Experiences of emotional eating in an Acceptance and Commitment Therapy based weight management intervention (SWiM): A qualitative study.
Appetite 2023 ; 193: 107138.
Kudlek L, Jones RA, Hughes C, Duschinsky R, Hill A, Richards R, Thompson M, Vincent A, Griffin SJ, Ahern AL
DOI : 10.1016/j.appet.2023.107138
PubMed ID : 38016600
PMCID :
URL : https://linkinghub.elsevier.com/retrieve/pii/S0195666323026004
Abstract
Emotional eating is a barrier to weight management. Interventions based on Acceptance and Commitment Therapy (ACT) promote the acceptance of uncomfortable feelings, which can reduce the urge to use food as a coping mechanism. We aimed to explore how participants of an ACT-based weight management intervention (WMI) experience emotional eating and relevant intervention content.
We conducted semi-structured telephone interviews with participants of a digital ACT-based guided self-help WMI. Fifteen participants were purposefully selected to represent a range of demographic characteristics and emotional eating scores. We used reflexive thematic analysis to explore experiences of emotional eating.
We generated five themes. Participants improved emotional eating by disconnecting emotions from behaviours though increased self-awareness (theme 1) and by implementing alternative coping strategies, including preparation, substitution, and acceptance (theme 2). Most participants maintained improvements in emotional eating over time but wished for more opportunities to re-engage with intervention content, including more immediate support in triggering situations (theme 3). Participants who struggled to engage with emotional eating related intervention content often displayed an external locus of control over emotional eating triggers (theme 4). The perceived usefulness of the intervention depended on participants' prior experiences of emotional eating, and was thought insufficient for participants with complex emotional experiences (theme 5).
This ACT-based WMI helped participants with emotional eating by improving self-awareness and teaching alternative coping strategies. Intervention developers may consider adding ongoing forms of intervention that provide both real-time and long-term support. Additionally, a better understanding of how to support people with an external locus of control and people with complex experiences of emotional eating is needed. Future research may explore ways of personalising WMIs based on participants' emotional needs.
Lay Summary
What are we studying? People tend to lose weight after weight management programmes, but maintaining the weight loss is difficult. Many people think this is because they tend to eat more in response to negative emotions (i.e. emotional eating). Unlike many weight management programs, those based on Acceptance and Commitment Therapy specifically aim to help with emotional eating. These programmes focus on teaching people how to recognise and accept difficult thoughts and feelings, such as food cravings. However, we know very little about people’s experiences of emotional eating during such weight management programmes. To explore this, we interviewed 15 participants from an online Acceptance and Commitment Therapy -based weight loss maintenance programme and asked them about how it influenced their emotional eating.
What did we find? We found that people felt the programme helped them with their emotional eating by improving their self-awareness and by teaching them strategies that help them to deal with negative emotions in other ways. However, people wanted more ongoing support with emotional eating, particularly in those moments where they felt strong negative emotions. Additionally, participants who felt they had little control over triggers of negative emotions reported that they struggled to engage with the programme. Lastly, we found that whether or not participants found the programme helpful depended on their previous experience and management of emotional eating. Importantly, participants with complex experiences of emotional eating, such as those connected to a traumatic past, reported needing more in-depth support.
Why does it matter? These conclusions can help researchers and health care practitioners improve the way they address emotional eating in future weight management interventions. For example, they might think of ways to better support people with complex emotional experiences and people feeling out of control over triggers of emotions. Additionally, they might include ongoing help with emotional eating.