title: Teaching Intuitive Eating and Acceptance and Commitment Therapy Skills Via a Web-Based Intervention: A Pilot Single-Arm Intervention Study.
abstract: BACKGROUND
  Middle-aged women are at risk of weight gain and associated comorbidities. Deliberate restriction of food intake (dieting) produces short-term weight loss but is largely unsuccessful for long-term weight management. Two promising approaches for the prevention of weight gain are intuitive eating (ie, eating in accordance with hunger and satiety signals) and the development of greater psychological flexibility (ie, the aim of acceptance and commitment therapy [ACT]).
  
  
  OBJECTIVE
  This pilot study investigated the usage, acceptability, and feasibility of "Mind, Body, Food," a Web-based weight gain prevention intervention prototype that teaches intuitive eating and psychological flexibility skills.
  
  
  METHODS
  Participants were 40 overweight women (mean age 44.8 [standard deviation, SD, 3.06] years, mean body mass index [BMI] 32.9 [SD 6.01] kg/m2, mean Intuitive Eating Scale [IES-1] total score 53.4 [SD 7.46], classified as below average) who were recruited from the general population in Dunedin, New Zealand. Module completion and study site metrics were assessed using Google Analytics. Use of an online self-monitoring tool was determined by entries saved to a secure online database. Intervention acceptability was assessed postintervention. BMI, intuitive eating, binge eating, psychological flexibility, and general mental and physical health were assessed pre- and postintervention and 3-months postintervention.
  
  
  RESULTS
  Of the 40 women enrolled in the study, 12 (30%) completed all 12 modules (median 7.5 [interquartile range, IQR, 2-12] modules) and 4 (10%) used the self-monitoring tool for all 14 weeks of the intervention period (median 3 [IQR 1-9] weeks). Among 26 women who completed postintervention assessments, most women rated "Mind, Body, Food" as useful (20/26, 77%), easy to use (17/25, 68%) and liked the intervention (22/25, 88%). From pre- to postintervention, there were statistically significant within-group increases in intuitive eating (IES-2 total score P<.001; all IES-2 subscale scores: P ≤.01), psychological flexibility (P=.01), and general mental health (P<.001) as well as significant decreases in binge eating (P=.01). At the 3-month follow-up, IES-2 improvements were maintained, and there were further improvements in binge eating (P<.001) and general mental health (P=.03), and a marginal yet nonsignificant tendency for further improvement in psychological flexibility (P=.06). There were no significant within-group changes in BMI from pre- to postintervention and postintervention to 3-month follow-up (P=.46 and P=.93, respectively).
  
  
  CONCLUSIONS
  The "Mind, Body, Food" prototype Web-based intervention is appealing to middle-aged women and may be a useful tool to help women learn intuitive eating and ACT skills, reduce binge eating, and maintain weight over 3 months. Further work to improve the user experience and engagement is required before testing the online intervention in a randomized controlled trial.
authors.affiliation: Department of Human Nutrition, University of Otago, Dunedin, New Zealand.
authors.forename: Sara
authors.identifier: http://orcid.org/0000-0002-8358-881X
authors.initials: S
authors.lastname: Boucher
authors.forename: Olivia
authors.identifier: http://orcid.org/0000-0002-0186-1131
authors.initials: O
authors.lastname: Edwards
authors.forename: Andrew
authors.identifier: http://orcid.org/0000-0003-4299-2194
authors.initials: A
authors.lastname: Gray
authors.forename: Shyamala
authors.identifier: http://orcid.org/0000-0001-5743-4107
authors.initials: S
authors.lastname: Nada-Raja
authors.forename: Jason
authors.identifier: http://orcid.org/0000-0002-0884-8730
authors.initials: J
authors.lastname: Lillis
authors.forename: Tracy L
authors.identifier: http://orcid.org/0000-0002-4994-1309
authors.initials: TL
authors.lastname: Tylka
authors.forename: Caroline C
authors.identifier: http://orcid.org/0000-0002-7045-832X
authors.initials: CC
authors.lastname: Horwath
keywords: BMI; Web-based intervention; acceptance and commitment therapy; intuitive eating; middle-aged women; obesity; overweight; prevention