While the name Matt Berry might conjure images of the comedic actor known for his roles in "Toast of London" and "The IT Crowd," this article delves into the realm of weight loss strategies, drawing parallels between Berry's dedication to his craft and the commitment required for successful weight management. We will explore behavioral weight loss treatments (BT) and the potential benefits of incorporating mindfulness and acceptance-based treatments (MABTs) to enhance weight loss outcomes.
The Landscape of Weight Loss Interventions
Obesity is a significant health concern associated with numerous health problems and increased mortality. Traditional behavioral weight loss treatments (BT) have proven effective, generally resulting in clinically significant weight losses of 5-8%. However, there is always room for improvement, which has led researchers to explore the potential of mindfulness and acceptance-based treatments (MABTs) to further enhance weight loss results.
Mindfulness and Acceptance-Based Treatments (MABTs): A Promising Avenue
Certain MABTs have shown superior weight loss efficacy compared to BT alone. However, MABTs are often delivered as comprehensive packages, making it challenging to pinpoint the specific intervention components that drive weight loss. While mediation analyses offer preliminary support for the role of willingness- and values-linked mechanisms of action, they have limitations in interpretability due to measurement error, assessment timing, and the inability to clarify which components affect which mediators.
Optimizing MABTs: The Multiphase Optimization Strategy (MOST) Framework
To address the challenges of optimizing MABTs, the Multiphase Optimization Strategy (MOST) framework offers a comprehensive approach. MOST is a method for optimizing and engineering multicomponent interventions by identifying core components and using a factorial design to test the individual and interactive efficacy of each component. A randomized controlled trial (RCT) can then evaluate the optimized intervention, which contains the most effective combination of components.
The MOST framework enables the identification of active treatment components, accelerating the development of enhanced intervention packages compared to successive RCTs. By evaluating the independent and interactive efficacy of each identified component, researchers can gain valuable insights into the most effective strategies for weight loss.
Read also: Diet and Exercise of a Champion
A Factorial Design Approach
A clinical trial employing a MOST approach with a 2 × 2 × 2 factorial design randomizes participants with overweight/obesity to one of eight conditions. These conditions represent all possible combinations of the following treatment components:
- Mindful Awareness (“Awareness”)
- Willingness (“Willingness”)
- Values Clarity (“Values”)
The foundation of each condition is a 20-session, small group-based, gold-standard behavioral weight loss program.
Treatment Conditions
The eight treatment conditions are:
- Behavioral treatment (BT) only (treatment as usual)
- BT + Values
- BT + Awareness
- BT + Willingness
- BT + Awareness + Values
- BT + Awareness + Willingness
- BT + Willingness + Values
- BT + Awareness + Willingness + Values
Assessments are conducted at baseline, mid-treatment (6-months), post-treatment (12-months, the primary study endpoint), and at 6-, 12-, and 24-month follow-up.
Study Aims
The primary aim is to evaluate the independent efficacy of the MABT components on weight loss above BT. The secondary aims are:
Read also: Quick Keto Smoothie
- Evaluating the independent efficacy of components on calorie intake, physical activity, and quality of life.
- Evaluating target engagement.
- Testing the hypothesis that susceptibility to internal and external food cues moderates component efficacy (i.e., those with greater susceptibility benefit most).
Exploratory aims include quantifying any component interaction effects, which may be synergistic, fully additive, or partially additive. The ultimate goal is to construct an optimized treatment that includes efficacious components, producing clinically meaningful differences in weight loss.
Key Treatment Components
Behavioral Treatment (BT)
This foundational component consists of core gold-standard behavioral weight loss strategies adapted from the Diabetes Prevention Program (DPP) and Look Ahead. Participants receive a calorie intake prescription designed to induce approximately 1-2 lbs. (0.45-0.91 kgs) of weight loss per week based on baseline body weight:
- <250 lbs. (113 kg): 1200-1500 cal per day
- >250 lbs. (113 kg): 1500-1800 cal per day
Participants also receive physical activity guidelines, gradually increasing to 250 minutes per week of moderate-to-vigorous physical activity. Other topics include nutrition and physical activity education, self-monitoring intake using a mobile app (MyFitnessPal), stimulus control techniques, setting individualized behavioral goals, problem-solving barriers to change, improving social support, and preventing relapse. Participants receive frequent praise and reinforcement for achieving behavioral and weight goals and individualized feedback on weekly self-monitoring records.
Mindful Awareness (“Awareness”)
Adapted from the MB-EAT program, this component teaches mindfulness techniques to promote the deliberate regulation of attention and awareness of the present moment, including internal experiences (e.g., thoughts, emotions, sensations, hunger, and fullness). Participants learn to monitor their internal experiences before, during, and after eating and exercise to explore cognitive and affective factors contributing to these behaviors. Experiential exercises cultivate innate appetitive regulatory processes by teaching participants to tune into their internal fullness, hunger, and taste satiety signals.
Participants are guided through mindful eating exercises (e.g., eating a raisin, decadent snacks, and a multi-component meal). Emphasis is placed on eating for quality rather than quantity. Participants are encouraged to develop a regular 15-min daily meditation practice and engage in brief “pre-meal meditations” (pausing and tuning into the present moment and one’s internal experiences prior to meals). Participants are taught to make eating decisions with both “inner wisdom” (knowledge of one’s fullness, hunger, and taste satiety) and “outer wisdom” (calorie tracking and portion control strategies), coupling Mindful Awareness strategies with core BT strategies. The goal is to help participants increase physical activity levels and adhere to calorie targets by moving from mindless/automatic patterns of eating and sedentary behavior to mindful/deliberate eating- and exercise-related decisions.
Read also: Halle Berry's Diet Secrets
Willingness (“Willingness”)
This component provides participants with strategies to psychologically accept discomfort (e.g., urges to eat, hunger, cravings, fatigue) or a loss of pleasure, enabling choices (e.g., eating an apple instead of a cookie) based on health goals rather than one’s internal state in a given moment. The core goal is to help participants “uncouple” internal experiences from chosen behaviors. To facilitate uncoupling, participants learn cognitive defusion skills to develop the ability to “look at thoughts rather than from thoughts” and gain distance from internal experiences. For example, participants learn to label thoughts as thoughts (“I’m having the thought that”) and feelings as feelings (“I’m having the feeling of…”).
The framework of the willingness component is “control what you can” and “accept what you can’t.” Participants learn to engage core behavioral strategies (e.g., portion control, stimulus control) and accept (i.e., be willing to experience) all internal experiences that arise when engaging these strategies, including unwanted emotions (e.g., frustration), thoughts (e.g., “this will never work”), and cravings. Emphasis is placed on being willing to engage in weight control behaviors even when uncomfortable or challenging thoughts, feelings, or sensations arise. Exercises adapted from prior treatments are incorporated to teach willingness skills.
Values Clarity (“Values”)
This component facilitates clarification of values and connection of those values to weight control behaviors to generate a meaningful and intrinsic source of motivation with which to sustain weight control behaviors long-term. Participants are guided through a structured process to identify life values in core life domains (e.g., family, community, spirituality). Participants are taught that they will be more motivated for goals that connect to freely-chosen, personal life values (e.g., living a long and healthy life; being a present, loving, and energetic grandparent).
Commitment to difficult behavioral goals is only likely to be maintained when one connects psychologically with life values meaningful enough to make such effort worthwhile. Emphasis is placed on making connections between these values and weight control behaviors (e.g., healthy eating as a way to live out the value of being a present and energetic grandparent). Participants also learn skills to keep values salient (e.g., through written or visual cues) and to use life values, rather than momentary desires to lessen discomfort, to guide decision-making.
The Role of Group Sessions
Groups last 85-130 minutes, depending on the number of components included. The goal of session timing and structure is to allocate an equal amount of time for foundational BT content across conditions and for time allotted to each MABT component to be consistent across conditions for which that component is included. Groups initially meet weekly, then decrease in frequency to facilitate increasing autonomy. Group sessions are conducted via the Zoom videoconference platform. Participants submit and receive feedback on assignments (worksheets and food records) via Google Classroom, an online learning platform.
Session Structure
Groups begin with “individual consultations” in which participants meet one-on-one with one of the two study interventionists in Zoom breakout rooms to discuss individualized weight trajectory and key issues. Individual consultations last approximately 3 minutes for each participant. During the time that participants are waiting for their individual consultation or for the group session to start (approximately 15 minutes), they are in a virtual “waiting room” with the other participants to facilitate unstructured conversation and group cohesion. Afterward, group check-ins are conducted, in which participants report to the group on compliance with their calorie prescription, exercise prescription, daily dietary self-monitoring, and homework completion. The remainder of the session is devoted to presenting skills and discussing strategies. Following each session, participants are assigned worksheets to facilitate skills utilization (“skill builders”) and are asked to submit food records. Participants submit and receive feedback on these assignments in Google Classroom. Group leaders leave comments on materials to facilitate skills utilization and increase accountability between sessions.