Health at Every Size and Acceptance and Commitment Therapy for Obese, Depressed Women: Treatment Development and Clinical Application

Abstract

Treatments for women with obesity, depression, and body image concerns are not optimal. Weight loss programs lead to long-term weight gain for most participants, and even successful participants typically sustain only modest weight loss. Psychotherapy for depression is more effective, but as many as 50 % do not fully remit. When depression and obesity co-occur in women, outcomes are even more modest. Innovative treatments are needed to enhance the physical and mental health of obese, depressed women. The goal of the current paper is to describe the development of a treatment that integrates two innovative approaches for mental and physical self-acceptance. The Health at Every Size (HAES) paradigm, used to enhance physical health without encouraging weight loss, causes improvements in physical health among overweight participants that are longer-lasting than weight loss programs. Acceptance and Commitment Therapy (ACT) focuses on valued life behaviors and acceptance of painful emotions. ACT is efficacious for depression and as an adjunct to obesity treatment, and may be more effective for treatment-resistant depression than standard approaches. An integrated HAES/ACT treatment, known as Accept Yourself! and its manual is described in this paper, with information about how we adapted HAES and ACT approaches to create the intervention, as well as clinical strategies for implementation.