Mindfulness interventions have shown promise in improving self-regulation, depression, anxiety, and stress levels across all ages. Obesity rates in children are rising worldwide. It has been postulated that through improvements in self-regulation with mindfulness interventions, obesity rates can be improved in children and adolescents. In this review, we attempt to explain how mindfulness interventions may impact obesity rates and obesity-related complications and give the current state of evidence for the following mindfulness interventions: Mindful Eating, Mindfulness-Based Stress Reduction, Yoga, Spirituality, and Dialectical Behavior Therapy.
Over the last 20 years, childhood obesity has become a major public health concern in the United States. According to the most recent data from the Center for Disease Control and Prevention (CDC) in 2015–2016, 18.5% of American youth between the ages of 2 and 19 were classified as being obese using a body mass index (BMI) threshold >95% for age.1
The rate of obesity increases with age in children. Children between the ages of 2 and 5 have an obesity rate of 13.9% as compared to 20.6% in children between the ages of 12 and 19. In addition, obesity has some ethnic predispositions, with obesity rates being most prevalent among Hispanic and Non-Hispanic Black children with no significant difference between the sexes.1
Obesity begins in childhood due to a combination of genetic, social, physical, and psychological factors.2 As children with obesity age, they often develop obesity-related comorbidities including insulin resistance, early onset diabetes mellitus (DM), hypertension, hyperlipidemia, depression, and sleep apnea.3 These medical conditions often persist into childbearing years and adulthood.4 Pregnancies of women with obesity are more likely to have perinatal complications or be stillborn.5 Infants born to mothers with obesity have increased rates of neuropsychiatric disorders including autism, attention deficit hyperactivity disorder (ADHD), anxiety, depression, eating disorders,6 and adult obesity.7 This circular pattern perpetuates, increasing obesity rates in all ages.
With the increase in families with obesity, pediatric medical providers are consistently charged with finding evidence-based treatments. One area of interest is the use of mindfulness interventions to modulate eating behaviors.
According to Jon Kabat-Zinn, mindfulness is a psychological process of purposely bringing one’s attention to experiences occurring in the present moment without judgment.8 Mindfulness activities have been effective in altering human behavior to improve health promoting behaviors.9–11 In addition, mindfulness activities have consistently shown improvements in levels of stress and anxiety and increased stress has been associated with weight gain.9–12 For these reasons, it seems that mindfulness activities may provide value as a treatment option for patients with obesity.
Human Eating Behavior
To further understand how mindfulness may affect obesity, it seems paramount to understand the psychology of human eating behavior. Human eating behaviors are based on the existence of personal and psychological constraints that operate in addition to food availability. Figure 1 was created by Ulijaszek et al13 based on the initial work of Mela et al,14 and describes a mechanism where human body-weight homeostasis may be maintained or lost based on different factors including food availability, energy density of the diet, genetic, psychological, physiological, behavioral and cultural factors.
Through this theory of the psychological contribution of weight gain, it would be a logical deduction that being more mindful of emotions and how emotions affect eating behaviors would allow one to control what he or she eats. As a consequence, there may be decreased consumption of high calorie foods and increased consumption of healthier, low-calorie foods. With time, this change in food preference may lead to weight control or weight loss and decreased amounts of obesity.
Figure 1. This flow chart explains that when one is exposed to high fat, sweet, or highly processed foods combined with learned feeding behaviors, preferences for these foods may be established. The combination these preferences, Increased availability of unhealthy foods, loss of dietary control from social and cultural eating patterns, and emotional eating or eating environments, predisposes individuals to over-consumption of energy dense foods. This in turn leads to overeating, positive energy balance, and weight gain. Low physical activity and genetic predisposition may negatively impact the picture further.