Abstract
Objectives
This study tested whether a mindfulness-based intervention for obesity that included components aimed at emotion regulation and mindful eating improved psychological outcomes including stress, anxiety, positive emotion, and depression, during the intervention period and at longer-term follow-up.
Methods
Adults with obesity (N=194) were randomized to a 5.5-month diet-exercise weight loss intervention with or without mindfulness training focused on emotion regulation and mindful eating. Participants completed self-report measures of mindfulness and psychological well-being, which were planned secondary outcomes, at baseline, at mid-intervention (3 months), and at 6, 12, and 18 months post-baseline (maintenance period). Mixed effects models and linear regression were used to test between- and within-group changes in psychological well-being. This study also explored whether changes in mindfulness (from baseline to each 6 and 18 months post-baseline) mediated the effects of intervention arm on changes in psychological outcomes during those respective time periods. Finally, this study explored whether changes in mindfulness from baseline to 6 months mediated the effects of intervention arm on changes in psychological outcomes from baseline to 18 months.
Results
Participants randomized to the mindfulness arm had significant increases in positive emotions at all follow-up times compared to controls. There were statistically significant increases in mindfulness, psychological flexibility, and reflection, as well as decreases in anxiety and depressive symptoms at 12 months compared to control participants. These changes remained significant for psychological flexibility and reflection at 18 months. There were no significant differences in perceived stress. Among mindfulness participants, greater increases in mindfulness from 6 to 18 months were associated with greater positive emotions and psychological flexibility as well as lower perceived stress, anxiety, depressive symptoms, and rumination at 18 months, adjusting for 6-month values. Mediation analyses indicated that randomization to the mindfulness intervention arm was associated with 6-month increases in mindfulness, and these increases were in turn associated with improved psychological outcomes at 6 months and 18 months. Changes from baseline to 18 months did not mediate 18-month changes in psychological outcomes.
Conclusions
Mindfulness training in emotion regulation and mindful eating may provide greater longer-term psychological well-being benefits in non-clinical populations with obesity compared to conventional diet-exercise interventions.
Trial Registration
ClinicalTrials.gov Identifier: NCT00960414
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Data Availability
All data are available at the Open Science Framework (https://osf.io/yh4cb/).
References
Adler, E., Dhruva, A., Moran, P. J., Daubenmier, J., Acree, M., Epel, E. S., Bacchetti, P., Prather, A., Mason, A. E., & Hecht, F. M. (2017). Impact of a mindfulness-based weight-loss intervention on sleep quality among adults with obesity: data from the SHINE randomized controlled trial. Journal of Alternative and Complementary Medicine, 23(3), 188–195. https://doi.org/10.1089/acm.2016.0141
Arnold, H. J., & Feldman, D. C. (1981). Social desirability response bias in self-report choice situations. The Academy of Management Journal, 24(2), 377–385. https://doi.org/10.2307/255848
Bacchetti, P. (2002). Peer review of statistics in medical research: the other problem. British Medical Journal, 324(7348), 1271–1273.
Baer, R. A., Smith, G. T., Hopkins, J., Krietemeyer, J., & Toney, L. (2006). Using self-report assessment methods to explore facets of mindfulness. Assessment, 13(1), 27–45. https://doi.org/10.1177/1073191105283504
Blaine, B. E., Rodman, J., & Newman, J. M. (2007). Weight loss treatment and psychological well-being: A review and meta-analysis. Journal of Health Psychology, 12(1), 66–82. https://doi.org/10.1177/1359105307071741
Bond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K. M., Guenole, N., Orcutt, H. K., Waltz, T., & Zettle, R. D. (2011). Preliminary psychometric properties of the acceptance and action questionnaire–II: A revised measure of psychological inflexibility and experiential Avoidance. Behavior Therapy, 42(4), 676–688. https://doi.org/10.1016/j.beth.2011.03.007
Cohen, S. (1988). Perceived stress in a probability sample of the United States. In S. E. Spacapan, & S. E. Oskamp (Eds.), The Social Psychology of Health (pp. 31-67, 251): Sage Publications, Inc.
Cohen, S., & Janicki-Deverts, D. (2012). Who’s stressed? distributions of psychological stress in the United States in probability samples from 1983, 2006, and 2009. Journal of Applied Social Psychology, 42(6), 1320–1334. https://doi.org/10.1111/j.1559-1816.2012.00900.x
Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24(4), 385–396. https://doi.org/10.2307/2136404
Dalen, J., Smith, B. W., Shelley, B. M., Sloan, A. L., Leahigh, L., & Begay, D. (2010). Pilot study: Mindful Eating and Living (MEAL): Weight, eating behavior, and psychological outcomes associated with a mindfulness-based intervention for people with obesity. Complementary Therapies in Medicine, 18(6), 260–264. https://doi.org/10.1016/j.ctim.2010.09.008
Daubenmier, J., Chao, M. T., Hartogensis, W., Liu, R., Moran, P. J., Acree, M., Kristeller, J., Epel, E. S., & Hecht, F. M. (2020). Exploratory analysis of racial/ethnic and educational differences in a randomized controlled trial of a mindfulness-based weight loss intervention. Psychosomatic Medicine, 83(6), 503–514. https://doi.org/10.1097/PSY.0000000000000859
Daubenmier, J., Epel, E. S., Moran, P. J., Thompson, J., Mason, A. E., Acree, M., Goldman, V., Kristeller, J., Hecht, F. M., & Mendes, W. B. (2019). A randomized controlled trial of a mindfulness-based weight loss intervention on cardiovascular reactivity to social-evaluative threat among adults with obesity. Mindfulness, 10(12), 2583–2595. https://doi.org/10.1007/s12671-019-01232-5
Daubenmier, J., Moran, P. J., Kristeller, J., Acree, M., Bacchetti, P., Kemeny, M. E., Dallman, M., Lustig, R. H., Grunfeld, C., Nixon, D. F., Milush, J. M., Goldman, V., Laraia, B., Laugero, K. D., Woodhouse, L., Epel, E. S., & Hecht, F. M. (2016). Effects of a mindfulness-based weight loss intervention in adults with obesity: A randomized clinical trial. Obesity (Silver Spring, Md.), 24(4), 794–804. https://doi.org/10.1002/oby.21396
de Vibe, M., Solhaug, I., Rosenvinge, J. H., Tyssen, R., Hanley, A. W., & Garland, E. L. (2018). Six-year positive effects of a mindfulness-based intervention on mindfulness, coping and well-being in medical and psychology students; Results from a randomized controlled trial. PLoS One, 13(4). https://doi.org/10.1371/journal.pone.0196053
Dreyer, D., & Dreyer, K. (2006). ChiWalking: Fitness walking for lifelong health and energy. Atria Books.
Farb, N. A. S., Anderson, A. K., Irving, J. A., & Segal, Z. V. (2014). Mindfulness interventions and emotion regulation. In J. Gross (Ed.), Handbook of emotion regulation (2nd ed., pp. 548–567). The Guilford Press.
Flegal, K. M., Kruszon-Moran, D., Carroll, M. D., Fryar, C. D., & Ogden, C. L. (2016). Trends in Obesity Among Adults in the United States, 2005 to 2014. JAMA, 315(21), 2284–2291. https://doi.org/10.1001/jama.2016.6458
Fredrickson, B. L. (2004). The broaden-and-build theory of positive emotions. Philosophical Transactions of the Royal Society of London. Series B, Biological Sciences, 359(1449), 1367–1378. https://doi.org/10.1098/rstb.2004.1512
Gariepy, G., Nitka, D., & Schmitz, N. (2010). The association between obesity and anxiety disorders in the population: a systematic review and meta-analysis. International Journal of Obesity, 34(3), 407–419. https://doi.org/10.1038/ijo.2009.252
Garland, E. L., Geschwind, N., Peeters, F., & Wichers, M. (2015). Mindfulness training promotes upward spirals of positive affect and cognition: multilevel and autoregressive latent trajectory modeling analyses. Frontiers in Psychology, 6, 15. https://doi.org/10.3389/fpsyg.2015.00015
Garland, E. L., Hanley, A. W., Goldin, P. R., & Gross, J. J. (2017). Testing the mindfulness-to-meaning theory: Evidence for mindful positive emotion regulation from a reanalysis of longitudinal data. PLoS One, 12(12). https://doi.org/10.1371/journal.pone.0187727
Godfrey, K. M., Gallo, L. C., & Afari, N. (2015). Mindfulness-based interventions for binge eating: a systematic review and meta-analysis. Journal of Behavioral Medicine, 38(2), 348–362. https://doi.org/10.1007/s10865-014-9610-5
Goyal, M., Singh, S., Sibinga, E. M. S., Gould, N. F., Rowland-Seymour, A., Sharma, R., Berger, Z., Sleicher, D., Maron, D. D., Shihab, H. M., Ranasinghe, P. D., Linn, S., Saha, S., Bass, E. B., & Haythornthwaite, J. A. (2014). Meditation programs for psychological stress and well-being: A systematic review and meta-analysis. JAMA Internal Medicine, 174(3), 357–368. https://doi.org/10.1001/jamainternmed.2013.13018
Graham-Engeland, J. E., Sin, N. L., Smyth, J. M., Jones, D. R., Knight, E. L., Sliwinski, M. J., Almeida, D. M., Katz, M. J., Lipton, R. B., & Engeland, C. G. (2018). Negative and positive affect as predictors of inflammation: Timing matters. Brain, Behavior, and Immunity, 74, 222–230. https://doi.org/10.1016/j.bbi.2018.09.011
Guendelman, S., Medeiros, S., & Rampes, H. (2017). Mindfulness and emotion regulation: insights from neurobiological, psychological, and clinical studies. Frontiers in Psychology, 8, 220. https://doi.org/10.3389/fpsyg.2017.00220
Hayes, A. (2018). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. The Guilford Press.
Hedges, L. V. (2007). Effect sizes in cluster-randomized designs. Journal of Educational and Behavioral Statistics, 32(4), 341–370.
Izard, C. E. (1991). The psychology of emotions. Plenum.
Kabat-Zinn, J. (1990). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness. Delacorte Press.
Kabat-Zinn, J. (1994). Wherever you go, there you are: mindfulness meditation in everyday life. Hyperion.
Kashdan, T. B., & Rottenberg, J. (2010). Psychological flexibility as a fundamental aspect of health. Clinical Psychology Review, 30(7), 865–878. https://doi.org/10.1016/j.cpr.2010.03.001
Keng, S.-L., Smoski, M. J., & Robins, C. J. (2011). Effects of mindfulness on psychological health: a review of empirical studies. Clinical Psychology Review, 31(6), 1041–1056. https://doi.org/10.1016/j.cpr.2011.04.006
Kocalevent, R.-D., Hinz, A., & Brähler, E. (2013). Standardization of the depression screener patient health questionnaire (PHQ-9) in the general population. General Hospital Psychiatry, 35(5), 551–555. https://doi.org/10.1016/j.genhosppsych.2013.04.006
Kristeller, J., & Bowman, A. (2015). The joy of half a cookie: Using mindfulness to lose weight and end the struggle with food. Tarcher Perigee.
Kristeller, J., Wolever, R. Q., & Sheets, V. (2014). Mindfulness-Based Eating Awareness Training (MB-EAT) for binge eating: A randomized clinical trial. Mindfulness, 5(3), 282–297. https://doi.org/10.1007/s12671-012-0179-1
Kristeller, J. L., & Wolever, R. Q. (2011). Mindfulness-based eating awareness training for treating binge eating disorder: the conceptual foundation. Eating Disorders, 19(1), 49–61. https://doi.org/10.1080/10640266.2011.533605
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9. Journal of General Internal Medicine, 16(9), 606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x
Kroenke, K. (2012). Enhancing the clinical utility of depression screening. Canadian Medical Association Journal, 184(3), 281–282. https://doi.org/10.1503/cmaj.112004
Lindsay, E. K., Chin, B., Greco, C. M., Young, S., Brown, K. W., Wright, A. G. C., Smyth, J. M., Burkett, D., & Creswell, J. D. (2018). How mindfulness training promotes positive emotions: Dismantling acceptance skills training in two randomized controlled trials. Journal of Personality and Social Psychology, 115(6), 944–973. https://doi.org/10.1037/pspa0000134
Luppino, F. S., Wit, L. M. D., Bouvy, P. F., Stijnen, T., Cuijpers, P., Penninx, B. W. J. H., & Zitman, F. G. (2010). Overweight, obesity, and depression: A systematic review and meta-analysis of longitudinal Studies. Archives of General Psychiatry, 67(3), 220–229. https://doi.org/10.1001/archgenpsychiatry.2010.2
Mason, A. E., Epel, E. S., Aschbacher, K., Lustig, R. H., Acree, M., Kristeller, J., Cohn, M., Dallman, M., Moran, P., Bacchetti, P., Laraia, B., Hecht, F. M., & Daubenmier, J. (2016a). Reduced reward-driven eating accounts for the impact of a mindfulness-based diet and exercise intervention on weight loss: Data from the SHINE randomized controlled trial. Appetite, 100, 86–93. https://doi.org/10.1016/j.appet.2016.02.009
Mason, A. E., Epel, E. S., Kristeller, J., Moran, P. J., Dallman, M., Lustig, R. H., Acree, M., Bacchetti, P., Laraia, B., Hecht, F. M., & Daubenmier, J. (2016b). Effects of a mindfulness-based intervention on mindful eating, sweets consumption, and fasting glucose levels in obese adults: data from the SHINE randomized controlled trial. Journal of Behavioral Medicine, 39(2), 201–213. https://doi.org/10.1007/s10865-015-9692-8
Mason, A. E., Hecht, F. M., Daubenmier, J. J., Sbarra, D. A., Lin, J., Moran, P. J., Schleicher, S. G., Acree, M., Prather, A., & Epel, E. S. (2018). Weight loss, weight-loss maintenance, and cellular aging in the Supporting Health through Nutrition and Exercise (SHINE) study. Psychosomatic Medicine, 80(7), 609.
Michie, S., van Stralen, M. M., & West, R. (2011). The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implementation Science: IS, 6, 42. https://doi.org/10.1186/1748-5908-6-42
Niles, A. N., & O'Donovan, A. (2019). Comparing anxiety and depression to obesity and smoking as predictors of major medical illnesses and somatic symptoms. Health Psychology, 38(2), 172–181. https://doi.org/10.1037/hea0000707
O'Reilly, G. A., Cook, L., Spruijt-Metz, D., & Black, D. S. (2014). Mindfulness-based interventions for obesity-related eating behaviours: a literature review. Obesity Reviews, 15(6), 453–461. https://doi.org/10.1111/obr.12156
Perneger, T. V. (1998). What’s wrong with Bonferroni adjustments. British Medical Journal, 316(7139), 1236–1238.
Podsakoff, P. M., MacKenzie, S. B., & Podsakoff, N. P. (2012). Sources of method bias in social science research and recommendations on how to control it. Annual Review of Psychology, 63, 539–569.
Pressman, S. D., Jenkins, B. N., & Moskowitz, J. T. (2019). Positive affect and health: What do we know and where next should we go? Annual Review of Psychology, 70(1), 627–650. https://doi.org/10.1146/annurev-psych-010418-102955
Rand, K., Vallis, M., Aston, M., Price, S., Piccinini-Vallis, H., Rehman, L., & Kirk, S. F. L. (2017). “It is not the diet; it is the mental part we need help with.” A multilevel analysis of psychological, emotional, and social well-being in obesity. International Journal of Qualitative Studies on Health and Well-being, 12(1). https://doi.org/10.1080/17482631.2017.1306421
Sansone, R. A., & Sansone, L. A. (2012). Rumination. Innovations in Clinical Neuroscience, 9(2), 29–34.
Schneiderman, N., Ironson, G., & Siegel, S. D. (2005). Stress and health: psychological, behavioral, and biological determinants. Annual Review of Clinical Psychology, 1, 607–628. https://doi.org/10.1146/annurev.clinpsy.1.102803.144141
Schwartz, M. B., & Brownell, K. D. (2004). Obesity and body image. Body Image, 1(1), 43–56. https://doi.org/10.1016/S1740-1445(03)00007-X
Simmons, J. P., Nelson, L. D., & Simonsohn, U. (2011). False-positive psychology: Undisclosed flexibility in data collection and analysis allows presenting anything as significant. Psychological Science, 22(11), 1359–1366. https://doi.org/10.1177/0956797611417632
Singh, M. (2014). Mood, food, and obesity. Frontiers in Psychology, 5. https://doi.org/10.3389/fpsyg.2014.00925
Spielberger, C. D., Gorsuch, R. L., & Lushene, R. E. (1970). Manual for the state-trait anxiety inventory. Consulting Psychologist Press.
Tomiyama, A. J., Carr, D., Granberg, E. M., Major, B., Robinson, E., Sutin, A. R., & Brewis, A. (2018). How and why weight stigma drives the obesity ‘epidemic’ and harms health. BMC Medicine, 16(1), 123. https://doi.org/10.1186/s12916-018-1116-5
Torres, S. J., & Nowson, C. A. (2007). Relationship between stress, eating behavior, and obesity. Nutrition, 23(11), 887–894. https://doi.org/10.1016/j.nut.2007.08.008
Trapnell, P. D., & Campbell, J. D. (1999). Private self-consciousness and the five-factor model of personality: Distinguishing rumination from reflection. Journal of Personality and Social Psychology, 76(2), 284–304.
Treynor, W., Gonzalez, R., & Nolen-Hoeksema, S. (2003). Rumination reconsidered: A psychometric analysis. Cognitive Therapy and Research, 27(3), 247–259. https://doi.org/10.1023/A:1023910315561
Winkens, L. H. H., van Strien, T., Brouwer, I. A., Penninx, B. W. J. H., Visser, M., & Lähteenmäki, L. (2018). Associations of mindful eating domains with depressive symptoms and depression in three European countries. Journal of Affective Disorders, 228, 26–32. https://doi.org/10.1016/j.jad.2017.11.069
Acknowledgements
We would like to thank the research participants involved in this study.
Funding
This study was supported by NIH grants from the National Center for Complementary and Integrative Health (NCCIH) P01AT005013, K24AT007827, K01AT004199, and T32AT003997 as well as the National Center for Advancing Translational Sciences, UCSF-CTSI Grant Number UL1 TR000004.
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ARH contributed to the study conception, analyzed and interpreted the data, and drafted and critically revised the manuscript. SJSH contributed to the study conception, assisted with data analysis and interpretation, and drafted and critically revised the manuscript. JD designed and executed the study, assisted with data interpretation, and drafted and critically revised the manuscript. PJM: executed the study and drafted and critically revised the manuscript. WH: assisted with data analysis and interpretation, and drafted and critically revised the manuscript. MA: assisted with data management and drafted and critically revised the manuscript. JK: designed intervention components and critically revised the manuscript. ESE: designed the study and critically revised the manuscript. AEM: drafted and critically revised the manuscript. FMH: designed and executed the study, secured grant funding, and drafted and critically revised the manuscript. Ashley E. Mason and Frederick M. Hecht contributed equally as senior co-authors. All authors have read and approved the final manuscript.
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Hooker, A.R., Sagui-Henson, S.J., Daubenmier, J. et al. Effects of a Mindfulness-Based Weight Loss Intervention on Long-term Psychological Well-being Among Adults with Obesity: Secondary Analyses from the Supporting Health by Integrating Nutrition and Exercise (SHINE) Trial. Mindfulness 13, 2227–2242 (2022). https://doi.org/10.1007/s12671-022-01951-2
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DOI: https://doi.org/10.1007/s12671-022-01951-2