Maternal responsiveness and toddler body mass index z-score: Prospective analysis of maternal and child mealtime interactions.

Responsive feeding, where parents are guided by children's hunger and satiation cues and provide appropriate structure and support for eating, is believed to promote healthier weight status. However, few studies have assessed prospective associations between observed parental feeding and toddler growth. We characterized toddler growth from 18 to 36 months and, in a subset of families, examined whether observed maternal responsiveness to toddler satiation cues and encouraging prompts to eat at 18 and 24 months were associated with toddler body mass index z-score (BMIz) from 18 to 36 months. Participants included 163 toddlers and their mothers with overweight/obesity who had participated in a lifestyle intervention during pregnancy. Anthropometrics were measured at 18, 24, and 36 months. In a subsample, mealtime interactions were recorded in families' homes at 18 (n = 77) and 24 (n = 75) months. On average, toddler BMIz remained stable from 18 to 36 months with 31.3% (n = 51) categorized with a healthy weight, 56.4% (n = 92) with at risk for overweight and 12.3% (n = 20) with overweight. Fewer maternal prompts to eat at 18 months was associated with both higher probability of having at risk for overweight/overweight (p < .05), and higher child 36-month BMIz (p = .002). Higher child weight status at 12 months was also associated with both higher probability of having at risk for overweight/overweight (p < .05), and higher child 36-month BMIz (p < .001). Neither 24-month maternal prompts nor 18 or 24 month responsiveness to satiation cues were associated with toddler BMIz. In this diverse sample, weight status was relatively stable from 18 to 36 months. Maternal prompts to eat measured earlier in toddlerhood and prior child weight status were associated with toddler BMIz.

Novel behavioral interventions to improve long-term weight loss: A randomized trial of acceptance and commitment therapy or self-regulation for weight loss maintenance.

Maintenance of weight loss is hard to achieve, and novel interventions are needed to improve long-term outcomes. In this pilot randomized controlled trial, N = 188 participants received an online, 12-week weight loss intervention and N = 102 who lost ≥ 5% were then randomly assigned to a 1-day, 5-h workshop based on Acceptance and Commitment Therapy (ACT), Self-Regulation (SR), or no workshop (Control) with 3 months of limited email follow-up. Assessments were conducted at baseline, 3, 6, 12, 18, and 24 months. The primary outcome was percent weight change; secondary outcomes were weight-related experiential avoidance and health values-consistent behavior. ACT had greater overall weight loss (-7.18%, SE = 1.33) when compared to Control (-1.15%, SE = 1.50; p = .03). Post hoc analyses showed that ACT had significantly greater weight losses than Control (6.11%, ß = -2.03, p = .048) among those with lower initial weight loss (5-7%), and significantly greater weight loss than SR (6.19%, ß = -1.77, p = .05) among those with the highest initial weight losses (10% +). There is potential for continuing to develop ACT in a limited interventionist-contact format with modifications. This pilot study represents an innovative model for behavioral weight loss by reversing the typical treatment intensity model with the aim of providing interventionist support during a critical period after initial weight loss. REGISTRATION: Clinicaltrials.org #NCT02156752 https://www.clinicaltrials.gov/ct2/show/NCT02156752 .

Weight gain prevention buffers the impact of CETP rs3764261 on high density lipoprotein cholesterol in young adulthood: The Study of Novel Approaches to Weight Gain Prevention (SNAP).

BACKGROUND AND AIMS: Two weight gain prevention strategies, one targeting small changes to diet and physical activity and a second targeting large changes, significantly reduced weight gain in young adulthood. We examined whether weight gain prevention blunts genetic risk for body weight increase and/or high density lipoprotein cholesterol (HDL-C) lowering over two years. METHODS AND RESULTS: Participants were 524 male and female young adults (mean age = 28.2, SD = 4.3; mean BMI = 25.5, SD = 2.6). Obesity-related SNPs accounting for ≥ 0.04% of the variance were genotyped and combined into a genetic risk score. For HDL-C, SNPs within CETP, LIPC and FADS2 were genotyped. The obesity-related genetic risk score did not predict change in BMI independently or in interaction with treatment arm. However, consistent with the prior literature, each copy of the HDL-C risk, C, allele at CETP rs3764261 was associated with lower HDL-C at baseline. Moreover, significant interaction between SNP and treatment arm for change in HDL-C was observed (p = 0.02). In the control group, HDL-C change was dependent upon rs3764261 (p = 0.004) with C allele carriers showing a continued reduction in HDL-C. In contrast, within the two intervention groups, HDL-C increased on average with no differential effect of rs3764261 (p > 0.24). Notably, even among carriers of the CC genotype, small and large change arms were associated with increased HDL-C and the control arm a reduction (p = 0.013). CONCLUSIONS: The C allele at CETP rs3764261 is a strong risk factor for low HDL-C in young adulthood but weight gain prevention may mitigate this risk. CLINICAL TRIAL REGISTRY NUMBER AND WEBSITE: clinicaltrials.gov Identifier: NCT01183689, https://clinicaltrials.gov/.

Examination of whether early weight loss predicts 1-year weight loss among those enrolled in an Internet-based weight loss program.

One-month weight loss (WL) predicts posttreatment WL in face-to-face interventions; however, whether this holds true within Internet programs is unknown. This study examined whether 4-week WL predicts WL following a 12-week Internet program and at 6 and 12 months follow-up. A total of 181 participants (body mass index=33.4±5.5 kg m(-)(2); 83.1% female) received a 12-week behavior-based Internet WL program consisting of weekly video lessons. Participants were given a daily WL, calorie and physical-activity goal and asked to enter these data on the study website weekly. Personalized feedback was provided. Using 4-week WL, individuals were categorized as 'early nonresponders' (<2.0% WL) or 'early responders' (⩾2.0% WL). Early nonresponders had significantly lower WL than early responders at 3 (-1.3±3.8% vs -6.3±4.3%), 6 (-1.7±5.1% vs -5.8±5.2%) and 12 months (-0.05±6.8% vs -2.7±6.3%, P<0.05). The odds of achieving a ⩾5% WL were 8.5 (95% confidence interval (CI), 3.3-22.1), 3.4 (95% CI, 1.4-8.3) and 2.6 (95% CI, 0.93-7.4) times lower in early nonresponders, compared with early responders at 3, 6 and 12 months, respectively. Compared with early responders, early nonresponders viewed fewer video lessons and self-monitored less often across the 12-week intervention (P<0.05). This study provides initial evidence that a 4-week WL of <2.0% places an individual at an increased risk of failing to achieve clinically significant WL following an Internet program.

Adaptations of leptin, ghrelin or insulin during weight loss as predictors of weight regain: a review of current literature.

Numerous laboratory studies involving both animal and human models indicate that weight loss induces changes in leptin, ghrelin and insulin sensitivity, which work to promote weight regain. It is unclear, however, whether these biological changes serve as a biomarker for predicting weight regain in free-living humans in which biological, behavioral and environmental factors are likely at play. We identified 12 studies published between January 1995 and December 2011 that reported changes in leptin, ghrelin or insulin during intentional weight loss with a follow-up period to assess regain. Two of the nine studies examining leptin suggested that larger decreases were associated with greater regain, three studies found the opposite (smaller decreases were associated with greater regain), whereas four studies found no significant relationship; none of the studies supported the hypothesis that increases in ghrelin during weight loss were associated with regain. One study suggested that improvements in insulin resistance were associated with weight gain, but five subsequent studies reported no association. Changes in leptin, ghrelin or insulin sensitivity, taken alone, are not sufficient to predict weight regain following weight loss in free-living humans. In future studies, it is important to include a combination of physiological, behavioral and environmental variables in order to identify subgroups at greatest risk of weight regain.

Implications of Look AHEAD for clinical trials and clinical practice.

Look AHEAD (Action for Health in Diabetes) was a randomized clinical trial designed to examine the long-term health effects of weight loss in overweight and obese individuals with type 2 diabetes. The primary result was that the incidence of cardiovascular events over a median follow-up of 9.6 years was not reduced in the Intensive Lifestyle Group relative to the control group. This finding is discussed, with emphasis on its implications for design of trials and clinical treatment of obese persons with type 2 diabetes.

FTO predicts weight regain in the Look AHEAD clinical trial.

BACKGROUND: Genome-wide association studies have provided new insights into the genetic factors that contribute to the development of obesity. We hypothesized that these genetic markers would also predict magnitude of weight loss and weight regain after initial weight loss. METHODS: Established obesity risk alleles available on the Illumina CARe iSelect (IBC) chip were characterized in 3899 overweight or obese participants with type 2 diabetes from the Look AHEAD (Action for Health in Diabetes), a randomized trial to determine the effects of intensive lifestyle intervention (ILI) and diabetes support and education (DSE) on cardiovascular morbidity and mortality. Primary analyses examined the interaction between 13 obesity risk polymorphisms in eight genes and randomized treatment arm in predicting weight change at year 1, and weight regain at year 4 among individuals who lost 3% or more of their baseline weight by year 1. RESULTS: No single-nucleotide polymorphisms (SNPs) were significantly associated with magnitude of weight loss or interacted with treatment arm at year 1. However, fat mass and obesity associated gene (FTO) rs3751812 predicted weight regain within DSE (1.56 kg per risk allele, P=0.005), but not ILI (P=0.761), resulting in SNP × treatment arm interaction (P=0.009). In a partial replication of prior research, the obesity risk (G) allele at BDNF rs6265 was associated with greater weight regain across treatment arms (0.773 kg per risk allele), although results were of borderline statistical significance (P=0.051). CONCLUSIONS: Variations in the FTO and BDNF loci may contribute risk of weight regain after weight loss.

A motivation-focused weight loss maintenance program is an effective alternative to a skill-based approach.

OBJECTIVE: Maintaining weight loss is a major challenge in obesity treatment. Individuals often indicate that waning motivation prompts cessation of effective weight management behaviors. Therefore, a novel weight loss maintenance program that specifically targets motivational factors was evaluated. DESIGN: Overweight women (N=338; 19% African American) with urinary incontinence were randomized to lifestyle obesity treatment or control and followed for 18 months. All participants in lifestyle (N=226) received the same initial 6-month group behavioral obesity treatment and were then randomized to (1) a novel motivation-focused maintenance program (N=113) or (2) a standard skill-based maintenance approach (N=113). MAIN OUTCOME MEASURE: Weight assessed at baseline, 6 and 18 months. RESULTS: Both treatment groups (motivation-focused and skill-based) achieved comparable 18-month weight losses (-5.48% for motivation-focused vs -5.55% in skill-based, P=0.98), and both groups lost significantly more than controls (-1.51%; P=0.0012 in motivation-focused and P=0.0021 in skill-based). CONCLUSIONS: A motivation-focused maintenance program offers an alternative, effective approach to weight maintenance expanding available evidence-based interventions beyond traditional skill-based programs.

Cardiovascular disease risk factors, depression symptoms and antidepressant medicine use in the Look AHEAD (Action for Health in Diabetes) clinical trial of weight loss in diabetes.

AIMS/HYPOTHESIS: To determine the associations of baseline depression symptoms and use of antidepressant medicines (ADMs) with baseline cardiovascular disease (CVD) risk factors in Look AHEAD (Action for Health in Diabetes) trial participants. METHODS: Look AHEAD participants (n = 5,145; age 58.7 +/- 6.8 years; BMI 35.8 +/- 5.8 kg/m(2)) were assessed for CVD risk factors (elevated HbA(1c) or insulin use, elevated BP or antihypertensive use, elevated lipid levels or lipid-lowering medication, current smoking, BMI > or = 30 kg/m(2), lower peak exercise capacity assessed as metabolic equivalents [METs], and ankle-brachial index <0.9 or >1.3). Participants also completed the Beck Depression Inventory (BDI) and reported their use of ADMs. RESULTS: Of the participants, 14.7% had BDI scores > or = 11, consistent with mild-moderate depression, and 16.5% took ADMs; 4.4% had both depression markers (i.e. elevated symptom scores and took ADMs). In logistic regression analyses of CVD risk (elevated risk factor or use of medication to control the risk factor), controlled for demographic factors, continuous BDI scores and ADM use were each independently associated with elevated BP (or medication), current smoking, BMI > or = 30 kg/m(2) and lower MET values. ADM use was also associated with elevated serum lipids or use of lipid-lowering medication. CONCLUSIONS/INTERPRETATION: Among Look AHEAD participants, depression symptoms or ADM use on entry to the study were each independently associated with a wide range of CVD risk factors. Future research should assess the temporal dynamics of the relationships of depression symptoms and ADM use with CVD risk factors. TRIAL REGISTRATION: Clinicaltrials.gov NCT00017953 FUNDING: This study is funded by the National Institutes of Health with additional support from the Centers for Disease Control and Prevention.

Salivary habituation to food stimuli in successful weight loss maintainers, obese and normal-weight adults.

OBJECTIVE: Research shows that slower habituation of salivary responses to food stimuli is related to greater energy intake and that obese (Ob) individuals habituate slower than those of normal weight (NW). No study has examined habituation rates in weight loss maintainers (WLMs) who have reduced from obese to normal weight, relative to those who are Ob or NW. DESIGN: Salivation to two baseline water trials and 10 lemon-flavored lollipop trials were studied in 14 WLMs, 15 Ob and 18 NW individuals comparable in age, gender and ethnicity. Linear mixed models were used to compare WLMs with Ob and NW groups. RESULTS: Salivation in the WLM and NW groups decreased significantly (for both P <0.005) across trials, indicative of habituation. Salivary responses in the Ob group did not habituate (P=0.46). When compared with Ob group, WLMs showed a quicker reduction in salivation (P<0.05). WLM and NW groups did not differ in habituation rate (P=0.49). CONCLUSIONS: WLMs have habituation rates that are comparable to NW individuals without previous history of obesity, and show quicker habituation than those who are currently obese. These results suggest that physiological responses to food may 'normalize' with successful weight loss maintenance.

Use of artificial sweeteners and fat-modified foods in weight loss maintainers and always-normal weight individuals.

OBJECTIVE: The purpose of this study was to compare the dietary strategies, and use of fat- and sugar-modified foods and beverages in a weight loss maintainer group (WLM) and an always-normal weight group (NW). SUBJECTS: WLM (N=172) had maintained > or = 10% weight loss for 11.5 years, and had a body mass index (BMI) of 22.0 kg m(-2). NW (N=131) had a BMI of 21.3 kg m(-2) and no history of being overweight. Three, 24-h recalls on random, non-consecutive days were used to assess dietary intake. RESULTS: WLM reported consuming a diet that was lower in fat (28.7 vs 32.6%, P<0.0001) and used more fat-modification strategies than NW. WLM also consumed a significantly greater percentage of modified dairy (60 vs 49%; P=0.002) and modified dressings and sauces (55 vs 44%; P=0.006) than NW. WLM reported consuming three times more daily servings of artificially sweetened soft drinks (0.91 vs 0.37; P=0.003), significantly fewer daily servings of sugar-sweetened soft drinks (0.07 vs 0.16; P=0.03) and more daily servings of water (4.72 vs 3.48; P=0.002) than NW. CONCLUSIONS: These findings suggest that WLM use more dietary strategies to accomplish their weight loss maintenance, including greater restriction on fat intake, use of fat- and sugar-modified foods, reduced consumption of sugar-sweetened beverages and increased consumption of artificially sweetened beverages. Ways to promote the use of fat-modified foods and artificial sweeteners merits further research in both prevention- and treatment-controlled trials.

Weight-loss maintenance in successful weight losers: surgical vs non-surgical methods.

OBJECTIVE: As large weight losses are rarely achieved through any method except bariatric surgery, there have been no studies comparing individuals who initially lost large amounts of weight through bariatric surgery or non-surgical means. The National Weight Control Registry (NWCR) provides a resource for making such unique comparisons. This study compared the amount of weight regain, behaviors and psychological characteristics in NWCR participants who were equally successful in losing and maintaining large amounts of weight through either bariatric surgery or non-surgical methods. DESIGN: Surgical participants (n=105) were matched with two non-surgical participants (n=210) on gender, entry weight, maximum weight loss and weight-maintenance duration, and compared prospectively over 1 year. RESULTS: Participants in the surgical and non-surgical groups reported having lost approximately 56 kg and keeping > or =13.6 kg off for 5.5+/-7.1 years. Both groups gained small but significant amounts of weight from registry entry to 1 year (P=0.034), but did not significantly differ in magnitude of weight regain (1.8+/-7.5 and 1.7+/-7.0 kg for surgical and non-surgical groups, respectively; P=0.369). Surgical participants reported less physical activity, more fast food and fat consumption, less dietary restraint, and higher depression and stress at entry and 1 year. Higher levels of disinhibition at entry and increased disinhibition over 1 year were related to weight regain in both groups. CONCLUSIONS: Despite marked behavioral differences between the groups, significant differences in weight regain were not observed. The findings suggest that weight-loss maintenance comparable with that after bariatric surgery can be accomplished through non-surgical methods with more intensive behavioral efforts. Increased susceptibility to cues that trigger overeating may increase risk of weight regain regardless of initial weight-loss method.

Are standard behavioral weight loss programs effective for young adults?

OBJECTIVE: To compare the enrollment, attendance, retention and weight losses of young adults in behavioral weight loss (BWL) programs with older participants in the same trials. METHODS: Data were pooled from three NIH-funded adult BWL trials from two clinical centers in different regions of the country (total N=298); young adults were defined as those aged 18-35 years. Both young adults and adults were compared on session attendance, retention at the 6-month assessment, weight loss and physical activity at 6 months. RESULTS: Young adults represented 7% of the sample, attended significantly fewer sessions than did adults (52 vs 74%, respectively; P<0.001) and were less likely to be retained for the 6-month assessment (67 vs 95%, respectively; P<0.05). Controlling for demographic variables, study and baseline weight, the mean weight losses achieved were significantly less for young adults compared with adults (-4.3 kg (6.3) vs -7.7 kg (7.0), respectively; P<0.05); fewer young adults achieved > or =5% weight loss at 6 months compared with older participants (8/21 (38%) vs 171/277 (62%); P<0.05). After controlling for session attendance, differences in the mean weight loss were not significant (P=0.81). Controlling for baseline values, study and demographics, changes in total physical activity over the initial 6 months of treatment were less for young adults compared with adults, but these differences only approached statistical significance (P=0.07). CONCLUSION: These data indicate that standard programs do not meet the weight control needs of young adults. Research is urgently required to improve recruitment and retention efforts with this high-risk group.

Factors associated with early non-response within an Internet-based behavioural weight loss program.

OBJECTIVE: While behavioural weight loss interventions are effective overall, many individuals fail to achieve a clinically significant weight loss. Given that 4-week weight loss has been shown to predict longer term outcomes, one potential strategy for improving rates of success is to provide additional support to early non-responders. To inform these early rescue efforts, it is important to first identify how they may differ from their more successful peers. METHODS: At week 4 of a 12-week Internet-delivered weight loss program, 130 adults (age: 49.8 ± 9.8 years, body mass index: 31.2 ± 4.6 kg m-2) were asked to complete an 11-item survey assessing mood and weight-related cognitions and behaviours. Participants were then categorized as early non-responders (4-week weight loss <2%) or initial responders (4-week weight loss ≥2%), and groups were compared on intervention adherence during weeks 1-4 and week 4 survey question responses. RESULTS: Early non-responders and initial responders did not differ on any intervention adherence variables (ps > 0.05). Compared to initial responders, early non-responders reported less positive mood (p = 0.011), greater boredom with weight loss efforts (p = 0.036), greater temptation to eat foods not consistent with their goals (p = 0.023), and that their eating choices were less consistent with their goals (p < 0.001). CONCLUSIONS: These findings identify important differences between early non-responders and initial responders, offering potential intervention targets for rescuing early non-responders (i.e. making it easier for individuals to choose healthier foods, reducing boredom in Internet-delivered weight loss programs and providing strategies to limit exposure to dietary temptations).

Weight self-stigma and weight loss during behavioural weight loss intervention.

OBJECTIVE: Despite the myriad negative effects of weight self-stigma, its role in weight loss intervention has not been thoroughly examined. The aim of this study was to examine the association between weight self-stigma and weight loss. METHODS: This longitudinal study examined the association between weight loss and changes in self-stigma, assessed by the Weight Self-Stigma Questionnaire, which distinguished between self-devaluation and fear of enacted stigma. Participants were adults with overweight or obesity enrolled in a 24-month weight loss intervention trial (groups were collapsed for this post hoc analysis) who were assessed at baseline, 6, 12, 18 and 24 months. RESULTS: Baseline levels of self-stigma were not associated with weight loss outcomes. However, mixed models analysis showed that reductions in one aspect of weight self-stigma, self-devaluation, was associated with greater weight loss (p = 0.01). Cross products mediation analysis showed that increases in use of weight control strategies mediated the association between reductions in self-devaluation and greater weight loss (F = 14.86, p < 0.001; CI 0.09-0.37). CONCLUSIONS: Results suggest that there may be potential for incorporating intervention methods targeting the reduction of self-stigma in order to improve weight loss outcomes.

Sustaining eHealth engagement in a multi-year weight gain prevention intervention.

INTRODUCTION: Digital tools are widely used and effective in weight management interventions; however, usage declines over time. Strategies to promote continued engagement should be explored. We examined the effects of offering additional modes of weight reporting as well as periodic online campaigns to promote engagement, assessed by frequency of weight reporting, in a weight gain prevention study for young adults. METHODS: Using an observational design, self-reported weights obtained through digital tools were pooled across participants assigned to two interventions (n = 312). Analysis examined the effects before during and after introduction of an additional reporting modality (email) and for three time-limited refresher campaigns over 2 years. RESULTS: Adding a new modality to the three existing modes (SMS, web, and mobile web) increased weight reporting as well as the number of modalities participants used to report weights. The use of several modes of reporting was associated with more weights submitted (p < 0.01). Refresher campaigns did not increase the proportion of participants reporting; however, the number of weights submitted during the 4-week campaigns increased compared with the 4 weeks before the campaign (p's ≥ 0.45, <0.001, respectively). CONCLUSION: Using multiple digital modalities and periodic campaigns shows promise for sustaining engagement with weight reporting in a young adult population, and incorporating such strategies may mitigate typical declines in eHealth and mHealth interventions.

Weight loss treatment influences untreated spouses and the home environment: evidence of a ripple effect.

OBJECTIVES: To examine whether a weight loss program delivered to one spouse has beneficial effects on the untreated spouse and the home environment. METHODS: We assessed untreated spouses of participants in three sites of Look AHEAD, a multicenter randomized controlled trial evaluating the impact of intentional weight loss on cardiovascular outcomes in overweight individuals with type 2 diabetes. Participants and spouses (n=357 pairs) were weighed and completed measures of diet and physical activity at 0 and 12 months. Spouses completed household food and exercise environment inventories. We examined differences between spouses of participants assigned to the intensive lifestyle intervention (ILI) or to the enhanced usual care (DSE; diabetes support and education). RESULTS: Spouses of ILI participants lost -2.2+/-4.5 kg vs -0.2+/-3.3 kg in spouses of DSE participants (P<0.001). In addition, more ILI spouses lost > or =5% of their body weight than DSE spouses (26 vs 9%, P<0.001). Spouses of ILI participants also had greater reductions in reported energy intake (P=0.007) and percent of energy from fat (P=0.012) than DSE spouses. Spouse weight loss was associated with participant weight loss (P<0.001) and decreases in high-fat foods in the home (P=0.05). CONCLUSION: The reach of behavioral weight loss treatment can extend to a spouse, suggesting that social networks can be utilized to promote the spread of weight loss, thus creating a ripple effect.

Successful weight loss initiation and maintenance among adolescents with overweight and obesity: does age matter?

Treatments for adolescents with overweight/obesity demonstrate mixed success, which may be due to a lack of consideration for developmental changes during this period. Potential developmental differences in weight loss motivations, weight maintenance behaviours and the role of parents in these efforts were examined in a sample of successful adolescent weight losers. Participants enrolled in the Adolescent Weight Control Registry (n = 49) self-reported demographic information and weight history, reasons for weight loss and weight control, weight loss approach and weight maintenance strategies, and perceived parental involvement with weight loss. Associations between age at weight loss initiation and the aforementioned factors were examined using linear and generalized regressions, controlling for highest z-BMI and sex. Adolescents who were older (≥16 years) at their weight loss initiation were more likely to report losing weight on their own (37.5% vs. 75%, P = 0.01) and reported greater responsibility for their weight loss and weight loss maintenance (P < 0.001) compared to younger adolescents. Younger age at weight loss initiation was associated with greater parental involvement (P = 0.005), whereas older age was associated with greater adolescent responsibility for the decision to lose weight (P = 0.002), the weight loss approach (P = 0.007) and food choices (P < 0.001). Findings suggest the importance of considering developmental differences in responsibility for weight loss and maintenance among adolescents with overweight/obesity.

Characteristics of adults with overweight/obesity and high internal disinhibition: do they fit with targets for acceptance-based interventions?

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.

Exploring process variables through which acceptance-based behavioral interventions may improve weight loss maintenance.

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.