Promoting Positive Mental Health for Sustainable Eating Behaviors

Obesity Clinical Trial

— PROMISE  

Official title:

Promoting Positive Mental Health for Sustainable Eating Behaviors: the PROMISE Study in Patients With Obesity

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT06416215
• Other study ID #: PROMISE_BO_2024
• Status: Recruiting
• Phase: N/A
• Start date: January 30, 2024
• Est. completion date: December 31, 2024

Study information

• Verified date: May 2024
• Source: University of Bologna
• Contact: Elena Tomba
• Phone: +390512091339
• Email: elena.tomba[@]unibo.it
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The main aim of the present study is to assess the effects and the effectiveness of a psychological intervention based on the principles of well-being therapy (WBT) in promoting weight-loss, sustainable and healthy eating behaviors and an optimal psychological functioning in patients with obesity.

Description:

The primary objective of this pilot study is to assess the effects and the effectiveness, both post-treatment and at 1- and 3-month follow-ups, of a group intervention inspired by the principles of Well-Being Therapy (WBT), combined with a nutritional education, compared to treatment as usual (TAU), namely a Basic Nutritional Intervention (BNI) in a group setting, in terms of weight loss.

The secondary objective is to evaluate the effects and effectiveness of this intervention, both post-treatment and at 1- and 3-month follow-ups, compared to BNI, in promoting healthy and sustainable eating behaviors and an optimal psychological functioning. This includes the promotion of balanced psychological well-being levels and functional eating styles, and the reduction of both psychological distress and dysfunctional justification cognitive mechanisms use.

After being informed about the study and its potential risks, all patients giving written informed consent will be randomly assigned to either the experimental group or the control group. Both groups will participate in five weekly online group sessions of two hours each.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 50
• Est. completion date: December 31, 2024
• Est. primary completion date: December 31, 2024
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

INCLUSION CRITERIA

Patients are included in the study if they:

1. are affiliated with the Clinical Nutrition and Metabolism Unit of Policlinico S. Orsola-Malpighi;

2. have a BMI = 30;

3. are aged = 18 years;

4. voluntarily agree to participate in the study;

5. have access to a computer and can use it independently.

EXCLUSION CRITERIA

Patients are excluded from the study if they:

1. do not sign the informed consent to participate in the study;

2. have limited knowledge of the Italian language;

3. have cognitive deficits;

4. meet the diagnostic criteria for one or more of the following psychiatric diagnoses:

drug and/or alcohol abuse, psychotic disorders, neuro-cognitive disorders, suicidal behaviors;

5. participate in another weight loss study or program;

6. take weight loss medications;

7. engage in individual or group psychotherapeutic interventions;

8. have undergone weight loss surgery in the 16 months preceding the study and during the entire study period (approximately five months);

9. (only women) were/are pregnant or were/are planning pregnancy in the 16 months preceding the study and during the entire study period (approximately five months).

Related Conditions & MeSH terms

• Obesity

Intervention

Other:
• Psychological intervention based on WBT and cognitive restructuring
Participants will engage in 6 weekly group session of two hours. One part will be held by a trained dietician and will focus on nutritional education, particularly emphasizing the adoption of healthy and sustainable eating behaviors. The remaining part will be dedicated to a group psychological intervention inspired by the principles of Well-Being Therapy and will be held by a trained psychologist. During these sessions, participants will be introduced to the six dimensions of psychological well-being and will be gradually provided with cognitive-behavioral strategies to enhance psychological well-being and seek a balance between the presented dimensions. Participants will be given cognitive-behavioral tools to recognize justification cognitive mechanisms and replace them with more functional cognitions. These objectives will also be achieved through the use of a food diary to highlight emotions and thoughts experienced during food intake.
• Basic Nutritional Intervention
Participants will receive treatment as usual (TAU) by participating in 6 weekly group sessions of two hours of a Basic Nutritional Intervention (BNI) held by a trained dietician. This course focuses on promoting healthier lifestyles through nutritional education, diet monitoring using a dedicated food diary, and recommendations for proper physical activity.

Locations

Country	Name	City	State
Italy	IRCCS-S. Orsola-Malpighi Hospital, University of Bologna,	Bologna

Sponsors (3)

Lead Sponsor	Collaborator
University of Bologna	European Union, IRCCS Azienda Ospedaliero-Universitaria di Bologna

Country where clinical trial is conducted

Italy, 

References & Publications (32)

Aguera Z, Lozano-Madrid M, Mallorqui-Bague N, Jimenez-Murcia S, Menchon JM, Fernandez-Aranda F. A review of binge eating disorder and obesity. Neuropsychiatr. 2021 Jun;35(2):57-67. doi: 10.1007/s40211-020-00346-w. Epub 2020 Apr 28. — View Citation

Alimoradi Z, Golboni F, Griffiths MD, Brostrom A, Lin CY, Pakpour AH. Weight-related stigma and psychological distress: A systematic review and meta-analysis. Clin Nutr. 2020 Jul;39(7):2001-2013. doi: 10.1016/j.clnu.2019.10.016. Epub 2019 Oct 31. — View Citation

Bischoff SC, Boirie Y, Cederholm T, Chourdakis M, Cuerda C, Delzenne NM, Deutz NE, Fouque D, Genton L, Gil C, Koletzko B, Leon-Sanz M, Shamir R, Singer J, Singer P, Stroebele-Benschop N, Thorell A, Weimann A, Barazzoni R. Towards a multidisciplinary appro — View Citation

Bottesi G, Ghisi M, Altoe G, Conforti E, Melli G, Sica C. The Italian version of the Depression Anxiety Stress Scales-21: Factor structure and psychometric properties on community and clinical samples. Compr Psychiatry. 2015 Jul;60:170-81. doi: 10.1016/j. — View Citation

Brantley PJ, Stewart DW, Myers VH, Matthews-Ewald MR, Ard JD, Coughlin JW, Jerome GJ, Samuel-Hodge C, Lien LF, Gullion CM, Hollis JF, Svetkey LP, Stevens VJ. Psychosocial predictors of weight regain in the weight loss maintenance trial. J Behav Med. 2014 — View Citation

Castelnuovo G, Pietrabissa G, Manzoni GM, Corti S, Ceccarini M, Borrello M, Giusti EM, Novelli M, Cattivelli R, Middleton NA, Simpson SG, Molinari E. Chronic care management of globesity: promoting healthier lifestyles in traditional and mHealth based set — View Citation

Chu DT, Minh Nguyet NT, Dinh TC, Thai Lien NV, Nguyen KH, Nhu Ngoc VT, Tao Y, Son LH, Le DH, Nga VB, Jurgonski A, Tran QH, Van Tu P, Pham VH. An update on physical health and economic consequences of overweight and obesity. Diabetes Metab Syndr. 2018 Nov; — View Citation

da Luz FQ, Hay P, Touyz S, Sainsbury A. Obesity with Comorbid Eating Disorders: Associated Health Risks and Treatment Approaches. Nutrients. 2018 Jun 27;10(7):829. doi: 10.3390/nu10070829. — View Citation

Dakanalis A, Zanetti MA, Clerici M, Madeddu F, Riva G, Caccialanza R. Italian version of the Dutch Eating Behavior Questionnaire. Psychometric proprieties and measurement invariance across sex, BMI-status and age. Appetite. 2013 Dec;71:187-95. doi: 10.101 — View Citation

Fava GA. Well-Being Therapy: Current Indications and Emerging Perspectives. Psychother Psychosom. 2016;85(3):136-45. doi: 10.1159/000444114. Epub 2016 Apr 5. No abstract available. — View Citation

Fava GA. Well-being therapy: Treatment manual and clinical applications. Karger Medical and Scientific Publishers. 2016

Fischer M, Oberander N, Weimann A. Four main barriers to weight loss maintenance? A quantitative analysis of difficulties experienced by obese patients after successful weight reduction. Eur J Clin Nutr. 2020 Aug;74(8):1192-1200. doi: 10.1038/s41430-020-0 — View Citation

GBD 2015 Obesity Collaborators; Afshin A, Forouzanfar MH, Reitsma MB, Sur P, Estep K, Lee A, Marczak L, Mokdad AH, Moradi-Lakeh M, Naghavi M, Salama JS, Vos T, Abate KH, Abbafati C, Ahmed MB, Al-Aly Z, Alkerwi A, Al-Raddadi R, Amare AT, Amberbir A, Amegah — View Citation

Hudson JI, Hiripi E, Pope HG Jr, Kessler RC. The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biol Psychiatry. 2007 Feb 1;61(3):348-58. doi: 10.1016/j.biopsych.2006.03.040. Epub 2006 Jul 3. Erratum In: Biol — View Citation

Kantartzis K, Machann J, Schick F, Rittig K, Machicao F, Fritsche A, Haring HU, Stefan N. Effects of a lifestyle intervention in metabolically benign and malign obesity. Diabetologia. 2011 Apr;54(4):864-8. doi: 10.1007/s00125-010-2006-3. Epub 2010 Dec 21. — View Citation

Kawasaki Y, Nagao-Sato S, Yoshii E, Akamatsu R. Integrated consumers' sustainable and healthy dietary behavior patterns: Associations between demographics, psychological factors, and meal preparation habits among Japanese adults. Appetite. 2023 Jan 1;180: — View Citation

Lillis J, Kendra KE. Acceptance and Commitment Therapy for weight control: Model, evidence, and future directions. J Contextual Behav Sci. 2014 Jan;3(1):1-7. doi: 10.1016/j.jcbs.2013.11.005. — View Citation

Lovibond PF, Lovibond SH. The structure of negative emotional states: comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behav Res Ther. 1995 Mar;33(3):335-43. doi: 10.1016/0005-7967(94)00075-u. — View Citation

Mantzios M, Egan HH. On the Role of Self-compassion and Self-kindness in Weight Regulation and Health Behavior Change. Front Psychol. 2017 Feb 16;8:229. doi: 10.3389/fpsyg.2017.00229. eCollection 2017. No abstract available. — View Citation

Manzoni GM, Cribbie RA, Villa V, Arpin-Cribbie CA, Gondoni L, Castelnuovo G. Psychological well-being in obese inpatients with ischemic heart disease at entry and at discharge from a four-week cardiac rehabilitation program. Front Psychol. 2010 Aug 3;1:38 — View Citation

Popkin BM, Ng SW. The nutrition transition to a stage of high obesity and noncommunicable disease prevalence dominated by ultra-processed foods is not inevitable. Obes Rev. 2022 Jan;23(1):e13366. doi: 10.1111/obr.13366. Epub 2021 Oct 10. — View Citation

Ruini C, Ottolini F, Rafanelli C, Ryff CD, Fava GA. La validazione italiana delle Psychological Well-being Scales (PWB). Rivista di psichiatria. 2003; 38(3): 117-130.

Ryff CD, Singer B. Psychological well-being: meaning, measurement, and implications for psychotherapy research. Psychother Psychosom. 1996;65(1):14-23. doi: 10.1159/000289026. — View Citation

Sarwer DB, Allison KC, Wadden TA, Ashare R, Spitzer JC, McCuen-Wurst C, LaGrotte C, Williams NN, Edwards M, Tewksbury C, Wu J. Psychopathology, disordered eating, and impulsivity as predictors of outcomes of bariatric surgery. Surg Obes Relat Dis. 2019 Ap — View Citation

Sharma M. Behavioural interventions for preventing and treating obesity in adults. Obes Rev. 2007 Sep;8(5):441-9. doi: 10.1111/j.1467-789X.2007.00351.x. — View Citation

Taylor C, Webb TL, Sheeran P. 'I deserve a treat!': justifications for indulgence undermine the translation of intentions into action. Br J Soc Psychol. 2014 Sep;53(3):501-20. doi: 10.1111/bjso.12043. Epub 2013 Jul 15. — View Citation

Teixeira PJ, Going SB, Houtkooper LB, Cussler EC, Metcalfe LL, Blew RM, Sardinha LB, Lohman TG. Pretreatment predictors of attrition and successful weight management in women. Int J Obes Relat Metab Disord. 2004 Sep;28(9):1124-33. doi: 10.1038/sj.ijo.0802 — View Citation

Turton R, Chami R, Treasure J. Emotional Eating, Binge Eating and Animal Models of Binge-Type Eating Disorders. Curr Obes Rep. 2017 Jun;6(2):217-228. doi: 10.1007/s13679-017-0265-8. — View Citation

Vallis M. Quality of life and psychological well-being in obesity management: improving the odds of success by managing distress. Int J Clin Pract. 2016 Mar;70(3):196-205. doi: 10.1111/ijcp.12765. Epub 2016 Feb 4. — View Citation

Van Strien T, Frijters JE, Bergers GP, Defares PB. The Dutch Eating Behavior Questionnaire (DEBQ) for assessment of restrained, emotional, and external eating behavior. International journal of eating disorders. 1986; 5(2): 295-315.

Webber KH, Casey EM, Mayes L, Katsumata Y, Mellin L. A comparison of a behavioral weight loss program to a stress management program: A pilot randomized controlled trial. Nutrition. 2016 Jul-Aug;32(7-8):904-9. doi: 10.1016/j.nut.2016.01.008. Epub 2016 Jan — View Citation

Zhu B, Gostoli S, Benasi G, Patierno C, Petroni ML, Nuccitelli C, Marchesini G, Fava GA, Rafanelli C. Promoting weight loss and psychological well-being in patients with obesity: A sequential combination of behavioural lifestyle intervention and well-bein — View Citation

* Note: There are 32 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Change from baseline in weight-loss	Body weight will be both self-evaluated by patients and will be verified by the medical staff during follow-up visits	Baseline, 35 days after starting the intervention, 1 month after finishing the intervention and 3 months after finishing the intervention
Secondary	Change from baseline in the Sustainable and Healthy Dietary Behaviors (SHDB) questionnaire	The Sustainable and Healthy Dietary Behaviors (SHDB) is 30-item self-reported questionnaire on a 6-point Likert scale to assess sustainable and healthy dietary behaviors through five dimensions and the total score: food choices, storing, cooking, food consumption and food disposal. For each sub-scale and the total score, scores range from 0 to 6, with higher scores indicating more sustainable and healthy eating behaviors (better outcome).	Baseline, 35 days after starting the intervention, 1 month after finishing the intervention and 3 months after finishing the intervention
Secondary	Change from baseline in the Psychological Well-Being Scale (PWBs)	The Psychological Well-Being Scale (PWBs) is a 42-item self-reported questionnaire on a 6-point Likert scale that assesses psychological well-being through six dimensions: autonomy, personal growth, environmental mastery, purpose in life, acceptance and positive relations with others. For each dimension scores range from 14 to 84, with higher scores indicating higher levels on that specific PWB dimension (better outcome).	Baseline, 35 days after starting the intervention, 1 month after finishing the intervention and 3 months after finishing the intervention
Secondary	Change from baseline in the Dutch Eating Behavior Questionnaire (DEBQ)	The Dutch Eating Behavior Questionnaire (DEBQ) is 33-item self-reported questionnaire on a 5-point Likert scale to assess eating styles through three sub-scales: restrictive eating, emotional eating and external eating.; For each sub-scale scores range from 1 to 5, with higher scores indicating higher levels on that specific dimension (worse outcome).	Baseline, 35 days after starting the intervention, 1 month after finishing the intervention and 3 months after finishing the intervention
Secondary	Change from baseline in the Depression and Anxiety Stress Scale (DASS-21)	The Depression and Anxiety Stress Scale (DASS-21) is a 21-item self-reported questionnaire on a 4-point Likert scale to assess psychological distress through three subscales: depression, anxiety and stress.; For each sub-scale scores range from 0 to 56, with higher scores indicating higher levels on that specific dimension (worse outcome).	Baseline, 35 days after starting the intervention, 1 month after finishing the intervention and 3 months after finishing the intervention
Secondary	Change from baseline in the use of dysfunctional cognitive justification mechanisms assessed through an ad-hoc form	An ad-hoc assessment index adapted from a previous study will be used to assess dysfunctional cognitive justification mechanisms through the presentation of three hypothetical scenarios that could pose dilemmas regarding the adherence to a healthy diet. Participants will be asked to assess their level of identification with the scenario (from 1 to 10) and to specify the type of justification most frequently used in similar situations.	Baseline, 35 days after starting the intervention, 1 month after finishing the intervention and 3 months after finishing the intervention