Family-Based Mindful Eating Intervention for Overweight Adolescents
Condition: Overweight; Adolescent Behavior; Family Research; Weight Loss
MeSH terms: Overweight; Weight Loss
Study type: Interventional

Summary: 
      With currently 35% of U.S. adolescents being overweight and one in six having metabolic
      syndrome, adolescent obesity is one of the major global health challenges of the 21st
      century. Few enduring treatment strategies have been identified in adolescent populations and
      the majority of standard weight loss programs fail to adequately address the impact of
      psychological factors on eating behavior and the beneficial contribution of parental
      involvement in adolescent behavior change. A critical need exists to expand treatment
      development efforts beyond traditional education and cognitive-behavioral programs and to
      explore alternative treatment models for adolescent obesity. Meditation-based mindful eating
      programs may represent a unique and novel scientific approach to the current adolescent
      obesity epidemic as they address key psychological variables affecting weight. Furthermore,
      the recent expansion of mindfulness programs to include family relationships shows the
      immense potential for broadening the customarily individual focus of this intervention to
      include broader factors thought to influence adolescent health outcomes. Thus, we propose to
      develop a mindful eating approach to eating behavior and weight loss specifically tailored
      for adolescents and their families. The first phase of our three phase development process
      will be devoted to adapting an adolescent protocol (Mindful Eating-A) based on an established
      mindful eating program currently being used with adult populations. We will then develop a
      'family enhanced Mindful Eating-A' (Mindful Eating-A+F) protocol that integrates a family
      systems perspective. The goal of Mindful Eating-A+F is to expand the focus of Mindful
      Eating-A to include family factors that influence adolescent eating behaviors. The second
      design phase will consist of an initial test of both intervention components to provide
      feedback on usefulness and acceptability (N = 10 families). The final phase will examine the
      overall efficacy of the optimized Mindful Eating-A+F, relative to the Mindful Eating-A
      intervention with 30 overweight adolescents (BMI > 85th percentile) ages 14-17 and at least
      one parent. Within this examination, post-treatment and 3-month follow-up comparisons across
      the two treatment approaches will be made and effect sizes within and between treatments will
      be assessed.
    

Detailed description: 
      Adolescent obesity is one of the major global health challenges of the 21st century.
      Currently, 35% of adolescents are overweight (BMI > 85th percentile), and one in six are
      diagnosed with metabolic syndrome. While the adoption and maintenance of healthful dietary
      practices has been identified as a high priority topic for future research, few enduring
      treatment strategies have been identified. The cause of adolescent obesity is
      multi-factorial; psychological and family factors largely contribute to this epidemic along
      with biological and environmental influences. However, the majority of standard weight loss
      programs fail to adequately address the impact of psychological factors on eating behavior
      and the beneficial contribution of parental involvement in making dietary change in
      overweight adolescent populations.

      Meditation-based programs may improve the efficacy of more established weight-loss
      interventions for adolescents by addressing key psychological variables affecting weight.
      Mindfulness-Based Stress Reduction (MBSR) is a well-established, systematic patient-centered
      educational approach that uses training in mindfulness meditation to increase awareness of
      and the ability to respond skillfully to experiences that contribute to emotional distress
      and maladaptive behavior. The efficacy of MBSR in reducing psychological distress and
      symptoms of stress in adults has been consistently shown in controlled studies. Significant
      improvements in physiological measures related to metabolic syndrome including blood
      pressure, cholesterol, and glycemic control have also been demonstrated. Similar meditation
      programs have been successfully implemented with adolescents to address problems such as
      hypertension, depression, and eating behaviors. Furthermore, the recent expansion of
      mindfulness programs to include family relationships shows the immense potential for
      broadening the customarily individual focus of meditation-based interventions to include
      broader factors thought to influence adolescent health outcomes. This is important given that
      greater involvement of the family is thought to increase the effectiveness of interventions
      aimed at adolescent weight control, weight maintenance and weight loss.

      Recently, researchers have begun to modify the MBSR program specifically for populations
      attempting to make dietary health changes. One newly modified program for adults is Mindful
      Eating & Living (MEAL), a brief 6-session program designed to teach skills which can lead to
      increased awareness of eating, emotions, and judgment. Preliminary data from our own research
      with adults shows significant changes in eating behaviors and other obesity related problems,
      including reduced psychological distress, regulation of intake patterns, disordered eating,
      improved metabolic regulation, and weight loss.

      Although theoretically compelling, mindful eating interventions have never been examined with
      an overweight adolescent population. Thus, an unprecedented opportunity exists to develop a
      systematic program of research investigating a mindfulness approach to eating behavior and
      weight loss specifically tailored for adolescents and their families. This is critical given
      that adolescence is a period with special developmental considerations, and it is not clear
      that weight loss programs developed for children or adults are effective with adolescents.
      Interventions aimed at adolescent eating behaviors have met with mixed success, and it has
      been theorized that this may be due, in part, to an inadequate understanding of the factors
      (e.g. psychological and family-based) associated with eating behaviors among adolescents that
      need to be addressed in interventions. To address these gaps, this study proposes to
      systematically adapt, pilot, refine, and evaluate a developmentally appropriate Mindful
      Eating intervention for overweight adolescents based on the current protocol format taught in
      the adult MEAL program. We have designed a three-phase iterative development process that
      includes: 1) community key informant and consultant input; 2) beta-testing and further
      refinement of the program; and 3) formal pilot testing. Study aims include:

      Aim 1: Adapt a mindful eating intervention protocol (Mindful Eating -A) for an overweight
      adolescent population (BMI ≥ 85th percentile), ages 14-17. The intervention will be tailored
      to the unique developmental challenges of adolescence, suitable for use in applied community
      settings, and demonstrate feasibility and acceptability.

      Aim 2: Develop a 'family enhanced mindful eating -A' (Mindful Eating -A+F) intervention
      protocol that integrates a family systems perspective into Mindful Eating -A. The goal is to
      expand the focus of Mindful Eating -A to include family factors that influence adolescent
      eating behaviors. These include food-related parenting styles, food organization behaviors,
      family support, and the parents' own eating-related behaviors. Mindful Eating -A+F will
      demonstrate feasibility, and acceptability, and will be suitable for use in applied community
      settings.

      Aim 3: To examine the overall efficacy of the optimized Mindful Eating -A+F, relative to the
      Mindful Eating -A intervention. Within this examination, post-treatment and 3-month follow-up
      comparisons across the two treatment approaches will be made. Effect sizes within and between
      treatments will be assessed. We expect that Mindful Eating -A+F will show stronger and more
      enduring effects than Mindful Eating -A alone on adolescent outcomes. Primary outcomes
      include adolescent weight, BMI, and eating behaviors. Secondary outcomes include adolescent's
      markers of metabolic syndrome, psychological distress, family barriers, and mindfulness.
    

Intervention name(s): Adolescent Mindful Eating Group; Parent Integrated Group
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Adolescents will learn mindfulness and meditation, how to be mindful when eating, mindful yoga, how to recognize hunger cures, understand emotional eating, trigger foods and how to apply mindful eating in social situations.; Adolescents will receive learn same techniques as adolescents in Adolescent Mindful Eating Group. The group component of the parent intervention is designed for parents only and will be run parallel to the adolescent group. The goal of these sessions is to teach parents skills to support adolescent by developing effective parenting styles, parenting skills, strategies around eating behavior change, productive problem solving, and the role of all other family members with regard to the treatment process. The last five sessions will be dedicated to teaching a slightly reduced MEAL adult protocol to allow parents to learn mindfulness skills as it applies to their own eating behaviors and affective reactivity.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Overweight Adolescents; Mindful Eating and Living; Family Systems; Body-Mass Index; Mindfulness