) for SBT (P = 0.204). Secondary analyses showed that the ABBI group regained less weight from the end of treatment to the final follow-up (4.6 vs. 7.1 kg; P = 0.005), and that a significantly higher proportion of ABBI participants achieved a 5% weight loss (38% vs. 25%; P = 0.038) at 24 months. CONCLUSIONS Results suggest that ABBI could be helpful for improving the maintenance of weight loss for individuals who report high internal disinhibition.
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Affiliation(s)
- Jason Lillis
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University/The Miriam Hospital Weight Control and Diabetes Research Center, Providence, RI, USA
| | - Heather M. Niemeier
- Department of Psychology, University of Wisconsin-Whitewater, Whitewater, WI, USA
| | - John G. Thomas
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University/The Miriam Hospital Weight Control and Diabetes Research Center, Providence, RI, USA
| | - Jessica Unick
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University/The Miriam Hospital Weight Control and Diabetes Research Center, Providence, RI, USA
| | - Kathryn M. Ross
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University/The Miriam Hospital Weight Control and Diabetes Research Center, Providence, RI, USA
| | - Tricia M. Leahey
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA
| | - Kathleen E. Kendra
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University/The Miriam Hospital Weight Control and Diabetes Research Center, Providence, RI, USA
| | - Leah Dorfman
- The Miriam Hospital Weight Control and Diabetes Research Center, Providence, RI, USA
| | - Rena R. Wing
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University/The Miriam Hospital Weight Control and Diabetes Research Center, Providence, RI, USA
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Levoy E, Lazaridou A, Brewer J, Fulwiler C. An exploratory study of Mindfulness Based Stress Reduction for emotional eating. Appetite 2016; 109:124-130. [PMID: 27890474 DOI: 10.1016/j.appet.2016.11.029] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 10/31/2016] [Accepted: 11/21/2016] [Indexed: 11/17/2022]
Abstract
Emotional eating is an important predictor of weight loss and weight regain after weight loss. This two part study's primary aim was to explore changes in emotional eating in a general population of individuals taking the Mindfulness Based Stress Reduction (MBSR) program, with a secondary aim to explore whether changes in mindfulness predicted changes in emotional eating. Self-reported survey data exploring these questions were collected before and after the intervention for two sequential studies (Study 1 and Study 2). While there were no control groups for either study, in both studies emotional eating scores following the MBSR were significantly lower than scores prior to taking the MBSR (p < 0.001; p < 0.001) In Study 2, changes in mindfulness were correlated with changes in emotional eating (r = 0.317, p = 0.004). These results suggest that MBSR may be an effective intervention for emotional eating, and that further research is warranted to examine effects on weight loss and maintenance.
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Affiliation(s)
- Emily Levoy
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
| | - Asimina Lazaridou
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
| | - Judson Brewer
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA; Department of Medicine, Center for Mindfulness, University of Massachusetts Medical School, Worcester, MA, USA
| | - Carl Fulwiler
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA; Department of Medicine, Center for Mindfulness, University of Massachusetts Medical School, Worcester, MA, USA.
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Schaumberg K, Schumacher LM, Rosenbaum DL, Kase CA, Piers AD, Lowe MR, Forman EM, Butryn ML. The role of negative reinforcement eating expectancies in the relation between experiential avoidance and disinhibition. Eat Behav 2016; 21:129-34. [PMID: 26854594 PMCID: PMC4856013 DOI: 10.1016/j.eatbeh.2016.01.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 01/09/2016] [Accepted: 01/19/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Eating-related disinhibition (i.e., a tendency to overeat in response to various stimuli) is associated with weight gain and poorer long-term weight loss success. Theoretically, experiential avoidance (i.e., the desire or attempts to avoid uncomfortable internal experiences), may predispose individuals to developing negative reinforcement eating expectancies (i.e., the belief that eating will help to mitigate distress), which in turn promote disinhibition. Such relationships are consistent with an acquired preparedness model, which posits that dispositions influence learning and subsequent behavior. Drawing from this framework, the current study represents the first investigation of relations between negative reinforcement eating expectancies, experiential avoidance (both general and food-specific) and disinhibited eating. In particular, the mediating role of negative reinforcement eating expectancies in the relation between experiential avoidance and disinhibited eating was examined. METHOD Participants (N=107) were overweight and obese individuals presenting for behavioral weight loss treatment who completed measures of general and food-related experiential avoidance, negative reinforcement eating expectancies, and disinhibition. RESULTS Experiential avoidance and negative reinforcement eating expectancies significantly related to disinhibition. Furthermore, the relation between experiential avoidance and disinhibition was mediated by negative reinforcement eating expectancies. DISCUSSION The current study supports an acquired preparedness model for disinhibition, such that the relation between experiential avoidance and disinhibition is accounted for by expectations that eating will alleviate distress. Findings highlight the potential role of eating expectancies in models accounting for obesity risk, and identify negative reinforcement eating expectancies as a potential treatment target for reducing disinhibition.
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Lillis J, Thomas JG, Niemeier H, Wing RR. Internal disinhibition predicts 5-year weight regain in the National Weight Control Registry (NWCR). Obes Sci Pract 2016; 2:83-87. [PMID: 27812382 PMCID: PMC5066638 DOI: 10.1002/osp4.22] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 11/20/2015] [Accepted: 11/29/2015] [Indexed: 11/11/2022] Open
Abstract
Background Maintenance of weight loss remains elusive for most individuals. One potential innovative target is internal disinhibition (ID) or the tendency to eat in response to negative thoughts, feelings or physical sensations. Individuals high on ID do worse on average in standard behavioural treatment programmes, and recent studies suggest that disinhibition could play a significant role in weight regain. Purpose The purpose of the current study was to examine whether ID was associated with weight change over 5 years of follow‐up in the National Weight Control Registry, a registry of individuals who have successfully lost weight and maintained it. Methods From the National Weight Control Registry, 5,320 participants were examined across 5 years. Weight data were gathered annually. The disinhibition subscale of the Eating Inventory was used to calculate internal disinhibition and External Disinhibition (ED) and was collected at baseline, year 1, year 3 and year 5. Linear mixed models were used to estimate the weight loss maintained across follow‐up years 1 to 5 using ID and ED as baseline and prospective predictors. Results Internal disinhibition predicted weight regain in all analyses. ED interacted with ID, such that individuals who were high on ID showed greater weight regain if they were also higher on ED. Conclusions The ID scale could be a useful screening measure for risk of weight regain, given its brevity. Improved psychological coping could be a useful target for maintenance or booster interventions.
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Affiliation(s)
- J Lillis
- Department of Psychiatry and Human Behavior Warren Alpert Medical School of Brown University, The Miriam Hospital/Weight Control and Diabetes Research Center Providence RI USA
| | - J G Thomas
- Department of Psychiatry and Human Behavior Warren Alpert Medical School of Brown University, The Miriam Hospital/Weight Control and Diabetes Research Center Providence RI USA
| | - H Niemeier
- Department of Psychology University of Wisconsin-Whitewater Whitewater WI USA
| | - R R Wing
- Department of Psychiatry and Human Behavior Warren Alpert Medical School of Brown University, The Miriam Hospital/Weight Control and Diabetes Research Center Providence RI USA
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Lillis J, Wing RR. The role of avoidance-based coping in the psychosocial functioning of weight loss treatment-seeking adults. Obes Sci Pract 2015; 1:59-64. [PMID: 29071094 PMCID: PMC5523666 DOI: 10.1002/osp4.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 02/04/2015] [Accepted: 02/07/2015] [Indexed: 11/12/2022] Open
Abstract
Objective The aim of this study was to determine the role of avoidance‐based coping in the psychosocial functioning of weight loss treatment‐seeking persons with obesity who report high internal disinhibition. Methods Participants were 162 overweight or obese adults entering a behavioural weight loss intervention programme who reported high internal disinhibition at screening. We conducted multivariate regression analyses by using mental and physical quality of life and satisfaction with relationships as dependent variables and examining the association of demographic variables, experiential avoidance (avoidance‐based coping) and symptoms of depression. We hypothesized that higher levels of experiential avoidance and symptoms of depression would be associated with poorer mental and physical quality of life and relationship satisfaction. Post‐hoc analyses examined results relative to non‐obese norms. Results Both experiential avoidance and depression were significantly and independently associated with each of the three psychosocial outcome measures. Individuals who were high on both experiential avoidance and depression scored significantly below the population mean for non‐clinical samples on mental and physical quality of life and relationship satisfaction. Conclusion In a sample of weight loss treatment‐seeking adults with high internal disinhibition, elevated levels of experiential avoidance and psychological symptoms are prevalent. Adding intervention components specifically designed to address unhealthy coping could results in improvements in overall psychosocial functioning and possibly weight loss.
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Affiliation(s)
- J Lillis
- Department of Psychiatry and Human Behavior Brown Medical School Providence RI USA.,Department of Behavioral Medicine The Miriam Hospital Providence RI USA
| | - R R Wing
- Department of Psychiatry and Human Behavior Brown Medical School Providence RI USA.,Department of Behavioral Medicine The Miriam Hospital Providence RI USA
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Abstract
Obesity affects more than one-third of U.S. adults and is a major cause of preventable morbidity and mortality, primarily from cardiovascular disease. Traditional behavioral interventions for weight loss typically focus on diet and exercise habits and often give little attention to the role of stress and emotions in the initiation and maintenance of unhealthy behaviors, which may account for their modest results and considerable variability in outcomes. Stress eating and emotional eating are increasingly recognized as important targets of weight loss interventions. Mindfulness-based interventions were specifically developed to promote greater self-efficacy in coping with stress and negative emotions, and appear to be effective for a variety of conditions. In recent years researchers have begun to study mindfulness interventions for weight loss and CVD risk management. This review describes the rationale for the use of mindfulness in interventions for weight loss and CVD risk management, summarizes the research to date, and suggests priorities for future research.
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Lillis J, Niemeier HM, Ross KM, Thomas JG, Leahey T, Unick J, Kendra KE, Wing RR. Weight loss intervention for individuals with high internal disinhibition: design of the Acceptance Based Behavioral Intervention (ABBI) randomized controlled trial. BMC Psychol 2015; 3:17. [PMID: 26019869 PMCID: PMC4446109 DOI: 10.1186/s40359-015-0075-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 05/21/2015] [Indexed: 11/22/2022] Open
Abstract
Background Obesity is public health problem associated with significant health risks and healthcare costs. Behavioral weight control programs produce clinically meaningful weight losses, however outcomes have high variability and maintenance continues to be a problem. The current study is an NIH-funded randomized clinical trial testing a novel approach, Acceptance-Based Behavioral Intervention (ABBI), that combines techniques from standard behavioral treatment (SBT) and Acceptance and Commitment Therapy (ACT). We test this approach among individuals reporting high internal disinhibition who typically respond poorly to standard interventions and appear to benefit from ACT components. Methods/Design The ABBI study targets recruitment of 160 overweight or obese adults (BMI of 25–50) who report that they overeat in response to negative emotional states. These individuals are randomly assigned to either (1) ABBI or (2) SBT. Both interventions involve weekly meetings for 22 sessions, bi-weekly for 6 sessions, and then monthly for 3 sessions and both receive the same calorie intake target (1200–1800, depending on starting weight), exercise goal (work up to 250 min per week), and self-monitoring skills training. SBT incorporates current best practice interventions for addressing problematic thoughts and emotions, sometimes called “change” or “control” strategies. ABBI uses acceptance-based techniques based on ACT. Full assessments occur at baseline, 6, 12, and 18 months. Weight loss from baseline to 18 months is the primary outcome. Discussion The ABBI study is unique in its focus on integrating acceptance-based techniques into a SBT intervention and targeting a group of individuals with problems with emotional overeating who might experience particular benefit from this novel approach. Trial Registration ClinicalTrials.gov, NCT01461421 (registered October 25, 2011)
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Affiliation(s)
- Jason Lillis
- The Miriam Hospital, Brown Medical School, Providence, USA ; Weight Control and Diabetes Research Center, The Miriam Hospital, Brown Medical School, 196 Richmond Street, Providence, RI 02903 USA
| | | | - Kathryn M Ross
- The Miriam Hospital, Brown Medical School, Providence, USA
| | | | | | - Jessica Unick
- The Miriam Hospital, Brown Medical School, Providence, USA
| | | | - Rena R Wing
- The Miriam Hospital, Brown Medical School, Providence, USA
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Urbanek JK, Metzgar CJ, Hsiao PY, Piehowski KE, Nickols-Richardson SM. Increase in cognitive eating restraint predicts weight loss and change in other anthropometric measurements in overweight/obese premenopausal women. Appetite 2015; 87:244-50. [DOI: 10.1016/j.appet.2014.12.230] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 12/23/2014] [Accepted: 12/30/2014] [Indexed: 12/01/2022]
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Ramage S, Farmer A, Eccles KA, McCargar L. Healthy strategies for successful weight loss and weight maintenance: a systematic review. Appl Physiol Nutr Metab 2013; 39:1-20. [PMID: 24383502 DOI: 10.1139/apnm-2013-0026] [Citation(s) in RCA: 114] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The rates of overweight and obesity are rising in Canada and worldwide, and there is a need for effective methods for weight loss and weight maintenance to empower individuals to make changes. The purpose of this systematic review was to examine the evidence available for successful diet strategies for weight loss and weight maintenance among adults. A search was conducted of the following databases: CAB Abstracts, Central Register of Controlled Trials, EMBASE, MEDLINE, Food Science and Technology Abstracts, and Web of Knowledge. The studies investigated had participants who were overweight or obese and between 18 and 65 years of age. A successful study was defined as one that reported an intervention that created ≥5% weight loss from baseline and a maintenance phase during which the ≥5% weight loss was maintained from baseline to 12 months. After exclusions, the search resulted in 67 papers. Overall, for significant safe weight loss, an energy deficit was required, which was commonly achieved by reduced fat intake. Increased dietary fibre was also a component of 21% of successful interventions. Physical activity was included in 88% of successful interventions, and behaviour training such as self-monitoring was part of 92% of successful interventions. The same combination of energy and fat restriction, regular physical activity, and behavioural strategies was also required for successful weight maintenance. This review confirmed previous knowledge about weight loss and weight maintenance in adults. A comprehensive approach, including reduced dietary intake, regular physical activity, and behavioural strategies, is warranted and is supported by the research evidence.
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Affiliation(s)
- Stephanie Ramage
- a Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB T6G 2P5, Canada
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Forman EM, Butryn ML, Juarascio AS, Bradley LE, Lowe MR, Herbert JD, Shaw JA. The mind your health project: a randomized controlled trial of an innovative behavioral treatment for obesity. Obesity (Silver Spring) 2013; 21:1119-26. [PMID: 23666772 PMCID: PMC3735809 DOI: 10.1002/oby.20169] [Citation(s) in RCA: 122] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 11/06/2012] [Indexed: 11/20/2022]
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.
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Affiliation(s)
- E M Forman
- Department of Psychology, Drexel University, 245 N. 15th Street, MS 626, Philadelphia, PA 19102, USA.
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King NA, Horner K, Hills AP, Byrne NM, Wood RE, Bryant E, Caudwell P, Finlayson G, Gibbons C, Hopkins M, Martins C, Blundell JE. The Interaction Between Exercise, Appetite, and Food Intake. Am J Lifestyle Med 2013. [DOI: 10.1177/1559827613475584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Exercise could indirectly affect body weight by exerting changes on various components of appetite control, including nutrient and taste preferences, meal size and frequency, and the drive to eat. This review summarizes the evidence on how exercise affects appetite and eating behavior and in particular answers the question, “Does exercise induce an increase in food intake to compensate for the increase in energy expenditure?” Evidence will be presented to demonstrate that there is no automatic increase in food intake in response to acute exercise and that the response to repeated exercise is variable. The review will also identify areas of further study required to explain the variability. One limitation with studies that assess the efficacy of exercise as a method of weight control is that only mean data are presented—the individual variability tends to be overlooked. Recent evidence highlights the importance of characterizing the individual variability by demonstrating exercise-induced changes in appetite. Individuals who experience lower than theoretically predicted reductions in body weight can be characterized by hedonic (eg, pleasure) and homeostatic (eg, hunger) features.
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Affiliation(s)
- Neil Anthony King
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia (NAK, KH, APH, NMB, REW)
- Centre for Psychology Studies, University of Bradford, UK (EB)
- BioPsychology Group, Institute of Psychological Sciences, University of Leeds, Leeds, UK (PC, GF, CG, JEB)
- Department of Sport, Health, and Nutrition, Leeds Trinity University College, Leeds, UK (MH)
- Obesity Research Group, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway (CM)
| | - Katy Horner
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia (NAK, KH, APH, NMB, REW)
- Centre for Psychology Studies, University of Bradford, UK (EB)
- BioPsychology Group, Institute of Psychological Sciences, University of Leeds, Leeds, UK (PC, GF, CG, JEB)
- Department of Sport, Health, and Nutrition, Leeds Trinity University College, Leeds, UK (MH)
- Obesity Research Group, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway (CM)
| | - Andrew Peter Hills
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia (NAK, KH, APH, NMB, REW)
- Centre for Psychology Studies, University of Bradford, UK (EB)
- BioPsychology Group, Institute of Psychological Sciences, University of Leeds, Leeds, UK (PC, GF, CG, JEB)
- Department of Sport, Health, and Nutrition, Leeds Trinity University College, Leeds, UK (MH)
- Obesity Research Group, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway (CM)
| | - Nuala Mary Byrne
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia (NAK, KH, APH, NMB, REW)
- Centre for Psychology Studies, University of Bradford, UK (EB)
- BioPsychology Group, Institute of Psychological Sciences, University of Leeds, Leeds, UK (PC, GF, CG, JEB)
- Department of Sport, Health, and Nutrition, Leeds Trinity University College, Leeds, UK (MH)
- Obesity Research Group, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway (CM)
| | - Rachel Elise Wood
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia (NAK, KH, APH, NMB, REW)
- Centre for Psychology Studies, University of Bradford, UK (EB)
- BioPsychology Group, Institute of Psychological Sciences, University of Leeds, Leeds, UK (PC, GF, CG, JEB)
- Department of Sport, Health, and Nutrition, Leeds Trinity University College, Leeds, UK (MH)
- Obesity Research Group, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway (CM)
| | - Eleanor Bryant
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia (NAK, KH, APH, NMB, REW)
- Centre for Psychology Studies, University of Bradford, UK (EB)
- BioPsychology Group, Institute of Psychological Sciences, University of Leeds, Leeds, UK (PC, GF, CG, JEB)
- Department of Sport, Health, and Nutrition, Leeds Trinity University College, Leeds, UK (MH)
- Obesity Research Group, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway (CM)
| | - Phillipa Caudwell
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia (NAK, KH, APH, NMB, REW)
- Centre for Psychology Studies, University of Bradford, UK (EB)
- BioPsychology Group, Institute of Psychological Sciences, University of Leeds, Leeds, UK (PC, GF, CG, JEB)
- Department of Sport, Health, and Nutrition, Leeds Trinity University College, Leeds, UK (MH)
- Obesity Research Group, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway (CM)
| | - Graham Finlayson
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia (NAK, KH, APH, NMB, REW)
- Centre for Psychology Studies, University of Bradford, UK (EB)
- BioPsychology Group, Institute of Psychological Sciences, University of Leeds, Leeds, UK (PC, GF, CG, JEB)
- Department of Sport, Health, and Nutrition, Leeds Trinity University College, Leeds, UK (MH)
- Obesity Research Group, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway (CM)
| | - Catherine Gibbons
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia (NAK, KH, APH, NMB, REW)
- Centre for Psychology Studies, University of Bradford, UK (EB)
- BioPsychology Group, Institute of Psychological Sciences, University of Leeds, Leeds, UK (PC, GF, CG, JEB)
- Department of Sport, Health, and Nutrition, Leeds Trinity University College, Leeds, UK (MH)
- Obesity Research Group, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway (CM)
| | - Mark Hopkins
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia (NAK, KH, APH, NMB, REW)
- Centre for Psychology Studies, University of Bradford, UK (EB)
- BioPsychology Group, Institute of Psychological Sciences, University of Leeds, Leeds, UK (PC, GF, CG, JEB)
- Department of Sport, Health, and Nutrition, Leeds Trinity University College, Leeds, UK (MH)
- Obesity Research Group, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway (CM)
| | - Catia Martins
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia (NAK, KH, APH, NMB, REW)
- Centre for Psychology Studies, University of Bradford, UK (EB)
- BioPsychology Group, Institute of Psychological Sciences, University of Leeds, Leeds, UK (PC, GF, CG, JEB)
- Department of Sport, Health, and Nutrition, Leeds Trinity University College, Leeds, UK (MH)
- Obesity Research Group, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway (CM)
| | - John Edward Blundell
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia (NAK, KH, APH, NMB, REW)
- Centre for Psychology Studies, University of Bradford, UK (EB)
- BioPsychology Group, Institute of Psychological Sciences, University of Leeds, Leeds, UK (PC, GF, CG, JEB)
- Department of Sport, Health, and Nutrition, Leeds Trinity University College, Leeds, UK (MH)
- Obesity Research Group, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway (CM)
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Lesdéma A, Fromentin G, Daudin JJ, Arlotti A, Vinoy S, Tome D, Marsset-Baglieri A. Characterization of the Three-Factor Eating Questionnaire scores of a young French cohort. Appetite 2012; 59:385-90. [DOI: 10.1016/j.appet.2012.05.027] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Revised: 05/24/2012] [Accepted: 05/27/2012] [Indexed: 11/15/2022]
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Wong MHT, Holst C, Astrup A, Handjieva-Darlenska T, Jebb SA, Kafatos A, Kunesova M, Larsen TM, Martinez JA, Pfeiffer AFH, van Baak MA, Saris WHM, McNicholas PD, Mutch DM, DiOGenes OBO. Caloric restriction induces changes in insulin and body weight measurements that are inversely associated with subsequent weight regain. PLoS One 2012; 7:e42858. [PMID: 22905179 PMCID: PMC3414506 DOI: 10.1371/journal.pone.0042858] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Accepted: 07/12/2012] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Successful weight maintenance following weight loss is challenging for many people. Identifying predictors of longer-term success will help target clinical resources more effectively. To date, focus has been predominantly on the identification of predictors of weight loss. The goal of the current study was to determine if changes in anthropometric and clinical parameters during acute weight loss are associated with subsequent weight regain. METHODOLOGY The study consisted of an 8-week low calorie diet (LCD) followed by a 6-month weight maintenance phase. Anthropometric and clinical parameters were analyzed before and after the LCD in the 285 participants (112 men, 173 women) who regained weight during the weight maintenance phase. Mixed model ANOVA, Spearman correlation, and linear regression were used to study the relationships between clinical measurements and weight regain. PRINCIPAL FINDINGS Gender differences were observed for body weight and several clinical parameters at both baseline and during the LCD-induced weight loss phase. LCD-induced changes in BMI (Spearman's ρ = 0.22, p = 0.0002) were inversely associated with weight regain in both men and women. LCD-induced changes in fasting insulin (ρ = 0.18, p = 0.0043) and HOMA-IR (ρ = 0.19, p = 0.0023) were also associated independently with weight regain in both genders. The aforementioned associations remained statistically significant in regression models taking account of variables known to independently influence body weight. CONCLUSIONS/SIGNIFICANCE LCD-induced changes in BMI, fasting insulin, and HOMA-IR are inversely associated with weight regain in the 6-month period following weight loss.
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Affiliation(s)
- Monica H. T. Wong
- Department of Mathematics and Statistics, University of Guelph, Guelph, Ontario, Canada
| | - Claus Holst
- Institute of Preventive Medicine, Copenhagen University Hospital, Copenhagen, Denmark
| | - Arne Astrup
- Department of Human Nutrition, University of Copenhagen, Copenhagen, Denmark
| | | | - Susan A. Jebb
- Elsie Widdowson Laboratory, Medical Research Council Human Nutrition Research, Cambridge, United Kingdom
| | - Anthony Kafatos
- Department of Social Medicine, Preventive Medicine and Nutrition Clinic, University of Crete School of Medicine, Heraclion, Crete, Greece
| | - Marie Kunesova
- Obesity Management Centre, Institute of Endocrinology, Prague, Czech Republic
| | - Thomas M. Larsen
- Department of Human Nutrition, University of Copenhagen, Copenhagen, Denmark
| | - J. Alfredo Martinez
- Department of Physiology and Nutrition, University of Navarra, Pamplona, Spain
| | - Andreas F. H. Pfeiffer
- Department of Clinical Nutrition, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | - Marleen A. van Baak
- Department of Human Biology, Nutrition and Toxicology Research Institute Maastricht, University of Maastricht, Maastricht, The Netherlands
| | - Wim H. M. Saris
- Department of Human Biology, Nutrition and Toxicology Research Institute Maastricht, University of Maastricht, Maastricht, The Netherlands
| | - Paul D. McNicholas
- Department of Mathematics and Statistics, University of Guelph, Guelph, Ontario, Canada
| | - David M. Mutch
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
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Niemeier HM, Leahey T, Reed KP, Brown RA, Wing RR. An acceptance-based behavioral intervention for weight loss: a pilot study. Behav Ther 2012; 43:427-35. [PMID: 22440077 PMCID: PMC3535069 DOI: 10.1016/j.beth.2011.10.005] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Revised: 09/30/2011] [Accepted: 10/02/2011] [Indexed: 10/15/2022]
Abstract
On average, participants in behavioral weight-loss interventions lose 8 kilograms (kg) at 6 months, but there is marked variability in outcomes with some participants losing little or no weight. Individuals with difficulties with internal disinhibition (i.e., eating in response to emotions or thoughts) typically lose less weight in such programs and may require an innovative, specialized approach. This pilot study examined the preliminary acceptability and efficacy of a 24-week acceptance-based behavioral intervention for weight loss among overweight and obese adults reporting difficulty with eating in response to emotions and thoughts. Participants were 21 overweight or obese men and women (mean age=52.2±7.6 years; baseline mean body mass index=32.8±3.4). Eighty-six percent completed the 6-month program and a 3-month follow-up assessment. Ratings of program satisfaction averaged 4.9 on a five-point scale. Multilevel modeling analyses indicated participants lost an average of 12.0 kg (SE=1.4) after 6 months of treatment and 12.1 kg (SE=1.9) at 3-month follow-up, thus exceeding the weight losses typically seen in behavioral treatment programs. Decreases in internal disinhibition and weight-related experiential avoidance were found at 6- and 3-months follow-up. Greater decreases in weight-related experiential avoidance were associated with greater weight loss at the end of the program (r=.64, p=.002), suggesting a potential mechanism of action. Although there have been a few preliminary studies using acceptance-based approaches for obesity, this is the first study to specifically target emotional overeaters, a subgroup that might be particularly responsive to this new approach. Our findings provide initial support for the feasibility, efficacy, and acceptability of this approach for this subgroup of participants. Further study with longer follow-up, a more diverse sample, and comparison to a standard behavioral program is clearly warranted.
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Affiliation(s)
- Heather M. Niemeier
- University of Wisconsin—Whitewater, Department of Psychology, 800 W. Main St., Whitewater, WI 53190, 262-472-5418
| | - Tricia Leahey
- Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Weight Control and Diabetes Research Center, 196 Richmond St., Providence, RI 02903, 401-793-8950
| | - Kathleen Palm Reed
- Clark University, Department of Psychology, 950 Main St., Worchester, MA 01610, 508-793-7277
| | - Richard A. Brown
- Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Butler Hospital, 345 Blackstone Blvd., Providence, RI 02906, 401-455-6254
| | - Rena R. Wing
- Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Weight Control and Diabetes Research Center, 196 Richmond St., Providence, RI 02903, 401-793-8947
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Bryant E, Caudwell P, Hopkins M, King N, Blundell J. Psycho-markers of weight loss. The roles of TFEQ Disinhibition and Restraint in exercise-induced weight management. Appetite 2012; 58:234-41. [DOI: 10.1016/j.appet.2011.09.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Revised: 07/28/2011] [Accepted: 09/05/2011] [Indexed: 11/27/2022]
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Behavioural factors related with successful weight loss 15 months post-enrolment in a commercial web-based weight-loss programme. Public Health Nutr 2011; 15:1299-309. [DOI: 10.1017/s1368980011003090] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
AbstractObjectiveAs further understanding is required of what behavioural factors are associated with long-term weight-loss success, the aim of the present study was to determine the prevalence of successful weight loss 15 months post-enrolment in a commercial web-based weight-loss programme and which behavioural factors were associated with success.DesignAn online survey was completed 15 months post-enrolment in a commercial web-based weight-loss programme to assess weight-related behaviours and current weight. Participants were classified as successful if they had lost ≥5 % of their starting weight after 15 months.SettingCommercial users of a web-based weight-loss programme.SubjectsParticipants enrolled in the commercial programme between August 2007 and May 2008. Six hundred and seventy-seven participants completed the survey.ResultsThe median (interquartile range) weight change was −2·7 (−8·2, 1·6) % of enrolment weight, with 37 % achieving ≥5 % weight loss. Multivariate logistic regression analysis found success was associated with frequency of weight self-monitoring, higher dietary restraint score, lower emotional eating score, not skipping meals, not keeping snack foods in the house and eating takeaway foods less frequently.ConclusionsThe findings suggest that individuals trying to achieve or maintain ≥5 % weight loss should be advised to regularly weigh themselves, avoid skipping meals or keeping snack foods in the house, limit the frequency of takeaway food consumption, manage emotional eating and strengthen dietary restraint. Strategies to assist individuals make these changes to behaviour should be incorporated within obesity treatments to improve the likelihood of successful weight loss in the long term.
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Phelan S, Wing RR, Loria CM, Kim Y, Lewis CE. Prevalence and predictors of weight-loss maintenance in a biracial cohort: results from the coronary artery risk development in young adults study. Am J Prev Med 2010; 39:546-54. [PMID: 21084075 PMCID: PMC3308341 DOI: 10.1016/j.amepre.2010.08.008] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2010] [Revised: 06/30/2010] [Accepted: 08/03/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Few population-based studies have examined the behavioral and psychosocial predictors of long-term weight-loss maintenance. PURPOSE The goal of this study was to determine the prevalence and predictors of weight-loss maintenance in a biracial cohort of younger adults. METHODS This study examined a population-based sample of overweight/obese African-American and white men and women who had ≥ 5% weight loss between 1995 and 2000. Subsequent changes in weight, physical activity, and behavioral and psychosocial factors were examined between 2000 and 2005. Analyses were conducted in 2008-2009. RESULTS Among the 1869 overweight/obese individuals without major disease in 1995, a total of 536 (29%) lost ≥ 5% between 1995 and 2000. Among those who lost weight, 34% (n=180) maintained at least 75% of their weight loss between 2000 and 2005, whereas 66% subsequently regained. Higher odds of successful weight-loss maintenance were related to African-American race (OR=1.7, p=0.03); smoking (OR=3.4, p=0.0001); history of diabetes (OR=2.2, p=0.04); increases in moderate physical activity between 2000 and 2005 (OR=1.4, p=0.005); increases in emotional support over the same period (OR=1.6, p=0.01); and less sugar-sweetened soft drink consumption in 2005 (OR=0.8, p=0.006). CONCLUSIONS One third of overweight men and women who lost weight were able to maintain 75% or more of their weight loss over 5 years. Interventions to promote weight-loss maintenance may benefit from targeting increased physical activity and emotional support and decreased sugar-sweetened soft drink consumption.
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Affiliation(s)
- Suzanne Phelan
- Department of Kinesiology, California Polytechnic State University, California, USA.
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