1. Introduction
he epidemic of obesity requires proper living habits and the modification of eating behavior and physical activity. Improving lifestyle habits has always been effective in preventing obesity in the long run. Unhealthy living habits significantly impact the emergence of this public health issue [5]. Accordingly, fostering unhealthy lifestyle habits is highly effective in the incidence of obesity. Individuals’ living habits in various countries have undergone concerning alternation. Moreover, changes in the lifestyle habits of obese individuals, like increased use of high-calorie foods, e.g. fast food and snacks, seem to be effective determinants in developing obesity [6]. In addition to poor living habits, disordered eating behaviors can also contribute to obesity. According to relevant literature, numerous characteristics influence the etiology of disordered eating behaviors [7]. The current study aimed to determine the effects of group-based Acceptance and Commitment Therapy (ACT) and Cognitive-Behavioral Therapy (CBT) on living habits, disordered eating behavior, and health-promoting lifestyle in obese women.
2. Materials and Methods
This was a quasi-experimental study with a pretest-posttest-follow-up and a control group design. The statistical population included all women referring to obesity clinics in region 2 of Tehran City, Iran in 2018. The convenience sampling method was used to select the research subjects. The sample size was measured per Cohen’s method to be 45 individuals. The research subjects were randomly divided into 3 groups (2 experimental and 1 control) of 15 subjects. Furthermore, the study groups were compared before and after the interventions and 2 months after the completion of the treatment program. Random assignment as well as matching in three groups (gender, marital status, & age) were observed to control additional and unwanted variables. The study participants were assessed using the Assessment of Life Habits Scale (LIFE-H), the Eating Attitudes Test (EAT), and the Health Promoting Lifestyle Profile-II (HPLP-II). The ACT group underwent nine 90-minute sessions and the CBT group received eight 90-minute sessions. The control group received no training. The collected data were analyzed using Mixed Design and repeated-measures Analysis of Variance (ANOVA) in SPSS.
3. Results   
The effects of the provided treatment methods only significantly differed concerning life habits responsibilities (F2,56=5.20 P<0.01). Group-based ACT, compared with group CBT was a more effective approach to increase responsibilities in women with obesity. The obtained data indicated that ACT was a more successful method to increase life habits responsibilities in the explored obese women, compared to CBT. Furthermore, the difference in the effect of the presented interventions on other components of life habits was not significant at 0.05. The collected results also revealed that except for health-promoting lifestyle (F2,56=5.79, P<0.05) the difference between the effect of these treatment approaches on other components of health-promoting lifestyle at 0.05 were not significant. The mean scores of lifestyle responsibility in individuals participating in group ACT have increased, compared to the group CBT in the posttest and follow-up stages. Furthermore, ACT was more effective than CBT in promoting the study participants’ responsibility concerning health.
4. Discussion and Conclusion
Considering the significant effect of group-based ACT and CBT, it is suggested that these methods be applied to improve mental health in obese individuals. The obtained data respecting the efficacy of ACT on lifestyle habits in the explored obese females, highlight various aspects of this approach. It is believed that thoughts are products of a healthy mind. Subsequently, individuals’ fusion with the contents of thoughts transforms thoughts into beliefs [39]. When an individual experiences fusion with a content of a thought (e.g. I cannot avoid eating when everyone else is eating near me.) and acts upon that, eating practice is combined with the relevant thoughts, leading to binge eating. ACT, by defusion methods, assists clients to not inflexibly surrender to their thoughts; instead, it helps them find more effective coping strategies with the directly experienced world. As a result, ACT provided greater efficacy in lifestyle changes among obese females, compared to CBT.
There existed no significant difference between group-based ACT and CBT concerning eating behaviors in obese females. By direct training, ACT initially facilitates positive attitudes to thoughts and emotions related to body image-induced avoidance. Then, using mindfulness-based practices, facilitates change in the daily living activities, and lifestyle, leading to the generation of adoptable coping styles to control disordered eating behaviors [25].

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Research Ethics Committee of Islamic Azad University, Karaj Branch (Code: IR.IAU.K.REC.1398.039). All ethical principles are considered in this article. The participants were informed about the purpose of the research and its implementation stages. They were also assured about the confidentiality of their information and were free to leave the study whenever they wished, and if desired, the research results would be available to them.

Funding
This article was extracted from the PhD. dissertation of the first author at the Department of Psychology, Faculty of Psychology and Educational Sciences, Islamic Azad University, Karaj Branch. 

Authors' contributions
All authors equally contributed to preparing this article.

Conflicts of interest
The authors declared no conflict of interest.

Acknowledgements
The authors would like to thank the Vice-Chancellor for Research of the Islamic Azad University, Karaj Branch.
 

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