{"id":{"repo_id":"cambridge","oai_identifier":"oai:www.repository.cam.ac.uk:1810/383129"},"canonical_url":"https://search.dev.ndltd.org/etd/cambridge/oai:www.repository.cam.ac.uk:1810/383129","repository":{"repo_id":"cambridge","name":"Cambridge University","base_url":"https://api.repository.cam.ac.uk/server/oai/request"},"display":{"title":"Investigating the Role of Eating Behaviour Traits in Behavioural Weight Management Interventions from a Precision Treatment Perspective","abstract":"Obesity is associated with serious health risks and while behavioural weight management interventions (BWMIs) can be effective, they do not work equally well for everyone. Precision treatments aim to improve outcomes by matching individuals to different intervention types based on their personal characteristics, such as their Eating Behaviour Traits (EBTs). EBTs are defined as tendencies determining an individual’s food intake and have previously been linked to the development of obesity. Though early attempts at precision treatments have shown promise, the evidence remains scarce and methods for evaluating the suitability of potential target characteristics have been inconsistent. This thesis explores the role of various EBTs in BWMIs to inform their potential as precision treatment targets through four main projects. The projects were organised along a series of steps I proposed to systematically investigate precision targets, focusing on those investigating (a) the modifiability of EBTs and (b) their impact on weight loss outcomes. Projects in Chapter 2 & 3 address the modifiability of EBTs. After introducing the thesis background in Chapter 1, in Chapter 2, I conducted a systematic review and meta-analysis of 27 trials and found that BWMIs had small to moderate effects on restraint and uncontrolled eating, though I found no evidence to support changes in emotional eating. Subgroup analyses suggested that 3wCBT-based intervention types, including BWMIs based on Acceptance and Commitment Therapy (ACT), may be particularly suited to address uncontrolled eating. ACT promotes the acceptance of uncomfortable feelings and has been proposed by previous research for targeting dysregulated EBTs. Considering these findings, in Chapter 3, I conducted a qualitative study to further investigate the experience of emotional eating in the context of an ACT-based BWMI. I conducted semi-structured interviews with 15 participants of the Supporting Weight Management (SWIM) feasibility trial testing a digital guided self-help ACT intervention and used thematic analysis to guide conclusions. Participants described the intervention as helpful for managing emotional eating by increasing self-awareness and encouraging alternative coping strategies. However, many expressed a need for ongoing support, particularly during triggering moments, and some reported external circumstances as a barrier to managing emotional eating. Additionally, intervention content preferences varied across the more extreme ends of the emotional eating spectrum, with those participants describing not to experience emotional eating wanting to skip related content and those with complex experiences wishing for more intensive support. Projects in Chapters 4, 5, and 6 focus on the effects of EBTs on weight loss outcomes, specifically within ACT-based BWMIs. Given the scarcity of data sources large enough to conduct analyses that are powered to investigate effect modifiers and mechanisms of action, I generated my own database of ACT-based BWMI trials by systematically searching for and collecting relevant individual participant data (IPD) in Chapter 4. In Chapters 5 & 6, I conducted two separate one-stage IPD meta-analyses investigating the mediating role of EBTs on weight loss in 8 trials (N = 1391) (Chapter 5) and the moderating role of EBTs in on weight loss in 15 trials (N = 2535) (Chapter 6). I found small partial mediating effects of a number of EBTs in Chapter 5, suggesting that acceptance-based interventions impact on weight loss through changes in emotional eating, external eating, internal disinhibition and restraint. In Chapter 6, I found evidence to suggest a greater benefit of acceptance-based interventions for participants with medium compared to high levels of emotional eating and internal disinhibition. Overall, this thesis provides insights into the modifiability of EBTs and their impact on weight loss outcomes. While these findings are preliminary and do not fully establish the suitability of EBTs for precision treatment, they highlight several priorities for future research and clinical practice. These include a need for improving the targeting of EBTs, such as by providing more intensive psychological therapy, and identifying pathways of support for individuals with high emotional eating and internal disinhibition.","abstract_html":"Obesity is associated with serious health risks and while behavioural weight management interventions (BWMIs) can be effective, they do not work equally well for everyone. Precision treatments aim to improve outcomes by matching individuals to different intervention types based on their personal characteristics, such as their Eating Behaviour Traits (EBTs). EBTs are defined as tendencies determining an individual’s food intake and have previously been linked to the development of obesity. Though early attempts at precision treatments have shown promise, the evidence remains scarce and methods for evaluating the suitability of potential target characteristics have been inconsistent. This thesis explores the role of various EBTs in BWMIs to inform their potential as precision treatment targets through four main projects. The projects were organised along a series of steps I proposed to systematically investigate precision targets, focusing on those investigating (a) the modifiability of EBTs and (b) their impact on weight loss outcomes. Projects in Chapter 2 & 3 address the modifiability of EBTs. After introducing the thesis background in Chapter 1, in Chapter 2, I conducted a systematic review and meta-analysis of 27 trials and found that BWMIs had small to moderate effects on restraint and uncontrolled eating, though I found no evidence to support changes in emotional eating. Subgroup analyses suggested that 3wCBT-based intervention types, including BWMIs based on Acceptance and Commitment Therapy (ACT), may be particularly suited to address uncontrolled eating. ACT promotes the acceptance of uncomfortable feelings and has been proposed by previous research for targeting dysregulated EBTs. Considering these findings, in Chapter 3, I conducted a qualitative study to further investigate the experience of emotional eating in the context of an ACT-based BWMI. I conducted semi-structured interviews with 15 participants of the Supporting Weight Management (SWIM) feasibility trial testing a digital guided self-help ACT intervention and used thematic analysis to guide conclusions. Participants described the intervention as helpful for managing emotional eating by increasing self-awareness and encouraging alternative coping strategies. However, many expressed a need for ongoing support, particularly during triggering moments, and some reported external circumstances as a barrier to managing emotional eating. Additionally, intervention content preferences varied across the more extreme ends of the emotional eating spectrum, with those participants describing not to experience emotional eating wanting to skip related content and those with complex experiences wishing for more intensive support. Projects in Chapters 4, 5, and 6 focus on the effects of EBTs on weight loss outcomes, specifically within ACT-based BWMIs. Given the scarcity of data sources large enough to conduct analyses that are powered to investigate effect modifiers and mechanisms of action, I generated my own database of ACT-based BWMI trials by systematically searching for and collecting relevant individual participant data (IPD) in Chapter 4. In Chapters 5 & 6, I conducted two separate one-stage IPD meta-analyses investigating the mediating role of EBTs on weight loss in 8 trials (N = 1391) (Chapter 5) and the moderating role of EBTs in on weight loss in 15 trials (N = 2535) (Chapter 6). I found small partial mediating effects of a number of EBTs in Chapter 5, suggesting that acceptance-based interventions impact on weight loss through changes in emotional eating, external eating, internal disinhibition and restraint. In Chapter 6, I found evidence to suggest a greater benefit of acceptance-based interventions for participants with medium compared to high levels of emotional eating and internal disinhibition. Overall, this thesis provides insights into the modifiability of EBTs and their impact on weight loss outcomes. While these findings are preliminary and do not fully establish the suitability of EBTs for precision treatment, they highlight several priorities for future research and clinical practice. These include a need for improving the targeting of EBTs, such as by providing more intensive psychological therapy, and identifying pathways of support for individuals with high emotional eating and internal disinhibition.","abstract_has_math":false,"creators":["Kudlek, Laura"],"institution":"University of Cambridge","degree_name":"Doctor of Philosophy (PhD)","degree_level":"Doctoral","degree_discipline":null,"degree_department":null,"school":null,"contributors":[],"advisors":["Ahern, Amy"],"committee_chairs":[],"committee_members":[],"year":2024,"date_issued":"2024-11-29","date_published":"2024-11-29","updated_at":"2026-07-22T22:24:30Z","subjects":["Eating Behaviour Traits","Obesity","Weight Management","Acceptance and Commitment Therapy"],"languages":["eng"],"rights":[],"rights_urls":["https://apollo8-f-pro.lib.cam.ac.uk/bitstreams/368c506d-1bda-46e3-b1b5-172e67ad79af/download","https://creativecommons.org/licenses/by/4.0/"],"identifier_entries":[{"key":"dc:creator.authoridentifier","label":"Author Identifier","values":["0000000309473640"],"render_values":[{"text":"0000-0003-0947-3640","href":"https://orcid.org/0000-0003-0947-3640","code":true}]}]},"links":{"outbound_url":"https://doi.org/10.17863/CAM.117667","outbound_label":"DOI","outbound_source":"dc:identifier.doi"},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:contributor.advisor","label":"Advisor","values":["Ahern, Amy"]},{"key":"dc:contributor.sponsor","label":"Sponsor","values":["Medical Research Council MC_UU_00006/6; National Institute for Health and Care Research (NIHR) Cambridge Biomedical Research Centre (NIHR203312) and NIHR Programme Grants for Applied Research (RP-PG-0216-20010)"]},{"key":"dc:creator","label":"Author","values":["Kudlek, Laura"]},{"key":"dc:creator.authoridentifier","label":"Author Identifier","values":["0000000309473640"]}]},{"id":"academic_context","label":"Academic Context","entries":[{"key":"dc:date.issued","label":"Date","values":["2024-11-29"]},{"key":"dc:publisher.institution","label":"Dc Publisher Institution","values":["University of Cambridge"]},{"key":"dc:relation.isreferencedby.uri","label":"Dc Relation Isreferencedby URI","values":["https://www.repository.cam.ac.uk/handle/1810/383129"]},{"key":"dc:type","label":"Dc Type","values":["Thesis"]},{"key":"dc:type.qualificationlevel","label":"Dc Type Qualificationlevel","values":["Doctoral"]},{"key":"dc:type.qualificationname","label":"Dc Type Qualificationname","values":["Doctor of Philosophy (PhD)"]}]},{"id":"subjects_keywords","label":"Subjects and Keywords","entries":[{"key":"dc:subject","label":"Dc Subject","values":["Eating Behaviour Traits","Obesity","Weight Management","Acceptance and Commitment Therapy"]}]},{"id":"language_rights","label":"Language and Rights","entries":[{"key":"dc:language","label":"Dc Language","values":["eng"]},{"key":"dc:rights","label":"Dc Rights","values":["https://apollo8-f-pro.lib.cam.ac.uk/bitstreams/368c506d-1bda-46e3-b1b5-172e67ad79af/download","https://creativecommons.org/licenses/by/4.0/"]}]},{"id":"identifiers","label":"Identifiers","entries":[{"key":"dc:identifier.doi","label":"DOI","values":["https://doi.org/10.17863/CAM.117667"]},{"key":"dc:identifier.uri","label":"Identifier URI","values":["https://apollo8-f-pro.lib.cam.ac.uk/bitstreams/651923c8-caad-4662-811f-42371a00e8ef/download"]}]},{"id":"additional","label":"Additional Metadata","entries":[{"key":"dc:description.abstract","label":"Abstract","values":["Obesity is associated with serious health risks and while behavioural weight management interventions (BWMIs) can be effective, they do not work equally well for everyone. 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After introducing the thesis background in Chapter 1, in Chapter 2, I conducted a systematic review and meta-analysis of 27 trials and found that BWMIs had small to moderate effects on restraint and uncontrolled eating, though I found no evidence to support changes in emotional eating. Subgroup analyses suggested that 3wCBT-based intervention types, including BWMIs based on Acceptance and Commitment Therapy (ACT), may be particularly suited to address uncontrolled eating. ACT promotes the acceptance of uncomfortable feelings and has been proposed by previous research for targeting dysregulated EBTs. Considering these findings, in Chapter 3, I conducted a qualitative study to further investigate the experience of emotional eating in the context of an ACT-based BWMI. I conducted semi-structured interviews with 15 participants of the Supporting Weight Management (SWIM) feasibility trial testing a digital guided self-help ACT intervention and used thematic analysis to guide conclusions. Participants described the intervention as helpful for managing emotional eating by increasing self-awareness and encouraging alternative coping strategies. However, many expressed a need for ongoing support, particularly during triggering moments, and some reported external circumstances as a barrier to managing emotional eating. Additionally, intervention content preferences varied across the more extreme ends of the emotional eating spectrum, with those participants describing not to experience emotional eating wanting to skip related content and those with complex experiences wishing for more intensive support. Projects in Chapters 4, 5, and 6 focus on the effects of EBTs on weight loss outcomes, specifically within ACT-based BWMIs. Given the scarcity of data sources large enough to conduct analyses that are powered to investigate effect modifiers and mechanisms of action, I generated my own database of ACT-based BWMI trials by systematically searching for and collecting relevant individual participant data (IPD) in Chapter 4. In Chapters 5 & 6, I conducted two separate one-stage IPD meta-analyses investigating the mediating role of EBTs on weight loss in 8 trials (N = 1391) (Chapter 5) and the moderating role of EBTs in on weight loss in 15 trials (N = 2535) (Chapter 6). I found small partial mediating effects of a number of EBTs in Chapter 5, suggesting that acceptance-based interventions impact on weight loss through changes in emotional eating, external eating, internal disinhibition and restraint. In Chapter 6, I found evidence to suggest a greater benefit of acceptance-based interventions for participants with medium compared to high levels of emotional eating and internal disinhibition. Overall, this thesis provides insights into the modifiability of EBTs and their impact on weight loss outcomes. While these findings are preliminary and do not fully establish the suitability of EBTs for precision treatment, they highlight several priorities for future research and clinical practice. 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Precision treatments aim to improve outcomes by matching individuals to different intervention types based on their personal characteristics, such as their Eating Behaviour Traits (EBTs). EBTs are defined as tendencies determining an individual’s food intake and have previously been linked to the development of obesity. Though early attempts at precision treatments have shown promise, the evidence remains scarce and methods for evaluating the suitability of potential target characteristics have been inconsistent. This thesis explores the role of various EBTs in BWMIs to inform their potential as precision treatment targets through four main projects. The projects were organised along a series of steps I proposed to systematically investigate precision targets, focusing on those investigating (a) the modifiability of EBTs and (b) their impact on weight loss outcomes. Projects in Chapter 2 & 3 address the modifiability of EBTs. After introducing the thesis background in Chapter 1, in Chapter 2, I conducted a systematic review and meta-analysis of 27 trials and found that BWMIs had small to moderate effects on restraint and uncontrolled eating, though I found no evidence to support changes in emotional eating. Subgroup analyses suggested that 3wCBT-based intervention types, including BWMIs based on Acceptance and Commitment Therapy (ACT), may be particularly suited to address uncontrolled eating. ACT promotes the acceptance of uncomfortable feelings and has been proposed by previous research for targeting dysregulated EBTs. Considering these findings, in Chapter 3, I conducted a qualitative study to further investigate the experience of emotional eating in the context of an ACT-based BWMI. I conducted semi-structured interviews with 15 participants of the Supporting Weight Management (SWIM) feasibility trial testing a digital guided self-help ACT intervention and used thematic analysis to guide conclusions. Participants described the intervention as helpful for managing emotional eating by increasing self-awareness and encouraging alternative coping strategies. However, many expressed a need for ongoing support, particularly during triggering moments, and some reported external circumstances as a barrier to managing emotional eating. Additionally, intervention content preferences varied across the more extreme ends of the emotional eating spectrum, with those participants describing not to experience emotional eating wanting to skip related content and those with complex experiences wishing for more intensive support. Projects in Chapters 4, 5, and 6 focus on the effects of EBTs on weight loss outcomes, specifically within ACT-based BWMIs. Given the scarcity of data sources large enough to conduct analyses that are powered to investigate effect modifiers and mechanisms of action, I generated my own database of ACT-based BWMI trials by systematically searching for and collecting relevant individual participant data (IPD) in Chapter 4. In Chapters 5 & 6, I conducted two separate one-stage IPD meta-analyses investigating the mediating role of EBTs on weight loss in 8 trials (N = 1391) (Chapter 5) and the moderating role of EBTs in on weight loss in 15 trials (N = 2535) (Chapter 6). I found small partial mediating effects of a number of EBTs in Chapter 5, suggesting that acceptance-based interventions impact on weight loss through changes in emotional eating, external eating, internal disinhibition and restraint. In Chapter 6, I found evidence to suggest a greater benefit of acceptance-based interventions for participants with medium compared to high levels of emotional eating and internal disinhibition. Overall, this thesis provides insights into the modifiability of EBTs and their impact on weight loss outcomes. While these findings are preliminary and do not fully establish the suitability of EBTs for precision treatment, they highlight several priorities for future research and clinical practice. These include a need for improving the targeting of EBTs, such as by providing more intensive psychological therapy, and identifying pathways of support for individuals with high emotional eating and internal disinhibition."],"dc:format.checksum.md5":["87eda9de84448d1f82354d60eee3eb5f","93a15a393ecc7a6d9eb85082c684d01f"],"dc:identifier.doi":["https://doi.org/10.17863/CAM.117667"],"dc:identifier.uri":["https://apollo8-f-pro.lib.cam.ac.uk/bitstreams/651923c8-caad-4662-811f-42371a00e8ef/download"],"dc:language":["eng"],"dc:publisher.institution":["University of Cambridge"],"dc:relation.isreferencedby.uri":["https://www.repository.cam.ac.uk/handle/1810/383129"],"dc:rights":["https://apollo8-f-pro.lib.cam.ac.uk/bitstreams/368c506d-1bda-46e3-b1b5-172e67ad79af/download","https://creativecommons.org/licenses/by/4.0/"],"dc:subject":["Eating Behaviour Traits","Obesity","Weight Management","Acceptance and Commitment Therapy"],"dc:title":["Investigating the Role of Eating Behaviour Traits in Behavioural Weight Management Interventions from a Precision Treatment Perspective"],"dc:type":["Thesis"],"dc:type.qualificationlevel":["Doctoral"],"dc:type.qualificationname":["Doctor of Philosophy (PhD)"]},"updated_at":"2026-07-22T22:24:30Z"}