Mindfulness-Based Mobile Health to Address Unhealthy Eating Among Middle-Aged Sexual Minority Women With Early Life Adversity: Mixed Methods Feasibility Trial (Preprint)

Abstract

BACKGROUND Sexual minority women remain considerably unrepresented in health research despite being at a higher risk for diabetes and obesity as well stigma, and psychological distress compared with heterosexual peers. Additionally, sexual minority women are likely to encounter early life adversity (ELA), increasing already present risk of obesity, psychological distress, and poor cardiovascular health into adulthood. App-based mindfulness interventions may offer premise for sexual minority women both in mitigating the adverse health effects of ELA as well as reducing food craving and unhealthy eating reducing risks associated with obesity. OBJECTIVE This mixed-methods feasibility trial aimed to test a mindfulness-based mobile health (mHealth) approach for mid-age sexual minority women (age 30-55) with early life adversity and overweight/obesity (BMI ≥25) to improve health outcomes. METHODS Feasibility and acceptability were assessed at post-intervention via surveys and exit-interviews. At baseline, post-intervention (2-month), and 4-months follow-up, participants completed assessments of primary outcomes (food craving, emotional eating, and weight via a mailed standard scale) and secondary outcomes (depression, anxiety, mindfulness, and emotion dysregulation). RESULTS Among 30 sexual minority women enrolled, 20 (66.7%) completed all intervention modules, 25 (83.3%) were retained at 2-months and 20 (66.7%) at 4-months follow-up. None reported adverse effects. Participants reported the program aligned with their goals and expectations, was easy to use, and facilitated changes in eating behavior and mental health. Barriers for engagement included needs for diverse teachers, individualized support, and body positive language. From baseline to 4-month follow-up, large effects were found in food craving (d = 1.64) and reward-based eating (d = 1.56). Small effects were found with weight (d = 0.20, 4.21kg on average). Significant improvements were also found in secondary outcomes (depression, d = 0.98; anxiety, d = 0.50; mindfulness, d = 0.49; emotion dysregulation, d = 0.44). Participants with higher parental verbal and emotional abuse were particularly responsive to the intervention. CONCLUSIONS This early phase feasibility trial provides proof-of-concept support for a mindfulness mHealth approach to improve obesity-related outcomes among sexual minority women and warrants a larger randomized controlled trial in the future. CLINICALTRIAL ClinicalTrials.gov Identifier: NCT05201391