Mindfulness Intervention for Stress Eating to Reduce Cortisol and Abdominal Fat among Overweight and Obese Women: An Exploratory Randomized Controlled Study

“The sample reported significantly greater levels of perceived stress compared to a representative sample of US women in 2006, as assessed by total scores on the Perceived Stress Scale (19.0 ± 5.9 versus 16.1 ± 7.7; t(46) = −166.0; P < .001) [79].”

“Some individuals are more susceptible to stress-induced eating than others and may adopt a self-regulation strategy for coping with aversive states in which attention is shifted away from negative selfappraisal or affect and towards the immediate stimulus environment, such as food [48, 49].”

“Some individuals are more susceptible to stress-induced eating than others and may adopt a self-regulation strategy for coping with aversive states in which attention is shifted away from negative selfappraisal or affect and towards the immediate stimulus environment, such as food [48, 49].”

“Individuals who are identified as “emotional eaters” are more vulnerable to weight gain compared to nonemotional eaters, [43, 50] and they may regain more weight after successful weight loss through either diet and exercise [51] or bariatric surgery [52].”

“Most behavioral weight loss interventions do not aim to reduce psychological stress as a primary goal, if at all, and stress may be one factor contributing to the modest success of long-term weight loss maintenance [51, 53].”

“Some individuals are more susceptible to stress-induced eating than others and may adopt a self-regulation strategy for coping with aversive states in which attention is shifted away from negative selfappraisal or affect and towards the immediate stimulus environment, such as food [48, 49].”

“These findings are congruent with those of rat studies demonstrating a link between stress eating and fat distribution [9].”

“001) [79].”

“However, a lower CAR is also related to fatigue and posttraumatic stress disorder, and norms have not been established to differentiate hypo- from hyper-CAR; thus, careful consideration of sample characteristics is needed when interpreting CAR [29].”

“Thus, abdominal adiposity is an important target for reducing risk of type 2 diabetes and cardiovascular disease (CVD) [2].”

“A mindfulness-based intervention may be effective in reducing stress and improving stress-related overeating as previous studies suggest that mindfulness training reduces psychological stress and enhances psychological well-being for a variety of health conditions, [54–58] may improve cortisol patterns, [59] may reduc…”

“The program was originally developed for binge eating disorder (BED), and in an uncontrolled pilot study and a randomized clinical trial, it was associated with reductions in binge-eating, depression, other indicators of regulation of food intake, as well as weight loss in proportion to amount of mindfulness practice…”

“Psychological distress and elevated cortisol secretion promote abdominal fat, a feature of the Metabolic Syndrome.”

“The combination of chronic stress and a high fat and sugar diet markedly increases visceral adipose tissue through stress-mediated upregulation of neuropeptide Y and its receptors in fat tissues of rodents [42].”

“Increases in cortisol in combination with increased levels of insulin mobilize amino acids and fatty acids from peripheral to abdominal regions for immediate use by the liver for gluconeogenesis and ketones for energy use by the brain [7, 8].”

“A preliminary, novel intervention was developed drawing on components from MindfulnessBased Stress Reduction (MBSR), [54] Mindfulness-Based Cognitive Therapy (MBCT), [56] and Mindfulness-Based Eating Awareness Training (MB-EAT) [69, 70].”

“One day of CAR assessment has been shown to be highly influenced by situational factors and 2–6 days of assessment on work days are needed to achieve sufficient reliability as a trait measure [77].”

“, reverse coded item: “I suppress my bodily feelings and sensations”) [72].”

“Healthy men and women who exhibit increased cortisol reactivity in response to laboratory stress tasks have greater abdominal adiposity [18–20], and among depressed, postmenopausal women, those with higher morning cortisol have greater levels of visceral fat as measured by computed tomography compared to those with lo…”

“…Medicine, Department of Medicine, University of California, San Francisco, CA 94115, USA 2 Department of Psychology, Indiana State University, Terre Haute, IN 47809, USA 3 California National Primate Research Center, University of California, Davis, CA 95616, USA 4 Department of Pediatrics,…”

“Finally, because stress eating is more common in women than in men [67], and women and men differ in fat distribution profiles, we targeted overweight and obese women who felt that stress influenced their eating behavior and weight for recruitment.”

“…Medicine, Department of Medicine, University of California, San Francisco, CA 94115, USA 2 Department of Psychology, Indiana State University, Terre Haute, IN 47809, USA 3 California National Primate Research Center, University of California, Davis, CA 95616, USA 4 Department of Pediatrics,…”

“Individuals who are identified as “emotional eaters” are more vulnerable to weight gain compared to nonemotional eaters, [43, 50] and they may regain more weight after successful weight loss through either diet and exercise [51] or bariatric surgery [52].”

“Laboratory measures of increased HPA axis activity associated with abdominal adiposity include elevated cortisol secretion after lunch [13], elevated cortisol and ACTH levels after administration of corticotrophin-releasing hormone (CRH) [14], and elevated cortisol concentrations after challenges with CRH and arginine…”

“In addition to direct effects of chronic stress on abdominal obesity, psychological stress can also trigger consumption of high fat and sweet food, leading to overall weight gain [31– 41].”

“Individuals who are identified as “emotional eaters” are more vulnerable to weight gain compared to nonemotional eaters, [43, 50] and they may regain more weight after successful weight loss through either diet and exercise [51] or bariatric surgery [52].”

“However, a lower CAR is also related to fatigue and posttraumatic stress disorder, and norms have not been established to differentiate hypo- from hyper-CAR; thus, careful consideration of sample characteristics is needed when interpreting CAR [29].”

“Some individuals are more susceptible to stress-induced eating than others and may adopt a self-regulation strategy for coping with aversive states in which attention is shifted away from negative selfappraisal or affect and towards the immediate stimulus environment, such as food [48, 49].”

“GR’s are found on visceral compared to peripheral fat cells partly explaining why fat stores are redistributed to intraabdominal regions in the presence of elevated cortisol [9– 11].”

“A naturalistic, noninvasive indicator of basal HPA activity, the cortisol awakening response (CAR), has been related to greater visceral adiposity as measured by waist to hip ratio in men [23–25] and magnetic resonance imaging in adolescent girls [26], although not all studies have shown a positive association [27].”

“Healthy men and women who exhibit increased cortisol reactivity in response to laboratory stress tasks have greater abdominal adiposity [18–20], and among depressed, postmenopausal women, those with higher morning cortisol have greater levels of visceral fat as measured by computed tomography compared to those with lo…”

“However, a lower CAR is also related to fatigue and posttraumatic stress disorder, and norms have not been established to differentiate hypo- from hyper-CAR; thus, careful consideration of sample characteristics is needed when interpreting CAR [29].”

“Laboratory measures of increased HPA axis activity associated with abdominal adiposity include elevated cortisol secretion after lunch [13], elevated cortisol and ACTH levels after administration of corticotrophin-releasing hormone (CRH) [14], and elevated cortisol concentrations after challenges with CRH and arginine…”

“Healthy men and women who exhibit increased cortisol reactivity in response to laboratory stress tasks have greater abdominal adiposity [18–20], and among depressed, postmenopausal women, those with higher morning cortisol have greater levels of visceral fat as measured by computed tomography compared to those with lo…”

“…Department of Medicine, University of California, San Francisco, CA 94115, USA 2 Department of Psychology, Indiana State University, Terre Haute, IN 47809, USA 3 California National Primate Research Center, University of California, Davis, CA 95616, USA 4 Department of Pediatrics,…”

“Postmenopausal women were excluded because fat is redistributed to visceral depots after menopause and is primarily determined by alterations in estrogen levels [68].”

“Laboratory measures of increased HPA axis activity associated with abdominal adiposity include elevated cortisol secretion after lunch [13], elevated cortisol and ACTH levels after administration of corticotrophin-releasing hormone (CRH) [14], and elevated cortisol concentrations after challenges with CRH and arginine…”

“74) [78] and was used as an estimate of visceral fat in the present study.”

“Despite evidence linking stress to overeating and abdominal fat accumulation, to our knowledge, no published studies have examined whether behavioral interventions designed to improve stress, stress eating, and/or cortisol responses lead to reductions in abdominal adiposity.”

“The link between elevated cortisol concentrations and increased abdominal fat was first observed in patients diagnosed with Cushing’s syndrome who had adrenal tumors leading to hypercortisolemia [12].”

“A greater density of GR’s are found on visceral compared to peripheral fat cells partly explaining why fat stores are redistributed to intraabdominal regions in the presence of elevated cortisol [9– 11].”

“Given recent evidence that upper trunk as well as visceral fat is associated with increased insulin resistance [64] and leg fat is associated with lower metabolic risk [65, 66], we also examined the overall change in ratio of total trunk to leg fat as an index of relative body fat distribution.”

“A greater density of GR’s are found on visceral compared to peripheral fat cells partly explaining why fat stores are redistributed to intraabdominal regions in the presence of elevated cortisol [9– 11].”

“Cortisol binds to glucocorticoid receptors (GR) on fat cells activating lipoprotein lipase, an enzyme that converts circulating triglycerides into free fatty acids in adipocytes [6].”

“A greater density of GR’s are found on visceral compared to peripheral fat cells partly explaining why fat stores are redistributed to intraabdominal regions in the presence of elevated cortisol [9– 11].”

“Individuals who are identified as “emotional eaters” are more vulnerable to weight gain compared to nonemotional eaters, [43, 50] and they may regain more weight after successful weight loss through either diet and exercise [51] or bariatric surgery [52].”

“Healthy men and women who exhibit increased cortisol reactivity in response to laboratory stress tasks have greater abdominal adiposity [18–20], and among depressed, postmenopausal women, those with higher morning cortisol have greater levels of visceral fat as measured by computed tomography compared to those with lo…”

“Individuals who are identified as “emotional eaters” are more vulnerable to weight gain compared to nonemotional eaters, [43, 50] and they may regain more weight after successful weight loss through either diet and exercise [51] or bariatric surgery [52].”

“A naturalistic, noninvasive indicator of basal HPA activity, the cortisol awakening response (CAR), has been related to greater visceral adiposity as measured by waist to hip ratio in men [23–25] and magnetic resonance imaging in adolescent girls [26], although not all studies have shown a positive association [27].”

“Despite evidence linking stress to overeating and abdominal fat accumulation, to our knowledge, no published studies have examined whether behavioral interventions designed to improve stress, stress eating, and/or cortisol responses lead to reductions in abdominal adiposity.”

“Body responsiveness also increased among overweight and obese women participating in a mindfulness intervention for stress eating compared to waitlist controls [106].”

“…for example, practices involve bringing greater attention to the pleasure of seeing, smelling, tasting, and eating of palatable foods and noticing when the satisfaction subsides, as taste-specific satiety mechanisms become apparent (Kristeller and Wolever, 2010; Daubenmier et al., 2011).”

“Studies reporting positive body weight results used a variety of mindfulness practices including combinations of mindfulness exercises (67,68), acceptance-based practices (57,58), mindful eating exercises (30,59), and programmes such as MBCT (23,37), MBSR (23) and MB-EAT (23,71), thus, not allowing us to make any firm…”

“Attendance was reported in five studies (Dalen et al., 2010; Daubenmier et al., 2011; Kearney et al., 2012; Leahey et al., 2008; Miller et al., 2012) and ranged from 70% (Miller et al.”