Racial disparities in the efficacy of traditional versus acceptance-based behavioral weight loss

Standard behavioral weight loss (SBT) is a first-line intervention for obesity, but its efficacy with Black adults is limited. Some preliminary work suggests that acceptance-based behavioral therapy (ABT), which integrates mindful decision making, experiential acceptance, and reflection on values, may be a better fit for the needs of Black adults. In this fully powered secondary data analysis, we compared the efficacy of SBT and ABT for Black adults.

Black and non-Hispanic White adults (N = 737) with overweight or obesity (body mass index = 27-50 kg/m²) were enrolled in one of the five randomized controlled trials investigating the effectiveness of ABT versus SBT. Analyses assessed the impact of race, treatment condition, and their interaction on percent weight loss at posttreatment and first follow-up assessment while controlling for clinical trial.

The interaction effects between race and treatment condition on weight loss were trending toward significance (p < .05) at posttreatment, F(1, 729) = 2.74, p = .089, but not at follow-up, F(1, 729) = .003, p = .957. Pairwise comparisons revealed that the disparity in posttreatment weight loss between Black and White participants in the SBT condition (M = 3.5%, p = .001) was attenuated in the ABT condition (M = 1.5%, p = .05).

ABT has promise for supporting Black adults in weight loss attempts, although weight regain after treatment remains persistent for Black and White adults alike. Future research is warranted to continue developing this treatment approach as a tool to reduce health disparities. (PsycInfo Database Record (c) 2026 APA, all rights reserved).