Individual participant data meta-analysis of eating behaviour traits as effect modifiers in acceptance and commitment therapy-based weight management interventions.

Amy L Ahern, Misty Hawkins, Charlotte Hagerman, Evan Forman, Patricia Eustachio Colombo, Kirsi H Pietiläinen, Laura Kudlek, Stephanie Manasse, Christina Chwyl, Marjukka Kolehmainen, Lara Palmeira, 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: International journal of obesity (2005) 2025;49(6):1142-1152

PMID: 40211060

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Abstract

BACKGROUND

Obesity care may benefit from precision approaches, matching patients to treatment types based on their individual characteristics, including eating behaviour traits (EBTs) like emotional eating, uncontrolled eating, external eating, internal disinhibition and restraint. Initial evidence suggests that Acceptance and Commitment Therapy (ACT)-based interventions might address dysregulated EBTs more effectively than standard behavioural treatments. However, it is unclear if ACT is more effective for certain EBT levels.

METHODS AND ANALYSIS

This pre-registered (CRD42022359691) one-stage Individual Participant Data (IPD) meta-analysis explored the moderating effects of baseline EBTs on weight outcomes in trials of ACT-based interventions for adults with a BMI ≥ 25 kg/m. Unlike traditional meta-analyses, IPD meta-analyses re-analyse existing data to answer novel research questions. We identified 16 eligible trials through a systematic search of eight databases until June 20, 2022. We obtained, checked, and harmonised data from 15 trials (N = 2535). We used mixed regression models to investigate both continuous and categorical interaction effects.

RESULTS

We found no evidence of interactions between ACT vs. control and baseline EBTs as continuous variables on percentage weight change. However, we found evidence to suggest an added difference in weight change of -4.47% (95%CI -1.15, -7.73) from baseline to 12-months after intervention end in participants with medium levels of internal disinhibition compared to those with high levels. Sensitivity analyses similarly indicated a greater intervention benefit for participants with medium, rather than high, emotional eating levels (in trials that reduced experiential avoidance and in trials using the three-factor eating questionnaire) and internal disinhibition (in analyses of participants with at least 60% attendance). Given the exploratory nature of analyses, results should be interpreted with caution.

CONCLUSION

Findings suggest potential non-linear interaction effects of ACT with internal disinhibition but require replication in confirmatory trials. These results may help guide further research on precision approaches based on EBTs.

Address: MRC Epidemiology Unit, University of Cambridge, Cambridge, UK. [email protected].; MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.; Department of Psychology, Drexel University, Philadelphia, PA, USA.; Department of Health and Wellness Design, School of Public Health, Indiana University, Bloomington, IN, USA.; Department of Psychology, McGill University, Montreal, Quebec, Canada.; Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.; Department of Psychology, Utah State University, 2810 Old Main Hill, Logan, UT, 84322, USA.; The Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.; The Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, Rhode Island, USA.; Department of Clinical and Health Psychology and Research Methodology, University of the Basque Country UPV/EHU, Donostia-San Sebastian, Basque Country, Spain.; RISE-Health, Department of Psychology and Education, Universidade Portucalense Infante D. Henrique, Rua Dr. António Bernardino de Almeida, 541, 4200-072, Porto, Portugal.; Obesity Research Unit, Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland.; Healthy Weight Hub, Abdominal Center, Helsinki University Hospital, Helsinki, Finland.; Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA.

DOI: 10.1038/s41366-025-01759-9

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MeSH Terms: Humans, Feeding Behavior, Acceptance and Commitment Therapy, Obesity, Adult, Female, Weight Reduction Programs, Male