Aceptación y compromiso versus coaching conductual en un programa nutricional y de actividad física contra el sobrepeso / Acceptance and Commitment Versus Behavioral Coaching in a Nutritional and Physical Activity Program Against to Overweight

RESUMEN

Resumen En los últimos años, Colombia registra un aumento tanto de sobrepeso como de obesidad, aspecto que produce el establecimiento de modelos complejos de intervención que generen cambios de actitud, compromiso en las personas y el mejoramiento de hábitos alimenticios y de actividad física. Este estudio pretendió comparar la efectividad entre dos componentes psicológicos (estrategias conductuales tradicionales y un entrenamiento en aceptación y compromiso), sumados al entrenamiento físico concurrente y la educación nutricional (junto con una dieta hipocalórica), sobre variables antropométricas, la aptitud física, los aspectos de la conducta alimentaria y la sintomatología de salud mental. El diseño de investigación fue de caso único ABA (línea base-intervención-línea base) para cada condición de tratamiento. La muestra estuvo conformada por cinco mujeres y un hombre, entre los 33 y 49 años de edad, con preobesidad y obesidad tipo I, asignados entre los grupos de coaching conductual y entrenamiento en aceptación y compromiso. Los hallazgos muestran un mejoramiento en composición corporal, resistencia aeróbica, fuerza prensil, compromiso y fusión cognitiva frente a situación de alimentación y actividad física en dos participantes de la estrategia de aceptación y compromiso, mientras que hubo mayor variación en los resultados de los participantes de coaching conductual. Este es un pilotaje de un estudio con mayor capacidad de inferencia.

ABSTRACT

Abstract There is an increase in both overweight and obesity in the world, aspect that tends for the approach of integral models of intervention, that generate changes in attitude, and commitment in people towards their eating habits and physical activity, that counteract a sedentary lifestyle and the influence of counterproductive processed foods for energy balance. This study aimed to compare the effectiveness between two psychological components (traditional behavioral strategies and a 6-session acceptance and commitment training), added together, each one a) concurrent physical training (strength/endurance) with bioadaptation process, b) hypocaloric diet and c) Nutritional education. Measurements of anthropometric variables were obtained, physical fitness and mental health symptoms, while the average of steps was measured during the whole process, constituting this part in a single ABA case design for each treatment condition. The sample consisted of five women and one man, between 33 and 49 years of age, with pre-obesity and type I obesity, assigned in a non-random way between the behavioral coaching and acceptance and commitment training groups. In physical training, priority was initially given to the conditional capacity of strength, being an incident in the mobilization of large muscle groups (multi-joint) in order to generate a greater caloric expenditure, directly influencing exercises that optimize postural hygiene by working in the core zone and complementing training with synergistic or accompanying biarticular exercises in the movement of daily physical activities, subsequently the execution of aerobic resistance in search of the increase in the maximum oxygen consumption capacity ( max), ending with the implementation of vital flexibility exercises for physical exercise releasing muscle tension, favoring conditional physical ability. Regarding the intervention of the nutritional component, the most important input to begin to identify eating habits and subsequently modify them was the 24-hour reminder, applying in the first week of the baseline and the reversal phase. The nutritional intervention consisted of (a) education so that participants understood and generated greater adherence to the nutritional proposal and (b) hypocaloric diet, reducing daily intake between 500 and 600 kilocalories per day. A follow-up anthropometric assessment was also carried out towards the third week of the intervention phase to obtain feedback on the incidence of their behavior on the anthropometric variables. Regarding the record of the number of steps, both in the baseline and reversion phases the monitor screens were covered, contrary to the intervention phase, since its observation allows self-monitoring towards the weekly personal goal of steps that was established and accompanied by a professional, who in turn generated a graph with the results of the week and gave feedback to each participant. The findings show an improvement in body composition, aerobic endurance (VO2 max) and grip strength, being the main factor of result in the realization of the physical exercise. Likewise, an increase in the number of steps from the baseline is identified in both groups (X = 9 228.07; S = 1 985.89) to the intervention phase (X = 9 734.22; S = 1 660.86) and a decrease in reversion (X = 9 099.88; S = 2 328.69). In the acceptance and commitment group, no increase in mental health symptoms was identified, increased or sustained cognitive restriction and decreased scores for uncontrolled eating and emotional eating, while there was greater variation in the results of the behavioral coaching participants. This is a pilot of a study with greater capacity for inference.