Effects of a Mindfulness-Based Weight Loss Program on Overweight Adults in a Patient Centered Medical Home

Jennifer Gordon, MSW, Jeremiah Eckhaus, MD, ABHM, Barbara Stewart, PhD Montpelier Integrative Family Health

Statement of Problem

 More than one-third of adults are obese with a body mass index of ≥ 30 kg/m 2 . They are presenting to their PCPs with co-morbid conditions.

 PCPs under-identify and inconsistently address weight concerns due to insufficient behavioral training, time, and reimbursement.

 Simply knowing how to change diet and exercise patterns is inadequate. The psychological processes leading to behaviors associated with weight gain must be addressed for sustainable weight loss to occur.

What is the norm in obesity treatment?

  PCP’s typically advise patients to decrease calories and increase exercise.

Weight loss programs include behavioral counseling and nutrition education.

  A mere 5% maintain weight loss after 5 years 1 . 30% of participants in weight loss programs report binge eating (consuming large amounts of food in a discrete time period while feeling out of control.)  Emotional eating (overeating due to negative emotions) and external eating (overeating in response to food-related stimuli) are positively associated with BMI and obesity 2 and may predict weight regain 3 .

 Mindfulness-based interventions may be an important component of weight loss programs due to the frequency of behavioral and emotional dysregulation among obese individuals.

Mindfulness

- non-judgmental awareness cultivated by paying attention to what is happening in the present moment.  Mindfulness meditation can increase cognitive-attentional processes that promote self-regulation and has potential effects across multiple domains of psychological functioning.

Specific Aims

 The pilot study explored the effects of Eat for Life, a primary care mindfulness based weight loss program for overweight adults. Eat for Life includes mindfulness-based techniques, behavioral counseling and nutrition education.

Primary Hypotheses:

 The Eat for Life program will produce a significant reduction in weight,  BMI and abdominal circumference.

Individuals in the Eat for Life program will report an increase in mindfulness and a reduction in binge eating severity and depression.

Secondary Goals:

 to explore possible mechanisms of change.

 to identify mediating variables, particularly the role of change in mindfulness.

Method

Design:

 Pre-post questionnaires  Biometric assessment completed prior to session 1 and at session 8

Participants:

N = 47, 4 dropped prior to session 5. PCP or self-referred

Inclusion Criteria:

 Gender: Men and women 18 and older  BMI of ≥ 25 and medically stable

Primary Outcome Measures:

 Change in weight, BMI, abdominal circumference

Secondary Measures:

 Psychological Status: Patient Health Questionnaire (PHQ-9): screens for depression  Mediator Variables: Binge Eating Scale (BES): assesses the presence/ severity of binge eating, Five Facet Mindfulness Questionnaire (FFMQ), and mindfulness meditation practice 3 4 5 6 7 8 9

Session

1 2

Eat for Life Intervention

Mindfulness, Mindful Raisin Eating Exercise, Completing a Food Log Mini-Meditations, Trigger Food Eating Exercise, Reading Labels, Calorie Counting Hunger Awareness, Emotional Eating and Other Triggers, Body Scan, Calorie Counting Exercise , Calorie Counting Stomach Fullness, Introduction to Taste Satiety, Plate Method Mindful Cooking , Calorie Counting Emotional Eating, Anger and Forgiveness, Hourly Energy Balance Taste Satiety , Mindful Eating and Potluck Mindful Movement , Continue Change/Self-Acceptance

Change in Weight

250 245 240 235 237,3 230 229,4 225 220

Baseline 8 weeks

M loss = 7.8 lbs, SE of mean change = 0.9 paired t = 8.4, p < .001, one-tailed

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Mean Changes Pre-Post

Measure

Weight BMI Abdominal Circumference Binge Eating Scale Depression (PHQ-9)

Baseline M (SD)

237.3

(48.6) 39.3 (7.0) 48.3 (6.9) 20.1

(8.4) 8.1

(4.6)

8-weeks M (SD)

229.4 (48.7) 38.0

(7.1) 46.7

(6.4) 11.7

(8.3) 4.6

(3.6)

Mean Change p (one-tailed) -7.8 lbs p < .001 -1.3

p < .001

-1.6 in.

p < .001

-8.3

p < .001

-3.5

p < .001

Change in Mindfulness x Other Variables

Average Minutes in Formal Meditation (weekly) Average # of times in Mini Meditation (weekly) Change in FFMQ Observe

Results: Change Change in Binge in Weight Eating Scale (BES)

-.55

-.30

-.01

** * -.12

-.20

-.33

*

Change in Depression (PHQ-9)

.13

.17

-.18

Change in FFMQ Describe Change in FFMQ-Act with Awareness .04

-.12

-.39

-.16

** .03

-.01

Change in FFMQ Nonjudgmental Change in FFMQ Nonreactionary .10

-.07

-.24

-.31

* -.20

-.22

Pearson Correlation Coefficients: ** p < .01, * p < .05

Change in Facets of Mindfulness (FFMQ)

4 3.5

3 3.40

3.36

3.29

2.98

2.91

3.77** 3.58* 3.51* 3.29** 3.19**

Results

Observe Describe Act with awareness Nonjudgmental Nonreactionary 2.5

Baseline 8 weeks

**p < .001, *p < .05, one-tailed

Results and Conclusions

          Eat for Life appears to have initial beneficial effects on weight/BMI and abdominal circumference. Average overall weight loss = 7.8 lbs. 3 gained and 40 lost weight from .8 lbs. to 20.8 lbs.

Participants had a 1.6 inch mean reduction in abdominal circumference and over 1.25 point reduction in BMI.

Greater time spent in meditation was related to more weight loss. Improvement in three facets of mindfulness was related to reduction in severity of binge eating.

There was a significant reduction in severity of binge eating and depression.

There was significant improvement in five facets of mindfulness.

Eat for Life is a promising weight loss program and does as well as traditional behavioral/nutrition education programs in effecting weight loss. Longitudinal research is needed to examine the long-term effects of Eat for Life. Randomized controlled trials are needed to determine if effects are significant and can be sustained when compared with standard dietary and exercise interventions.

References

1. Kramer FM, Jeffrey RW, Forster JL, Snell MK.

Long-term Follow-up of Behavioural Treatment for Obesity: Patterns of weight regain among men and women.

Obesity, 1989.

13

: p. 123-136.

International Journal of 2. Van Strien, T., Schippers, G.M., & Cox, W.M. (1995). On the relationship between emotional and external eating behaviour. Addictive Behaviors, 20, 585-594.

3. McGuire, J.G., Wing, R.R., Klem, M.L., Lang, W., & Hill, J.O. (1999). What predicts weight regain ina group of successful weight losers? Journal of Consulting and Clinical Psychology, 67, 177-185.

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