A Mindfulness-based Pilot Study to Reduce Childhood Obesity Risk in Underserved Urban Hispanic Children: Feasibility, Acceptability and Preliminary Findings

MM Leung1and D Forbes21Hunter College School of Urban Public Health, Nutrition Program; 2Brooklyn College School Counseling Program

Participants 23 children from a New York City public school

Ages 11 to 13 years

INTRODUCTIONMinority youth in low-income communities have higher obesity rates and elevated environmental stressors compared to economically-advantaged peers, which can result in long-term emotional and physical problems.

A comprehensive mindfulness-based program incorporating physical activity, nutrition and stress reduction could provide a unique opportunity to decrease obesity risk and improve overall health of this at-risk population.The study objective was to explore the feasibility, acceptability, and potential impact of a mindfulness-based pilot intervention focused on reducing obesity risk in school-aged children residing in a low-income New York City neighborhood.

Study Design Two-group quasi-experimental study with

intervention and untreated control groups Assessments completed at baseline and

immediately post-intervention

Intervention Description 6-session mindfulness-based afterschool pilot

program Guided by Social Cognitive Theory and Learning

to Breathe curriculum (Broderick, 2013)

Comprised of three components: yoga, mindful eating and mindful breathing

Sessions offered once a week; 75 minutes in duration

Conclusions & Implications• While preliminary analysis of quantitative data did not find any significant changes from pre- to post-intervention within both

groups, certain domains of Mindfulness and Resilience outcomes tended to improve in Intervention participants highlighting potentially promising results. Participants also acknowledged the program was beneficial physically and psychologically.

• Study limitations include limited sample size and quasi-experimental design. Additionally, only 5 out of the 6 sessions were implemented as intended as an instructor was missing for one class due to extenuating circumstances.

• It is important to seek innovative and wide-reaching approaches to connect with youth as childhood obesity prevalence remains high.

• A comprehensive mindfulness-based program focused on yoga, mindful eating and breathing could be a unique approach to improve health of underserved youth. However, further research is needed to determine if such an intervention could promote health and enhance well-being of this at-risk population.

Acknowledgements:Thank you to our New York City community partner and the youth participants.

This project was funded by a City University of New York Interdisciplinary Research Grant.

Group Intervention ControlGender

Male 3 (27.3) 4 (33.3)Female 8 (72.7) 8 (66.7)

Grade6th 0 (0.0) 12 (100.0)7th 11 (100.0) 0 (0.0)

EthnicityHispanic 11 (100.0) 12 (100.0)Black/AA 2 (22.2)Mixed Race 1 (11.1)

Meets F/V Recommendationsb 4 (36.4) 5 (41.7)Meets PA Recommendationsc 2 (18.2) 4 (33.3)Data presented as N(%).aNo significant differences found between the two groups for demographic variables of sex, race, YRBSS Fruit/Veg or CDC PA.bMeets YRBSS definition for healthy consumption of fruits and vegetables (5 or more times in the past 7 days).cMeets CDC recommendation for physical activity (60 minutes daily, 7 days per week).

Participant characteristics Group I p-value C p-value

Mindful Eating

Awareness 1 (4.3) 0.48 1.7 (3.7) 0.80

External Cues 3 (2.5) 0.08* 0.9 (5.3) 0.58

Distraction -2.1 (2.3) 0.17 0.1 (2.9) 0.23

Composite 2 (8.6) 0.48 2.7 (5.7) 0.76

Resilience

Confidence 0.6 (5.1) 0.23 -2.1 (4.8) 0.06*

Emotional Insight 2 (2.2) 0.09* -1.7 (5.2) 0.24

Negative Cognition -0.8 (2.9) 0.71 -0.3 (3.6) 0.61

Social Skills 0.3 (2.8) 0.46 -1.2 (3.7) 0.58

Empathy/ Tolerance -1.1 (3.5) 0.74 -0.9 (3.0) 0.47

Composite 1.1 (15.8) 0.32 -6.2 (18.1) 0.14Data presented as change from pre- to post-intervention (SD).I= Intervention group; C=Control group; Composite= sum of all domains. P-values reported for change between pre- and post-intervention within groups.*p<0.10

Pre- to post-test change in primary outcome variables, by groups: Domains and Composite

Intervention Fidelity 75% average attendance across the 6 weeks 81.8% (9 out of 11 participants) retention rate at

Week 6 Students were engaged most to all of the time 83%

of the time (5 out of 6 classes) 5 out of 6 sessions implemented as intended

83% yoga & mindful eating sessions and 100% stress reduction sessions successfully implemented

Intervention Acceptability 100% satisfied with and enjoyed the program Majority thought program was beneficial as it taught

them:

MeasuresFeasibility & Acceptability Feasibility (fidelity and attendance) measured throughout

intervention by trained research assistants for each session Brief interviews with intervention group subsample (n=9)

conducted to determine pilot intervention acceptabilityPrimary Outcomes

Mindful eating: 16-item tailored Mindful Eating Questionnaire (Framson et al, 2009) Domains: Awareness (7 items), External Cues (6 items)

and Distraction (3 items) Resilience

26-item tailored Adolescent Resilience Questionnaire (Gartland et al, 2011)

Domains: Confidence (7 items), Emotional Insight (6 items), Negative Cognition (5 items), Social Skills (3 items) and Empathy/Tolerance (5 items)

Both questionnaires: Response options on a 5-point Likert scale Almost Never (1) to Almost Always (5)

Data analyzed within groups, from pre- to post-intervention, using Wilcoxon Rank Sum test with IBM SPSS® v22.0

To be more kind and positive towards themselves and others

To eat healthier and/or less food

How to be in control of their emotions and be more relaxed

How to better focus on schoolwork

INTRODUCTION

METHODS

METHODS (cont.) RESULTS

“(mindfulness)…would help us because it would help us not to hurt ourselves or anybody else”

”when you're mindfully eating you pay attention if it’s junk food or if it's good

for your body”

“(mindfulness) helps me take the situation one step at the time, instead of just hitting it

head on”

“after I did my test I mindfully looked over all my questions

and the steps and I actually got a pretty good grade on that

one”.

No significant differences were observed, from pre- to post-intervention, for Mindful Eating and Resilience composite scores, in both groups.

Intervention group tended to improve in the Mindful Eating External Cues domain (p=0.083) and the Resilience Emotional Insight domain (p=0.091), while Control group tended to decrease in resilience Confidence domain (p=0.064).