Obesity rates have reached pandemic levels, and current treatment options generally fail to produce long-term sustainable changes in weight. Obesity is a major risk factor for the metabolic syndrome, as well as heart disease and type 2 diabetes. One additional risk factor for metabolic dysfunction, independent of weight status, is stress eating (defined here by separate, but related non-homeostatic eating behaviors, primarily stress eating, and secondarily binge eating). A second potential risk factor is psychological stress-related hypothalamic-pituitary-adrenal axis activity resulting in excessive cortisol. Excess cortisol can, in turn, contribute to abdominal obesity as well as increases in appetite, energy intake, and stress-induced and binge eating. Hence, stress eating and excessive stress reactivity may be potential mechanisms that underpin obesity for some individuals. As such, they are also potential targets for behavioral interventions. Tailored mindfulness-based interventions can address each of these targets, and therefore may represent one promising pathway through which to improve metabolic health in obesity. Indeed, mindfulness-based interventions can reduce perceived stress, stress reactivity, and stress eating. The purpose of the current proposal is to provide me with training that will allow me to become an independent researcher focused on the design and testing of integrative medicine interventions in the context of obesity treatment. By completing the enclosed training plan and receiving expert mentorship at UCSF, I will gain a deep understanding of how mindfulness treatments impact stress eating and profiles of autonomic and cortisol reactivity by analyzing data from an NCCIH-funded intervention (SHINE), which randomized 194 participants to (1) a diet and exercise arm that incorporated mindfulness meditation, or (2) an active control arm that focused solely on diet and exercise. Completing the proposed series of analyses guided by experts will also provide me the opportunity to develop bio-statistical skills, especially in the context of RCT analytic methods. I predict that those who suffer from greater stress eating and stress reactivity will benefit more if randomized to the mindfulness arm. Clarifying the impacts of mindfulness interventions on basic bio-behavioral mechanisms that underlie cardiometabolic health, such as stress eating and stress reactivity, is an important step in understanding and optimizing mindfulness interventions, and shedding light on for whom mindfulness interventions may be most effective. As my long- term career goal is to develop and disseminate complementary and integrative interventions to improve the health of individuals with obesity and other health-related conditions, the F32 NRSA mechanism through NCCIH will provide me with opportunities to develop as an independent clinical researcher, and develop better evidence-based strategies for promoting health.
Overweight and obesity remain significant public health concerns in the United States, and are difficult to treat; specific factors which may contribute to failure in ability to lose weight include stress and stress eating. This fellowship proposal will provide me with high-level training to become an independent researcher, strengthening my skills in statistics, grant writing, and in understanding mindfulness interventions and their potential ability to impact stress reactivity, stress eating, and weight loss success. My postdoctoral fellowship research addressing these questions in an already completed trial may help tailor future interventions of stress- related obesity.
