Mindfulness-based eating in obesity and anxiety: a randomized controlled trial and feasibility assessment.

Abstract

There is a high prevalence of people living with obesity (LWO) and mental disorders, which could worsen stigma. Internalized weight stigma (IWS) impairs psychological functioning and eating behaviors. This study, therefore, evaluated the acute effects of a Mindfulness-based Eating (ME) intervention and the feasibility of incorporating IWS assessment into a randomized controlled trial for adults LWO and generalized anxiety disorder (GAD). It also explores associations between IWS, device use, and psychological outcomes. Seventy adults LWO and GAD were randomized to a five-week ME group intervention (n = 36) or an asynchronous health educational video control (n = 34). The inhibitory control measured by the Go/No Go test was the primary RCT outcome. Post hoc feasibility outcomes were attendance and completion of the IWS assessment. The Weight Bias Internalization scale (WBIS) was applied alongside measures of body appreciation (BAS2), self-compassion (SCS), anxiety symptoms (GAD7), depressive symptoms (PHQ9), emotional dysregulation (DERS), shame (OAS), early memories (EMWSS), personality assessment (ER5FP), Mindful Eating (MEQ), binge eating (BES), impulsivity (BIS), and device use (smartphone/tablet). Associations were analyzed using correlation, regression and moderation; analyses of psychological outcomes were considered hypothesis-generating. NCT Number NCT06087185. The ME group showed no clear improvement in inhibitory control on the food Go/No-Go task, but resulted in improvements across several psychological outcomes (p < 0.05). All participants completed the WBIS; retention in the RCT was 58.6%. WBIS was positively associated with GAD7 (B = 0.869, p = 0.005) and negatively with BAS2 (B = -0.619, p = 0.005). Device use moderated the association between BAS2 and WBIS at baseline (B = 0.116, p = 0.021), with body appreciation being more protective against IWS at lower device use. ME shows promise for improving psychological outcomes linked to IWS. This study supports the feasibility of integrating IWS measures in trials examining obesity and GAD. Findings highlight the important effect of device use moderates the BAS2-IWS association. These findings can support clinicians and researchers in developing more effective, stigma-informed interventions for individuals LWO, particularly those with psychiatric disorders. CAPES; CNPq; FIPE-HCPA (ROR: https://ror.org/010we4y38).