Elsevier

Appetite

Volume 84, 1 January 2015, Pages 171-180
Appetite

Research review
A new look at the science of weight control: How acceptance and commitment strategies can address the challenge of self-regulation

https://doi.org/10.1016/j.appet.2014.10.004Get rights and content

Highlight

  • A self-regulation framework is applied to the challenge of weight control.

  • The framework includes acceptance-based skills, e.g. tolerating reduction in comfort.

  • Commitment to defined values and awareness of decision-making are also key.

  • Treatments incorporating these elements have demonstrated promising results.

Abstract

The current manuscript proposes an acceptance-based, self-regulation framework for understanding the challenge of weight maintenance and describes how this framework can be integrated into the behavioral treatment of obesity. According to this framework, intrinsic drives to consume palatable, high-calorie food interact with a modern environment in which high calorie foods are easily accessible. This combination produces a chronic desire to eat unhealthy foods that exists in opposition to individuals' weight control goals. Similarly, low energy expenditure requirements reduce physical activity. We suggest that individuals vary in their responsivity to cues that motivate overeating and sedentary behavior, and that those higher in responsivity need specialized self-regulatory skills to maintain healthy eating and exercise behaviors. These skills include an ability to tolerate uncomfortable internal reactions to triggers and a reduction of pleasure, behavioral commitment to clearly-defined values, and metacognitive awareness of decision-making processes. So-called “acceptance-based” interventions based on these skills have so far proven efficacious for weight control, especially for those who are the most susceptible to eating in response to internal and external cues (as predicted by the model). Despite the current empirical support for the postulated model, much remains to be learned including whether acceptance-based interventions will prove efficacious in the longer-term.

Section snippets

Current status of obesity problem and obesity interventions

Obesity is associated with serious health problems and with a high proportion of the nation's annual health care budget (Cawley, Meyerhoefer, 2012, Centers for Disease Control and Prevention, 2012, Danaei et al, 2009, Finkelstein et al, 2009). Yet, a full two-thirds of adults in the United States are overweight (body mass index or BMI > 25 kg/m2) or obese (BMI > 30 mg/m2; Flegal, Carroll, Kit, & Ogden, 2012). Individuals who attempt to lose weight on their own commonly report that they abandon

Challenge of behavior change

A priority for addressing the obesity epidemic is to better understand the difficulty of successfully modifying and maintaining desired dietary and PA behaviors. Those who participate in obesity interventions are usually motivated to lose weight and receive extensive education in the behavioral changes that are required for successful weight control. However, it has been hypothesized that these motivations are (eventually) overwhelmed by a biological predisposition to consume high-energy foods,

Psychological skills necessary for successful weight control

In the modern environment, the chronicity of our desires combined with the pervasive ability to eat and be at rest suggest that overeating and sedentariness are default positions, i.e., the decisions we will make (whether implicitly or explicitly) unless we deliberately apply psychological skills designed to resist the powerful forces at work (Schulz et al, 2006, Tordoff, 2002, Wansink, 2006). Our synthesis of the literature and our recent work suggest several specific psychological skills that

Conceptual model

In our conceptual model (Fig. 1), evolved neurobiological drives generate a chronic “wanting” for food and the desire to conserve energy (Finlayson et al, 2008, Rowland, 1998). These drives are activated by the presence of food and sedentary cues that are omnipresent in the current environment (Lowe et al., 2003). Internal states (emotion, fatigue) also cue a desire to move towards or maintain a higher hedonic state through consuming tasty foods and avoiding physical activity (Lowe et al., 2009

An acceptance-based behavioral approach to dietary and physical activity change

Behavioral treatments have evolved over time, with some scholars noting three waves of development: behavioral, cognitive and most recently the integration of mindfulness- and experiential acceptance-based constructs (Hayes, 2004). Treatments in this “third wave” category, also referred to as acceptance-based therapies (ABTs), which include Mindfulness-based Cognitive Therapy (Segal et al, 2004, Segal et al, 2012), Dialectical Behavior Therapy (Linehan, 1993) and Acceptance and Commitment

Efficacy of acceptance-based interventions for weight control

Until recently, only theoretical support existed for the notion that incorporating acceptance-based strategies into behavioral interventions would improve outcomes for treating obesity. However, the past few years has seen accumulating empirical support for acceptance-based behavioral interventions for weight control in the form of analog studies, open trials, workshop studies and randomized controlled trials.

Exemplar of an acceptance-based behavioral treatment for obesity

A variety of acceptance-based treatments have been developed including those that emphasize distress tolerance (Telch et al., 2001), those that emphasize mindful awareness of eating (Dalen et al, 2010, Kristeller, Hallett, 1999, Kristeller et al, 2013), and those that emphasize developing fully internalized motivation not emanating from self-stigma (Lillis et al, 2009, Lillis, Kendra, 2014). In our analysis, no one pre-existing treatment is a perfect fit for weight control. ACT is likely the

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