Using an acceptance-based behavioral approach as a supplement to obesity treatment: A stepped-care approach

Abstract

ObjectivesThe aims of the current study were twofold: 1) examine the effectiveness of an acceptance-based behavioral approach as a supplement to a stepped-care obesity treatment, and 2) examine factors that contribute to poor weight loss outcomes and the need for more intensive treatment. MethodsFifty-three participants recruited from a large southeastern university completed a four-month weight loss program (Mage = 48.0, SDage = 13.2, MBaseline BMI = 35.5, SDBaseline BMI = 5.3, 69.8% female, 56.6% white, 39.6% black, 69.8% college degree or higher). A two-step treatment approach was implemented over four months. Step 1 included the Diabetes Prevention Program manual adapted for self-administration and the exercise and caloric monitoring portion of DPP was augmented by technology. In Step 2, participants who did not meet an established weight loss goal of 2.5% of body weight were randomized to continue with self-help (MISS-SH) or to participate in a weekly acceptance-based weight loss group (MISS-ABT). ResultsParticipants who met a 2.5% weight loss at week 8 and continued with SH (MISS-SH) lost a clinically significant amount of weight, averaging a weight loss of 5.3% (SD = 3.3) over the total 16 weeks of the intervention. Stepped participants randomized to MISS-ABT lost 1.3% of their body weight, and stepped participants randomized to continue with self-help (MISS-SH) achieved a 0.4% weight loss. There was evidence that the MISS-ABT group helped participants who attended the groups more regularly to lose weight. Participants who lost less weight and/or were eligible for stepped-care reported significantly higher levels of depression, internalized weight bias, binge eating, cognitive fusion with food cravings, and obstruction to valued living. ConclusionsIn this investigation, approximately half of the participants were able to lose a clinically significant amount of weight utilizing a minimally intensive intervention with little additional support. MISS-ABT participants were adherent to treatment and lost significantly more weight than participants eligible for stepped care but randomized to continue with SH. A number of psychological factors discriminated between those who were successful and unsuccessful at losing weight. The current preliminary research offers support to continue investigating ABT's potential beneficial effects in promoting weight loss outcomes.