An Eight-Week Mindful Eating Program Applied in a Mediterranean Population With Overweight or Obesity: The EATT Intervention Study

'Surgery is my only hope': A qualitative study exploring perceptions of living with obesity and the prospect of having bariatric surgery

The health benefits of bariatric surgery are well documented; however, the occurrence of weight-regain after surgery, along with the development of mental health difficulties poses a question of how contemporary psychology could assist to prepare people living with obesity prior to undergoing bariatric surgery. This research explored individuals' (in the immediate pre-operative and post-operative population) attitudes, beliefs and experiences towards obesity and their journey to bariatric surgery. Seventeen adult participants (males n = 4; age range: 26-64 years) were recruited and participated in a semi-structured interview. Twelve individuals participated prior to undergoing bariatric surgery. Five individuals participated in the early post-operative period (<3 months post-surgery). People living with obesity displayed high optimism for positive outcomes, with participants hoping that bariatric surgery would be different to previous attempts at weight regulation, with there being a clear shift in the locus of control for weight management from self to healthcare professionals. Whilst this is adaptive, there was the presence of seemingly unrealistic optimism, with many pre-surgery participants not relaying the realistic possibility of post-surgery weight-regain. Despite the optimism individuals feel about bariatric surgery, participants felt that the psychological factors influencing eating behaviours are not being addressed by healthcare. These findings suggest that mindfulness, mindful eating, and self-compassion approaches should be incorporated into clinical practice to support weight regulation and adaption to physiological changes after bariatric surgery.

Does controlling for epicurean eating or the tendency to supersize food portions change the relationship between mindful eating and grazing?

The study examines the potential for Epicurean eating to offer fresh perspectives on the predictive value of mindful eating. This research seeks to ascertain whether accounting for Epicurean eating (or its antithesis, supersizing), could influence the previously identified negative relationship between mindful eating and grazing habits. In a cross-sectional study, 419 participants completed questionnaires on epicurean eating, grazing, and mindful eating. The findings suggested mindful eating and epicurean eating were significantly associated with grazing, with both variables accounting for a significant amount of variance in grazing. Further analysis of the mindful eating subscales showed that eating without distraction, eating with awareness, and hunger and satiety cues accounted for this association with grazing when epicurean eating was included. Finally, whilst eating without distraction, eating with awareness, and hunger and satiety cues were associated with grazing, preference for supersizing did not account for a significant amount of variance in the relationship with grazing. The complex interplay between grazing and mindful eating becomes more apparent when considering the influence of epicurean eating. Exploring cross-cultural factors through additional research could provide valuable insights into the dynamics of epicurean eating and grazing. Simultaneously, incorporating alternative mindful eating scales may yield a more nuanced interpretation of mindful eating. Collectively, these avenues of inquiry warrant further investigation. Limitations and future directions are discussed.

Meditation for the primary and secondary prevention of cardiovascular disease

BACKGROUND

Interventions incorporating meditation to address stress, anxiety, and depression, and improve self-management, are becoming popular for many health conditions. Stress is a risk factor for cardiovascular disease (CVD) and clusters with other modifiable behavioural risk factors, such as smoking. Meditation may therefore be a useful CVD prevention strategy.

OBJECTIVES

To determine the effectiveness of meditation, primarily mindfulness-based interventions (MBIs) and transcendental meditation (TM), for the primary and secondary prevention of CVD.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, three other databases, and two trials registers on 14 November 2021, together with reference checking, citation searching, and contact with study authors to identify additional studies.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) of 12 weeks or more in adults at high risk of CVD and those with established CVD. We explored four comparisons: MBIs versus active comparators (alternative interventions); MBIs versus non-active comparators (no intervention, wait list, usual care); TM versus active comparators; TM versus non-active comparators.

DATA COLLECTION AND ANALYSIS

We used standard Cochrane methods. Our primary outcomes were CVD clinical events (e.g. cardiovascular mortality), blood pressure, measures of psychological distress and well-being, and adverse events. Secondary outcomes included other CVD risk factors (e.g. blood lipid levels), quality of life, and coping abilities. We used GRADE to assess the certainty of evidence.

MAIN RESULTS

We included 81 RCTs (6971 participants), with most studies at unclear risk of bias. MBIs versus active comparators (29 RCTs, 2883 participants) Systolic (SBP) and diastolic (DBP) blood pressure were reported in six trials (388 participants) where heterogeneity was considerable (SBP: MD -6.08 mmHg, 95% CI -12.79 to 0.63, I2 = 88%; DBP: MD -5.18 mmHg, 95% CI -10.65 to 0.29, I2 = 91%; both outcomes based on low-certainty evidence). There was little or no effect of MBIs on anxiety (SMD -0.06 units, 95% CI -0.25 to 0.13; I2 = 0%; 9 trials, 438 participants; moderate-certainty evidence), or depression (SMD 0.08 units, 95% CI -0.08 to 0.24; I2 = 0%; 11 trials, 595 participants; moderate-certainty evidence). Perceived stress was reduced with MBIs (SMD -0.24 units, 95% CI -0.45 to -0.03; I2 = 0%; P = 0.03; 6 trials, 357 participants; moderate-certainty evidence). There was little to no effect on well-being (SMD -0.18 units, 95% CI -0.67 to 0.32; 1 trial, 63 participants; low-certainty evidence). There was little to no effect on smoking cessation (RR 1.45, 95% CI 0.78 to 2.68; I2 = 79%; 6 trials, 1087 participants; low-certainty evidence). None of the trials reported CVD clinical events or adverse events. MBIs versus non-active comparators (38 RCTs, 2905 participants) Clinical events were reported in one trial (110 participants), providing very low-certainty evidence (RR 0.94, 95% CI 0.37 to 2.42). SBP and DBP were reduced in nine trials (379 participants) but heterogeneity was substantial (SBP: MD -6.62 mmHg, 95% CI -13.15 to -0.1, I2 = 87%; DBP: MD -3.35 mmHg, 95% CI -5.86 to -0.85, I2 = 61%; both outcomes based on low-certainty evidence). There was low-certainty evidence of reductions in anxiety (SMD -0.78 units, 95% CI -1.09 to -0.41; I2 = 61%; 9 trials, 533 participants; low-certainty evidence), depression (SMD -0.66 units, 95% CI -0.91 to -0.41; I2 = 67%; 15 trials, 912 participants; low-certainty evidence) and perceived stress (SMD -0.59 units, 95% CI -0.89 to -0.29; I2 = 70%; 11 trials, 708 participants; low-certainty evidence) but heterogeneity was substantial. Well-being increased (SMD 0.5 units, 95% CI 0.09 to 0.91; I2 = 47%; 2 trials, 198 participants; moderate-certainty evidence). There was little to no effect on smoking cessation (RR 1.36, 95% CI 0.86 to 2.13; I2 = 0%; 2 trials, 453 participants; low-certainty evidence). One small study (18 participants) reported two adverse events in the MBI group, which were not regarded as serious by the study investigators (RR 5.0, 95% CI 0.27 to 91.52; low-certainty evidence). No subgroup effects were seen for SBP, DBP, anxiety, depression, or perceived stress by primary and secondary prevention. TM versus active comparators (8 RCTs, 830 participants) Clinical events were reported in one trial (201 participants) based on low-certainty evidence (RR 0.91, 95% CI 0.56 to 1.49). SBP was reduced (MD -2.33 mmHg, 95% CI -3.99 to -0.68; I2 = 2%; 8 trials, 774 participants; moderate-certainty evidence), with an uncertain effect on DBP (MD -1.15 mmHg, 95% CI -2.85 to 0.55; I2 = 53%; low-certainty evidence). There was little or no effect on anxiety (SMD 0.06 units, 95% CI -0.22 to 0.33; I2 = 0%; 3 trials, 200 participants; low-certainty evidence), depression (SMD -0.12 units, 95% CI -0.31 to 0.07; I2 = 0%; 5 trials, 421 participants; moderate-certainty evidence), or perceived stress (SMD 0.04 units, 95% CI -0.49 to 0.57; I2 = 70%; 3 trials, 194 participants; very low-certainty evidence). None of the trials reported adverse events or smoking rates. No subgroup effects were seen for SBP or DBP by primary and secondary prevention. TM versus non-active comparators (2 RCTs, 186 participants) Two trials (139 participants) reported blood pressure, where reductions were seen in SBP (MD -6.34 mmHg, 95% CI -9.86 to -2.81; I2 = 0%; low-certainty evidence) and DBP (MD -5.13 mmHg, 95% CI -9.07 to -1.19; I2 = 18%; very low-certainty evidence). One trial (112 participants) reported anxiety and depression and found reductions in both (anxiety SMD -0.71 units, 95% CI -1.09 to -0.32; depression SMD -0.48 units, 95% CI -0.86 to -0.11; low-certainty evidence). None of the trials reported CVD clinical events, adverse events, or smoking rates.

AUTHORS' CONCLUSIONS

Despite the large number of studies included in the review, heterogeneity was substantial for many of the outcomes, which reduced the certainty of our findings. We attempted to address this by presenting four main comparisons of MBIs or TM versus active or inactive comparators, and by subgroup analyses according to primary or secondary prevention, where there were sufficient studies. The majority of studies were small and there was unclear risk of bias for most domains. Overall, we found very little information on the effects of meditation on CVD clinical endpoints, and limited information on blood pressure and psychological outcomes, for people at risk of or with established CVD. This is a very active area of research as shown by the large number of ongoing studies, with some having been completed at the time of writing this review. The status of all ongoing studies will be formally assessed and incorporated in further updates.

Advancing the assessment of mindful eating: Exploring the psychometric properties and validating the mindful eating behaviour scale in English

Background: Mindful eating has been described as significant in motivating research and clinical outcomes in weight regulation and healthy eating. The use of psychometric tools to measure mindful eating is problematic, with results often leading to interpretations that are not reflective of mindful eating theory and fundamentals of mindfulness. Aim: In this research, we explored the Mindful Eating Behaviour Scale (MEBS) within a British sample to validate the factorial structure, and widen the use of a scale that appears appropriate for measuring mindful eating. Methods: A community sample (n = 742) was recruited via social media, and the findings supported the factorial structure proposed through the original Dutch sample. Predictive validity was also assessed, with the scale and subscales predicting fat and sugar consumption. Results: Cronbach's α values were acceptable and similar to the original findings, also supporting the internal consistency of the scale. Conclusion: While factorial structure, predictive validity and internal consistency propose a scale that can be adopted with English speaking populations, we propose the potential of furthering scientific inquiry on mindful eating research by highlighting the behavioural aspects of the scale.

Examining socio-cognitive factors and beliefs about mindful eating in healthy adults with differing practice experience: a cross-sectional study

Background

Mindful eating (ME), defined as a “non-judgmental awareness of bodily and emotional sensations regarding food consumption”, may be a promising strategy to promote healthy eating behaviors. However, little is known about the psychosocial factors and underlying beliefs that explain ME adoption.

Methods

Participants (N = 282; M_age = 43.2) responded to an online questionnaire based on the I-Change Model. Groups with different frequencies of prior engagement in ME, i.e., low (n = 82; LME), medium (n = 96), and high (n = 104), were compared via (M)ANOVAs on factors and individual beliefs regarding predisposing (i.e., habits, experience with mindfulness, emotional eating, facets of ME), pre-motivational (i.e., knowledge, behavioral cognizance, risk perception, cues to action), and motivational factors (i.e., attitudes, self-efficacy, social influence) as well as their intentions and action planning. Bivariate correlations and a forward-stepwise regression with ICM constructs were conducted to examine model fit.

Results

LME had a greater habit of mindless eating and significantly lower internal awareness, cognizance, cues, and less favorable attitudes, self-efficacy, engagement and support by their social environment, intention, and action plans about engaging in ME than the other two groups. Less habitual mindless eating, and greater experience, internal awareness, cognizance, susceptibility, support, and intention explained 54% of the variance in ME.

Discussion and conclusion

Results indicate that individuals need to be treated differently when promoting ME with respect to their psychosocial characteristics, rather than as a single group with homogenous baseline beliefs, abilities, support, and motivation. Future longitudinal research should examine which determinants are predictors of ME to better tailor program contents.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40359-022-00977-4.

Orthorexia nervosa, mindful eating, and perfectionism: an exploratory investigation

PURPOSE

Research has drawn associations between Mindful Eating (ME) and perfectionism in the aetiology and treatment of eating disorders (ED), but understanding into the relationship between these factors and Orthorexia nervosa (ON) is limited. The purpose of this research is to explore the relationship between perfectionism, ME, and ON.

METHOD

Participants (n = 670) completed the Düsseldorf Orthorexia scale, the Mindful Eating Behavior scale, and the Big-Three Perfectionism scale Short-form, to reveal the relationship between ON, ME, and perfectionism. The relationship was assessed using correlational and regression analyses.

RESULTS

A positive association was observed between perfectionism and ON. Moreover, perfectionism demonstrated a significant negative correlation with three out of four ME facets, with "eating without distraction" displaying the highest correlation. The "eating with awareness" facet of ME demonstrated a significant relationship with ON, in a negative direction. An unexpected relationship was observed between the focused eating facet of ME and ON, with a positive association being found. A further regression analysis revealed both perfectionism and ME to predict orthorexic tendencies.

CONCLUSION

These findings identify a relationship between ON, ME, and perfectionism. It offers suggestion for the complexity of ME, and how it should be recognised by its different components, estimating a differential predictability and estimation of ON. Further research is required to clarify the direction of causality in the relationships observed, to inform the clinical diagnoses and intervention of ON.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

The Challenges of Eating Well for People Living with Cystic Fibrosis: an Interview Study Exploring the Use of Mindful Eating Approaches and Behaviours to Support Optimal Nutritional Status

BACKGROUND

Nutritional status and weight are closely linked to lung function and health status in cystic fibrosis (CF). The investigation of eating behaviours has shown mindfulness practices to be useful in modifying eating behaviours, particularly with obesity; to date, no research specifically explores how these concepts may be utilised within a CF population who face specific challenges in eating behaviours.

METHOD

Adult patients (n = 20, M = 8, age range 21-62 years) were recruited from a UK CF regional centre to take part in qualitative semi-structured interviews. Experiences of eating behaviours focusing on the use of mindful (or mindless) eating as barriers and enablers to achieving and maintaining optimal nutritional status were explored. Data were analysed using thematic analysis with a contextualist approach to understand how participants experienced eating behaviours within the context of health and weight status.

RESULTS

Participants engaged readily in discussions of eating behaviour describing active self-regulation of food eaten and calorie intake. Participants who struggled to maintain weight employed strategies to increase calorie intake such as distraction and multitasking while eating. Most participants reported no pleasure in food, describing eating as another treatment to endure. Confusion existed around how to eat healthily for CF alongside co-morbid health conditions including diabetes, cholesterol and heart disease.

CONCLUSION

Participants were highly aware of their eating behaviours, engaging in intentional and deliberate preparations, which could be described as mindful, for making eating a more automatic or mindless activity. Modifications to usual mindful eating interventions are needed to support people with CF.