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% 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.

Abnormal liver function tests in patients with Type 1 diabetes mellitus: prevalence, clinical correlations and underlying pathologies.

AIMS: To determine the prevalence of elevated alanine transaminase (ALT) in a large cohort of patients with Type 1 diabetes and to examine the clinical correlations and causes. Methods Patients with Type 1 diabetes mellitus were prospectively recruited and ALT, glycated haemoglobin and lipid profile were measured. Patients with Type 2 diabetes mellitus were recruited as a comparison group. PATIENTS: with abnormal ALT were investigated for underlying causes. Prevalence of abnormal ALT was analysed at three separate cut-offs and multivariable analysis used to identify independent risk factors. RESULTS: Nine hundred and eleven with Type 1 diabetes and 963 with Type 2 diabetes were included. The prevalence of elevated ALT was dependent on the cut-off value: > 30 IU/l in males and > 19 IU/l in females, > 50 and > 63 IU/l was 34.5, 4.3 and 1.9%, respectively, in Type 1 diabetes and 51.4, 8.2 and 3.7%, respectively, in Type 2 diabetes. In Type 1 diabetes an elevated ALT was associated with worse glycaemic control, age > 55 years and elevated triglycerides. Investigation of these patients revealed a cause in 43.6% of patients, predominantly non-alcoholic fatty liver disease (NAFLD). CONCLUSIONS: Elevated ALT is not uncommon in Type 1 diabetes and is associated with NAFLD-related risk factors. Patients with Type 1 diabetes and elevated ALT should be investigated as significant abnormalities may be found which are amenable to interventions.