Comparison of a mindful eating intervention to a diabetes self-management intervention among adults with type 2 diabetes: a randomized controlled trial

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.

Mindful Eating and Current Glycemic Control in Patients With Type 2 Diabetes

Objective Lifestyle adjustments are essential in the management of type 2 diabetes mellitus (T2DM). Mindful eating involves being more attentive to and aware of meals. This study aimed to investigate the relationship between mindful eating and glycemic control, as well as body mass index (BMI), in people with T2DM. Materials and methods This cross-sectional study included 448 participants who had been diagnosed with T2DM for at least six months. The participants were categorized into three groups based on their HbA1c levels. The Turkish adaptation of the Mindful Eating Questionnaire (MEQ-30) was employed to assess levels of mindful eating behavior. Obesity was defined as a BMI ≥ 30. Anthropometric measurements, laboratory tests, and questionnaire responses were also collected. Results Participants with well-controlled diabetes (HbA1c ≤7%) demonstrated significantly higher scores on the MEQ-30 and its various subgroups in comparison to those with poorly controlled diabetes (HbA1c >9%). The suboptimal glycemic control groups exhibited noticeable variations in mindful eating behaviors. Moreover, participants with lower BMIs displayed stronger inclinations toward mindful eating. Weak negative correlations were observed between BMI and specific MEQ-30 subgroups. Notably, subgroups such as emotional eating, eating control, eating discipline, and interference demonstrated weak negative correlations with the HbA1c levels. Conclusion  Higher levels of mindful eating were associated with lower levels of HbA1c and BMI, indicating that incorporating mindful eating practices may present promising advantages for individuals diagnosed with type 2 diabetes, specifically in terms of glycemic control and weight management.

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.

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.

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.

The spectrum of eating environments encountered in free living adults documented using a passive capture food intake wearable device

Introduction

The aim of this feasibility and proof-of-concept study was to examine the use of a novel wearable device for automatic food intake detection to capture the full range of free-living eating environments of adults with overweight and obesity. In this paper, we document eating environments of individuals that have not been thoroughly described previously in nutrition software as current practices rely on participant self-report and methods with limited eating environment options.

Methods

Data from 25 participants and 116 total days (7 men, 18 women, M_age = 44 ± 12 years, BMI 34.3 ± 5.2 kg/mm²), who wore the passive capture device for at least 7 consecutive days (≥12h waking hours/d) were analyzed. Data were analyzed at the participant level and stratified amongst meal type into breakfast, lunch, dinner, and snack categories. Out of 116 days, 68.1% included breakfast, 71.5% included lunch, 82.8% included dinner, and 86.2% included at least one snack.

Results

The most prevalent eating environment among all eating occasions was at home and with one or more screens in use (breakfast: 48.1%, lunch: 42.2%, dinner: 50%, and snacks: 55%), eating alone (breakfast: 75.9%, lunch: 89.2%, dinner: 74.3%, snacks: 74.3%), in the dining room (breakfast: 36.7%, lunch: 30.1%, dinner: 45.8%) or living room (snacks: 28.0%), and in multiple locations (breakfast: 44.3%, lunch: 28.8%, dinner: 44.8%, snacks: 41.3%).

Discussion

Results suggest a passive capture device can provide accurate detection of food intake in multiple eating environments. To our knowledge, this is the first study to classify eating occasions in multiple eating environments and may be a useful tool for future behavioral research studies to accurately codify eating environments.

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.

Advancing the assessment of mindful eating: Exploring the psychometric properties and validating the mindful eating behaviour scale in English

Background: Mindful eating has been described as significant in motivating research and clinical outcomes in weight regulation and healthy eating. The use of psychometric tools to measure mindful eating is problematic, with results often leading to interpretations that are not reflective of mindful eating theory and fundamentals of mindfulness. Aim: In this research, we explored the Mindful Eating Behaviour Scale (MEBS) within a British sample to validate the factorial structure, and widen the use of a scale that appears appropriate for measuring mindful eating. Methods: A community sample (n = 742) was recruited via social media, and the findings supported the factorial structure proposed through the original Dutch sample. Predictive validity was also assessed, with the scale and subscales predicting fat and sugar consumption. Results: Cronbach's α values were acceptable and similar to the original findings, also supporting the internal consistency of the scale. Conclusion: While factorial structure, predictive validity and internal consistency propose a scale that can be adopted with English speaking populations, we propose the potential of furthering scientific inquiry on mindful eating research by highlighting the behavioural aspects of the scale.

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.

Age and fasting blood sugar levels are associated factors for mindful eating among Type 2 diabetes mellitus patients during COVID-19 pandemic confinement

The COVID-19 pandemic has impacted the eating behaviours of many people, especially Type 2 Diabetes Mellitus (T2DM) patients. This study aimed to determine the level of mindful eating and its associated factors among T2DM patients at a primary care clinic near Kuala Lumpur. A cross-sectional study was conducted from 18th December 2020 to 5th March 2021 during the movement control order in Malaysia. Respondents were recruited using systematic random sampling via an electronic appointment system. They completed a questionnaire consisting of sociodemographic, clinical profiles, and a Malay-translated Mindful Eating Questionnaire (MEQ-M). Their blood pressure and body mass index were taken during the appointment day while the remaining clinical profiles such as fasting blood sugar (FBS) were obtained from the medical record. Two hundred respondents were recruited with a mean (SD) age of 57.0 (10.90) years. More than half of them were female (54%). Two-thirds of them had uncontrolled diabetes based on elevated FBS of >7 mmol/L (61.5%) and glycated haemoglobin (HbA1c) of >7% (67%), respectively. The mean (SD) score for mindful eating was 2.9 (0.25). Multiple logistic regression revealed that older respondents had a higher level of mindful eating [(AOR = 1.05, p-value 0.01, 95% CI = 1.01–1.09)]. In addition, elevated FBS level was also associated with a greater level of mindful eating [(AOR = 2.55, p-value 0.01, 95% CI = 1.28–5.07)]. Therefore, healthcare providers should promote mindful eating during the consultation, especially among younger patients. Blood glucose monitoring is also recommended to instil awareness of the importance of healthy eating habits.

The Challenges of Eating Well for People Living with Cystic Fibrosis: an Interview Study Exploring the Use of Mindful Eating Approaches and Behaviours to Support Optimal Nutritional Status

BACKGROUND

Nutritional status and weight are closely linked to lung function and health status in cystic fibrosis (CF). The investigation of eating behaviours has shown mindfulness practices to be useful in modifying eating behaviours, particularly with obesity; to date, no research specifically explores how these concepts may be utilised within a CF population who face specific challenges in eating behaviours.

METHOD

Adult patients (n = 20, M = 8, age range 21-62 years) were recruited from a UK CF regional centre to take part in qualitative semi-structured interviews. Experiences of eating behaviours focusing on the use of mindful (or mindless) eating as barriers and enablers to achieving and maintaining optimal nutritional status were explored. Data were analysed using thematic analysis with a contextualist approach to understand how participants experienced eating behaviours within the context of health and weight status.

RESULTS

Participants engaged readily in discussions of eating behaviour describing active self-regulation of food eaten and calorie intake. Participants who struggled to maintain weight employed strategies to increase calorie intake such as distraction and multitasking while eating. Most participants reported no pleasure in food, describing eating as another treatment to endure. Confusion existed around how to eat healthily for CF alongside co-morbid health conditions including diabetes, cholesterol and heart disease.

CONCLUSION

Participants were highly aware of their eating behaviours, engaging in intentional and deliberate preparations, which could be described as mindful, for making eating a more automatic or mindless activity. Modifications to usual mindful eating interventions are needed to support people with CF.

Systematic Review for the Medical Applications of Meditation in Randomized Controlled Trials

Background: Meditation has been increasingly adapted for healthy populations and participants with diseases. Its beneficial effects are still challenging to determine due to the heterogeneity and methodological obstacles regarding medical applications. This study aimed to integrate the features of therapeutic meditation in randomized controlled trials (RCTs). Methods: We conducted a systematic review of RCTs with meditation for populations with diseases using the PubMed database through June 2021. We analyzed the characteristics of the diseases/disorders, participants, measurements, and their overall benefits. Results: Among a total of 4855 references, 104 RCTs were determined and mainly applied mindfulness-based (51 RCTs), yoga-based (32 RCTs), and transcendental meditation (14 RCTs) to 10,139 patient-participants. These RCTs were conducted for participants with a total of 45 kinds of disorders; the most frequent being cancer, followed by musculoskeletal and connective tissue diseases and affective mood disorder. Seven symptoms or signs were frequently assessed: depressive mood, feeling anxious, quality of life, stress, sleep, pain, and fatigue. The RCTs showed a higher ratio of positive outcomes for sleep (73.9%) and fatigue (68.4%). Conclusions: This systematic review produced the comprehensive features of RCTs for therapeutic meditation. These results will help physicians and researchers further study clinical adaptations in the future as reference data.

Mindful Eating Proficiency and Healthy Eating Literacy among Japanese Mothers: Associations with Their Own and Their Children's Eating Behavior

Mindfulness is a process of focusing one’s attention on the present moment. Applying this concept to eating (i.e., mindful eating (ME)) is associated with regulated eating behaviors, particularly in people with obesity and who are overweight. Sustaining healthy eating habits requires both healthy eating literacy (HEL) and proficiency in ME. However, ME proficiency in Japanese people has not been sufficiently investigated. In this paper, we conduct a survey of mothers with 4- to 5-year-old children in Aomori City, Japan, to investigate their ME proficiency and HEL level and eating behavior and self-reported body mass index in both mothers and their children from August to September 2019. This study is the first to describe ME proficiency in Japanese mothers. The study sample includes 128 participants from 18 nursery schools. ME proficiency in mothers was positively correlated with both their own and their children’s eating behaviors, thereby suggesting a potential relationship, while strong relationships were not observed between the HEL level and eating behaviors of mothers and children. Improving ME skills, rather than HEL, may be an effective way to sustain healthier eating behaviors in mothers and their children. The level of evidence was Level V: Opinions of respected authorities based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.

Development and Validation of the Four Facet Mindful Eating Scale (FFaMES)

OBJECTIVES

Previous mindful eating scales stress the attentional domains of eating-specific mindfulness, such as present-moment attention to homeostatic cues of hunger and satiety while discounting other important domains such as non-judgment and decentering. The purpose of the series of studies was to develop and evaluate a multifaceted mindful eating scale that assesses several domains of eating-specific mindfulness.

METHODS

A multistep process was used to construct the Four Facet Mindful Eating Scale (FFaMES). Study 1 outlined the initial scale construction and the development of a novel item pool (N = 480). Study 2 examined the internal structure of the observed variables using exploratory analysis (N = 445) and confirmatory analysis in a separate sample (N = 445). Reliability and validity were assessed in Study 3 (N = 166).

RESULTS

The final scale consists of 29 items with 4 factors: Non-Reactance, Non-Judgment, External Awareness, and Internal Awareness. The FFaMES demonstrated good internal consistency, retest reliability as well as preliminary convergent and divergent validity.

CONCLUSIONS

Our findings provide reliability evidence and initial support for the construct validity of the FFaMES and the continued study of multiple facets of eating-specific mindfulness. Future research should continue to investigate the differential effects of various aspects of eating-specific mindfulness in the prevention and treatment of obesity and its comorbidities.

The Relationship between Adults' Perceptions, Attitudes of COVID-19, Intuitive Eating, and Mindful Eating Behaviors

In total, 1224 Turkish adults (27.5 ± 9.6 years; 80.6% female) answered sociodemographic questions, and three instruments: Mindful Eating Questionnaire (MEQ), Intuitive Eating Scale-2 (IES-2), and COVID-19 Perception and Attitude Scale. Women's perceptions and attitudes toward COVID-19 indicated higher concerns than men (p < .001). It was found that IES-2 scores of all subjects increased as body mass index (BMI) decreased and education level increased (p < .001; p = .033, respectively). During the social isolation of COVID-19, the MEQ scores of married couples and those who did not eat take-out foods were higher (p = .027; p = .006, respectively). Interestingly, it was found that as the BMI of the subjects increased, their MEQ scores increased (p < .001). The COVID-19 pandemic, which has social and economic consequences, has a great impact on human health and causes sudden lifestyle changes through social distance and isolation at home. Although social isolation during the epidemic is a necessary precaution to protect public health, the results of this study support that it causes changes in intuitive eating, and mindful eating behaviors.

Effects of self-management programs on behavioral modification among individuals with chronic disease: A systematic review and meta-analysis of randomized trials

The prevalence of chronic disease associated with unhealthy lifestyles has been increasing worldwide. Health professionals have recognized that self-management programs (SMPs) can provide health benefits by promoting health behaviors, especially when applied to individuals with lifestyle-related chronic disease. This review performed a meta-analysis of the features of SMPs using randomized studies and analyzed the magnitude of the combined effects of self-management on behavioral modification. We searched the PubMed, CINAHL, ScienceDirect, SCOPUS, Web of Science, Embase, Cochrane Library, DBpia, and KISS to identify randomized trials that evaluated the behavioral outcomes of SMPs. Subgroup analyses were performed for program duration, providers, type of comparisons, and program settings. We selected 25 studies (N = 5,681) to perform analyses with random-effects models. The effect sizes of SMPs were small but significant for physical activity (standardized difference in means [SDM] = 0.25), dietary habits (SDM = 0.28), and health responsibility (SDM = 0.18), and not significant for stress management and smoking behaviors. A short-term SMPs (less than 12 weeks) was indicated as being effective in modifying physical activity, dietary habits, and health responsibility, while the program effects on dietary habits were significant only with expert-delivered education and when compared with inactive controls. The findings of this study indicate that SMPs can effectively improve physical activity, dietary habits, and health responsibility in individuals with chronic disease, with a small but significant effect size. Future studies should explore the effects of SMPs on stress management and smoking cessation and assess the long-term maintenance of healthy lifestyles in individuals with lifestyle-related chronic disease.

The Hearing Intervention for the Aging and Cognitive Health Evaluation in Elders Randomized Control Trial: Manualization and Feasibility Study

OBJECTIVES

This work describes the development of a manualized best-practice hearing intervention for older adults participating in the Aging and Cognitive Health Evaluation in Elders (ACHIEVE) randomized controlled clinical trial. Manualization of interventions for clinical trials is critical for assuring intervention fidelity and quality, especially in large multisite studies. The multisite ACHIEVE randomized controlled trial is designed to assess the efficacy of a hearing intervention on rates of cognitive decline in older adults. We describe the development of the manualized hearing intervention through an iterative process that included addressing implementation questions through the completion of a feasibility study (ACHIEVE-Feasibility).

DESIGN

Following published recommendations for manualized intervention development, an iterative process was used to define the ACHIEVE-hearing intervention elements and create an initial manual. The intervention was then delivered within the ACHIEVE-Feasibility study using one-group pre-post design appropriate for assessing questions related to implementation. Participants were recruited from the Tampa, Florida area between May 2015 and April 2016. Inclusion criteria were cognitively healthy adults aged 70 to 89 with symmetrical mild-to-moderately severe sensorineural hearing loss. The ACHIEVE-Feasibility study sought to assess the implementation of the manualized hearing intervention by: (1) confirming improvement in expected outcomes were achieved including aided speech-in-noise performance and perception of disease-specific self-report measures; (2) determining whether the participants would comply with the intervention including session attendance and use of hearing aids; and (3) determining whether the intervention sessions could be delivered within a reasonable timeframe.

RESULTS

The initial manualized intervention that incorporated the identified best-practice elements was evaluated for feasibility among 21 eligible participants and 9 communication partners. Post-intervention expected outcomes were obtained with speech-in-noise performance results demonstrating a significant improvement under the aided condition and self-reported measures showing a significant reduction in self-perceived hearing handicap. Compliance was excellent, with 20 of the 21 participants (95.2%) completing all intervention sessions and 19 (90.4%) returning for the 6-month post-intervention visit. Furthermore, self-reported hearing aid compliance was >8 hr/day, and the average daily hearing aid use from datalogging was 7.8 hr. Study completion was delivered in a reasonable timeframe with visits ranging from 27 to 85 min per visit. Through an iterative process, the intervention elements were refined, and the accompanying manual was revised based on the ACHIEVE-Feasibility study activities, results, and clinician and participant informal feedback.

CONCLUSION

The processes for the development of a manualized intervention described here provide guidance for future researchers who aim to examine the efficacy of approaches for the treatment of hearing loss in a clinical trial. The manualized ACHIEVE-Hearing Intervention provides a patient-centered, yet standardized, step-by-step process for comprehensive audiological assessment, goal setting, and treatment through the use of hearing aids, other hearing assistive technologies, counseling, and education aimed at supporting self-management of hearing loss. The ACHIEVE-Hearing Intervention is feasible in terms of implementation with respect to verified expected outcomes, compliance, and reasonable timeframe delivery. Our processes assure intervention fidelity and quality for use in the ACHIEVE randomized controlled trial (ClinicalTrials.gov Identifier: NCT03243422).

Exploratory Analysis of Racial/Ethnic and Educational Differences in a Randomized Controlled Trial of a Mindfulness-Based Weight Loss Intervention

OBJECTIVE

People of color and lower socioeconomic groups have higher obesity prevalence, lose less weight compared with Whites and higher socioeconomic groups, and are underrepresented in randomized controlled trials of mindfulness-based interventions. We examined whether mindfulness approaches reduce disparities in weight loss interventions.

METHODS

We analyzed data from a randomized controlled trial of 194 participants with obesity (41% participants of color, 36% without college degree) comparing a 5.5-month mindfulness-based weight loss intervention to an active-control with identical diet-exercise guidelines. We assessed attendance, 18-month attrition, and weight change at 6, 12, and 18 months by race/ethnicity and education level using linear mixed models, adjusting for baseline body mass index, age, and education or race/ethnicity, respectively.

RESULTS

Participants without versus with a college degree attended fewer sessions and had higher attrition across interventions. Participants of color attended fewer intervention sessions in the mindfulness compared with the control intervention. Overall, participants of color lost significantly less weight at 12 and 18 months compared with Whites. However, during the 6- to 18-month maintenance period, we found an interaction of intervention arm, race/ethnicity, and time (p = .035), indicating that participants of color compared with Whites regained more weight in the control (0.33 kg/mo; p = .005) but not mindfulness intervention (0.06 kg/mo; p = .62). Participants without a college degree had greater initial weight loss in the mindfulness compared to control intervention from 0 to 6 months (-0.46 kg/mo; p = .039).

CONCLUSIONS

Although disparities persist, mindfulness approaches may mitigate some racial/ethnic and socioeconomic differences in weight loss compared with conventional diet-exercise programs.Trial Registration: Clinicaltrials.gov registration: NCT00960414.

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.

Effects of mindfulness- and acceptance-based interventions on diabetes distress and glycaemic level in people with type 2 diabetes: Systematic review and meta-analysis

AIM

For people with type 2 diabetes, self management and fear of disease complication often cause psychological distress. Mindfulness and acceptance might be beneficial for reducing diabetes-related distress and glycaemic level. We systematically review the effects of mindfulness- and acceptance-based interventions on diabetes distress and glycaemic level in community-dwelling adults with type 2 diabetes.

METHODS

Seven electronic databases (English and Chinese) were searched comprehensively from inception to June 2020. Data extraction and methodological quality assessment were independently performed by two reviewers using Grading of Recommendations, Assessment, Development and Evaluations criteria.

RESULTS

Nine RCTs (801 participants) examining the effects of acceptance and commitment therapy, mindfulness-based cognitive therapy, mindfulness-based stress reduction and self-directed mindfulness practice were included. In the reviewed RCTs, the majority of participants (mean age: 50-66 years, average disease duration: 4-10 years) had suboptimal diabetes control (HbA_1c >7.0%, 53 mmol/mol). Compared with controls, the interventions significantly reduced diabetes distress (standardised mean difference, SMD = -0.37, 95% confidence intervals, CI: -0.63, -0.12; p < 0.01) and HbA_1c (mean difference, MD = -0.35, 95% CI: -0.67, -0.04; p = 0.03) up to 1-month post-intervention. However, the underpowered studies may have led to overestimation, the interventions for diabetes distress and HbA_1c were heterogeneous.

CONCLUSIONS

Within evidenced-based diabetes education programmes, mindfulness- and acceptance-based approaches may reduce distress and HbA_1c levels and promote self care in people with type 2 diabetes. Further controlled trials are recommended to examine the clinical effectiveness of such programmes for people with type 2 diabetes of diverse clinical, cultural and socio-demographic backgrounds.

Mindful eating, obesity, and risk of type 2 diabetes in university students: A cross-sectional study

BACKGROUND

Understanding gender differences in type 2 diabetes mellitus (T2DM) and obesity risk among university students is critical for the development of health promotion interventions. Mindful eating focuses on how and why eating behavior occurs rather than what is eaten. Current research on this topic is limited in the university-aged population.

PURPOSE

The aim of this study was to (1) assess gender differences in risk of developing T2DM and elevated body mass index (BMI)/obesity; (2) explore the mindful eating levels according to the gender perspective; and (3) evaluate the relationship between mindful eating, BMI, and the risk of T2DM among young Turkish adults.

METHOD

This cross-sectional correlational study was conducted in Karabuk University University, Turkey, during the 2017-2018 university calendar year. Eight hundred young adults were selected by the convenience sampling method. Data analyses used were the independent t test and Pearson correlational statistics.

RESULTS

BMI values of males were significantly higher than those of females (p < 0.01). There were no significant differences between males and females regarding the risk of developing T2DM (p > 0.05). Mindful eating was significantly associated with BMI and the risk of developing T2DM in the young adult populations (p < 0.01).

CONCLUSIONS

Our findings can provide a basic reference for developing interventions that improve healthy eating habits and weight-loss strategies.

Value-based eating habits; exploring religio-cultural nutritional behavior norms

Purpose

Defining a standard norm is critical in nutritional cognitive-behavioral interventions. These norms can be derived from a statistical or value-based point of view. Religion and subsequent cultural values can have significant effects on social behaviors, especially on eating habits. In this study, the authors quantify the presence of religio-cultural nutritional behavior norms in Abrahamic scriptures.

Methods

Qualitative content analysis and descriptive analysis were applied to these texts to provide a better understanding of the subject.

Results

The extracted norms were categorized into nine main behavioral domains, and most of the observed value-based norms were in agreement with previous experimental researches.

Conclusion

There is strong emphasis on nutritional habits in value-based religio-cultural sources. The use of these norms in later policies and practices is advised. This approach can lead to healthier nutritional choices and a decrease in non-communicable diseases.

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.

Multidisciplinary Approach for Weight Regain-how to Manage this Challenging Condition: an Expert Review

Weight regain is a multifactorial condition that affects many patients following bariatric surgery. The purpose of the paper is to review the multidisciplinary approach for the management of weight regain. We performed a search in current clinical evidence regarding the causes, consequences, and treatments of weight regain. The multidisciplinary approach with periodic monitoring is of fundamental importance to prevent or treat weight regain. Several therapeutic options are ranging from nutritional to surgical options, which should be tailored according to patients' anatomy, lifestyle behavior, and compliance. Specialized multidisciplinary care is the key to achieve optimal long-term weight loss and maintenance goals following bariatric surgery.

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.

A Moderated-Mediation Model of the Relationship between Dietary Satisfaction and Fatigue in Older Adults with Diabetes: The Role of Meal Planning and Depressive Symptoms

Little research has examined the pathways between psychological factors and fatigue in older adults with diabetes. This study explored the pathways between diet-related quality of life and depressive symptoms in predicting fatigue using a moderated-mediation model. A convenience sample of adults ≥65 years (n = 127) with diabetes completed a cross-sectional survey including measures of fatigue severity, diet-related quality of life, and depressive symptoms, and a moderated-mediation analysis assessed the relationships between them. Diet satisfaction was negatively related to fatigue, which was mediated by depressive symptoms. In the moderated-mediation model, diet satisfaction had a conditional effect on fatigue through the mediating effect of depressive symptoms, moderated by meal planning difficulty. At higher levels of perceived meal planning difficulty, lower diet satisfaction was indirectly associated with higher fatigue through depressive symptoms, but this pathway was non-significant at lower levels. Findings suggest that supportive care for diet therapy might improve psychological outcomes in older adults with diabetes, especially for those having difficulties with daily dietary practice. Meal planning difficulties in the dietary management of diabetes accompanied by low diet satisfaction may lead to negative psychological outcomes. Monitoring satisfaction and burdens associated with dietary practices could improve fatigue in this population.

Weight Reduction by the Low-Insulin-Method-A Randomized Controlled Trial

Continuous high insulin levels are associated with weight gain and lead to cardiometabolic diseases. Therefore, we have developed the Low-Insulin-Method and integrated it into the multi-component, occupational healthcare program SHAPE-AND-MOTION-Medical-Accompanied-Slimming (SAMMAS) to reduce daily insulin levels for long-term weight reduction in overweight or obesity. Employees were randomized into a starting intervention group (SI, n = 15) or waiting list control group (WL, n = 15). SAMMAS consisted of group-based seminars, low-carbohydrate nutrition including formula diet, continuous glucose monitoring, telemetric monitoring, and telemedical coaching. Both groups received telemetric devices at baseline. Intention-to-treat analyses were performed after 12, 26, and 52 weeks. The estimated treatment difference in weight reduction after 12 weeks, which is the primary endpoint of the study, showed a pronounced effect in favour of SI (−6.3 kg with (95% confidence interval) (−7.4; −4.5) (p < 0.001)) after 12 weeks. Furthermore, SI improved fasting blood glucose, HbA1c, quality of life, fasting insulin, blood pressure, and eating behaviour (all p < 0.05) in the within-group analysis, while WL did not. After 26 and 52 weeks, weight reduction could be maintained in the whole group (both groups together) by −6.7 kg (−9.5; −3.8) (p < 0.001) and −6.1 kg (−9.2; −2.7) (p < 0.01). SAMMAS supports clinically relevant weight reduction and long-term weight loss maintenance in individuals with overweight or obesity.

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.

Effectiveness of theory-based diabetes self-care training interventions; a systematic review

BACKGROUND

Permanent compliance of self-care behaviors is a challenging issue in managing chronic diseases like diabetes. The evidence supports theory-based intervention in promoting self-care behaviors. However, no systematic review was done to monitor these interventions and compare more effective constructs. This study was conducted to investigate the studies using self-care theories and introducing the most effective theories.

METHODS

This is a systematic review study during which some scientific databases including Scopus, Elsevier, Google scholar and PubMed were searched by using some key words like self-care or self-management, diabetes, theory or model. English articles from the start of 2013 up to the end of November 2020 were monitored.

RESULTS

20 articles were selected and studied based on eight theories which they used. These theories were: Social support theory, Health Belief Model, Heath Belief Model and Empowerment Theory, Empowerment Theory, Self-efficacy Theory, precede-proceed model, Self-regulation Theory, behavioral theory and Social Cognitive Theory.

CONCLUSION

Four theories appeared to be more effective for the target behavior of present research: Social Support Theory and the combination of Empowerment Theory and Health Belief Model, Social Cognitive Theory and Self Efficacy Theory. Taken together, the findings of this systematic review suggest that interventions that go beyond individual determinants (such as changing knowledge and attitudes) to determinants of upper cognitive, motor, and social levels (such as the development of skills and competencies) they have led to raised self-care outcomes.

A Tailored Cognitive-Behavioural Intervention Produces Comparable Reductions in Regimen-Related Distress in Adults With Type 2 Diabetes Regardless of Insulin Use: 12-Month Outcomes From the COMRADE Trial

OBJECTIVES

Our aim in this study was to determine whether a cognitive-behavioural therapy plus small changes lifestyle intervention can produce comparable improvements in insulin users vs patients not using insulin with uncontrolled type 2 diabetes (T2D) and comorbid depressive or regimen-related distress (RRD) symptoms.

METHODS

This study is a secondary analysis of Collaborative Care Management for Distress and Depression in Rural Diabetes Study, a randomized, controlled trial of a 16-session, severity-tailored cognitive-behavioural therapy plus small changes lifestyle intervention compared with usual care. Outcomes included glycated hemoglobin (A1C), regimen-related distress, depression, medication adherence and diabetes self-care. Our investigation provides 2 sets of contrasts: 1) insulin users in the intervention group compared with insulin users in the usual-care group and 2) insulin users compared with noninsulin users in the intervention group only.

RESULTS

Of the 139 participants, 72 (52%) were using insulin at baseline and had significantly higher levels of A1C (10.2±2.1% vs 8.9±1.6%) and RRD (3.3±1.4 vs 2.8±1.1), and significantly poorer medication adherence (5.2±2.1 days/wk vs 5.5±1.7 days/wk). Intervention patients using insulin exhibited significantly greater reductions in RRD and marginally significant improvements in medication adherence and A1C compared with insulin users in usual care. Within the intervention group, changes in RRD, medication adherence and A1C did not differ significantly by insulin use.

CONCLUSIONS

Tailored cognitive-behavioural therapy with a small-changes lifestyle intervention improved elevated RRD and A1C outcomes at least as effectively in insulin users as non‒insulin users. Future powered studies need to address the role of insulin use in uptake and treatment outcomes.

The effects of mindfulness training on the level of happiness and blood sugar in diabetes patients

Purpose

The present study aimed at investigating the effect of mindfulness training on the level of happiness and blood glucose in diabetic patients in Zarghan city, Iran.

Methods

This quasi-experimental study was conducted in 2018 in Fars province, Iran. 136 diabetic patients who were eligible (had diabetes for more than one year, older than 18 years, willingness to participate in the research, and reside in Zarqan city) were selected based on convenience sampling method. Next the participants were randomly divided into two groups, each comprising 68 individuals. Both of the study samples and statistical analyser were blinded to intervention group (mindfulness training) and control group (without intervention). Before and three month after the intervention the patients' levels of happiness (based on Oxford Happiness Questionnaire), fasting blood sugar (FBS) and Glycated Hemoglobin test (HbA1c) were measured.

Results

The results indicated that after the sessions, the level of happiness in the Intervention group was significantly higher than the control group (p value <0.001). Also, the level of blood glucose and HbA1c after the sessions was significantly lower in the Intervention group compared to the control group (p value<0.001, p value = 0.004). After the intervention, there was a significant correlation between mean blood glucose levels and mean HbA1c levels in the Intervention group and their level of happiness (p value<0.01 and p value<0.001).

Conclusion

The findings revealed that the mindfulness-based educational intervention can increase happiness in people with diabetes and regulate their blood glucose.

Does food intake mediate the association between mindful eating and change in depressive symptoms?

OBJECTIVE

To examine mediation by (i) diet quality and (ii) diet quantity in the associations of mindful eating domains with 3-year change in depressive symptoms.

DESIGN

Depressive symptoms were measured with the Center for Epidemiologic Studies Depression scale at baseline and 3-year follow-up. Four mindful eating domains (Focused Eating; Eating in response to Hunger and Satiety Cues; Eating with Awareness; Eating without Distraction) were measured with the Mindful Eating Behavior Scale. Food intake was measured with a 238-item FFQ. Diet quality was defined as the Mediterranean Diet Score (MDS). Diet quantity was defined as total energy intake (kcal/d; 1 kcal = 4·184 kJ). Mediation analyses with percentile-corrected bootstrap confidence intervals were conducted to calculate indirect effects.

SETTING

Longitudinal Aging Study Amsterdam.

PARTICIPANTS

Adults aged 55 years or above (n 929).

RESULTS

Diet quality (MDS) did not mediate associations of any of the four mindful eating domains with change in depressive symptoms. In contrast, total energy intake did mediate the associations with change in depressive symptoms for the mindful eating domains Eating with Awareness (indirect effects fully adjusted models: B = -0·014, 95 % CI -0·037, -0·002) and Eating without Distraction (B = -0·013, 95 % CI -0·033, -0·001), but not for the other two domains. Post hoc multiple mediation analyses showed similar results.

CONCLUSIONS

Higher scores on two mindful eating domains were associated with a decrease in depressive symptoms through lower total energy intake. Diet quantity, but not diet quality, could be a possible underlying mechanism in the associations between mindful eating and change in depressive symptoms.

Shared Medical Appointments and Mindfulness for Type 2 Diabetes-A Mixed-Methods Feasibility Study

INTRODUCTION

Type 2 diabetes (T2DM) is a major health concern with significant personal and healthcare system costs. There is growing interest in using shared medical appointments (SMAs) for management of T2DM. We hypothesize that adding mindfulness to SMAs may be beneficial. This study aimed to assess the feasibility and acceptability of SMAs with mindfulness for T2DM within primary care in Australia.

MATERIALS AND METHODS

We conducted a single-blind randomized controlled feasibility study of SMAs within primary care for people with T2DM living in Western Sydney, Australia. People with T2DM, age 21 years and over, with HbA1c > 6.5% or fasting glucose >7.00 mmol/L within the past 3 months were eligible to enroll. The intervention group attended six 2-h programmed SMAs (pSMAs) which were held fortnightly. pSMAs included a structured education program and mindfulness component. The control group received usual care from their healthcare providers. We collected quantitative and qualitative data on acceptability as well as glycemic control (glycated hemoglobin and continuous glucose monitoring), lipids, anthropometric measures, blood pressure, self-reported psychological outcomes, quality of life, diet, and physical activity using an ActiGraph accelerometer.

RESULTS

Over a 2-month period, we enrolled 18 participants (10 females, 8 males) with a mean age of 58 years (standard deviation 9.8). We had 94.4% retention. All participants in the intervention group completed at least four pSMAs. Participants reported that attending pSMAs had been a positive experience that allowed them to accept their diagnosis and empowered them to make changes, which led to beneficial effects including weight loss and better glycemic control. Four pSMA participants found the mindfulness component helpful while two did not. All of the seven participants who contributed to qualitative evaluation reported improved psychosocial wellbeing and found the group setting beneficial. There was a significant difference in total cholesterol levels at 12 weeks between groups (3.86 mmol/L in intervention group vs. 4.15 mmol/L in the control group; p = 0.025) as well as pain intensity levels as measured by the PROMIS-29 (2.11 vs. 2.38; p = 0.034).

CONCLUSION

pSMAs are feasible and acceptable to people with T2DM and may result in clinical improvement. A follow-up fully-powered randomized controlled trial is warranted.

CLINICAL TRIAL REGISTRATION

Australia and New Zealand Clinical Trial Registry, identifier ACTRN12619000892112.

Obesity and Eating Disturbance: the Role of TFEQ Restraint and Disinhibition

PURPOSE OF REVIEW

Literature from the past five years exploring roles of Three-Factor Eating Questionnaire (TFEQ) Restraint and Disinhibition in relation to adult obesity and eating disturbance (ED) was reviewed.

RECENT FINDINGS

Restraint has a mixed impact on weight regulation, diet quality, and vulnerability to ED, where it is related detrimentally to weight regulation, diet, and psychopathology, yet can serve as a protective factor. The impact of Disinhibition is potently related to increased obesity, poorer diet, hedonically driven food choices, and a higher susceptibility to ED. Restraint and Disinhibition have distinct influences on obesity and ED and should be targeted differently in interventions. Further work is required to elucidate the mechanisms underlying TFEQ eating behavior traits.

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).

Fatigue-Related Factors for Community-Dwelling Older Adults with Diabetes: A Theory-Guided Multi-Dimensional Approach Using the Dynamic Biopsychosocial Model

Older adults with diabetes appear more susceptible to fatigue compared to younger adults with diabetes or healthy older adults, since aging and diabetes independently and synergistically influence fatigue. Few studies have investigated fatigue in older adults with diabetes using a multidimensional approach. This study explored the influences of physical, psychological, interpersonal, and contextual factors on diabetes fatigue using a dynamic biopsychosocial model. Face-to-face surveys were administered to community-dwelling older adults with diabetes and included variables across four domains (i.e., physical, psychological, interpersonal, and contextual factors). Univariate analyses and multiple linear regression were used. The mean fatigue score was 3.94 (standard deviation (SD) = 1.81) out of 7, and the prevalence of fatigue was 48.8%. Significant differences in fatigue severity by psychological, interpersonal, and contextual factors were found. Comorbidity and psychological factors were significant predictors of fatigue in the model, explaining 31.9% of the variance. As nearly half the sample experienced moderate or severe fatigue, which was significantly influenced by both comorbidity and psychological factors, including depression, sleep quality, and diet-related psychological characteristics, assessing patients' psychological status may be important. Awareness of fatigue could be incorporated into dietary interventions for older adults with diabetes.

Updating the Food-Based Dietary Guidelines for the Spanish Population: The Spanish Society of Community Nutrition (SENC) Proposal

Diet-related risk factors and physical inactivity are among the leading risk factors for disability and are responsible for a large proportion of the burden of chronic non-communicable diseases. Food-based dietary guidelines (FBDGs) are useful tools for nutrition policies and public health strategies to promote healthier eating and physical activity. In this paper, we discuss the process followed in developing the dietary guidelines for the Spanish population by the Spanish Society of Community Nutrition (SENC) and further explain the collaboration with primary healthcare practitioners as presented in the context of the NUTRIMAD 2018 international congress of SENC. From a health in all policies approach, SENC convened a group of experts in nutrition and public health to review the evidence on diet-health, nutrient intake and food consumption in the Spanish population, as well as food preparation, determinants and impact of diet on environmental sustainability. The collaborative group drafted the document and designed the graphic icon, which was then subject to a consultation process, discussion, and qualitative evaluation. Next, a collaborative group was established to plan a dissemination strategy, involving delegates from all the primary healthcare scientific societies in Spain. A product of this collaboration was the release of an attractive, easy-to-understand publication.

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.

The Impact of a Community-Based Food Education Program on Nutrition-Related Knowledge in Middle-Aged and Older Patients with Type 2 Diabetes: Results of a Pilot Randomized Controlled Trial

The purpose of this study was to evaluate the impact of a community-based food education program on nutrition-related knowledge in middle-aged and older patients with type 2 diabetes (T2D). Participants (n = 36; 65.9 ± 6.0 years old) were recruited in primary health care to a 9-month community-based lifestyle intervention program for patients with T2D and randomly assigned to an exercise program (control group; n = 16) or an exercise program plus a food education program (experimental group; n = 20). Nutrition-related knowledge was assessed through a modified version of the General Nutrition Knowledge Questionnaire. The increase in total nutrition-related knowledge score and sources of nutrients area score was significantly higher in the experimental group compared to the control group. No significant changes in nutrition-related knowledge were found between groups in dietary recommendations and diet-disease relationship areas, although improvements were observed. This community-based food education program, with the use of easy to implement strategies (short-duration lectures and dual-task problem solving activities during exercise), had a positive and encouraging impact on nutrition-related knowledge in middle-aged and older patients with T2D.

Evaluation design of the Social Engagement Framework for Addressing the Chronic-disease-challenge (SEFAC): a mindfulness-based intervention to promote the self-management of chronic conditions and a healthy lifestyle

BACKGROUND

The Social Engagement Framework for Addressing the Chronic-disease-challenge (SEFAC) project intends to empower citizens at risk of or with type 2 diabetes (T2DM) and/or cardiovascular disease (CVD) to self-manage their chronic conditions through the SEFAC intervention. The intervention combines the concepts of mindfulness, social engagement and information and communication technology support, in order to reduce the burden of citizens with chronic conditions and to increase the sustainability of the health system in four European countries.

METHODS

A prospective cohort study with a 6-month pre-post design will be conducted in four European countries: Croatia, Italy, the Netherlands and the United Kingdom. A total of 360 community-dwelling citizens ≥50 years of age will be recruited; 200 citizens at risk of T2DM and/or CVD in the next 10 years (50 participants in each country) and 160 citizens with T2DM and/or CVD (40 participants in each country). Effects of the intervention in terms of self-management, healthy lifestyle behavior, social support, stress, depression, sleep and fatigue, adherence to medications and health-related quality of life will be assessed. In addition, a preliminary cost-effectiveness analysis will be performed from a societal and healthcare perspective.

DISCUSSION

The SEFAC project will further elucidate whether the SEFAC intervention is feasible and (cost-) effective among citizens at risk of and suffering from T2DM and/or CVD in different settings.

TRIAL REGISTRATION

ISRCTN registry number is ISRCTN11248135 . Date of registration is 30/08/2018 (retrospectively registered).

[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.

Interventions for self-management of type 2 diabetes: An integrative review

BACKGROUND

Type 2 diabetes mellitus has been identified as one of the most challenging chronic illnesses to manage. Since the management of diabetes is mainly accomplished by patients and families, self-management has become the mainstay of diabetes care. However, a significant proportion of patients fail to engage in adequate self-management. A priority research question is how do interventions affect the self-management behaviors of persons with Type 2 diabetes?

PURPOSE/OBJECTIVES

The purpose of this integrative review is to provide a summary and critique of interventions that support diabetes self-management in the patient with Type II diabetes mellitus.

DESIGN

An integrative review design, with a comprehensive methodological approach of reviews, allowing inclusion of experimental and non-experimental studies.

PROCEDURES

A comprehensive search was conducted via Ebscohost using databases of Academic Search Complete, CINAHL, Health Source: Nursing/Academic Edition, MEDLINE, PsycArtiCLES, and PsycInfo. The final number of papers used for this review were: motivational interviewing (6), peer support/coaching (10), problem solving therapy (3), technology-based interventions (30), lifestyle modification programs (7), patient education (11), mindfulness (3), and cognitive behavioral therapy (5).

RESULTS

Studies were examined from seventeen countries including a broad range of cultures and ethnicities. While interventions have shown mixed results in all interventional categories, many studies do support small to modest improvements in physiologic, behavioral, and psychological outcome measures. Considerable heterogeneity of interventions exists. The most commonly reported physiologic measure was HbA1c level. Outcome measures were collected mostly at 6 and 12 months. Duration of most research was limited to one year.

CONCLUSIONS

Research exploring the impact of interventions for self-management has made major contributions to the care of persons with type 2 diabetes, from offering suggestions for improving care, to stimulating new questions for research. However, implications for clinical practice remain inconclusive, and limitations in existing research suggest caution in interpreting results of studies.

Well-being interventions for individuals with diabetes: A systematic review

In patients with diabetes, psychological well-being constructs (e.g., optimism, positive affect) have been associated with superior medical outcomes, including better glucose control and lower mortality rates. Well-being interventions may be well-suited to individuals with diabetes, as they are simple to deliver, broadly applicable across a range of psychological distress, and may help increase self-efficacy and motivation for diabetes self-care. This systematic review, completed using PRISMA guidelines, examined peer-reviewed studies indexed in PubMed, PsycINFO, and/or Scopus between database inception and October 2017 that investigated the effects of well-being interventions (e.g., positive psychology interventions, mindfulness-based interventions, resilience-based interventions) on psychological and physical health outcomes in individuals with Type 1 or Type 2 diabetes. The search yielded 34 articles (N = 1635 participants), with substantial variability in intervention type, measures used, and outcomes studied; the majority found the intervention to provide benefit. Overall, results indicate that a range of well-being interventions appear to have promise in improving health outcomes in this population, but the literature does not yet provide definitive data about which specific interventions are most effective. The variability in interventions and outcomes points to a need for further rigorous, controlled, and well-powered studies of specific interventions, with well-accepted, clinically relevant outcome measures.

Association of health literacy and diabetes self-management: a systematic review

The purpose of this review is to summarise the existing evidence about the association of health literacy (HL) with type 2 diabetes mellitus self-management. The PubMed, Medline, CINHAL, Scopus and Web of Science databases were searched for randomised control trials of type 2 diabetes mellitus (T2DM) self-management and HL published between 2009 and 2018. Fourteen randomised control trials were included in this review. Our findings showed that HL was instrumental in improving diabetes knowledge, physical activity, self-efficacy and quality of life; however, its associations with glycaemic control, self-monitoring of blood glucose, foot care and medication adherence was inconclusive. Customized and community-based HL interventions were more efficient compared to patient-focused HL interventions. This review concludes that HL is key for T2DM self-management, but customised, structured and community-based interventions are more likely to yield better outcomes.