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Cited by 182Mindfulness and Compassion InterventionsEating Disorders and BehaviorsObesity, Physical Activity, Diet

The mind your health project: a randomized controlled trial of an innovative behavioral treatment for obesity

Open access
Forman, E.M., Butryn, M.L., Juarascio, A.S., Bradley, L.E., Lowe, M.R., Herbert, J.D., Shaw, J.A.·2013·Obesity
DOI 10.1002/oby.20169PMC PMC3735809
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Abstract

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% vs. 7.54%) and 6-month follow-up (10.98% vs. 4.83%). Moreover, 64% of those receiving ABT from experts (vs. 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 versus 4.63% in SBT; other comparisons were 10.51% versus 6.00% (emotional eating), 8.29% versus 6.35% (disinhibition), and 9.70% versus 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.

AI snapshot

Written from the paper’s full text.

TL;DR

This randomized trial tested whether acceptance-based behavioral treatment (ABT) outperformed standard behavioral treatment (SBT) for weight loss over 40 weeks and at 6-month follow-up. ABT was not superior overall, but it produced substantially greater weight loss when delivered by weight-control experts and among participants with greater depression, emotional eating, disinhibition, or food-cue responsivity.

Key findings

  • Across the full sample, ABT and SBT did not differ significantly: ABT lost 10.90% versus SBT 8.74% at post-treatment, and 9.16% versus 7.36% at follow-up.
  • With expert interventionists, ABT produced greater loss than SBT at post-treatment (13.17% vs. 7.54%) and follow-up (10.98% vs. 4.83%); 64% of expert-delivered ABT participants maintained at least 10% loss by follow-up versus 46% for SBT.
  • Moderation analyses showed larger ABT advantages at follow-up among those with higher baseline depression (11.18% vs. 4.63%), emotional eating (10.51% vs. 6.00%), disinhibition (8.29% vs. 6.35%), and food-cue responsivity (9.70% vs. 4.46%).
  • Mediation was not supported overall, but moderated mediation appeared for food-related psychological acceptance among participants high in emotional eating at 40 weeks and 6 months.

Methods

  • Overweight/obese adults (n = 128; BMI 27–40 kg/m²; ages 21–65) were randomized to 40 weeks of SBT or ABT, with 30 group sessions (weekly for weeks 1–20, biweekly for weeks 21–40).
  • ABT added acceptance, commitment, mindfulness, defusion, and urge-surfing strategies; SBT used standard cognitive-behavioral weight-control components. Interventionists were either novice doctoral students or expert clinical psychologists.
  • Assessments occurred at baseline, 10, 20, and 40 weeks, and 6-month follow-up. Main analyses used ANOVAs controlling for baseline weight, with intent-to-treat and completer analyses, plus moderation and bootstrapped mediation tests.

Limitations

  • The authors note that the 6-month follow-up was too short to assess long-term maintenance, mediator variables relied on self-report, novice interventionists may have limited findings, and fidelity was monitored but not formally rated.
  • The text also makes evident that expert status was confounded with greater clinical experience, and the randomized groups were unequal (74 ABT vs. 54 SBT), which may affect interpretation.
  • The sample was predominantly Caucasian (62.3%), which may limit generalizability.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1002/oby.20169

Cites

42 of 42 references verified0 citation errors · 0 not checkable

Statistics

13 tests recomputed · 0 with the reported and recomputed p on opposite sides of .05

Claims the paper makes

0 of 42 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Among expert-led groups, 64% of acceptance-based treatment participants maintained at least 10% weight loss by follow-up, versus 46% of standard behavioral treatment participants.

    “Moreover, 64% of those receiving ABT from experts (v. 46% for SBT) maintained at least a 10% weight loss by follow-up.”
    Quote in the paperSubstantial claim
  • Findingown data

    For emotional eating, follow-up weight loss was 10.51% with acceptance-based treatment and 6.00% with standard behavioral treatment.

    “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).”
    Quote in the paperSubstantial claim
  • Findingown data

    For participants with higher baseline depression symptoms, follow-up weight loss was 11.18% with acceptance-based treatment and 4.63% with standard behavioral treatment.

    “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).”
    Quote in the paperSubstantial claim
  • Findingown data

    For disinhibition, follow-up weight loss was 8.29% with acceptance-based treatment and 6.35% with standard behavioral treatment.

    “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).”
    Quote in the paperSubstantial claim
  • Findingown data

    Moderation analyses indicated that acceptance-based treatment had a strong advantage over standard behavioral treatment at follow-up among participants with greater susceptibility to eating cues.

    “Moderation analyses revealed a powerful advantage, at follow-up, of ABT over SBT in those potentially more susceptible to eating cues.”
    Quote in the paperSubstantial claim
  • May combine two claims. 33
  • The quote only partly states this claim. 1
  • Classified as probably not a substantial claim. 21

  • May combine two claims.

    Findingown data

    Both the standard behavioral treatment and the acceptance-based behavioral treatment groups achieved significant weight loss.

    “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%).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In the full ITT sample, mood disturbance and susceptibility to the food environment significantly moderated the effect of treatment group on weight loss, with trends for emotional eating and disinhibition.

    “Examining the full intent-to-treat sample, the effect of treatment group on weight loss was significantly moderated by mood disturbance and susceptibility to the food environment, and showed a trend towards significance for emotional eating and disinhibition (Table 2).”
    Quote in the paperSubstantial claim

  • May combine two claims. The quote only partly states this claim.

    Findingown data

    Among participants with higher emotional eating, higher disinhibition, or higher susceptibility to the food environment, ABT showed greater weight loss than SBT at follow-up.

    “Amongst those with higher emotional eating, higher disinhibition, and higher susceptibility to the food environment the pattern was similar (Table 3, Figure 3).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    64% of participants receiving expert-delivered ABT maintained at least 10% weight loss by follow-up, compared with 46% receiving SBT.

    “In terms of clinical significance, 64% of those receiving ABT from experts maintained at least a 10% weight loss by follow-up, whereas this figure was 46% for those receiving SBT.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Quality of life improved significantly over the course of treatment, but improvements did not differ between conditions.

    “Results revealed a strong main effect for time (F(2,97)=29.56, p<.001, ηp2=.23) but no interaction effect (F(2,97)=0.25, p=.61, ηp2=.003), suggesting that while QoL did improve significantly during the course of treatment, the improvements were similar across condition.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Among completers, average weight loss was 13.29% by post-treatment and 11.06% by follow-up.

    “For completers (NABT=50, NSBT=37), weight loss was 13.29± 7.10% (95% CI: 12.58, 13.98) by post-treatment and 11.06±7.67% (95%CI: 10.26, 11.86) by follow-up.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    A total of 128 participants were randomized, with 74 assigned to ABT and 54 to SBT.

    “A total of 128 individuals provided written consent, completed baseline assessments, and were randomized to ABT or SBT using a 5 ABT groups (total n = 74) to 4 SBT groups (n = 54) split.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Across both conditions, participants lost an average of 10.17% of body weight by post-treatment and 8.16% by follow-up.

    “Overall, participants experienced a 10.17±8.36% (95% CI: 9.27, 11.07) weight loss by post-treatment and an 8.16±8.57% (95% CI: 7.46, 8.86) weight loss by follow-up.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Both ABT and SBT participants reported high satisfaction and helpfulness ratings.

    “On a 1 (lowest) to 5 (highest) rating scale, ABT participants demonstrated high satisfaction (M = 4.50±.69; and helpfulness ratings (M = 4.50±.74), as did SBT participants (Msatisfaction = 4.29±1.03; Mhelpfulness = 4.21±1.16).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    The sample was predominantly Caucasian, with a mean age of about 45.7 years and a mean starting BMI of about 34.1 kg/m2.

    “The sample was primarily Caucasian (62.3%; African American: 24.6%; Asian: 1.6%; Hispanic: 3.8%) with a mean age of 45.69 ± 12.81 years and mean starting BMI of 34.10 ± 3.64 kg/m2.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Among completers treated by experts, ABT produced greater weight loss than SBT at post-treatment (16.09% vs 11.76%, p=.06) and at follow-up (13.52% vs 5.78%, p<.05).

    “This pattern repeated among those who completed the treatment, with ABT demonstrating a 16.09±8.45% post-treatment weight loss (95% CI: 12.49, 19.69) versus 11.76±5.46% for SBT (95% CI: 9.26, 14.26; F(1,39)=3.65, p=.06, ηp2=.08); at follow-up ABT demonstrated a 13.52±8.39% weight loss (95% CI: 9.94, 17.10) versus 5.78±6.07% for SBT (95% CI: 4.94, 11.34; F(1,39)=4.57, p<.05, ηp2=.10).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    The PFS has adequate internal and test-retest reliability and convergent and discriminant validity.

    “The PFS has adequate internal and test-retest reliability and convergent and discriminant validity.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [30] Lowe, 2009, The power of food scale. A new measure of the psychological influence of the food environment, Appetite source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Acceptance-based strategies are central to third-generation behavior therapies such as Dialectical Behavior Therapy, Marlatt's Relapse Prevention Model, and Acceptance and Commitment Therapy.

    “Acceptance-based strategies are a key feature of several novel, “third generation” behavior therapies such as Dialectical Behavior Therapy,9 Marlatt’s Relapse Prevention Model10 and Acceptance and Commitment Therapy (ACT).11”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [9] Linehan, 1993

      Not checked in the free run.

    • cites [10] Marlatt, 1984, Relapse prevention: introduction and overview of the model, Br J Addict source

      Not checked in the free run.

    • cites [11] Hayes, 1999

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    A difference in long-term results between two similar RCTs of ABT for emotional disorders could conceivably be attributed to differences in therapist expertise.

    “In fact, a difference in long-term results between two similar randomized controlled trials of ABT for emotional disorders could conceivably be attributed to differences in the expertise of the therapists.23,24”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [23] Arch, 2012, Randomized Clinical Trial of Cognitive Behavioral Therapy (CBT) Versus Acceptance and Commitment Therapy (ACT) for Mixed Anxiety Disorders, J Consult Clini Psychol source

      Not checked in the free run.

    • cites [24] Forman, 2012, Using session-by-session measurement to compare mechanisms of action for acceptance and commitment therapy and cognitive therapy, Behav Ther source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Mindful awareness and metacognitive understanding of decision-making likely decrease mindless eating and increase behavioral adherence.

    “Mindful awareness and a better “metacognitive” understanding of our decision-making processes are also likely to result in decreased “mindless” eating13 and increased behavioral adherence.14”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [13] Wansink, 2006

      Not checked in the free run.

    • cites [14] Metcalfe, 1999, A hot/cool-system analysis of delay of gratification: dynamics of willpower, Psychol Rev source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In a randomized workshop study, 84 self-selected weight loss participants assigned to a 1-day ACT workshop continued to lose weight at 3 months while waitlist controls regained weight.

    “In one, 84 individuals in a self-selected weight loss program (e.g., Weight Watchers) were randomized to a 1-day ACT workshop or to a waitlist control. At 3-months follow-up, waitlisted participants regained weight while those in the ACT condition continued to lose weight.18”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [18] Lillis, 2009, Teaching acceptance and mindfulness to improve the lives of the obese: a preliminary test of a theoretical model, Ann Behav Med source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationnone given

    Synthesizing sophisticated acceptance-based psychological and behavioral principles might require particularly sophisticated clinical skills.

    “The ability to synthesize sophisticated acceptance-based psychological and behavioral principles might require particularly sophisticated clinical skills.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Cognitive-behavioral weight control interventions require knowledge of nutritional, behavioral, cognitive, and motivational principles.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    More cognitive work by a dieting individual is associated with more disinhibition of eating, suggesting cognitively intensive strategies may reduce self-regulation.

    “Moreover, empirical work suggests that the more cognitive “work” (e.g., solving puzzles) in which a dieting individual engages, the more disinhibition of eating occurs, raising the possibility that cognitively-intensive strategies may reduce self-regulation rather than enhance it.8”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [8] Ward, 2000, Don't mind if I do: disinhibited eating under cognitive load, J Pers Soc Psychol source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Interventionists administered both ABT and SBT groups, and assignment was balanced by expertise level.

    “Interventionists administered ABT and SBT groups, and assignment was balanced by expertise level.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premiseown data

    In the authors' pilot study, 19 overweight women assigned to a 12-session acceptance-based intervention showed robust weight loss at post-intervention and 6-month follow-up (8.1% and 10.3%).

    “In our own pilot study, we assigned 19 overweight women to a 12-session acceptance-based intervention and observed robust weight loss at post-intervention and a 6-month follow-up (8.1% and a 10.3%).21”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [21] Forman, 2009, An open trial of an acceptance-based behavioral treatment for weight loss, Cogn Behav Pract source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In another workshop study, 62 women randomized to four 2-hour ACT workshops showed increases in physical activity and decreases in BMI at 6 months relative to controls, at least when nonparticipating participants were excluded.

    “In another workshop study, 62 women were randomized to four 2-hour ACT workshops or to a control condition. At 6 months, ACT participants, relative to control, showed increases in PA and decreases in BMI, at least when nonparticipating participants were excluded.19”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [19] Tapper, 2009, Exploratory randomised controlled trial of a mindfulness-based weight loss intervention for women, Appetite source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    When ABT is manualized, expert status may be less critical.

    “On the other hand, when ABT is employed as a manualized treatment, expert status may be less critical.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    People who fully adhere to standard behavioral obesity regimens achieve large weight losses and little weight regain.

    “Those who fully adhere to these regimens experience large weight losses and minimal weight regain.1”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [1] Klem, 1997, A descriptive study of individuals successful at long-term maintenance of substantial weight loss, Am J Clin Nutr source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Most participants in behavioral weight loss treatments regain significant weight within one year and substantial or full weight within five years.

    “Moreover, most experience significant weight regain within a year and substantial, if not full, regain within 5 years.4”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [4] Butryn, 2011, Behavioral treatment of obesity, Psychiatr Clin North Am source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The QOLI has good internal consistency, test-retest reliability, and convergent, discriminant, and criterion-related validity.

    “The QOLI has good internal consistency, test-retest reliability, and convergent, discriminant, and criterion-related validity.29”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [29] Frisch, 1992, Clinical validation of the quality of life Inventory, Psychol Assess source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Weight was measured with a standardized Seca scale accurate to 0.1 kg.

    “Weight was measured with the participant in street clothes (without shoes) using a standardized Seca scale accurate to 0.1 kg.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Participants in behavioral treatments on average do not maintain prescribed calorie and physical activity levels and lose less weight than expected from those prescriptions.

    “Yet, participants in behavioral treatments, on average, fall far short of maintaining prescribed calorie and PA levels, and lose far less weight than would be expected given these prescriptions.2,3”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [2] Brownell, 1987, Improving long-term weight loss: pushing the limits of treatment, Behav Ther source

      Not checked in the free run.

    • cites [3] Wilson, 1994, Behavioral treatment of obesity: thirty years and counting, Adv Behav Res Ther source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    The results support adding acceptance-based skills to behavioral weight loss treatments, especially for people with greater depression, responsivity to the food environment, disinhibition, and emotional eating, and especially when weight control experts deliver the intervention.

    “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.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Standard programs teach direct control over thoughts or feelings, which can be ineffective or paradoxically increase distressing internal experiences.

    “Moreover, existing programs teach participants to exert direct control over the content of thoughts or feelings (e.g. distraction-based strategies), which can be ineffective or even have the paradoxical effect of increasing distressing internal experiences.6”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [6] Abramowitz, 2001, Paradoxical effects of thought suppression: a meta-analysis of controlled studies, Clin Psychol Rev source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductown data

    Participants were randomly assigned to SBT or ABT using computer-based random allocation with blocking by baseline BMI.

    “Participants were assigned to SBT or ABT via computer-based random allocation, with blocking by baseline BMI.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Acceptance-based strategies aim to foster willingness to experience aversive internal experiences while promoting behavior consistent with goals and values, rather than reducing the frequency of aversive experiences.

    “The goal of acceptance-based strategies is not to reduce the frequency of aversive experiences; rather, the aim is to foster willingness to experience potentially aversive internal experiences while simultaneously promoting behavior that is consistent with desired goals and values.12”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [12] Forman, 2009

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Sample size, number of groups, and total number of waves were determined by an a priori power analysis.

    “Sample size, the number of groups, and total number of waves were determined by an a priori power analysis.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    Using novice interventionists, though it enabled study of expert status, is a limitation.

    “The use of novice interventionists, while allowing an investigation of the impact of expert status, can also be viewed as a limitation.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A prior trial reported that acceptance-based training reduced chocolate intake in a taste test relative to thought suppression.

    “Recently, Hooper and colleagues demonstrated that those who received an acceptance-based intervention consumed less chocolate during a taste test compared to those who received a thought-suppression intervention.17”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [17] Hooper, 2012, Comparing thought suppression and acceptance as coping techniques for food cravings, Eat Behav source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A program tailored to high internal disinhibition yielded large weight loss (12.0 kg) that was maintained at 3 months (12.1 kg).

    “For example, an acceptance-based behavioral program was designed specifically for those with high internal disinhibition and displayed impressive weight loss (12.0 kg) that persisted 3 months after the intervention (12.1 kg).20”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [20] Niemeier, 2012, An acceptance-based behavioral intervention for weight loss: a pilot study, Behav Ther source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The EES is a reliable measure of eating in response to negative mood states.

    “Emotional eating was measured with the Emotional Eating Scale (EES), a reliable measure of eating in response to negative mood states.32”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [32] Arnow, 1995, The Emotional Eating Scale: the development of a measure to assess coping with negative affect by eating, Int J Eat Disord source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    The trial demonstrated acceptability, with high satisfaction and feasibility, in a large overweight/obese sample.

    “We established treatment acceptability, including higher average levels of reported satisfaction and feasibility within a large sample of overweight and obese individuals.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Earlier work found that gains in psychological flexibility and acceptance mediated BMI changes after an acceptance-based workshop.

    “Previous research has also demonstrated that increases in psychological flexibility and acceptance mediate changes in BMI following an acceptance-based workshop.38”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [38] Gifford, 2009, Avoidance and inflexibility as a common clinical pathway in obesity and smoking treatment, J Health Psychol source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The FAAQ has been validated across clinical and normative samples and has adequate convergent and divergent validity and internal consistency.

    “The FAAQ has been validated across clinical and normative samples and has adequate convergent and divergent validity and internal consistency.34”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [34] Juarascio, 2011, The development and validation of the food craving acceptance and action questionnaire (FAAQ), Eat Behav source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductreasoning

    Mediators were self-reported, so they may be biased and constrained by what participants can report.

    “In addition, potentially mediating variables were measured by self-report and were thus subject to bias and limited by participants’ ability to report.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Fidelity was checked via audio review and oversight, but no formal fidelity ratings were collected.

    “Finally, while we attempted to ensure fidelity through the monitoring of audio recordings and close oversight, we have no formal ratings of fidelity.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The Eating Inventory has strong psychometric properties.

    “Disinhibition (i.e., eating in response to cues) was measured with the Eating Inventory (EI), which also has strong psychometric properties.33”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [33] Cappelleri, 2009, Psychometric analysis of the Three-Factor Eating Questionnaire-R21: results from a large diverse sample of obese and non-obese participants, Int J Obes (Lond) source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    Acceptance-based strategies seem especially helpful for people with more depression, more food-environment responsivity, and more susceptibility to eating from cues besides physical hunger.

    “It appears that these strategies would be particularly beneficial for those with greater levels of depression, greater responsivity to the food environment, and greater susceptibility to eating in response to cues other than physical hunger.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The BDI-II has adequate test-retest reliability, high internal consistency, and established convergent validity.

    “The BDI-II has adequate test-retest reliability and high internal consistency, and convergent validity has been established.31”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [31] Steer, 1999, Use of the Beck Depression Inventory for Primary Care to screen for major depression disorders, Gen Hosp Psychiatry source

      Not checked in the free run.

44 of 44

  • The paper relies on this without support.

    The current study is the first randomized controlled trial of a full-scale acceptance-based behavioral treatment for obesity.

    “The current study represents the first randomized controlled trial of a full-scale acceptance-based behavioral treatment (ABT) for obesity.”

  • The paper relies on this without support.

    Cognitive-behavioral weight control interventions require knowledge of nutritional, behavioral, cognitive, and motivational principles.

    “Cognitive-behavioral weight control interventions require knowledge about nutritional, behavioral, cognitive and motivational principles.”

  • The authors state this as an assumption.

    Dropouts in the weight-loss analyses were assumed to have regained 0.3 kg per month.

    “Based on recommendations by Wing et al (2006)35 dropouts were assumed to have regained 0.3 kg per month.”
3 of 3

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Statistics that don’t add up

Each reported p-value recomputed from its test statistic and degrees of freedom.

  • Inconsistent p-value: F(3,124)=5.70, p = .02

    Minor

    The paper reports p = .02 here; recomputing from the test statistic and its degrees of freedom gives p = .001. The check cannot tell whether the statistic or the p-value is the misprint.

    Reported p = .02 · recomputed p = .001

  • p-value fits an unstated one-tailed test: F(1,55)=6.01, p = .01

    Minor

    The paper reports p = .01 here; recomputing from the test statistic and its degrees of freedom gives p = .017. The reported value is what a one-tailed test gives, but the paper does not say near this result that a one-tailed test was used.

    Reported p = .01 · recomputed p = .017

  • Inconsistent p-value: t(126)=−0.93, p = .31

    Minor

    The paper reports p = .31 here; recomputing from the test statistic and its degrees of freedom gives p = .354 (two-tailed). The check cannot tell whether the statistic or the p-value is the misprint.

    Reported p = .31 · recomputed p = .354

  • Inconsistent p-value: F(1,126)=1.35, p = .24

    Minor

    The paper reports p = .24 here; recomputing from the test statistic and its degrees of freedom gives p = .247. The check cannot tell whether the statistic or the p-value is the misprint.

    Reported p = .24 · recomputed p = .247

  • Inconsistent p-value: F(2,97)=0.25, p = .61

    Minor

    The paper reports p = .61 here; recomputing from the test statistic and its degrees of freedom gives p = .779. The check cannot tell whether the statistic or the p-value is the misprint.

    Reported p = .61 · recomputed p = .779

  • Inconsistent p-value: F(1, 88)=.348, p = .54

    Minor

    The paper reports p = .54 here; recomputing from the test statistic and its degrees of freedom gives p = .557. The check cannot tell whether the statistic or the p-value is the misprint.

    Reported p = .54 · recomputed p = .557

6 of 6

Statistics recomputed

Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.

  • Doesn’t add upF(1, 88) = 0.348reported p = .54 · recomputed p = .557

    “F(1, 88)=.348, p = .54”

  • Doesn’t add upt(126) = -0.93reported p = .31 · recomputed p = .354

    “t(126)=−0.93, p = .31”

  • Doesn’t add upF(1, 126) = 1.35reported p = .24 · recomputed p = .247

    “F(1,126)=1.35, p = .24”

  • Doesn’t add upF(3, 124) = 5.7reported p = .02 · recomputed p = .001

    “F(3,124)=5.70, p = .02”

  • Doesn’t add upF(1, 55) = 6.01reported p = .01 · recomputed p = .017

    “F(1,55)=6.01, p = .01”

  • Doesn’t add upF(2, 97) = 0.25reported p = .61 · recomputed p = .779

    “F(2,97)=0.25, p = .61”

  • ConsistentF(1, 88) = 0.47reported p = .5 · recomputed p = .495

    “F(1, 88)=.47, p = .50”

  • ConsistentF(1, 126) = 0.81reported p = .37 · recomputed p = .370

    “F(1,126)=0.81, p = .37”

  • ConsistentF(3, 124) = 5.7reported p < .01 · recomputed p = .001

    “F(3,124)=5.70, p < .01”

  • ConsistentF(1, 55) = 7.73reported p < .01 · recomputed p = .007

    “F(1,55)=7.73, p < .01”

  • ConsistentF(1, 39) = 3.65reported p = .06 · recomputed p = .063

    “F(1,39)=3.65, p = .06”

  • ConsistentF(1, 39) = 4.57reported p < .05 · recomputed p = .039

    “F(1,39)=4.57, p < .05”

  • ConsistentF(2, 97) = 29.56reported p < .001 · recomputed p < .001

    “F(2,97)=29.56, p < .001”

13 of 13

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Discussion adds an unsupported mediation subgroup

    Minor

    The results state that food-related psychological acceptance mediated the treatment advantage only among participants high in emotional eating. The discussion says it also did so among those high in disinhibition.

  • Expert-delivered SBT follow-up confidence interval is off-center

    Minor

    The reported mean is 4.83%, but the midpoint of its stated 95% confidence interval is 4.275%. A conventional confidence interval for this reported mean would be centered on the mean.

    Reported 4.83 · recomputed 4.275

  • SBT completer follow-up confidence interval is off-center

    Minor

    The stated interval has a midpoint of 8.14%, substantially different from the reported mean of 5.78%.

    Reported 5.78 · recomputed 8.14

3 of 3

Cites

Flagged first, then by citations

Research works printed but not linked: 3

  1. Brownell, 2000, The LEARN program for weight management
  2. Marlatt, 1999, Integrating Spirituality in Treatment, 67
  3. Hayes, 2012, An analytic primer and computational tool for observed variable moderation, mediation, and conditional process modeling, Manuscript submitted for publication.

Cited by

Sorted by citations

Related

Authors
Forman, E. M., Butryn, M. L., Juarascio, A. S., Bradley, L. E., Lowe, M. R., Herbert, J. D., & Shaw, J. A.
Affiliations
  • Drexel University (US)
  • Department of Psychology; Drexel University; 245 N. 15th Street, MS 626 Philadelphia PA 19102 USA
Corresponding author
Forman, E.M.
ORCID
Venue
Obesity
Publisher
Wiley
Published
2013-05-13
Volume
21
Issue
6
Pages
1119-1126
ISSN
1930-7381 (ISSN-L)
DOI
10.1002/oby.20169
PMC
PMC3735809
OpenAlex
W2165795209
Cited by
182
References
42
Citations by year
2026: 4 · 2025: 11 · 2024: 9 · 2023: 13 · 2022: 13 · 2021: 16 · 2020: 14 · 2019: 16 · 2018: 18 · 2017: 19 · 2016: 22 · 2015: 13 · 2014: 10 · 2013: 4
FWCI
18.17
Type
journal article
Language
en
Update notices
erratum (2013-12-06)
Open access
Licence
Locations
  • Obesity (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Diabetes & Digestive & Kidney Diseases (R21DK080430)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
  • Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
Keywords
weight loss, depression, emotional eating, disinhibition, medication adherence, psychological acceptance, overweight
MeSH terms
Adolescent, Adult, Aged, Behavior Therapy, Diet, Double-Blind Method, Feasibility Studies, Female, Follow-Up Studies, Humans, Male, Middle Aged, Motor Activity, Obesity, Quality of Life, Weight Loss, Body Mass Index, Treatment Outcome, Young Adult

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-06.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-06.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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