An individual participant data meta-analysis investigating the mediating role of eating behavior traits in Acceptance and Commitment Therapy-based weight management interventions.

Lara Palmeira, Misty Hawkins, Charlotte Hagerman, Evan Forman, Patricia Eustachio Colombo, Kirsi H Pietiläinen, Amy Ahern, Laura Kudlek, Stephanie Manasse, Christina Chwyl, Marjukka Kolehmainen, Julia Mueller, Nancy E Sherwood, Simon J Griffin, Michael E Levin, Adrienne Juarascio, Jason Lillis, Stephen J Sharp, Bärbel Knäuper, Meghan Butryn, Edurne Maiz, Clare E Boothby

Journal: Annals of behavioral medicine : a publication of the Society of Behavioral Medicine 2025;59(1):

PMID: 40451242

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Abstract

BACKGROUND

Identifying mechanisms of action can aid the refinement of weight management interventions. Acceptance and Commitment Therapy (ACT)-based interventions may support long-term weight management by improving self-regulation of eating behavior traits (EBTs). However, it remains unclear if changing EBTs like emotional eating, external eating, internal disinhibition, and restraint during ACT causes improved weight management.

METHODS

For this 1-stage Individual Participant Data (IPD) meta-analysis, we requested IPD from 9 trials identified through a systematic search of ACT-based interventions for adults with a body mass index >25 kg/m2 across 8 databases until June 20, 2022. We obtained, checked, and harmonized data from 8 of those trials (N = 1391) and conducted separate structural equation models with complex survey analysis to estimate short- and long-term mediating effects of changes in each EBT on percent weight change.

RESULTS

In the short-term (ie, follow-up closest to intervention end), we found indirect effects of the intervention on percent weight change through changes in emotional eating, external eating, internal disinhibition, and restraint. Each 1-unit change in these EBTs led to a 0.02% (95% CI, 0.05-0.001), 0.03% (95% CI, 0.06-0.001), 0.05% (95% CI, 0.11-0.02), and 0.09% (95% CI, 0.14-0.04) decrease in weight, respectively. In the long term (ie, 12 months after intervention end), we found both indirect and total effects for emotional eating, internal disinhibition, and restraint, with EBT changes explaining 23.78%, 23.12%, and 25.64% of total effects.

CONCLUSION

Findings suggest small partial mediating effects of ACT on weight through EBTs. Targeting EBTs may support improved weight management outcomes, particularly in the long term.

Address: MRC Epidemiology Unit, University of Cambridge, Cambridge, CB2 0QQ, United Kingdom.; Department of Psychology, Drexel University, Philadelphia, PA 19104, United States.; Department of Health and Wellness Design, School of Public Health, Indiana University, Bloomington, IN 47405, United States.; Department of Psychology, McGill University, Montreal, Quebec, H3A 1G1, Canada.; Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, FI-70211, Finland.; Department of Psychology, Utah State University, Logan, UT 84322, United States.; The Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI 02912,United States.; The Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI 02903, United States.; Department of Clinical and Health Psychology and Research Methodology, University of the Basque Country UPV/EHU, Donostia-San Sebastian, Basque Country, 20018, Spain.; RISE-Health, Department of Psychology and Education, Universidade Portucalense Infante D. Henrique, Rua Dr. António Bernardino de Almeida, Porto, 4200-319, Portugal.; Obesity Research Unit, Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, FI-00014, Finland.; Healthy Weight Hub, Abdominal Center, Helsinki University Hospital, Helsinki, 00290, Finland.; Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN 55454, United States.

DOI: 10.1093/abm/kaaf039

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MeSH Terms: Adult, Humans, Acceptance and Commitment Therapy, Feeding Behavior, Obesity, Self-Control, Weight Reduction Programs