A Randomized Pilot Study of a Phone-Based Mindfulness and Weight Loss Program

Impact of a Mindfulness Mobile Application on Weight Loss and Eating Behavior in People with Metabolic Syndrome: a Pilot Randomized Controlled Trial

BACKGROUND

Weight-loss approaches involving mindfulness have been reported to reduce overeating behavior. We conducted a preliminary evaluation of the feasibility and effectiveness of a mindfulness mobile application (MMA) combined with a comprehensive lifestyle intervention (CLI) focused on weight loss and eating behaviors for people with metabolic syndrome based on post-intervention follow-up data.

METHOD

Participants were randomly assigned (1:1) to a CLI group or a CLI + MMA group. Participants received weekly CLI for 13 weeks, followed by telephone counseling for 13 weeks. The CLI + MMA group also had access to the MMA. Feasibility was assessed by the number of people who refused to participate, rate of adherence to the MMA, follow-up rate, and participant satisfaction. The preliminary endpoint was weight change (at 26 weeks). Participants completed the Dutch Eating Behavior Questionnaire (DEBQ). A mixed linear model was used for efficacy analysis.

RESULTS

Eight of the 40 participants declined to participate. The MMA was used 4.4 ± 1.7 days per week, but the rate of adherence declined over time. The follow-up rate was 100%, and there was no difference in participant satisfaction between the groups. There was no significant group-by-time interaction for weight loss (p = 0.924), but there was a significant interaction for the DEBQ restrained eating score (p = 0.033).

CONCLUSIONS

This study found that CLI plus MMA was highly feasible and moderately acceptable. There were no significant differences in weight loss between the groups, but the CLI + MMA group showed an increase in restrained eating. Further large-scale studies are needed.

TRIAL REGISTRATION

Japanese University Hospital Medical Information Network (UMIN-ICDR). Clinical Trial identifier number UMIN000042626.

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.

Eating disorder risk during behavioral weight management in adults with overweight or obesity: A systematic review with meta-analysis

This systematic review examined change in eating disorder risk during weight management interventions. Four databases and clinical trials registries were searched in March and May 2022, respectively, to identify behavioral weight management intervention trials in adults with overweight/obesity measuring eating disorder symptoms at pre- and post-intervention or follow-up. Random effects meta-analyses were conducted examining within group change in risk. Of 12,023 screened, 49 were eligible (n = 6337, mean age range 22.1 to 59.9 years, mean (SD) 81(20.4)% female). Interventions ranged from 4 weeks to 18 months, with follow-up of 10 weeks to 36 months post-intervention. There was a within group reduction in global eating disorder scores (20 intervention arms; Hedges' g = -0.27; 95% CI -0.36, -0.17; I2 67.1%) and binge eating (49 intervention arms; -0.66; 95% CI -0.76, -0.56; I2 82.7%) post-intervention, both maintained at follow-up. Of 14 studies reporting prevalence or episodes of binge eating, all reported a reduction. Four studies reported eating disorder symptoms, not present at baseline, in a subset of participants (0%-6.5%). Overall, behavioral weight management interventions do not increase eating disorder symptoms for most adults; indeed, a modest reduction is seen post-intervention and follow-up. A small subset of participants may experience disordered eating; therefore, monitoring for the emergence of symptoms is important.

Effects of mindfulness-based interventions on anthropometric outcomes: A systematic review and meta-analysis

BACKGROUND AND OBJECTIVES

The effects of mindfulness-based interventions (MBIs) on anthropometrics remain obscure. This review quantitatively synthesizes the effects of MBIs on decreasing body mass index (BMI), waist circumference (WC), weight, and percent body fat (%BF).

METHODS

Seven databases, including CINAHL Plus with Full Text, PubMed, PsycINFO, Cochrane, Web of Science Core Collection, Embase, and Sociological Abstracts were searched; studies with a comparison group were selected. Random-effects models were then applied to estimate the pooled effects (Hedge's g), while exploratory moderation analyses with mixed-effects models were performed to explore potential moderators of MBIs on anthropometrics.

RESULTS

The pooled effect size was -0.36 (p < .001) on BMI, -0.52 (p < .001) on WC, -1.20 (p < .004) on weight loss, and -0.43 (p = .389) on %BF. The long-term effects from baseline to follow-up and from post-intervention to follow-up were sustained on BMI (-0.37, p = .027; -.24, p = .065) and weight loss (-1.91, p = .027; -0.74, p = .011) respectively. For weight loss, adding mindful movement had greater effects than those without (-2.65 vs -0.39, p < .001).

CONCLUSION

Our findings support the short-term MBI effects on BMI reduction, WC, weight, and %BF, and long-term effects on reducing BMI and weight. Future efforts should focus on sustaining effects on reducing WC and %BF.

Emotional Eating Interventions for Adults Living with Overweight or Obesity: A Systematic Review and Meta-Analysis

BACKGROUND

Emotional eating (EE) may be defined as a tendency to eat in response to negative emotions and energy-dense and palatable foods, and is common amongst adults with overweight or obesity. There is limited evidence regarding the effectiveness of interventions that address EE.

OBJECTIVES

To synthesize evidence on the effectiveness of EE interventions for weight loss and EE in adults living with overweight or obesity.

METHODS

This is a systematic review and meta-analysis. Adhering to the PRISMA guidance, a comprehensive electronic search was completed up to February 2022. Random effects meta-analysis was carried out to determine the percentage change in weight and EE scores.

RESULTS

Thirty-four studies were included. The combined effect size for percentage weight change was -1.08% (95% CI: -1.66 to -0.49, I² = 64.65%, n = 37), once adjusted for publication bias. Similarly, the combined effect size for percentage change in EE was -2.37%, (95% CI: -3.76 to -0.99, I² = 87.77%, n = 46). Cognitive Behavioural Therapy showed the most promise for reducing weight and improving EE.

CONCLUSIONS

Interventions to address EE showed promise in reducing EE and promoted a small amount of weight loss in adults living with overweight or obesity.

Development of a Web-Based, Guided Self-help, Acceptance and Commitment Therapy-Based Intervention for Weight Loss Maintenance: Evidence-, Theory-, and Person-Based Approach

Background

The long-term impact and cost-effectiveness of weight management programs depend on posttreatment weight maintenance. There is growing evidence that interventions based on third-wave cognitive behavioral therapy, particularly acceptance and commitment therapy (ACT), could improve long-term weight management; however, these interventions are typically delivered face-to-face by psychologists, which limits the scalability of these types of intervention.

Objective

The aim of this study is to use an evidence-, theory-, and person-based approach to develop an ACT-based intervention for weight loss maintenance that uses digital technology and nonspecialist guidance to minimize the resources needed for delivery at scale.

Methods

Intervention development was guided by the Medical Research Council framework for the development of complex interventions in health care, Intervention Mapping Protocol, and a person-based approach for enhancing the acceptability and feasibility of interventions. Work was conducted in two phases: phase 1 consisted of collating and analyzing existing and new primary evidence and phase 2 consisted of theoretical modeling and intervention development. Phase 1 included a synthesis of existing evidence on weight loss maintenance from previous research, a systematic review and network meta-analysis of third-wave cognitive behavioral therapy interventions for weight management, a qualitative interview study of experiences of weight loss maintenance, and the modeling of a justifiable cost for a weight loss maintenance program. Phase 2 included the iterative development of guiding principles, a logic model, and the intervention design and content. Target user and stakeholder panels were established to inform each phase of development, and user testing of successive iterations of the prototype intervention was conducted.

Results

This process resulted in a guided self-help ACT-based intervention called SWiM (Supporting Weight Management). SWiM is a 4-month program consisting of weekly web-based sessions for 13 consecutive weeks followed by a 4-week break for participants to reflect and practice their new skills and a final session at week 18. Each session consists of psychoeducational content, reflective exercises, and behavioral experiments. SWiM includes specific sessions on key determinants of weight loss maintenance, including developing skills to manage high-risk situations for lapses, creating new helpful habits, breaking old unhelpful habits, and learning to manage interpersonal relationships and their impact on weight management. A trained, nonspecialist coach provides guidance for the participants through the program with 4 scheduled 30-minute telephone calls and 3 further optional calls.

Conclusions

This comprehensive approach facilitated the development of an intervention that is based on scientific theory and evidence for supporting people with weight loss maintenance and is grounded in the experiences of the target users and the context in which it is intended to be delivered. The intervention will be refined based on the findings of a planned pilot randomized controlled trial.

Two decades of mindfulness-based interventions for binge eating: A systematic review and meta-analysis

OBJECTIVE

Mindfulness-based interventions (MBIs) are being increasingly used as interventions for eating disorders including binge eating. This systematic review and meta-analysis aimed to assess two decades of research on the efficacy of MBIs in reducing binge eating severity.

METHODS

We searched PubMed, Scopus and Cochrane Library for trials assessing the use of MBIs to treat binge eating severity in both clinical and non-clinical samples. The systematic review and meta-analysis was pre-registered at PROSPERO (CRD42020182395).

RESULTS

Twenty studies involving 21 samples (11 RCT and 10 uncontrolled samples) met inclusion criteria. Random effects meta-analyses on the 11 RCT samples (n = 618: MBIs n = 335, controls n = 283) showed that MBIs significantly reduced binge eating severity (g = -0.39, 95% CI -0.68, -0.11) at end of trial, but was not maintained at follow-up (g = -0.06, 95% CI, -0.31, 0.20, k = 5). No evidence of publication bias was detected. On the Cochrane Risk of Bias Tool 2, trials were rarely rated at high risk of bias and drop-out rates did not differ between MBIs and control groups. MBIs also significantly reduced depression, and improved both emotion regulation and mindfulness ability.

CONCLUSION

MBIs reduce binge eating severity at the end of trials. Benefits were not maintained at follow-up; however, only five studies were assessed. Future well-powered trials should focus on assessing diversity better, including more men and people from ethnic minority backgrounds.

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.

Mindfulness and eating disorder psychopathology: A meta-analysis

OBJECTIVE

Mindfulness is implicated in eating disorder (ED) psychopathology. However, this literature has not been synthesized to date. The current meta-analysis examined the associations between mindfulness and ED psychopathology.

METHODS

A total of 74 independent samples (effects = 576) were included. We used a multilevel random-effects model to estimate summary study-level effect sizes, and multilevel mixed-effects models to examine moderator effects.

RESULTS

Mindfulness was negatively associated with ED psychopathology (r = -.25, p < .001), both concurrently (r = -.25, p < .001) and prospectively (rs = -.22 to -.24, ps < .001). Associations were strongest for binge eating, emotional/external eating, and body dissatisfaction as well as the acting with awareness and nonjudging facets.

DISCUSSION

Mindfulness may be an important process in ED psychopathology. Future research should prospectively and experimentally examine the relation between mindfulness and ED psychopathology.

Are workplace health promotion programmes effective for all socioeconomic groups? A systematic review

Decreasing socioeconomic health inequalities is considered an important policy priority in many countries. Workplace health promotion programmes (WHPPs) have shown modest improvements in health behaviour. This systematic review aims to determine the presence and magnitude of socioeconomic differences in effectiveness and the influence of programme characteristics on differential effectiveness of WHPPs. Three electronic databases were searched for systematic reviews published from 2013 onwards and for original studies published from 2015 onwards. We synthesised the reported socioeconomic differences in effectiveness of WHPPs on health behaviours, and calculated effectiveness ratios by dividing the programme effects in the lowest socioeconomic group by the programme effects in the highest socioeconomic group. Thirteen studies with 75 comparisons provided information on the effectiveness of WHPPs across socioeconomic groups. Ten studies with 54 comparisons reported equal effectiveness and one study with 3 comparisons reported higher effectiveness for lower socioeconomic groups. Quantitative information on programme effects was available for six studies with 18 comparisons, of which 13 comparisons showed equal effectiveness and 5 comparisons showed significantly higher effect sizes among workers in low socioeconomic position. The differential effectiveness of WHPPs did not vary across programme characteristics. In this study no indications are found that WHPPs increase socioeconomic inequalities in health behaviour. The limited quantitative information available suggests that WHPPs may contribute to reducing socioeconomic inequalities. Better insight is needed on socioeconomic differences in effectiveness of WHPPs to develop strategies to decrease socioeconomic inequalities in health in the workforce.

Mindful eating and common diet programs lower body weight similarly: Systematic review and meta-analysis

Common strategies for reducing body weight rely on limiting energy intake and restricting food choices. However, these strategies have often been proven ineffective in achieving long-term and sustainable weight reduction. More recently, mindful eating as an alternative weight management strategy has gained increasing attention, yet systematic reviews on intuitive or mindful eating published so far present contradictory results. We performed a systematic review and meta-analysis on randomized controlled trials on weight loss programs based on mindful or intuitive eating. We analyzed results using meta-regressions. We included a total of 10 studies and found a significant weight loss effect of mindful/intuitive eating strategies compared with nonintervention controls (-0.348 kg, 95% CI: -0.591 to -0.105, P = 0.005). However, there was no difference compared with conventional diet programs (P = 0.99). Reduction of BMI (-0.137 kg/m² , 95% CI: -0.365 to 0.091, P = 0.240) or waist circumference (-0.358 cm, 95% CI: -0.916 to 0.200, P = 0.209) were not statistically significant. Mindful/intuitive eating could be a practical approach to weight control. Limitations of this study include the unbalanced sex, origin, place of residence of the participants, and the short duration of interventions. Future research should aim at investigating long-term effects and include a more heterogeneous study population.

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.

The Mindfulness App Trial for Weight, Weight-Related Behaviors, and Stress in University Students: Randomized Controlled Trial

Background

University students are at risk of weight gain during their studies. Key factors related to weight gain in this population include unhealthy weight-related behaviors because of stress. Mindfulness holds promise for weight management. However, there has not been any previous trial that has explored the effectiveness of a student-tailored mindfulness app for stress, weight-related behaviors, and weight. There is limited evidence that current mindfulness apps use evidence-based mindfulness techniques. A novel app was developed that combined evidence-based, mindfulness-based stress reduction and mindful eating (ME) techniques that were tailored to university students, with student-relevant themes for targeting weight behaviors, weight, and stress.

Objectives

The aim of this study was to test the effectiveness, acceptability, and feasibility of a student-tailored mindfulness app for weight, weight-related behaviors, and stress. Testing this app in a rigorous randomized controlled trial (RCT) for these outcomes is a novelty and contribution to this emerging field.

Methods

A 2-arm RCT of an 11-week duration was undertaken at the University of Queensland. Students were either randomized to the mindfulness app (n=45) or to a behavioral self-monitoring electronic diary (e-diary; n=45) for diet and exercise. Analysis of covariance was used to compare differences in weight, stress, mindfulness, ME, physical activity, and eating behaviors between both groups.

Results

Neither the mindfulness app group nor the e-diary group lost weight and there were no differences between the groups at follow-up. The mindfulness app group had significantly lower stress levels (P=.02) (adherers only), lower emotional eating (P=.02), and uncontrolled eating (P=.02) as well as higher mindfulness (P≤.001) and ME levels overall (P≤.001). The e-diary group had higher metabolic equivalents of moderate activity levels (P≤.01). However, the effect sizes were small. Regular adherence to mindfulness exercises in the app was low in the group. The majority of students (94%) liked the app and found it to be acceptable. Compared with other exercises, the most helpful reported meditation was the short breathing exercise observing the breath (39.4% [13/33] preferred it).

This was the first RCT that tested a mindfulness app for weight and weight-related behaviors in students. The modest level of user adherence likely contributes to the lack of effect on weight loss. However, there was a small, albeit promising, effect on weight-related eating behavior and stress.

Conclusions

A mindfulness app demonstrated effectiveness for stress, eating behaviors, mindfulness, and ME, but the effect sizes were small. Future studies should be conducted over longer periods of time and with greater participant compliance.

Trial Registration

Australian New Zealand Trial Registry ACTRN12616001349437; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371370 (Archived by WebCite at http://www.webcitation.org/761cc2K6ft)

Findings From a Randomized Trial of Weight Gain Prevention Among Overweight Puerto Rican Young Adults

OBJECTIVE

Assess impact of multimodality weight gain prevention intervention.

METHODS

Randomized clinical trial among 39 overweight young Puerto Rico college students using 10 weekly peer-support sessions promoting dietary, physical activity, and other lifestyle changes enhanced by stress-reduction and mindfulness approaches. Body mass index (BMI) and self-reported behaviors were measured at baseline and at 10 weeks and 6 months after baseline.

RESULTS

At the completion of the intervention, BMIs in the experimental arm were 0.8 units lower than at baseline (z = -3.0; P = .008) and 1.2 lower at 6 months after baseline (z = -4.1; P < .001); BMIs in the control arm were 0.7 higher (z = 2.7; P = .02) at 10 weeks and 0.8 higher at 6 months (z = 3.1; P = .005). Group × time interaction confirmed that BMI differed significantly over time between arms (χ² = 26.9; degrees of freedom = 2; P < .001). Analysis of behavioral changes was mostly inconclusive although the experimental arm reported a considerable increase in walking at 10 weeks. Qualitative data suggested that yoga and mindfulness components were particularly useful for motivating participants to maintain healthier lifestyle patterns.

CONCLUSIONS

Body mass index in the experimental arm decreased at the end of intervention and was maintained at 6 months' follow-up.