Treatments for women with obesity, depression, and body image concerns are not optimal. Weight loss programs lead to long-term weight gain for most participants, and even successful participants typically sustain only modest weight loss. Psychotherapy for depression is more effective, but as many as 50 % do not fully remit. When depression and obesity co-occur in women, outcomes are even more modest. Innovative treatments are needed to enhance the physical and mental health of obese, depressed women. The goal of the current paper is to describe the development of a treatment that integrates two innovative approaches for mental and physical self-acceptance. The Health at Every Size (HAES) paradigm, used to enhance physical health without encouraging weight loss, causes improvements in physical health among overweight participants that are longer-lasting than weight loss programs. Acceptance and Commitment Therapy (ACT) focuses on valued life behaviors and acceptance of painful emotions. ACT is efficacious for depression and as an adjunct to obesity treatment, and may be more effective for treatment-resistant depression than standard approaches. An integrated HAES/ACT treatment, known as Accept Yourself! and its manual is described in this paper, with information about how we adapted HAES and ACT approaches to create the intervention, as well as clinical strategies for implementation.
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Ahmad, M. W. (2008, May 10). Guest post: 28 days to a bikini mind. Shapely prose. Retrieved from http://kateharding.net/2008/05/20/guest-post-28-days-to-a-bikini-mind/
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Association for Contextual Behavioral Science. (2011). Social work and ACT special interest group. Retrieved from https://contextualscience.org/Social_Work_ACT_SIG
Bacon, L. (2008). Health at every size. Dallas: BenBella Books.
Bacon, L., & Aphramor, L. (2011). Weight science: Evaluating the evidence for a paradigm shift. Nutrition Journal, 10(9), 2–13.
Bacon, L., & Matz, J. (2010). Intuitive eating: Enjoy your food, respect your body. Diabetes Self-Management, 27(6), 44–51.
Brownell, K., Puhl, R., Schwartz, M., & Rudd, L. (Eds.). (2005). Weight bias: Nature, consequences and remedies. New York: The Guilford Press.
Bruno, B. A. (1996). Worth your weight: What you can do about a weight problem. London: Routledge Books.
Burgard, D. (2011a). Doorhangers. Retrieved from http://www.bodypositive.com/doorhangers.htm
Burgard, D. (2011b). Gratitude for this body: A meditation. Retrieved from http://www.bodypositive.com/meditation_g.htm
Carr, D., & Friedman, M. A. (2005). Is obesity stigmatizing? Body weight, perceived discrimination, and psychological well-being in the United States. Journal of Health and Social Behavior, 46(3), 244–259.
Center for Spirituality and Healing [UMNCSH]. (2010, December 22). Chair yoga (video file). Retrieved from https://www.youtube.com/watch?feature=player_embedded&v=6mi_2LMJFdo&list=PL2BDBE9A4EE79CA28
Chastain, R. (Producer). (2012a). Every body dance now beginner’s class: Love to love you by Candye Kane (video file). United States: Producer.
Chastain, R. (Producer). (2012b). Every body dance now beginner’s class: Smoke and leather by Darci Monet (video file). United States: Producer.
Clark, M. M., Niaura, R., King, T. K., & Pera, V. (1996). Depression, smoking, activity level, and health status: Pretreatment predictors of attrition in obesity treatment. Addictive Behaviors, 21(4), 509–513.
Durso, L. E., & Latner, J. D. (2008). Understanding self-directed stigma: Development of the Weight Bias Internalization Scale. Obesity, 16(S2), S80–S86.
Ellis, A. (1961). The folklore of sex. NYC: Grove Press.
Fitzgibbon, M. L., Stolley, M. R., & Kirschenbaum, D. S. (1993). Obese people who seek treatment have different characteristics than those who do not seek treatment. Health Psychology, 12(5), 342.
Forman, E. M., Shaw, J. A., Goetter, E. M., Herbert, J. D., Park, J. A., & Yuen, E. K. (2012). Long-term follow-up of a randomized controlled trial comparing acceptance and commitment therapy and standard cognitive behavior therapy for anxiety and depression. Behavior Therapy, 43(4), 801–811.
Friedman, M. A., & Brownell, K. D. (1995). Psychological correlates of obesity: Moving to the next research generation. Psychological Bulletin, 117(1), 3–20.
Friedman, K. E., Reichmann, S. K., Costanzo, P. R., & Musante, G. J. (2002). Body image partially mediates the relationship between obesity and psychological distress. Obesity Research, 10(1), 33–41.
Goldsmith, S. J., Anger-Friedfeld, K., Rudolph, D., Boeck, M., & Aronne, L. (1992). Psychiatric illness in patients presenting for obesity treatment. International Journal of Eating Disorders, 12(1), 63–71.
Gracia, J. A., Martínez, M., Elia, M., Aguilella, V., Royo, P., Jiménez, A., et al. (2009). Obesity surgery results depending on technique performed: Long-term outcome. Obesity Surgery, 19(4), 432–438.
Harding, K. (2008, June 22). If no one mentions it, it doesn’t exist! Shapely prose. Retrieved from http://kateharding.net/2008/06/22/if-no-one-mentions-it-it-doesnt-exist/
Harding, K. (2009, April 10). Bachelorettes, bathing suits, etc. Shapely prose. Retrieved from http://kateharding.net/2009/04/10/bachelorettes-bathing-suits-etc/
Harding, K., & Kirby, M. (2009). Lessons from the fat-o-sphere: Quit dieting and declare a truce with your body. NYC: Penguin Perigee.
Hayes, S. C., Levin, M. E., Plumb-Vilardaga, J., Villatte, J. L., & Pistorello, J. (2013). Acceptance and commitment therapy and contextual behavioral science: Examining the progress of a distinctive model of behavioral and cognitive therapy. Behavior Therapy, 44(2), 180–198.
Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change. NYC: Guilford Press.
Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and commitment therapy (2nd ed.). NYC: Guilford Press.
Heffner, M., & Eifert, G. H. (2004). The anorexia workbook: How to accept yourself, heal your suffering, and reclaim your life. Oakland: New Harbinger.
Herrin, M. (2013). Herrin food plan. Retrieved from http://www.eatingdisorderguides.com/HerrinFoodPlan.2013.pdf
Holtzheimer, P. E., & Mayberg, H. S. (2011). Stuck in a rut: Rethinking depression and its treatment. Trends in Neurosciences, 34(1), 1–9.
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 593.
Kinzel, L. (2010, January 28). Q&A: On dressing femme, being a bad fat, and changing the FA blogosphere. Two whole cakes. Retrieved from http://blog.twowholecakes.com/2010/01/q-a-on-dressing-femme-being-a-bad-fat-and-changing-the-fa-blogosphere/
Kornfield, J. (1994). Buddha’s little instruction book. New York: Bantam.
Lawrence, S. A., Hazlett, R., & Abel, E. M. (2012). Obesity related stigma as a form of oppression: Implications for social work education. Social Work Education, 31, 63–74.
Lillis, J., Hayes, S., Bunting, K., & Masuda, A. (2009). Teaching acceptance and mindfulness to improve the lives of the obese: A preliminary test of a theoretical model. Annals of Behavioral Medicine, 37, 58–69.
Linde, J. A., Simon, G. E., Ludman, E. J., Ichikawa, L. E., Operskalski, B. H., Arterburn, D., et al. (2011). A randomized controlled trial of behavioral weight loss treatment versus combined weight loss/depression treatment among women with comorbid obesity and depression. Annals of Behavioral Medicine, 41(1), 119–130.
Linehan, M. (1993). Skills training manual for treating borderline personality disorder. New York: Guilford Press.
Mann, T., Tomiyama, A. J., Westling, E., Lew, A. M., Samuels, B., & Chatman, J. (2007). Medicare’s search for effective obesity treatments: Diets are not the answer. American Psychologist, 62(3), 220–233.
Markanday, S., Data-Franco, J., Dyson, L., Murrant, S., Arbuckle, C., McGillvray, J., & Berk, M. (2012). Acceptance and commitment therapy for treatment-resistant depression. Australian and New Zealand Journal of Psychiatry, 46(12), 1198–1199.
Markowitz, S., Friedman, M. A., & Arent, S. M. (2008). Understanding the relation between obesity and depression: Causal mechanisms and implications for treatment. Clinical Psychology: Science and Practice, 15(1), 1–20.
Matz, J., & Frankel, E. (2004). Beyond a shadow of a diet: The therapist’s guide to treating compulsive eating disorders. New York: Routledge.
McGuire, M. T., Wing, R. R., Klem, M. L., Lang, W., & Hill, J. O. (1999). What predicts weight regain in a group of successful weight losers? Journal of Consulting and Clinical Psychology, 67(2), 177–185.
Media Education Foundation (ChallengingMedia). (2012, August 24). Killing us softly 4: Advertising’s image of women (trailer). Retrieved from https://www.youtube.com/watch?v=jWKXit_3rpQ&feature=iv&src_vid=PTlmho_RovY&annotation_id=annotation_493134379
Montgomery, K. L., Kim, J. S., & Franklin, C. (2011). Acceptance and commitment therapy for psychological and physiological illnesses: A systematic review for social workers. Health and Social Work, 36(3), 169–181.
My Body Gallery. (2015). My body gallery. Retrieved from http://www.mybodygallery.com/
Neumark-Sztainer, D., Wall, M., Guo, J., Story, M., Haines, J., & Eisenberg, M. (2006). Obesity, disordered eating, and eating disorders in a longitudinal study of adolescents: How do dieters fare 5 years later? Journal of the American Dietetic Association, 106(4), 559–568.
Ogden, C. L., Carroll, M. D., Kit, B. K., Flegal, K. M. (2012). Prevalence of obesity in the United States, 2009–2010. NCHS data brief, no. 82. Hyattsville, MD: National Center for Health Statistics.
Pagoto, S., Bodenlos, J. S., Kantor, L., Gitkind, M., Curtin, C., & Ma, Y. (2007). Association of major depression and binge eating disorder with weight loss in a clinical setting. Obesity, 15(11), 2557–2559.
Pagoto, S., Schneider, K. L., Whited, M. C., Oleski, J. L., Merriam, P., Appelhans, B., et al. (2013). Randomized controlled trial of behavioral treatment for comorbid obesity and depression in women: The Be Active Trial. International Journal of Obesity, 37(11), 1427–1434.
Pausch, R. (2008). The last lecture. New York: Hyperion.
Pearl, R. L., White, M. A., & Grilo, C. M. (2014). Weight bias internalization, depression, and self-reported health among overweight binge eating disorder patients. Obesity, 22(5), E142–E148.
Pugh, S. (Producer). (2011). Grateful spirit yoga: Expanding into fullness (DVD). United States: Producer.
Puhl, R. M., & Heuer, C. A. (2010). Obesity stigma: Important considerations for public health. American Journal of Public Health, 100(6), 1019–1028.
Richardson, L. P., Davis, R., Poulton, R., McCauley, E., Moffitt, T. E., Caspi, A., & Connell, F. (2003). A longitudinal evaluation of adolescent depression and adult obesity. Archives of Pediatrics and Adolescent Medicine, 157(8), 739–745.
Roberts, R. E., Deleger, S., Strawbridge, W. J., & Kaplan, G. A. (2003). Prospective association between obesity and depression: Evidence from the Alameda County Study. International Journal of Obesity, 27(4), 514–521.
Ross, C. E. (1994). Overweight and depression. Journal of Health and Social Behavior, 35, 63–79.
Rucker, D., Padwal, R., Li, S. K., Curioni, C., & Lau, D. C. (2007). Long term pharmacotherapy for obesity and overweight: updated meta-analysis. BMJ, 335, 1194–1199.
Sattyr, E. (2015). What is normal eating? Retrieved from http://ellynsatterinstitute.org/hte/whatisnormaleating.php
Schwartz, M. B., & Brownell, K. D. (2004). Obesity and body image. Body Image, 1(1), 43–56.
Simon, G. E., Ludman, E. J., Linde, J. A., Operskalski, B. H., Ichikawa, L., et al. (2008). Association between obesity and depression in middle-aged women. General Hospital Psychiatry, 30(1), 32–39.
Stice, E., Cameron, R. P., Killen, J. D., Hayward, C., & Taylor, C. B. (1999). Naturalistic weight-reduction efforts prospectively predict growth in relative weight and onset of obesity among female adolescents. Journal of Consulting and Clinical Psychology, 67(6), 967.
Zettle, R. D. (2011). The evolution of a contextual approach to therapy: From comprehensive distancing to ACT. International Journal of Behavioral Consultation and Therapy, 7(1), 76.
This research was supported in part by a Grant from the Geisel School of Medicine Department of Psychiatry.
Conflict of interest
The authors declare that they have no conflict of interest
All procedures performed in this study were in accordance with the ethical standards of our institutional review board and with the 1964 Helsinki declaration and its amendments or comparable ethical standards.
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Berman, M.I., Morton, S.N. & Hegel, M.T. Health at Every Size and Acceptance and Commitment Therapy for Obese, Depressed Women: Treatment Development and Clinical Application. Clin Soc Work J 44, 265–278 (2016). https://doi.org/10.1007/s10615-015-0565-y
- Health at every size
- Acceptance and commitment therapy