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Quinones D, Barrow M, Seidler K. Investigating the Impact of Ashwagandha and Meditation on Stress Induced Obesogenic Eating Behaviours. JOURNAL OF THE AMERICAN NUTRITION ASSOCIATION 2024:1-21. [PMID: 39254702 DOI: 10.1080/27697061.2024.2401054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 07/30/2024] [Accepted: 09/01/2024] [Indexed: 09/11/2024]
Abstract
Obesity has been identified as a rapidly rising pandemic within the developed world, potentially increasing the risks of type 2 diabetes and cardiovascular disease. Various studies have identified a positive association between stress, elevated cortisol levels and obesity. Mechanisms of the stress response lead to hyperpalatable food preference and increased appetite through the activation of the HPA axis, elevated cortisol and the resulting interactions with the dopaminergic system, neuropeptide Y, ghrelin, leptin and insulin. The methodology of this review involved a Systematic Search of the Literature with a Critical Appraisal of papers considering ashwagandha, mediation and mindfulness in relation to mechanisms of the stress response. It incorporated 12 searches yielding 330 hits. A total of 51 studies met the inclusion criteria and were critically appraised with ARRIVE, SIGN50 and Strobe checklists. Data from the 51 studies was extracted, coded into key themes and summarized in a narrative analysis. Thematic analysis identified 4 key themes related to ashwagandha and 2 key themes related to meditation. Results provide an overview of evidence assessing the efficacy of ashwagandha and meditation in relation to weight loss interventions by supporting the stress response and the pathways highlighted. Results of Clinical studies indicate that ashwagandha supports weight loss through reduced stress, cortisol and food cravings. Pre-clinical studies also suggest that ashwagandha possesses the capacity to regulate food intake by improving leptin and insulin sensitivity and reducing addictive behaviors through dopamine regulation. Clinical studies on meditation indicate it may enhance a weight loss protocol by reducing the stress response, cortisol release and blood glucose and improving eating behaviors.
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Affiliation(s)
- Daniel Quinones
- CNELM (Centre for Nutrition Education and Lifestyle Management), Wokingham, Berkshire, UK
| | - Michelle Barrow
- CNELM (Centre for Nutrition Education and Lifestyle Management), Wokingham, Berkshire, UK
| | - Karin Seidler
- CNELM (Centre for Nutrition Education and Lifestyle Management), Wokingham, Berkshire, UK
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Preissner CE, Vilier L, de Vries H, Oenema A. Consistency between definitions and measurement of mindfulness in eating and physical activity behavior: a scoping review. Health Psychol Rev 2024; 18:574-598. [PMID: 38306410 DOI: 10.1080/17437199.2024.2310115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 01/18/2024] [Indexed: 02/04/2024]
Abstract
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.
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Affiliation(s)
| | - Lieke Vilier
- Department of Health Promotion, Maastricht University, Maastricht, The Netherlands
| | - Hein de Vries
- Department of Health Promotion, Maastricht University, Maastricht, The Netherlands
| | - Anke Oenema
- Department of Health Promotion, Maastricht University, Maastricht, The Netherlands
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Van Beekum M, Shankland R, Rodhain A, Robert M, Marchand C, Herry A, Prioux C, Touvier M, Barday M, Turgon R, Avignon A, Leys C, Péneau S. Development and validation of the mindful eating scale (mind-eat scale) in a general population. Appetite 2024; 199:107398. [PMID: 38710449 DOI: 10.1016/j.appet.2024.107398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 02/19/2024] [Accepted: 05/03/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND Mindful eating is a concept that is increasingly being used to promote healthy eating. Observational studies have suggested associations with healthier eating behaviors, lower weight status, and favorable cardiovascular biomarkers. However, existing scales assessing mindful eating have some limitations. Our study aimed to develop and validate a scale assessing the level of mindful eating in a general population. METHODS The Mind-Eat Scale was developed in four main steps: 1. Generating an initial item pool covering all aspects of mindful eating; 2. Reviewing items with experts and naive individuals; 3. Administering the scale to a large and representative sample from the NutriNet-Santé cohort (N = 3102); 4. Conducting psychometric analyses. Construct validity was assessed using exploratory (EFA) (N1 = 1302) and confirmatory (CFA) (N2 = 1302, N3 = 498) factor analyses. Content, discriminant, convergent, and divergent validity, internal consistency, and test-retest reliability were examined. RESULTS The initial pool of 95 items was refined to 24 items using EFA. The EFA highlighted six dimensions: Awareness, Non-reactivity, Openness, Gratitude, Non-judgement, and Hunger/Satiety, consisting of four items per dimension. CFAs showed a good fit for first and second-order models. Adequate content validity was confirmed. Discriminant, convergent, and divergent validity were supported by significant differences between subgroups of individuals, and correlations with eating behaviors and psychological well-being scales. The Mind-Eat Scale showed good reliability for all six dimensions, with high McDonald's ω and adequate intraclass correlation coefficients (ICC). CONCLUSIONS This study validated the first tool assessing a total mindful eating score and its sub-dimensions in a general population. This scale can be an asset for clinical and epidemiological research on dietary behavior and related chronic diseases.
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Affiliation(s)
- Marion Van Beekum
- Université Sorbonne Paris Nord and Université Paris Cité, Inserm, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), F-93017, Bobigny, France; University of Montpellier, Montpellier Research in Management (MRM), Place Eugène Bataillon - CC 19001 - Bâtiment 19, 34095, Montpellier, France; Institute Desbrest of Epidemiology and Public Health, University of Montpellier, INSERM, 34090, Montpellier, France.
| | - Rebecca Shankland
- Department of Psychology, Univ. Lumière Lyon 2, DIPHE, Bron Cedex, France; Institut Universitaire de France, France
| | - Angélique Rodhain
- University of Montpellier, Montpellier Research in Management (MRM), Place Eugène Bataillon - CC 19001 - Bâtiment 19, 34095, Montpellier, France
| | - Margaux Robert
- Université Sorbonne Paris Nord and Université Paris Cité, Inserm, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), F-93017, Bobigny, France
| | - Camille Marchand
- Université Sorbonne Paris Nord and Université Paris Cité, Inserm, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), F-93017, Bobigny, France
| | - Athéna Herry
- Université Sorbonne Paris Nord and Université Paris Cité, Inserm, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), F-93017, Bobigny, France
| | - Clémentine Prioux
- Université Sorbonne Paris Nord and Université Paris Cité, Inserm, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), F-93017, Bobigny, France
| | - Mathilde Touvier
- Université Sorbonne Paris Nord and Université Paris Cité, Inserm, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), F-93017, Bobigny, France
| | - Marie Barday
- Université Sorbonne Paris Nord and Université Paris Cité, Inserm, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), F-93017, Bobigny, France
| | - Roxane Turgon
- Department of Psychology, Univ. Lumière Lyon 2, DIPHE, Bron Cedex, France
| | - Antoine Avignon
- Institute Desbrest of Epidemiology and Public Health, University of Montpellier, INSERM, 34090, Montpellier, France; Nutrition-Diabetes Department, University Hospital of Montpellier, 34090, Montpellier, France
| | - Christophe Leys
- Faculty of Psychology, Educational Sciences, and Speech and Language Therapy, Université Libre de Bruxelles, Avenue Franklin Roosevelt, 50 - CP191, 1050, Brussels, Belgium
| | - Sandrine Péneau
- Université Sorbonne Paris Nord and Université Paris Cité, Inserm, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), F-93017, Bobigny, France
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Rees K, Takeda A, Court R, Kudrna L, Hartley L, Ernst E. Meditation for the primary and secondary prevention of cardiovascular disease. Cochrane Database Syst Rev 2024; 2:CD013358. [PMID: 38358047 PMCID: PMC10867897 DOI: 10.1002/14651858.cd013358.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
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.
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Affiliation(s)
- Karen Rees
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Rachel Court
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Laura Kudrna
- Institute of Applied Health, University of Birmingham, Birmingham, UK
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Kao TSA, Ling J, Alanazi M, Atwa A, Suriyawong W. Effects of mindfulness-based interventions on anthropometric outcomes: A systematic review and meta-analysis. Obes Res Clin Pract 2023:S1871-403X(23)00046-7. [PMID: 37211464 DOI: 10.1016/j.orcp.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/08/2023] [Accepted: 05/12/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND AND OBJECTIVES The effects of mindfulness-based interventions (MBIs) on anthropometrics remain obscure. This review quantitatively synthesizes the effects of MBIs on decreasing body mass index (BMI), waist circumference (WC), weight, and percent body fat (%BF). METHODS Seven databases, including CINAHL Plus with Full Text, PubMed, PsycINFO, Cochrane, Web of Science Core Collection, Embase, and Sociological Abstracts were searched; studies with a comparison group were selected. Random-effects models were then applied to estimate the pooled effects (Hedge's g), while exploratory moderation analyses with mixed-effects models were performed to explore potential moderators of MBIs on anthropometrics. RESULTS The pooled effect size was -0.36 (p < .001) on BMI, -0.52 (p < .001) on WC, -1.20 (p < .004) on weight loss, and -0.43 (p = .389) on %BF. The long-term effects from baseline to follow-up and from post-intervention to follow-up were sustained on BMI (-0.37, p = .027; -.24, p = .065) and weight loss (-1.91, p = .027; -0.74, p = .011) respectively. For weight loss, adding mindful movement had greater effects than those without (-2.65 vs -0.39, p < .001). CONCLUSION Our findings support the short-term MBI effects on BMI reduction, WC, weight, and %BF, and long-term effects on reducing BMI and weight. Future efforts should focus on sustaining effects on reducing WC and %BF.
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Affiliation(s)
| | - Jiying Ling
- College of Nursing, Michigan State University, East Lansing, MI, USA
| | - Mohammed Alanazi
- College of Nursing, Michigan State University, USA; University of Bisha, Bisha, Saudi Arabia
| | - Ahmed Atwa
- Department of Translational Neuroscience, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA; Neuroscience Program, Michigan State University, East Lansing, MI, USA
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Mercado D, Werthmann J, Antunes-Duarte T, Campbell IC, Schmidt U. A randomised controlled feasibility study of food-related computerised attention training versus mindfulness training and waiting-list control for adults with overweight or obesity: the FOCUS study. J Eat Disord 2023; 11:61. [PMID: 37046356 PMCID: PMC10099893 DOI: 10.1186/s40337-023-00780-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 03/28/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND In a feasibility randomised controlled trial in people with overweight/obesity with and without binge eating disorder (BED) symptoms, we assessed eight weekly sessions of attention bias modification training (ABMT) and mindfulness training (MT) versus waiting list (WL) and explored potential mechanisms. METHODS 45 participants were randomly allocated to one of three trial arms. Primary outcomes were recruitment, retention and treatment adherence rates. Secondary outcomes included measures of eating behaviour, mood, attention and treatment acceptability. Assessments were conducted at baseline, post-intervention (week 8), and follow-up (week 12). RESULTS Participant retention at follow-up was 84.5% across groups. Session completion rates in the laboratory were 87% for ABMT and 94% for MT, but home practice was much poorer for ABMT. Changes in BMI and body composition were small between groups and there was a medium size BMI reduction in the MT group at follow-up. Effect sizes of eating disorder symptom changes were not greater for either intervention group compared to WL, but favoured ABMT compared to MT. Hedonic hunger and mindful eating scores favoured MT compared to ABMT and WL. ABMT reduced attention biases towards high-calorie food cues, which correlated with lower objective binge eating days at post-intervention. No significant changes were observed in the MT, or WL conditions. CONCLUSIONS Both ABMT and MT have potential value as adjuncts in the treatment of obesity and BED, and a larger clinical trial appears feasible and indicated. TRIAL REGISTRATION ISRCTN Registry, ISRCTN15745838. Registered on 22 May 2018.
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Affiliation(s)
- Daniela Mercado
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Jessica Werthmann
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Albert-Ludwigs University of Freiburg, Freiburg im Breisgau, Germany
| | - Tiago Antunes-Duarte
- Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisbon, Portugal
| | - Iain C. Campbell
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Ulrike Schmidt
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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Smith J, Ang XQ, Giles EL, Traviss-Turner G. Emotional Eating Interventions for Adults Living with Overweight or Obesity: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2722. [PMID: 36768088 PMCID: PMC9915727 DOI: 10.3390/ijerph20032722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Emotional eating (EE) may be defined as a tendency to eat in response to negative emotions and energy-dense and palatable foods, and is common amongst adults with overweight or obesity. There is limited evidence regarding the effectiveness of interventions that address EE. OBJECTIVES To synthesize evidence on the effectiveness of EE interventions for weight loss and EE in adults living with overweight or obesity. METHODS This is a systematic review and meta-analysis. Adhering to the PRISMA guidance, a comprehensive electronic search was completed up to February 2022. Random effects meta-analysis was carried out to determine the percentage change in weight and EE scores. RESULTS Thirty-four studies were included. The combined effect size for percentage weight change was -1.08% (95% CI: -1.66 to -0.49, I2 = 64.65%, n = 37), once adjusted for publication bias. Similarly, the combined effect size for percentage change in EE was -2.37%, (95% CI: -3.76 to -0.99, I2 = 87.77%, n = 46). Cognitive Behavioural Therapy showed the most promise for reducing weight and improving EE. CONCLUSIONS Interventions to address EE showed promise in reducing EE and promoted a small amount of weight loss in adults living with overweight or obesity.
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Affiliation(s)
- Jo Smith
- School of Health and Life Sciences, Teesside University, Middlesbrough TS1 3BX, UK
- Tees, Esk and Wear Valleys NHS Foundation Trust, Darlington DL2 2TS, UK
| | - Xiao Qi Ang
- School of Health and Life Sciences, Teesside University, Middlesbrough TS1 3BX, UK
| | - Emma L. Giles
- School of Health and Life Sciences, Teesside University, Middlesbrough TS1 3BX, UK
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Chung CY, Yang AWH, Foe A, Li M, Lenon GB. The clinical evaluation of electroacupuncture combined with mindfulness meditation for overweight and obesity: study protocol for a randomized sham-controlled clinical trial. Trials 2022; 23:818. [PMID: 36167579 PMCID: PMC9513962 DOI: 10.1186/s13063-022-06725-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 09/08/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Overweight and obesity have reached an epidemic level which impacts individual health and creates a financial burden worldwide. Evidence has shown that electroacupuncture is effective for weight loss when combined with lifestyle intervention, while mindfulness meditation can enhance the outcome of weight loss programs. This study aims to evaluate the safety and the add-on effect of electroacupuncture and mindfulness meditation for weight management in overweight and obesity. METHODS/DESIGN This is a sham-controlled, three-armed randomized clinical trial. A total of 165 participants with BMI between 25 and 39.99 and aged between 18 and 60 who meet the inclusion and exclusion criteria will be randomized into [1] electroacupuncture plus mindfulness meditation group, [2] sham electroacupuncture plus mindfulness meditation group, and [3] electroacupuncture only group. The total duration of this study will be 22 weeks, which consists of a 2-week run-in period, a 12-week intervention period, and an 8-week follow-up period. Participants will receive 12 weekly treatments during the intervention period. Primary outcomes will include body mass index, waist and hip ratio, and body composition. Secondary outcomes will be measured by the Weight-Related Symptom Measure, Obesity and Weight Loss Quality of Life, the Power of Food Scale, and the Chinese medicine differential diagnosis questionnaire. Outcomes will be assessed at the baseline, and endpoints of the 3rd, 6th, 9th, 12th, 14th, 16th, and 20th week. DISCUSSION This clinical trial will investigate the add-on effect of two combined interventions for weight loss treatment. The findings of this study may contribute to the development of a cost-effective and multidisciplinary weight management approach. TRIAL REGISTRATION Australia and New Zealand Clinical Trials Registry (ANZCTR) ACTRN12618000964213. Registered on 07 June 2018.
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Affiliation(s)
- Ching Yee Chung
- Discipline of Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, PO Box 71, Bundoora, VIC, 3083, Australia
| | - Angela Wei Hong Yang
- Discipline of Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, PO Box 71, Bundoora, VIC, 3083, Australia
| | - Alexander Foe
- Discipline of Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, PO Box 71, Bundoora, VIC, 3083, Australia
| | - Mingdi Li
- Discipline of Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, PO Box 71, Bundoora, VIC, 3083, Australia
- Department of Preventative and Health Care, Qingdao Traditional Chinese Medicine Hospital (Qingdao Hiser Hospital), Qingdao, Shandong, China
| | - George Binh Lenon
- Discipline of Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, PO Box 71, Bundoora, VIC, 3083, Australia.
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Pellegrini M, Carletto S, Scumaci E, Ponzo V, Ostacoli L, Bo S. The Use of Self-Help Strategies in Obesity Treatment. A Narrative Review Focused on Hypnosis and Mindfulness. Curr Obes Rep 2021; 10:351-364. [PMID: 34050891 PMCID: PMC8408071 DOI: 10.1007/s13679-021-00443-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/21/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The aim of this narrative review was to summarize the evidence evaluating the possibilities and limitations of self-hypnosis and mindfulness strategies in the treatment of obesity. RECENT FINDINGS Psychological factors, such as mood disorders and stress, can affect eating behaviors and deeply influence weight gain. Psychological approaches to weight management could increase the motivation and self-control of the patients with obesity, limiting their impulsiveness and inappropriate use of food. The cognitive-behavioral therapy (CBT) represents the cornerstone of obesity treatment, but complementary and self-directed psychological interventions, such as hypnosis and mindfulness, could represent additional strategies to increase the effectiveness of weight loss programs, by improving dysfunctional eating behaviors, self-motivation, and stimulus control. Both hypnosis and mindfulness provide a promising therapeutic option by improving weight loss, food awareness, self-acceptance of body image, and limiting food cravings and emotional eating. Greater effectiveness occurs when hypnosis and mindfulness are associated with other psychological therapies in addition to diet and physical activity. Additional research is needed to determine whether these strategies are effective in the long term and whether they can be routinely introduced into the clinical practice.
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Affiliation(s)
- Marianna Pellegrini
- Department of Medical Sciences, University of Torino, c.so AM Dogliotti 14, 10126, Torino, Italy
| | - Sara Carletto
- Department of Neuroscience "Rita Levi Montalcini", University of Torino, Torino, Italy
| | - Elena Scumaci
- Department of Medical Sciences, University of Torino, c.so AM Dogliotti 14, 10126, Torino, Italy
| | - Valentina Ponzo
- Department of Medical Sciences, University of Torino, c.so AM Dogliotti 14, 10126, Torino, Italy
| | - Luca Ostacoli
- Department of Clinical and Biological Sciences, University of Torino, Torino, Italy
| | - Simona Bo
- Department of Medical Sciences, University of Torino, c.so AM Dogliotti 14, 10126, Torino, Italy.
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Daniela Mercado, Robinson L, Gordon G, Werthmann J, Campbell IC, Schmidt U. The outcomes of mindfulness-based interventions for Obesity and Binge Eating Disorder: A meta-analysis of randomised controlled trials. Appetite 2021; 166:105464. [PMID: 34146647 DOI: 10.1016/j.appet.2021.105464] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 04/11/2021] [Accepted: 06/09/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Mindfulness Based Interventions (MBIs) for weight loss and overeating-related behaviours have recently gained popularity. Previous systematic reviews and meta-analyses included studies of variable quality, which hinders interpretation of results. This meta-analysis examined only randomised controlled trials (RCTs) comparing the efficacy of MBIs with control groups primarily encouraging either dietary or exercise-based behavioural change in individuals with overweight/obesity and/or binge eating disorder (BED). METHODS Using PRISMA guidelines, we systematically reviewed relevant articles in Medline, Psychinfo and EMBASE. Twelve eligible RCTs were identified, with three random-effects meta-analyses conducted on primary outcome measures of body mass (N = 11), mindfulness (N = 7) and BED symptoms (N = 3). RESULTS MBIs were more efficacious than control in increasing mindfulness scores and decreasing BED symptoms from pre-to post-treatment. However, they were no more efficacious than control in reducing body mass which may be attributed to variability in the duration of interventions. Based on intervention duration, exploratory cumulative meta-analyses revealed that while shorter interventions (i.e., 6 weeks) showed greater reductions in body mass compared to longer interventions (i.e., 24 weeks), longer interventions led to greater improvements in mindfulness scores and BED symptoms. CONCLUSIONS These results highlight the potential of MBIs to improve obesity-related behaviours compared to lifestyle interventions, but their effects on short-term weight loss remain unclear. Future research with a rigorous methodology should consider long-term follow-ups including body mass and mindfulness-related outcome measures in order to establish the clinical potential of MBIs.
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Affiliation(s)
- Daniela Mercado
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Section of Eating Disorders, UK.
| | - Lauren Robinson
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Section of Eating Disorders, UK.
| | - Gemma Gordon
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Section of Eating Disorders, UK.
| | - Jessica Werthmann
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Albert-Ludwigs University of Freiburg, Germany.
| | - Iain C Campbell
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Section of Eating Disorders, UK.
| | - Ulrike Schmidt
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Section of Eating Disorders, UK; South London and Maudsley NHS Foundation Trust, London, UK.
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Ma Q, Yang C, Wu R, Wu M, Liu W, Dai Z, Li Y. How Experiences Affect Psychological Responses During Supervised Fasting: A Preliminary Study. Front Psychol 2021; 12:651760. [PMID: 34093340 PMCID: PMC8170085 DOI: 10.3389/fpsyg.2021.651760] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 04/21/2021] [Indexed: 11/13/2022] Open
Abstract
As an unusual event, fasting can induce strong physiological and psychological reactions, but there is still no clear understanding of how previous fasting experiences affect people’s responses to current fasting. This study aimed to investigate the influence of previous fasting experiences on participants’ basic physiological and psychological responses in a fasting experiment conducted under intensive medical monitoring. For a 22-day experiment divided into four phases (3-day Baseline; 10-day Complete Fasting; 4-day Calorie Restriction; and 5-day Recovery phases), a total of 13 persons participated; the participants were divided into a group with prior fasting experience (Experienced: N = 6) and a group without prior fasting experience (Newbie: N = 7). The results indicate no group differences in physiological responses (i.e., weight, glucose, and ketone bodies); however, differences in psychological states were observed, with the Newbie group showing more negative psychological states overall throughout the experiment (i.e., greater appetite, more negative mood states, more stress, less vitality, and fewer recovery resources). Hence, previous fasting experience may be a buffer against negative feelings during current fasting. For this reason, it is important to consider fasting experiences as a vital factor in future research.
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Affiliation(s)
- Qianying Ma
- Department of Psychology, Beihang University, Beijing, China
| | - Chao Yang
- State Key Laboratory of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, Beijing, China
| | - Ruilin Wu
- Department of Psychology, Beihang University, Beijing, China.,State Key Laboratory of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, Beijing, China
| | - Manrui Wu
- Department of Psychology, Beihang University, Beijing, China
| | - Wenjun Liu
- Beijing Ziyuan Fasting Training Center, Beijing, China
| | - Zhongquan Dai
- State Key Laboratory of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, Beijing, China
| | - Yinghui Li
- State Key Laboratory of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, Beijing, China
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12
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Lawlor ER, Islam N, Bates S, Griffin SJ, Hill AJ, Hughes CA, Sharp SJ, Ahern AL. Third-wave cognitive behaviour therapies for weight management: A systematic review and network meta-analysis. Obes Rev 2020; 21:e13013. [PMID: 32181957 PMCID: PMC7379202 DOI: 10.1111/obr.13013] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 01/28/2020] [Accepted: 02/06/2020] [Indexed: 12/30/2022]
Abstract
This systematic review and network meta-analysis synthesized evidence on the effects of third-wave cognitive behaviour therapies (3wCBT) on body weight, and psychological and physical health outcomes in adults with overweight or obesity. Studies that included a 3wCBT for the purposes of weight management and measured weight or body mass index (BMI) pre-intervention and ≥ 3 months post-baseline were identified through database searches (MEDLINE, CINAHL, Embase, Cochrane database [CENTRAL], PsycINFO, AMED, ASSIA, and Web of Science). Thirty-seven studies were eligible; 21 were randomized controlled trials (RCT) and included in the network meta-analyses. Risk of bias was assessed using RoB2, and evidence quality was assessed using GRADE. Random-effects pairwise meta-analysis found moderate- to high-quality evidence suggesting that 3wCBT had greater weight loss than standard behavioural treatment (SBT) at post-intervention (standardized mean difference [SMD]: -0.09, 95% confidence interval [CI]: -0.22, 0.04; N = 19; I2 = 32%), 12 months (SMD: -0.17, 95% CI: -0.36, 0.02; N = 5; I2 = 33%), and 24 months (SMD: -0.21, 95% CI: -0.42, 0.00; N = 2; I2 = 0%). Network meta-analysis compared the relative effectiveness of different types of 3wCBT that were not tested in head-to-head trials up to 18 months. Acceptance and commitment therapy (ACT)-based interventions had the most consistent evidence of effectiveness. Only ACT had RCT evidence of effectiveness beyond 18 months. Meta-regression did not identify any specific intervention characteristics (dose, duration, delivery) that were associated with greater weight loss. Evidence supports the use of 3wCBT for weight management, specifically ACT. Larger trials with long-term follow-up are needed to identify who these interventions work for, their most effective components, and the most cost-effective method of delivery.
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Affiliation(s)
| | - Nazrul Islam
- MRC Epidemiology UnitUniversity of CambridgeCambridgeUK
| | - Sarah Bates
- School of Health and Related Research, Faculty of Medicine, Dentistry and HealthUniversity of SheffieldSheffieldUK
| | - Simon J. Griffin
- MRC Epidemiology UnitUniversity of CambridgeCambridgeUK
- Primary Care Unit, Institute of Public HealthUniversity of CambridgeCambridgeUK
| | - Andrew J. Hill
- Division of Psychological and Social Medicine, School of MedicineUniversity of LeedsLeedsUK
| | - Carly A. Hughes
- Fakenham Medical PracticeNorfolkUK
- Norwich Medical SchoolUniversity of East AngliaNorwichUK
| | | | - Amy L. Ahern
- MRC Epidemiology UnitUniversity of CambridgeCambridgeUK
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Moore JM, Haemer MA, Fox CK. Lifestyle and pharmacologic management before and after bariatric surgery. Semin Pediatr Surg 2020; 29:150889. [PMID: 32238284 PMCID: PMC8456424 DOI: 10.1016/j.sempedsurg.2020.150889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
As metabolic and bariatric surgery (MBS) increasingly becomes a treatment of choice for adolescents with severe obesity, there is a need to understand how to deliver pre- and postoperative care in ways that maximize long-term safety and efficacy. This article describes major pre- and postoperative goals, lifestyle modification targets, and, when necessary, pharmacologic management strategies for adolescents undergoing MBS. Three categories of evidence were used-studies of pre- and postoperative interventions and factors influencing MBS outcomes in adolescents, studies of pre- and postoperative associations and interventions in adults, and studies of non-surgical weight management applicable to adolescents pursuing MBS. Finally, priority areas for future research within this topic are identified.
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Affiliation(s)
- Jaime M Moore
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States.
| | - Matthew A Haemer
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States
| | - Claudia K Fox
- Center for Pediatric Obesity Medicine, Department of Pediatrics, University of Minnesota Masonic Children's Hospital, University of Minnesota Medical School, Minneapolis, MN 55455, United States
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14
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Anguah KOB, Syed-Abdul MM, Hu Q, Jacome-Sosa M, Heimowitz C, Cox V, Parks EJ. Changes in Food Cravings and Eating Behavior after a Dietary Carbohydrate Restriction Intervention Trial. Nutrients 2019; 12:nu12010052. [PMID: 31878131 PMCID: PMC7019570 DOI: 10.3390/nu12010052] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 12/16/2019] [Accepted: 12/19/2019] [Indexed: 12/20/2022] Open
Abstract
Compared to low-fat diets, low-carbohydrate (CHO) diets cause weight loss (WL) over a faster time frame; however, it is unknown how changes in food cravings and eating behavior contribute to this more rapid WL in the early phases of dieting. We hypothesized that reductions in food cravings and improved eating behaviors would be evident even after a relatively short (4-week) duration of CHO-restriction, and that these changes would be associated with WL. Adult participants (n = 19, 53% males, mean ± SD: BMI = 34.1 ± 0.8 kg/m2; age 40.6 ± 1.9 years) consumed a CHO-restricted diet (14% CHO, 58% fat, 28% protein) for 4 weeks. Before and after the intervention, specific and total cravings were measured with the Food Craving Inventory (FCI) and eating behaviors assessed with the Three-Factor Eating questionnaire. Food cravings were significantly reduced at week 4, while women had significantly greater reductions in sweet cravings than men. Dietary restraint was significantly increased by 102%, while disinhibiton and hunger scores were reduced (17% and 22%, respectively, p < 0.05). Changes in cravings were unrelated to changes in body weight except for the change in high-fat cravings where those who lost the most weight experienced the least reductions in fat cravings (r = −0.458, p = 0.049). Changes in dietary restraint were inversely related to several FCI subscales. A short-term, low-CHO diet was effective in reducing food cravings. These data suggest that in subjects that have successfully lost weight on a low-CHO diet, those who craved high-fat foods at the onset were able to satisfy their cravings—potentially due to the high-fat nature of this restricted diet.
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Affiliation(s)
- Katherene O.-B. Anguah
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO 65211, USA; (M.M.S.-A.); (Q.H.); (E.J.P.)
- Correspondence: ; Tel.: +1-573-882-8966
| | - Majid M. Syed-Abdul
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO 65211, USA; (M.M.S.-A.); (Q.H.); (E.J.P.)
| | - Qiong Hu
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO 65211, USA; (M.M.S.-A.); (Q.H.); (E.J.P.)
- Department of Child Health, School of Medicine, University of Missouri, Columbia, MO 65212, USA
| | - Miriam Jacome-Sosa
- Department of Internal Medicine, Division of Nutritional Science, Washington University School of Medicine, St. Louis, MO 63110, USA;
| | | | - Vicki Cox
- Department of Nutrition, West Chester University, West Chester, PA 19383, USA;
| | - Elizabeth J. Parks
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO 65211, USA; (M.M.S.-A.); (Q.H.); (E.J.P.)
- Department of Child Health, School of Medicine, University of Missouri, Columbia, MO 65212, USA
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Sampaio C, Magnavita G, Ladeia AM. Effect of Healing Meditation on Weight Loss and Waist Circumference of Overweight and Obese Women: Randomized Blinded Clinical Trial. J Altern Complement Med 2019; 25:930-937. [PMID: 31373827 DOI: 10.1089/acm.2019.0092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: To evaluate the effect of healing meditation on weight loss and waist circumference for women undergoing a standard weight loss treatment. Design: We conducted a randomized, parallel-controlled, blinded clinical trial. Randomization was stratified by body mass index category and based on blocks of four. Setting: An outpatient clinic in Brazil. Subjects: Women with overweight and obesity. Intervention: For 8 weeks, in addition to the standard weight loss treatment, the intervention group underwent a healing meditation program, and the control group participated in a two round table just to observe the treatment compliance. Outcome measures: The primary outcome was the percentage of weight loss, blindly assessed regarding the allocation group. Results: Of 121 women interested in participating in the study, 55 were included and randomized, 27 for the intervention group and 28 for the control group. Baseline characteristics were similar between groups. After 8 weeks, the intervention group had the highest relative reduction to initial body weight (-2.9% [interquartile range {IQR} -4.4 to -1.6] vs. -0.7% [IQR -1.1 to -5.0], p < 0.001). Waist circumference outcome was also significantly reduced in the intervention group (5 cm [IQR -6.0 to 4.0] vs. -1 cm [IQR -2.0 to 0.0], p < 0.001). The result of the intervention group was maintained until the 16th week. Between 8th and 16th week, the control group underwent meditation and presented significant weight reduction (-1.95 kg [IQR -3.2 to -1.1], p < 0.001 and -2.3% [IQR -4.1 to -1.3], p < 0.001), showing similar effect to the intervention group (p = 0.428). Conclusion: The addition of healing meditation to the standard weight loss treatment may reduce weight and waist circumference over a short period in overweight or obese women.
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Affiliation(s)
- Cynthia Sampaio
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil
| | - Guilherme Magnavita
- Psychiatry Service, University Hospital, Universidade Federal da Bahia, Salvador, Brazil
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Acceptance- and Mindfulness-Based Interventions for Health Behavior Change: Systematic Reviews and Meta-Analyses. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2019; 13:74-93. [PMID: 32832377 DOI: 10.1016/j.jcbs.2019.06.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Behavioral health issues such as smoking and overweight are risk factors for a variety of adverse health outcomes, including mortality. Over the past decade, a growing number of randomized controlled trials have examined the efficacy of acceptance- and mindfulness-based interventions for smoking cessation and weight loss. The purpose of the current meta-analytic reviews was to quantitatively synthesize the existing literature comparing these interventions to controls for a) smoking cessation and b) weight loss outcomes. Searches identified 17 smoking cessation studies and 31 weight loss studies eligible for inclusion. Meta-analytic results indicated a non-significant effect favoring acceptance- and mindfulness-based interventions over controls for smoking cessation (OR = 1.13) and a small, significant effect favoring these interventions over controls for weight loss outcomes (Hedge's g = 0.30). Statistical heterogeneity and risk of bias were assessed. Subgroup and meta-regression analyses were conducted to examine moderating variables (e.g., sample and intervention characteristics). The findings indicated that acceptance- and mindfulness-based interventions were at least as efficacious as active control conditions. Given the significant health risks associated with smoking and overweight, these findings have important clinical and public health implications. Limitations (e.g., relative infancy of the literature; lack of diversity in sample demographics) and future directions (e.g., further exploration of mediators and moderators of change) are discussed.
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Bock BC, Thind H, Fava JL, Dunsiger S, Guthrie KM, Stroud L, Gopalakrishnan G, Sillice M, Wu W. Feasibility of yoga as a complementary therapy for patients with type 2 diabetes: The Healthy Active and in Control (HA1C) study. Complement Ther Med 2018; 42:125-131. [PMID: 30670230 DOI: 10.1016/j.ctim.2018.09.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 09/20/2018] [Accepted: 09/20/2018] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES This study:Healthy Active and in Control (HA1C), examined the feasibility and acceptability of yoga as a complementary therapy for adults with Type-2 Diabetes (T2DM). DESIGN A 2-arm randomized clinical trial comparing Iyengar yoga with a supervised walking program. SETTING Hospital based gym-type facility and conference rooms. INTERVENTIONS Participants were randomized to a 12-week program of either; (1) a twice weekly Iyengar yoga, or (2) a twice-weekly program of standard exercise (SE). MAIN OUTCOME MEASURES Primary outcomes assessed feasibility and acceptability, including enrollment rates, attendance, study completion, and participant satisfaction. Secondary outcomes included HbA1c, physical activity, and measures of diabetes-related emotional distress, self-care and quality of life (QOL). Assessments were conducted at baseline, end of treatment, 6-months and 9-months post-enrollment. RESULTS Of 175 adults screened for eligibility, 48 (30 women, 18 men) were eligible and enrolled. The most common reasons for ineligibility were orthopedic restrictions, HbA1c levels <6.5 and BMI > 42. Session attendance was high (82% of sessions attended), as was follow-up completion rates (92%). Program satisfaction rated on a 5-point scale, was high among both Yoga (M = 4.63, SD = 0.57) and SE (M = 4.77, SD = 0.52) participants. Overall 44 adverse events (26 Yoga, 18 SE) were reported. Of these, six were deemed "possibly related" (e.g., neck strain, back pain), and 1 "probably related" (ankle pain after treadmill) to the study. Yoga produced significant reductions in HbA1c. Median HbA1c at 6 months was 1.25 units lower for Yoga compared to SE (95% CI: -2.54 -0.04). Greater improvements in diabetes self-care, quality of life, and emotional distress were seen among Yoga participants than among SE participants. Increases in mindfulness were seen in Yoga but not in SE. CONCLUSIONS The yoga intervention was highly feasible and acceptable, and produced improvements in blood glucose and psychosocial measures of diabetes management.
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Affiliation(s)
- B C Bock
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, 164 Summit Avenue, Providence, RI, 02906, United States.
| | - H Thind
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, 164 Summit Avenue, Providence, RI, 02906, United States
| | - J L Fava
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, 164 Summit Avenue, Providence, RI, 02906, United States
| | - S Dunsiger
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, 164 Summit Avenue, Providence, RI, 02906, United States
| | - K M Guthrie
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, 164 Summit Avenue, Providence, RI, 02906, United States
| | - L Stroud
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, 164 Summit Avenue, Providence, RI, 02906, United States
| | - G Gopalakrishnan
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, 164 Summit Avenue, Providence, RI, 02906, United States
| | - M Sillice
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, 164 Summit Avenue, Providence, RI, 02906, United States
| | - W Wu
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, 164 Summit Avenue, Providence, RI, 02906, United States
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