Comparative effectiveness of a mindful eating intervention to a diabetes self-management intervention among adults with type 2 diabetes: a pilot study

A comprehensive review on the implications of Yogic/Sattvic diet in reducing inflammation in type 2 diabetes

Chronic inflammation in type 2 diabetes (T2D), characterized by constitutively activated immune cells and elevated pro-inflammatory mediators along with hyperglycaemia and increased free fatty acids and branched chain amino acid levels, significantly alters the immuno-metabolic axis. Over the years, dietary intervention has been explored as an effective strategy for managing T2D. Evidence from experimental and clinical studies indicates that various diets, including Mediterranean, Nordic, Palaeolithic and ketogenic diets, increase insulin sensitivity, decrease gluconeogenesis, and adiposity, and exert anti-inflammatory effects, thus preserving immuno-metabolic homeostasis in individuals with T2D. Indian dietary sources are categorized as Sattvic, Rajasic, and Tamasic, depending on their impact on health and behaviour. The Yogic diet, commonly recommended during yoga practice, is predominantly Sattvic, emphasizing plant-based whole foods while limiting processed and high-glycaemic-index items. Yogic diet is also recommended for Mitahara, emphasizing mindful eating, which is attributed to calorie restriction. Adopting a Yogic diet, featuring low-fat vegetarian principles, strongly reduces inflammatory mediator levels. This diet not only ameliorates insulin resistance and maintains a healthy body weight but also regulates immunomodulation, enhances gut microbiome diversity and provides essential phytonutrients, collectively preventing inflammation. Although, preliminary studies show aforementioned beneficial role of Yogic diet in improving diabetes associated metabolic and inflammatory changes, precise cellular and molecular mechanisms are not yet understood. Hence, further studies are warranted to decipher the mechanisms. This review summarizes the multiple roles of Yogic diet and related dietary components in mitigating inflammation and enhancing glycaemic control in T2D.

Practical Awareness-Based Strategies for Eating (PASE): A Pilot and Feasibility Randomized Trial

Background

Few prior interventions for obesity have focused on reward-related eating. Researchers developed a mobile health mindfulness-based intervention, Eat Right Now (ERN), for improving reward related eating; ERN has not yet been feasibility tested as a weight loss intervention.

Objective

To obtain 6-month pilot and feasibility data in patients using the ERN intervention alone or with asynchronous coaching.

Methods

A 6-month, two-arm pilot and feasibility randomized trial was conducted involving 20 adults with a BMI ≥ 25 kg/m2 recruited from Kaiser Permanente Washington. Participants were randomized to ERN alone or ERN plus individualized coaching. Weight loss was assessed via a Wi-Fi-enabled digital scale.

Results

Among the 20 randomized participants, 17 (85%) started the intervention and remained enrolled in six months. Among these, 82% (14/17) had weight data captured by a Wi-Fi scale and 70.5% (12/17) completed follow-up questionnaires at the 6-month time point. The coached ERN participants had 4.3% weight loss (95% confidence interval (CI): 2.3%, 6.3%) and uncoached participants had 3.6% weight loss (95% CI: 1.2%, 5.9%). Participants in both approaches reported reductions in reward-related eating.

Conclusions

This pilot randomized trial of ERN demonstrates the feasibility and acceptability of the intervention for the majority of both the coached and uncoached groups. Further efforts are needed to ensure high retention and data capture in future studies.

Investigating the Impact of Ashwagandha and Meditation on Stress Induced Obesogenic Eating Behaviours

Obesity has been identified as a rapidly rising pandemic within the developed world, potentially increasing the risks of type 2 diabetes and cardiovascular disease. Various studies have identified a positive association between stress, elevated cortisol levels and obesity. Mechanisms of the stress response lead to hyperpalatable food preference and increased appetite through the activation of the HPA axis, elevated cortisol and the resulting interactions with the dopaminergic system, neuropeptide Y, ghrelin, leptin and insulin. The methodology of this review involved a Systematic Search of the Literature with a Critical Appraisal of papers considering ashwagandha, mediation and mindfulness in relation to mechanisms of the stress response. It incorporated 12 searches yielding 330 hits. A total of 51 studies met the inclusion criteria and were critically appraised with ARRIVE, SIGN50 and Strobe checklists. Data from the 51 studies was extracted, coded into key themes and summarized in a narrative analysis. Thematic analysis identified 4 key themes related to ashwagandha and 2 key themes related to meditation. Results provide an overview of evidence assessing the efficacy of ashwagandha and meditation in relation to weight loss interventions by supporting the stress response and the pathways highlighted. Results of Clinical studies indicate that ashwagandha supports weight loss through reduced stress, cortisol and food cravings. Pre-clinical studies also suggest that ashwagandha possesses the capacity to regulate food intake by improving leptin and insulin sensitivity and reducing addictive behaviors through dopamine regulation. Clinical studies on meditation indicate it may enhance a weight loss protocol by reducing the stress response, cortisol release and blood glucose and improving eating behaviors.

Association between intuitive eating and health outcomes in outpatients with type 2 diabetes: a cross-sectional study

PURPOSE

To evaluate the association between intuitive eating and health outcomes in patients with type 2 diabetes in a cross-sectional study.

METHODS

Consecutively, outpatients attending at university hospital underwent clinical, laboratory, lifestyle, and eating behavior evaluations. Intuitive eating was assessed using the Intuitive Eating Scale-2 (IES-2), and the Three Factor Eating Questionnaire-21 was adopted as a confirmatory tool for disordered eating behavior. Optimized health outcomes were considered according to the American Diabetes Association criteria for BMI, HbA1c, lipid profile, and blood pressure values, and the International Diabetes Federation criteria for waist circumference. Considering the answers of the IES-2 items, patients were grouped by latent class analysis, and their characteristics were compared by appropriate tests.

RESULTS

In total, 267 patients were evaluated: 62.2% women, with 60 (53-65) years, BMI 31.9 ± 5.4 kg/m², diabetes duration of 16 ± 9 years, HbA1c 8.5 ± 1.5%, and an IES-2 total score of 58 (50-67)%. Three intuitive eating groups were identified: higher intuitive eating, nonemotional-oriented coping, and lower intuitive eating. Patients with higher intuitive eating have higher chances of having optimized BMI and serum triglycerides values compared to patients with lower intuitive eating. Also, the 10-point increase on IES-2 was associated with a 0.62 kg/m² reduction on BMI values (95%CI -1.18;-0.06), 1.90 cm on waist circumference (95%CI -3.26;-0.54), and 23 mg/dL in serum triglycerides values (95%CI -38.27;-7.40) after adjustment for age, sex, psychotropic drug use, medication effect score, smoking, and BMI.

CONCLUSION

Intuitive eating seems to be associated with optimized health outcomes and may contribute to better personalized interventions in nutritional treatment that promote adaptive behaviors in diabetes management, but should be tested.

Mindful eating questionnaire: Validation and reliability in Brazilian adults with type 2 diabetes mellitus

OBJECTIVE

The objective was to evaluate the psychometric properties of the Mindful Eating Questionnaire (MEQ) in Brazilian subjects with type 2 diabetes mellitus (T2DM) and validate a Brazilian version of the MEQ for adults with T2DM (MEQ-DM).

METHODOLOGY

Baseline data from the multicentre Nutritional Strategy for Glycaemic Control in Patients with Type 2 Diabetes Mellitus (NUGLIC) trial were used. Construct validity was assessed using exploratory factor analysis (EFA). The root mean square error of approximation (RMSEA), comparative fit index (CFI) and Tucker‒Lewis index (TLI) fit indices indicated the adequacy of the model. The reliability of the questionnaire was evaluated considering the different factor loadings. Criterion validity was tested by correlating the MEQ-DM with sociodemographic variables, body mass index (BMI) and physical activity levels.

RESULTS

A total of 370 participants were included, who were mostly female (60.8 %) and had a median age of 61 (54-67) years. The EFA results supported the two-factor structure of the 25-item MEQ-DM: disinhibition and awareness. The results of the fit indices (RMSEA = 0.04; CFI = 0.95 and TLI = 0.94) and composite reliability (disinhibition = 0.84 and awareness = 0.81) were consistent. The criterion validity analysis indicated a significant association between MEQ-DM scores and age, sex, civil status, education level, BMI and physical activity (p < 0.05).

CONCLUSION

When explored with Brazilian adults with T2DM, the MEQ-DM presented a factorial model with two dimensions: disinhibition and awareness. This model must be confirmed in future studies with Brazilians with T2DM.

Meditation for the primary and secondary prevention of cardiovascular disease

BACKGROUND

Interventions incorporating meditation to address stress, anxiety, and depression, and improve self-management, are becoming popular for many health conditions. Stress is a risk factor for cardiovascular disease (CVD) and clusters with other modifiable behavioural risk factors, such as smoking. Meditation may therefore be a useful CVD prevention strategy.

OBJECTIVES

To determine the effectiveness of meditation, primarily mindfulness-based interventions (MBIs) and transcendental meditation (TM), for the primary and secondary prevention of CVD.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, three other databases, and two trials registers on 14 November 2021, together with reference checking, citation searching, and contact with study authors to identify additional studies.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) of 12 weeks or more in adults at high risk of CVD and those with established CVD. We explored four comparisons: MBIs versus active comparators (alternative interventions); MBIs versus non-active comparators (no intervention, wait list, usual care); TM versus active comparators; TM versus non-active comparators.

DATA COLLECTION AND ANALYSIS

We used standard Cochrane methods. Our primary outcomes were CVD clinical events (e.g. cardiovascular mortality), blood pressure, measures of psychological distress and well-being, and adverse events. Secondary outcomes included other CVD risk factors (e.g. blood lipid levels), quality of life, and coping abilities. We used GRADE to assess the certainty of evidence.

MAIN RESULTS

We included 81 RCTs (6971 participants), with most studies at unclear risk of bias. MBIs versus active comparators (29 RCTs, 2883 participants) Systolic (SBP) and diastolic (DBP) blood pressure were reported in six trials (388 participants) where heterogeneity was considerable (SBP: MD -6.08 mmHg, 95% CI -12.79 to 0.63, I2 = 88%; DBP: MD -5.18 mmHg, 95% CI -10.65 to 0.29, I2 = 91%; both outcomes based on low-certainty evidence). There was little or no effect of MBIs on anxiety (SMD -0.06 units, 95% CI -0.25 to 0.13; I2 = 0%; 9 trials, 438 participants; moderate-certainty evidence), or depression (SMD 0.08 units, 95% CI -0.08 to 0.24; I2 = 0%; 11 trials, 595 participants; moderate-certainty evidence). Perceived stress was reduced with MBIs (SMD -0.24 units, 95% CI -0.45 to -0.03; I2 = 0%; P = 0.03; 6 trials, 357 participants; moderate-certainty evidence). There was little to no effect on well-being (SMD -0.18 units, 95% CI -0.67 to 0.32; 1 trial, 63 participants; low-certainty evidence). There was little to no effect on smoking cessation (RR 1.45, 95% CI 0.78 to 2.68; I2 = 79%; 6 trials, 1087 participants; low-certainty evidence). None of the trials reported CVD clinical events or adverse events. MBIs versus non-active comparators (38 RCTs, 2905 participants) Clinical events were reported in one trial (110 participants), providing very low-certainty evidence (RR 0.94, 95% CI 0.37 to 2.42). SBP and DBP were reduced in nine trials (379 participants) but heterogeneity was substantial (SBP: MD -6.62 mmHg, 95% CI -13.15 to -0.1, I2 = 87%; DBP: MD -3.35 mmHg, 95% CI -5.86 to -0.85, I2 = 61%; both outcomes based on low-certainty evidence). There was low-certainty evidence of reductions in anxiety (SMD -0.78 units, 95% CI -1.09 to -0.41; I2 = 61%; 9 trials, 533 participants; low-certainty evidence), depression (SMD -0.66 units, 95% CI -0.91 to -0.41; I2 = 67%; 15 trials, 912 participants; low-certainty evidence) and perceived stress (SMD -0.59 units, 95% CI -0.89 to -0.29; I2 = 70%; 11 trials, 708 participants; low-certainty evidence) but heterogeneity was substantial. Well-being increased (SMD 0.5 units, 95% CI 0.09 to 0.91; I2 = 47%; 2 trials, 198 participants; moderate-certainty evidence). There was little to no effect on smoking cessation (RR 1.36, 95% CI 0.86 to 2.13; I2 = 0%; 2 trials, 453 participants; low-certainty evidence). One small study (18 participants) reported two adverse events in the MBI group, which were not regarded as serious by the study investigators (RR 5.0, 95% CI 0.27 to 91.52; low-certainty evidence). No subgroup effects were seen for SBP, DBP, anxiety, depression, or perceived stress by primary and secondary prevention. TM versus active comparators (8 RCTs, 830 participants) Clinical events were reported in one trial (201 participants) based on low-certainty evidence (RR 0.91, 95% CI 0.56 to 1.49). SBP was reduced (MD -2.33 mmHg, 95% CI -3.99 to -0.68; I2 = 2%; 8 trials, 774 participants; moderate-certainty evidence), with an uncertain effect on DBP (MD -1.15 mmHg, 95% CI -2.85 to 0.55; I2 = 53%; low-certainty evidence). There was little or no effect on anxiety (SMD 0.06 units, 95% CI -0.22 to 0.33; I2 = 0%; 3 trials, 200 participants; low-certainty evidence), depression (SMD -0.12 units, 95% CI -0.31 to 0.07; I2 = 0%; 5 trials, 421 participants; moderate-certainty evidence), or perceived stress (SMD 0.04 units, 95% CI -0.49 to 0.57; I2 = 70%; 3 trials, 194 participants; very low-certainty evidence). None of the trials reported adverse events or smoking rates. No subgroup effects were seen for SBP or DBP by primary and secondary prevention. TM versus non-active comparators (2 RCTs, 186 participants) Two trials (139 participants) reported blood pressure, where reductions were seen in SBP (MD -6.34 mmHg, 95% CI -9.86 to -2.81; I2 = 0%; low-certainty evidence) and DBP (MD -5.13 mmHg, 95% CI -9.07 to -1.19; I2 = 18%; very low-certainty evidence). One trial (112 participants) reported anxiety and depression and found reductions in both (anxiety SMD -0.71 units, 95% CI -1.09 to -0.32; depression SMD -0.48 units, 95% CI -0.86 to -0.11; low-certainty evidence). None of the trials reported CVD clinical events, adverse events, or smoking rates.

AUTHORS' CONCLUSIONS

Despite the large number of studies included in the review, heterogeneity was substantial for many of the outcomes, which reduced the certainty of our findings. We attempted to address this by presenting four main comparisons of MBIs or TM versus active or inactive comparators, and by subgroup analyses according to primary or secondary prevention, where there were sufficient studies. The majority of studies were small and there was unclear risk of bias for most domains. Overall, we found very little information on the effects of meditation on CVD clinical endpoints, and limited information on blood pressure and psychological outcomes, for people at risk of or with established CVD. This is a very active area of research as shown by the large number of ongoing studies, with some having been completed at the time of writing this review. The status of all ongoing studies will be formally assessed and incorporated in further updates.

Impact of Diabetes Self-Management Education on A1C Levels Among Black/African Americans: A Systematic Review

PURPOSE

The purpose of this systematic review was to examine the impact of diabetes self-management education (DSME) programs on A1C levels of Black/African American adults with type 2 diabetes.

METHODS

Authors followed PRISMA guidelines and searched PubMed and CINAHL databases to identify articles published from 2000 to date. The primary outcome was A1C and participation in a DSME program among Black/African Americans with diabetes.

RESULTS

Nine high-quality randomized control trials (RCTs) were included in this review. Sample sizes ranged between 48 and 211. Studies reported Black/African American samples ranging from 23% to 57% (n = 4), 4 reported 100%, and 1 reported 96%. Most (56%) reported a statistically significant decline in A1C levels postprogram, whereas 44% noted insignificant changes. All the studies compared the DSME intervention effect to a control group or another type of diabetes self-management program.

CONCLUSION

The results suggest that DSME programs can be effective at lowering A1C levels in Black/African American adults; however, more research with larger sample sizes of Black/African Americans is warranted. The availability of meta-analyses and more RCTs could also further strengthen the external validity of this review. Additionally, future studies focused on A1C outcomes within DSME programs not combined with other self-management interventions among Black/African Americans can advance science regarding the impact of DSME programs among this disparate population.

Components in downstream health promotions to reduce sugar intake among adults: a systematic review

Excessive sugar consumption is well documented as a common risk factor for many Non-Communicable Diseases (NCDs). Thus, an adequate intervention description is important to minimise research waste and improve research usability and reproducibility. A systematic review was conducted to identify components in published evidence interventions pertaining to the health promotions on reducing sugar intake among adults. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and used the Mixed Methods Appraisal Tool (MMAT) for quality appraisal. The period for the selected study was from 2000 to 2022, and articles were retrieved from Web of Science (WOS), Medline, Scopus, and PubMed. The target population was adults aged 18 years old and above who underwent intervention to assess the changes in their sugar intake. Data sources and all human epidemiologic studies were included. Out of the 9,333 papers identified, 25 were included. The overall quality of evidence of the studies was considered moderate. Apart from the characteristics of the reviewed studies, components of interventions are including the basis of theoretical or model for the intervention, which majority use Social Cognitive Theory, followed by PRECEDE-PROCEED model, socio-ecological and process-improvement theories and Transtheoretical Model; providers, who are commercial provider, qualified nutritionist, professor of nutrigenomics and nutrigenetics, doctor, dietitian nutritionist, lifestyle coaches, and junior public health nurses; duration of the intervention and follow-up time, varies from as short as one month to as long as 24 months; material provided either softcopy or hardcopy; tailoring approach, based on the individual goals, the process of change, genotype analysis, beliefs, barriers, and sociocultural norms; delivery mechanism either face-to-face or technology-mediated; and tools to measure the sugar consumption outcome mostly used Food Frequency Questionnaire (FFQ), besides 24-h dietary recalls, and food diaries. There are various components in downstream health promotion to reduce sugar intake among adults that can be adapted according to the local health promotion and intervention context. More well-designed interventions using integration components are encouraged in further studies.

Exploring the association between self-compassion, mindfulness and mindful eating with eating behaviours amongst patients with obesity

Background: People who have obesity often experience problematic eating behaviours, contributing towards their excessive weight gain. Aims: Understanding problematic eating behaviours and their association to self-compassion, mindfulness and mindful eating is important for the development of future interventions that improve weight-loss and weight-regulation. Methods: One hundred and one participants attending their first session of a 6-session dietetic programme within a Tier 3 medical weight management service in the West Midlands, UK were recruited to complete questionnaires on self-compassion, mindfulness, mindful eating and eating behaviours, such as, emotional, restrained, external, fat and sugar consumption and grazing. Results: The findings suggested all three constructs, self-compassion, mindfulness and mindful eating were significantly and negatively associated with grazing and emotional eating, but mindful eating was the only construct that also displayed a significant and negative association with other eating behaviours that are often barriers to successful weight regulation, such as external eating and fat consumption. Further investigation suggested mindful eating had an indirect effect on fat consumption and grazing via external eating. Conclusion: Whilst, self-compassion, mindfulness and mindful eating displayed a negative relationship with grazing and emotional eating, mindful eating also displayed a negative relationship with fat consumption and external eating. Possible explanations and directions for future work are discussed with an emphasis on the need for more empirical work.

Effects of Meditation Intervention on Self-management in Adult Patients With Type 2 Diabetes: A Systematic Literature Review and Meta-analysis

BACKGROUND

Diabetes complications are prevalent and cause adverse effects on the physical, psychological, and economic status of adult patients with type 2 diabetes. Meditation may positively affect self-management and, in turn, reduce diabetes complications. However, the systematic examination of the effects of meditation without additional components on self-management in this population have been rarely examined.

PURPOSE

The aim of this study was to examine the effects of meditation interventions on self-management (ie, control of glucose, blood pressure, cholesterol, and obesity and self-management) among adult patients with type 2 diabetes in randomized controlled trials.

METHODS

In this systematic review and meta-analysis, 6 electronic databases were searched using major keywords of meditation , diabetes , and self-management during March 2022.

RESULTS

Eight studies (9 articles) using mindfulness-based meditation were included. The meta-analysis showed that meditation improved hemoglobin A 1c (effect size = -0.75; 95% confidence interval, -1.30 to -0.21; P = .007) but not fasting blood glucose. Only a few studies examined meditation effects on other types of self-management (eg, blood pressure, body mass index, cholesterol, diet, exercise, foot care, and monitoring of blood glucose), and the effects were inconsistent. In 1 study, meditation improved diabetes self-management.

CONCLUSIONS

Mindfulness-based meditation reduced hemoglobin A 1c levels in adult patients with type 2 diabetes but did not consistently improve other types of self-management in a few studies examined. This may imply the need for additional intervention components to improve different types of self-management. Further studies are needed to examine the effects of different types of meditations with additional components on different types of self-management.

Diet Quality and Consumption of Healthy and Unhealthy Foods Measured via the Global Diet Quality Score in Relation to Cardiometabolic Outcomes in Apparently Healthy Adults from the Mediterranean Region: The ATTICA Epidemiological Cohort Study (2002-2022)

The Global Diet Quality Score (GDQS) is a novel food-based score that assesses both nutrient adequacy and chronic disease risk, by evaluating healthy (GDQS+) and unhealthy foods (GDQS-). The aim of this study was to evaluate the association among GDQS, GDQS+, and GDQS- against the 20-year risk of cardiometabolic outcomes in a Mediterranean population. The sample was n = 2169 initially free of cardiovascular disease (CVD) participants of the ATTICA study (2002-2022) that participated in the 20-year follow-up. The incidence of CVD, hypertension, hypercholesterolemia, and type 2 diabetes mellitus (T2DM) was defined according to WHO-ICD-10 criteria. The GDQS was computed based on previously published instructions. In multivariate analyses, a higher diet quality, per 1/49 of the GDQS, was associated with an 8% [95% Confidence Interval-CI: 6-9%] and 2% [95% CI: 1-3%] lower CVD and T2DM risk, respectively. A higher consumption of healthy foods, per 1/32 of GDQS+, was associated with a 9% [95% CI: 7-11%] and 2% [95% CI: 1-3%] lower CVD and T2DM risk, respectively. Contrarily, a lower consumption of unhealthy foods (GDQS-) was not associated with cardiometabolic events in the adjusted models (all p value< 0.05). In clinical practice or future public health actions to ameliorate dietary habits and prevent CVD and T2DM, more attention should be focused on healthy foods that should be included in our diets.

The Effects of Mindfulness on Glycemic Control in People with Diabetes: An Overview of Systematic Reviews and Meta-Analyses

Background: Previous research has demonstrated the effectiveness of mindfulness interventions in improving glycemic control. By enhancing attention control, emotion regulation, and self-awareness, mindfulness shows promise in managing the lifestyle factors associated with cardiovascular disease risk. However, the impact of mindfulness on glycemic control in people with diabetes remains unclear. This overview aims to summarize the current evidence of the impact of mindfulness interventions on glycemic control in people with diabetes and propose suggestions for future research. Methods: The author searched electronic databases (PubMed/MEDLINE, Embase, and Cochrane Library) to identify relevant systematic reviews and meta-analyses. The current evidence regarding the effects of mindfulness on glycemic control in people with diabetes was summarized. Results: This review evaluated a total of five systematic reviews and meta-analyses of randomized controlled trials (RCTs). Mindfulness interventions show potential for improving glycemic control as measured by hemoglobin A1c (HbA1c) levels, as well as reducing stress, depression, and anxiety in people with diabetes. Four out of five systematic reviews and meta-analyses reported a significant reduction in HbA1c levels by approximately 0.3%. However, the available studies lacked adequate description of key characteristics of study subjects, such as body mass index, medication, and disease conditions, which are essential for assessing the impact of mindfulness on glycemic control. Moreover, there was significant heterogeneity in the intervention methods employed across the included RCTs. Conclusions: Mindfulness interventions are effective in improving glycemic control in people with type 2 diabetes. However, the overall quality of the reviewed studies raises uncertainty regarding the effectiveness of mindfulness as a treatment for people with diabetes. Further research is necessary to elucidate the biological effects of mindfulness on physiological, neurological, and endocrinological functions in humans.

Intuitive and mindful eating to improve physiological health parameters: a short narrative review of intervention studies

OBJECTIVES

This brief narrative review aims to give an up-to-date overview of intuitive and mindful eating (I/ME) interventions with specific focus on cardiometabolic risk factors, including glucose, lipid profile, blood pressure and inflammatory markers.

CONTENT

I/ME intervention studies in adults which measured at least one physiological parameter other than weight were identified from PubMed. The clinical trial/randomized controlled trial filters and publication dates 2001 through April 2021 with variations of the following keywords were applied: intuitive eating, mindful eating, weight neutral. Ten articles were identified.

SUMMARY AND OUTLOOK

Of the 10 studies, seven showed I/ME interventions were more effective than control in at least one cardiometabolic outcome, two showed significant I/ME within-group improvements but no between-group differences, and one showed neither within-group nor between-group differences. Specifically, I/ME improved glucose levels among pregnant women with or without gestational diabetes, lipid profile among adults with overweight or obesity, blood pressure among participants with overweight and inflammatory markers among post-menopausal women with obesity. However, the positive impact of I/ME on each of these cardiometabolic parameters was not consistent across studies: of the six studies that examined glucose regulation, two demonstrated positive outcomes for I/ME group, whereas four found no effect compared to control. Three out of five studies had positive lipid effects, one out of five demonstrated systolic blood pressure (SBP) improvements and one of two showed improvements in inflammatory markers. Given these mixed results, more research is needed to understand the possible effectiveness of I/ME to improve cardiometabolic health.

Comparative efficacy of remotely delivered mindfulness-based eating awareness training versus behavioral-weight loss counseling during COVID-19

Introduction

Dysregulated eating (emotional eating, cue-elicited eating, and dietary restraint and restriction) has been linked to being overweight or obese. The present investigation used a random controlled trial (RCT) to test the differential efficacy of remotely delivered Mindfulness-Based Eating Awareness Training (MB-EAT) and Behavioral Weight Loss (BWL) counseling.

Methods

The sample was recruited through advertisements that offered help to people "with problems controlling their eating" or "interested in improving their relationship with food" (n = 135).

Results

Retention was low in both groups (42%), but not dissimilar to retention rates reported in related clinical trials delivered "in person." Among the participants who completed treatment, we found no between-group differences in any of the treatment outcomes, but participants in both groups experienced significant increases in eating-related mindfulness [Mindful Eating Questionnaire (MEQ) and awareness [Multidimensional Assessment of Interoceptive Awareness (MAIA), and significant decreases in unhealthy eating patterns [Dutch Eating Behavior Questionnaire (DEBQ); Binge Eating Scale (BES), and weight over the course of treatment. Participants in both groups also experienced increases in self-reported depression and anxiety symptoms [Hospital Anxiety and Depression Scale (HADS)], although these increases likely reflected normative changes observed in the population at large during COVID-19.

Discussion

Overall, the results suggest that dysregulated eating and weight loss intervention delivered remotely via teleconference can be effective.

'Mindful eating' for reducing emotional eating in patients with overweight or obesity in primary care settings: A randomized controlled trial

OBJECTIVE

The primary aim of this study was to analyse the efficacy of a 'mindful eating' programme for reducing emotional eating in patients with overweight or obesity.

METHOD

A cluster randomized controlled trial (reg. NCT03927534) was conducted with 76 participants with overweight/obesity who were assigned to 'mindful eating' (7 weeks) + treatment as usual (TAU), or to TAU alone. They were assessed at baseline, posttreatment and 12-month follow-up. The main outcome was 'emotional eating' (Dutch Eating Behaviour Questionnaire, DEBQ); other eating behaviours were also assessed along with psychological and physiological variables.

RESULTS

'Mindful eating' + TAU reduced emotional eating both at posttreatment (B = -0.27; p = 0.006; d = 0.35) and follow-up (B = -0.53; p < 0.001; d = 0.69) compared to the control group (TAU alone). 'External eating' (DEBQ) was also significantly improved by the intervention at both timepoints. Significant effects at follow-up were observed for some secondary outcomes related to bulimic behaviours, mindful eating, mindfulness, and self-compassion. Weight and other physiological parameters were not significantly affected by 'mindful eating' + TAU.

CONCLUSIONS

These findings support the efficacy of the 'mindful eating' + TAU programme for reducing emotional and external eating, along with some other secondary measures, but no significant changes in weight reduction were observed.

Weight-neutral interventions in young people with high body mass index: A systematic review

AIM

This systematic review explored the feasibility, acceptability and effect on health outcomes of weight-neutral interventions in health improvement-seeking young people with overweight/obesity.

METHODS

Six databases were searched to March 2021 for health, but not weight, focused interventions (PROSPERO, CRD42020152671). Eligible studies recruited young people (10-24 years) with overweight/obesity. The studies were described using narrative synthesis, with numerical results summarised. The quality of included studies was assessed using the Joanna Briggs Institute critical appraisal tools.

RESULTS

Six articles were included, representing three pilot studies. Study 1 (n = 37, 14-17 years) compared a 6-week mindful eating program with single-session lifestyle education; Study 2 (n = 35, 14-17 years) compared 12-week weight-neutral lifestyle education focused on intuitive eating and carbohydrate quality, with/without guided imagery; and Study 3 (n = 33, 12-17 years) compared a 6-week mindfulness intervention with cognitive behavioural therapy in adolescents with depressive symptoms at risk of type 2 diabetes. All interventions explored feasibility (intervention group retention 57%-88%, attendance >80%) and reported interventions were acceptable. Studies 1 and 3 reported no change in mindfulness. Study 2 reported an increase (p < 0.05) in intuitive eating following weight-neutral plus guided imagery (0.32 ± 0.36, Hawks' Scale, score 1-4), compared with weight-neutral alone (0.15 ± 0.29). Study 1 reported decreased body mass index (p < 0.001) following mindful eating (-1.1 kg/m² ), compared with single-session lifestyle education (+0.7 kg/m² ); Studies 2 and 3 found no change in body mass index or body mass index z-score.

CONCLUSIONS

Weight-neutral interventions may be feasible and acceptable in adolescents with overweight/obesity in the short term (≤12 weeks), but data are limited.

Dietary changes in an acceptance-based weight loss pilot intervention study

OBJECTIVE

To evaluate pre-post changes in dietary intake and the possible role of emotional eating (EE) as a mediator of dietary changes in a novel behavioral weight loss intervention (Live FREE).

DESIGN

Secondary analysis of an open label pilot study.

PARTICIPANTS

Thirty-nine adults with overweight/obesity and EE.

INTERVENTION

Live FREE is a 16-week group-based program in which participants learn emotional regulation skills from Dialectical Behavior Therapy followed by traditional behavioral weight loss techniques.

MAIN OUTCOME MEASURE

Dietary intake and EE were measured at baseline and post-treatment with the Automated Self-Administered 24-Hour Dietary Assessment Tool and the depression subscale of the revised Emotional Eating Scale.

ANALYSIS

Paired sample t-tests and mediation for repeated measures designs.

RESULTS

Consumption of calories (t(33) = 5.31, p < .001), saturated fat (t(33) = 5.25, p < .001), and added sugar (t(33) = 4.44, p < .001) decreased from pre-post-treatment. EE change mediated the effect of the intervention on change in saturated fat intake pre-post-treatment, B = 6.16, BootSE = 2.47, 95 % CI (1.53 to 11.37), but did not mediate change in caloric or added sugar intake.

CONCLUSIONS AND IMPLICATIONS

Participants reported improvement in caloric, saturated fat, and added sugar intake. Improvement in EE may be closely related to decreasing saturated fat consumption. (200).

Mindful eating for weight loss in women with obesity: a randomised controlled trial

Mindful eating (ME) has been linked to improvement in binge eating disorder, but this approach in obesity management has shown conflicting results. Our aim was to assess the effect of ME associated with moderate energy restriction (MER) on weight loss in women with obesity. Metabolic parameters, dietary assessment, eating behaviour, depression, anxiety and stress were also evaluated. A total of 138 women with obesity were randomly assigned to three intervention groups: ME associated with MER (ME + MER), MER and ME, and they were followed up monthly for 6 months. ME + MER joined seven monthly mindfulness-based intervention group sessions each lasting 90 min and received an individualised food plan with MER (deficit of 2092 kJ/d - 500 kcal/d). MER received an individualised food plan with MER (deficit of 2092 kJ/d - 500 kcal/d), and ME joined seven monthly mindfulness-based intervention group sessions each lasting 90 min. Seventy patients completed the intervention. Weight loss was significant, but no statistically significant difference was found between the groups. There was a greater reduction in uncontrolled eating in the ME group than in the MER group and a greater reduction in emotional eating in the ME group than in both the MER and the ME + MER groups. No statistically significant differences were found in the other variables evaluated between groups. The association between ME with energy restriction did not promote greater weight loss than ME or MER.

Intuitive Eating Intervention and Diet Quality in Adults: A Systematic Literature Review

INTRODUCTION

Intuitive eating interventions aim to improve individual health and promote sustainable changes to one's relationship with food. However, there is no evidence-based consensus on the impact of intuitive eating interventions on diet quality. This systematic review aimed to investigate intuitive eating interventions and their impact on diet quality.

METHOD

PubMed, Embase, CINAHL, PsycInfo, and Cochrane databases were systematically searched to October 2021 for studies reporting interventions that encompassed the principles of intuitive eating and measured diet quality. Other health outcomes were used for secondary analysis. Findings were synthesized narratively.

RESULTS

Seventeen papers reporting 14 intervention studies (n = 3,960) were included in the review. All studies found a positive or neutral effect on diet quality following an intuitive eating intervention. A favorable change in eating behavior following these interventions was also observed.

DISCUSSION

Intuitive eating promotes an attunement to the body, which aids in improving diet quality because of increased awareness of physiological cues. The reduction of emotional and binge eating may also increase diet quality.

IMPLICATIONS FOR RESEARCH AND PRACTICE

Findings from the current review suggest that intuitive eating interventions are most effective face-to-face, in a group setting, and sustained for at least 3 months.

Exploring the Feasibility of an Online Diabetes Wellness Programme among Periodontitis Patients with Type II Diabetes Mellitus during the COVID-19 Pandemic

There were massive interruptions, including patient visits for dietary advice and dental services, during the COVID-19 outbreak. This study assessed the feasibility of an online diabetes wellness programme among periodontitis patients with type II diabetes mellitus. Patients were grouped into the intervention group (IG) and control group (CG). At baseline and week 12, all patients answered online questionnaires on diabetes-related knowledge, physical activity, and oral impacts on daily performances (OIDP). Body weight and waist circumference were self-measured with guided instructions. Diet recalls were used to estimate dietary and added sugar intake. All patients received a weekly educational video, but the IG attended three e-consultation sessions with a dietitian (weeks 1, 3, and 8) and a dentist (week 8) via video call. A semi-structured interview was conducted to collate qualitative feedback among the IG participants at the end of the programme. A total of 24 periodontitis patients (14 IG and 10 CG) participated in this study. Among the IG patients, significant improvements in diabetes knowledge, body weight, BMI, calories, carbohydrates, fat, and added sugar intakes were observed at week 12. The CG patients only had a significant reduction in carbohydrate intake post intervention. No changes were reported in physical activity level and OIDP for both groups. Feedback received from the IG participants included convenience, practical, preferred approach during the pandemic, increased awareness and knowledge, and favourable lifestyle changes. This study demonstrates that an online diabetes wellness programme with healthcare professionals is feasible and can facilitate knowledge and lifestyle improvements that can be adapted during the crisis situation.

Effects of meditation on physiological and metabolic parameters in patients with type 2 diabetes mellitus "MindDM": study protocol for a randomized controlled trial

BACKGROUND

Sri Lanka is faced with the challenge of managing a large population with diabetes mellitus by 2030. Psychological stress plays a major role in disease outcome by exerting physiological, psychological and social effects on individuals with chronic disorders. Meditation-based interventions have positive effects on the management of stress and diabetes, which are mediated via modulation of neuro-humoral mechanisms and autonomic functions, among others. Mechanisms of bio-physiological effects of meditation are considered to be through reduction of stress hormones, improvement of insulin resistance and improvement of autonomic dysfunction.

METHODS

This study will be conducted as an open-label, randomized controlled clinical trial in the Faculty of Medicine, University of Colombo. The aim is to investigate the effects of meditation on glycaemic control and possible mechanisms of how meditation affects glycaemic control in patients with type 2 diabetes. The study was approved by the Ethics Review Committee of the Faculty of Medicine, University of Colombo (ERC/2019/094). Patients who are attending the professorial unit medical clinic with type 2 diabetes (172 in total) will be recruited based on inclusion-exclusion criteria. Patients who have never meditated or rarely meditated (less than once every three months) will be randomized using block randomization to meditation and waitlisted arms (1:1 allocation ratio). The meditation arm will undergo a mindfulness meditation program (selected after studying several meditation methods) conducted by a qualified instructor weekly for a period of 12 weeks in addition to usual care, while the waitlisted arm will only receive usual care. Daily meditation practices will be recorded in a diary. The primary outcome measure is HbA1c. Secondary outcome measures are fasting blood sugar, fructosamine, insulin resistance (calculated using fasting serum insulin), 24-h urinary cortisol, body mass index, cardiac autonomic reflex testing (Ewing's battery of tests) and orocecal transit time using hydrogen breath analysis. All these will be done prior to commencement of the intervention and after 3 months in both arms. Data will be analysed using SPSS V-23.

DISCUSSION

This study aims to identify the effect of mindfulness meditation on glycaemic control and the possible mechanisms (neuro humoral and autonomic functions) by which beneficial effects are mediated.

TRIAL REGISTRATION

Registered under Sri Lanka Clinical Trial Registry: SLCTR/2021/015 The Universal Trial Number (UTN) U1111-1266-8640.

The relationship between intuitive eating and eating attitude and glycemic control in patients with type 2 diabetes mellitus

Amaç: Bu çalışma, Tip 2 Diabetes Mellitus (T2DM) hastalarında sezgisel yemenin yeme tutumu ve glisemik kontrol ile ilişkisini belirlemek amacıyla yapılmıştır. Gereç ve Yöntem: Araştırmanın örneklemini; 18 Kasım 2019 – 12 Mart 2020 tarihleri arasında Endokrinoloji ve Metabolizma Hastalıkları Bilim Dalı Polikliniği’ne gelen T2DM tanılı ve dahil edilme kriterlerini karşılayan 385 birey oluşturmuştur. Çalışma verileri; bireylerin demografik bilgilerine, sağlık bilgilerine ve biyokimyasal verilerine yönelik sorular ile Sezgisel Yeme Ölçeği (IES-2) ve Yeme Tutum Testinin (EAT-26) yer aldığı bir form kullanılarak yüz yüze görüşme yöntemi ile elde edilmiştir. Bulgular: Çalışmaya katılan bireylerin yaş ortalaması 59,12±9,78 olup %62,6’sı kadındı. Sezgisel yeme ile bireylerin vücut ağırlığı, BKİ değeri, bel çevresi ve trigliserit değeri arasında istatistiksel olarak negatif yönde ve zayıf düzeyde anlamlı bir ilişki saptandı (p&lt;0,05). EAT-26 puanı ile IES-2 alt ölçeklerinden olan “duygusal sebeplerden ziyade fiziksel sebeplerle yeme” alt ölçeği arasında istatistiksel olarak negatif yönde ve zayıf düzeyde anlamlı bir ilişki belirlendi (p&lt;0,05). Ayrıca EAT-26 puanı ile “açlık ve tokluk işaretlerine güven” alt ölçeği arasında istatistiksel olarak pozitif yönde ve zayıf düzeyde anlamlı bir ilişki bulundu (p&lt;0.05). Sonuç: Çalışma sonucunda; sezgisel yeme ile T2DM’li bireylerin antropometrik ölçümleri, trigliserit değerleri ve yeme tutumları arasında zayıf düzeyde anlamlı ilişki olduğu belirlenmiştir. Sezgisel yemenin yeme tutumu ve glisemik kontrol ile arasındaki nedensellik ilişkisini daha iyi belirleyebilmek için ileri çalışmalara ihtiyaç vardır.

Direct Yet Opposite Effects of Stress-related and Mindful Eating on Diet Quality

OBJECTIVE

Examine the relationships among dietary quality, mindful eating, and constructs of the Transactional Model of Stress and Coping.

METHODS

In this cross-sectional study, women (n = 67) aged 25-50 years, with a body mass index of 25-40 kg/m² completed 3 days of 24-hour recalls and a survey that included the Perceived Stress Scale, Eating and Appraisal Due to Emotions and Stress Questionnaire, and the Mindful Eating Questionnaire. Structural equation modeling assessed relationships among all constructs with the dependent variable, the Healthy Eating Index-2015.

RESULTS

Mindful Eating Questionnaire (β = 0.60, P = 0.001) and Emotion and Stress-related Eating scores from Eating and Appraisal Due to Emotions and Stress Questionnaire (β = -0.69, P < 0.001) (r² = 0.50) were directly associated with Healthy Eating Index-2015, but no indirect effects were identified.

CONCLUSIONS AND IMPLICATIONS

Overall dietary quality is associated with greater mindful eating but more emotion and stress-related eating scores among women who were overweight or obese. Future studies could assess model constructs using other diet quality scores and including additional coping mechanisms such as substance use, physical activity, and meditation.

Effect of lifestyle intervention in Type II diabetes

Introduction and Aim: Sedentary habits, unhealthy dietary patterns and psychological stress are the major potential problems for the advancements of a various life style disorders like Diabetes mellitus. Yoga is a lifestyle intervention, an effort to keep the condition under control and ameliorate overall quality of life. The idea of this research study among Type II diabetics is to assess the effectiveness of metabolic control with life style intervention (yoga) for 6 months.   Materials and Methods: 200 subjects aged 30–60 years of either gender recently diagnosed with Type II diabetes were randomized into 4 groups and were given 6 months intervention which included supervised regular yoga practice, diet and educational sessions. Weight, BMI, glucose, HbA1c, Insulin and lipid profile were measured before commencement, and after 6 months of the intervention. The statistical methods‘t’ test and ANOVA were applied to assess the “mean and difference” at p value 0.05.   Results: Alterations in the life style of Type II diabetics with the intervention of  yoga, diet and educational sessions showed a significant profitable impact on weight, BMI, fasting glucose,  insulin, HbA1c, and lipid profile.   Conclusion: Short term interventions produced positive modest changes in metabolic control. These lifestyle modifications with the intervention of yoga and diet counselling is effective in the management of  weight loss, glycemic control, plasma  Insulin and lipid profile levels which on longer duration may yield a better effective result along with constant motivation.

Results from the first culturally tailored, multidisciplinary diabetes education in Lebanese adults with type 2 diabetes: effects on self-care and metabolic outcomes

OBJECTIVE

Diabetes self-management education (DSME) is an essential component of lifestyle management needed for diabetes care. This pilot-study tested the effect of culturally-tailored education targeting diabetes selfcare on glycemia and cardiovascular risk factors of Lebanese with type 2 diabetes mellitus (T2DM) (n = 27; Age: 61 ± 10 yrs, 59% males, HbA1c: 8.98 ± 1.38%).

RESULTS

Diabetes self-care (Diet, Self-Monitoring Blood Glucose and foot care) improved after 6 months, which was reflected in a significant drop in glycemic levels (HbA1c:-0.5%; FPG: - 38 mg/dl), and cholesterol/HDL ratio (4.45 ± 1.39 vs. 4.06 ± 1.29). Waist circumference decreased at 6 months compared to 3 months (p < 0.05). This is the first effective culturally-tailored intervention that improved self-care, glycemic control, body adiposity and lipid profile of Lebanese with T2DM. Larger scale implementation with representative sample is warranted.

Maternal mindful eating as a target for improving metabolic outcomes in pregnant women with obesity

BACKGROUND

Maternal diet and eating behaviors have the potential to influence the metabolic milieu in pregnancies complicated by obesity, with implications for the developmental programming of offspring obesity. Emerging evidence suggests that mindfulness during eating may influence metabolic health in non-pregnant populations, but its effects in the context of pregnancy is less well understood. This study explored the individual and combined effects of mindful eating and diet quality on metabolic outcomes among pregnant women with obesity.

METHODS

In 46 pregnant women (body mas index >30 kg/m2) enrolled in the MomEE observational study, mindful eating (Mindful Eating Questionnaire, MEQ) and energy-adjusted dietary inflammatory index (DII, from 7 days of food photography) was assessed at two time points and the mean pregnancy values computed. Rate of gestational weight gain (GWG) and fat mass gain per week were determined from measured weight and body composition using a three-compartment method, respectively, at each assessment. Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) and ghrelin concentrations were determined from fasting blood samples in late gestation (35-37 weeks). Linear regression was used to examine the association of the MEQ and its subscales (where higher values indicate more mindful eating) with metabolic outcomes, adjusting for covariates: maternal age, pregravid body mass index, race, parity, DII. The effects of the MEQ*DII interaction was also tested.

RESULTS

Total MEQ scores were not associated with rate of weight or fat mass gain, although greater distracted eating behavior was associated with greater adiposity gain (weight and fat mass). Mindful eating was inversely associated with insulin resistance, although this was attenuated to non-significance after additional adjustment for GWG. Total MEQ and the external eating subscale was significantly inversely associated with fasted ghrelin, such that less tendency to eat under the influence of external cues was associated with lower ghrelin concentrations. After false discovery rate adjustment for multiple testing, only the association of the total MEQ and external eating subscale with ghrelin levels trended towards significance. The DII was not associated with MEQ scores or outcome variables, nor did it moderate the effect of MEQ on any of the outcomes.

CONCLUSION

This study generates early evidence to suggest that mindful eating holds potential as a tool to improve metabolic health outcomes in pregnant women with obesity, although further research is required on this topic. Prenatal lifestyle interventions should consider including mindfulness during eating to determine its efficacy for reducing adverse pregnancy and offspring health outcomes associated with maternal obesity.

Effects of mindfulness-based intervention on glycemic control and psychological outcomes in people with diabetes: A systematic review and meta-analysis

AIMS/INTRODUCTION

Psychological therapies have showed benefits for both glycemic control and psychological outcomes in people with diabetes. However, the effects of mindfulness-based intervention (MBI) on glycemic control and psychological outcomes are inconsistent across studies, and the evidence for MBI has not been summarized. We aimed to identify the effects of MBI on glycemic control and psychological outcomes in people with diabetes by carrying out a systematic review and meta-analysis.

MATERIALS AND METHODS

Six databases (Pubmed, Embase, CINAHL, Cochrane, Web of science and PsycINFO) were searched from inception to October 2019. Randomized controlled trials of MBI for people with type 1 and type 2 diabetes were included. Two authors independently extracted relevant data and assessed the risk of bias, with a third reviewer as arbitrator. Subgroup analyses and sensitivity analyses were also carried out.

RESULTS

Eight studies with 841 participants met the eligibility criteria. Meta-analysis showed that MBI can slightly improve glycosylated hemoglobin (HbA1c; -0.25%, 95% confidence interval [CI] -0.43 to -0.07) and diabetes-related distress (-5.81, 95% CI -10.10 to -1.52) contribute to a moderate effect size in reducing depression (standardized mean difference -0.56, 95% CI -0.82 to -0.30) and stress (standardized mean difference -0.53, CI -0.75 to -0.31). Subgroup analyses showed greater HbA1c reductions in subgroups with baseline HbA1c levels <8% and follow-up duration >6 months. Mixed effects were observed for anxiety.

CONCLUSIONS

MBI appears to have benefits on HbA1c, depression, stress and diabetes-related distress in people with diabetes. More rigorous studies with longer follow-up duration are warranted to establish the full potential of MBI.

Effectiveness of Diabetes Self-management Education Against Diet Behavior in Patients Type 2 Diabetes Mellitus: A Literature Review

BACKGROUND: Diabetes mellitus (DM) is a disease that describes a problem with insulin deficiency and the inability of the pancreas to produce enough insulin. The World Health Organization predicts that the number of people with DM type II in Indonesia will increase to 12 million by 2030. AIM: This study looks at Journals on diabetes selfmanagement education (DSME) on DM patients in improving dietary behavior. METHODS: This study uses an online journal database that provides free articles and journals in PDF such as: ProQuest, EBCSO, PubMed, Elsevier, Scinapse, MDPI, and Google Scholar. Literature was collected from the past 10 years, namely, 2010–2020 using the following set of keywords: “DSME,” “DSME Program Evaluation,” and “Diabetes Self-Care Education.” RESULTS: DSME intervention can improve the condition of DM patients if it is routinely carried out. In addition, the DSME intervention was able to control hemoglobin A1c levels and control blood sugar. This intervention still needs to be developed, considering that various forms of education in DM patients have been carried out such as using text messages, leaflets, illustrated pictures or leaflets, by telephone, video, handbooks, or direct education. These investigations can be developed into empirical research. CONCLUSIONS: The application of DSME interventions can help improve the conditions experienced by DM type II sufferers if it is routinely carried out.

Intuitive eating is associated with glycemic control in type 2 diabetes

PURPOSE

The intuitive eating approach has shown promise, but studies on its association with diabetics are scarce. The aim of this study is to identify the association between intuitive eating and glycemic control in individuals with type 2 diabetes mellitus.

METHODS

This is an observational cross-sectional analytical study in patients at the endocrinology service of a university hospital in Vitória/ES, Brazil. For data collection, a semi-structured questionnaire was used and intuitive eating was assessed by Intuitive Eating Scale-2.

RESULTS

A total of 179 individuals, mostly female and elderly, and predominantly taking oral antidiabetic drugs without association with insulin were evaluated. In adjusting for the total scale score, the most intuitive eating was associated with lower chances of patients presenting inadequate glycemic control by 89% (OR = 0.114; CI 0.024-0.540; p = 0.006), and a higher score on the Body-Food-Choice Congruence subscale was associated with lower chances of participants presenting this inadequacy by almost 66% (OR = 0.341; CI 0.131-0.891; p = 0.028), regardless of their body mass index.

CONCLUSION

Eating intuitively, especially in accordance with body needs may be associated with lower chances of type 2 diabetics having inadequate glycemic control.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Opportunities for Interventions That Address Socioeconomic Barriers to Type 2 Diabetes Management: Patient Perspectives

PURPOSE

The purpose of the study was to explore patient perspectives on socioeconomic barriers related to diabetes self-management and interventions to address these barriers.

METHODS

Focus groups (n = 8) were conducted with a diverse sample of adults with type 2 diabetes (T2D; n = 53). Researchers used a semistructured moderator guide; focus groups were audio recorded and transcribed verbatim. Researchers employed the constant comparison method for qualitative content analysis and utilized Atlas.ti (Version 8.1.1) to digitalize the analytic process.

RESULTS

Findings revealed 3 primary themes: (1) Existing food and nutrition resources are insufficient to support healthy eating for diabetes; (2) healthy eating is critical for diabetes management, but socioeconomic circumstances make doing so challenging; and (3) participants supported several broad categories of preferred intervention strategies. First, they endorsed lifestyle intervention informed by socioeconomic status (SES; eg, focusing on food resource management, sensitive health coaching and nutritional counseling). Next, they expressed enthusiasm for group-based learning opportunities, such as cooking classes and support groups with similar SES peers. Finally, they suggested healthy food access resources.

CONCLUSIONS

Participant suggestions should be incorporated into intervention development. Ultimately, these interventional strategies should be tested and refined to help improve health for individuals with type 2 diabetes.

Keeping weight off: Mindfulness-Based Stress Reduction alters amygdala functional connectivity during weight loss maintenance in a randomized control trial

Obesity is associated with significant comorbidities and financial costs. While behavioral interventions produce clinically meaningful weight loss, weight loss maintenance is challenging. The objective was to improve understanding of the neural and psychological mechanisms modified by mindfulness that may predict clinical outcomes. Individuals who intentionally recently lost weight were randomized to Mindfulness-Based Stress Reduction (MBSR) or a control healthy living course. Anthropometric and psychological factors were measured at baseline, 8 weeks and 6 months. Functional connectivity (FC) analysis was performed at baseline and 8 weeks to examine FC changes between regions of interest selected a priori, and independent components identified by independent component analysis. The association of pre-post FC changes with 6-month weight and psychometric outcomes was then analyzed. Significant group x time interaction was found for FC between the amygdala and ventromedial prefrontal cortex, such that FC increased in the MBSR group and decreased in controls. Non-significant changes in weight were observed at 6 months, where the mindfulness group maintained their weight while the controls showed a weight increase of 3.4% in BMI. Change in FC at 8-weeks between ventromedial prefrontal cortex and several ROIs was associated with change in depression symptoms but not weight at 6 months. This pilot study provides preliminary evidence of neural mechanisms that may be involved in MBSR’s impact on weight loss maintenance that may be useful for designing future clinical trials and mechanistic studies.

Evidence generated from a realist synthesis of trials on educational weight loss interventions in type 2 diabetes mellitus

BACKGROUND

Obesity and diabetes are major public health problems. Current approaches to weight loss show varying success. Complex community-based interventions work through several interconnected stages. An individual's actions in response to an intervention depend on many known and unknown factors, which vary among individuals.

AIM

To conduct a realist synthesis to identify in which context, for whom, in what circumstances, and how weight loss interventions work in obese or overweight individuals with type 2 diabetes.

METHODS

A total of 49 trials identified during a systematic review were subsequently analysed using realist methodology. This iterative process involved hypothesis generation about how participants within a particular context respond to an intervention's resources producing the outcomes. We used established behaviour change theory to look for repeating themes. Theory and 'mechanisms' were tested against the literature on what is shown to be effective. Where established theory was lacking, we discussed issues during discussion groups with individuals living with the condition to generate our own programme theories.

RESULTS

Mechanisms that were repeatedly identified included high-frequency contact with those delivering the intervention, social support, education increasing awareness of diabetes-related modifiable risk factors, motivational interviewing and counselling, goal-setting, self-monitoring and feedback and meal replacements. The central theme underlying successful mechanisms was personalising each intervention component to the participants' gender, culture and family setting.

CONCLUSION

This is the first comprehensive realist synthesis in this field. Our findings suggest that, for weight loss interventions to be successful in those with diabetes, they must be personalized to the individual and their specific context.

Mindfulness Practice for Glycemic Control: Could it be a New Strategy for an Old Problem? A Systematic Review and Meta-Analysis

BACKGROUND

The management of type 2 diabetes mellitus (T2DM) requires a complex and organized care that includes patient's lifestyle change. Additionally, emotional well-being is an important part of self-management, and it may impair the individual's adherence. Therefore, equipping the patients with the necessary coping and self-care techniques may be an important step in managing diabetes.

OBJECTIVE

To evaluate the effect of interventions using established mindfulness-based protocols on glycemic control of individuals with T2DM.

METHODS

Data sources: Two electronic databases (PubMed and EMBASE) were searched from inception to December 2019. We limited our search to published studies in English, Spanish and Portuguese languages.

STUDY SELECTION

Randomized clinical trials that assessed the effects of mindfulness in individuals with T2DM were selected.

DATA EXTRACTION

Two authors independently assessed the risk of bias and extracted data from the included trials. Data were pooled using inverse-variance random-effects meta-analyses. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.

RESULTS

Four randomized trials were included. There were no differences in blood glucose change (mean difference between groups (MD) -0.73mg/dl; 95% CI, -10.49; 9.02; I2 =0%; very low quality of evidence) or glycated hemoglobin (MD 0.05%; 95%CI -0.22 to 0.32; I2 =29%; very low quality of evidence).

CONCLUSION

Although the quality of current evidence is very low, our findings suggest that established protocols involving mindfulness have no effect on blood glucose or glycated hemoglobin in individuals with T2DM. Indeed, large-scale trials are needed to evaluate the contribution of mindfulness to glycemic control in clinical practice. PROSPERO Registration ID: RD42020161940.

The Influence of Mindful Eating and/or Intuitive Eating Approaches on Dietary Intake: A Systematic Review

BACKGROUND

Stimuli that promote eating in the absence of the physiological need for food are pervasive and can facilitate excessive energy intake. The practices of mindful eating (ME) and intuitive eating (IE) have been developed to minimize external drivers of energy intake by helping individuals emphasize the sensory properties of foods and internal indicators of hunger and fullness.

OBJECTIVE

To enhance understanding about the effect of ME and IE interventions on dietary intake, this systematic review included randomized trials of ME and IE interventions that examined dietary intake, defined as energy intake or diet quality, in adults of varying weight status without a diagnosis of an eating disorder.

METHODS

The selection of literature followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses systematic review process, in which PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and PsycINFO databases were searched for studies published between January 1980 and November 2019. Studies were included if they met the following criteria: randomized trial design in which 1 arm was an intervention with an ME or IE component and there was at least 1 control or active comparison arm; enrolled participants were of a healthy weight or with overweight or obesity and reported not having an eating disorder (ie, anorexia, bulimia nervosa, or binge eating disorder) or other health conditions in which dietary restrictions were applied; were at least 18 years of age; and outcomes of energy intake or diet quality were reported at baseline and post intervention. The modified Downs and Black checklist was used to assess risk of bias for each study that met inclusion criteria.

RESULTS

A total of 13 studies, including 8 investigating ME interventions and 5 investigating IE interventions, represented in 14 articles, were included in the review. Seven of the 9 articles reporting on energy intake did not find significant group differences. Eight of the 12 articles reporting on diet quality did not find significant group differences. The mean bias assessment score was 13.6 out of 28, indicating poor quality.

CONCLUSIONS

Little evidence suggests that ME and IE interventions influence energy intake or diet quality. To draw strong conclusions about the effect of ME and IE on dietary intake, future research using study designs of high rigor are needed.

Internally regulated eating style: a comprehensive theoretical framework

Internally regulated eating style, the eating style that is driven by internal bodily sensations of hunger and satiation, is a concept that has received increasing attention in the literature and health practice over the last decades. The various attempts that have been made so far to conceptualise internally regulated eating have taken place independently of one another, and each sheds light on only parts of the total picture of what defines internally regulated eating. This has resulted in a literature that is rather fragmented. More importantly, it is not yet clear which are the characteristics that comprise this eating style. In this paper, we identify and describe the full spectrum of these characteristics, namely, sensitivity to internal hunger and satiation signals, self-efficacy in using internal hunger and satiation signals, self-trusting attitude for the regulation of eating, relaxed relationship with food and tendency to savour the food while eating. With this research, we introduce a common language to the field and we present a new theoretical framework that does justice not just to the full breadth of characteristics that are necessary for the internally regulated eating style but also to the associations between them and the potential mechanisms by which they contribute to this eating style.

Third-wave cognitive behaviour therapies for weight management: A systematic review and network meta-analysis

This systematic review and network meta-analysis synthesized evidence on the effects of third-wave cognitive behaviour therapies (3wCBT) on body weight, and psychological and physical health outcomes in adults with overweight or obesity. Studies that included a 3wCBT for the purposes of weight management and measured weight or body mass index (BMI) pre-intervention and ≥ 3 months post-baseline were identified through database searches (MEDLINE, CINAHL, Embase, Cochrane database [CENTRAL], PsycINFO, AMED, ASSIA, and Web of Science). Thirty-seven studies were eligible; 21 were randomized controlled trials (RCT) and included in the network meta-analyses. Risk of bias was assessed using RoB2, and evidence quality was assessed using GRADE. Random-effects pairwise meta-analysis found moderate- to high-quality evidence suggesting that 3wCBT had greater weight loss than standard behavioural treatment (SBT) at post-intervention (standardized mean difference [SMD]: -0.09, 95% confidence interval [CI]: -0.22, 0.04; N = 19; I2 = 32%), 12 months (SMD: -0.17, 95% CI: -0.36, 0.02; N = 5; I2 = 33%), and 24 months (SMD: -0.21, 95% CI: -0.42, 0.00; N = 2; I2 = 0%). Network meta-analysis compared the relative effectiveness of different types of 3wCBT that were not tested in head-to-head trials up to 18 months. Acceptance and commitment therapy (ACT)-based interventions had the most consistent evidence of effectiveness. Only ACT had RCT evidence of effectiveness beyond 18 months. Meta-regression did not identify any specific intervention characteristics (dose, duration, delivery) that were associated with greater weight loss. Evidence supports the use of 3wCBT for weight management, specifically ACT. Larger trials with long-term follow-up are needed to identify who these interventions work for, their most effective components, and the most cost-effective method of delivery.

Educational weight loss interventions in obese and overweight adults with type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials

AIM

The worldwide prevalence of type 2 diabetes mellitus is increasing, with most individuals with the disease being overweight or obese. Weight loss can reduce disease-related morbidity and mortality and weight losses of 10-15 kg have been shown to reverse type 2 diabetes. This review aimed to determine the effectiveness of community-based educational interventions for weight loss in type 2 diabetes.

METHODS

This is a systematic review and meta-analysis of randomized controlled trials (RCT) in obese or overweight adults, aged 18-75 years, with a diagnosis of type 2 diabetes. Primary outcomes were weight and/or BMI. CINAHL, MEDLINE, Embase, Scopus and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from inception to June 2019. Trials were classified into specified a priori comparisons according to intervention type. A pooled standardized mean difference (SMD) (from baseline to follow-up) and 95% confidence intervals (95% CI) between trial groups (difference-in-difference) were estimated through random-effects meta-analyses using the inverse variance method. Heterogeneity was quantified using I² and publication bias was explored visually using funnel plots.

RESULTS

Some 7383 records were screened; 228 full-text articles were assessed and 49 RCTs (n = 12 461 participants) were included in this review, with 44 being suitable for inclusion into the meta-analysis. Pooled estimates of education combined with low-calorie, low-carbohydrate meal replacements (SMD = -2.48, 95% CI -3.59, -1.49, I²  = 98%) or diets (SMD = -1.25, 95% CI -2.11, -0.39, I²  = 95%) or low-fat meal replacements (SMD = -1.15, 95%CI -2.05, -1.09, I²  = 85%) appeared most effective.

CONCLUSION

Low-calorie, low-carbohydrate meal replacements or diets combined with education appear the most promising interventions to achieve the largest weight and BMI reductions in people with type 2 diabetes.

Efficacy of a mindful-eating programme to reduce emotional eating in patients suffering from overweight or obesity in primary care settings: a cluster-randomised trial protocol

INTRODUCTION

Little is known about the applicability of mindfulness-based interventions in Spanish adults with overweight/obesity. The objective of the present study protocol is to describe the methods that will be used in a cluster randomised trial (CRT) that aims to evaluate the effectiveness of a mindfulness eating (ME) programme to reduce emotional eating (EE) in adults with overweight/obesity in primary care (PC) settings.

METHODS AND ANALYSIS

A CRT will be conducted with approximately 76 adults with overweight/obesity from four PC health centres (clusters) in the city of Zaragoza, Spain. Health centres matched to the average per capita income of the assigned population will be randomly allocated into two groups: 'ME +treatment as usual (TAU)' and 'TAU alone'. The ME programme will be composed of seven sessions delivered by a clinical psychologist, and TAU will be offered by general practitioners. The primary outcome will be EE measured by the Dutch Eating Behaviour Questionnaire (DEBQ) at post test as primary endpoint. Other outcomes will be external and restrained eating (DEBQ), binge eating (Bulimic Investigatory Test Edinburgh), eating disorder (Eating Attitude Test), anxiety (General Anxiety Disorder-7), depression (Patient Health Questionnaire-9), mindful eating (Mindful Eating Scale), dispositional mindfulness (Five Facet Mindfulness Questionnaire) and self-compassion (Self-Compassion Scale). Anthropometric measures, vital signs and blood tests will be taken. A primary intention-to-treat analysis on EE will be conducted using linear mixed models. Supplementary analyses will include secondary outcomes and 1-year follow-up measures; adjusted models controlling for sex, weight status and levels of anxiety and depression; the complier average causal effect of treatment; and the clinical significance of improvements.

ETHICS AND DISSEMINATION

Positive results of this study may have a significant impact on one of the most important current health-related problems. Approval was obtained from the Ethics Committee of the Regional Authority. The results will be submitted to peer-reviewed journals, and reports will be sent to participants.

TRIAL REGISTRATION NUMBER

NCT03927534 (5/2019).

Do stress eating or compulsive eating influence metabolic health in a mindfulness-based weight loss intervention?

OBJECTIVE

We aimed to understand the associations of compulsive eating (CE) and stress eating (SE) with metabolic health among adults with obesity and whether mindfulness-based weight loss training may buffer these associations.

METHOD

We used data from a trial in which we randomized 194 participants with obesity to a diet-exercise weight loss intervention with either mindful eating training plus mindfulness-based eating awareness and stress management training (n = 100) or active control components (n = 94). We measured CE, SE, weight, and fasting blood glucose (FBG) at baseline, and 6, 12 months, and 18 months. We tested CE and SE as both moderators and mediators of intervention effects on changes in metabolic health.

RESULTS

Participants higher (+ 1 SD) in CE at baseline randomized to the mindfulness (vs. control) intervention had greater improvements in FBG at 18 months (p = .05). Twelve-month reductions in CE mediated the effect of the intervention on changes in FBG and weight at 12 and 18 months postbaseline (p ≤ .05). Furthermore, those higher (+ 1 SD) in SE at baseline were nearly 2 BMI points higher than those lower (-1 SD) in SE (p < .01). Decreases in SE (B = 3.42; p < .001; 95% CI [2.55, 4.30]) and CE (B = 0.45; p < .001; 95% CI [0.36, 0.54]) in all participants at 6 months were associated with greater weight loss at 18 months.

CONCLUSIONS

Those with greater compulsive eating may reduce risk for metabolic decline by participating in a mindfulness-based weight loss program. Future obesity interventions should consider tailoring treatment toward trait-level characteristics, such as compulsive eating. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Effects of a Mindfulness-Based Intervention on Distress, Weight Gain, and Glucose Control for Pregnant Low-Income Women: A Quasi-Experimental Trial Using the ORBIT Model

BACKGROUND

Stress can lead to excessive weight gain. Mindfulness-based stress reduction that incorporates mindful eating shows promise for reducing stress, overeating, and improving glucose control. No interventions have tested mindfulness training with a focus on healthy eating and weight gain during pregnancy, a period of common excessive weight gain. Here, we test the effectiveness of such an intervention, the Mindful Moms Training (MMT), on perceived stress, eating behaviors, and gestational weight gain in a high-risk sample of low income women with overweight/obesity.

METHOD

We conducted a quasi-experimental study assigning 115 pregnant women to MMT for 8 weeks and comparing them to 105 sociodemographically and weight equivalent pregnant women receiving treatment as usual. Our main outcomes included weight gain (primary outcome), perceived stress, and depression.

RESULTS

Women in MMT showed significant reductions in perceived stress (β = - 0.16) and depressive symptoms (β = - 0.21) compared to the treatment as usual (TAU) control group. Consistent with national norms, the majority of women (68%) gained excessive weight according to Institute of Medicine weight-gain categories, regardless of group. Slightly more women in the MMT group gained below the recommendation. Among secondary outcomes, women in MMT reported increased physical activity (β = 0.26) and had lower glucose post-oral glucose tolerance test (β = - 0.23), being 66% less likely to have impaired glucose tolerance, compared to the TAU group.

CONCLUSION

A short-term intervention led to significant improvements in stress, and showed promise for preventing glucose intolerance. However, the majority of women gained excessive weight. A longer more intensive intervention may be needed for this high-risk population. Clinical Trials.gov #NCT01307683.

Effects of weight-neutral approaches compared with traditional weight-loss approaches on behavioral, physical, and psychological health outcomes: a systematic review and meta-analysis

Context

Weight-neutral approaches for health are emerging therapeutic alternatives to traditional weight-loss approaches. The existing literature base comparing these approaches has not yet been systematically evaluated by a meta-analysis.

Objective

This review aims to determine if weight-neutral approaches are valid alternatives to weight-loss approaches for improving physical, psychological, and behavioral health outcomes.

Data Sources

Embase, Scopus, PsycINFO, PubMed, CINAHL, and the University of Queensland Library databases were searched.

Study Selection

Peer-reviewed, experimental, or quasi-experimental studies that included weight-neutral and weight-loss arms and reported physical, psychological, or behavioral outcomes were eligible. A total of 525 studies were identified through initial database searches, with 10 included in the final analysis after exclusion criteria were applied.

Data Extraction

Screening and eligibility assessment of studies followed the PRISMA protocol. The following outcomes were extracted: weight, body mass index, lipid and glucose variables, blood pressure, eating behavior, self-esteem, depression, quality of life, physical activity, and diet quality.

Data Analysis

Studies were graded per the National Health and Medical Research Council (NHMRC) level-of-evidence tool and the Academy of Nutrition and Dietetics quality-evaluation tool. Effect sizes were examined as a meta-analysis of standardized and mean differences using a random-effects inverse-variance model with 95%CIs. Practice recommendations for each outcome were graded per NHMRC body-of-evidence guidelines.

Conclusions

Weight-neutral approaches resulted in greater improvement in bulimia (P = 0.02), but no significant differences were observed for any other outcome. Weight-neutral approaches may be as effective as weight-loss methods for improving physical, psychological, and behavioral outcomes. Limitations include inconsistent definitions of both approaches and variable time frames of follow-up.

Acceptance- and Mindfulness-Based Interventions for Health Behavior Change: Systematic Reviews and Meta-Analyses

Behavioral health issues such as smoking and overweight are risk factors for a variety of adverse health outcomes, including mortality. Over the past decade, a growing number of randomized controlled trials have examined the efficacy of acceptance- and mindfulness-based interventions for smoking cessation and weight loss. The purpose of the current meta-analytic reviews was to quantitatively synthesize the existing literature comparing these interventions to controls for a) smoking cessation and b) weight loss outcomes. Searches identified 17 smoking cessation studies and 31 weight loss studies eligible for inclusion. Meta-analytic results indicated a non-significant effect favoring acceptance- and mindfulness-based interventions over controls for smoking cessation (OR = 1.13) and a small, significant effect favoring these interventions over controls for weight loss outcomes (Hedge's g = 0.30). Statistical heterogeneity and risk of bias were assessed. Subgroup and meta-regression analyses were conducted to examine moderating variables (e.g., sample and intervention characteristics). The findings indicated that acceptance- and mindfulness-based interventions were at least as efficacious as active control conditions. Given the significant health risks associated with smoking and overweight, these findings have important clinical and public health implications. Limitations (e.g., relative infancy of the literature; lack of diversity in sample demographics) and future directions (e.g., further exploration of mediators and moderators of change) are discussed.

[Emotional therapies for overweight or obesity]

Obesity has become a public health problem. But care, mainly diets, is often ineffective over the long term. Emotional therapies seem to be an interesting track especially for emotional eating. After defining two key concepts of emotional eating and acceptance, the theoretical frameworks of the different emotional therapies used in the treatment of overweight or obesity will be presented: Mindfulness-Based for Eating Disorder (MB-EAT), Acceptance and Commitment Therapy, and Acceptance-Based Behavioral Treatment for Weight Loss (ABT). The goal is to understand their usefulness in the treatment of overweight or obesity and perhaps avoid using contradictory techniques such as dieting with mindfulness. If current results are promising, the effectiveness of these therapies needs to be confirmed by new studies. Finally, the article points to the emergence of new "integrative" therapies that resemble the others presented and are related but are in fact the exact opposite. Control and acceptance are indeed antithetical.

Why WAIT? Preliminary evaluation of the weight assistance and intervention techniques (WAIT) group

Individuals who attempt to lose weight may struggle because they lack skills to address problematic eating behaviors. There are multiple programs that have taught patients some of these behavioral strategies; however, it is not clear which strategies patients find to be the most useful. The purpose of this study was to examine preliminary outcomes after completion of a six-week integrative group for weight management. Retrospective chart reviews were conducted of 51 patients who completed an integrative, psychological weight management group. Patients were mailed surveys 1-2 years after completion of the group assessing for current problematic eating behaviors (i.e. emotional eating and food addiction), satisfaction with treatment, and skills they continue to use. The majority of patients lost weight, were satisfied with the group, found the group to be helpful, and felt confident they could maintain behavior changes. The strategies patients most commonly continued to use post-group included mindful eating, keeping a food diary, carrying out an exercise plan, regular weigh-ins, and planning for social eating. The number of food addiction symptoms decreased from pre- to post-group. An integrative psychological weight management group may provide patients with skills and confidence to assist with managing problematic eating behaviors and weight loss.

The role of mindfulness in physical activity: a systematic review

Despite continued public health campaigns to promote physical activity, a majority of the population is inactive. In recent years, mindfulness-based approaches have been used in health and lifestyle interventions for physical activity promotion. We conducted a systematic literature review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to investigate the evidence for the potential of mindfulness-based approaches for physical activity. We searched electronic databases for papers that met eligibility criteria and identified 40 studies for inclusion. Evidence from cross-sectional studies (n = 20) indicated a positive relationship between dispositional mindfulness and physical activity, particularly with psychological factors related to physical activity. Five studies found that the mindfulness-physical activity relationship was mediated by stress, psychological flexibility, negative affect and shame, satisfaction and state mindfulness. Evidence from mindfulness-based interventions (n = 20) suggested positive between-subjects effects on physical activity, but interventions varied in duration, session length, group size, delivery, content and follow-up. Mindfulness-based interventions were more likely to be successful if they were physical activity-specific and targeted psychological factors related to physical activity. The body of research shows a need for more methodologically rigorous studies to establish the effect of mindfulness on physical activity and to identify potential mechanisms involved in the mindfulness-physical activity relationship reliably.

Understanding the Dietary Habits of Black Men With Diabetes

Diabetes is highly prevalent in African American men. To provide nurse practitioners with practice strategies we explored African American men's perceived needs for dietary health and diabetes self-management using the Social Cognitive Theory. Twenty-five African American men participated in four focus groups. The data were analyzed using a combination of inductive/deductive content analysis approach. Focus group analysis identified personal, behavioral and environmental barriers to and facilitators for diabetes self-management. Nurse practitioners may need to provide extra emotional support in the absence of informal social support from families for diabetes self-management and dietary health in African American men with diabetes.

The Effects of Mindfulness-Based Interventions on Diabetes-Related Distress, Quality of Life, and Metabolic Control Among Persons with Diabetes: A Meta-Analytic Review

Mindfulness-based interventions (MBIs) have improved psychological outcomes for multiple chronic health conditions, including diabetes. A meta-analytic review of the literature was conducted on all located studies (n = 14) investigating MBIs that targeted diabetes-related distress (DRD) and diabetes-related outcomes among people with Type 1 and Type 2 diabetes. PsychInfo, PubMed, Medline, and Web of Science were searched for MBIs that were designed to improve DRD and other secondary outcomes, including quality of life and measures of metabolic control. A meta-analysis of these outcomes uncovered small-to-moderate effect sizes for intervention studies measuring pretreatment to posttreatment changes in DRD and metabolic control among treatment group participants. However, the pretreatment to follow-up comparisons for DRD and metabolic control were small and unreliable. For control groups, all pre-treatment to post-treatment and pre-treatment to follow-up comparisons were unreliable for all outcomes. A moderate effect size for treatment-control comparisons was found for intervention studies measuring quality of life outcomes at posttreatment, but not at follow-up comparisons. All other effect sizes for treatment-control comparisons were unreliable. Limitations and implications for MBIs among individuals with diabetes are discussed.

Therapeutic Role of Yoga in Type 2 Diabetes

Yoga originated in India more than 5,000 years ago and is a means of balancing and harmonizing the body, mind, and emotions. Yoga practice is useful in the management of various lifestyle diseases, including type 2 diabetes. Psycho-neuro-endocrine and immune mechanisms are involved in the beneficial effects of yoga on diabetes. Incorporation of yoga practice in daily life helps to attain glycaemic control and reduces the risk of complications in people with diabetes. In this review, we briefly describe the role of various yoga practices in the management of diabetes based on evidence from various clinical studies.