Practical Awareness-Based Strategies for Eating (PASE): A Pilot and Feasibility Randomized Trial

Overview

Journal Obes Sci Pract

Date 2025 Feb 14

PMID 39949653

Authors

David Arterburn

Robin Garcia

Dori Rosenberg

Eric Johnson

Kayne Mettert

Janet Ng

Judson Brewer

Affiliations

Soon will be listed here.

Abstract

Background: Few prior interventions for obesity have focused on reward-related eating. Researchers developed a mobile health mindfulness-based intervention, Eat Right Now (ERN), for improving reward related eating; ERN has not yet been feasibility tested as a weight loss intervention.

Objective: To obtain 6-month pilot and feasibility data in patients using the ERN intervention alone or with asynchronous coaching.

Methods: A 6-month, two-arm pilot and feasibility randomized trial was conducted involving 20 adults with a BMI ≥ 25 kg/m recruited from Kaiser Permanente Washington. Participants were randomized to ERN alone or ERN plus individualized coaching. Weight loss was assessed via a Wi-Fi-enabled digital scale.

Results: Among the 20 randomized participants, 17 (85%) started the intervention and remained enrolled in six months. Among these, 82% (14/17) had weight data captured by a Wi-Fi scale and 70.5% (12/17) completed follow-up questionnaires at the 6-month time point. The coached ERN participants had 4.3% weight loss (95% confidence interval (CI): 2.3%, 6.3%) and uncoached participants had 3.6% weight loss (95% CI: 1.2%, 5.9%). Participants in both approaches reported reductions in reward-related eating.

Conclusions: This pilot randomized trial of ERN demonstrates the feasibility and acceptability of the intervention for the majority of both the coached and uncoached groups. Further efforts are needed to ensure high retention and data capture in future studies.

References

Stunkard A, Messick S . The three-factor eating questionnaire to measure dietary restraint, disinhibition and hunger. J Psychosom Res. 1985; 29(1):71-83. DOI: 10.1016/0022-3999(85)90010-8. View

Rada P, Avena N, Hoebel B . Daily bingeing on sugar repeatedly releases dopamine in the accumbens shell. Neuroscience. 2005; 134(3):737-44. DOI: 10.1016/j.neuroscience.2005.04.043. View

Kaouk L, Hsu A, Tanuseputro P, Jessri M . Modifiable factors associated with weight regain after bariatric surgery: a scoping review. F1000Res. 2020; 8:615. PMC: 7492783. DOI: 10.12688/f1000research.18787.2. View

Shteingart H, Loewenstein Y . Reinforcement learning and human behavior. Curr Opin Neurobiol. 2014; 25:93-8. DOI: 10.1016/j.conb.2013.12.004. View

Coughlin S, Vernon M, Hatzigeorgiou C, George V . Health Literacy, Social Determinants of Health, and Disease Prevention and Control. J Environ Health Sci. 2021; 6(1). PMC: 7889072. View

Warren J, Smith N, Ashwell M . A structured literature review on the role of mindfulness, mindful eating and intuitive eating in changing eating behaviours: effectiveness and associated potential mechanisms. Nutr Res Rev. 2017; 30(2):272-283. DOI: 10.1017/S0954422417000154. View

Mennis J, McKeon T, Coatsworth J, Russell M, Coffman D, Mason M . Neighborhood disadvantage moderates the effect of a mobile health intervention on adolescent depression. Health Place. 2021; 73:102728. DOI: 10.1016/j.healthplace.2021.102728. View

Thomas J, Raynor H, Bond D, Luke A, Cardoso C, Foster G . Weight loss in Weight Watchers Online with and without an activity tracking device compared to control: A randomized trial. Obesity (Silver Spring). 2017; 25(6):1014-1021. DOI: 10.1002/oby.21846. View

Volkow N, Wang G, Fowler J, Telang F . Overlapping neuronal circuits in addiction and obesity: evidence of systems pathology. Philos Trans R Soc Lond B Biol Sci. 2008; 363(1507):3191-200. PMC: 2607335. DOI: 10.1098/rstb.2008.0107. View

10.

Mitchell E, Yang Q, Behr H, Ho A, DeLuca L, May C . Psychosocial Characteristics by Weight Loss and Engagement in a Digital Intervention Supporting Self-Management of Weight. Int J Environ Res Public Health. 2021; 18(4). PMC: 7916717. DOI: 10.3390/ijerph18041712. View

11.

Schachter S, Goldman R, Gordon A . Effects of fear, food deprivation, and obesity on eating. J Pers Soc Psychol. 1968; 10(2):91-7. DOI: 10.1037/h0026284. View

12.

Brewer J, Ruf A, Beccia A, Essien G, Finn L, van Lutterveld R . Can Mindfulness Address Maladaptive Eating Behaviors? Why Traditional Diet Plans Fail and How New Mechanistic Insights May Lead to Novel Interventions. Front Psychol. 2018; 9:1418. PMC: 6139346. DOI: 10.3389/fpsyg.2018.01418. View

13.

Aronne L, Hall K, Jakicic J, Leibel R, Lowe M, Rosenbaum M . Describing the Weight-Reduced State: Physiology, Behavior, and Interventions. Obesity (Silver Spring). 2021; 29 Suppl 1:S9-S24. PMC: 9022199. DOI: 10.1002/oby.23086. View

14.

Born J, Lemmens S, Rutters F, Nieuwenhuizen A, Formisano E, Goebel R . Acute stress and food-related reward activation in the brain during food choice during eating in the absence of hunger. Int J Obes (Lond). 2009; 34(1):172-81. DOI: 10.1038/ijo.2009.221. View

15.

Vainik U, Eun Han J, Epel E, Tomiyama A, Dagher A, Mason A . Rapid Assessment of Reward-Related Eating: The RED-X5. Obesity (Silver Spring). 2019; 27(2):325-331. PMC: 6352904. DOI: 10.1002/oby.22374. View

16.

Morgan J, Reid F, Lacey J . The SCOFF questionnaire: assessment of a new screening tool for eating disorders. BMJ. 1999; 319(7223):1467-8. PMC: 28290. DOI: 10.1136/bmj.319.7223.1467. View

17.

Miller C, Kristeller J, Headings A, Nagaraja H, Miser W . Comparative effectiveness of a mindful eating intervention to a diabetes self-management intervention among adults with type 2 diabetes: a pilot study. J Acad Nutr Diet. 2012; 112(11):1835-42. PMC: 3485681. DOI: 10.1016/j.jand.2012.07.036. View

18.

Ludwig V, Brown K, Brewer J . Self-Regulation Without Force: Can Awareness Leverage Reward to Drive Behavior Change?. Perspect Psychol Sci. 2020; 15(6):1382-1399. DOI: 10.1177/1745691620931460. View

19.

Feig E, Piers A, Kral T, Lowe M . Eating in the absence of hunger is related to loss-of-control eating, hedonic hunger, and short-term weight gain in normal-weight women. Appetite. 2018; 123:317-324. DOI: 10.1016/j.appet.2018.01.013. View

20.

Michaelides A, Major J, Pienkosz Jr E, Wood M, Kim Y, Toro-Ramos T . Usefulness of a Novel Mobile Diabetes Prevention Program Delivery Platform With Human Coaching: 65-Week Observational Follow-Up. JMIR Mhealth Uhealth. 2018; 6(5):e93. PMC: 5958286. DOI: 10.2196/mhealth.9161. View