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

Abstract

Many individuals with obesity report overeating despite intentions to maintain or lose weight. Two barriers to long-term weight loss are reward-driven eating, which is characterized by a lack of control over eating, a preoccupation with food, and a lack of satiety; and psychological stress. Mindfulness training may address these barriers by promoting awareness of hunger and satiety cues, self-regulatory control, and stress reduction. We examined these two barriers as potential mediators of weight loss in the Supporting Health by Integrating Nutrition and Exercise (SHINE) randomized controlled trial, which compared the effects of a 5.5-month diet and exercise intervention with or without mindfulness training on weight loss among adults with obesity. Intention-to-treat multiple mediation models tested whether post-intervention reward-driven eating and psychological stress mediated the impact of intervention arm on weight loss at 12-and 18-months post-baseline among 194 adults with obesity (BMI: 30–45). Mindfulness (relative to control) participants had significant reductions in reward-driven eating at 6 months (post-intervention), which, in turn, predicted weight loss at 12 months. Post-intervention reward-driven eating mediated 47.1% of the total intervention arm effect on weight loss at 12 months [β=-0.06, SE(β)=0.03, p=.030, 95% CI (−0.12, −0.01)]. This mediated effect was reduced when predicting weight loss at 18 months (p=.396), accounting for 23.0% of the total intervention effect, despite similar weight loss at 12 months. Psychological stress did not mediate the effect of intervention arm on weight loss at 12 or 18 months. In conclusion, reducing reward-driven eating, which can be achieved using a diet and exercise intervention that includes mindfulness training, may promote weight loss (clinicaltrials.gov registration: NCT00960414).

Mindfulness Is Associated With Treatment Response From Nonpharmacologic Exercise Interventions in Knee Osteoarthritis

“…These results are consistent with a previous study wherein mindfulness predicted treatment response to exercise intervention for weight loss 42 , and extend prior observational research showing that mindfulness was associated with reduced stress and disability 43 , lower pain catastrophizing 44 , and increased physical activity 24 . Overall, these results contribute to the evidence indicating that as a characteristic, mindfulness may influence better health outcomes from exercise.…”

Mindfulness‐based interventions for weight loss: a systematic review and meta‐analysis

“…Results suggest moderate effects of MBIs on weight loss in pre–post analyses ( n = 16; Hedge's g = .42; 95% CI [.26, .59], p < .000001). Studies that used a combination of informal and formal meditation practice showed higher effects ( n = 6; Hedge's g = .55; CI 95% [.32, .77], p < .00001) than formal meditation practice alone ( n = 4; Hedge's g = .46; 95% CI [.10, .83], p < .05). The effects of informal mindfulness exercises alone on weight loss were not significant ( n = 6; p = .17).…”

“…Although MB‐EAT was first developed as a treatment for binge‐eating disorder , derivatives of the program are currently being implemented in non‐clinical populations as an intervention for weight loss (e.g. Timmerman & Brown ; Mason and colleagues ; Daubenmier and colleagues ). Even though third‐wave cognitive behavioural therapies such as ACT and DBT contain elements of mindfulness, they were excluded from our analyses as these programs include additional cognitive and behavioural components, which can lead to confounding interpretations regarding the effectiveness of mindfulness as a strategy for weight loss.…”

“…Four studies were (non-randomized) pre-post pilot studies; 14 were randomized controlled trials. Out of the 14 randomized controlled trials, two studies compared MBI with a waitlist control group (63,54), seven studies compared MBI with a standard weight loss program (of which five used a diet and exercise component similar to lifestyle change programs (77,76,64,84), one used a diabetes self-management program (78) and one used psychoeducation for nutrition and exercise (81)) and five studies compared MBI with an active control group (52,(72)(73)(74)(75).…”

Uncontrolled eating: a unifying heritable trait linked with obesity, overeating, personality and the brain

“…A conceptually related eating-related cognitive control construct is dietary restraint, an attempt to control one's food intake. Broadly, the questionnaires measuring restraint and uncontrolled eating tend not to correlate (Price et al, 2015;Mason et al, 2016). At the same time, different combinations of high/low uncontrolled eating and high/low restraint may produce differential behaviours (Johnson et al, 2011).…”