Department of Behavioral and Social Sciences, Brown University, Providence, RI, United States.
Mindfulness Center at Brown, Brown University, Providence, RI, United States.
J Med Internet Res. 2023 Sep 26;25:e46310. doi: 10.2196/46310.
Sexual minority women (lesbian, gay, bisexual, pansexual, queer, and other nonheterosexual women) remain considerably underrepresented in health research despite being at a higher risk for diabetes and obesity as well as stigma and psychological distress than their heterosexual peers. In addition, early life adversity (ELA) is prevalent among sexual minority women, which further increases risks for obesity, psychological distress, and poor cardiovascular health. App-based mindfulness interventions are potentially promising for this group in mitigating the adverse health effects of ELA, reducing food craving and unhealthy eating, addressing the risks associated with obesity.
This mixed methods feasibility trial aimed to test a mindfulness-based mobile health approach for middle-aged sexual minority women (aged 30-55 years) with ELA and overweight or obesity (BMI ≥25 kg/m) to improve health outcomes.
The single-arm trial was advertised on social media and various lesbian, gay, bisexual, transgender, and queer web-based groups. At baseline, after the intervention (2 months), and at the 4-month follow-up, participants completed assessments of primary outcomes (food craving, emotional eating, and weight via a mailed scale) and secondary outcomes (depression, anxiety, mindfulness, and emotion dysregulation). A standardized weight measure was mailed to participants for weight reporting. Feasibility and acceptability were assessed after the intervention via surveys and semistructured exit interviews.
We screened 442 individuals, among which 30 eligible sexual minority women (mean age 40.20, SD 7.15 years) from various US regions were enrolled in the study. At baseline, 86% (26/30) and 80% (24/30) of participants had elevated depressive and anxiety symptoms, respectively. Among the 30 enrolled participants, 20 (66%) completed all intervention modules, 25 (83%) were retained at the 2-month follow-up, and 20 (66%) were retained at the 4-month follow-up. None reported adverse effects. From baseline to the 4-month follow-up, large effects were found in food craving (Cohen d=1.64) and reward-based eating (Cohen d=1.56), whereas small effects were found with weight (Cohen d=0.20; 4.21 kg on average). Significant improvements were also found in the secondary outcomes (depression, Cohen d=0.98; anxiety, Cohen d=0.50; mindfulness, Cohen d=0.49; and emotion dysregulation, Cohen d=0.44; all P<.05). Participants with higher levels of parental verbal and emotional abuse were particularly responsive to the intervention. Participants reported that the program aligned with their goals and expectations, was easy to use, and facilitated changes in eating behavior and mental health. Barriers to engagement included the need for diverse teachers, individualized support, and body positive language.
This early phase feasibility trial provides proof-of-concept support for a mindfulness mobile health approach to improve obesity-related outcomes among sexual minority women and warrants a larger randomized controlled trial in the future. The findings also suggest the need to address trauma and psychological health when addressing weight-related outcomes among sexual minority women.
尽管性少数群体女性（女同性恋、男同性恋、双性恋、泛性恋、酷儿和其他非异性恋女性）患糖尿病和肥胖症的风险以及受到污名化和心理困扰的风险比其异性恋同龄人更高，但在健康研究中，她们的代表性仍然严重不足。此外，性少数群体女性中早期生活逆境（ELA）普遍存在，这进一步增加了肥胖、心理困扰和心血管健康不良的风险。基于应用程序的正念干预措施对于减轻 ELA 的不良健康影响、减少食物渴望和不健康的饮食、解决与肥胖相关的风险，可能对这一群体具有很大的潜力。
本混合方法可行性试验旨在测试一种基于正念的移动健康方法，用于治疗有 ELA 和超重或肥胖（BMI≥25kg/m²）的中年性少数群体女性（30-55 岁），以改善健康结果。
该单臂试验通过社交媒体和各种女同性恋、男同性恋、双性恋、跨性别和酷儿网络群体进行宣传。在基线、干预后（2 个月）和 4 个月随访时，参与者完成了主要结果（通过邮寄的量表评估食物渴望、情绪性进食和体重）和次要结果（抑郁、焦虑、正念和情绪调节）的评估。为了报告体重，向参与者邮寄了标准化的称重工具。干预后通过调查和半结构化退出访谈评估可行性和可接受性。
我们筛选了 442 个人，其中 30 名符合条件的性少数群体女性（平均年龄 40.20 岁，SD7.15 岁）来自美国不同地区，被纳入了这项研究。在基线时，分别有 86%（26/30）和 80%（24/30）的参与者存在抑郁和焦虑症状。在纳入的 30 名参与者中，有 20 名（66%）完成了所有干预模块，25 名（83%）在 2 个月随访时保留，20 名（66%）在 4 个月随访时保留。没有人报告不良反应。从基线到 4 个月随访，食物渴望（Cohen d=1.64）和基于奖励的进食（Cohen d=1.56）的效果较大，而体重的效果较小（Cohen d=0.20；平均 4.21kg）。次要结果也有显著改善（抑郁，Cohen d=0.98；焦虑，Cohen d=0.50；正念，Cohen d=0.49；和情绪调节，Cohen d=0.44；均 P<.05）。经历过父母言语和情感虐待的参与者对干预的反应特别强烈。参与者报告称，该项目符合他们的目标和期望，易于使用，并促进了饮食行为和心理健康的改变。参与的障碍包括需要多样化的教师、个性化支持和身体积极语言。
这项早期可行性试验为改善性少数群体女性肥胖相关结果的基于正念的移动健康方法提供了概念验证支持，未来值得进行更大规模的随机对照试验。研究结果还表明，在解决性少数群体女性的体重相关结果时，需要解决创伤和心理健康问题。
