A mindful eating group as an adjunct to individual treatment for eating disorders: a pilot study

Using clinician and patient input to assess utility, accuracy, efficiency, and therapeutic implementation of a new data-driven digital therapeutic for personalized clinical eating disorder treatment: Awaken digital guide

OBJECTIVE

Eating disorders (EDs) take a life every 52 minutes and treatments are ineffective for ∼50% of individuals. Though EDs are heterogeneous illnesses, current evidence-based treatments take a "one-size-fits-all" approach. Network-Informed Personalized Treatment is a new promising treatment for EDs, but clinician-patient-friendly software tools are needed to integrate this guidance system into routine treatment. Adoption is key for impact, necessitating the inclusion of clinicians in the software development. The current pilot assessed a new data-driven clinician-guidance therapeutic.

METHOD

A two-part pilot was analyzed for quantitative (0-not at all to 10-extremely) and qualitative input on user perception through quantitative and open-ended prompted questions evaluating using personalizing ED treatment with the Awaken Digital Guide therapeutic.

RESULTS

Results demonstrated that clinicians in a focus group (N = 9) and clinician/patient dyads within implementation (N = 10) endorsed improved efficiency, effectiveness, self-awareness, and accuracy using Awaken Digital Guide compared to current treatment as suggested by quantitative and qualitative results. Both clinicians and patients rated the tool positively (6.8-9.6/5.8-8.6, respectively) with an average rating of good and excellent.

CONCLUSION

Findings suggest that ED-specialized clinicians desire data-driven guidance on personalizing ED treatment. Users perceive Awaken Digital Guide therapeutic with potential to increase collaboration, motivation, efficiency, and effectiveness of ED personalized treatment.

Evidence-Based Assessments for Transdiagnostic Eating Disorder Symptoms: Guidelines for Current Use and Future Directions

Eating disorders are severe and often chronic mental illnesses that are associated with high impairment and mortality rates. Recent estimates suggest that eating disorder prevalence rates are on the rise, indicating an increased need for accurate assessment and detection. The current review provides an overview of transdiagnostic eating disorder assessments, including interview, self-report, health and primary care screeners, and technology-based and objective assessments. We focused on assessments that are transdiagnostic in nature and exhibit high impact in the field. We provide recommendations for how these assessments should be used in research and clinical settings. We also discuss considerations that are crucial for assessment, including the use of a categorical versus dimensional diagnostic framework, assessment of eating disorders in related fields (i.e., anxiety and depression), and measurement-based care for eating disorders. Finally, we provide suggestions for future research, including the need for more research on short transdiagnostic screeners for use in health care settings, standardized assessments for ecological momentary assessment, development of state-based assessment of eating disorder symptoms, and consideration of assessment across multiple timescales.

Self-Compassion, Mindful Eating, Eating Attitudes and Wellbeing Among Emerging Adults

Mindful eating behavior and self-compassion have been individually shown to contribute to healthy eating. Evidence suggests that they may interact and that interaction may increase our understanding of eating behavior. The aim of the current study was to explore the relationship between mindful eating behavior, self-compassion, healthy/unhealthy weight, eating disorder and wellbeing in a sample of university students. An online survey using questionnaire data collection in a sample of 349 students (105 males and 244 females). Variables measured included body mass index (BMI), mindful eating behavior, eating attitudes, self-compassion and mental wellbeing. Regression and path analysis show mindful eating behavior and self-compassion to individually and interaction predict eating attitudes and wellbeing. BMI was shown to have a curvilinear relationship with mindful eating behavior, self-compassion and wellbeing with both the underweight and obese reporting lower self-compassion, less Mindful eating behavior, lower wellbeing and more likely to exhibit disordered eating. These results indicate that self-compassion and mindful eating behavior might be usefully targeted in interventions to prevent both obesity and eating disorder.

Understanding training needs in eating disorders of graduating and new graduate dietitians in Australia: an online survey

BACKGROUND

Following recent reforms by the Australian Government to the Medicare Benefits Schedule, people living with a diagnosed eating disorder (ED) in Australia have greater access to dietetic services. However, new graduate dietitians anecdotally lack confidence to provide appropriate interventions to support patients with an ED. Therefore, this cross-sectional study aims to explore the perceived confidence, and educational and professional development needs of student dietitians and new graduate dietitians in the area of EDs.

METHODS

An online survey with 17 questions was designed, consisting of a combination of discrete (yes/no) questions, free text, ordered scales and 5-point Likert scales. Student dietitians, and first- and second- year graduates (n = 1456) were approached via email as potential participants, from the professional organisation Dietitians Australia member list. Survey data was analysed using descriptive statistics and odds ratios.

RESULTS

In total, 150 surveys were completed, with a response rate of 10.3%. Respondents reported a lack of confidence in managing patients with an ED and implementing ED treatment approaches (81 and 95%, respectively). However, participants previously exposed to patients with an ED, such as anorexia nervosa, were 4.7 times (95% CI 1.72, 12.97) more likely to be confident compared to those not exposed to patients with an ED. The majority of respondents (37%) stated they would seek assistance from other dietitians, and develop their skills via online webinars (27%) and workshops (25%).

CONCLUSIONS

This survey identified that final year dietetics students and new graduate dietitians perceive lower levels of confidence to practice in the area of EDs. The desire for further ED-specific training and education was reported.

Comparison of mindful and slow eating strategies on acute energy intake

Mindfulness and slow eating techniques are commonly recommended to achieve weight loss within behavioural weight management programmes; yet the role of these eating strategies on acute energy intake (EI) and satiety are not clear. This study investigated the effects of mindful and slow eating strategies on acute EI and satiety. Twenty-four participants were randomized to one of three eating conditions (EAT, MIND, SLOW). For the EAT condition, participants were instructed to eat as they normally would for both test meal sessions. For the SLOW condition, participants were instructed to eat as they normally would for their first test meal session and to slow their eating for the second test meal session. For the MIND condition, participants were instructed to eat as they normally would during their first test meal session and were given brief instructions on mindful eating for their second test meal session. For each condition, participants were provided ad libitum access to a test meal, and EI was calculated based upon food consumed. Participants rated their level of satiety following each meal. There were no significant differences in EI between eating strategy conditions. There was a trend towards a decrease in energy intake in the MIND condition compared with the EAT condition and a prevention of increased intake in the SLOW condition. There were no significant differences in ratings of satiety between conditions. Although, neither mindful nor slow eating strategies significantly decreased acute EI or satiety; the results suggest that both strategies blunted the increase in EI observed in EAT that occurred across two eating episodes, which may suggest that these strategies can be important for modifying eating behaviour that may contribute to body weight regulation. Additional appropriately designed studies investigating these strategies appear warranted to confirm these findings.

Mindfulness and eating disorder psychopathology: A meta-analysis

OBJECTIVE

Mindfulness is implicated in eating disorder (ED) psychopathology. However, this literature has not been synthesized to date. The current meta-analysis examined the associations between mindfulness and ED psychopathology.

METHODS

A total of 74 independent samples (effects = 576) were included. We used a multilevel random-effects model to estimate summary study-level effect sizes, and multilevel mixed-effects models to examine moderator effects.

RESULTS

Mindfulness was negatively associated with ED psychopathology (r = -.25, p < .001), both concurrently (r = -.25, p < .001) and prospectively (rs = -.22 to -.24, ps < .001). Associations were strongest for binge eating, emotional/external eating, and body dissatisfaction as well as the acting with awareness and nonjudging facets.

DISCUSSION

Mindfulness may be an important process in ED psychopathology. Future research should prospectively and experimentally examine the relation between mindfulness and ED psychopathology.

Review of Mindfulness-Related Interventions to Modify Eating Behaviors in Adolescents

There are few well-established treatments for adolescent eating disorders, and for those that do exist, remission rates are reported to be between 30 and 40%. There is a need for the development and implementation of novel treatment approaches. Mindfulness approaches have shown improvements in eating disorder-related psychopathology in adults and have been suggested for adolescents. The present review identifies and summarizes studies that have used mindfulness approaches to modify eating behaviors and to treat eating disorders in adolescents. Focused searches were conducted in Embase, Medline, and PsycINFO, and identified articles were checked for relevance. A small number of studies (n = 15) were designated as appropriate for inclusion in the review. These studies were divided into those that focused on the promotion of healthy eating/the prevention of disordered eating (n = 5), those that concentrated on targeted prevention among high risk adolescents (n = 5), and those that focused on clinical eating disordered adolescents (n = 5). Thirteen of the 15 studies reviewed reported at least one positive association between mindfulness treatment techniques and reduced weight/shape concerns, dietary restraint, decreased body mass index (BMI), eating in the absence of hunger (EAH), binge eating, increased willingness to eat novel healthy foods, and reduced eating disorder psychopathology. In summary, incorporating mindfulness to modify eating behaviors in adolescent non-clinical and clinical samples is still in the early stages, with a lack of data showing clear evidence of acceptability and efficacy. Further studies and preferably controlled conditions are warranted.

Mechanisms and moderators in mindfulness- and acceptance-based treatments for binge eating spectrum disorders: A systematic review

OBJECTIVE

Increasing evidence suggests that mindfulness- and acceptance-based psychotherapies (MABTs) for bulimia nervosa (BN) and binge eating disorder (BED) may be efficacious; however, little is known about their active treatment components or for whom they may be most effective.

METHODS

We systematically identified clinical trials testing MABTs for BN or BED through PsychINFO and Google Scholar. Publications were categorized according to analyses of mechanisms of action and moderators of treatment outcome.

RESULTS

Thirty-nine publications met inclusion criteria. Twenty-seven included analyses of therapeutic mechanisms, and five examined moderators of treatment outcome. Changes were largely consistent with hypothesized mechanisms of MABTs, but substandard mediation analyses, inconsistent measurement tools, and infrequent use of mid-treatment assessment points limited our ability to make strong inferences.

DISCUSSION

Analyses of mechanisms of action and moderators of outcome in MABTs for BN and BED appear promising, but the use of more sophisticated statistical analyses and adequate replication is necessary.

Shared Concerns and Opportunity for Joint Action in Creating a Food Environment That Supports Health

The food industry is a for-profit industry with high relevance to universal eating disorders prevention. To date, policy which targets the food industry and food environment has been underutilized in efforts to decrease the incidence of eating disorders and associated risk factors. In contrast, food policy has been extensively leveraged with the aim of reducing the incidence of obesity. While philosophical misalignments with these later efforts may have constituted an obstacle to identifying the food environment as a key target for eating disorders prevention, food policy is an area where shared interests can be found. Specifically, a shared goal of obesity and eating disorders prevention efforts is creating a food environment that supports health, while minimizing the influence of the food industry that profits from the sale of highly palatable, processed foods and “diet” foods and from increasing portions of foods served and eaten.

Mindfulness in Anorexia Nervosa: An Integrated Review of the Literature

BACKGROUND

Anorexia nervosa is a serious psychiatric illness with limited evidenced-based treatment options. Mindfulness appears useful in many conditions, but few studies focus on its use in individuals with anorexia nervosa.

OBJECTIVE

To examine and summarize studies of mindfulness in individuals with anorexia nervosa and identify areas for future research.

DESIGN

An integrated review was conducted by searching health care computerized databases.

RESULTS

Results were mixed among the eight studies that met inclusion criteria. Multimodal mindfulness-based therapies appear effective, while brief interventions may be equally useful or result in greater anxiety compared to distraction. Qualitative data support that some participants feel mindfulness is challenging but beneficial.

CONCLUSION

Mindfulness as a concurrent part of therapy and/or when routinely practiced may be more clinically useful than single-episode mindful eating interventions. Due to the complexity of the concept of mindfulness and limited existing data, additional research is needed.

Video-Based Grocery Shopping Intervention Effect on Purchasing Behaviors Among Latina Shoppers

OBJECTIVES

To compare changes in food-purchasing knowledge, self-efficacy, and behavior after viewing nutrition education videos among Los Angeles, California Latinas responsible for household grocery shopping.

METHODS

From February to May 2015, a convenience sample of 113 Latinas watched 1 video (El Carrito Saludable) featuring MyPlate guidelines applied to grocery shopping (1-video intervention) and another convenience sample of 105 Latinas watched 2 videos (El Carrito Saludable and Ser Consciente), the latter featuring mindfulness to support attention and overcome distractions while grocery shopping (2-video intervention). We administered questionnaires before and after intervention. A preselected sample in each intervention condition (n = 72) completed questionnaires at 2-months after intervention and provided grocery receipts (before and 2-months after intervention).

RESULTS

Knowledge improved in both intervention groups (P < .001). The 2-video group improved more in self-efficacy and use of a shopping list (both P < .05) and purchased more healthy foods (d = 0.60; P < .05) at 2 months than did the 1-video group.

CONCLUSIONS

Culturally tailored videos that model food-purchasing behavior and mindfulness show promise for improving the quality of foods that Latinas bring into the home.

A qualitative analysis of participants' reflections on body image during participation in a randomized controlled trial of acceptance and commitment therapy

BACKGROUND

Negative body image is a risk factor for development and relapse in eating disorders (ED). Many patients continue to be dissatisfied with their body shape or weight after treatment. This study presents a qualitative analysis of written reflections on body image from patients with an ED and a negative body image before and after an Acceptance and Commitment Therapy group treatment at a specialized ED-unit.

METHOD

Before and after the treatment participants (n = 47) answered a questionnaire with open ended questions on their thoughts on body image. Data were analyzed through conventional content analysis.

RESULTS

Body image meant different things for different participants. For some it had to do with how you evaluate your body, whereas others focused on whether their body image was realistic or not. Some emphasized their relationship with their body, while some described body image as strongly related to global self-esteem. These different views on the concept of body image affected the participants' descriptions of their own body image, and how they wanted it to change. Body image was considered a state that fluctuated from day to day. After treatment the participants described changes in their body image, for instance perceiving oneself as less judgmental towards one's body, and a shift in focus to the important things in life.

CONCLUSIONS

The participants had different views on body image and how they wished it to change. Thus treatment interventions targeting negative body image needs to address various aspects of this complex construct.

TRIAL REGISTRATION

This study is part of an RCT registered 02/06/2014 in Clinical Trials, registration number: NCT02058121.

Mindfulness meditation as an intervention for binge eating, emotional eating, and weight loss: a systematic review

Mindfulness-based approaches are growing in popularity as interventions for disordered eating and weight loss. Initial research suggests that mindfulness meditation may be an effective intervention for binge eating; however, no systematic review has examined interventions where mindfulness meditation was the primary intervention and no review has examined its effect on subclinical disordered eating or weight. Using the PRISMA method for systematic reviews, we reviewed 14 studies that investigated mindfulness meditation as the primary intervention and assessed binge eating, emotional eating, and/or weight change. Results suggest that mindfulness meditation effectively decreases binge eating and emotional eating in populations engaging in this behavior; evidence for its effect on weight is mixed. Additional research is warranted to determine comparative effectiveness and long-term effects of mindfulness training.

A review of interventions that promote eating by internal cues

Traditional diet programs that encourage individuals to consciously restrict their dietary intake have not only been ineffective in terms of weight outcomes, but have also been counterproductive, promoting psychological distress and unhealthy eating behaviors. Nondiet approaches shift the focus away from weight outcomes to the improvement of health outcomes and psychological well-being. One such approach, intuitive eating, promotes dietary intake based on internal cues of hunger and fullness, body acceptance, and making behavior choices based on health as well as enjoyment. Several studies have implemented such ideas into intervention programs. The purpose of our review was to examine the physical and psychological effects of these programs. Twenty interventions were identified. Overall, studies had positive results, demonstrating improvements in eating habits, lifestyle, and body image as measured by dietary restraint, restrictive dieting, physical activity, body satisfaction, and drive for thinness. Participants also experienced improved psychological health as measured by depression, ineffectiveness, anxiety, self-esteem, negative affect, and quality of life. Several improvements were sustained through follow-up periods as long as 2 years. Completion rates were as high as 92% in nondieting groups. In addition, improvements in eating behaviors and maintaining a nondiet approach, increased self-esteem, and decreased body dissatisfaction were sustained long-term. Overall, studies that encourage individuals to eat intuitively help participants abandon unhealthy weight control behaviors, improve metabolic fitness, increase body satisfaction, and improve psychological distress. Results from our review favor the promotion of programs that emphasize a nonrestrictive pattern of eating, body acceptance, and health rather than weight loss.

A mindful eating group intervention for obese women: a mixed methods feasibility study

The purpose of this mixed methods study was to: 1) describe the effect of an 8-week mindful eating intervention on mindful eating, weight loss self-efficacy, depression, and biomarkers of weight in urban, underserved, obese women; and 2) identify themes of the lived experience of mindful eating. A convenience sample of 12 obese women was recruited with data collected at baseline and 8 weeks followed by a focus group. Only self-efficacy for weight loss significantly increased over 8 weeks (t=-2.63, P=.04). Qualitative findings of mindful eating supported quantitative findings and extended understanding about the effect of the intervention.

Rumination and modes of processing around meal times in women with anorexia nervosa: qualitative and quantitative results from a pilot study

OBJECTIVE

The primary aim of this exploratory study was to examine qualitatively and quantitatively the effects of rumination, mindful breathing, and distraction on processing styles and the meal time experience in women with a history of anorexia nervosa (AN).

METHOD

A quasi-experimental within-participant design was employed. Thirty-seven women with history of AN and all experiencing current eating disorder psychopathology listened to a single rumination, mindful breathing and distraction exercise before a meal time. Qualitative and quantitative analyses were employed.

RESULTS

Specific themes were extracted for each exercise including avoidance, being in the moment and rumination. The rumination exercise led to significantly greater analytical self-focus. Mindful breathing led to significantly greater experiential self-focus compared with distraction in partially weight-restored AN participants.

CONCLUSIONS

In AN, self-material is processed in a ruminative way and avoidance is valued. It is difficult to shift individuals with AN out of a rumination around meal times using brief mindful breathing. Future research should investigate at what stage of AN illness mindful-based and acceptance-based strategies are useful and how these strategies could be incorporated in treatment.

Adding mindfulness to CBT programs for binge eating: a mixed-methods evaluation

The current study investigated the effectiveness of a combined mindfulness-CBT group therapy program for women with binge eating problems. Questionnaires were completed by group participants pre-program (n = 30), post-program (n = 30) and 3 month follow-up (n = 28). Significant reductions between pre- and post-program scores were found on standardised measures assessing binge eating, dieting, and body image dissatisfaction, with all reductions maintained at follow-up. Qualitative interviews with 16 women following completion of the program revealed the value of mindfulness in improving eating behaviour through increased self-awareness. This exploratory study supports the value of adding mindfulness to the more commonly utilised CBT-based programs for binge eating.

Mindfulness Intervention for Stress Eating to Reduce Cortisol and Abdominal Fat among Overweight and Obese Women: An Exploratory Randomized Controlled Study

Psychological distress and elevated cortisol secretion promote abdominal fat, a feature of the Metabolic Syndrome. Effects of stress reduction interventions on abdominal fat are unknown. Forty-seven overweight/obese women (mean BMI = 31.2) were randomly assigned to a 4-month intervention or waitlist group to explore effects of a mindfulness program for stress eating. We assessed mindfulness, psychological distress, eating behavior, weight, cortisol awakening response (CAR), and abdominal fat (by dual-energy X-ray absorptiometry) pre- and posttreatment. Treatment participants improved in mindfulness, anxiety, and external-based eating compared to control participants. Groups did not differ on average CAR, weight, or abdominal fat over time. However, obese treatment participants showed significant reductions in CAR and maintained body weight, while obese control participants had stable CAR and gained weight. Improvements in mindfulness, chronic stress, and CAR were associated with reductions in abdominal fat. This proof of concept study suggests that mindfulness training shows promise for improving eating patterns and the CAR, which may reduce abdominal fat over time.