A Randomized Controlled Trial of a Mindfulness-Based Weight Loss Intervention on Cardiovascular Reactivity to Social-Evaluative Threat Among Adults with Obesity
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Mindfulness-based interventions have been found to reduce psychological and physiological stress reactivity. In obesity, however, stress reactivity is complex, with studies showing both exaggerated and blunted physiological responses to stressors. A nuanced view of stress reactivity is the “challenge and threat” framework, which defines adaptive and maladaptive patterns of psychophysiological stress reactivity. We hypothesized that mindfulness training would facilitate increased challenge-related appraisals, emotions, and cardiovascular reactivity, including sympathetic nervous system activation paired with increased cardiac output (CO) and reduced total peripheral resistance (TPR) compared to a control group, which would exhibit an increased threat pattern of psychophysiological reactivity to repeated stressors.
Adults (N = 194) with obesity were randomized to a 5.5-month mindfulness-based weight loss intervention or an active control condition with identical diet-exercise guidelines. Participants were assessed at baseline and 4.5 months later using the Trier Social Stress Task. Electrocardiogram, impedance cardiography, and blood pressure were acquired at rest and during the speech and verbal arithmetic tasks to assess pre-ejection period (PEP), CO, and TPR reactivity.
Mindfulness participants showed significantly greater maintenance of challenge-related emotions and cardiovascular reactivity patterns (higher CO and lower TPR) from pre- to post-intervention compared to control participants, but groups did not differ in PEP. Findings were independent of changes in body mass index.
Mindfulness training may increase the ability to maintain a positive outlook and mount adaptive cardiovascular responses to repeated stressors among persons with obesity though findings need to be replicated in other populations and using other forms of mindfulness interventions.
KeywordsMindfulness Trier Social Stress Test Cardiovascular reactivity Obesity Stress Randomized controlled trial
We would like to thank the research participants involved in this study and Wendy Hartogensis for her assistance in reviewing the statistical methods section and computing effect sizes.
JD: designed and executed the study, assisted with the data analysis, and wrote the first draft of the manuscript. ESE: designed the study, collaborated in the writing and editing of the final manuscript. PJM: executed the study and collaborated in the writing and editing of the final manuscript. JT: collaborated in the writing and editing of the final manuscript. AEM: collaborated in the writing and editing of the final manuscript. MA: analyzed the data and collaborated in the writing and editing of the final manuscript. VG: executed the study and collaborated in the writing and editing of the final manuscript. JK: designed the study and collaborated in the writing and editing of the final manuscript. FMH: designed and executed the study and collaborated in the writing and editing of the final manuscript. MWB: designed the study, analyzed the data, and collaborated in the writing and editing of the final manuscript.
This study was supported by NIH grants from the National Center for Complementary and Integrative Health (NCCIH) P01AT005013, K24AT007827, and K01AT004199, as well as the National Center for Advancing Translational Sciences, UCSF-CTSI Grant Number UL1 TR000004.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflicts of interest.
All procedures performed in studies involving human participants were approved by University of California, San Francisco in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
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