A critical problem facing behavioral weight-loss interventions for adults with obesity is the tendency towards weight regain following weight loss. This is due in part to a failure to address the behavioral lynchpins that underlie obesity for a significant subset: overeating drive (e.g., eating for psychological relief, compulsive eating). This drive can independently lead to insulin resistance and metabolic syndrome, making it a crucial behavioral target. The objective of this K23 Mentored Patient-Oriented Research Career Development application is to provide me with high-level training to become an expert in targeting overeating drive, using mindfulness-based and motivational approaches to promote healthy eating. Mindful eating (ME) components may be an important addition to weight loss programs to more directly target overeating drive. Motivational interviewing (MI) is already established as an effective treatment component to help with weight loss and may help reduce overeating drive. No studies have examined MI in combination with ME, herein referred to as ?Mindful Motivation? (MM). Congruent with NCCIH?s initiative on advancing the science of symptom management through integrative health interventions, the proposed project aims to 1) identify and optimize specific targets of MM interventions that may reduce overeating drive and 2) pilot test the refined MM intervention in an RCT design with an active control condition (general digital mindfulness). To this end, I will examine pilot study data in which adults with overweight receive 8-weeks of MM. Based on these findings, along with data from focus groups and consultation with a team of experts, I will identify which aspects of the MM intervention most strengthened the target (overeating drive) and optimize these components. I will develop a light touch intervention utilizing both MI and ME components. I will examine which treatment components are most effective (in comparison to the active control) in targeting mechanisms of overeating drive (primarily self- efficacy, impulse control). Preliminary findings will inform an R-level application that evaluates the MM intervention in an adequately powered RCT. This research will help develop mindfulness-based treatments most suitable for adults with overweight and overeating drive, and may promote long-term metabolic health. Building on my advanced training as a clinical health psychologist with expertise in eating behavior, the K23 mechanism addresses my critical training needs in mechanism-focused intervention development and evaluation. The training plan includes coursework, meetings, readings, and qualitative research to fill these gaps. I have assembled an outstanding team of mentors and advisors at UCSF (Drs. Epel, Mason, Adler, Hartogensis, Le Grange, and Garber) and outside of UCSF (Drs. Wolever, Cassin and West) with expertise in complementary areas. As my long-term career goal is to develop and disseminate integrative interventions to improve the health of individuals with obesity, the K23 mechanism will provide me with opportunities to grow as an independent clinical researcher, and develop better evidence-based strategies.
Overweight and obesity remain significant public health concerns in the United States, and are difficult to treat; A strong overeating drive may contribute to weight gain and the common challenge of maintaining weight loss. The proposed K23 project refines the development of a healthy eating intervention, and conducts preliminary testing of this mechanism-focused mindfulness-based intervention to reduce overeating drive among adults with overweight. This research will advance our knowledge of specific mechanisms that can reduce overeating drive, and will have the potential to impact long-term metabolic health.
