ACTonHEALTH Study Protocol: Promoting Psychological Flexibility With Activity Tracker and mHealth Tools to Foster Healthy Lifestyle for Obesity and Other Chronic Health Conditions

Background The condition of being overweight is an increasing problem worldwide, becoming an epidemic both in Europe and in the United States. Recent estimates that over 60% of adults are overweight and at the same time obesity affects around 35% of the population. In the US the cost of the health system to cope with obesity and related diseases now exceeds the sum of 100 billion and in Europe costs are currently similar. Health risks related to being overweight include psychological difficulties, depression and stigma, physical problems and heart diseases, cancer and respiratory diseases not to mention musculoskeletal and metabolic problems.

Obesity is a chronic health condition, but is also a major risk factor for various diseases both chronic and acute. This problem is currently steadily rising, with prevalence data and epidemiological estimates that should be of great concern. Despite strong biological components and hereditary aspects, obesity is primarily linked to incorrect habits of everyday life, mainly eating habits and physical activity. Numerous studies have documented that regular physical activity and wise choices in food uptake can prevent obesity and related conditions.

The main challenge in addressing obesity and associated disorders is represented by developing and making available and sustainable comprehensive programs that include combinations of physical activity, dietary aspects and psychological interventions.

Interventions developed in this way, including dietary education protocols, physical rehabilitation and exercises programs, nutritional, endocrinological, psychological, surgical and pharmacological treatments are mainly effective in the short term, despite many of which are characterized by high costs and several periods of hospitalization. The analysis of the literature suggests the superiority of intensive multidisciplinary interventions: health protocols, dietary programs, psychological and physical rehabilitation. One of the problems of such interventions is that they are often only possible during an hospitalization period, with high costs associated. However, despite good evidence of effectiveness, the long-term results are generally limited.

In general, availability, costs, compliance and long-term efficacy are important limitations to this variety of approaches. Frequently obese individuals regain about 30% of the weight they lost within the first year. After only 3 years they are returning to pre-treatment weight. Psychological intervention are generally assumed to be one of the core parts in the treatment aimed to obesity. In particular, Cognitive-Behavioral interventions, usually within multidisciplinary paths and rarely implemented individually, are generally considered the gold-standard for addressing the epidemic of obesity, or "globesity".