A Pilot Randomized Controlled Trial of an Acceptance- Based Therapy Intervention for Adolescent Girls

Background: Acceptance-based therapy (ABT) is a behavioral intervention that is effective for weight loss in adults. Among adolescents, ABT is effective for conditions like chronic pain and anorexia and has been deemed feasible and acceptable for adolescent weight loss. Assessing the potential effectiveness of ABT for adolescent weight loss is warranted. This pilot randomized controlled trial (RCT) assessed the effects of an adolescent tailored ABT intervention on weight, quality of life (QOL), psychological flexibility, and depression. Methods: In a 6-month trial, participants were randomized to the ABT intervention, consisting of fifteen, 90-minute virtual group sessions, or the enhanced care group, where they received 15 healthy lifestyle handouts and met with a dietitian twice. Participants in the intervention group were encouraged to self-monitor food, physical activity, psychosocial factors, and weight. Results: There were a total of 40 participants, (n=20) in the intervention group and (n=20) in the enhanced care group. The mean age was 15.8 ± 1.5 and the mean baseline BMI was 33.7 ± 6.7 kg/m2. Most participants (77.5%) identified as White. There were small effects observed in psychological flexibility (d= -0.3, 95% CI: (-0.6, -0.1)) and the 95th BMI percentile (d= -0.2, 95% CI: (-0.4, -0.02)) in the intervention group. In both groups, there were no effects in change scores observed in healthy eating index, quality of life, depression, perceived stress, or anxiety sensitivity. There was no evidence of an intervention effect between groups. Conclusions: In this pilot RCT, ABT was not more effective for weight loss than enhanced care. Given that all previous ABT weight studies were conducted in-person, and this study was conducted virtually during COVID, future research is needed to explore the potential effectiveness of ABT among adolescents in-person and how virtual studies can be optimized.

Wellness Achieved through Changing Habits: A Randomized Controlled Trial of an Acceptance-Based Intervention for Adolescent Girls with Overweight or Obesity.

Background: Obesity prevalence among adolescent girls continues to rise. Acceptance-based therapy (ABT) is effective for weight loss in adults and feasible and acceptable for weight loss among adolescents. This pilot randomized controlled trial (RCT) assessed effectiveness of an adolescent-tailored ABT intervention on decreasing weight-related outcomes and improving psychological outcomes compared with enhanced care. Methods: In this 6-month, two-arm pilot RCT, participants were randomized to the ABT intervention or to enhanced care. The ABT intervention condition attended 15 virtual, 90-minute group sessions. The enhanced care comparison received 15 healthy lifestyle handouts and virtually met twice with a registered dietitian. The primary outcome assessed was change in BMI expressed as a percentage of the 95th percentile (%BMIp95). Results: Participants included 40 girls (ages 14-19) assigned to ABT (n = 20) or enhanced care (n = 20). A decrease in %BMIp95 was observed within the ABT intervention [d = -0.19, 95% confidence interval, CI: (-0.36 to -0.02)], however, not within the enhanced care comparison [d = -0.01, 95% CI: (-0.09 to 0.07)]. The ABT group showed slight changes in psychological flexibility [d = -0.34, 95% CI: (-0.62 to -0.06)] over enhanced care [d = -0.11, 95% CI: (-0.58 to 0.37)]. There was no significant intervention effect noted between groups. Conclusion: In this pilot RCT, the ABT intervention was as effective as enhanced care for weight loss. However, previous ABT studies occurred in person, and this study was conducted virtually due to COVID-19. Thus, future research investigating the potential effectiveness of ABT in-person among adolescents and optimization of virtual interventions is needed.

The Reward Re-Training protocol: A novel intervention approach designed to alter the reward imbalance contributing to binge eating during COVID-19.

Reduced exposure to social reward during the COVID-19 pandemic may result in both reduced reward response to day-to-day life activities and elevated reward response to substances or naturally rewarding stimuli (e.g., food). The combined hypo- and hyper-reward responses results in a reward imbalance, which has been noted as a relevant maintenance factor for eating disorders (EDs) characterized by binge eating. This registered report describes the protocol for a pilot randomized controlled trial (RCT) comparing supportive therapy to a novel treatment targeting reward imbalance (Reward Re-Training; RRT) for individuals with binge eating. Aims of the current study include to confirm feasibility and acceptability of RRT, to evaluate the ability of RRT to engage critical targets, and to provide preliminary estimates of efficacy in reducing ED symptoms at both posttreatment and 3-month follow-up. Sixty participants will be randomized to either RRT or supportive therapy. For both conditions, treatment will be delivered in 10 weekly group outpatient therapy sessions conducted remotely using videoconferencing software. Assessments will be conducted at baseline, mid-treatment, posttreatment, and 3-month follow-up to measure feasibility, acceptability, critical treatment targets (i.e., reward to day-to-day life activities, reward to palatable foods, social isolation, and loneliness), and ED symptoms.

COVID-19 Impacts Mental Health Outcomes and Ability/Desire to Participate in Research Among Current Research Participants.

OBJECTIVE: This study aimed to examine the impact of coronavirus disease 2019 (COVID-19) on current research participants' mental health outcomes, ability to adhere to behavioral intervention recommendations, and desire to participate in research. METHODS: A quantitative/qualitative cross-sectional survey was used among adults currently enrolled in health-related research (N = 250; 85% women; > 50% currently enrolled in behavioral weight loss intervention). RESULTS: COVID-19 was perceived as a severe threat by most (62.3%). Related to COVID-19, 29.6% of participants reported moderate/severe symptoms of anxiety/depression, and 68.4% reported moderate/severe posttraumatic stress disorder (PTSD) symptomatology, with women more likely to demonstrate moderate/severe anxiety/depression (P = 0.047) and PTSD symptomatology (P = 0.028) relative to men. Those with moderate/severe levels of anxiety/depression (P = 0.0154) and distress (P = 0.0330) were more likely to report a decreased desire to participate in research. Among those in behavioral interventions, individuals perceiving COVID-19 as a moderate/severe threat or experiencing moderate/severe depression or PTSD symptomatology were 4 to 19 times more likely to report that COVID-19 affected their ability to adhere to behavioral recommendations. Qualitative analysis identified four themes describing COVID-19's impact on research experiences: transition, remote intervention delivery, ability to adhere to program goals, and research participation interest. CONCLUSIONS: These data suggest that participants engaged in health-related research perceive COVID-19 as a significant threat, affecting mental health, desire to participate in research, and ability to adhere to intervention recommendations.