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Di Sante J, Akeson B, Gossack A, Knäuper B. Efficacy of ACT-Based treatments for dysregulated eating behaviours: A systematic review and meta-analysis. Appetite 2022; 171:105929. [PMID: 35032613 DOI: 10.1016/j.appet.2022.105929] [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: 07/21/2021] [Revised: 01/04/2022] [Accepted: 01/10/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND An increasing number of studies have investigated the efficacy of Acceptance and Commitment Therapy (ACT) for the reduction of dysregulated eating behaviours such as binge eating and emotional eating. However, little is known about their short- and long-term efficacy and underlying mechanisms of change. OBJECTIVES To conduct a systematic effect size analysis to estimate the efficacy of ACT-based treatments on measures of dysregulated eating and of psychological flexibility, a theorized ACT mechanism of change. METHODS Literature searches were conducted in PsycInfo, Medline, Web of Science, and ProQuest Dissertations. Within-group and between-group standardized mean differences were computed using Comprehensive Meta-Analysis Version 3. Additional subgroup and meta-regression analyses by study characteristics were conducted. RESULTS A total of 20 publications (22 samples, n = 1269) were included. Pre-post and pre-follow-up effects suggest that ACT-based treatments are moderately effective in reducing dysregulated eating behaviours and increasing psychological flexibility. These effects were comparable for binge-eating and emotional eating outcomes and for face-to-face interventions, Web-based interventions, and interventions that used a self-help book. Longer treatments were associated with larger outcome effect sizes, and changes in psychological flexibility were not associated with changes in dysregulated eating outcomes. Small significant effects were found in favour of ACT when compared to inactive control groups. The only three studies that included active control groups and did not show significant differences in outcomes between ACT and other treatments. CONCLUSION Future studies should aim to compare ACT-based treatments to active treatments and to provide empirical evidence for the theoretical mediating role of psychological flexibility in reported changes in eating behaviour.
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Affiliation(s)
| | - Bianca Akeson
- Department of Psychology, McGill University, Quebec, Canada
| | - Amanda Gossack
- Department of Psychology, McGill University, Quebec, Canada
| | - Bärbel Knäuper
- Department of Psychology, McGill University, Quebec, Canada
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Casu G, Gremigni P, Masheb RM. Emotional overeating questionnaire: a validation study in Italian adults with obesity, overweight or normal weight. Eat Weight Disord 2020; 25:1747-1754. [PMID: 31782027 DOI: 10.1007/s40519-019-00821-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 11/15/2019] [Indexed: 01/07/2023] Open
Abstract
PURPOSE This study aimed at testing the validity and reliability of the Emotional Overeating Questionnaire (EOQ) in a sample of Italian adults with obesity, overweight or normal weight. MATERIALS AND METHODS Participants were 314 Italian adults (72.6% females, aged 18-76 years) with obesity (27.4%), overweight (21.3%), or normal weight (51.3%), who completed the EOQ and measures of binge eating, mental well-being, and mindful eating. Retesting was performed 4 weeks later in a randomly selected subsample of 60 participants. Factor structure of the EOQ was estimated by confirmatory factor analysis (CFA). Reliability was tested with McDonald's ω and ordinal α coefficients for internal consistency and Cohen's weighted Kappa coefficient (Kw) for test-retest reliability. RESULTS Based on CFA, the five negative emotional items formed one factor (EOQ-5) with good reliability (ω = 0.89; ordinal α = 0.88; Kw= 0.71), while the item referring to happiness was dropped. EOQ-5 scores were associated with higher binge eating, lower mental well-being, and lower mindful eating. A cut-off point of two identified individuals at risk for binge eating disorders with 75% sensitivity and 67% specificity. Negative emotional overeating was more frequent in women with obesity than women with normal weight and men with obesity. CONCLUSIONS EOQ-5 is a valid and reliable tool for measuring the frequency of emotional overeating at the Italian community-level. LEVEL OF EVIDENCE Level V, cross-sectional, descriptive study.
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Affiliation(s)
- Giulia Casu
- Department of Psychology, University of Bologna, Viale Berti Pichat, 5, 40127, Bologna, Italy
| | - Paola Gremigni
- Department of Psychology, University of Bologna, Viale Berti Pichat, 5, 40127, Bologna, Italy.
| | - Robin M Masheb
- Department of Psychiatry, Yale School of Medicine, 300 George St, New Haven, CT, 06511, USA
- VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT, 06516, USA
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Masood A, Alsheddi L, Alfayadh L, Bukhari B, Elawad R, Alfadda AA. Dietary and Lifestyle Factors Serve as Predictors of Successful Weight Loss Maintenance Postbariatric Surgery. J Obes 2019; 2019:7295978. [PMID: 30891313 PMCID: PMC6390255 DOI: 10.1155/2019/7295978] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 01/06/2019] [Indexed: 12/25/2022] Open
Abstract
Bariatric surgery is considered to be an effective treatment for the resolution of severe obesity; however, in more than half of the bariatric surgery patients, weight reacquisition occurs as early as 18 months postsurgery, compromising the surgery's beneficial effects. Maintaining weight loss after surgery poses a great challenge, necessitating the identification of predicting factors. In the present study, we explored the association between weight regain and dietary habits and behavioral lifestyle practices in patients following bariatric surgery. Fifty patients who underwent bariatric surgery with ≥18-month postoperative period of follow-up were included. They were classified into two groups: weight maintainers (n = 29) were patients who regained <15% of their weight, and weight regainers (n = 21) were patients who regained ≥15% of their weight compared to their lowest postoperative weight. The mean age of the study participants was 41.4 ± 8.9 years, and twenty-eight patients (56%) of the total, were females. A detailed analysis of dietary and lifestyle habits was performed by questionnaire-based interviews. Significant weight regain was noted in the regainers compared to the maintainers (19.6 ± 8.4 kg vs. 4.5 ± 3.5 kg, respectively, P ≤ 0.001), which was attributed to their following of unhealthy dietary habits and behavioral lifestyle practices. The dietary and behavioral lifestyle practices adopted by the maintainers were higher fiber consumption and water intake, monitored pace of eating, evasion of emotional binge, and distracted eating and following of self-assessment behaviors. Additionally, regular nutritional follow-ups and compliance with postoperative dietary counseling significantly helped to improve weight maintenance. In conclusion, the effectiveness of weight loss postbariatric surgery was compromised by weight regain due to unhealthy dietary and behavioral lifestyle practices stemming from a lack of nutritional guidance and knowledge. The implementation of comprehensive nutritional counseling and advice on behavioral changes before and after surgery will help achieve optimal weight results.
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Affiliation(s)
- Afshan Masood
- Obesity Research Center, College of Medicine, King Saud University, P.O. Box 2925 (98), Riyadh 11461, Saudi Arabia
| | - Lujain Alsheddi
- Clinical Nutrition Program, Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, P.O. Box 10219, Riyadh 11433, Saudi Arabia
| | - Loura Alfayadh
- Clinical Nutrition Program, Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, P.O. Box 10219, Riyadh 11433, Saudi Arabia
| | - Bushra Bukhari
- Clinical Nutrition Program, Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, P.O. Box 10219, Riyadh 11433, Saudi Arabia
| | - Ruba Elawad
- Obesity Research Center, College of Medicine, King Saud University, P.O. Box 2925 (98), Riyadh 11461, Saudi Arabia
| | - Assim A. Alfadda
- Obesity Research Center, College of Medicine, King Saud University, P.O. Box 2925 (98), Riyadh 11461, Saudi Arabia
- Department of Medicine, College of Medicine, King Saud University, P.O. Box 2925 (38), Riyadh 11461, Saudi Arabia
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Sellberg F, Possmark S, Ghaderi A, Näslund E, Willmer M, Tynelius P, Thorell A, Sundbom M, Uddén J, Szabo E, Berglind D. A dissonance-based intervention for women post roux-en-Y gastric bypass surgery aiming at improving quality of life and physical activity 24 months after surgery: study protocol for a randomized controlled trial. BMC Surg 2018; 18:25. [PMID: 29743040 PMCID: PMC5944022 DOI: 10.1186/s12893-018-0358-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 05/02/2018] [Indexed: 12/12/2022] Open
Abstract
Background Roux-en-Y gastric bypass (RYGB) surgery is the most common bariatric procedure in Sweden and results in substantial weight loss. Approximately one year post-surgery weight regain for these patient are common, followed by a decrease in health related quality of life (HRQoL) and physical activity (PA). Our aim is to investigate the effects of a dissonance-based intervention on HRQoL, PA and other health-related behaviors in female RYGB patients 24 months after surgery. We are not aware of any previous RCT that has investigated the effects of a similar intervention targeting health behaviors after RYGB. Methods The ongoing RCT, the “WELL-GBP”-trial (wellbeing after gastric bypass), is a dissonance-based intervention for female RYGB patients conducted at five hospitals in Sweden. The participants are randomized to either control group receiving usual follow-up care, or to receive an intervention consisting of four group sessions three months post-surgery during which a modified version of the Stice dissonance-based intervention model is used. The sessions are held at the hospitals, and topics discussed are PA, eating behavior, social and intimate relationships. All participants are asked to complete questionnaires measuring HRQoL and other health-related behaviors and wear an accelerometer for seven days before surgery and at six months, one year and two years after surgery. The intention to treat and per protocol analysis will focus on differences between the intervention and control group from pre-surgery assessments to follow-up assessments at 24 months after RYGB. Patients’ baseline characteristics are presented in this protocol paper. Discussion A total of 259 RYGB female patients has been enrolled in the “WELL-GBP”-trial, of which 156 women have been randomized to receive the intervention and 103 women to control group. The trial is conducted within a Swedish health care setting where female RYGB patients from diverse geographical areas are represented. Our results may, therefore, be representative for female RYGB patients in the country as a whole. If the intervention is effective, implementation within the Swedish health care system is possible within the near future. Trial registration The trial was registered on February 23th 2015 with registration number ISRCTN16417174.
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Affiliation(s)
- Fanny Sellberg
- Department of Public Health Sciences, Karolinska Institutet, K9, Social Medicin, SE-171 77, Stockholm, Sweden.
| | - Sofie Possmark
- Department of Public Health Sciences, Karolinska Institutet, K9, Social Medicin, SE-171 77, Stockholm, Sweden
| | - Ata Ghaderi
- Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - Erik Näslund
- Division of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, SE-182 88, Stockholm, Sweden
| | - Mikaela Willmer
- Department of Health and Caring Sciences, University of Gävle, SE-801 76, Gävle, Sweden
| | - Per Tynelius
- Department of Public Health Sciences, Karolinska Institutet, K9, Social Medicin, SE-171 77, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Stockholm County Council, Box 45436, SE-104 31, Stockholm, Sweden
| | - Anders Thorell
- Department of Clinical Science at Danderyd Hospital, Karolinska Institutet, SE-116 91, Stockholm, Sweden.,Department of Surgery, Ersta Hospital, SE-116 91, Stockholm, Sweden
| | - Magnus Sundbom
- Department of Surgical Sciences, Uppsala University, SE-751 85, Uppsala, Sweden
| | - Joanna Uddén
- Department of Medicine, Karolinska Institutet, SE-141 86, Stockholm, Sweden.,Department of Endocrine and Obesity, Capio st Görans Hospital, SE-141 86, Stockholm, Sweden
| | - Eva Szabo
- Department of Surgery, Faculty of Medicine and Health, Örebro University, SE-701 85, Örebro, Sweden
| | - Daniel Berglind
- Department of Public Health Sciences, Karolinska Institutet, K9, Social Medicin, SE-171 77, Stockholm, Sweden
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Raves DM, Brewis A, Trainer S, Han SY, Wutich A. Bariatric Surgery Patients' Perceptions of Weight-Related Stigma in Healthcare Settings Impair Post-surgery Dietary Adherence. Front Psychol 2016; 7:1497. [PMID: 27777562 PMCID: PMC5056165 DOI: 10.3389/fpsyg.2016.01497] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 09/20/2016] [Indexed: 01/14/2023] Open
Abstract
Background: Weight-related stigma is reported frequently by higher body-weight patients in healthcare settings. Bariatric surgery triggers profound weight loss. This weight loss may therefore alleviate patients' experiences of weight-related stigma within healthcare settings. In non-clinical settings, weight-related stigma is associated with weight-inducing eating patterns. Dietary adherence is a major challenge after bariatric surgery. Objectives: (1) Evaluate the relationship between weight-related stigma and post-surgical dietary adherence; (2) understand if weight loss reduces weight-related stigma, thereby improving post-surgical dietary adherence; and (3) explore provider and patient perspectives on adherence and stigma in healthcare settings. Design: This mixed methods study contrasts survey responses from 300 postoperative bariatric patients with ethnographic data based on interviews with 35 patients and extensive multi-year participant-observation within a clinic setting. The survey measured experiences of weight-related stigma, including from healthcare professionals, on the Interpersonal Sources of Weight Stigma scale and internalized stigma based on the Weight Bias Internalization Scale. Dietary adherence measures included patient self-reports, non-disordered eating patterns reported on the Disordered Eating after Bariatric Surgery scale, and food frequencies. Regression was used to assess the relationships among post-surgical stigma, dietary adherence, and weight loss. Qualitative analyses consisted of thematic analysis. Results: The quantitative data show that internalized stigma and general experiences of weight-related stigma predict worse dietary adherence, even after weight is lost. The qualitative data show patients did not generally recognize this connection, and health professionals explained it as poor patient compliance. Conclusion: Reducing perceptions of weight-related stigma in healthcare settings and weight bias internalization could enhance dietary adherence, regardless of time since patient's weight-loss surgery.
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Affiliation(s)
- Danielle M Raves
- Mayo Clinic/ASU Obesity Solutions, Arizona State University Tempe, AZ, USA
| | - Alexandra Brewis
- School of Human Evolution and Social Change, Arizona State University Tempe, AZ, USA
| | - Sarah Trainer
- Mayo Clinic/ASU Obesity Solutions, Arizona State University Tempe, AZ, USA
| | - Seung-Yong Han
- Mayo Clinic/ASU Obesity Solutions, Arizona State University Tempe, AZ, USA
| | - Amber Wutich
- School of Human Evolution and Social Change, Arizona State University Tempe, AZ, USA
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Mindfulness-based interventions for binge eating: a systematic review and meta-analysis. J Behav Med 2014; 38:348-62. [DOI: 10.1007/s10865-014-9610-5] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 11/12/2014] [Indexed: 10/24/2022]
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