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BACKGROUND Sexual minority women (lesbian/gay, bisexual, pansexual, queer, and other non-heterosexual women) remain considerably underrepresented in health research despite being at a higher risk for diabetes and obesity as well as stigma, and psychological distress compared with heterosexual peers. Additionally, 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 sexual minority women both in mitigating the adverse health effects of ELA as well as reducing food craving and unhealthy eating, reducing risks associated with obesity. OBJECTIVE This mixed-methods feasibility trial aimed to test a mindfulness-based mobile health (mHealth) approach for middle-aged sexual minority women (age 30-55) with early life adversity and overweight/obesity (BMI ≥25) to improve health outcomes. METHODS The study was advertised on social media and various LGBTQ+ online groups. Interested individuals were invited to complete a brief screener and if eligible, they were contacted by a research assistant for an interview and study enrollment. At baseline, post-intervention (2-month), and 4-months 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 at post-intervention via surveys and semi-structured exit-interviews. RESULTS We screened a total of 442 individuals, among which 30 eligible sexual minority women (Mean age = 40.20) from various regions of the U.S. enrolled in the study. At baseline, 86.7% and 80% of participants had elevated depressive and anxiety symptoms. Among enrolled participants, 20 (66.7%) completed all intervention modules, 25 (83.3%) were retained at the 2-month and 20 (66.7%) at 4-month follow-up. None reported adverse effects. From baseline to the 4-month follow-up, large effects were found in food craving (d = 1.64) and reward-based eating (d = 1.56) while small effects were found with weight (d = 0.20, 4.21kg on average). Significant improvements were also found in secondary outcomes (depression, d = 0.98; anxiety, d = 0.50; mindfulness, d = 0.49; emotion dysregulation, d = 0.44). Participants with higher parental verbal and emotional abuse were particularly responsive to the intervention. Participants reported the program aligned with their goals and expectations, was easy to use, and facilitated changes in eating behavior and mental health. Barriers for engagement included needs for diverse teachers, individualized support, and body positive language. CONCLUSIONS This early phase feasibility trial provides proof-of-concept support for a mindfulness mHealth approach to improve obesity-related outcomes among sexual minority women and warrants a larger randomized controlled trial in the future. Findings also suggest the need to attend to trauma and psychological health when addressing weight-related outcomes among sexual minority women. CLINICALTRIAL The study was preregistered as a clinical trial on Clinicaltrials.gov (trial identifier: NCT05201391). |
