Stress and Eating Study

Approximately two-thirds of all adults and close to 75% of Veterans are overweight or obese,
making obesity a national epidemic with significant impairments in physical and
psychological functioning, increasing healthcare costs, and high mortality rates. A
significant proportion of overweight and obese individuals binge eat in response to stress
or negative emotions, further contributing to obesity. Obesity and binge eating are
independently related to a number of physical and mental health co-morbidities such as
diabetes, coronary heart disease, osteoarthritis, respiratory symptoms, depression, and
anxiety. Although behavioral weight loss interventions have been partially effective, few
show long-term maintenance of weight loss, especially for patients with binge eating
behavior. Thus, a stepped-care approach that provides more intensive treatment to
specifically address the emotional and behavioral factors associated with problematic eating
and obesity may be necessary. Acceptance and Commitment Therapy (ACT), an
empirically-supported intervention that is being rolled out nationally by the VA, has been
effective in reducing distress, increasing quality of life, and improving other indices of
health in a wide range of conditions from depression to diabetes. The investigator's
preliminary findings suggest that a brief ACT-based group intervention for patients with
overweight or obesity can substantially reduce binge eating and distress, and improve
functioning. This study proposes to test the efficacy of an ACT intervention for binge
eating in conjunction with a standard behavioral weight loss intervention, Managing
Overweight and/or Obesity for Veterans Everywhere (MOVE!), at the VA San Diego Healthcare
System (VASDHS). Patients (N = 154) who are overweight or obese (body mass index > 25 kg/m2)
and meet the clinical criteria for binge eating will be randomized to receive either four
2-hour weekly ACT intervention groups or brief MOVE-II active control groups after their
participation in MOVE!. This study hypothesizes that: 1) patients in the ACT intervention
will experience significantly greater reductions in binge eating severity than patients in
the brief MOVE-II active control group (primary outcome); 2) patients in the ACT
intervention will experience significantly greater improvements in physical and mental
health functioning, obesity-related quality of life, physical activity levels, caloric and
nutrient intake, emotional distress symptoms, binge frequency, and other forms of emotional
eating than patients in the brief MOVE-II active control group; 3) gains associated with the
ACT intervention will be maintained longer than gains associated with the brief MOVE-II
active control group; 4) at 3-month and 6-month follow-ups, patients in the ACT intervention
will have greater decreases in body mass index compared to patients in the brief MOVE-II
active control group; and 5) measures of acceptance and action will mediate treatment
response in the ACT intervention on outcomes of interest. Given the significant physical and
psychological sequelae of binge eating and obesity, a brief intervention that can reduce
disordered eating, enhance the maintenance of weight loss, and improve functioning among
patients who suffer from binge eating, could be critical in the comprehensive approach to
patient care at the VA.

Inclusion Criteria:

- Diagnosis of overweight or obesity (i.e., BMI > 25 kg/m2), as verified by a study
physician after a medical evaluation and examination of medical records;

- Attendance of at least 60% of weight loss sessions of the MOVE! program (i.e., 5 of 8
sessions).

- At least 18 years old

Exclusion Criteria:

- Serious or unstable medical or psychiatric illness (i.e., current unmanaged
psychosis, manic episode, anorexia nervosa, bulimia nervosa, or substance abuse
within the past year) or psychosocial instability (e.g., homelessness) that could
compromise study participation;

- Conditions in which exercise or weight loss will be detrimental to one's health
(e.g., pregnancy);

- Active suicidal ideation or history of suicide attempt within 5 years;

- Pharmacotherapy for obesity (e.g., Orlistat or Meridia) or bariatric surgery within
the past 6 months or planning to start such treatments in the next 6 months;

- Current participation in group or individual psychotherapy for weight management or
binge eating;

- Previous treatment with ACT;

- Unwillingness to agree not to change professionally delivered mood treatments and
psychotherapy (e.g., begin new therapy or group; discontinue a treatment; increase
the dose of medication) for the duration of 4-week study treatment period unless
medically necessary.