Discussion
eating behavior, overweight
PATHOLOGY
Participants with overweight and moderate stress, who received either one of the digitally-based mindfulness programs showed expected reductions in perceived stress, thus confirming prior findings [We found preliminary evidence for a moderating effect of treatment adherence on reductions in perceived stress. Furthermore, meditation frequency was positively associated with greater tolerance for food cravings and decreases in sagittal diameter. It is plausible that treatment adherence, measured by meditation frequency using the Headspace app, accounts for treatment effects in a dose-like fashion, and suggests a Few digitally-based mindfulness interventions have examined treatment effects on weight and metabolic outcomes [Contrary to our hypothesis, we did not find a treatment effect on food cravings. However, the mindfulness groups reduced in binge eating (although this finding approached statistical significance). Thus, we were unable to replicate known effects of in-person mindfulness-based and mindful eating-based interventions on reductions in dysregulated eating [It should be noted that the healthy eating (active control) program was newly developed, and in need of further refining following feasibility and acceptability testing. Participants randomized to healthy eating showed good adherence (only 4% declined participation following the initial counseling session). The majority (73%) of participants rated the program as ‘good’ to ‘excellent’, and 91% of completers would recommend the program. Thus, while the healthy eating program, as packaged, did not reduce our measures of food craving, the feasibility data provided the necessary preliminary evidence for future refinement and testing. Qualitative data point to the potential added value of face-to-face counseling to establish health-related eating goals. It is plausible that participants first need to learn general mindfulness skills before showing eating-related improvements.Finally, while exploratory in nature, we replicated our prior findings with regard to treatment matching [This study had several strengths. We were able to deliver a primarily self-guided, scalable treatment for meditation to adults who experienced both perceived stress and overweight. We observed generally good adherence to our digital intervention, with only 11% being lost to follow-up. We had the added benefit of being able to compare our treatment (mindfulness) to what we considered to be an active control (healthy eating) matched for time and attention. However, our study was likely limited by a sample size that may have been too small to detect modest interaction effects. We were unable to truly ascertain whether participants in either control condition were accessing mindfulness programs or apps during the 8 week intervention period. Further, our measures of dysregulated eating may not fully reflect non-homeostatic eating behavior (vs. a semi-structured interview measure of eating pathology), and the scoring metrics for the FAAQ (a 6-point Likert scale ranging from 1 to 6) without the option for including negative (e.g., -1, -2) response may not yield particularly meaningful arithmetic means. Finally, our sample of participants were highly educated and primarily White. Thus, our findings may not fully generalize to the US population of adults with overweight.