Proof of Concept for a Mindfulness-Informed Intervention for Eating Disorder Symptoms, Self-Efficacy, and Emotion Regulation among Bariatric Surgery Candidates

Abstract

Up to 64% of patients seeking bariatric (weight-loss) surgery report eating disorder (ED) symptoms (addictive-like eating, binge eating, emotional eating, grazing) that can interfere with post-surgical weight loss. This prospective proof-of-concept study aimed to evaluate the impact of a pre-surgical mindfulness-informed intervention (MII) on ED symptoms and potential mechanisms-of-action to inform optimization of the intervention. Surgery-seeking adults attended four, 2-hour, MII sessions held weekly. Participants completed validated questionnaires assessing ED symptoms, eating self-efficacy, emotion regulation, and mindful eating pre-MII, post-MII, and at a 12-week follow-up. The MII consisted of mindfulness training, with cognitive, behavioral, and psychoeducational components. Fifty-six patients (M = 47.41 years old, 89.3% female) participated. Improvements in addictive-like eating, binge eating, emotional eating, and grazing were observed from pre- to post-MII. ED symptom treatment gains were either maintained or improved further at 12-week follow-up. Eating self-efficacy and emotion regulation improved from pre-MII to follow-up. Scores on the mindful eating questionnaire deteriorated from pre-MII to follow-up. In mediation analyses, there was a combined indirect effect of emotion regulation, eating self-efficacy, and mindful eating on grazing and binge eating, and an indirect effect of emotion regulation on emotional eating and addictive-like eating. Participation in the MII was associated with improvements in ED symptoms and some mechanisms-of-action, establishing proof-of-concept for the intervention. Future work to establish the MII’s efficacy in a randomized controlled trial is warranted.

Keywords:

• bariatric surgery
• binge eating
• grazing
• mindfulness intervention
• obesity

Acknowledgements

Author 1 acknowledges the support of the Markin Undergraduate Research Program in Health and Wellness for this study. Author 2 is supported by the Canadian Institutes of Health Research, and Alberta Innovates – Health Solutions doctoral scholarships. Author 5 is supported by the Canadian Institutes of Health Research, Alberta Innovates – Health Solutions, and an Izaak Walton Killam Predoctoral Fellowship. Patients and staff of the Bariatric Surgery Clinic are thanked for their participation and collaboration in this study.

Ethics approval

The Institutional Conjoint Health Research Ethics Board at the University of Calgary approved this study (REB18-1398).

Consent

Informed consent was obtained from all participants in this study.

Data availability

The dataset generated and analyzed in this study is available upon request to authors.

Additional information

Funding

This program of research (The BE-EMPOWERED Study: Bariatric Outcome Enhancement – Evaluating a Mindfulness-Based Program for Optimizing Weight-loss and Reducing Eating Disorder Symptoms) is supported by the University of Calgary’s Cumming School of Medicine Clinical Research Fund Seed Grant (CRF18-0701).