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