Digging into the Lasting Benefits of Acceptance Therapy
A hot catchphrase in popular culture is mindfulness. But for effective, evidence-based obesity care, we need more than buzzy phrases. Thus we have the emergence of acceptance-based therapy (ABT) as a way to enhance well-established techniques for intensive behavioral therapy. New study results in Obesity add to the evidence that acceptance therapy can help deliver lasting benefits.
What Is Acceptance-Based Therapy?
Well-established standard behavioral therapy (SBT) for weight management can reliably help people lose weight in the short term and maintain some of that loss over time. However, powerful internal and external cues work to erode those outcomes as time passes. A person is fighting both their own physiology and an environment that promotes weight gain.
ABT provides tools for coping with those cues by teaching self-regulation skills. These include a skill for tolerating the discomfort of hunger, cravings, and negative emotions. A commitment to clearly defined values is a key tool. Holding those values in mind in key moments of decision making can be quite helpful for coping with negative cues.
Long-Term Follow-Up of the Mind Your Health Project
In 2016, Evan Foreman and colleagues reported one-year results for their randomized trial of ABT versus SBT. The findings were impressive, but a key question remained. Does ABT produce lasting benefits? The present study follows up on that report and finds evidence that those benefits can last.
After three years, people receiving ABT were twice as likely to maintain a weight loss of 10 percent or more. On top of that, they reported a significantly higher quality of life.
Now this is not magic. Just as with any other tool for weight management, the benefits fade a bit over time. But they seem to be fading less with ABT than with the standard approach.
Forget the Buzz and Go with the Evidence
You can find any number of sketchy health coaches serving up their services with a buzz about mindfulness. (Of course, you can also find well-qualified and highly professional health coaches, too.) Buzz is no substitute for a real, certified practitioner with skills for delivering behavioral therapy broadly and ABT specifically.
One place to look for this is in a multi-specialty weight management clinic. In these clinics you will find a board-certified obesity medicine physician along with RDNs and perhaps other health professionals. These might be PAs, NPs, clinical psychologists, exercise physiologists, or other clinical counselors.
We now have more evidence that ABT can offer lasting benefits for health and wellness. To enjoy those benefits, look for real professionals with a focus on long term health – not short-term weight loss.
Click here for the latest study by Foreman et al and here for more on the study from Healio. For an excellent review of ABT, click here.
Acceptance, photograph © Matt / flickr
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March 19, 2019
March 18, 2019 at 8:15 am, Traci said:
“Focusing on long-term health- not short-term weight loss.” So, does that mean focusing on long-term health, not long-term weight loss, is also the best direction? The evidence supports weight loss in the short-term, however, much beyond 2-5 years the evidence is slim.
Helping our clients learn self-regulation skills to manage emotions and navigate environmental cues for the purpose of making positive health decisions sounds very reasonable. However, teaching skills to tolerate the discomfort of hunger sounds like a completely different issue. That sounds like a strategy to solely influence weight, and one that would leave a person very physically and emotionally uncomfortable, stressed, and vulnerable. Tolerating hunger in the short-term is possible, we see that with dieting all the time. Long-term hunger suppression is the reason why rebound over-eating/binge eating occur. This is a very powerful physiological function rooted in survival of the human body.
March 18, 2019 at 8:55 am, Ted said:
Traci, I understand what you’re saying. And I think my words are clear enough. Health is more important than weight. But weight isn’t irrelevant. Most important, though, is the simple fact that one size does not fit all. The needs of a person with binge eating disorder are very different from a person with obesity with different etiologies.
Thanks for sharing your views.
March 18, 2019 at 9:26 am, David Brown said:
“Well-established standard behavioral therapy (SBT) for weight management can reliably help people lose weight in the short term and maintain some of that loss over time. However, powerful internal and external cues work to erode those outcomes as time passes. A person is fighting both his own physiology and an environment that promotes weight gain. Acceptance-based therapy (ABT) provides tools for coping with those cues by teaching self-regulation skills. These include a skill for tolerating the discomfort of hunger, cravings, and negative emotions.”
I suppose teaching self-regulation skills can benefit people who are overweight simply because they are inclined to overeat. However, for the vast majority, it makes more sense to address the physiological problems and environmental factors that caused the global obesity epidemic in the first place.
In my opinion, standard dietary advice (SDA) is currently based on sloppy experimental protocols (SEP), questionable statistical models (QSM), and widely accepted assumptions (WAA).
On a personal note, I detest acronyms. I’m constantly reading scientific papers. So, constantly having to memorize new acronyms is annoying. That said, I can generally tolerate one or two acronyms if the usage is standardized. Unfortunately, in lipid science that is not the case. Both LA and LNA can refer to linoleic acid. Likewise, both AA and ARA can refer to arachidonic acid.
That said, I’m going to explain why I believe standard dietary advice is based on sloppy experimental protocols.
Annadie Krygsman has written a book chapter in which she exposes problems in murine experimental protocols. Excerpt: “The rising incidence of childhood obesity and T2D, high blood pressure, hyperinsulinemia and dyslipidemia are particularly worrisome as these children often mature to be obese adults.This risk of developing obesity and T2D has largely been blamed on the increased consumption of energy dense foods and fat intake, particularly saturated fat, but it is interesting to know that the mean fat intake of the human population has not increased much in the past 50 years.It is true that the vast advancement in technological developments has led to a reduction in physical activity worldwide, but as obesity now involves infants and the populations of developing countries, this obesity pandemic cannot be attributed to this alone.In addition, laboratory and other domesticated animals have also been subject to the increased prevalence of obesity, despite having largely unchanged living conditions for many years.”
Regarding the widely accepted assumption that saturated fat is a dietary villein Krygsman says, “It is especially dietary saturated fat acid (SFA) consumption that has been thought to lead to the elevation of these blood factors which are highly indicative of CHD risk. Most recently, through meta-analyses of large international studies, the consumption of SFA has been de-vilified and the causal link between these parameters and CHD disproven.” https://www.intechopen.com/books/glucose-tolerance/importance-of-dietary-fatty-acid-profile-and-experimental-conditions-in-the-obese-insulin-resistant-
Ah, but American Heart Association affiliated scientists and the United States Government continue to vilify saturated fats as if nothing has changed. In a 2016 article, T.Colin Campbell expressed his disapproval of questionable statistical models and unproven assumptions. “The evidence that saturated fat is a major cause of heart disease, and possibly certain cancers, arises primarily from studies showing a high correlation between saturated fat-laden diets with more heart disease. This is a classic case where correlation does not necessarily mean causation, a serious misinterpretation. Blindly accepting saturated fat as the causation of heart disease was a mistake. It is not biologically plausible, and this relationship should have been questioned.” https://nutritionstudies.org/plant-oils-are-not-a-healthy-alternative-to-saturated-fat/
As for a biologically plausible explanation for heart disease and obesity, German scientist Olaf Adam came up with one back in 1992. Excerpt from his review paper: “In Western communities, e.g., Germany, the consumption of meat and meat products has increased fourfold within the past 50 years, leading to the same increase in arachidonic acid (AA) uptake. Interestingly, during this time period the incidence of fatal coronary events also showed a fourfold increase. Epidemiologic observations in Greenland Eskimos and other populations with a traditionally high intake of fish rich in n-3 fatty acids have shown a low incidence of cardiovascular and the other diseases observed with increasing frequency in Western communities. The examination of their plasma fatty acids revealed a very low percentage of AA, which is only about 20% of that found in members of Western communities. The known augmented intake of AA in Western populations, together with the described metabolic properties of AA, favours the view of a pathogenetic role of dietary AA in the manifestations of these diseases. Further studies are needed to elucidate the role of increased AA consumption in Western communities for the manifestation of atherosclerosis, neoplasms, arthritis, psoriasis, and inflammatory bowel disease.” https://link.springer.com/article/10.1007/BF00180737
In other research, Dr. Adam has shown therapeutic benefit with reduced arachidonic acid intake. For example:
Conclusion: A diet low in arachidonic acid ameliorates clinical signs of inflammation in patients with rheumatoid arthritis and augments the beneficial effect of fish oil supplementation. https://www.ncbi.nlm.nih.gov/pubmed/12548439
In other research: “Subjects with greater adipose tissue arachidonic acid content had an increasing risk of the metabolic syndrome across quintiles: odds ratio (95% confidence interval), after adjustment for age, gender and area of residence. Further adjustment for metabolic risk factors, including adipose fatty acids and body mass index, did not significantly modify the result. Adipose tissue arachidonic acid was also independently associated with abdominal obesity, hypertriglyceridemia, elevated fasting glucose, and high blood pressure.”
Conclusions: “This study identifies arachidonic acid as an important independent marker of metabolic dysregulation. A better understanding of the role of this fatty acid in the pathogenesis of the metabolic syndrome is warranted. ” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2730166/
So, yes, the American Heart Association recommendation to reduce meat intake makes sense, but not because of the saturated fat content.
March 18, 2019 at 1:26 pm, Angela Golden said:
Thanks for this. I use ABT in my practice. And just as a reminder Nurse Practitioners may also be in obesity practices and we can be certified by SCOPE and OMA (no board certification for us quite yet) thus providing good evidenced based care and often with multiple disciplines.
Respectfully submitted, Angie