Identification of Facilitators and Barriers of Healthy Living and Type 2 Diabetes Prevention Among Latinx Families.

Youth-onset type 2 diabetes (T2D) is on the rise and may be associated with more adverse health outcomes than adult onset. Latinx adolescents are disproportionately at risk for T2D yet are underrepresented in prevention efforts. Extant interventions to prevent T2D in Latinx adolescents show limited effectiveness. Comprehensive understanding of Latinx adolescent/family needs is lacking, but necessary for cultural tailoring of T2D prevention. Researchers conducted focus groups with 32 Latinx adolescents (age 10-18 years) from Northern Colorado and 31 Spanish-speaking parents/caregivers, with 2.5-hr semistructured youth-specific and parent-specific discussions, respectively. No participants included in this study had T2D. Qualitative data were analyzed for emergent themes about barriers/facilitators of healthy living and T2D prevention preferences. Thematic content analysis yielded eight themes within three categories: barriers to healthy living, facilitators of healthy living, and program preferences. Barriers to healthy living included individual motivational factors/food preferences; financial cost and time demands of healthy eating/exercise; negative emotions; and external/relational factors such as parent feeding pressure and peer pressure/bullying. Facilitators of healthy living included individual motivational factors/enjoyment of healthy living and supportive family structure. Program preferences were for family-based programming with adolescent breakout sessions and for facilitation by culturally competent facilitators. T2D is recognized as a serious health concern among Latinx families. There is a need for culturally tailored prevention programming that, in order to be acceptable, should address cultural and socioeconomic considerations, provide coping skills for adolescent-specific psychosocial stressors, and utilize a family-based programming framework with adolescent breakout sessions and culturally competent facilitators.

La diabetes tipo 2 (DT2) que comienza en la juventud está en aumento y esta asociada con peores resultados en comparación con los de la edad adulta. Los adolescentes Latinx tienen un riesgo desproporcionado de DT2 sin embargo, no están representados en los esfuerzos de prevención. Las intervenciones existentes muestran una eficacia limitada. La comprensión sobre las necesidades de los adolescentes y las familias Latinx son escasas, pero son necesarias para prevenir DT2. Se realizaron grupos de enfoque con 32 adolescentes Latinx (de 10 a 18 añ3os) del Norte de Colorado y 31 padres de habla hispana, con sesiones de 2.5 horas para jóvenes y para padres. Ningún participante en este estudio tenía DT2. Se analizaron datos cualitativos que identificaron barreras/facilitadores para una vida sana y preferencias de programas para prevenir DT2. Las barreras incluyeron factores individuales; el costo y el tiempo para tener alimentación/ejercicio sano; emociones negativas; y factores externos como la presión de los padres/compañeros. Los facilitadores incluyeron factores individuales/disfrute de la salud y el apoyo familiar. Las preferencias fueron basada en la familia, con grupos de adolescentes y con facilitadores culturalmente competentes. La DT2 es un grave problema entre las familias Latinx. Se necesitan programas de prevención que consideren la cultura y factores socioeconómicos. También se deben proporcionar habilidades de afrontamiento de los estresores psicosociales para adolescentes, a través de facilitadores culturalmente competentes y utilizar programación basada en la familia, con actividades culturales para adolescentes.

Effects of a mindfulness-induction on subjective and physiological stress response in adolescents at-risk for adult obesity.

BACKGROUND: Mindfulness-training may benefit stress response and stress-eating, yet few studies have experimentally tested these effects in adolescents. In this short communication, we report whether a brief mindfulness-induction affected acute stress response and stress-eating in adolescents at-risk for adult obesity. We explored disordered eating as a moderator. METHOD: Twenty-nine adolescents (age 14 ± 2 y) at-risk for adult obesity participated in a within-subjects, randomized crossover experiment. Following a 10-minute mindfulness or neutral-induction on different days in random order, the Trier Social Stress Test adapted for adolescents was administered, followed by an ad libitum lunch meal. Physiological stress response (heart rate, blood pressure) and subjective stress response (anxiety, mindlessness) were determined with area under the curve with respect to increase. Stress-eating was measured as test meal energy consumed. Global disordered-eating and binge-eating were assessed with the Eating Disorders Examination-Questionnaire. RESULTS: Relative to a neutral-induction, a mindfulness-induction reduced state anxiety response (p = .04). There were significant interactions of induction-type by global disordered-eating (p = .02) and binge-eating (p = .03), such that the mindfulness-induction most reduced anxiety response in adolescents with relatively lower global disordered-eating and those with no binge-eating. Induction-type also interacted with binge-eating in predicting diastolic blood pressure (p = .03). A mindfulness-induction, versus neutral-induction, most reduced diastolic blood pressure response in adolescents with binge-eating. CONCLUSIONS: Brief mindfulness-training may alter some aspects of acute stress response, with variations by disordered-eating. Future research should test alternative mindfulness induction-types (e.g., acceptance/self-compassion) to improve our understanding of how mindfulness-training may benefit adolescents at-risk for adult obesity.

Associations of parental feeding practices and food reward responsiveness with adolescent stress-eating.

Rates of adolescent obesity have continued to rise over the past decade. As adolescence is an important time for developing eating habits that endure into adulthood, more information is needed about the potentially modifiable family- and individual-level factors that influence the development of common overeating behaviors such as stress-eating during adolescence. In this study, we conducted secondary data analyses to evaluate how parental feeding practices and adolescents' food reward responsiveness related to adolescents' stress-eating during a laboratory test meal. Participants were 90 healthy adolescents (50% female), 12-17 years of age (M = 14.3, SD = 1.7 years), at risk for excess weight gain (BMI percentile M = 92.7, SD = 7.5). Parental feeding behaviors were assessed with parent-report on the Child Feeding Questionnaire-Adolescent Version. Adolescents' relative reward value of food was measured with a behavioral task. Stress-eating was assessed as total energy intake from a buffet lunch meal after adolescents participated in the Trier Social Stress Test adapted for adolescents. Results revealed that parental concern about their child's weight (t = 2.27, p = .02) and adolescents' relative reward value of food (t = 2.24, p = .03) were related to greater stress-eating, controlling for BMI standard score, age, sex, and general perceived stress. Parental restriction was not related to stress-eating in this sample (p = .21). These findings suggest that parental attitudes about their adolescent's weight and adolescents' own internalized responsiveness to food as a reward may play a role in propensity to engage in overeating in response to stress.

One-Year Follow-Up of a Randomized Controlled Trial Piloting a Mindfulness-Based Group Intervention for Adolescent Insulin Resistance.

INTRODUCTION: To explore if a brief mindfulness-based intervention (MBI) leads to sustained, improved clinical outcomes in adolescents at-risk for type 2 diabetes (T2D). METHODS: Participants were 12-17y girls with overweight/obesity, elevated depression symptoms, and T2D family history participating in a randomized, controlled pilot trial of a six-session MBI vs. cognitive-behavioral therapy (CBT) group. At baseline and 1-year, mindfulness, depression, insulin resistance (IR), and body composition were assessed with validated instruments. RESULTS: One-year retention was 71% (n = 12) in MBI; 81% (n = 13) in CBT. At 1-year, depression decreased (Cohen's d = 0.68) and IR decreased (d = 0.73) in adolescents randomized to MBI compared to those in CBT. There were no significant between-condition differences in mindfulness, adiposity, or BMI. DISCUSSION: One-year outcomes from this randomized, controlled pilot trial suggest that brief MBI may reduce depression and IR in at-risk adolescents. Replication and exploration of mechanisms within the context of a larger clinical trial are necessary. CLINICAL TRIAL REGISTRATION: www.ClinicalTrials.gov, identifier NCT02218138.

Mindfulness-based group intervention in adolescents at-risk for excess weight gain: A randomized controlled pilot study.

OBJECTIVES: To assess feasibility/acceptability of a mindfulness-based approach to excess weight prevention in adolescents at-risk for excess weight gain. To pilot test efficacy of a mindfulness-based intervention for improving food reward sensitivity, stress-eating, executive function (EF), and BMI/adiposity. METHODS: A pilot randomized controlled trial was conducted with 12-17y adolescents at-risk for excess weight gain based on above-average weight (body mass index [BMI]≥70%ile) or parental history of obesity (BMI≥30 kg/m2). Adolescents were randomized to a mindfulness-based (n = 29) or health education control group (n = 25) that met for six weekly one-hour sessions. Feasibility/acceptability were determined from attendance and acceptability survey ratings. At baseline, six-week and six-month follow-up, adolescents' perceived stress was measured with the Perceived Stress Scale, food reward sensitivity with a behavioral task, stress-eating during a laboratory test meal, and EF with the parent-reported Behavior Rating Inventory of Executive Function and NIH Toolbox. At the same intervals, BMI indices and body fat by air displacement plethysmography were assessed in a fasted state. RESULTS: Median session attendance was 6:6 sessions in both conditions; program acceptability ratings were above-average. Compared to health education, adolescents in mindfulness had lower food reward sensitivity at six-months (Cohen's d = 0.64, p = .01). There were no between-condition differences in BMI (mindfulness vs. health educationΔsix-months 95%CI 0.20, 1.52 kg/m2 vs. 0.21, 1.62 kg/m2) or adiposity (-3.64, -0.61% vs. -4.31, -1.04%) changes. CONCLUSIONS: A mindfulness-based group intervention is feasible/acceptable among adolescents at-risk for excess weight. In this pilot sample, mindfulness and health education were equivocal for BMI/adiposity outcomes. Future trials with a larger, adequately-powered sample and longer-term follow-up are necessary to test efficacy of a mindfulness-based intervention for food reward sensitivity, stress-eating, EF, and stabilizing growth trajectories in youth at-risk for adult obesity.

Design of a randomized controlled trial to decrease depression and improve insulin sensitivity in adolescents: Mood and INsulin sensitivity to prevent Diabetes (MIND).

BACKGROUND: Depressive symptoms often manifest in adolescence and predict worsening insulin sensitivity, a key precursor in the path to ß-cell failure and type 2 diabetes (T2D). OBJECTIVE: To assess the efficacy of a six-week cognitive-behavioral group versus six-week health education group for improving insulin sensitivity and preserving ß-cell function in adolescent girls at-risk for T2D with depressive symptoms and evaluate mechanisms underlying the association between depression and insulin dynamics. DESIGN: Randomized controlled trial of N = 150 12-17-year-old girls with overweight/obesity (body mass index [BMI; kg/m2] ≥85th percentile), elevated depressive symptoms (Center for Epidemiologic Studies-Depression Scale [CES-D] total score > 20), and diabetes family history. METHODS: Girls at-risk for T2D with elevated depressive symptoms are recruited from the Denver-metropolitan area and randomized to participate in one of two six-week interventions. The cognitive-behavioral group is a depression prevention program involving psycho-education, restructuring negative thoughts, and behavioral activation. The health education group is a didactic control that provides knowledge about healthy living. Participants are assessed at baseline, immediate post-intervention, and one-year follow-up. Primary outcomes are insulin sensitivity and ß-cell function from oral glucose tolerance tests. Secondary outcomes are disinhibited eating, physical activity, sleep, and cortisol. SUMMARY: Results from this adequately powered randomized controlled trial will determine whether decreasing depressive symptoms with a behavioral health program preventatively alters insulin sensitivity and ß-cell function trajectories in adolescents at-risk for T2D. Results from the MIND Project will add to knowledge of the contribution of depressive symptoms to T2D risk.

Mindfulness and laboratory eating behavior in adolescent girls at risk for type 2 diabetes.

Mindfulness-based intervention has become increasingly popular to address disinhibited eating in obesity and type 2 diabetes (T2D). Theoretically, present-moment attention promotes the ability to recognize and respond to internal hunger cues and to differentiate physiological hunger from other stimuli. Yet, there is limited research describing the relationship of mindfulness with disinhibited eating patterns in adolescents. In this study, we evaluated the relationship of dispositional mindfulness to laboratory eating in 107 adolescent (12-17 years) girls at risk for T2D. Adolescents reported dispositional mindfulness, were evaluated for recent loss-of-control-eating (LOC-eating) by interview, and participated in two successive, standardized laboratory test meals to assess eating when hungry as well as eating in the absence of hunger (EAH). Adolescents rated state appetite throughout the test meal paradigms. In analyses adjusting for body composition and other possible confounds, mindfulness was inversely related to caloric intake during the EAH paradigm. Mindfulness did not relate to energy intake when hungry. Instead, there was a significant interaction of reported LOC-eating by state hunger, such that girls with recent, reported LOC-eating and high state hunger consumed more calories when hungry, regardless of mindfulness. Findings suggest that in girls at risk for T2D, mindfulness may play a role in disinhibited eating. A propensity for LOC-eating may be most salient for overeating in a high hunger state.

Mindfulness-based Group Intervention for an Adolescent Girl at Risk for Type 2 Diabetes: A Case Report.

CONTEXT: Behavioral lifestyle interventions to lower body mass index (BMI; kg/m2) are the standard approach for preventing adolescent-onset type 2 diabetes (T2D). Unfortunately, existing programs have had limited long-term success of lessening insulin resistance, the key physiological risk indicator for T2D. Underlying psychosocial factors, particularly depressive symptoms, have been related to insulin resistance, independent of BMI or body fat. Preliminary evidence indicates that mindfulness-based programs show promise for intervening with depression and T2D; yet, this approach is novel and data in adolescents are scarce. OBJECTIVE: The objectives of this study were (1) to evaluate the benefits, and potential underlying mechanisms, of a mindfulness-based intervention in adolescents at-risk for T2D with depressive symptoms and (2) to consider clinical implementation with this specific, psychologically, and medically at-risk adolescent population. DESIGN AND SETTING: The research team conducted a case study report. The setting was an outpatient therapy clinic and research laboratory at a university. PARTICIPANT: The participant was a 16-y-old female with elevated depressive symptoms, obesity, and insulin resistance, and a family history of T2D. INTERVENTION AND OUTCOMES: The intervention was a 6-wk mindfulness-based group program. The key outcomes were patterns of change in trait mindfulness, depression, and insulin resistance in the course of a 1-y follow-up. Secondary outcomes were patterns of change in reported-overeating patterns and cortisol awakening response. RESULTS: Compared with her scores at baseline, the participant displayed a pattern of increased trait mindfulness, decreased depressive symptoms, and lessening of insulin resistance immediately following the group program and at 1 y. BMI and body fat were stable. There was a remission in reported-overeating and a pattern of declining cortisol awakening response 1 y later. Participant feedback on the intervention was generally positive but also provided potential modifications to strengthen acceptability and effectiveness. CONCLUSIONS: The current case results suggest that teaching mindfulness skills to adolescent girls at risk for T2D with depressive symptoms may offer distinctive advantages for treating depression and T2D risk. Clinical implications for increasing the success of implementing mindfulness-based programs in this population include a focus on promotion of social connectedness within the group, implementation of strategies to increase adherence to home practice activities, and the use of facilitation techniques to promote concrete understanding of abstract mindfulness concepts. Future, adequately powered clinical trial data are required to test therapeutic mechanisms and recommended adaptations.

Pilot randomized controlled trial of a mindfulness-based group intervention in adolescent girls at risk for type 2 diabetes with depressive symptoms.

OBJECTIVE: (1) Evaluate feasibility and acceptability of a mindfulness-based group in adolescent girls at-risk for type 2 diabetes (T2D) with depressive symptoms, and (2) compare efficacy of a mindfulness-based versus cognitive-behavioral group for decreasing depressive symptoms and improving insulin resistance. DESIGN AND SETTING: Parallel-group, randomized controlled pilot trial conducted at a university. PARTICIPANTS: Thirty-three girls 12-17y with overweight/obesity, family history of diabetes, and elevated depressive symptoms were randomized to a six-week mindfulness-based (n=17) or cognitive-behavioral program (n=16). INTERVENTIONS: Both interventions included six, one-hour weekly group sessions. The mindfulness-based program included guided mindfulness awareness practices. The cognitive-behavioral program involved cognitive restructuring and behavioral activation. MAIN OUTCOME MEASURES: Adolescents were evaluated at baseline, post-intervention, and six-months. Feasibility/acceptability were measured by attendance and program ratings. Depressive symptoms were assessed by validated survey. Insulin resistance was determined from fasting insulin and glucose, and dual energy x-ray absorptiometry was used to assess body composition. RESULTS: Most adolescents attended ≥80% sessions (mindfulness: 92% versus cognitive-behavioral: 87%, p=1.00). Acceptability ratings were strong. At post-treatment and six-months, adolescents in the mindfulness condition had greater decreases in depressive symptoms than adolescents in the cognitive-behavioral condition (ps<.05). Compared to the cognitive-behavioral condition, adolescents in the mindfulness-based intervention also had greater decreases in insulin resistance and fasting insulin at post-treatment, adjusting for fat mass and other covariates (ps<.05). CONCLUSIONS: A mindfulness-based intervention shows feasibility and acceptability in girls at-risk for T2D with depressive symptoms. Compared to a cognitive-behavioral program, after the intervention, adolescents who received mindfulness showed greater reductions in depressive symptoms and better insulin resistance. ClinicalTrials.gov identifier: NCT02218138 clinicaltrials.gov.