RESUMO
BACKGROUND: Psychological stress has an established bi-directional relationship with obesity. Mindfulness techniques reduce stress and improve eating behaviours, but their long-term impact remains untested. CALMPOD (Compassionate Approach to Living Mindfully for Prevention of Disease) is a psychoeducational mindfulness-based course evidenced to improve eating patterns across a 6-month period, possibly by reducing stress. However, no long-term evaluation of impact exists. AIMS: This study retrospectively evaluates 2-year outcomes of CALMPOD on patient engagement, weight and metabolic markers. METHOD: All adults with a body mass index >35 kg/m2 attending an UK obesity service during 2016-2020 were offered CALMPOD. Those who refused CALMPOD were offered standard lifestyle advice. Routine clinic data over 2 years, including age, gender, 6-monthly appointment attendance, weight, haemoglobin A1C and total cholesterol, were pooled and analysed to evaluate CALMPOD. RESULTS: Of 289 patients, 163 participated in the CALMPOD course and 126 did not. No baseline demographic differences existed between the participating and non-participating groups. The CALMPOD group had improved attendance across all 6-monthly appointments compared with the non-CALMPOD group (P < 0.05). Mean body weight reduction at 2 years was 5.6 kg (s.d. 11.2, P < 0.001) for the CALMPOD group compared with 3.9 kg (s.d. 10.5, P < 0.001) for the non-CALMPOD group. No differences in haemoglobin A1C and fasting serum total cholesterol were identified between the groups. CONCLUSIONS: The retrospective evaluation of CALMPOD suggests potential for mindfulness and compassion-based group educational techniques to improve longer-term patient and clinical outcomes. Prospective large-scale studies are needed to evaluate the impact of stress on obesity and the true impact of CALMPOD.
RESUMO
Context: Mindfulness strategies may facilitate healthier eating behavior but have not previously been studied in a United Kingdom-based tier 3 obesity service. Objective: To demonstrate the clinical effectiveness of mindfulness as part of newly created group sessions within a tier 3 obesity service. Methods: Recruitment of participants (n = 53, including n = 33 completers) from patients attending a tier 3-based obesity service at University Hospitals Coventry and Warwickshire. Each participant attended four group sessions, at which mindfulness-based eating behavior strategies were taught. Self-reported eating behavior and body weight were assessed at baseline and following completion of attendance at the group sessions. Paired-sample t tests were performed. P < 0.05 was considered significant. Data are reported for the 33 completers. Weight difference was assessed in a retrospective control group of 33 patients who did not attend the group sessions but received the standard multidisciplinary input. Results: There were statistically significant improvements (P = 0.009) in self-reported eating behavior [driven by improvements in "fast-foodism" (P = 0.031)] and reduction in body weight [3.06 kg (SD 5.2 kg), P = 0.002] at 6 months following completion of the group sessions. This was statistically more (P = 0.036) than 6-month weight loss in the control group (0.21 kg). Participants reported improved self-esteem and confidence in self-management of body weight. Conclusion: Application of mindfulness-based eating behavior strategies, taught at group sessions within a tier 3 obesity service, resulted in significant improvement in eating behavior, and facilitated subsequent weight loss over 6 months. Such a strategy has potential for scalability to the wider obese population.