Weight loss intervention for individuals with high internal disinhibition: design of the Acceptance Based Behavioral Intervention (ABBI) randomized controlled trial

Jason Lillis, Heather M Niemeier, Kathryn M Ross, J Graham Thomas, Tricia Leahey, Jessica Unick, Kathleen E Kendra, Rena R Wing

Obesity is public health problem associated with significant health risks and healthcare costs. Behavioral weight control programs produce clinically meaningful weight losses, however outcomes have high variability and maintenance continues to be a problem. The current study is an NIH-funded randomized clinical trial testing a novel approach, Acceptance-Based Behavioral Intervention (ABBI), that combines techniques from standard behavioral treatment (SBT) and Acceptance and Commitment Therapy (ACT). We test this approach among individuals reporting high internal disinhibition who typically respond poorly to standard interventions and appear to benefit from ACT components. The ABBI study targets recruitment of 160 overweight or obese adults (BMI of 25-50) who report that they overeat in response to negative emotional states. These individuals are randomly assigned to either (1) ABBI or (2) SBT. Both interventions involve weekly meetings for 22 sessions, bi-weekly for 6 sessions, and then monthly for 3 sessions and both receive the same calorie intake target (1200-1800, depending on starting weight), exercise goal (work up to 250 min per week), and self-monitoring skills training. SBT incorporates current best practice interventions for addressing problematic thoughts and emotions, sometimes called "change" or "control" strategies. ABBI uses acceptance-based techniques based on ACT. Full assessments occur at baseline, 6, 12, and 18 months. Weight loss from baseline to 18 months is the primary outcome. The ABBI study is unique in its focus on integrating acceptance-based techniques into a SBT intervention and targeting a group of individuals with problems with emotional overeating who might experience particular benefit from this novel approach. ClinicalTrials.gov, NCT01461421 (registered October 25, 2011).