Healthy eating and sustainable nutrition through mindfulness? Mixed method results of a controlled intervention study

Psychological Theoretical Frameworks of Healthy and Sustainable Food Choices: A Systematic Review of the Literature

BACKGROUND

Non-sustainable diets are associated with several environmental and health-related problems. Psychology research is interested in the study of food choice determinants, and several theoretical frameworks have been applied to study mechanisms underlying behavioral change and to develop theory-based interventions. The present systematic review is aimed at reviewing the existing literature on the psychological theoretical frameworks used to study sustainable and/or healthy food choices and their application for the development of interventions promoting such food choices, both in general and clinical populations.

METHODS

A systematic search of PubMed, PsycInfo, and Scopus was conducted according to PRISMA criteria.

RESULTS

Forty-five articles met the inclusion criteria and thirty-five theoretical frameworks emerged, mostly pertaining to social psychology and with the most widely used being the Theory of Planned Behavior. The majority of studies had a cross-sectional design, were conducted in general populations, and focused on healthy food choices. Only a few studies tested theory-based interventions. Internal (i.e., self-efficacy, personal values, and motivation) and external (i.e., peers, family, and social media influence) factors emerged as relevant healthy and sustainable eating determinants.

CONCLUSIONS

The current review underlines that an integrative perspective combining prompts from different psychology fields is needed in order to identify the psychological factors influencing food choices and to develop psychological interventions for the promotion of more sustainable diets.

The Associations between Depression and Sugar Consumption Are Mediated by Emotional Eating and Craving Control in Multi-Ethnic Young Adults

BACKGROUND/OBJECTIVES

Individuals with mental health conditions such as depression are vulnerable to poor dietary habits, potentially due to the maladaptive eating behaviors often used to regulate negative emotion. However, the specific dietary components most associated with depression, as well as the mediating roles of emotion regulation and other eating behaviors, remains ambiguous in young adults.

METHODS

For this cross-sectional evaluation, a total of 151 (86 F, 65 M; BMI: 22.0 ± 5.1 kg/m2; age: 21.4 ± 2.5 y) multi-ethnic participants (50 White, 36 Black, 60 Asian, and 5 White Hispanic) completed a digital 24-h dietary recall and self-reported measures of depressive symptoms, emotional regulation, and eating behaviors. LASSO regression was used to identify the dietary variables most associated with each subscale and to remove extraneous dietary variables, and multiple regression and mediation analyses were conducted for the remaining variables.

RESULTS

Out of >100 dietary factors included, only added sugar in the combined sample (p = 0.043), and relative sugar in females (p = 0.045), were retained and positively associated with depressive symptoms. However, the relationships between depression and added and relative sugar intake were mediated by craving control and emotional eating, respectively. Individuals with higher added sugar intake (p = 0.012-0.037), and females with higher relative sugar intake (p = 0.029-0.033), had significantly higher odds of risk for major depression disorder and the use of mental health medications.

CONCLUSIONS

Added and relative sugar intake are significantly associated with depressive symptoms in young adults, but these relationships may be mediated by facets of emotional dysregulation, such as emotional eating and craving control.

Consistency between definitions and measurement of mindfulness in eating and physical activity behavior: a scoping review

Mindfulness (i.e., relating to one's internal and external awareness with non-evaluative attitudes) is increasingly applied as a determinant and strategy to change dietary and physical activity behaviours in the general adult population. However, current applications of mindfulness lack methodological standardisation, thereby limiting its comparison. The aim of this study was to examine currently applied conceptual definitions of mindfulness regarding their elements, their measurement, and the consistency between the defined elements and their measurement.Using scoping review methodology, we searched PubMed, PsycINFO, and Web of Science databases for peer-reviewed literature. Definitions were analyzed using an inductive content analysis approach. Consistency between defined elements and measurement was scored on an index. Across 57 records, less than half defined mindfulness as specific to a disposition, state, or action. One third described mindfulness as an attentional process without attitudinal elements. An additional 30% mentioned non-judgment as the singular attitudinal element underlying mindfulness. Empirical articles (n = 45) predominantly assessed dispositional mindfulness as a single score and frequently lacked measurement of defined attitudinal elements or measured elements that were not defined. To advance the systematic investigation of mindfulness, we present a conceptual model describing the measurement selection based on explicitly defined attentional and attitudinal mindfulness elements.

Can mindfulness-based training impact explicit and implicit attitudes and sustainable nutrition behavior? A focus on vegetarianism

OBJECTIVES

The aim of this study was to investigate the impact of a mindfulness intervention (IG) compared to an inactive control group (CG) on explicit and implicit attitudes toward vegetarian and meat-based foods, nutrition behavior measures, trait mindfulness and wellbeing.

METHODS

In the IG (N = 66), we implemented a mindfulness-based intervention consisting of eight weekly group sessions online, along with an additional half-day session held on campus. The CG (N = 71) received no intervention or training. We employed a pre-/post-intervention design involving questionnaires (trait mindfulness, wellbeing, sustainable nutrition behavior scale), an online supermarket scenario, as well as an explicit rating task and an implicit association task using pictures of vegetarian and meat-based foods. Additionally, a voluntary follow-up testing was conducted two months after the final group session.

RESULTS

No intervention effects were observed on explicit and implicit attitudes, wellbeing, or nutrition behavior measures. However, there was an increase in trait mindfulness within the IG. Exploratory cross-sectional findings indicated that trait mindfulness facets such as "Acting with Awareness" and "Outer Awareness", along with explicit attitudes, were significant predictors of self-reported sustainable consumption behavior. Additionally, sex and explicit attitudes were identified as significant predictors of vegetarian consumption behavior in the online supermarket task.

CONCLUSION

Our findings could not substantiate previous claims regarding the potential causal effects of mindfulness practice on sustainable consumption behavior, specifically in the realm of sustainable and vegetarian nutrition, as well as subjective wellbeing. Future studies may benefit from implementing longer-term mindfulness-based interventions and considering other potential decisive factors, such as connectedness to nature and others. Integrating training elements focusing on these specific variables into the intervention could be valuable.

Adapted Mindfulness Training for Interoception and Adherence to the DASH Diet: A Phase 2 Randomized Clinical Trial

Importance

Hypertension is a major cause of cardiovascular disease, and although the Dietary Approaches to Stop Hypertension (DASH) diet lowers blood pressure (BP), adherence is typically low. Mindfulness training adapted to improving health behaviors that lower BP could improve DASH adherence, in part through improved interoceptive awareness relevant to dietary consumption.

Objective

To evaluate the effects of the Mindfulness-Based Blood Pressure Reduction (MB-BP) program on interoceptive awareness and DASH adherence.

Design, Setting, and Participants

Parallel-group, phase 2, sequentially preregistered randomized clinical trials were conducted from June 1, 2017, to November 30, 2020. Follow-up was 6 months. Participants with elevated unattended office BP (≥120/80 mm Hg) were recruited from the population near Providence, Rhode Island. Of 348 participants assessed for eligibility, 67 did not meet inclusion criteria, 17 declined, and 63 did not enroll prior to study end date. In total, 201 participants were randomly assigned, 101 to the MB-BP program and 100 to the enhanced usual care control group, with 24 (11.9%) unavailable for follow-up. Outcome assessors and the data analyst were blinded to group allocation. Analyses were performed using intention-to-treat principles from June 1, 2022, to August 30, 2023.

Interventions

The 8-week MB-BP program was adapted for elevated BP, including personalized feedback, education, and mindfulness training directed to hypertension risk factors. Both MB-BP and control groups received home BP monitoring devices with instructions and options for referral to primary care physicians. The control group also received educational brochures on controlling high BP.

Main Outcomes and Measures

The primary outcome was Multidimensional Assessment of Interoceptive Awareness (MAIA) questionnaire scores (range 0-5, with higher scores indicating greater interoceptive awareness), and the secondary outcome was DASH adherence scores assessed via a 163-item Food Frequency Questionnaire (range 0-11, with higher scores indicating improved DASH adherence), all compared using regression analyses.

Results

Among 201 participants, 118 (58.7%) were female, 163 (81.1%) were non-Hispanic White, and the mean (SD) age was 60.0 (12.2) years. The MB-BP program increased the MAIA score by 0.54 points (95% CI, 0.35-0.74 points; P < .001; Cohen d = 0.45) at 6 months vs control. In participants with poor baseline DASH adherence, the MB-BP program also significantly increased the DASH score by 0.62 points (95% CI, 0.13-1.11 points; P = .01; Cohen d = 0.71) at 6 months vs controls. The intervention was also associated with a 0.34-point improvement in the DASH diet score in all MB-BP participants from baseline (95% CI, 0.09-0.59 points; P = .01; Cohen d = 0.27), while the control group showed a -0.04 point change in DASH diet score from baseline to 6 months (95% CI, -0.31 to 0.24 points; P = .78; Cohen d = -0.03).

Conclusions and Relevance

A mindfulness program adapted to improving health behaviors to lower BP improved interoceptive awareness and DASH adherence. The MB-BP program could support DASH dietary adherence in adults with elevated BP.

Clinical Trial Registration

ClinicalTrials.gov Identifiers: NCT03859076 and NCT03256890.

Survivors Overcoming and Achieving Resiliency (SOAR): Mindful Eating Practice for Breast Cancer Survivors in a Virtual Teaching Kitchen

The practice of mindful eating brings awareness to food choices, brings attention to the eating experience, and encourages selecting and preparing food that is both satisfying and nourishing. We examined mindful eating in breast cancer survivors following a 9-week, multidisciplinary virtual teaching kitchen intervention called Survivors Overcoming and Achieving Resiliency (SOAR). SOAR engaged participants through weekly cooking classes that also taught multiple domains of mindfulness. Participants (n = 102) were breast cancer survivors and completed the Mindful Eating Questionnaire (MEQ) prior to and after completion of the intervention. Linear regression analyses examined relationships between the aspects of mindful eating and body mass index (BMI). Wilcoxon (paired) rank sum tests evaluated the significance of the change in the MEQ total sum and subscales scores. A total of 102 participants completed both the pre- and post-intervention surveys. The mean change between the pre- and post-SOAR MEQ summary scores was 0.12 (sd = 0.30; Wilcoxon p-value = 0.0003). All MEQ subscale scores significantly increased with the exception of the distraction subscale. The MEQ summary scores increased for participants across both BMI stratifications. The SOAR teaching kitchen represents one of the first interventions that is tailored for breast cancer survivors and combines behavioral strategies from mindful eating training to nutritional knowledge and culinary medicine pedagogy in a virtual teaching kitchen. Further research is needed to examine whether mindful eating practices among cancer survivors result in sustainable healthy eating behaviors and food choices consistent with the cancer risk reduction guidelines.

Effects of Adapted Mindfulness Training on Interoception and Adherence to the Dietary Approaches to Stop Hypertension (DASH) Diet: The MB-BP Randomized Clinical Trial

Background

Hypertension is a major cause of cardiovascular disease. The Dietary Approaches to Stop Hypertension (DASH) diet lowers blood pressure (BP). However, adherence is typically low. Mindfulness training adapted to improving health behaviors that lower BP could improve DASH adherence, in part through improved interoceptive awareness relevant to dietary consumption. The primary objective of the MB-BP trial was to evaluate effects of the Mindfulness-Based Blood Pressure Reduction (MB-BP) program on interoceptive awareness. Secondary objectives assessed whether MB-BP impacts DASH adherence, and explored whether interoceptive awareness mediates DASH dietary changes.

Methods

Parallel-group phase 2 randomized clinical trial conducted from June 2017-November 2020 with 6 months follow-up. Data analyst was blinded to group allocation. Participants had elevated unattended office BP (≥120/80 mmHg). We randomized 201 participants to MB-BP (n=101) or enhanced usual care control (n=100). Loss-to-follow-up was 11.9%. Outcomes were the Multidimensional Assessment of Interoceptive Awareness (MAIA; range 0-5) score, and the DASH adherence score (range 0-11) assessed via a 163-item Food Frequency Questionnaire.

Results

Participants were 58.7% female, 81.1% non-Hispanic white, with mean age 59.5 years. Regression analyses demonstrated that MB-BP increased the MAIA score by 0.54 (95% CI: 0.35,0.74; p<.0001) at 6 months follow-up vs. control. MB-BP increased the DASH score by 0.62 (95% CI: 0.13,1.11; p=0.01) at 6 months vs. control, in participants with poor DASH adherence at baseline.

Conclusions

A mindfulness training program adapted to improving health behaviors that lower BP improved interoceptive awareness and DASH adherence. MB-BP could support DASH dietary adherence in adults with elevated BP.

Clinical Trial Registration

Clinicaltrials.gov identifier NCT03859076 (https://clinicaltrials.gov/ct2/show/NCT03859076; MAIA) and NCT03256890 (https://clinicaltrials.gov/ct2/show/NCT03256890; DASH diet adherence).

Heartfulness in Vegans, Vegetarians, and Omnivores

BACKGROUND

The primary goal of this study was to investigate the relation between the choice of a vegan or vegetarian diet as a criterion of sustainability and the aspect of heartfulness. We also analyzed which demographic, diet-related, and mindfulness practice-related variables could predict the different facets of heartfulness.

METHODS

In total, 419 persons participated. After providing demographic, diet-related, and mindfulness practice-related information, participants completed a gratitude questionnaire, a self-compassion scale, a compassion scale, and an equanimity scale.

RESULTS

The results show that vegans and vegetarians indicated higher scores than omnivores in some aspects of heartfulness, such as both self-compassion scales. These effects could not be shown for the two equanimity scales and for the gratitude questionnaire. Most aspects of heartfulness could either be predicted by demographic or diet-related variables. The best predictors of the elements of heartfulness were the ecological, ethical, or health-related reasons for choosing their diet stated by the participants, as well as the importance the participants attached to nutrition.

CONCLUSION

This study provides evidence that vegans and vegetarians scored higher in several aspects of heartfulness. Vegans tended to score even higher than vegetarians. Both demographic and diet-related variables could predict heartfulness.

Fostering collective climate action and leadership: Insights from a pilot experiment involving mindfulness and compassion

Recent research suggests that mindfulness, compassion, and self-compassion relate to inner transformative qualities/capacities and intermediary factors that can support increased pro-environmental behavior and attitudes across individual, collective, organizational, and system levels. However, current insights focus on the individual level, are restricted to certain sustainability fields, and wider experimental evidence is scarce and contradictory. Our pilot study addresses this gap and tests the aforementioned proposition in the context of an intervention: an EU Climate Leadership Program for high-level decision-makers. The intervention was found to have significant effects on transformative qualities/capacities, intermediary factors, and pro-environmental behaviors and engagement across all levels. The picture is, however, more complex for pro-environmental attitudes. With due limitations (e.g., small sample size), this preliminary evidence confirms the feasibility and potential of mindfulness- and compassion-based interventions to foster inner-outer transformation for sustainability and climate action. Aspects that should be taken into account in larger confirmatory trials are discussed.

Screen use during food consumption: Does it cause increased food intake? A systematic review

Nowadays people use screens, such as mobile phones, television, or tablets, more often during mealtimes, which may have an effect on intake. This review aims to analyze the effect of screen use, during food consumption, on intake. A systematic review was carried out, based on those protocols established by PRISMA. The Cochrane Library, PubMed, Web of Science and Scopus databases were consulted. Experimental studies, published between 2010 and 2021, that recorded individual intake while using screens such as television, cell phones, or tablets, were selected. A total of 7181 relevant articles were obtained, which were then assessed in accordance with predetermined inclusion and exclusion criteria. Finally, 35 studies were included in the complete review: 22 compared different kinds of television content (e.g., adverts), five which compared television versus the absence of screens, four which compared television versus video games, two which compared the use of simultaneous screens, and two studies which included cell phones. A total of 27 studies reported consumption increases related to the presence of advertisements and food signals on screens. No significant differences in intake were reported in the eight studies that reported design or sample size limitations, or lack of control of certain variables. It is thus concluded that screen use during food consumption may increase intake. Education is necessary to regulate the habit of consuming food in the presence of screens. Also, the creation of policies that regulate advertising and food cues on screens are justified and must be accompanied by strategies to monitor compliance. As a limitation, further evidence is necessary in order to determine the effect of mobile phone and tablet use while eating. This protocol was registered via PROSPERO, ID: CRD42020211797.

Sustainable Food Support during an Ultra-Endurance and Mindfulness Event: A Case Study in Spain

The present industrial food-production system is not suitably ecological for the environment. Mindful nutrition in sport is a relevant emergent sub-discipline that could help reduce environmental degradation. This case study describes a sustainable support diet during an ultra-endurance running (UR) event called the "Indoor Everest Challenge". This UR challenge involved attaining the altitude of Mount Everest (8849 m) in a simulated way, in less than 24 h, without using ultra-processed food and without wasting plastics. During this challenge, a male athlete (34 years, weight: 78 kg, and height: 173 cm) wore a SenseWear Armband® (BodyMedia Inc., Pittsburg, PA, USA) accelerometer on his right arm to estimate energy expenditure. To supply his nutritional requirements, the athlete consumed only specially prepared homemade and organic food. All consumption was weighed and recorded in real-time; we determined nutrients using two databases: a food composition software, Dial Alce Ingenieria® (Madrid, Spain), to measure energy and macro- and micro-nutrients, and Phenol Explorer Database® (INRA Institut National de Recherche pour l'Alimentation, Paris, France) precisely to determine polyphenolic content. Most energy intake (up to 96%) came from plant foods. We found that subject consumed 15.8 g/kg-1/d-1 or 1242 g of carbohydrates (CHO), (2.4 g/kg-1/d-1) or 190 g of proteins (P), and 10,692 mL of fluid. The total energy intake (7580 kcal) showed a distribution of 65% CHO, 10% P, and 25% lipids (L). Furthermore, this sustainable diet lead to a high antioxidant intake, specifically vitamin C (1079 mg), vitamin E (57 mg), and total polyphenols (1910 mg). This sustainable approach was suitable for meeting energy, CHO, and P recommendations for UR. Physical and mental training (mindfulness) were integrated from the specific preliminary phase to the day of the challenge. The athlete completed this challenge in 18 h with a low environmental impact. This sports event had an educational component, as it awakened curiosity towards food sustainability.

Development and validation of the Expanded Mindful Eating Scale

PURPOSE

To develop and validate the Expanded Mindful Eating Scale (EMES), an expanded mindful eating model created for the promotion of health and sustainability.

DESIGN/METHODOLOGY/APPROACH

A cross-sectional study using self-administered questionnaire surveys on Ochanomizu Health Study (OHS) was conducted. The survey was provided to 1,388 female university students in Tokyo, Japan. Exploratory factor analysis (EFA), confirmatory factor analysis (CFA) and a partial correlation analysis were used to confirm construct and criterion validity. Internal consistency of the EMES was confirmed to calculate Cronbach's alpha.

FINDINGS

The response rate was 38.7 % (n = 537). Mean BMI was 20.21 ± 2.12, and 18.8% of them were classified as "lean" (BMI < 18.5). The authors listed 25 items and obtained a final factor structure of five factors and 20 items, as a result of EFA. Through CFA, the authors obtained the following fit indices for a final model: GFI = 0.914, AGFI = 0.890, CFI = 0.870 and RMSEA = 0.061. The total EMES score was significantly correlated with BMI, mindfulness, body dissatisfaction, drive for thinness and life satisfaction (r = -0.138, -0.315, -0.339, -0.281 and 0.149, p < 0.01, respectively). Cronbach's alpha for all items in this scale was 0.687.

PRACTICAL IMPLICATIONS

The authors suggest the possibility that practitioners and researchers of mindful eating that includes this new concept can use authors' novel scale as an effective measurement tool.

ORIGINALITY/VALUE

The EMES, which can multidimensionally measure the concept of the expanded model of mindful eating was first developed in this study.

Practice Matters: Pro-environmental Motivations and Diet-Related Impact Vary With Meditation Experience

Mindfulness has emerged as a potential motivator for sustainable lifestyles, yet few studies provide insight into the relationship between mindfulness practice levels and individual engagement in pro-environmental behaviors. We also lack information about the significance of meditators' behavioral differences in terms of their measurable environmental impact and the motivational processes underlying these differences in pro-environmental performance. We classified 300 individuals in three groups with varying meditation experience and compared their pro-environmental motivations and levels of animal protein consumption. Exceeding prior attempts to compare high-impact behaviors of mindfulness practitioners and non-practitioners, we created the most detailed classification of practice engagement by assessing frequency, experience and type of meditation practice. This nuanced view on mindfulness practice reveals that advanced meditators, who reported high levels of connectedness with nature (CWN), subjective happiness and dispositional mindfulness showed significantly more concern for the environment. They also demonstrated the lowest levels of greenhouse gas emissions, land occupation and water use related to their animal-protein consumption. This study is the first to follow a self-determination theory perspective to deepen our understanding of the motivational differences between meditator groups. We revealed that advanced meditators reported significantly more integrated motivation toward the environment than non-meditators. We also provided preliminary evidence for a new theoretical framework suggesting that experiential strategies such as mindfulness practices could strengthen the relational pathway of pro-environmental behaviors. Using sequential mediation analysis, we confirmed that the negative effect of mindful compassion practice on greenhouse gas emissions from animal-protein consumption is partially mediated by CWN and integrated motivation toward the environment. While our study does not support assumptions of causality, it shows that much can be learned by studying the motivations of advanced meditators for maintaining high levels of pro-environmental behavior.

The Way Forward in Mindfulness and Sustainability: a Critical Review and Research Agenda

The ecological crisis demands new strategies to rapidly transform our society into a more sustainable one. A growing amount of research points towards the potential of mindfulness to help transform people’s motivations for sustainability. This article reviews 30 years of research in mindfulness and sustainability and disentangles theoretical knowledge from empirical evidence. We identified six leading theoretical links between mindfulness and sustainability which find backing in empirical work: reduced automaticity, enhanced health and subjective well-being, greater connectedness with nature, improved pro-sociality, recognition of intrinsic values and openness to new experiences. Many of the studies involve considerable methodological caveats, most importantly a lack of mindfulness practice indicators and environmental impact measures. To reach the point where policy makers could embrace mindfulness-based policies to promote societal well-being and sustainability, the research must go beyond the present focus on correlative research. The proof of causality posits the greatest challenge for the next decade of research. Inspired by principles from policy evaluation, we propose a research agenda that offers direction for collaborative efforts and innovative interdisciplinary study designs in a logical model: (how) does the practice of mindfulness contribute to individual behaviour change and (how) does this individual change translate into societal change?