Daily mindfulness, negative affect, and eating behaviors in adolescents at risk for excess weight gain.

OBJECTIVE: Loss-of-control and overeating are common in adolescents with high body mass index (BMI). Mindfulness may affect negative affect, and both may relate to loss-of-control and overeating. Yet, there is limited understanding of these associations in adolescents' daily lives. METHODS: Forty-five adolescents (77% female; Mage = 14.4 years, SDage = 1.7 years) with high weight (92% with BMI [kg/m2 ] ≥85th percentile for age/sex) provided daily, repeated measurements of mindfulness, negative affect, loss-of-control, and overeating for ~7 days (M = 5.6 days; range = 1-13). Multilevel mixed modeling was conducted to test within-person (intraindividual) and between-person (interindividual) associations for the same-day (concurrent) and next-day (time-ordered/prospective). RESULTS: There were within-person and between-person associations of higher mindfulness with lower negative affect on the same-day and next-day. Greater between-person mindfulness related to lower odds of adolescents' loss-of-control occurrence (same-day) and conversely, more perceived control over eating (same-day and next-day). Greater within-person mindfulness related to less odds of next-day overeating. DISCUSSION: Dynamic relations exist among mindfulness, negative affect, and eating in adolescents at-risk for excess weight gain. Mindfulness may be an important element to consider in loss-of-control and overeating. Future work using momentary-data within an experimental design would help disentangle the intraindividual effects of increasing mindfulness/decreasing negative affect on disordered eating. PUBLIC SIGNIFICANCE: Loss-of-control and overeating are common in teenagers with high weight. Greater mindfulness-present-moment, non-judgmental attention-and less negative emotions may relate to healthier eating, but we do not know how these processes play out in teenagers' daily lives. Addressing this knowledge gap, the current findings showed that greater daily mindfulness, but not negative affect, related to less loss-of-control/overeating, suggesting the importance of mindfulness for eating patterns in teenagers' daily lives.

Observations of parent-adolescent interactions relate to food parenting practices and adolescent disordered eating in adolescents at risk for adult obesity.

Adolescent disordered eating and obesity are interrelated and adversely relate to mental and metabolic health. Parental feeding practices have been associated with adolescent disordered eating and obesity. Yet, observable interactions related to food parenting have not been well characterized. To address this gap, N = 30 adolescents (M ± SD 14 ± 2 year) at risk for adult obesity due to above-average body mass index (BMI ≥70th percentile) or parental obesity (BMI ≥30 kg/m2 ) participated in a video-recorded parent-adolescent task to discuss a food/eating-related disagreement. Interactions were coded for individual/dyadic affect/content using the Interactional Dimensions Coding System. We examined associations of interaction qualities with parent-reported food practices, adolescent disordered eating behaviors/attitudes, and insulin resistance. Reported parenting practices were correlated with multiple interaction qualities (p-values <0.05), with the most consistent correspondence between parent-reported pressure to eat (e.g., pressure to eat more healthy foods) and negative aspects of parent-adolescent interactions. Also, after accounting for adolescent age, sex, and BMI-standard score, parent-adolescent interaction qualities were associated with adolescents' disordered eating and insulin resistance. Specifically, greater adolescent problem-solving related to less adolescent global disordered eating, shape, and weight concern (p-values <0.05); adolescent autonomy related to less weight concern (p = 0.03). Better parent communication skills were associated with less adolescent eating concern (p = 0.04), and observed dyadic mutuality related to adolescents' lower insulin resistance (p = 0.03). Parent-adolescent interaction qualities during food/eating-related disagreements show associations with parent-reported food practices and adolescent disordered eating. This method may offer a tool for measuring the qualities of parent-adolescent food/eating-related interactions. A nuanced understanding of conversations about food/eating may inform family-based intervention in youth at-risk for adult obesity.

Associations Between Children's Emotion Regulation, Mindful Parenting, Parent Stress, and Parent Coping During the COVID-19 Pandemic.

Stress among parents has increased during the COVID-19 pandemic. Research prior to the pandemic indicates that parents of children who struggle with emotion regulation (ER) and who themselves are less mindful report more stress and diminished coping abilities. We know little, however, about these associations in the context of COVID-19. To prevent COVID-related deteriorations in parent well-being and child outcomes and to support parents during this potentially challenging time, it is important to understand the factors that are associated with increased stress as well as adaptive coping. This paper discusses the association between children's ER, mindful parenting (MP), parent stress, and parents' coping with parenting during the pandemic in a sample of 217 caregivers of school-aged children (91.0% mothers). Results indicated that children's ER was associated with parents' self-reported coping with parenting in the pandemic but was not associated with increased stress. Further, MP moderated the association between children's ER and coping, such that parents who were the most mindful and had children with better ER skills reported significantly greater ability to cope with pandemic parenting. Coping was lower for other combinations of ER and mindful parenting. These findings contradict those from before COVID, suggesting the relationship between children's ER and parent outcomes may differ in the COVID-19 context, and offering insights into which parents may be most likely to struggle with coping with pandemic parenting.

The role of mindfulness in associations among depression symptoms, sleep duration, and insulin resistance in adolescents.

Sleep difficulties may be one explanatory factor in the association between depression and insulin resistance; yet, explicit tests of this hypothesis are lacking. We determined if there was an indirect effect of depression symptoms on insulin resistance through sleep duration in adolescents at risk for excess weight gain. We also investigated whether dispositional mindfulness moderated the interconnections among depression, sleep, and insulin resistance. Ninety adolescents (14.2 ± 1.6y; 50% female) at risk for excess weight gain (body mass index [BMI, kg/m2] z score 1.6 ± 0.6) participated in the cross-sectional, baseline phase of a health behaviors study. Depression was assessed with the Center for Epidemiologic Studies-Depression Scale, sleep duration with the Sleep Habits Survey, and mindfulness with the Mindful Attention and Awareness Scale. Homeostatic model assessment of insulin resistance was determined from fasting insulin and glucose. The product-of-coefficients method was used to test the indirect effect of depression on insulin resistance through sleep duration, accounting for age, sex, BMIz, puberty, and socioeconomic status (SES). Dispositional mindfulness was tested as a moderator of the associations among depression, sleep, and insulin resistance. There was a significant indirect effect of depression on insulin resistance through sleep duration, controlling for age, sex, BMIz, puberty, and SES, 95%CI [0.001, 0.05]. Dispositional mindfulness moderated the association between sleep duration and insulin resistance, such that lower sleep duration related to greater insulin resistance only among adolescents with lower mindfulness (p < .001). Short sleep may be one explanatory factor in the depression-insulin resistance connection in adolescents at risk for excess weight gain. Adolescents with poorer mindfulness and short sleep are at highest risk for insulin resistance, whereas higher mindfulness may be protective.

Associations of adverse childhood experiences with stress physiology and insulin resistance in adolescents at risk for adult obesity.

Adverse childhood experiences (ACEs) heighten the risk for adult obesity and cardiometabolic disease, but physiological factors underlying this connection are not well understood. We determined if ACEs were associated with physiological stress response and insulin resistance in adolescents at risk for adult obesity. Participants were 90 adolescents 12.0-17.5 years (50% female, 30% Hispanic/Latinx), at risk for adult obesity by virtue of above-average body mass index (BMI; kg/m2 ≥ 70th percentile) or parental obesity (BMI ≥ 30 kg/m2 ). ACEs were determined as presence (vs. absence) based upon the Schedule for Affective Disorders and Schizophrenia for School-Aged Children. Physiological stress response was measured as heart rate/blood pressure response to the Trier Social Stress Test. Homeostatic model assessment of insulin resistance was determined from fasting glucose/insulin. Sixty-one percent of adolescents reported positive ACE history. The presence of ACEs predicted greater heart rate (p < .001) and diastolic blood pressure (p = .02) response to stress, controlling for age, sex, race/ethnicity, puberty, and BMI standard score. Systolic blood pressure and insulin resistance did not differ by ACE history (p-values > .08). Findings suggest heightened sympathetic stress response in adolescence could be explanatory in how ACEs increase the risk for later cardiometabolic disease. Future studies should characterize ACEs in relationship to day-to-day variations in adolescents' stress physiology and glucose homeostasis.

Testing Bidirectional Within-Person Associations between Mindful Attention and Sleep in Adolescence.

Developments during adolescence increase risk for sleep problems. Research in adults suggests mindfulness and sleep are associated, with two different theoretical explanations for direction of effects. Our goal was to directly test these competing theoretical models at the daily level in adolescents using objective and self-reported measurements of sleep. Adolescents (N=138; 14-21yrs) reported mindful attention and sleep for a week, while wearing an actigraph. Results indicated that, within-person, poor sleep at night predicted less mindful attention the next day; however, mindful attention during the day did not predict sleep that night. These findings provide support for the developmental model of sleep and regulation and suggest poor sleep may impair regulatory abilities the following day.

Dispositional Mindfulness is Cross-Sectionally Predicted by Interactions between Interparental Conflict and Parent-Child Relationships.

Theory emphasizes the importance of the family environment for the development of dispositional mindfulness, but past research has focused exclusively on parent-child attachment relationships as family-level predictors of mindfulness. Our goal was to examine unique and joint associations of both interparental conflict and parent-child relationship quality with dispositional mindfulness. Participants were 150 youth (14-21 yrs) who reported the warmth and support in their relationships with mothers and fathers separately, as well as their appraisals of the properties of their parents' conflict, how threatening that conflict is, and how responsible for it they feel, in addition to dispositional mindfulness. Results indicated consistent interactions between conflict properties and mother-child relationship quality in relation to dispositional mindfulness. Dispositional mindfulness was lowest for youth who reported low levels of frequent/intense interparental conflict and poor-quality relationships with mothers. In contrast, either self-blame/threat or poor-quality relationships with mothers predicted lower levels of dispositional mindfulness. Implications for theory and practice are discussed.

Associations of parental feeding practices and food reward responsiveness with adolescent stress-eating.

Rates of adolescent obesity have continued to rise over the past decade. As adolescence is an important time for developing eating habits that endure into adulthood, more information is needed about the potentially modifiable family- and individual-level factors that influence the development of common overeating behaviors such as stress-eating during adolescence. In this study, we conducted secondary data analyses to evaluate how parental feeding practices and adolescents' food reward responsiveness related to adolescents' stress-eating during a laboratory test meal. Participants were 90 healthy adolescents (50% female), 12-17 years of age (M = 14.3, SD = 1.7 years), at risk for excess weight gain (BMI percentile M = 92.7, SD = 7.5). Parental feeding behaviors were assessed with parent-report on the Child Feeding Questionnaire-Adolescent Version. Adolescents' relative reward value of food was measured with a behavioral task. Stress-eating was assessed as total energy intake from a buffet lunch meal after adolescents participated in the Trier Social Stress Test adapted for adolescents. Results revealed that parental concern about their child's weight (t = 2.27, p = .02) and adolescents' relative reward value of food (t = 2.24, p = .03) were related to greater stress-eating, controlling for BMI standard score, age, sex, and general perceived stress. Parental restriction was not related to stress-eating in this sample (p = .21). These findings suggest that parental attitudes about their adolescent's weight and adolescents' own internalized responsiveness to food as a reward may play a role in propensity to engage in overeating in response to stress.

Is cortisol production in response to an acute stressor associated with diurnal cortisol production during adolescence?

The goal of the current study was to examine the extent to which cortisol responding to an acute stressor is related to diurnal cortisol patterns during adolescence. Participants were 105 adolescents (10-17 years of age) who experienced a robust social-evaluative stressor and provided saliva samples (before and immediately after, as well as 10, 20, and 30 min after the stressor) to assess both cortisol reactivity and recovery and also provided saliva samples (at wake-up, 30 min after wake-up, 4 pm, and at bedtime) on two consecutive days to measure diurnal cortisol production. Dual process latent growth curve models, one for cortisol reactivity and one for diurnal cortisol, indicated that dampened cortisol reactivity and prolonged cortisol recovery (i.e., less cortisol produced during reactivity but more cortisol produced during recovery) were associated with dampened decreases in cortisol production across the day, suggesting that adolescents are likely to show attenuation in multiple components of HPA axis functioning.

Impact of explained v. unexplained front-of-package nutrition labels on parent and child food choices: a randomized trial.

OBJECTIVE: The present study investigated whether parent/child pairs would select more healthful foods when: (i) products were labelled with front-of-package (FOP) nutrition labels relative to packages without labels; (ii) products were labelled with colour-coded Multiple Traffic Light (MTL) FOP labels relative to monochromatic Facts up Front (FuF) FOP labels; and (iii) FOP labels were explained via in-aisle signage v. unexplained. DESIGN: Participants were randomly assigned to one of five conditions: (i) FuF labels with in-aisle signs explaining the labels; (ii) FuF labels, no signage; (iii) MTL labels with in-aisle signage; (iv) MTL labels, no signage; (v) control group, no labels/signage. Saturated fat, sodium, sugar and energy (calorie) content were compared across conditions. SETTING: The study took place in a laboratory grocery aisle. SUBJECTS: Parent/child pairs (n 153) completed the study. RESULTS: Results did not support the hypothesis that MTL labels would lead to more healthful choices than FuF labels. The presence of FOP labels did little to improve the healthfulness of selected foods, with few exceptions (participants with v. without access to FOP labels selected lower-calorie cereals, participants with access to both FOP labels and in-aisle explanatory signage selected products with less saturated fat v. participants without explanatory signage). CONCLUSIONS: Neither MTL nor FuF FOP labels led to food choices with significantly lower saturated fat, sodium or sugar. In-aisle signs explaining the FOP labels were somewhat helpful to consumers in making more healthful dietary decisions. New FOP labelling programmes could benefit from campaigns to increase consumer awareness and understanding of the labels.

General and food-selection specific parenting style in relation to the healthfulness of parent-child choices while grocery shopping.

Past research has demonstrated that parenting style is related to children's health and eating patterns, and that parenting can vary across time and context. However, there is little evidence about similarities and differences between general, self-reported parenting style and observed parenting during grocery shopping. The goals of this study were to investigate links between general parenting style, parental warmth and limit setting (important dimensions of parenting style) during grocery shopping, and the healthfulness of foods chosen. Participants were 153 parent (88 mothers) - child (6-9 years old) dyads. Dyads were brought to a laboratory set up like a grocery store aisle and asked to choose two items from each of three categories (cookies/crackers, cereals, chips/snacks). Parents were observed in terms of warmth, responsiveness, autonomy granting, and limit setting; children were observed in terms of resistance and negotiation. Parents reported behaviors related to general parenting. Regression analyses were used to test study hypotheses. Observed parental limit setting was related to general parenting style; observed warmth was not. Observed limit setting (but not observed warmth or self-reported parenting style) was related to the healthfulness of food choices. Limit setting appears to be the dimension of parenting style that is expressed during grocery shopping, and that promotes healthier food choices. Implications are discussed regarding consistencies in parenting style across situations as well as contributions of parenting style to the development of children's healthy eating.

Associations Between Marital Conflict and Adolescent Conflict Appraisals, Stress Physiology, and Mental Health.

The goal of the current study was to examine conflict appraisals and diurnal cortisol production as mediators of the robust association between marital conflict and adolescent adjustment problems. Parents reported their marital conflict and were observed engaging in a marital conflict discussion; they also reported adolescent internalizing and externalizing behaviors. Adolescents (n = 105, 52% female, 10-17 years of age) appraised their parents' marital conflict and reported their internalizing and externalizing behaviors. After the laboratory visit, adolescents provided four saliva samples on each of 2 consecutive days to assess diurnal cortisol production. More-negative marital conflict predicted more self-blame for parental conflict, which in turn predicted less robust decreases in cortisol across the day. Further, this flattened cortisol production pattern mediated the relationship between greater self-blame for parental conflict and adolescents' elevated internalizing behaviors. Feeling responsible for parental conflict appears to be particularly damaging in terms of physiological regulation and adjustment, and may therefore be a particularly useful intervention target.

The effects of maternal respiratory sinus arrhythmia and behavioral engagement on mother-child physiological coregulation.

Parent-child coregulation is thought to be an important precursor for children's developing self-regulation, but we know little about how individual parent factors shape parent-child physiological coregulation. We examined whether maternal baseline respiratory sinus arrhythmia (RSA), teaching, and disengagement were associated with stronger or weaker coregulation of RSA between mothers and their 3-year-old children (N = 47), modeled across 18 min of observed dyadic interaction using multilevel coupled autoregressive models. Whereas greater maternal teaching was associated with stronger coregulation in mother and child RSA over time, maternal disengagement was related to weaker coregulation, specifically more divergent parent and child RSA at higher levels of maternal disengagement. Coregulation of mother-child RSA was also weaker when mothers' baseline RSA was higher. Findings contribute to the emerging knowledge base on real-time patterns of parent-child physiological coregulation in early childhood and suggest that mothers' physiology and behavioral engagement with the child play an important role in mother-child physiological coregulation patterns.

Adolescent Conflict Appraisals Moderate the Link Between Marital Conflict and Physiological Stress Reactivity.

The goal of this study was to advance understanding of how adolescent conflict appraisals contribute uniquely, and in combination with interparental conflict behavior, to individual differences in adolescent physiological reactivity. Saliva samples were collected from 153 adolescents (52% female; ages 10-17 years) before and after the Trier Social Stress Test. Saliva was assayed for cortisol and alpha-amylase. Results revealed interactive effects between marital conflict and conflict appraisals. For youth who appraised parental conflict negatively (particularly as threatening), negative marital conflict predicted dampened reactivity; for youth who appraised parental conflict less negatively, negative marital conflict predicted heightened reactivity. These findings support the notion that the family context and youth appraisals of family relationships are linked with individual differences in biological sensitivity to context.

Participation in Early Childhood Educational Environments for Young Children with and Without Developmental Disabilities and Delays: A Mixed Methods Study.

AIMS: This mixed methods study examined: 1) how young children with and without developmental disabilities and delays participate in daycare or preschool activities; 2) similarities and differences in environmental factors impacting daycare or preschool participation; and 3) strategies used by parents who desired a change in their child's participation. METHODS: Data were drawn from 129 parents of young children with and without developmental disabilities and delays (mean age = 49.3 months) residing in North America. Summary and item-level group differences based on disability status were assessed for participation and environmental supports to participation. Narrative data on parental strategies were content coded, transformed into numerical counts, and summarized to identify strategies commonly employed by parents to promote their child's participation. RESULTS: Moderate to large disability related group differences in participation and environmental support to participation were found even after controlling for confounding effects of child age, child gender, and family income. Parents commonly described strategies focused on "child care tasks" and "child peer groups," irrespective of the type(s) of change they desired. CONCLUSIONS: Study findings suggest that discrepancies in school participation between young children with and without disabilities and delays can be detected and intervened on during the early childhood period.

Assessing Biobehavioural Self-Regulation and Coregulation in Early Childhood: The Parent-Child Challenge Task.

Researchers have argued for more dynamic and contextually relevant measures of regulatory processes in interpersonal interactions. In response, we introduce and examine the effectiveness of a new task, the Parent-Child Challenge Task, designed to assess the self-regulation and coregulation of affect, goal-directed behavior, and physiology in parents and their preschoolers in response to an experimental perturbation. Concurrent and predictive validity was examined via relations with children's externalizing behaviors. Mothers used only their words to guide their 3-year-old children to complete increasingly difficult puzzles in order to win a prize (N = 96). A challenge condition was initiated mid-way through the task with a newly introduced time limit. The challenge produced decreases in parental teaching and dyadic behavioral variability and increases in child negative affect and dyadic affective variability, measured by dynamic systems-based methods. Children rated lower on externalizing showed respiratory sinus arrhythmia (RSA) suppression in response to challenge, whereas those rated higher on externalizing showed RSA augmentation. Additionally, select task changes in affect, behavior, and physiology predicted teacher-rated externalizing behaviors four months later. Findings indicate the Parent-Child Challenge Task was effective in producing regulatory changes and suggest its utility in assessing biobehavioral self-regulation and coregulation in parents and their preschoolers.

Coregulation of respiratory sinus arrhythmia between parents and preschoolers: differences by children's externalizing problems.

The coordination of physiological processes between parents and infants is thought to support behaviors critical for infant adaptation, but we know little about parent-child physiological coregulation during the preschool years. The present study examined whether time-varying changes in parent and child respiratory sinus arrhythmia (RSA) exhibited coregulation (across-person dynamics) accounting for individual differences in parent and child RSA, and whether there were differences in these parasympathetic processes by children's externalizing problems. Mother-child dyads (N = 47; Child age M = 3½ years) engaged in three laboratory tasks (free play, clean up, puzzle task) for 18 min, during which RSA data were collected. Multilevel coupled autoregressive models revealed that mothers and preschoolers showed positive coregulation of RSA such that changes in mother RSA predicted changes in the same direction in child RSA and vice versa, controlling for the stability of within-person RSA over time and individual differences in overall mean RSA. However, when children's externalizing behaviors were higher, coregulation was negative such that changes in real-time mother and child RSA showed divergence rather than positive concordance. Results suggest that mothers and preschoolers do coregulate RSA during real-time interactions, but that children's higher externalizing behavior problems are related to disruptions in these processes.

Bi-Directional and Time-Lagged Associations between Engagement and Mental Health Symptoms in a Group Mindfulness-Based Mental Health Intervention.

There is a high need for accessible avenues for improving mental health among emerging adults, particularly on college campuses. Mindfulness-based intervention (MBI) is a promising avenue for reducing mental health symptoms, but initial discomforts associated with MBI may cause symptoms to fluctuate before decreasing, which presents a barrier to engagement with mindfulness on a daily basis. Consistent mindfulness practice is key for forming habits related to MBI, and engagement with mindfulness at home, including between intervention sessions, is an important predictor of mental health outcomes. Research suggests that mental health symptoms may serve as barriers to their own treatment. Thus, it is important to understand how mental health symptom levels impact adherence to treatment protocols. To improve understanding of symptom-specific barriers to treatment and engagement with mindfulness, the present study collected daily diary surveys about engagement with mindfulness and mental health symptoms from a sample of 62 adults recruited to participate in a six-week mindfulness intervention. We explored mental health symptoms as a predictor of engagement with MBI at the mean level and whether within-person variability in symptoms predicted same-day or time-lagged changes in engagement via mixed-effects associations. Using heterogeneous location scale models, we further explored whether erraticism in either mental health symptoms or engagement with mindfulness predicted the other and if outcomes of the mindfulness intervention were homogeneous among subjects. Results showed that bi-directional and time-lagged associations exist between symptoms and engagement, indicating that there is a nuanced temporal and reciprocal relationship between engagement with mindfulness and mental health symptoms. Daily within-person elevations in engagement with mindfulness were associated with concurrent improvements in mental health but prospective increases in mental health symptoms. We also found that higher engagement (over personal averages) was not consistently associated with improvements in mental health across the sample but was instead associated with greater heterogeneity in outcomes. We also found that increases in mental health symptoms (over personal averages), as well as higher average levels of mental health symptoms, were both associated with lower levels of engagement in the mindfulness treatment protocol.

Momentary effects of life stressors on mindfulness and emotion regulation difficulties among adolescents exposed to chronic stressors.

Adolescents faced with chronic stressors (e.g., financial instability, interpersonal violence) are at heightened risk for developing mental health problems, likely due in part to stressors that interfere with effective emotion regulation. Although mindfulness may help to act as a buffer against the deleterious effects of life stressors, a relatively untested assumption is that adolescents can maintain mindfulness during periods of stress. This paper explores this assumption by investigating the real-time, dynamic relationships among life stressors, mindfulness, and emotion regulation difficulties among adolescents exposed to chronic stressors. Eighty-one participants who were 10-18 years old (M = 14.33; SD = 2.20; 56% male; 57% Non-Hispanic White) completed ecological momentary assessments (EMA) three times a day for 7 days and contributed a total of 1186 EMA reports. Multilevel structural equation modelling revealed that the presence (vs. absence) of stressors was associated with lower momentary mindfulness and greater momentary emotion regulation difficulties concurrently and prospectively. Stressors with greater severity were also concurrently, but not prospectively, associated with lower momentary mindfulness and greater momentary emotion regulation difficulties. Findings highlight that exposure to life stressors may degrade momentary mindfulness and emotion regulation. Given that mindfulness and emotion regulation are closely associated with mental health, these results also demonstrate one way that stressors may contribute to health disparities at the micro-level. Going forward, it will be important to investigate methods of helping adolescents learn to maintain mindfulness and adaptive emotion regulation in the face of stressful events. This study was preregistered (NCT04927286).

Mindfulness-based intervention for depression and insulin resistance in adolescents: Protocol for BREATHE, a multisite, pilot and feasibility randomized controlled trial.

BACKGROUND: Elevated depression symptoms have been associated with higher insulin resistance in adolescents, and consequently, greater risk for type 2 diabetes (T2D). Mindfulness-based intervention (MBI) may be suited for adolescents at risk for T2D given its potential to decrease depression and improve stress-related behavior/physiology underpinning insulin resistance. To prepare for a future multisite efficacy randomized controlled trial, a rigorous, multisite, pilot and feasibility study is needed to test this approach. The current paper describes the design and protocol for a multisite, pilot and feasibility randomized controlled trial of six-week MBI, cognitive-behavioral therapy (CBT), and health education (HealthEd) group interventions, to assess multisite fidelity, feasibility, and acceptability. METHODS: Participants are N = 120 adolescents ages 12-17, with body mass index (BMI) ≥85th percentile, elevated depression symptoms (20-item Center for Epidemiologic Studies-Depression Scale total score > 20), and family history of diabetes. Enrollment occurs across four United States (US) sites, two in Colorado, one in Washington, D·C., and one in Maryland. Group interventions are delivered virtually by trained psychologists and co-facilitators. Assessments occur at baseline, six-week follow-up, and one-year follow-up. RESULTS: Primary outcomes are intervention implementation fidelity, based upon expert ratings of audio-recorded sessions (≥80% adherence/competence), and recruitment feasibility, based upon percentage enrollment of eligible youth (≥80%). Secondary outcomes are intervention training fidelity/feasibility/acceptability, recruitment timeframe, and retention/assessment feasibility. CONCLUSION: Findings will inform optimization of training, recruitment, intervention delivery, retention, and assessment protocols for a multisite, efficacy randomized controlled trial evaluating MBI for decreasing depression and improving insulin resistance in adolescents at risk for developing T2D.