Elsevier

Appetite

Volume 100, 1 May 2016, Pages 86-93
Appetite

Reduced reward-driven eating accounts for the impact of a mindfulness-based diet and exercise intervention on weight loss: Data from the SHINE randomized controlled trial

https://doi.org/10.1016/j.appet.2016.02.009Get rights and content

Abstract

Many individuals with obesity report over eating despite intentions to maintain or lose weight. Two barriers to long-term weight loss are reward-driven eating, which is characterized by a lack of control over eating, a preoccupation with food, and a lack of satiety; and psychological stress. Mindfulness training may address these barriers by promoting awareness of hunger and satiety cues, self-regulatory control, and stress reduction. We examined these two barriers as potential mediators of weight loss in the Supporting Health by Integrating Nutrition and Exercise (SHINE) randomized controlled trial, which compared the effects of a 5.5-month diet and exercise intervention with or without mindfulness training on weight loss among adults with obesity. Intention-to-treat multiple mediation models tested whether post-intervention reward-driven eating and psychological stress mediated the impact of intervention arm on weight loss at 12- and 18-months post-baseline among 194 adults with obesity (BMI: 30–45). Mindfulness (relative to control) participants had significant reductions in reward-driven eating at 6 months (post-intervention), which, in turn, predicted weight loss at 12 months. Post-intervention reward-driven eating mediated 47.1% of the total intervention arm effect on weight loss at 12 months [β = −0.06, SE(β) = 0.03, p = .030, 95% CI (−0.12, −0.01)]. This mediated effect was reduced when predicting weight loss at 18 months (p = .396), accounting for 23.0% of the total intervention effect, despite similar weight loss at 12 months. Psychological stress did not mediate the effect of intervention arm on weight loss at 12 or 18 months. In conclusion, reducing reward-driven eating, which can be achieved using a diet and exercise intervention that includes mindfulness training, may promote weight loss (clinicaltrials.gov registration: NCT00960414).

Section snippets

Design

The current study reports on data from the Supporting Health by Integrating Nutrition and Exercise (SHINE) clinical trial (Clinicaltrials.gov registration: NCT00960414). Adults with obesity (BMI 30–45) were randomized in a 1:1 ratio to a 5.5-month diet and exercise weight-loss program with or without mindfulness training for eating awareness, stress management, and emotion regulation. See (Daubenmier et al., In Press) for detailed study design and methodology. The University of California, San

Participant characteristics and attrition

Participants (N = 194) in the two intervention arms were similar on baseline variables (Table 1). The majority of participants were female (82%) and White (59%). The average age was 47.0 ± 12.7 years and the average BMI was 35.5 ± 3.6. See (Daubenmier et al., In Press) for additional participant details. Retention was similar for the mindfulness and control participants at 6 months (84.0% and 77.0%; p = .21), 12 months (79.0% and 74.0%, p = .50), and 18 months (81.0% and 71.0%, p = .13). See

Discussion

We examined reward-driven eating and psychological stress as two mechanisms by which a 5.5-month diet and exercise intervention with or without adjuvant mindfulness training might impact long-term weight loss in adults with obesity. Mindfulness participants reported significantly lower levels of reward-driven eating than control participants at post-intervention (6 months). Furthermore, reductions in reward-driven eating at 6 months mediated the effect of intervention arm on weight loss at 12

Conclusion

These analyses suggest that integrating mindfulness components into a diet-exercise weight loss intervention leads to greater reductions in reward-driven eating. These reductions in reward-driven eating, in turn, are associated with greater weight loss, suggesting that decreases in reward-driven eating are a mechanism by which interventions impact weight change. Future interventions should target reductions in reward-driven eating so as to improve weight loss outcomes.

Acknowledgment

This research was supported by funding from the National Institutes of Health (NCCIH) to Frederick M. Hecht (1P01AT005013; K24AT007827) and Jennifer Daubenmier (K01AT004199). Ashley E. Mason was supported by The National Institutes of Health (NCCIH) (T32AT003997). This research was also supported by funding from the National Institutes of Health (NHLBI) to Elissa S. Epel (U01HL097973). This publication was supported by the National Center for Advancing Translational Sciences, National

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