'Surgery is my only hope': A qualitative study exploring perceptions of living with obesity and the prospect of having bariatric surgery.

The health benefits of bariatric surgery are well documented; however, the occurrence of weight-regain after surgery, along with the development of mental health difficulties poses a question of how contemporary psychology could assist to prepare people living with obesity prior to undergoing bariatric surgery. This research explored individuals' (in the immediate pre-operative and post-operative population) attitudes, beliefs and experiences towards obesity and their journey to bariatric surgery. Seventeen adult participants (males n = 4; age range: 26-64 years) were recruited and participated in a semi-structured interview. Twelve individuals participated prior to undergoing bariatric surgery. Five individuals participated in the early post-operative period (<3 months post-surgery). People living with obesity displayed high optimism for positive outcomes, with participants hoping that bariatric surgery would be different to previous attempts at weight regulation, with there being a clear shift in the locus of control for weight management from self to healthcare professionals. Whilst this is adaptive, there was the presence of seemingly unrealistic optimism, with many pre-surgery participants not relaying the realistic possibility of post-surgery weight-regain. Despite the optimism individuals feel about bariatric surgery, participants felt that the psychological factors influencing eating behaviours are not being addressed by healthcare. These findings suggest that mindfulness, mindful eating, and self-compassion approaches should be incorporated into clinical practice to support weight regulation and adaption to physiological changes after bariatric surgery.

Exploring the role of personality, perfectionism, and self-compassion on the relationship between clinical decision-making and nurses' wellbeing.

BACKGROUND: Clinical decision-making is a core competency of the nursing role, with nurses having to make decisions surrounding patient care and patient safety daily. With decision-making being linked to psychological outcomes, it is important to consider potential areas that may support or hinder nurses' wellbeing whilst navigating clinical decisions. AIM: The present study sought to investigate the relationship between clinical decision-making and moral distress, and further explore the role of personality, perfectionism, philotimo (a virtue describing the desire to do right by oneself and others, aligning with one's sense of morality), and self-compassion. DESIGN: An online cross-sectional survey was conducted using Qualtrics. Associations between clinical decision-making and moral distress, burnout, personality, perfectionism, philotimo, and self-compassion were examined using univariate and multivariate statistics. METHODS: One hundred and forty-three nurses from the United Kingdom completed an online questionnaire. Eligibility criteria included individuals who had practised in the nursing profession for a minimum of six months. To ensure that all participants were practising across the United Kingdom, the eligibility criteria was made clear in the study advertisement, and the consent form. The consent form required participants to confirm that they reached these criteria to proceed with the study. RESULTS: Results revealed that clinical decision-making was associated with moral distress experience, and that both openness to experience, and philotimo mediated this relationship, independently. In addition to this, self-compassion was significantly associated with clinical decision-making across senior banded nursing roles, but this was non-significant for junior banded nursing roles. CONCLUSION: Findings highlight the role of individual differences when looking at the impact of clinical decision-making upon nurses' wellbeing and offers explanation for any variance in moral distress experience across nursing professionals. This research identifies fundamental differences between junior and senior nurses in relation to clinical decision-making and self-compassion that should be considered in future research.

Does controlling for epicurean eating or the tendency to supersize food portions change the relationship between mindful eating and grazing?

The study examines the potential for Epicurean eating to offer fresh perspectives on the predictive value of mindful eating. This research seeks to ascertain whether accounting for Epicurean eating (or its antithesis, supersizing), could influence the previously identified negative relationship between mindful eating and grazing habits. In a cross-sectional study, 419 participants completed questionnaires on epicurean eating, grazing, and mindful eating. The findings suggested mindful eating and epicurean eating were significantly associated with grazing, with both variables accounting for a significant amount of variance in grazing. Further analysis of the mindful eating subscales showed that eating without distraction, eating with awareness, and hunger and satiety cues accounted for this association with grazing when epicurean eating was included. Finally, whilst eating without distraction, eating with awareness, and hunger and satiety cues were associated with grazing, preference for supersizing did not account for a significant amount of variance in the relationship with grazing. The complex interplay between grazing and mindful eating becomes more apparent when considering the influence of epicurean eating. Exploring cross-cultural factors through additional research could provide valuable insights into the dynamics of epicurean eating and grazing. Simultaneously, incorporating alternative mindful eating scales may yield a more nuanced interpretation of mindful eating. Collectively, these avenues of inquiry warrant further investigation. Limitations and future directions are discussed.

Exploring the relationship between orthorexia nervosa, mindful eating and guilt and shame.

BACKGROUND: Orthorexia nervosa (ON) is an under-researched maladaptive eating behaviour which focuses on the quality and purity of food. Mindful eating refers to being aware of what we eat by making conscious food choices. Guilt and shame are negative self-evaluative emotions which have been associated with maladaptive eating behaviours. This study explores the relationships between ON, mindful eating, and feelings of guilt and shame. PARTICIPANTS AND PROCEDURE: Two hundred and fifty-two participants were recruited from various online platforms, such as Facebook, Twitter, and Instagram. They were asked to complete self-report questionnaires on ON, mindful eating, and guilt and shame. RESULTS: The findings suggested that ON was significantly negatively associated with the mindful eating subscales focused eating, hunger and satiety, and eating with awareness and significantly positively associated with guilt and shame. In addition, guilt was significantly negatively associated with focused eating, whilst both guilt and shame were significantly negatively associated with hunger and satiety and eating with awareness. Further investigation suggested that guilt and shame mediated the association between mindful eating and ON. CONCLUSIONS: It was concluded that guilt and shame could explain the association between mindful eating and ON. Limitations and future directions are discussed.

Development and initial validation of the trait and state Mindful Eating Behaviour Scales.

PURPOSE: The quantitative assessment of mindful eating has been challenging, even with the latest additions to the field of multifactorial mindful eating psychometric tools. This manuscript presents the development, validity and reliability assessment of a trait and state Mindful Eating Behaviour Scale across four studies driven by recent theory (Mantzios in Nutr Health 27: 1-5, 2021). METHODS: Study 1 assessed the content validity of the scale through ratings of clinical and research experts in the field. Study 2 inspected the scale through exploratory and confirmatory factor, parallel, correlation, and reliability analyses. Study 3 assessed the temporal stability through a test-retest in a 2-week interval. Study 4 assessed the scale in a randomized control experimental design, where a mindful eating (vs. control group) received the trait scale before consuming chocolate, and an equivalent state scale was modified to assess state changes during the 10-min eating session. RESULTS: Study 1 yielded items to be reflective and concise of the definition of mindful eating behaviour. Study 2 indicated 2 potential factors through exploratory factor analyses, which were further verified through a parallel analysis, while subscales correlation indicated one-dimensionality, which was further verified through confirmatory factor analysis. In addition, the internal consistency of the scale and subscales was good. Study 3 certified the reliability of the scale over time, while Study 4 indicated that both the trait and state scales were significant indicators of eating mindfully. CONCLUSIONS: Together, all studies signal the utility of theoretically sound and empirically validated measurements for the replicable assessment of mindful eating behaviour. LEVEL OF EVIDENCE: No level of evidence: basic science.

Mindful eating and eating behaviours in Greece: exploring the validity and reliability of two mindful eating scales and other eating behaviours for Greek-speaking populations.

BACKGROUND: Mindful eating has seen an increase in clinical and non-clinical practices of changing health outcomes. Meanwhile, the restriction of not having validated scales in other languages proposes a barrier to exploring the impact of mindful eating cross-culturally, and specific to the present project, across Greek-speaking populations, limiting the potential of exploring the association with Mediterranean dieting. METHODS: In the present research, volunteers (n = 706) completed online the Mindful Eating Behaviour Scale and the Mindful Eating Scale. A forward-backwards translation, leading to face validity, and was assessed for internal consistency (Cronbach's Alpha) and followed up by an assessment of the factorial structure of the scales. Divergent and convergent validity was explored using motivations to eat palatable foods, grazing, craving, Dusseldorf orthorexia, Salzburg emotional eating, and the Salzburg stress eating scales. RESULTS: Results indicated that both scales displayed good internal consistency, and the assessment of the factorial structure of the scales was equally good and semi-consistent with the English versions, with parallel analyses and item loadings proposing problems that have been shown in critical review literature. Associations of mindful eating scales to other eating behaviours were replicated to previously established findings with English-speaking populations. CONCLUSIONS: Findings that deviated from the expected outcomes are central to the discussion on the measurement of mindful eating, and further direction highlights the way forward for researchers and clinicians. LEVEL V: Descriptive studies.

Meditative and non-meditative mindfulness-based interventions for mind and body.

The present editorial synopsises the benefits and challenges in meditative and non-meditative mindfulness practices and explores shorter and more creative approaches in mind-body interventions, emphasizing inclusivity and evidence-based practices. This collection, launched in BMC Complementary Medicine and Therapies, aims to bring together research on a variety of mindful practices, to discuss their role in supporting wellbeing.

'I didn't feel like I was a doctor': a qualitative interview study exploring the experiences and representations of healthcare professionals' capacity to deliver compassionate care and to practice self-care during the Covid-19 pandemic.

OBJECTIVE: The increased demand on healthcare professionals (HCPs) during the Coronavirus Disease (Covid-19) pandemic reduces opportunities for HCPs to deliver compassionate care to patients and to maintain self-care. This study explored how HCPs understand and experience compassionate working practices during the Covid-19 pandemic to better support HCPs' wellbeing and to sustain quality of care. DESIGN: All nineteen participants worked as an HCP during the Covid-19 pandemic, resided in the United Kingdom (UK) and took part in individual semi-structured interviews. MAIN OUTCOME MEASURES: Using a thematic analysis approach, we developed three themes: (a) The art of compassionate care: Feeling and action, (b) The impact of Covid-19 on compassionate care and (c) Suffering during Covid-19: The importance of self-compassion and self-care. RESULTS: Overall, the analysis illustrated the strong and negative impact that Covid-19 had on the ability to deliver compassionate care, resulting in moral injury and psychological and behavioural difficulties for HCPs, particularly in terms of self-care. CONCLUSIONS: This research demonstrates an imperative need for organisations to better support HCPs' health and wellbeing, through a self-care system that promotes self-compassionate and self-care practices.

Exploring the moderating role of mindfulness, mindful eating, and self-compassion on the relationship between eating-disordered quality of life and orthorexia nervosa.

Orthorexia nervosa (ON) is characterised by an obsessive focus on healthy eating, following restrictive dietary practices and dietary restrictions escalating over time. The aim of this study was to explore mindfulness, mindful eating, self-compassion and quality of life in a female population. Two hundred eighty-eight participants completed Orthorexia, Self-Compassion, Mindful eating, Mindfulness and Eating Disorder Quality of Life scales. The results indicated that there was a negative relationship between ON and mindfulness, self-compassion and mindful eating. Furthermore, the present study found a positive relationship between lower quality of life and ON, while findings indicated that self-compassion and the awareness facet of mindfulness moderated the relationship between ON and QOL. The present results contribute to a better understanding of orthorexic eating behaviours in a female population, and identify the moderating capacity of self-compassion and mindfulness. Further implications and future directions are discussed.Level of evidence Level V, cross-sectional descriptive study.

Mindful eating: A conceptual critical review of the literature, measurement and intervention development.

Background: Defining mindful eating and discussing all it entails has proven to be abstract, open-ended and biased to the interpretation of the researchers and authors in the field. Despite some consensus, different interpretations have led to different psychometric tools and practices not descriptive of mindful eating, contributing towards a replication crisis. Aim/Method: This narrative review will draw on the most appropriate definition of mindful eating in the framework of traditional secular mindfulness literature and discuss how mindful eating psychometrics and practices are unsuitable for precise research. Results/Discussion: A proposal and directive of separation between eating behaviours and decision-making in mindful eating as a way of developing evidence-based practices and psychometric tools are proposed for both clinical and non-clinical use.

The psychological implications and health risks of cystic fibrosis pre- and post- CFTR modulator therapy.

OBJECTIVES: Cystic Fibrosis (CF) care is entering a period of personalised medicine with the emergence of CF transmembrane conductance regulator (CFTR) modulator therapies. Anecdotally individuals are reporting life-changing effects of modulator therapies, proposing an important area of study. METHODS: Twenty adult participants (males: 8, age range: 22-51 years, average FEV1: 53.45%) were recruited via social media to participate in a semi-structured interview; 17 participants were currently taking Elexacaftor/Tezacaftor/Ivacaftor (Kaftrio). RESULTS: An appreciation of a "normal life" post-modulator therapy is paramount, with improvements in symptoms and quality-of-life bringing a more urgent imperative for the provision of effective support to encourage positive health and lifestyle choices. DISCUSSION: In this new era of CF care, there remains many challenges present for the CF community, with participants suggesting that proactive psychological support is required along with proactive awareness regarding health risk behaviours for the current and future CF generations.

Exploring the association between self-compassion, mindfulness and mindful eating with eating behaviours amongst patients with obesity.

Background: People who have obesity often experience problematic eating behaviours, contributing towards their excessive weight gain. Aims: Understanding problematic eating behaviours and their association to self-compassion, mindfulness and mindful eating is important for the development of future interventions that improve weight-loss and weight-regulation. Methods: One hundred and one participants attending their first session of a 6-session dietetic programme within a Tier 3 medical weight management service in the West Midlands, UK were recruited to complete questionnaires on self-compassion, mindfulness, mindful eating and eating behaviours, such as, emotional, restrained, external, fat and sugar consumption and grazing. Results: The findings suggested all three constructs, self-compassion, mindfulness and mindful eating were significantly and negatively associated with grazing and emotional eating, but mindful eating was the only construct that also displayed a significant and negative association with other eating behaviours that are often barriers to successful weight regulation, such as external eating and fat consumption. Further investigation suggested mindful eating had an indirect effect on fat consumption and grazing via external eating. Conclusion: Whilst, self-compassion, mindfulness and mindful eating displayed a negative relationship with grazing and emotional eating, mindful eating also displayed a negative relationship with fat consumption and external eating. Possible explanations and directions for future work are discussed with an emphasis on the need for more empirical work.

A systematic review of the relationship between alexithymia and emotional eating in adults.

Elucidating psychological characteristics associated with emotional eating may further inform interventions for this behaviour related to eating psychopathology. The present systematic review aimed to examine the relationship between alexithymia and self-reported emotional eating in adults, and provide a narrative synthesis of the existing literature. Using the PRISMA method for systematic reviews, six databases (MEDLINE, PsycInfo, PsycArticles, PubMed, SCOPUS, and Web of Science) were searched for peer-reviewed, quantitative research published between January 1994 and 20th July 2021, when the searches were conducted. Eligible articles investigated the association between alexithymia, as measured by the Toronto Alexithymia Scale (Bagby, Parker, & Taylor, 1994), and emotional eating, as measured by any validated self-report instrument. Nine cross-sectional articles were reviewed, and risk of bias was assessed using the Appraisal Tool for Cross-Sectional Studies (Downes, Brennan, Williams, & Dean, 2016). A narrative synthesis of articles suggests positive associations between alexithymia and self-reported emotional eating. Five measures of emotional eating were used across articles, with limited but consistent evidence for the relationship between alexithymia and emotional eating as measured by the Dutch Eating Behaviour Questionnaire (Van strien et al., 1986). Further research is required to add evidence to the nature of the relationship between alexithymia and emotional eating, and to explore mechanisms that might underpin any relationships. Understanding the association between alexithymia and emotional eating may support strategies and interventions for those seeking help for emotional eating and related eating behaviours.

Exploring the association of body mass index, mindful and emotional eating, and orthorexia.

BACKGROUND: Orthorexia nervosa (ON) is defined as a fixation on healthy eating behaviours. Research exploring ON and body mass index (BMI) has been inconsistent, with some findings indicating a positive relationship between ON and BMI, while other studies have suggested no relationship. To date, potential associations with emotional and mindful eating have been explored only in a vegan population. The present research adopted an exploratory approach and examined the relationship between orthorexia and BMI, and possible associations with emotional and mindful eating. The potential predictive value of mindful and emotional eating with respect to ON was also explored, while the role of four different types of emotional eating (happiness, sadness, anger, anxiety), utilising an emotional eating scale incorporating positive and negative emotions, was further explored. PARTICIPANTS AND PROCEDURE: Two hundred and twenty-three participants completed the online survey that was distributed via social media to a British sample. RESULTS: The findings suggested a negative correlation between ON and BMI. Participants who presented higher levels of orthorexia were more likely to display higher levels of focused eating, a central aspect of mindful eating, as well as lower levels of emotional eating in response to happiness - two elements that further predicted ON in multiple regression models. CONCLUSIONS: The results suggest a need to conduct further research to explore the possible role of happiness as a potential protective tool against ON, and further suggest the likely negative role of some components of mindful eating in ON. Future directions are discussed in light of the present findings.

Orthorexia nervosa, mindful eating, and perfectionism: an exploratory investigation.

PURPOSE: Research has drawn associations between Mindful Eating (ME) and perfectionism in the aetiology and treatment of eating disorders (ED), but understanding into the relationship between these factors and Orthorexia nervosa (ON) is limited. The purpose of this research is to explore the relationship between perfectionism, ME, and ON. METHOD: Participants (n = 670) completed the Düsseldorf Orthorexia scale, the Mindful Eating Behavior scale, and the Big-Three Perfectionism scale Short-form, to reveal the relationship between ON, ME, and perfectionism. The relationship was assessed using correlational and regression analyses. RESULTS: A positive association was observed between perfectionism and ON. Moreover, perfectionism demonstrated a significant negative correlation with three out of four ME facets, with "eating without distraction" displaying the highest correlation. The "eating with awareness" facet of ME demonstrated a significant relationship with ON, in a negative direction. An unexpected relationship was observed between the focused eating facet of ME and ON, with a positive association being found. A further regression analysis revealed both perfectionism and ME to predict orthorexic tendencies. CONCLUSION: These findings identify a relationship between ON, ME, and perfectionism. It offers suggestion for the complexity of ME, and how it should be recognised by its different components, estimating a differential predictability and estimation of ON. Further research is required to clarify the direction of causality in the relationships observed, to inform the clinical diagnoses and intervention of ON. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

Advancing the assessment of mindful eating: Exploring the psychometric properties and validating the mindful eating behaviour scale in English.

Background: Mindful eating has been described as significant in motivating research and clinical outcomes in weight regulation and healthy eating. The use of psychometric tools to measure mindful eating is problematic, with results often leading to interpretations that are not reflective of mindful eating theory and fundamentals of mindfulness. Aim: In this research, we explored the Mindful Eating Behaviour Scale (MEBS) within a British sample to validate the factorial structure, and widen the use of a scale that appears appropriate for measuring mindful eating. Methods: A community sample (n = 742) was recruited via social media, and the findings supported the factorial structure proposed through the original Dutch sample. Predictive validity was also assessed, with the scale and subscales predicting fat and sugar consumption. Results: Cronbach's α values were acceptable and similar to the original findings, also supporting the internal consistency of the scale. Conclusion: While factorial structure, predictive validity and internal consistency propose a scale that can be adopted with English speaking populations, we propose the potential of furthering scientific inquiry on mindful eating research by highlighting the behavioural aspects of the scale.

Exploring the role of mindful eating and self-compassion on eating behaviours and orthorexia in people following a vegan diet.

Orthorexia nervosa (ON) is a new concept that is more prevalent in vegan populations. ON is characterised by obsessive focus on healthy eating, following restrictive dietary practices and dietary restrictions escalating over time. The aim of this study was to explore problematic eating behaviours in a vegan population, and to explore whether mindful eating and self-compassion have an impact on ON. Two hundred and eighty-seven females and twenty-eight males who followed a vegan diet completed scales in Orthorexia, Self-Compassion, Mindful, Emotional, External and Restraint Eating. The results indicated that individuals with high levels of ON display low levels of self-compassion, and high levels of restrained eating. Moreover, the findings indicated that self-compassion, but not mindful eating, partially mediated the relationship between restrained eating and orthorexia nervosa. The present results contribute to a better understanding of orthorexic eating behaviours in a vegan population, and identifies the mediating capacity of self-compassion. Further implications and future directions are discussed.Level of evidence: Level V, cross-sectional descriptive study.

The Challenges of Eating Well for People Living with Cystic Fibrosis: an Interview Study Exploring the Use of Mindful Eating Approaches and Behaviours to Support Optimal Nutritional Status.

BACKGROUND: Nutritional status and weight are closely linked to lung function and health status in cystic fibrosis (CF). The investigation of eating behaviours has shown mindfulness practices to be useful in modifying eating behaviours, particularly with obesity; to date, no research specifically explores how these concepts may be utilised within a CF population who face specific challenges in eating behaviours. METHOD: Adult patients (n = 20, M = 8, age range 21-62 years) were recruited from a UK CF regional centre to take part in qualitative semi-structured interviews. Experiences of eating behaviours focusing on the use of mindful (or mindless) eating as barriers and enablers to achieving and maintaining optimal nutritional status were explored. Data were analysed using thematic analysis with a contextualist approach to understand how participants experienced eating behaviours within the context of health and weight status. RESULTS: Participants engaged readily in discussions of eating behaviour describing active self-regulation of food eaten and calorie intake. Participants who struggled to maintain weight employed strategies to increase calorie intake such as distraction and multitasking while eating. Most participants reported no pleasure in food, describing eating as another treatment to endure. Confusion existed around how to eat healthily for CF alongside co-morbid health conditions including diabetes, cholesterol and heart disease. CONCLUSION: Participants were highly aware of their eating behaviours, engaging in intentional and deliberate preparations, which could be described as mindful, for making eating a more automatic or mindless activity. Modifications to usual mindful eating interventions are needed to support people with CF.

Emotional eating during COVID-19 in the United Kingdom: Exploring the roles of alexithymia and emotion dysregulation.

Emotional eating, generally defined as (over)-eating in response to negative emotions, has been associated with poor physical and psychological outcomes. During a time of heightened negative affect, it is important to understand the impact of the COVID-19 pandemic and associated lockdown measures on eating behaviours, and further elucidate the ways in which emotional eating is related to emotion dysregulation and impaired abilities to identify emotions (i.e. alexithymia). The aims of this study were to explore perceived changes in eating behaviours in relation to self-reported negative affect during the pandemic and to examine direct and indirect effects of alexithymia on emotional eating. An online questionnaire measured these constructs in the general population of the United Kingdom (n = 136). Findings demonstrated that those who reported changes to their eating behaviours during the pandemic also reported greater levels of depression during the same time frame. Mediation analyses revealed that difficulties identifying and describing feelings both predicted emotional eating indirectly via emotion dysregulation. Findings contribute to the understanding of the mechanisms underpinning the relationship between alexithymia and emotional eating and describe changes to eating behaviours during COVID-19. We discuss how these findings should be applied, and recommendations for future research.