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      Characteristics of adults with overweight/obesity and high internal disinhibition: do they fit with targets for acceptance‐based interventions?

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          Summary

          Objective

          Adults with overweight/obesity reporting high levels of internal disinhibition (ID) tend to do poorly in standard behavioural weight loss programmes. The current study sought to compare a sample of individuals with overweight/obesity selected on the basis of high ID with an unselected treatment‐seeking sample of adults with overweight/obesity on characteristics that might make acceptance‐based treatments particularly appropriate for those with high ID.

          Methods

          Sample 1 included 162 treatment‐seeking adults with overweight/obesity who were selected for high ID; sample 2 included 194 unselected treatment‐seeking adults with overweight/obesity. First, the two samples were compared on levels of general and weight‐related experiential avoidance, and values‐consistent behaviour, both of which are targeted in acceptance‐based treatments, and on other general psychological characteristics. Next, the unselected sample was split into two groups, those meeting criteria for high ( N = 105; sample 2/high ID) vs. low ( N = 89; sample 2/low ID) ID, and the three groups were compared on the same characteristics.

          Results

          Sample 1 reported higher levels of both general and weight‐related experiential avoidance as well as less values‐consistent behaviour than sample 2. They reported greater psychological impairment in quality of life, depression and anxiety. Within sample 2, 54% met the criteria for high ID. Both sample 1 and sample 2/high ID reported higher levels of experiential avoidance and less values‐consistent behaviour than did the sample 2/low ID. The two high ID samples also reported greater psychological impairment in quality of life, depression and anxiety than sample 2/low ID.

          Conclusions

          Adults with overweight/obesity who report high levels of ID were characterized by higher levels of experiential avoidance, lower levels of values‐consistent behaviour, and more psychosocial impairment as compared with other adults with overweight/obesity. As these are important targets of acceptance‐based approaches, this subgroup may benefit from the integration of such approaches into behavioural weight loss programmes.

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          Most cited references16

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          The three-factor eating questionnaire to measure dietary restraint, disinhibition and hunger.

          This report describes the construction of a questionnaire to measure three dimensions of human eating behavior. The first step was a collation of items from two existing questionnaires that measure the related concepts of 'restrained eating' and 'latent obesity', to which were added items newly written to elucidate these concepts. This version was administered to several populations selected to include persons who exhibited the spectrum from extreme dietary restraint to extreme lack of restraint. The resulting responses were factor analyzed and the resulting factor structure was used to revise the questionnaire. This process was then repeated: administration of the revised questionnaire to groups representing extremes of dietary restraint, factor analysis of the results and questionnaire revision. Three stable factors emerged: (1) 'cognitive restraint of eating', (2) 'disinhibition' and (3) 'hunger'. The new 51-item questionnaire measuring these factors is presented.
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            Disinhibition: its effects on appetite and weight regulation.

            Over the past 30 years, the understanding of eating behaviour has been dominated by the concept of dietary restraint. However, the development of the Three Factor Eating Questionnaire introduced two other factors, Disinhibition and Hunger, which have not received as much recognition in the literature. The objective of this review was to explore the relationship of the Disinhibition factor with weight regulation, food choice and eating disorders, and to consider its aetiology. The review indicates that Disinhibition is an important eating behaviour trait. It is associated not only with a higher body mass index and obesity, but also with mediating variables, such as less healthful food choices, which contribute to overweight/obesity and poorer health. Disinhibition is also implicated in eating disorders and contributes to eating disorder severity. It has been demonstrated that Disinhibition is predictive of poorer success at weight loss, and of weight regain after weight loss regimes and is associated with lower self-esteem, low physical activity and poor psychological health. Disinhibition therefore emerges as an important and dynamic trait, with influences that go beyond eating behaviour and incorporate other behaviours which contribute to weight regulation and obesity. The characteristics of Disinhibition itself therefore reflect many components representative of a thrifty type of physiology. We propose that the trait of Disinhibition be more appropriately renamed as 'opportunistic eating' or 'thrifty behaviour'.
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              The Mind Your Health Project: A Randomized Controlled Trial of an Innovative Behavioral Treatment for Obesity

              Objective To determine whether acceptance-based behavioral treatment (ABT) would result in greater weight loss than standard behavioral treatment (SBT), and whether treatment effects were moderated by interventionist expertise or participants’ susceptibility to eating cues. Recent research suggests that poor long-term weight control outcomes are due to lapses in adherence to weight control behaviors, and that adherence might be improved by enhancing SBT with acceptance-based behavioral strategies. Design and Methods Overweight participants (n = 128) were randomly assigned to 40 weeks of SBT or ABT. Results Both groups produced significant weight loss and, when administered by experts, weight loss was significantly higher in ABT than SBT at post-treatment (13.17% v. 7.54%) and 6-month follow-up (10.98% v. 4.83%). Moreover, 64% of those receiving ABT from experts (v. 46% for SBT) maintained at least a 10% weight loss by follow-up. Moderation analyses revealed a powerful advantage, at follow-up, of ABT over SBT in those potentially more susceptible to eating cues. For participants with greater baseline depression symptomology, weight loss at follow-up was 11.18% in ABT vs. 4.63% in SBT; other comparisons were 10.51% vs. 6.00% (emotional eating), 8.29% v. 6.35% (disinhibition) and 9.70% v. 4.46% (responsivity to food cues). Mediation analyses produced partial support for theorized food-related psychological acceptance as a mechanism of action. Conclusions Results offer strong support for the incorporation of acceptance-based skills into behavioral weight loss treatments, particularly among those with greater levels of depression, responsivity to the food environment, disinhibition and emotional eating, and especially when interventions are provided by weight control experts. Trial Registration clinical trials.gov identifier: NCT00746265
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                Author and article information

                Contributors
                niemeieh@uww.edu
                Journal
                Obes Sci Pract
                Obes Sci Pract
                10.1002/(ISSN)2055-2238
                OSP4
                Obesity Science & Practice
                John Wiley and Sons Inc. (Hoboken )
                2055-2238
                14 March 2017
                September 2017
                : 3
                : 3 ( doiID: 10.1002/osp4.v3.3 )
                : 311-318
                Affiliations
                [ 1 ] Department of Psychology University of Wisconsin–Whitewater Whitewater WI USA
                [ 2 ] Department of Psychiatry and Human Behavior Alpert Medical School of Brown University, Weight Control and Diabetes Research Center of The Miriam Hospital Providence RI USA
                Author notes
                [*] [* ]Address for correspondence: HM Niemeier, PhD, Department of Psychology, University of Wisconsin–Whitewater, 800 W. Main St., Whitewater, WI 53190, USA. E‐mail: niemeieh@ 123456uww.edu
                Article
                OSP493 OSP4-2016-08-0053.R1
                10.1002/osp4.93
                5598016
                29071107
                4ca52519-ac25-4cc5-8aef-6a21c0df873c
                © 2016 The Authors. Obesity Science & Practice published by John Wiley & Sons Ltd, World Obesity and The Obesity Society.

                This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                : 20 August 2016
                : 21 November 2016
                : 22 November 2016
                Page count
                Figures: 0, Tables: 3, Pages: 8, Words: 3958
                Funding
                Funded by: National Institute of Diabetes and Digestive and Kidney Diseases
                Award ID: #R01DK087704
                Categories
                Short Communication
                Short Communication
                Custom metadata
                2.0
                osp493
                September 2017
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.1.9 mode:remove_FC converted:14.09.2017

                acceptance‐based treatment,behavioural weight loss,internal disinhibition,obesity

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