Mindful Eating and Active Living: Development and Implementation of a Multidisciplinary Pediatric Weight Management Intervention

Mindfulness-based eating awareness training versus itself plus implementation intention model: a randomized clinical trial

BACKGROUND

Obesity causes many physical and mental illnesses. This study compares mindfulness-based eating awareness training (MB-EAT) versus MB-EAT plus implementation intention model for effectiveness on body mass index (BMI), weight self-efficacy, and physical activity in obese women with BMIs ≤ 25 (n = 52).

METHODS

In this randomized clinical trial, the participants were selected by the simple random sampling method and randomly divided into three groups. A 12-session MB-EAT of 150 min per session was performed for experimental group I. The experimental group II received MB-EAT alone for physical activity planning and MB-EAT plus implementation intention; also, both groups were compared to the control group. Data were measured by the scales, a questionnaire, and a checklist, and the P-values are based on the results of the generalized estimating equation (GEE) test. P < 0.001 were considered the significance level.

RESULTS

The MB-EAT and MB-EAT + implementation intention effectiveness on the two experimental groups' BMI, weight self-efficacy, and physical activity was significantly different from the control group. In the integrated group versus the MB-EAT group, BMI, physical activity, and physical discomfort, were more effective than the weight self-efficacy subscales. Both intervention groups were effective on BMI, weight self-efficacy, and physical activity, but the integrated group's effectiveness was more.

CONCLUSIONS

The MB-EAT effectiveness trial is theory-based, reducing weight and the psychological and behavioral consequences of overweight and obese adults. The MB-EAT + the Implementation intention model is to plan regular and daily exercise according to each individual's specific circumstances.

TRIAL REGISTRATION

The trial registration number: (IRCT20200919048767N1).

Weight-neutral interventions in young people with high body mass index: A systematic review

AIM

This systematic review explored the feasibility, acceptability and effect on health outcomes of weight-neutral interventions in health improvement-seeking young people with overweight/obesity.

METHODS

Six databases were searched to March 2021 for health, but not weight, focused interventions (PROSPERO, CRD42020152671). Eligible studies recruited young people (10-24 years) with overweight/obesity. The studies were described using narrative synthesis, with numerical results summarised. The quality of included studies was assessed using the Joanna Briggs Institute critical appraisal tools.

RESULTS

Six articles were included, representing three pilot studies. Study 1 (n = 37, 14-17 years) compared a 6-week mindful eating program with single-session lifestyle education; Study 2 (n = 35, 14-17 years) compared 12-week weight-neutral lifestyle education focused on intuitive eating and carbohydrate quality, with/without guided imagery; and Study 3 (n = 33, 12-17 years) compared a 6-week mindfulness intervention with cognitive behavioural therapy in adolescents with depressive symptoms at risk of type 2 diabetes. All interventions explored feasibility (intervention group retention 57%-88%, attendance >80%) and reported interventions were acceptable. Studies 1 and 3 reported no change in mindfulness. Study 2 reported an increase (p < 0.05) in intuitive eating following weight-neutral plus guided imagery (0.32 ± 0.36, Hawks' Scale, score 1-4), compared with weight-neutral alone (0.15 ± 0.29). Study 1 reported decreased body mass index (p < 0.001) following mindful eating (-1.1 kg/m² ), compared with single-session lifestyle education (+0.7 kg/m² ); Studies 2 and 3 found no change in body mass index or body mass index z-score.

CONCLUSIONS

Weight-neutral interventions may be feasible and acceptable in adolescents with overweight/obesity in the short term (≤12 weeks), but data are limited.

How Effective Are Mindfulness-Based Interventions for Reducing Stress and Weight? A Systematic Review and Meta-Analysis

Stress contributes to the development and maintenance of obesity. Mindfulness-based therapies are being used to reduce stress and promote weight reduction and maintenance. This study aimed to determine the efficacy of mindfulness-based interventions for stress and weight reduction in the short, medium, and long term. Searches on PsycINFO, Medline, CINAHL, Scopus, WOS, and Science Direct were conducted until March 2021. Intervention studies with a sample of adults were included; these evaluated a mindfulness-based intervention and used stress and weight or body mass index as outcome variables. These criteria were met by 13 articles. A meta-analysis of 8 of the 13 articles was performed with a random-effects or fixed-effects model, depending on the level of heterogeneity between studies. Mindfulness-based interventions had a small effect on stress reduction over a 3-month period: effect size (standardized mean difference) = -0.29 (95% CI: -0.49, -0.10). However, no significant evidence was found for stress reduction from 3 months onwards, nor for weight or body mass index reduction in any period. Mindfulness-based interventions are effective in reducing stress in the short term, but not in the medium or long term, nor are they effective for weight or body mass index. More robust and longer study designs are needed to determine their effects.

Eating Competence, Food Consumption and Health Outcomes: An Overview

Eating Competence (EC) is one behavioral perspective of eating practices that has been associated with a healthy lifestyle. It emphasizes eating pleasure, self-regulation of eating, body weight satisfaction, and regular meal frequency that includes food variety without focusing on dietary guidelines. EC is composed of four components (Eating Attitude, Food Acceptance, Internal Regulation, and Contextual Skill), and its assessment is performed using the Eating Competence Satter Inventory (ecSI2.0™), developed and validated in English for an adult population. EC has been associated with diet quality and health indicators for various population groups and the development of skills that increase EC might be a strategy to improve nutritional health, and prevent obesity and other chronic diseases. In this sense, this study presents an overview of the background, concepts, features, and possible associations among EC, food consumption, and health outcomes. The high prevalence of diseases associated with food/nutrition draws attention to the necessity to broaden the view on food and its relationship with health and well-being, considering not only nutrients and food combinations but also the behavioral dimensions of eating practices. Healthy nutritional recommendations that take into account attitudes and behaviors are in accordance with the EC behavioral model. Studies on eating behavior emphasize the need to better understand attitudes towards food and eating in the general population using validated instruments. In this context, measuring EC and its association with health outcomes seems to be relevant to nutritional health. The complexity of food choices has been examined in social, behavioral, and biological sciences, representing a great challenge for applying unique and simple theoretical models. Multiple methods are required, as no single theory can fully explain food selection.

Mindfulness-based programs for the prevention of childhood obesity: A systematic review

INTRODUCTION

The prevalence of overweight and obesity has increased worldwide at an alarming rate in recent decades and has become a serious public health problem. The purpose of this study is to carry out a systematic review of scientific research on mindfulness-based programs for the prevention of childhood obesity carried out in the last 10 years.

METHOD

A search of studies that used mindfulness to promote good eating behavior in minors was conducted. After applying the inclusion and exclusion criteria, a total of 16 studies were found.

RESULTS

Statistically significant improvements were found in most of the cases where changes in eating habits, food portions, reduction of stress, or reduction of cravings in minors were evaluated.

CONCLUSIONS

Mindfulness programs applied to improve eating behaviors appear to be an effective alternative to prevent childhood obesity, but further studies are needed to draw conclusions.

Eating Competence among Brazilian Adults: A Comparison between before and during the COVID-19 Pandemic

The coronavirus pandemic started a worldwide emergency, and tight preventive actions were necessary to protect the population, changing individuals' daily habits. Dwelling and working at home can change dietary habits, affect food choice and access, as well as the practice of physical activity. In this regard, this study's goal was to compare eating competence (EC) among Brazilian adults before and during the coronavirus pandemic, using the Brazilian version of the eating competence Satter inventory (ecSI2.0™BR) with the "retrospective post-then-pre" design. This cross-sectional study was performed from 30 April to 31 May 2021 among a convenience sample of the Brazilian adult population using an online platform (Google® Forms). In the studied sample (n = 302 in which 76.82% were females), EC total score lowered during the pandemic (31.69 ± 8.26 vs. 29.99 ± 9.72; p < 0.005), and the decrease was worst after the beginning of the pandemic among those who reported weight gain, decreased the consumption of fruit and vegetables, and increased the consumption of sugary beverages. The contextual skill component seems relevant in this scenario, where our life and routines were changed entirely, demonstrating that the ability to manage the food context is essential, especially when sanitary and economic situations represent a new challenge.

Eating Competence Associated with Food Consumption and Health Outcomes among Brazilian Adult Population

This study aimed to associate Eating Competence (EC) with food consumption and health outcomes in the Brazilian adult population. Researchers developed a questionnaire to associate EC with sociodemographic information, health outcomes, and food consumption. Data on body weight and height was referred to by participants in the questionnaire, and body mass index (BMI) was calculated and classified. A question to evaluate the perception of body size was included. After constructing the questionnaire items, content validation and semantic evaluation were performed following the Delphi method with a group of judges composed of 26 health professionals. The judges evaluated the sociodemographic information, health outcomes, and food consumption items associated with the eating competence instrument (previously validated in Brazilian-Portuguese). The final version of the questionnaire was composed of 33 items. Our results confirmed good reliability, responsiveness, and internal consistency. A total of 1810 Brazilians answered the questionnaire. Most of the participants were female, up to 40 years old, with a high education level and high income. Most of the participants did not report diabetes or hypertension. The EC total score did not differ among males and females. Individuals up to 40 years old presented a lower total score. The increase in educational level and income also increased EC total score. Excess weight individuals showed lower EC compared to the normal weight/underweight. Individuals who consumed fruits and/or vegetables five or more days/week presented the best scores for total EC.

Eating Competence among a Select Sample of Brazilian Adults: Translation and Reproducibility Analyses of the Satter Eating Competence Inventory

This study aimed to translate and validate the Satter Eating Competence Inventory (ecSI2.0^TM) from English to Brazilian Portuguese. The process included three steps: (i) translation and back-translation of the original ecSI2.0^TM to Brazilian Portuguese; (ii) evaluation of its reproducibility; (iii) a pilot study to validate the Brazilian version of the Satter Eating Competence Inventory (ecSI2.0^TMBR) for a selected sample of the Brazilian adult population (internal consistency and factor validity). The reproducibility (test–retest reliability) was verified using the intraclass correlation coefficient (ICC) obtained by the responses of 32 Brazilian adults. All domains of the ecSI2.0^TMBR and the total score showed ICC > 0.8. Considering the entire questionnaire, none of the domains presented significant divergences among the participants’ responses (p < 0.001). In the pilot study with 662 individuals, 74.9% (n= 496) were female, mean age was 40.33 ± 12.55, and they presented a higher level of schooling and income. Analyses revealed Cronbach’s alpha coefficients of 0.869 for the ecSI2.0^TMBR total scale, 0.793 for Eating Attitudes, 0.527 for Internal Regulation, 0.728 for Food Acceptance, and 0.822 for Contextual Skills. In general, the ecSI2.0™BR presented good acceptability, showing total floor and ceiling effects of ≤0.6%. Factor validity was examined by confirmatory factor analysis. The four domains presented a good fit in the confirmatory factor analysis: RMSEA = 0.0123 (95% CI: 0–0.0266); CFI = 0.998; χ² = 75.9; df = 69; p = 0.266. The ecSI2.0^TMBR is the first tool designed to measure eating competence (EC) in the Brazilian population, showing good reproducibility and internal consistency. We expect the ecSI2.0^TMBR will support innovative research to investigate the association of EC and health outcomes, as well as new strategies based on emerging behavioral theories to enhance nutritional education policy.