If Diets Don’t Work, Then What? An Acceptance and Commitment Therapy (ACT) Approach to Weight Management Via Wellbeing: A Pilot Study.

Abstract Currently there is a worldwide overweight and obesity epidemic. As a consequence, there is a predominance of obesity-related health problems and an associated reduced quality of life (World Health Organization (WHO), 2014). Research over the past 50 years has repeatedly presented a pessimistic view that most dieters will regain the weight they have lost and subsequently gain further weight following a calorie-restrictive weight loss program (Wing & Hill, 2001). It is now recognised that obesity is a complex problem that is influenced by genetic predisposition, hormonal and metabolic factors (Bell, Walley, & Froguel, 2005), and environmental influences such as the ready availability of energy-dense food coupled with sedentary lifestyle (Ahima & Antwi, 2008; Flier, 2004). Therefore innovative approaches to improve weight loss and maintenance behavioural treatments for obesity are urgently required (Forman, Butryn, Hoffman, & Herbert, 2009). In view of the current worldwide overweight and obesity epidemic and the high rate of weight maintenance failure, it has been suggested that psychological aspects of weight loss and weight maintenance failure should be explored in greater detail (Byrne, 2002). The aim of this thesis was three-fold: (a) to explore perceptions of why diets might fail from the perspective of both health professionals, and first-year university students participating in focus groups; (b) to deliver and evaluate a pilot study of a brief Acceptance and Commitment Therapy (ACT) based intervention (The Weight Escape) for participants who were either concerned about weight-related issues, seeking a different approach to weight management, or seeking to improve wellbeing; and (c) to explore participants’ experiences of the ACT-based intervention and their ongoing use of the materials. This thesis consists of three studies: study 1 was a qualitative study that is presented in two sections: (a) health professionals’ individual interviews, and (b) feedback from focus groups. The participants of study 1 were explicitly prompted for their opinions regarding weight loss failure and an ACT-based approach. The information gathered from the individual health professional interviews and the focus group discussions provided different perspectives of the psychological impact of overweight and obesity. The feedback from the participants of study 1 was both insightful and valuable, and added to a greater understanding of the difficulties associated with weight loss failure on individuals, and the challenges of assisting individuals with these weight loss failure experiences. Study 1 also provided direction for the second part of this research as both the health professionals and the focus group participants generally offered support for a program that promotes weight management and wellbeing through valued living strategies (based on ACT) for people seeking a different approach to weight management. Study 2 was a quantitative pilot study that employed a within-subjects repeated measures design with the impact of the intervention assessed at three time points: pre-intervention (T1), post intervention (T2), and follow-up (T3). The study was conducted to determine whether an ACT-based intervention program that targeted lifestyle behaviours would increase participants’ self-perception of wellbeing two weeks post intervention, and over the period of three months follow-up. The results of study 2 demonstrated change over time in the anticipated direction after participation in the ACT-based program (The Weight Escape). The measures of wellbeing in which positive change occurred were mindful attention, body acceptance, valued living, self-compassion, satisfaction with life, and flourishing. In the subsidiary analyzes, change in the anticipated direction was also found with worry about weight, and worry about weight hindering participation in valued life activities. Study 3 was an evaluation of the intervention workshop and the materials used. This study is presented in two sections: (a) brief participant evaluations, and (b) a series of three case studies. Overall, the participants reported that they liked the program, they thought the program was relevant, and they appreciated the focus on something other than weight and weight loss. Although the in-depth interviews were variable as to the perceived usefulness and versatility of the program, in general, the evaluations were still generally positive and promising