THE "ACTYOURCHANGE STUDY": PROMOTING A HEALTHY LIFESTYLE IN PATIENTS WITH OBESITY WITH ACCEPTANCE AND COMMITMENT THERAPY

Inserita nel campo della riabilitazione dell'obesità, la presente tesi di dottorato si propone di valutare l'efficacia di un intervento psicologico orientato all'Acceptance and Commitment Therapy nel promuovere l'adozione di uno stile di vita sano e nel migliorare le condizioni psicologiche dei pazienti affetti da obesità, all'interno di un programma di riabilitazione multidisciplinare per la perdita di peso. Il Capitolo 1 della presente tesi fornisce una panoramica della malattia dell'obesità, discutendo la sua prevalenza, le sue principali cause e le sue conseguenze sulla salute fisica e psicologica generale, e presentando le linee guida che informano il trattamento dell'obesità. Il capitolo 2 introduce l'Acceptance and Commitment Therapy (ACT), una delle CBT di terza ondata più promettenti per quanto riguarda l'autoconsapevolezza e l'autoregolazione. Nel capitolo 2 sono stati discussi il quadro teorico alla base dell'ACT e le prove empiriche a sostegno dell'applicazione dell'ACT nel campo del trattamento dell'obesità. Il capitolo 3 e il capitolo 4 hanno fornito i primi due contributi empirici della presente tesi. Assumendo una prospettiva orientata all'ACT, si è cercato di esplorare l'impatto dell'inflessibilità psicologica sull'alimentazione emotiva, sia negli adulti (capitolo 3) sia negli adolescenti (capitolo 4). Tale premessa è stata alla base dei successivi contributi empirici della presente tesi (presentati nei capitoli 5 e 6), entrambi volti a valutare l'effetto di un intervento psicologico orientato all'ACT per soggetti affetti da obesità, frequentanti un programma riabilitativo multidisciplinare per la perdita di peso. Lo studio presentato nel capitolo 5 è stato specificamente finalizzato a valutare il ruolo specifico di ogni sottocomponente del modello di flessibilità psicologica (Openness, Awareness e Engagement), nel promuovere la perdita di peso e il suo mantenimento nel tempo e nel migliorare le condizioni psicologiche in un campione di individui adulti italiani con obesità. Infine, lo studio presentato nel capitolo 6 era specificamente rivolto a valutare gli effetti di un intervento basato sull'ACT aggiunto a un programma multidisciplinare standard di riabilitazione per la perdita di peso in un gruppo di adolescenti con obesità per migliorare le loro condizioni psicologiche.Grounded in the field of obesity rehabilitation, the current PhD thesis is aimed at evaluating the effectiveness of an Acceptance and Commitment Therapy-oriented psychological intervention in promoting the adoption of a healthy lifestyle and improving the psychological conditions of patients with obesity, within a multidisciplinary rehabilitation program for weight loss. Chapter 1 of the current thesis provides an overview of obesity disease, discussing its prevalence, its main causes, and its consequences on general physical and psychological health, and presenting guidelines that inform the treatment of obesity. Chapter 2 introduced Acceptance and Commitment Therapy (ACT), one of the most promising third-wave CBTs in targeting self-awareness and self-regulation. In chapter 2 the theoretical framework underlying ACT as well as empirical evidence to support the application of ACT in the field of obesity treatment have been discussed. Chapter 3 and chapter 4 provided the first two empirical contributions of the current thesis. By assuming an ACT-oriented perspective, they have aimed to explore the impact of psychological inflexibility on emotional eating, both in adults (chapter 3) and adolescents (chapter 4). Such premise was the basis for the subsequent empirical contributions of the current thesis (presented in chapters 5 and 6) both aimed at evaluating the effect of an ACT-oriented psychological intervention for individuals with obesity, attending a multidisciplinary rehabilitation program for weight loss. The study presented in chapter 5 was specifically aimed at assessing the specific role of each subcomponent of the psychological flexibility model (Openness, Awareness, and Engagement), in promoting weight loss and weight loss maintenance over time as well as improving psychological conditions in a sample of Italian adult individuals with obesity. Finally, the study presented in chapter 6 was specifically aimed at assessing the effects of an ACT-based intervention added to a standard multidisciplinary rehabilitation program for weight loss in a group of adolescents with obesity to improve their psychological condition

The Role of Pain Catastrophizing and Pain Acceptance in Performance-Based and Self-Reported Physical Functioning in Individuals with Fibromyalgia and Obesity

Impaired physical functioning is one of the most critical consequences associated with fibromyalgia, especially when there is comorbid obesity. Psychological factors are known to contribute to perceived (i.e., subjective) physical functioning. However, physical function is a multidimensional concept encompassing both subjective and objective functioning. The contribution of psychological factors to performance-based (i.e., objective) functioning is unclear. This study aims to investigate the contribution of pain catastrophizing and pain acceptance to both self-reported and performancebased physical functioning. In this cross-sectional study, 160 participants completed self-report measures of pain catastrophizing, pain acceptance, and pain severity. A self-report measure and a performance-based test were used to assess physical functioning. Higher pain catastrophizing and lower pain acceptance were associated with poorer physical functioning at both self-reported and performance-based levels. Our results are consistent with previous evidence on the association between pain catastrophizing and pain acceptance with self-reported physical functioning. This study contributes to the current literature by providing novel insights into the role of psychological factors in performance-based physical functioning. Multidisciplinary interventions that address pain catastrophizing and pain acceptance are recommended and might be effective to improve both perceived and performance-based functioning in women with FM and obesity

A three-week in-hospital multidisciplinary body weight reduction program exerts beneficial effects on physical and mental health and fatiguability of elderly patients with obesity

IntroductionObesity represents one of the most serious problems of public health affecting elderly populations in an increasingly relevant way. The aim of the current study was to assess the effects of a 3-week in-hospital multidisciplinary body weight reduction program (BWRP) in a sample of elderly patients with obesity on reducing body mass index (BMI), improving fatigue, muscle performance, and psychological well-being.MethodsTwo hundred and thirty-seven consecutive elderly in-patients with obesity (males = 84; females = 153; age range = 65–86 yrs.; mean BMI = 43.7) undergoing a three-week multidisciplinary BWRP participated in the study. Data on BMI, fatiguability (measured with the Fatigue Severity Scale, FSS), muscle performance (evaluated with the Stair Climbing Test, SCT), and psychological well-being (assessed with the Psychological General Well- Being Index, PGWBI) were collected before and after the intervention.ResultsResults showed that BWRP was capable to reduce BMI [F(1.00, 235.00) = 1226.8; p < 0.001; ƞ2 = 0.024], improve perceived fatigue [F(1,234) = 296.80125; p < 0.001; ƞ2 = 0.129], physical performance [F(1.00,158.00) = 119.26; p < 0.001; ƞ2 = 0.026], and enhance psychological well-being [F(1,235) = 169.0; p < 0.001; ƞ2 = 0.103] in both males and females.DiscussionAlthough it will be necessary to demonstrate with further longitudinal studies whether the reported beneficial effects will be maintained over time, the effectiveness of a 3-week BWRP on different aspects involved in determining a level of autonomy and good quality of life of elderly obese patients appears to represent a valid attempt to counteract – at least in part – the unavoidable and progressive disability of these patients

Psychological Considerations for Bariatric Surgery

Obesity management requires a multidisciplinary, integrated treatment composed of medical, nutritional, physical, and psychological interventions. Currently, bariatric surgery is the most suitable treatment available in case of severe obesity, or obesity with comorbid medical conditions. Despite bariatric surgery results in a significant weight loss in most of the cases, a not-inconsiderable portion of patients does not achieve relevant outcomes, in terms of limited weight loss or weight regain due to psychological problems. The pre-operative evaluation of the psychological conditions of the candidates for bariatric interventions and pre/post-surgical psychological support is required in order to achieve the desired post-operative outcomes for a long time. In this chapter, we will elucidate the core components of the psychological assessment of bariatric candidates. Moreover, the main directions for the pre/post-surgery psychological support will be provided

The ACTyourCHANGE in Teens Study Protocol: An Acceptance and Commitment Therapy-Based Intervention for Adolescents with Obesity: A Randomized Controlled Trial

This Randomized Controlled Trial [(RCT) aims to evaluate the effectiveness of a brief Acceptance and Commitment Therapy (ACT)-based intervention combined with treatment as usual (TAU) compared to TAU only in improving psychological conditions in a sample of adolescents with obesity (body mass index, BMI > 97th percentile for age and sex) within the context of a wider multidisciplinary rehabilitation program for weight loss. Fifty consecutive adolescents (12-17 years) of both genders with obesity will be recruited among the patients hospitalized in a clinical center for obesity rehabilitation and randomly allocated into two experimental conditions: ACT + TAU vs. TAU only. Both groups will attend a three-week in-hospital multidisciplinary rehabilitation program for weight loss. The ACT + TAU condition comprises a psychological intervention based on ACT combined with a standard psychological assessment and support to the hospitalization. The TAU comprises the standard psychological assessment and support to the hospitalization. At pre- to post-psychological intervention, participants will complete the Avoidance and Fusion Questionnaire for Youth, the Psychological Well-Being Scale, the Depression Anxiety Stress Scale, the Difficulties in Emotion Regulation Scale, and the Emotional Eating subscale of the Dutch Eating Behavior Questionnaire to assess psychological well-being as the primary outcome and experiential avoidance, psychological distress, emotional dysregulation, and emotional eating as secondary outcomes. Repeated-measures ANOVAs (2 x 2) will be conducted. The study will assess the effectiveness of a brief ACT-based intervention for adolescents with obesity in improving their psychological conditions by targeting specific core processes of the ACT framework (openness, awareness, and engagement). Future directions of the study will assess whether these psychological processes will contribute to addressing long-term weight loss

The ACTyourCHANGE study protocol: promoting a healthy lifestyle in patients with obesity with Acceptance and Commitment Therapy-a randomized controlled trial

BackgroundAs treatment of choice in promoting psychological flexibility, Acceptance and Commitment Therapy (ACT) was found to be effective in several conditions, and among different populations, including weight management in individuals with obesity. However, the mechanism of action of psychological flexibility is less known. The aim of the present study is, within the context of a brief ACT intervention for behavioral change and behavioral maintenance of a healthy lifestyle in a sample of inpatients with obesity, to explore the effect of each subcomponent of the psychological flexibility model on treatment processes and outcomes.MethodsA randomized controlled trial will be conducted. Ninety Italian adult inpatients with obesity attending a rehabilitation program for weight loss will be randomly allocated into three experimental conditions targeting respectively each subcomponent of the psychological flexibility model: group Engage focused on values-oriented behaviors, group Openness focused on acceptance and cognitive defusion, and group Awareness focused on being present and aware of thoughts, feelings, and behaviors at every moment. Weight, BMI (kg/m(2)), the Psychological General Well-Being Inventory (PGWBI), the Outcome Questionnaire-45.2 (OQ-45.2), the Depression Anxiety and Stress Scale (DASS-21), the Difficulties in Emotion Regulation Scale (DERS), the Dutch Eating Behaviors Questionnaire (DEBQ), the Brief Values Inventory (BVI), the Committed Action Questionnaire (CAQ), the Italian-Cognitive Fusion Questionnaire (I-CFQ), the Five Facet Mindfulness Questionnaire (FFMQ), and the Acceptance and Action Questionnaire (AAQ-II) will be assessed at the beginning (time 0), at the end of psychological intervention (time 1), and after 3 (time 2) and 6months (time 3) and 9months (time 4) from discharge. During the following month after discharge, outpatients will be monitored in their adherence to a healthy lifestyle, using a wearable device.To assess the effectiveness of the intervention, mixed between-within 3 (conditions) x4 (times) repeated measure ANOVAs will be conducted to examine changes from time 0 to time 1, 2, 3, and 4 in means of weight, BMI, and means of scores PGWBI, OQ-45.2, DASS, DERS, DEBQ, AAQ-II, BVI, CAQ, I-CFQ, and FFMQ, between three groups.DiscussionThis study will contribute to clarify the mechanism of action of each subcomponent of the psychological flexibility model and understand its impact on the promotion of a healthy lifestyle.Trial registrationClinicalTrials.govNCT04474509. Registered on July 4, 202

Cognitive Fusion and Emotional Eating among Adolescents with Obesity: A Preliminary Cross-Sectional Study

Cognitive fusion and avoidance are supposed to exert a key role in the development and maintenance of disordered eating behaviors related to obesity, such as emotional eating. A large portion of the research has focused on adult populations, while few data are available on adolescents so far. The current cross-sectional study is intended to explore the association between cognitive fusion, avoidance, and emotional eating in a sample of fifty-six Italian adolescents (13–17 years) with obesity (body mass index > 97th centile). For this purpose, participants attending a 3-week body weight reduction program were assessed using demographical, physical, and clinical data. A multivariate linear regression model was performed in order to preliminarily investigate the predictive role of cognitive fusion on emotional eating, controlling for possible confounding factors. Results showed a significant association between cognitive fusion and emotional eating. Regression revealed that cognitive fusion was a significant contributor for explaining emotional eating (controlling for sex) [R2 = 0.551; Adjusted R2 = 0.534; F(2,53) = 32.5; p < 0.001]. Even if preliminary, our findings suggest a predictive role of cognitive fusion on emotional eating, and also suggest that cognitive fusion can be considered a key component in understanding and addressing of disordered eating behaviors related to obesity. Future replications are required to expand the sample and collect longitudinal data. Intervention programs for childhood obesity could benefit from this line of research

A three-week in-hospital multidisciplinary body weight reduction program exerts beneficial effects on physical and mental health and fatiguability of elderly patients with obesity

Introduction: Obesity represents one of the most serious problems of public health affecting elderly populations in an increasingly relevant way. The aim of the current study was to assess the effects of a 3-week in-hospital multidisciplinary body weight reduction program (BWRP) in a sample of elderly patients with obesity on reducing body mass index (BMI), improving fatigue, muscle performance, and psychological well-being. Methods: Two hundred and thirty-seven consecutive elderly in-patients with obesity (males = 84; females = 153; age range = 65–86 yrs.; mean BMI = 43.7) undergoing a three-week multidisciplinary BWRP participated in the study. Data on BMI, fatiguability (measured with the Fatigue Severity Scale, FSS), muscle performance (evaluated with the Stair Climbing Test, SCT), and psychological well-being (assessed with the Psychological General Well- Being Index, PGWBI) were collected before and after the intervention. Results: Results showed that BWRP was capable to reduce BMI [F(1.00, 235.00) = 1226.8; p < 0.001; ƞ2 = 0.024], improve perceived fatigue [F(1,234) = 296.80125; p < 0.001; ƞ2 = 0.129], physical performance [F(1.00,158.00) = 119.26; p < 0.001; ƞ2 = 0.026], and enhance psychological well-being [F(1,235) = 169.0; p < 0.001; ƞ2 = 0.103] in both males and females. Discussion: Although it will be necessary to demonstrate with further longitudinal studies whether the reported beneficial effects will be maintained over time, the effectiveness of a 3-week BWRP on different aspects involved in determining a level of autonomy and good quality of life of elderly obese patients appears to represent a valid attempt to counteract – at least in part – the unavoidable and progressive disability of these patients

Does Kinesiophobia Mediate the Relationship between Pain Intensity and Disability in Individuals with Chronic Low-Back Pain and Obesity?

Individuals suffering from chronic low-back pain and obesity face severe physical and functional limitations. According to the fear-avoidance model, kinesiophobia might play a crucial role in the relationship between pain intensity and disability. Thus, the purpose of this study was to verify the role of kinesiophobia as a mediator in the association between pain intensity and disability in individuals with both chronic low-back pain and obesity. A total of 213 individuals with chronic low-back pain and obesity were included in the study. The level of kinesiophobia, pain intensity and disability were all assessed using self-reported questionnaires. We verified through a simple mediation analysis that kinesiophobia partially mediated the association between pain intensity and disability in our sample. According to our findings, we emphasize the crucial role of kinesiophobia as a psychological factor that should be addressed in chronic low-back pain rehabilitative protocols to reduce disability in individuals with obesity