Cognitive behavioral therapy and acceptance and commitment therapy in the comprehensive management of overweight and obesity: a review of current evidence
https://doi.org/10.15829/3034-4123-2026-121
EDN: QKPWTW
Abstract
Aim. To compare current evidence on the effectiveness of cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT) (including digital formats) in the treatment of obesity and overweight based on following parameters: body weight/body mass index, eating behavior, and mental status, as well as the sustainability of the effect at follow-up.
Material and methods. A literature search was conducted in the PubMed, Web of Science, and Scopus databases for the period from January 1, 2020, to October 1, 2025. The search employed Russian and English keywords using the Boolean operators AND/OR, including terms such as: ("cognitive behavioral therapy" OR CBT OR "acceptance and commitment therapy" OR ACT) AND ("obesity" OR "overweight") AND ("weight loss" OR "weight maintenance" OR BMI) AND ("eating behavior" OR "binge eating" OR "emotional eating").
Results. CBT, particularly within multidisciplinary programs, is more frequently associated with clinically significant changes in eating behavior and a more predictable trajectory of weight change. In turn, ACT demonstrates advantages in the long-term maintenance of changes by fostering psychological flexibility. Both approaches improve patients' mental status, reducing manifestations of depression, anxiety, and maladaptive eating behavior even in the absence of significant weight dynamics, underscoring their independent clinical value. Digital formats (online/telephone/self-help) enhance the accessibility and acceptability of interventions.
Conclusion. CBT and ACT are evidence- based components of comprehensive obesity therapy. CBT is appropriate when the priority is structured behavior modification and self-monitoring skills. ACT is preferable when emotional reactivity, distress tolerance, and difficulties with long-term maintenance of changes are key factors. A personalized selection or integration of approaches appears optimal.
About the Authors
D. O. Savchenko
National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Health of Russia
Russian Federation
Russian Federation
Darya O. Savchenko
Moscow
O. M. Drapkina
National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Health of Russia; Russian University of Medicine of the Ministry of Health of Russia
Russian Federation
Russian Federation
Oksana M. Drapkina
Moscow
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What is already known about the subject?
- Obesity is maintained not only by biological factors but also by psychosocial mechanisms, including emotional reactivity, self-stigma, and maladaptive eating patterns.
- Cognitive behavioral therapy (CBT) is a structured method for changing cognitions and behaviors, widely used for lifestyle modification.
- Acceptance and commitment therapy (ACT) is a third wave approach and focuses on developing psychological flexibility and acting in accordance with values.
What might this study add?
- The differences in the focus of CBT and ACT in clinical obesity practice are demonstrated: CBT focuses more on self-regulation skills and relapse prevention. ACT focuses on the sustainability of changes in the face of emotional discomfort and long-term maintenance.
- Data on in-person and digital formats (online/phone/self-help) were compared as a means of expanding access to psychotherapy.
- A personalized approach is needed depending on the dominant mechanism: compulsivity/cognitive distortions vs emotional avoidance/self-stigma.
Review
For citations:
Savchenko DO, Drapkina OM. Cognitive behavioral therapy and acceptance and commitment therapy in the comprehensive management of overweight and obesity: a review of current evidence. Primary Health Care (Russian Federation). 2026;3(1):34-45. (In Russ.) https://doi.org/10.15829/3034-4123-2026-121. EDN: QKPWTW
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