This proposal represents an early phase clinical research study to adapt and pilot a family-based mindful eating intervention for overweight adolescents, utilizing an iterative approach to formative treatment development. With currently 35% of U.S. adolescents being overweight and one in six having metabolic syndrome, adolescent obesity is one of the major global health challenges of the 21st century. Few enduring treatment strategies have been identified in adolescent populations and the majority of standard weight loss programs fail to adequately address the impact of psychological factors on eating behavior and the beneficial contribution of parental involvement in adolescent behavior change. A critical need exists to expand treatment development efforts beyond traditional education and cognitive-behavioral programs and to explore alternative treatment models for adolescent obesity. Meditation-based mindful eating programs may represent a unique and novel scientific approach to the current adolescent obesity epidemic as they address key psychological variables affecting weight. Furthermore, the recent expansion of mindfulness programs to include family relationships shows the immense potential for broadening the customarily individual focus of this intervention to include broader factors thought to influence adolescent health outcomes. Although theoretically compelling, mindful eating interventions have never been examined with an overweight adolescent population. Thus, we propose to develop a mindful eating approach to eating behavior and weight loss specifically tailored for adolescents and their families. The first phase of our three phase development process will be devoted to adapting an adolescent protocol (MEAL-A) based on an established mindful eating program currently being used with adult populations. We will then develop a 'family enhanced MEAL-A'(MEAL-A+F) protocol that integrates a family systems perspective. The goal of MEAL-A+F is to expand the focus of MEAL-A to include family factors that influence adolescent eating behaviors. The second design phase will consist of an initial test of both intervention components to provide feedback on usefulness and acceptability (N = 10 families). The final phase will examine the overall efficacy of the optimized MEAL-A+F, relative to the MEAL-A intervention with 30 overweight adolescents (BMI >85th percentile) ages 14-17 and at least one parent. Within this examination, post-treatment and 3-month follow-up comparisons across the two treatment approaches will be made and effect sizes within and between treatments will be assessed. We expect MEAL-A+F to show stronger and more enduring effects than MEAL-A alone on adolescent outcomes including weight, BMI, and eating behaviors. Design considerations are based on optimal positioning for future larger efficacy studies and reflect our priority of examining a mindful eating approach to adolescent weight loss in the context of the family. Study data will help to inform and propel further advances in the treatment of obesity and shed light on how mindfulness can be successfully integrated with broader social factors influencing adolescent health outcomes.
This study makes an important contribution by combining behavioral and biomedical science and by applying an evidence-based meditation technique to an important research priority area, adolescent obesity, in a real-world community-based setting. The study would constitute one of the first treatment development efforts to integrate mindfulness techniques with family-based factors for overweight adolescents and has the potential to enhance public health, lower health care costs, and facilitate translation of a relatively inexpensive, low-tech clinical service to high risk and underserved overweight adolescent populations.