Intervention basée sur la pleine conscience auprès de patients souffrant d’obésité et de trouble de binge eating : résultats préliminaires de l’essai contrôlé randomisé MindOb

Abstract

La pleine conscience pourrait permettre de réduire l’impulsivité alimentaire et augmenter la motivation à pratiquer des activités physiques, à condition d’être pratiquée quotidiennement par des individus souffrant d’obésité et de trouble de binge eating. L’objectif est de tester l’efficacité d’une intervention à distance basée sur la pleine conscience auprès de patients obèses souffrant de trouble de binge eating et observer l’adhésion quotidienne mesurée de manière objective. Seize patients obèses présentant un trouble de binge eating ont été randomisés dans trois groupes : pleine conscience, méditation factice, liste d’attente. Les deux interventions testées consistaient en l’écoute de pistes audio sur internet, tous les jours pendant 12 mois. Le poids, les processus alimentaires, les apports énergétiques, la motivation à l’activité physique, la dépense énergétique, la détresse psychologique et les capacités de pleine conscience ont été mesurés à l’inclusion, un mois, six mois et douze mois. Parmi les 16 patients inclus (dont sept abandons ou perdus de vue), aucun n’a suivi entièrement l’intervention ni pendant le premier mois (24,76 % d’audio écouté en moyenne), ni après la première visite de suivi (9,80 % d’audio écouté en moyenne). Il semble donc difficile de tester l’efficacité d’une intervention à distance sans mettre en place des techniques ayant pour objectif d’améliorer l’adhésion des participants. Mindfulness is the ability to voluntarily focus on the present moment without judgment. Several systematic reviews and meta-analyses have demonstrated the effectiveness of mindfulness-based interventions among individuals with obesity, mainly on the reduction of binge episodes and related factors such as impulsive and emotional eating. Therefore, mindfulness could decrease impulsive eating and increase motivation toward physical activity. Furthermore, daily online mindfulness training for individuals diagnosed with binge eating disorder that benefit from usual care in a clinical nutrition department could be more adapted than standardized weekly group interventions. To test the effectiveness of an online mindfulness-based intervention among patients with obesity and binge eating disorder, and to objectively observe measured daily adherence to the intervention. Sixteen patients with obesity and binge eating disorder (based on DSM5 criteria) were randomized to one of three of the following groups: mindfulness training (n = 5), sham meditation (n = 8), waitlist (n = 3). Both interventions consisted of online 10-minute daily audio sessions lasting for 12 months in addition to usual care in nutrition. Weight, eating processes (Three-Factor Eating Questionnaire R18), energy intake (7-day dietary recall), motivation toward physical activity (Behavioral Regulation Toward Exercise Questionnaire 2), energy expenditure (International Physical Activity Questionnaire and a 7-day pedometer log), psychological distress (Hospital Anxiety and Depression Scale), and mindfulness skills (Mindful Attention Awareness Scale and Daily Mindful Responding Scale over 7 days) were measured at baseline, one month, six months, and 12 months. An objective measure of participants’ adherence to both interventions was provided by the hosting server for each individual. Data was analyzed using the Reliable Change Index formulas to estimate the effect of the intervention on each participant on an individual change basis. From 47 patients potentially eligible for the MindOb study, 28 were screened for eligibility and 16 were randomized (10 women; mean age 40 years old ± 14.37; mean BMI 36.93 kg/m2 ± 4.24). The main result of the case series remains in the number of drop-outs (n = 4), and lost patients (n = 3). Among the 16 participants, none attended 100% of the online sessions neither during the first month (24.76% of the sessions) nor after the first visit (9.80% of the sessions). A majority of participants from the sham meditation group showed a decrease in impulsive and emotional eating, and an increase in extrinsic motivation for physical activity after one month of intervention. However, no participant in the intervention groups showed clinically significant change on mindfulness scores or increased scores of psychological distress after one month of intervention. The results highlight the challenges in testing the effectiveness of online interventions among patients with obesity and binge eating disorder. Additional techniques (e.g. action planning) could increase adherence to such interventions. Furthermore, increasing the sample size and analyzing the 6- and 12-month data could result in an increase of statistical power as well as increased possibility to conduct group comparison analyses instead of an estimate of individual change.