Celiac disease symptom profiles and their relationship to gluten-free diet adherence, mental health, and quality of life.

BACKGROUND: A subgroup of adults with celiac disease experience persistent gastrointestinal and extraintestinal symptoms, which vary between individuals and the cause(s) for which are often unclear. METHODS: The present observational study sought to elucidate patterns of persistent symptoms and the relationship between those patterns and gluten-free diet adherence, psychiatric symptoms, and various aspects of quality of life (QOL) in an online sample of adults with celiac disease. U.S. adults with self-reported, biopsy-confirmed celiac disease (N = 523; Mage = 40.3 years; 88% women; 93.5% White) voluntarily completed questionnaires as part of the iCureCeliac® research network: (a) Celiac Symptoms Index (CSI) for physical symptoms and subjective health; (b) Celiac Dietary Adherence Test for gluten-free diet adherence; (c) PROMIS-29, SF-36, and Celiac Disease Quality of Life Survey for psychiatric symptoms and QOL. Symptom profiles were derived using latent profile analysis and profile differences were examined using auxiliary analyses. RESULTS: Latent profile analysis of CSI items determined a four-profile solution fit best. Profiles were characterized by: (1) little to no symptoms and excellent subjective health (37% of sample); (2) infrequent symptoms and good subjective health (33%); (3) occasional symptoms and fair to poor subjective health (24%); (4) frequent to constant symptoms and fair to poor subjective health (6%). Profiles 2 and 3 reported moderate overall symptomology though Profile 2 reported relatively greater extraintestinal symptoms and Profile 3 reported relatively greater gastrointestinal symptoms, physical pain, and worse subjective health. Profiles differed on anxiety and depression symptoms, limitations due to physical and emotional health, social functioning, and sleep, but not clinical characteristics, gluten-free diet adherence, or QOL. Despite Profile 3's moderate symptom burden and low subjective health as reported on the CSI, Profile 3 reported the lowest psychiatric symptoms and highest quality of life on standardized measures. CONCLUSIONS: Adults with celiac disease reported variable patterns of persistent symptoms, symptom severity, and subjective health. Lack of profile differences in gluten-free diet adherence suggests that adjunctive dietary or medical assessment and intervention may be warranted. Lower persistent symptom burden did not necessarily translate to better mental health and QOL, suggesting that behavioral intervention may be helpful even for those with lower celiac symptom burden.

Associations Among Stress, Internalized Weight Stigma, Emotional Eating, and Body Composition in Active-Duty Service Members Enrolling in a Randomized Controlled Trial of a Weight Management Program.

BACKGROUND: Obesity is a critical public health concern with particular relevance to US military personnel. Stress and internalized weight stigma ("stigma") may contribute to and maintain obesogenic processes and behaviors, including emotional eating. In this secondary cross-sectional analysis, we examined (1) associations among stress and stigma with emotional eating and body fat percentage (BF%), (2) whether stress explains the association between stigma and emotional eating, and (3) whether emotional eating explains associations between stress and stigma with BF%. METHOD: Active-duty military service members (N = 178) completed BF% assessment and questionnaires assessing stress, stigma, and emotional eating. RESULTS: Structural equation modeling path analyses showed that stress and stigma were both significantly associated with emotional eating (b = 0.35, p < 0.001 and b = 0.23, p < 0.001, respectively) and with BF% (b = 0.38, p < 0.001 and b = 0.29, p < 0.001, respectively) such that individuals who reported higher stress and stigma tended to report more emotional eating and had higher BF%. Stress partially explained the association between internalized weight stigma and emotional eating, and emotional eating partially explained the relationship between stress and BF% but did not significantly mediate the association between stigma and BF%. CONCLUSION: Greater stress and internalized weight stigma were associated with more emotional eating and higher BF%; however, emotional eating only partially explained the association between stress and BF%. Results highlight the importance of interventions targeting stress management skills, but additional research is needed to identify mechanisms that explain the association between stigma and BF%.

Psychometric validation of the celiac disease-specific quality of life survey (CD-QOL) in adults with celiac disease in the United States.

PURPOSE: Celiac disease and its treatment negatively impact quality of life, indicating potential need for measurement of disease-specific quality of life domains to inform interdisciplinary intervention. The Celiac Disease Quality of Life Survey (CD-QOL) has been used in clinical research; however, its factor structure has not been confirmed and psychometric properties have not been evaluated in English-speaking adults in the U.S. AIMS: (1) Confirm the factor structure of the 20-item English CD-QOL; (2) assess psychometric properties including internal consistency reliability, convergent validity, known groups validity, and incremental validity. METHODS: 453 adults with self-reported Celiac disease (Mage = 40.57; 88% female; 92% White) completed the CD-QOL and validated measures of generic health-related quality of life (SF-36), gluten-free diet adherence (CDAT), anxiety and depression symptoms (PROMIS), and physical symptoms (CSI) as part of the iCureCeliac® patient-powered research network. RESULTS: Confirmatory factor analysis found superior fit for a bifactor structure with one general factor and four group factors. Ancillary bifactor analyses suggest the CD-QOL can be considered primarily unidimensional. Total and three subscale scores demonstrated acceptable internal consistency reliability. Convergent and known groups validity were supported. The CD-QOL demonstrated some incremental validity over the SF-36. CONCLUSION: The English CD-QOL can be used as a measure of disease-specific quality of life among adults with Celiac disease in the U.S. Compared to generic instruments, the CD-QOL appears to better capture specific cognitive and affective aspects of living with Celiac disease. Use of a total score is recommended. Its utility as a screening and outcome measurement tool in clinical settings should be examined.

Relationships Between Dietary Intake and Weight-Related Experiential Avoidance Following Behavioral Weight-Loss Treatment.

BACKGROUND: Interventions targeting weight-related experiential avoidance (EA) and disinhibited eating (DE) may also improve diet quality. Participants with overweight/obesity and DE who recently completed a behavioral weight-loss program were randomized to receive acceptance and commitment therapy or continued behavioral weight-loss treatment. In this secondary analysis, we explored (1) change in diet quality from baseline to 6-month follow-up (FU) and (2) whether weight-related EA at baseline and (3) change in weight-related EA during treatment were related to change in diet quality from baseline to FU. METHOD: Veterans (N = 68) completed food frequency questionnaires at baseline and FU, which were used to generate diet quality scores on the healthy eating index-15 (HEI-15). Weight-related EA was assessed using the Acceptance and Action Questionnaire for Weight-Related Difficulties-Revised (AAQW-R) at baseline, post-treatment, and FU. Aims were examined with mixed ANOVA analyses. RESULTS: Across both treatment groups, HEI-15 scores declined from baseline to FU. Women's HEI-15 decreased by about 5 times that of men. Baseline AAWQ-R was negatively associated with change in HEI-15. Neither AAWQ-R at post-treatment nor change in AAQW-R from baseline to post-treatment was significantly associated with change in HEI-15 at FU. CONCLUSIONS: Greater weight-related EA at baseline was associated with lower diet quality at FU, but change in weight-related EA during treatment did not predict change in diet quality at FU. Interventions targeting DE and weight-loss may require specific components to improve and sustain healthy dietary intake in Veterans with obesity and DE.

Understanding relationships between posttraumatic stress disorder symptoms, binge-eating symptoms, and obesity-related quality of life: the role of experiential avoidance.

Obesity, binge-eating symptoms, and PTSD symptoms commonly co-occur. Avoidance, a key feature of PTSD and proposed mechanism of binge-eating, is one potential mechanism for explaining this clinical overlap. The purpose of the current study was to: 1) examine the associations between PTSD symptoms (PTSD Checklist-Civilian; PCL-C) and measures of bingeeating symptoms (Binge Eating Scale; BES) and obesity-related quality of life (Obesity Related Well-Being Questionnaire-97; ORWELL-97) in a sample of veterans with overweight or obesity (N = 89), and 2) determine whether experiential avoidance (The Acceptance and Action Questionnaire-II; AAQ-II) explains the relationship between PTSD symptoms and binge-eating symptoms, and PTSD symptoms and obesity-related quality of life, respectively. Scores on the PCL-C, BES, ORWELL-97, and AAQ-II were all significantly correlated. Linear regression analyses indicated that higher PCL-C scores were related to higher scores on the BES and ORWELL-97 after controlling for potentially confounding factors (BMI and race). Effect sizes were in the medium-large range. Further, AAQ-II mediated the relationship between PCL-C and ORWELL-97, but did not mediate the relationship between PCL-C and BES. These findings suggest that experiential avoidance should be considered in interventions addressing co-occurring PTSD, binge-eating, and poor obesity-related well-being. Longitudinal research is needed to better understand directionality of these relationships and changes over time.

Genetic and environmental influences on posttraumatic stress disorder symptoms and disinhibited eating behaviors.

Posttraumatic stress disorder (PTSD) and eating disorders (ED) frequently co-occur, but the mechanisms underlying this association remain unclear. EDs are characterized by features of maladaptive eating behaviors including disinhibited eating and cognitive dietary restraint. Identifying the genetic overlap between PTSD symptoms and maladaptive eating behaviors may elucidate biological mechanisms and potential treatment targets. A community sample of 400 same-sex twins (102 monozygotic and 98 dizygotic pairs) completed the PTSD Checklist-Civilian (PCL-C) for PTSD symptoms and the Three-Factor Eating Questionnaire-Reduced (TFEQ-R18) for eating behaviors (uncontrolled eating, emotional eating, and cognitive dietary restraint). We used biometric modeling to examine the genetic and environmental relationships between PCL-C and TFEQ-R18 total and subscales scores. Heritability was estimated at 48% for PTSD symptoms and 45% for eating behavior overall. Bivariate models revealed a significant genetic correlation between PTSD symptoms and eating behavior overall (rg =.34; CI:.07,.58) and Uncontrolled Eating (rg =.53; CI:.24,.84), and a significant environmental correlation between PTSD symptoms and Emotional Eating (re =.30; CI:.12,.45). These findings suggest the influence of common etiology. Future research and clinical efforts should focus on developing integrated treatments.

Ethnic Differences in the Association Between Pain and Social Support in Iraq and Afghanistan Veterans.

OBJECTIVE: Although past research has identified differences in pain between non-Latino white (NLW) and Latino persons, few studies have focused on the influence of social support. The purpose of the present study was to determine if the association between the number of social support sources and ratings of pain intensity and pain interference differed as a function of ethnicity. DESIGN: Cross-sectional. SETTING: Veterans Affairs San Diego Healthcare System. SUBJECTS: Participants were NLW (N = 389) and Latino (N = 207) Iraq and Afghanistan veterans. METHODS: Linear regression analyses were used to examine the interaction between ethnicity and number of social support sources on pain intensity and pain interference as measured by the Patient-Reported Outcomes Measurement Information System pain inventory. RESULTS: The association between number of social support sources and pain intensity and interference significantly differed by ethnicity (P < 0.01 and P = 0.01, respectively). Among NLW veterans, there was a significant negative association between number of social support sources and pain intensity. Among Latino veterans, there was a significant positive association between number of social support sources and pain intensity and interference. CONCLUSIONS: These findings suggest important differences between NLW and Latino Iraq and Afghanistan veterans in the association between social support and pain. Future research should examine ethnic differences in pain-specific support received from the social environment.

An exploratory component analysis of emotion regulation strategies for improving emotion regulation and emotional eating.

Emotion-focused treatments are generally efficacious for improving emotion regulation and consequently, improving clinical symptoms across numerous disorders. However, emotion-focused treatment approaches often contain numerous treatment components, limiting our ability to identify which are most efficacious. As such, the current pilot study sought to isolate three components common across a range of emotion-focused treatments (i.e. emotional awareness, emotion down-regulation, and distress tolerance) and test the impact of each component on (1) emotion regulation and (2) emotional eating behavior. Adults (N = 76) who reported four or more emotional eating episodes in the past month were assigned to attend a one-time, three-hour workshop focused on either awareness, down-regulation or tolerance of emotions, and were subsequently evaluated at one-week and two-weeks follow-up. All groups experienced equivalent improvements in emotional eating at two-weeks follow-up (F [1.47, 85.38 ] = 7.60, p < .01). However, groups showed differential patterns of change across facets of emotion regulation. Improvements in access to healthy emotion regulation strategies was moderately related to improvements in emotional eating in Down-Regulation and Distress Tolerance groups (r [18] = 0.40, r [20] = 0.63, respectively). In the Distress Tolerance group, improvements in emotional eating were moderately related to improvements in acceptance of emotions (r[20] = 0.33) and ability to refrain from impulses (r[20] = 0.41). In the Emotional Awareness group, improvements in emotional acceptance (r[20] = 0.30), awareness (r[20] = 0.38) and clarity (r[20] = 0.39) were moderately related to improvements in emotional eating. While several components of emotion-focused treatments may improve outcomes, each component may demonstrate a unique mechanism of action. Further study is needed to isolate these treatment components in fully powered clinical trials to better understand the mechanisms of action for emotion-focused treatments and ultimately develop more efficient and effective treatment approaches.

Acceptance and Commitment Therapy for Chronic Pain: Does Post-traumatic Stress Disorder Influence Treatment Outcomes?

OBJECTIVE: The aim of this study was to determine whether post-traumatic stress disorder (PTSD) moderates treatment outcomes in Acceptance and Commitment Therapy for chronic pain. DESIGN: Longitudinal. SETTING: Veterans Affairs San Diego Healthcare System. SUBJECTS: A total of 126 veterans with chronic pain participating in an Acceptance and Commitment Therapy intervention for chronic pain. A structured clinical interview was used at baseline to designate PTSD-positive (N = 43) and -negative groups (N = 83). METHODS: Linear mixed-effects models to determine whether PTSD moderated change in pain interference, pain severity, pain acceptance, depressive symptoms, or pain-related anxiety at post-treatment and six-month follow-up. RESULTS: Participants with co-occurring PTSD reported greater pain interference, pain severity, depressive symptoms, and pain-related anxiety at baseline. PTSD status did not moderate treatment effects post-treatment. Rather, there were significant improvements on all study measures across groups (P < 0.001). PTSD status moderated change in depressive symptoms at six-month follow-up (P < 0.05). Specifically, participants with chronic pain alone demonstrated improvement in depressive symptoms compared with pretreatment levels, whereas participants with PTSD regressed to pretreatment levels. CONCLUSIONS: PTSD status did not significantly affect treatment outcomes, with the exception of depressive symptoms at six-month follow-up. Overall, Acceptance and Commitment Therapy for chronic pain appears helpful for improving outcomes among veterans with co-occurring PTSD; however, veterans with co-occurring PTSD may experience fewer long-term gains compared with those with chronic pain alone.

Improvement in 6-min Walk Test Distance Following Treatment for Behavioral Weight Loss and Disinhibited Eating: an Exploratory Secondary Analysis.

BACKGROUND: Poor functional exercise capacity is common among those with obesity; however, objective measures of exercise capacity are rarely examined in behavioral treatments targeting obese individuals. We examined whether a 4-week acceptance and commitment therapy (ACT) intervention for disinhibited eating or a behavioral weight loss (BWL) intervention improved exercise capacity and explored demographic and disinhibited eating variables related to exercise capacity. METHODS: Veterans (n = 61), randomized to receive ACT or BWL, completed an assessment of exercise capacity via the 6-min walk test (6MWT) at baseline and 6-month follow-up. Measures of disinhibited eating patterns and body mass index (BMI), at baseline and post-treatment, were also collected. Change in 6MWT distance and treatment group differences were examined using mixed ANOVAs. Characteristics related to baseline 6MWT and predictors of improvement in 6MWT at 6 months were examined with hierarchical multiple regression. RESULTS: There were overall significant improvements on the 6MWT from baseline to 6-month follow-up (F(1,59) = 11.14, p = .001, ηp2 = .159) but no differences between the ACT and BWL groups. Baseline BMI (ß = - .33, p = .005) was the only variable related to baseline 6MWT. Improvements on the 6MWT were related to younger age (ß = - .41, p = 0.001), female gender (ß = .36, p = .001), and treatment-related increases in dietary restraint behaviors (ß = .42, p = .001). CONCLUSIONS: Functional exercise capacity improved among participants completing behavioral interventions for weight and disinhibited eating. Improvements in dietary behavior regulatory skills may have generalized to improved regulation in other behavioral domains associated with exercise capacity.

Dietary restraint and weight loss in relation to disinhibited eating in obese Veterans following a behavioral weight loss intervention.

Ability to restrain one's dietary intake is a necessary skill for weight loss. However, dietary restraint has been shown to paradoxically increase disinhibited eating in certain populations, thereby negatively impacting weight loss and leading to worse overall health outcomes. The aim of this study was to address gaps in the literature regarding the relationships between separate facets of dietary restraint (intention; behavior) with weight loss and various types of disinhibited eating (binge eating, external eating, emotional eating) in overweight and obese adults who recently completed a weight loss intervention. A sample of mostly male Veterans with overweight and obesity (N = 88) self-reported their dietary restraint intention, restraint behavior, and current disinhibited eating following completion of an 8-week behavioral weight loss treatment. Greater dietary restraint intention was related to greater dietary restraint behavior, p < .05. Greater dietary restraint behavior was significantly related to greater recent weight loss, p < .05, while restraint intention was not, p > .05. Greater dietary restraint intention was related to greater current binge eating and external eating, while greater self-reported restraint behavior was related to less binge eating, p < .05. Thus, dietary restraint behavior appears to be adaptive for this population, whereas rigid dietary restraint intention may increase risk for disinhibited eating. To decrease disinhibited eating and improve weight loss outcomes in Veterans, interventions might specifically address rigid rule-following associated with abandonment of weight loss goals and help Veterans develop specific yet flexible eating plans. Future research should examine whether dietary restraint intention and behavior differentially predict disinhibited eating and weight loss outcomes prospectively.

Mechanisms and moderators in mindfulness- and acceptance-based treatments for binge eating spectrum disorders: A systematic review.

OBJECTIVE: Increasing evidence suggests that mindfulness- and acceptance-based psychotherapies (MABTs) for bulimia nervosa (BN) and binge eating disorder (BED) may be efficacious; however, little is known about their active treatment components or for whom they may be most effective. METHODS: We systematically identified clinical trials testing MABTs for BN or BED through PsychINFO and Google Scholar. Publications were categorized according to analyses of mechanisms of action and moderators of treatment outcome. RESULTS: Thirty-nine publications met inclusion criteria. Twenty-seven included analyses of therapeutic mechanisms, and five examined moderators of treatment outcome. Changes were largely consistent with hypothesized mechanisms of MABTs, but substandard mediation analyses, inconsistent measurement tools, and infrequent use of mid-treatment assessment points limited our ability to make strong inferences. DISCUSSION: Analyses of mechanisms of action and moderators of outcome in MABTs for BN and BED appear promising, but the use of more sophisticated statistical analyses and adequate replication is necessary.

Promising technological innovations in cognitive training to treat eating-related behavior.

One potential reason for the suboptimal outcomes of treatments targeting appetitive behavior, such as eating and alcohol consumption, is that they do not target the implicit cognitive processes that may be driving these behaviors. Two groups of related neurocognitive processes that are robustly associated with dysregulated eating and drinking are attention bias (AB; selective attention to specific stimuli) and executive function (EF; a set of cognitive control processes such as inhibitory control, working memory, set shifting, that govern goal-directed behaviors). An increasing body of work suggests that EF and AB training programs improve regulation of appetitive behaviors, especially if trainings are frequent and sustained. However, several key challenges, such as adherence to the trainings in the long term, and overall potency of the training, remain. The current manuscript describes five technological innovations that have the potential to address difficulties related to the effectiveness and feasibility of EF and AB trainings: (1) deployment of training in the home, (2) training via smartphone, (3) gamification, (4) virtual reality, and (5) personalization. The drawbacks of these innovations, as well as areas for future research, are also discussed. The above-mentioned innovations are likely to be instrumental in the future empirical work to develop and evaluate effective EF and AB trainings for appetitive behaviors.

Using ecological momentary assessment to better understand dietary lapse types.

Frequency of lapsing from a diet predicts weight loss failure, however previous studies have only utilized one definition of dietary lapse. No study has examined different types of lapse behaviors among individuals with overweight/obesity. The current study uses ecological momentary assessment (EMA) to examine predictors of three lapse types-eating a larger portion than intended, eating an unintended type of food, and eating at an unplanned time-in adults (N = 189; MBMI = 36.93 ±â€¯5.83 kg/m2; 82.0% female; Mage = 51.81 ±â€¯9.76 years) enrolled in a 12-month randomized controlled trial of two behavioral weight loss treatments. Participants completed 14 days of EMA at the start of treatment during which they indicated types of lapses that occurred with time and location of the lapse. Participants also responded to questions assessing current physical (e.g., hunger, tiredness), environmental (e.g., presence of "delicious" foods), and affective (e.g., loneliness, sadness) states at each prompt. Weight change was assessed at post-treatment. Separate generalized estimating equations were used to examine whether states prospectively predicted lapse occurrence at the next survey. Results indicated that lapse types differed significantly across time and location. Momentary increases in deprivation, hunger, and boredom increased likelihood of different lapse types. Lastly, we examined the prospective association between lapse type and weight loss. Eating at an unintended time was the only lapse type that predicted worse weight loss outcomes. Results support the theory that distinct lapse types exist, and that lapse types can be predicted by both momentary conditions and individual tendencies toward certain physical and affective states. However, not all lapse types may impact weight outcomes. Future research on behaviors that constitute dietary lapse is warranted and could inform personalized weight loss treatments.

Not so fast: The impact of impulsivity on weight loss varies by treatment type.

Behavioral weight loss (BWL) treatments result in suboptimal weight losses for many individuals. Impulsivity appears to be a maintenance factor of obesity, yet few studies have examined impulsivity as a predictor of outcomes from BWL. We examined specific facets of impulsivity (inhibitory control and delay discounting) as moderators of outcome in BWL. Overweight adults (n = 190) were randomized to standard behavioral treatment (SBT) or acceptance-based behavioral treatment (ABT). We hypothesized that impulsivity would be inversely associated with weight loss, and that the association between impulsivity and outcome would be attenuated in the ABT condition. Poorer general inhibitory control predicted lower percent weight lost at 12 months across conditions at the trend level (b = -0.003, p = 0.06). The negative impact of low inhibitory control on weight loss was attenuated by assignment to ABT versus SBT (b = 0.004, p = 0.03). Treatment condition, at trend level, also moderated the impact of delay discounting (b = -0.011, p = .098) and food-specific inhibitory control (b = 0.003, p = 0.06) on percent weight loss such that those with greater impulsivity benefitted most from ABT. Results reveal a potential pattern that impulsivity reduces benefit derived from SBT but not ABT. Further research on the moderating effect of impulsivity is necessary to inform the development of targeted treatments for clinically meaningful subtypes of patients.

Confirmatory Factor Analysis of the Comprehensive Assessment of Acceptance and Commitment Therapy (CompACT) in Active-Duty Military Personnel.

Acceptance and Commitment Therapy (ACT) is a third-wave cognitive-behavioral treatment that targets psychological flexibility (PF), or the ability to persist in behavior consistent with values regardless of unwanted private experiences. The growing use of ACT necessitates an accurate assessment of PF. The Comprehensive Assessment of Acceptance and Commitment Therapy (CompACT) is a three-factor measure of PF (Openness to Experience, Valued Action, and Behavioral Awareness) whose psychometric properties have been examined in limited populations. The current study examined the factor structure and psychometric properties of the CompACT in U.S. military personnel who enrolled in a weight management randomized controlled trial. Military personnel who either failed or were at risk of failing the Navy's physical fitness assessment or had overweight/obese body mass index (BMI; N = 178, Mage = 29.15 years; MBMI = 33.13 kg/m2; 61.8% female) completed the CompACT and other questionnaires. Confirmatory factor analysis was used to evaluate the three-factor structure of the original 23-item CompACT (CompACT-23) as well as an 18-item version identified in a Portuguese sample (CompACT-18). Internal consistency and convergent validity with measures of weight-related experiential avoidance, perceived stress, anxiety, depression, PTSD symptoms, and life satisfaction were examined. The three-factor structure of the CompACT-23 showed poor fit to the data while the fit of the CompACT-18 was acceptable, as indicated by three descriptive indices (χ2/df = 1.73, RMSEA = 0.069, SRMR = 0.074). All descriptive fit indices in addition to two comparative fit indices (AIC and BIC) indicated improved model fit over the CompACT-23. The CompACT-18 and its subscales exhibited adequate internal consistency (α = 0.768 to 0.861) and convergent validity in expected directions with measures of weight-related experiential avoidance, perceived stress, anxiety, depression, PTSD symptoms, and satisfaction with life. Results support using the refined, English language CompACT-18 as a three-factor measure of PF in populations such as U.S. military personnel who may benefit from weight management intervention. Future research should explore the content validity of the full measure and the removed items. Lost content could mean the CompACT-23 and the CompACT-18 differentially assess PF. Additional studies should examine psychometric properties in large and more diverse samples to further evaluate the appropriateness of the measure across populations. Longitudinal studies are needed to examine test-retest reliability and sensitivity to change.

Baseline Characteristics and Their Associations with Body Composition of Active-Duty Service Members Enrolling in a Randomized Controlled Trial of a Weight Management Program.

INTRODUCTION: Increasing rates of overweight and obesity among military service members (SMs) necessitate the implementation of weight management interventions. Evidence for the effectiveness of military weight management interventions is mixed. Effectiveness may be impacted by individual sociodemographic, psychiatric, psychological, and behavioral factors. Baseline data from SMs who were overweight/obese or at risk of failing body composition or physical fitness tests and enrolling in a weight management randomized controlled trial were used to examine (1) individual characteristics of this sample as a whole and by gender and (2) relationships between those characteristics and body composition metrics that are targeted by military weight management interventions. Understanding these relationships may inform intervention approaches. MATERIALS AND METHODS: Active duty SMs (N = 178) who enrolled in a randomized clinical trial of the Navy's weight management program "ShipShape" at a large military hospital provided data at their baseline visit. Because of gender differences in average body fat percentage (BF%) and underrepresentation of women SMs in research, independent samples t-tests and chi-square analyses were used to examine differences between male and female SMs across study variables. Multiple regression analyses were used to examine relationships of sociodemographic, psychiatric, psychological, and behavioral variables with body composition metrics, including weight, body mass index (BMI), BF%, and waist circumference (WC). RESULTS: Participants (61% female; Mage = 29.66 ± 6.92 years; 59.60% White) had an average BMI in the "obese" range (MBMI = 33.1 ± 3.9 kg/m2). Female participants had significantly higher BF% and significantly lower weight and WC than male participants. Compared to male participants, females reported significantly higher rates of pain and headache diagnoses, lifetime diagnosis of an anxiety disorder, lifetime treatment for a mental health concern, lifetime experiences of sexual trauma/harassment and military sexual trauma, and higher current anxiety and post-traumatic stress disorder symptoms. Across all SMs, body composition metrics were significantly associated with several demographic variables, including gender, age, marital status, Asian race, and Black race. Higher weight-related stigma was significantly associated with higher weight, BMI, BF%, and WC. Additionally, more emotional eating was significantly associated with higher BF%, and higher weight-loss confidence was significantly associated with higher BMI. Sociodemographic, psychiatric, psychological, and behavioral variables predicted the greatest variance in BF% compared to other body composition metrics evaluated. CONCLUSIONS: Participants in this study were more likely to be female, relatively young members of the Navy with overweight/obesity, who endorsed pain-related medical conditions, probable mental health conditions, and traumatic experiences at relatively high rates. Despite high endorsement of anxiety, depression, and post-traumatic stress disorder symptoms in this group, only weight-related stigma consistently emerged as significantly associated with body composition metrics. Regression results varied by body composition metric, with the most variance explained in BF%, suggesting that BF% may relate most strongly to sociodemographic, psychiatric, psychological, and behavioral variables associated with weight management. These results highlight the need for weight management programs that address weight-related stigma and mental health concerns of SMs to maximize the effectiveness of intervention efforts.

Technology-supported Acceptance and Commitment Therapy for chronic health conditions: A systematic review and meta-analysis.

Chronic health conditions (CHCs) are common and associated with functional limitations. Acceptance and commitment therapy (ACT) shows promise in improving functioning, quality of life, and distress across several CHCs. The purpose of this study was to conduct a systematic review of technology-supported ACT for CHCs and perform a meta-analysis on functioning and ACT process outcomes. Multiple databases were systematically searched for randomized controlled trials. A total of 20 unique studies with 2,430 randomized participants were included. CHCs addressed in these studies were chronic pain (k = 9), obesity/overweight (k = 4), cancer (k = 3), hearing loss (k = 1), HIV (k = 1), multiple sclerosis (k = 1), and tinnitus (k = 1). Internet and telephone were the most used technology platforms. All studies included therapist contact with considerable heterogeneity between studies. Random effects meta-analyses found medium effect sizes showing technology-supported ACT outperformed comparator groups on measures of function at post-treatment (Hedges' g = -0.49; p = 0.002) and follow-up (Hedges' g = -0.52; p = 0.02), as well as ACT process outcomes at post-treatment (Hedges' g = 0.48; p < 0.001) and follow-up (Hedges' g = 0.44; p < 0.001). Technology-supported ACT shows promise for improving function and ACT process outcomes across a range of CHCs. Recommendations are provided to optimize technology-supported ACT for CHCs. PROSPERO registration number: CRD42020200230.

Single-Session Acceptance and Commitment Therapy (ACT) Interventions for Patients with Chronic Health Conditions: A Systematic Review and Meta-Analysis.

RATIONALE: Chronic health conditions (CHCs) are costly and difficult to manage. Patients often struggle with behavioral adherence to complex treatment regimens and experience psychiatric distress. Acceptance and Commitment Therapy (ACT) is a transdiagnostic behavioral approach that aims to improve functioning and quality of life (QoL), which are important treatment outcomes for this population. Preliminary efficacy of multi-session ACT in patients with CHCs has been demonstrated, and single-session ACT interventions have since been developed to increase feasibility, acceptability, and accessibility. The purpose of this systematic review and meta-analysis was to describe the literature on single-session ACT intervention studies in CHC populations with regards to (1) study design and methodology, (2) patient characteristics and conditions targeted, and (3) efficacy for outcomes across various domains, using narrative and quantitative methods. METHODS: PsycINFO, PubMed, and Web of Science were systematically searched in August 2020. Studies of single-session ACT interventions in adult patients with CHCs that reported quantitative outcomes in any of the following domains were included: (a) functioning and related domains (e.g., disability, QoL, well-being); (b) mental health; (c) physical health; (d) ACT processes. Both controlled and uncontrolled studies were included. Study quality was assessed using the Psychotherapy Outcome Study Methodology Rating Scale (POMRF). Between-group random effects meta-analysis was conducted on general functioning outcomes. RESULTS: Fourteen manuscripts reporting outcomes from 13 studies (N = 793) met inclusion criteria. Ten studies were identified by their authors as pilot or feasibility trials. Eight studies used comparison or control groups. Twelve studies delivered the ACT content in workshop format. Studies recruited for a variety of conditions. Narrative review found that between- and within-group effect sizes showed generally positive results favoring single-session ACT overall (69%), especially for measures of functioning and related domains (88%), mental health (67%), and ACT processes (73%). Meta-analysis found that ACT did not significantly outperform comparison groups on measures of general functioning (Hedges' g: -0.51, 95% confidence interval: [-1.19, 0.16]; I 2 = 86%; K = 5) despite a medium-sized pooled effect. DISCUSSION: Use of single-session ACT interventions in CHC populations is an emergent field. There is preliminary evidence for the acceptability, feasibility, and efficacy of these interventions, which provides support for further testing in fully-powered RCTs. Additional RCTs will enable larger meta-analyses and stronger conclusions about efficacy. Recommendations for future trials are provided.

Confirmatory Factor Analysis of the Acceptance and Action Questionnaire for Weight-Related Difficulties-Revised (AAQW-R) in a United States Sample of Adults with Overweight and Obesity.

OBJECTIVE: To examine the psychometric properties of the English language version of the 10-item Acceptance and Action Questionnaire for Weight-Related Difficulties-Revised (AAQW-R) in a United States (U.S.) sample of women and men with overweight/obesity (OW/OB). METHOD: Adults with OW/OB seeking weight loss (N = 283; 59% women) completed the AAQW-R and other weight-related and psychosocial measures. Confirmatory factor analysis was used to examine single-factor, three-factor, and second-order factor structures of the AAQW-R, which were previously examined in a sample of Portuguese women. A chi-square difference test was used to compare the fit of a single-factor structure with three-factor and second-order factor structures. Internal reliability and convergent validity were examined for the total and three-factor subscale scores. RESULTS: The single-factor structure evidenced poor fit to the data whereas the three-factor structure evidenced acceptable fit. The second-order structure was assessed qualitatively due to limitations to statistical model specification. The internal reliability of the AAQW-R total score and each of the three subscales were in the good and acceptable ranges, respectively. Total and subscale scores demonstrated good convergent validity. DISCUSSION: Findings suggest that the English language version of the AAQW-R can be used to assess weight-related experiential avoidance in U.S. adult samples with OW/OB as a three-factor construct (food as control, weight as a barrier to living, weight stigma), with or without a total score. Additional research should confirm measurement invariance among various sociodemographic groups.