一项基于正念的减肥干预随机对照试验中种族/民族和教育差异的探索性分析
Exploratory Analysis of Racial/Ethnic and Educational Differences in a Randomized Controlled Trial of a Mindfulness-Based Weight Loss Intervention.
作者信息
Daubenmier Jennifer, Chao Maria T, Hartogensis Wendy, Liu Rhianon, Moran Patricia J, Acree Michael C, Kristeller Jean, Epel Elissa S, Hecht Frederick M
机构信息
From the Institute of Holistic Health Studies (Daubenmier), San Francisco State University; Osher Center for Integrative Medicine (Chao, Hartogensis, Liu, Moran, Acree, Hecht), University of California, San Francisco, San Francisco, California; Department of Psychology (Kristeller), Indiana State University, Terre Haute, Indiana; and Department of Psychiatry (Epel), University of California, San Francisco, San Francisco, California.
出版信息
Psychosom Med. 2021;83(6):503-514. doi: 10.1097/PSY.0000000000000859.
OBJECTIVE
People of color and lower socioeconomic groups have higher obesity prevalence, lose less weight compared with Whites and higher socioeconomic groups, and are underrepresented in randomized controlled trials of mindfulness-based interventions. We examined whether mindfulness approaches reduce disparities in weight loss interventions.
METHODS
We analyzed data from a randomized controlled trial of 194 participants with obesity (41% participants of color, 36% without college degree) comparing a 5.5-month mindfulness-based weight loss intervention to an active-control with identical diet-exercise guidelines. We assessed attendance, 18-month attrition, and weight change at 6, 12, and 18 months by race/ethnicity and education level using linear mixed models, adjusting for baseline body mass index, age, and education or race/ethnicity, respectively.
RESULTS
Participants without versus with a college degree attended fewer sessions and had higher attrition across interventions. Participants of color attended fewer intervention sessions in the mindfulness compared with the control intervention. Overall, participants of color lost significantly less weight at 12 and 18 months compared with Whites. However, during the 6- to 18-month maintenance period, we found an interaction of intervention arm, race/ethnicity, and time (p = .035), indicating that participants of color compared with Whites regained more weight in the control (0.33 kg/mo; p = .005) but not mindfulness intervention (0.06 kg/mo; p = .62). Participants without a college degree had greater initial weight loss in the mindfulness compared to control intervention from 0 to 6 months (-0.46 kg/mo; p = .039).
CONCLUSIONS
Although disparities persist, mindfulness approaches may mitigate some racial/ethnic and socioeconomic differences in weight loss compared with conventional diet-exercise programs.Trial Registration: Clinicaltrials.gov registration: NCT00960414.
目的
有色人种和社会经济地位较低的群体肥胖患病率较高，与白人和社会经济地位较高的群体相比，体重减轻较少，且在基于正念的干预随机对照试验中代表性不足。我们研究了正念疗法是否能减少减肥干预中的差异。
方法
我们分析了一项针对194名肥胖参与者（41%为有色人种参与者，36%没有大学学位）的随机对照试验数据，该试验将为期5.5个月的基于正念的减肥干预与遵循相同饮食运动指南的积极对照进行比较。我们使用线性混合模型，分别根据基线体重指数、年龄以及教育程度或种族，按种族/民族和教育水平评估了6个月、12个月和18个月时的出勤情况、18个月的损耗率以及体重变化。
结果
没有大学学位的参与者与有大学学位的参与者相比，参加的课程较少，且在所有干预措施中的损耗率较高。与对照干预相比，有色人种参与者在正念干预中参加的课程较少。总体而言，有色人种参与者在12个月和18个月时的体重减轻明显少于白人。然而，在6至18个月的维持期内，我们发现干预组、种族/民族和时间之间存在交互作用（p = 0.035），这表明与白人相比，有色人种参与者在对照干预中体重反弹更多（0.33千克/月；p = 0.005），而在正念干预中则不然（0.06千克/月；p = 0.62）。与对照干预相比，没有大学学位的参与者在0至6个月的正念干预中初始体重减轻更多（-0.46千克/月；p = 0.039）。
结论
尽管差异仍然存在，但与传统的饮食运动计划相比，正念疗法可能会减轻减肥过程中的一些种族/民族和社会经济差异。试验注册：Clinicaltrials.gov注册编号：NCT00960414。
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