Do Mindfulness Interventions Improve Obesity Rates in Children and Adolescents: A Review of the Evidence

Do Mindfulness Interventions Improve Obesity Rates in Children and Adolescents

Mindfulness interventions have shown promise in improving self-regulation, depression, anxiety, and stress levels across all ages. Obesity rates in children are rising worldwide. It has been postulated that through improvements in self-regulation with mindfulness interventions, obesity rates can be improved in children and adolescents. In this review, we attempt to explain how mindfulness interventions may impact obesity rates and obesity-related complications and give the current state of evidence for the following mindfulness interventions: Mindful Eating, Mindfulness-Based Stress Reduction, Yoga, Spirituality, and Dialectical Behavior Therapy.

Over the last 20 years, childhood obesity has become a major public health concern in the United States. According to the most recent data from the Center for Disease Control and Prevention (CDC) in 2015–2016, 18.5% of American youth between the ages of 2 and 19 were classified as being obese using a body mass index (BMI) threshold >95% for age.1

The rate of obesity increases with age in children. Children between the ages of 2 and 5 have an obesity rate of 13.9% as compared to 20.6% in children between the ages of 12 and 19. In addition, obesity has some ethnic predispositions, with obesity rates being most prevalent among Hispanic and Non-Hispanic Black children with no significant difference between the sexes.1

Obesity begins in childhood due to a combination of genetic, social, physical, and psychological factors.2 As children with obesity age, they often develop obesity-related comorbidities including insulin resistance, early onset diabetes mellitus (DM), hypertension, hyperlipidemia, depression, and sleep apnea.3 These medical conditions often persist into childbearing years and adulthood.4 Pregnancies of women with obesity are more likely to have perinatal complications or be stillborn.5 Infants born to mothers with obesity have increased rates of neuropsychiatric disorders including autism, attention deficit hyperactivity disorder (ADHD), anxiety, depression, eating disorders,6 and adult obesity.7 This circular pattern perpetuates, increasing obesity rates in all ages.

With the increase in families with obesity, pediatric medical providers are consistently charged with finding evidence-based treatments. One area of interest is the use of mindfulness interventions to modulate eating behaviors.

According to Jon Kabat-Zinn, mindfulness is a psychological process of purposely bringing one’s attention to experiences occurring in the present moment without judgment.8 Mindfulness activities have been effective in altering human behavior to improve health promoting behaviors.9–11 In addition, mindfulness activities have consistently shown improvements in levels of stress and anxiety and increased stress has been associated with weight gain.9–12 For these reasons, it seems that mindfulness activities may provide value as a treatment option for patients with obesity.

Human Eating Behavior

To further understand how mindfulness may affect obesity, it seems paramount to understand the psychology of human eating behavior. Human eating behaviors are based on the existence of personal and psychological constraints that operate in addition to food availability. Figure 1 was created by Ulijaszek et al13 based on the initial work of Mela et al,14 and describes a mechanism where human body-weight homeostasis may be maintained or lost based on different factors including food availability, energy density of the diet, genetic, psychological, physiological, behavioral and cultural factors.

Through this theory of the psychological contribution of weight gain, it would be a logical deduction that being more mindful of emotions and how emotions affect eating behaviors would allow one to control what he or she eats. As a consequence, there may be decreased consumption of high calorie foods and increased consumption of healthier, low-calorie foods. With time, this change in food preference may lead to weight control or weight loss and decreased amounts of obesity.

Figure 1. This flow chart explains that when one is exposed to high fat, sweet, or highly processed foods combined with learned feeding behaviors, preferences for these foods may be established. The combination these preferences, Increased availability of unhealthy foods, loss of dietary control from social and cultural eating patterns, and emotional eating or eating environments, predisposes individuals to over-consumption of energy dense foods. This in turn leads to overeating, positive energy balance, and weight gain. Low physical activity and genetic predisposition may negatively impact the picture further.

Teach children how to be responsible for their own learning to gain agency

Teach children how to be responsible for their own learning to gain agency

One cannot fail to notice that concerns about mental health and wellbeing are increasingly figuring in all news media, especially in relation to young people. This raises questions as to whether this is primarily a product of our rapidly changing, volatile and unpredictable times, or a lack of parenting and schooling practices that fail to develop strong volition, perseverance and the capability to deal with life’s inevitable challenges. Challenges, albeit in different forms, have always been part of human history. For example, bullying was ever-present in yesteryear, but we hear more about it nowadays, especially in relation to the online environment. Similarly, poverty and discrimination of various kinds are not new existential phenomena, they have always been part of human interactions – or the lack of them.

Certainly, statistics paint a disturbing picture, with one in eight children and adolescents in the UK experiencing a mental illness (NHS, 2018). The high prevalence of depression and anxiety in young people is often said to be a result of the lack of resilience among them. Similarly, Loretta Breuning, in her article Why I Don’t Believe Reports of a Mental Health Crisis (2014) argues that the escalating emotional distress experienced by millennials is, in part, due to over-reliance on mental-health services, which aim to alleviate natural emotional responses. She maintains that by depending on mental-health services individuals do not learn how to manage life’s disappointments themselves, and consequently often lack self-reliance.

Invariably, aspects of all the above scenarios will apply to some individuals, certainly not all, and generalisations can be dangerous. In this article, I will focus on what can be done to help students to self-regulate their learning and maintain a positive sense of wellbeing. Also, to identify environments and experiences that have negative effects, and how best to mitigate the consequences.

In the final analysis people, young and old, irrespective of culture or context, have to make choices and take action on how they respond to the demands that the external environment may throw at them – whether caused by their prior actions, the actions of others, or serendipity. Furthermore, they must fully realise that their ability to effectively manage internal perceptions and emotional states is a crucial part of self-regulation and maintaining wellbeing.

We know from extensive research that a whole host of physical, social and emotional experiences have massive implications for brain development, physical and mental wellbeing. For example, Swaab (2015) summarising the evidence, highlights: Children who are seriously neglected during their early development… have smaller brains; their intelligence and linguistic and fine motor control are permanently impaired, and they are impulsive and […]

What Is Integrative Medicine for ADHD? A Holistic Health & Wellness Guide

What Is Integrative Medicine for ADHD? A Holistic Health & Wellness Guide

ADHD doesn’t only affect attention. Better considered an executive function and self-regulation deficit, ADHD affects the whole person — the mental, emotional, physical, spiritual, and social self. It increases daily stress and chips away at a positive sense of self. It interferes with self-care and makes it hard to keep healthy habits.

This helps to explain why ADHD is linked to chronic stress, burnout, anxiety , mood disorder , sleep problems , substance use, and other conditions and issues. The reverse is also true: chronic stress and anxiety can worsen ADHD symptoms.

ADHD impacts the whole self, so is treatments must likewise target more than inattention and impulsivity. Integrative medicine is growing in popularity because it’s a treatment approach that addresses symptoms and promotes general health and wellness. Integrative Medicine for People with ADHD: Index of Topics

What Is Integrative Medicine?

Integrative medicine considers the whole person and leverages all options — holistic thinking , complementary therapies , and conventional treatments — in devising a patient’s care plan.

Studies exploring the effectiveness of integrative approaches for ADHD specifically are limited. Moreover, the most common treatments for ADHD are the conventional – medication and psychotherapy. Still, just as ADHD affects many aspects of wellbeing, a variety of treatments and approaches can do the same.

As an integrative practitioner, my approach for treating patients with ADHD is this: If the ADHD symptoms are significantly impairing, I start with medication, and then phase in other strategies, often outside of conventional care. If the ADHD symptoms are mild to moderate, the non-medication and lifestyle approaches can be tried first.

Over time, as the other skills and strategies are employed, the need for medication can be re-evaluated and the dose reduced.

An example of an integrative medicine plan for ADHD may combine psychotherapy (a conventional strategy), stress-management skills (holistic thinking), and omega-3 fatty acids (a complementary supplement).

Conventional Treatments for ADHD

Holistic Wellness and Lifestyle Approaches for ADHD

Complementary and Alternative Medicine (CAM)

  • Brain-gut health
  • Acupuncture

Integrative Medicine for ADHD: Combining Holistic & Conventional Care

Most of the following approaches address ADHD’s secondary symptoms — namely stress, anxiety, mood, low self-esteem, and emotional dysregulation. Treating these factors can help decrease the severity and impairment of ADHD’s core symptoms.

Stress Management and Executive Function

Psychotherapy

Cognitive behavioral therapy (CBT) helps patients develop a greater understanding of their ADHD symptoms and teaches skills that help with executive dysfunction.

CBT aims to improve patients’ problem-solving and stress-management skills by setting realistic goals and teaching organizational and time-management skills to achieve them. This type of psychotherapy can also improve balanced thinking and communication skills by focusing on one’s unique challenges (e.g., history of trauma or other comorbid mental health conditions).

ADHD coaching

Like CBT, coaching helps individuals meet their goals and develop skills to address ADHD-related barriers along the way.

Mindfulness

Mindfulness — a practice that includes meditation as well as awareness shifts in daily activities — has been shown to improve both inattentive and hyperactive/impulsive symptoms, as well as selected measures of attention, emotion regulation, and executive functions1.

By analysis of automatic habits, the practice allows you to change them in the moment. For example, mindful awareness may help you realize that you are procrastinating, and help you tune in to the emotions that are driving the procrastination.

Self-Compassion

A facet of mindfulness, practicing self-compassion is particularly important for mental health. Offering yourself some validation and kindness — “This is hard. I’m stressed. I’m struggling” — will make a difference in how stress is experienced.

Study among Syrian refugees suggests mothers’ post-traumatic stress impacts children’s emotional processing abilities

Study suggests mothers’ post-traumatic stress impacts children’s emotional processing abilities

A study published in the journal Royal Society Open Science explored the mental health of Syrian refugee families living in Turkish communities. The researchers found that mothers with greater post-traumatic stress had children with worse emotional processing abilities, suggesting that a mother’s post-traumatic stress can negatively impact her children’s social cognitive development.

In the last decade, over 5.5 million refugees have fled Syria to escape civil war, making it the largest refugee crisis in the world. Study authors Gustaf Gredebäck and his colleagues note that the severe hardships faced by refugees have left many of them with symptoms of post-traumatic stress disorder (PTSD). The researchers were interested in studying how PTSD among refugee parents might influence the psychological development of refugee children, given that parental stress has been found to negatively impact children’s social cognitive development.

“The tragedies of the Syrian war and the hardship of refugees from this conflict is something that many of us carry with us, but it is not always clear what we as researchers can do to help. This is our first attempt at making a contribution,” Gredebäck, a professor of developmental psychology at Uppsala University, told PsyPost.

While many studies have investigated the mental health of Syrian refugees, Gredebäck and his team say that these studies have largely focused on refugees who are living in refugee camps or in Europe. The current research has neglected to investigate those who have migrated to neighboring countries, who make up the largest percentage of Syrian refugees.

In their study, the researchers investigated 100 Syrian refugee families living in Konya, Turkey — a total of 174 adults and 220 children. In their homes, both adults and children completed a range of experimental tasks including an emotional processing task. The task presented participants with a series of faces and asked them to identify the emotion being expressed in each face (anger, fear, happiness, sadness, or neutral). Parents additionally completed a questionnaire that measured their demographics, migration history, risk factors, social environment, discrimination, and history of traumatic events. The questionnaire also included a post-traumatic stress (PTS) assessment that measured the presence of disturbing memories and the tendency to avoid reminders of a stressful event.

The results revealed that the prevalence of PTSD among parents was high — according to scores on the PTS questionnaire, 81% of mothers and 71% of fathers met criteria for a PTSD diagnosis.

Gredebäck and his fellow researchers next conducted a statistical analysis to investigate the interplay between parents’ PTSD symptoms, parents’ traumatic past, and children’s emotional processing. The results revealed that children’s emotional processing scores were negatively related to mothers’ post-traumatic stress scores — mothers with higher post-traumatic stress had children with lower emotional processing abilities. This was even after controlling for history of trauma, suggesting that the observed effect was not driven by the mother and child’s shared experience of trauma.

Remarkably, as a mothers’ PTS symptoms dropped by one point on the scale, a child’s emotional processing scores increased by the equivalent of one year of development. By contrast, fathers’ PTS symptoms were not significantly related to children’s emotional processing scores, perhaps because mothers tend to play a more influential role in the development of children.

Cumulative risk exposure and emotional symptoms among early adolescent girls

From early adolescence, girls and women report the highest rates of emotional symptoms, and there is evidence of increased prevalence in recent years. We investigate risk factors and cumulative risk exposure (CRE) in relation to emotional symptoms among early adolescent girls.

Four risk factors were found to have a statistically significant relationship with emotional symptoms among early adolescent girls: low academic attainment, special educational needs, low family income, and caregiving responsibilities. CRE was positively associated with emotional symptoms, with a small effect size.

Results identify risk factors (outlined above) that are associated with emotional symptoms among early adolescent girls, and highlight that early adolescent girls experiencing a greater number of risk factors in their lives are likely to also experience greater emotional distress. Findings highlight the need for identification and targeted mental health intervention (e.g., individual or group counselling, approaches targeting specific symptoms), for those facing greater risk and/or with emergent symptoms.

In early adolescence, evidence suggests that girls begin to experience greater levels of emotional symptoms (i.e., depressive and anxious symptoms) than boys, typically around the age of 12 years[1].1 Studies show this disparity exists throughout the lifespan; girls and women are twice as likely to report depressive symptoms and disorder from mid-adolescence compared to boys and men [1]. They are also more likely to experience anxious symptoms and disorders, though this fluctuates based on type of anxiety [2]. Depressive and anxious symptoms are distinct but strongly inter-related, with high comorbidity rates among adolescents [3]. Research indicates a significant increase in emotional symptoms and disorder among adolescent girls in recent years, in the United Kingdom [4,5,6,7] and other Western and non-Western countries [8, 9], necessitating urgent research into the factors associated with such difficulties. These studies consistently point to apparent increases in emotional difficulties as a whole (i.e., rather than just depressive or anxious symptomatology) and to increases only among girls, and not among boys in the same cohorts [4,5,6,7,8,9]. Effects have been observed across different points in adolescence, starting in early adolescence [6]. Typically these increases among girls are small, but as noted by Fink et al. [6] the effect is not negligible and warrants attention.

We set out to investigate the risk factors associated with emotional symptoms among girls aged 11–12 years, given evidence that such symptoms are increasing among girls. Furthermore, as risk factors tend to co-occur [10], we also examined whether exposure to a greater number of risk factors corresponds to increased symptoms. We focused on investigating possible factors associated with symptoms among a 2017 sample of adolescent girls, offering valuable insight into epidemiological patterns and levels of exposure for a vulnerable group at a recent timepoint, rather than factors that may be contributing to an increase in such symptoms, which currently are not well understood. We focused on symptoms rather than disorder given the reported increase in general symptomatology among girls [4,5,6,7]. Furthermore, evidence indicates that depression and anxiety symptoms go beyond those specified within constricted diagnostic criteria, suggesting that psychopathology is continuous and not narrowly expressed through distinct disorders [11, 12].

Your Child Is Struggling. Could Your Marriage Be to Blame?

Your Child Is Struggling. Could Your Marriage Be to Blame?

Well-documented research cites trauma, socioeconomic status, education, peer effects, parental bonding, nutrition, and sleep habits as clear contributors to a child’s overall health outcomes. But one unique area of research — and one not often addressed — has shown that the role of the parental couple’s relationship also has a hugely significant effect on the health of their children.

Study: The couple relationship and children’s health

Both born in Toronto, Drs. Phil and Carolyn Cowan are both professors emeritus at UC Berkeley. When they began their work in the 1970s, there was no research on the role of the couple relationship on the outcomes for children’s health or overall adjustment. And many child therapists did not even allocate regular time to seeing parents at all. There was a fair bit of research on parenting — as well as John Bowlby’s pioneering work on attachment theory — but nothing that looked at the couple’s dynamic, in and of itself, as a cause for a child’s emotional health.

The Cowans’ research considered this dynamic. They noted that marital satisfaction and happiness decline after having children, and surmised that this decline adversely affects their children’s wellbeing. (The decline in marital and personal happiness in parenthood is well documented. Many couples never regain their pre-child levels of satisfaction with their lives, or perhaps not until the children leave home, and by then divorce has often intervened.)

The Cowans devised an intervention: a 16-week peer couples’ group, facilitated by clinically trained co-leaders. Two similar group interventions were designed. Each provided a similar curriculum, but with a different focus. After the unstructured opening segment of each week, the curriculum then focused on either (1) improving the couple’s wellbeing as a couple or (2) improving their parenting skills.

Results

The most impressive gains resulted in the first group: Couples maintained (though did not improve) their previous level of satisfaction with their marriage. Other significant improvements did occur in the second group: fathers’ parental participation rates, children’s academic performance, and the parental relationship as it related specifically to their shared parenting.

To be more specific, both groups showed improvement, but the group that focused on the relationship between the parents talking about their own issues showed superior results, especially in supporting their children’s social and academic achievement. While the parenting-focused group did help with parenting, the relationship-focused groups did both that and also affected the quality of the relationship between the parents. (A surprising bonus came when the researchers discovered an unintended consequence: Overall, the families also increased their income.)

Over subsequent years, the Cowans have validated that initial finding: Maintaining marital and personal satisfaction and reducing couple conflict creates a huge benefit for the mental health of families and their children. The emotional challenges of having children are well known; we all know that having young or adolescent children in our lives — while very much worth the pain — is indeed often a pain! Never before has a research project looked at the toll this change can take on parents’ mental health and marital health, and then intervened with treatment intended to reverse the damage this inflicts on their children.

The intervention trials originally were conducted with working- and middle-class couples, but in the last two decades, in collaboration with Marsha Kline Pruett and Kyle Pruett, they have shown that the same curriculum and format leads to positive results for parents and children in more than 1,000 ethnically diverse low-income families.