Proof-of-concept testing of a brief virtual ACT workshop for emotional eating.

BACKGROUND: Emotional eating, or eating in response to negative emotions, is a commonly reported short-term emotion regulation strategy but has been shown to be ineffective in the long term. Most emotional eating interventions based on Acceptance and Commitment Therapy (ACT) have been delivered in the context of weight loss trials, highlighting a need for ACT-based emotional eating interventions in weight-neutral contexts. AIMS: This proof-of-concept study aimed to test the acceptability and efficacy potential of a brief virtual ACT workshop for emotional eating in a small sample of adults identifying as emotional eaters. METHODS: Twenty-six adult emotional eaters completed an ACT workshop delivered in two 1.5-h sessions over two weeks. The workshop targeted awareness and acceptance of emotions and eating urges, and valued actions around eating. RESULTS: The acceptability of the workshop was demonstrated by high participant satisfaction. Significant improvements on all outcome measures were found and maintained up to 3 months follow-up. CONCLUSIONS: These proof-of-concept findings suggest that a brief virtual ACT workshop may improve emotional eating and associated ACT processes. Results from this study can inform a future randomized controlled trial to test the efficacy of the workshop and the role of theoretical processes of change. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04457804. LEVEL OF EVIDENCE: Level IV, evidence obtained from multiple time series with the intervention.

Patient perceptions of the relationship between food insecurity and eating disorder treatment: A qualitative exploration.

INTRODUCTION: Independently, food insecurity (FI) and binge-spectrum eating disorders (B-ED) are widespread problems; moreover, FI is associated with elevated binge-eating symptoms. However, extant research has not explored how FI may contribute to the development of B-ED symptoms, nor potential impacts of FI on eating disorder treatment. METHOD: This study aimed to qualitatively examine (1) mechanisms by which FI impacts B-ED development and maintenance, (2) effects of past and/or present FI on ED treatment, and (3) participant recommendations for addressing FI in future B-ED treatment. Fourteen individuals who completed B-ED treatment and endorsed FI completed a 30-min interview about their experiences. RESULTS: Participants reported that FI contributed to binge eating by maintaining dietary restraint-binge-eating cycle and by leading them to use food as a coping mechanism or for emotional comfort, both in past and present situations. Present FI interfered with treatment, particularly with adhering to treatment recommendations and food purchasing choices, however, participants did not report any impact of past FI on B-ED treatment. Participants reported that rarely was FI addressed as part of treatment; most participants suggested that future treatments work to (1) assess and problem solve present FI to minimize interference and (2) assess and understand the influence of past FI on current symptoms to validate the function of behavior. DISCUSSION: These findings provide qualitative support that FI may reinforce B-ED symptoms and present FI may interfere with treatment. This study emphasizes the need for assessment and consideration of FI as a factor when treating individuals with B-EDs.

COVID-19 and binge eating: Patient perceptions of eating disorder symptoms, tele-therapy, and treatment implications.

COVID-19 has been shown to detrimentally affect eating disorder symptoms, including increased dietary restriction and increased binge eating. However, research in this area is thus far limited. Additionally, as a result of the pandemic, many eating disorder treatments have converted to tele-health platforms, however, little is known about patient perceptions of this modality. The aim of the present, exploratory study was to qualitatively examine: (1) The impact of COVID-19 on binge eating spectrum disorder symptoms (2) Patient perceptions of tele-therapy, and (3) Ways to address COVID-19 in eating disorder treatment. Data were collected through one-on-one, semi-structured interviews (N = 11), conducted as part of a mid-program assessment for those undergoing individual, outpatient therapy for binge eating spectrum disorders. After thematic analysis, it was identified that patients reported both symptom deterioration and improvement during COVID-19. Factors surrounding social distancing and stay-at-home measures were found to both improve and worsen symptoms for different patients. Further, patients reported positive perceptions of tele-therapy, particularly appreciating the convenience of this modality. Finally, patients provided variable feedback on the incorporation of COVID-related concerns into their eating disorder treatment, with some participants wishing for this inclusion, and others viewing COVID-19 and their eating disorder as separate issues. Findings from the present study preliminarily identify ways in which binge eating spectrum disorder symptoms may have improved due to COVID-19 and indicate positive patient perceptions of tele-therapy. Our results may be used to inform the adaptation of future eating disorder treatment during COVID-19.

The effects of if-then plans on weight loss: results of the 24-month follow-up of the McGill CHIP Healthy Weight Program randomized controlled trial.

BACKGROUND: Current evidence suggests that some of the most effective weight loss approaches are changes in dietary and physical activity behaviors through lifestyle modification programs. The Group Lifestyle Balance (GLB) program is a group-based behavior modification program aimed at changing diet and physical activity for weight loss. It was developed to be more cost-effective and easier to disseminate than its individually administered parent program, the Diabetes Prevention Program (DPP). However, the average weight loss following participation in the GLB is only approximately 3.5%, with low long-term weight loss maintenance. PURPOSE: We aimed to optimize the weight loss outcomes of the GLB to increase the efficacy already afforded by its cost-effectiveness and ease of dissemination. We did this by integrating the habit formation tool of if-then plans into the program. This program is called the enriched GLB or the McGill Comprehensive Health Improvement (CHIP) Healthy Weight Program. Results at 3 and 12 months of participation have already been published elsewhere. They showed no between-group differences between the standard and enriched GLB but higher weight loss in both groups compared to the DPP. This paper reports the long-term weight loss maintenance data following participation in the program. METHODS: Of the 172 participants enrolled at the beginning of the study, data from 110 participants were available and analyzed at 24 months, i.e., 12 months after the end of the 12-month intervention. RESULTS: No between-group difference in weight loss maintenance was observed. Pooled results showed a significant weight regain from 12 to 24 months, i.e., an average of 7.85 lbs. of the 20.36 lbs. lost. However, participants from both groups were still 12.51lbs or 6.13% lighter at 24 months than at baseline. CONCLUSION: If-then plans did not result in a higher percentage of weight loss at 24-month follow-up compared to the standard GLB. However, at 24 months, both groups did show a maintenance of a significant portion of the weight lost at the end of intervention. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02008435, registered 6 December 2013.

A 1-day acceptance and commitment therapy workshop leads to reductions in emotional eating in adults.

PURPOSE: Emotional eating has been defined as the tendency to overeat in response to negative emotions and is a symptom of emotion dysregulation. Interventions for emotional eating have been developed based on acceptance and commitment therapy (ACT). However, these interventions only address emotional eating in the context of weight loss programs and are therefore not available in a weight neutral context. METHODS: The present study aimed to test the feasibility and acceptability of a 1-day ACT workshop that taught skills to reduce emotional eating, without promoting weight loss. The workshop was delivered in a single day and aimed to reduce emotional eating by improving values clarification and commitment, acceptance, and mindfulness. Follow-ups were conducted at 2 weeks and 3 months post-intervention. RESULTS: Results suggest feasibility and acceptability of the 1-day workshop; participants described appreciating the brevity of the program and its applicability to their everyday lives. Improvements in emotional eating were found at 2 weeks (t(31) = 5.80, p < 0.001) and 3 months (t(29) = 6.96, p < 0.001). A repeated measures MANOVA revealed a significant main effect of time (F(14, 96) = 4.98, p < 0.001, partial η2 = 0.421), with follow-up ANOVAs indicating that this effect held for all variables. CONCLUSION: The results from this study can be used to inform a larger-scale randomized controlled trial to determine the efficacy of the program in a larger sample and eventually disseminate it in other real-world settings. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03744780. LEVEL OF EVIDENCE: Level IV, evidence obtained from multiple time series with the intervention.

Emotional eating and weight regulation: a qualitative study of compensatory behaviors and concerns.

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.

The Effects of If-Then Plans on Weight Loss: Results of the McGill CHIP Healthy Weight Program Randomized Controlled Trial.

OBJECTIVE: The NIH-developed Diabetes Prevention Program (DPP) is successful in achieving clinically significant weight loss in individuals with overweight/obesity when delivered one-on-one. The group-based DPP is less effective, with average weight losses of only 3.5%. The objective of this study was to increase weight loss outcomes of the group-based DPP by integrating habit formation tools (i.e., if-then plans). This two-arm randomized controlled trial tested the efficacy of the habit formation-enhanced group-based DPP compared with the standard group-based DPP on changes in body weight (primary outcome). This study presents the 3- and 12-month results of this 24-month trial. METHODS: A total of 208 participants were randomly assigned to the standard or enhanced DPP, and 172 participated. Participants were men and women with overweight/obesity who self-reported less than 200 min/wk of exercise. RESULTS: Both groups achieved high weight losses at 3 (5.76%) and 12 (9.98%) months, with no differences between groups (χ2 < 1). Both groups improved in blood pressure and physical activity. CONCLUSIONS: If-then plans did not result in higher weight loss. Both program versions resulted in higher weight loss than the group-based DPP. This may suggest that cognitive behavioral therapy skills of the coaches (clinical psychology doctoral students) was a key factor in treatment outcome.

A sad mood increases attention to unhealthy food images in women with food addiction.

Food addiction and emotional eating both influence eating and weight, but little is known of how negative mood affects the attentional processes that may contribute to food addiction. The purpose of this study was to compare attention to food images in adult women (N = 66) with versus without food addiction, before and after a sad mood induction (MI). Participants' eye fixations were tracked and recorded throughout 8-s presentations of displays with healthy food, unhealthy food, and non-food images. Food addiction was self-reported using the Yale Food Addiction Scale. The sad MI involved watching an 8-min video about a young child who passed away from cancer. It was predicted that: (1) participants in the food addiction group would attend to unhealthy food significantly more than participants in the control group, and (2) participants in the food addiction group would increase their attention to unhealthy food images following the sad MI, due to increased emotional reactivity and poorer emotional regulation. As predicted, the sad MI had a different effect for those with versus without food addiction: for participants with food addiction, attention to unhealthy images increased following the sad MI and attention to healthy images decreased, whereas for participants without food addiction the sad MI did not alter attention to food. These findings contribute to researchers' understanding of the cognitive factors underlying food addiction.

Eye gaze tracking reveals heightened attention to food in adults with binge eating when viewing images of real-world scenes.

Individuals with eating disorders often exhibit food-related biases in attention tasks. To assess the engagement and maintenance of attention to food in adults with binge eating, in the present study, eye gaze tracking was used to compare fixations to food among non-clinical adults with versus without binge eating while they viewed images of real-world scenes. Fifty-seven participants' eye fixations were tracked and recorded throughout 8-second presentations of scenes containing high-calorie and/or low-caloriefood items in various settings (restaurants, social gatherings, etc.). Participants with binge eating fixated on both high-calorie and low-calorie food items significantly more than controls, and this was the case when the high- and low-calorie food items were presented in the same image and in different images. Participants with binge eating also fixated on food items significantly earlier in the presentations. A time course analysis that divided each 8-second presentation into 2-second intervals revealed that participants with binge eating attended to food items more than control participants throughout the 8-second presentation. These results have implications for theory regarding the initiation and maintenance of binge eating.