Implementing a Text Message-

and Facebook-based intervention

as an Effort towards increasing
Mindful Eating Behavior
Principal Investigators: Graysha Chinea and
Chloe Seddon
04/27/2018
Outline
Introduction to Mindless Eating

● Mindless eating- Eating food without paying

adequate attention to what and how much is being
eaten

● People are not aware of the daily decisions they

make about food nor the factors influencing their
decisions

● If it’s not driven by hunger or nutritional needs, it

can be characterized as mindless eating

● It can be influenced by external cues such as stress,

images of desirable food, family and friends
 Background—Mindless eating is described as inadequate attention to what and
or how much is eaten. We piloted whether an intervention to diminish mindless
eating, delivered by accessible technologies, is effective and feasible. Text
messages and Facebook are accessible, low-cost technologies to support
behavior change. Design/methods—Pre/post test with convenience sample of 18
adults who perceived having mindless eating behaviors. Across 4 weeks, adults
self-selected to receive short messages concerning mindless eating by Facebook
(n=7), or text messages (n=11). The Facebook intervention encouraged
participants to comment and/or “like” a post if it enhanced their awareness. The
texting intervention was individualized, providing anonymity. Messages were
sent thrice weekly. The primary outcome was pre-post improvement in the

Abstra Mindless Eating Questionnaire (MEQ); feasibility by attrition and satisfaction

with the intervention. Results—Participants averaged as overweight (BMI from
measured weight/height). Average MEQ score did not vary significantly
between either group at baseline. Sign test across all participants showed

ct significant improvement in MEQ score from pre-to-post-intervention (p<0.05),

with similar improvements in Facebook (5 of 7 adults) and text (8 of 11 adults)
groups. Drop-out was similar in the groups (n=3 for text; n=2 for Facebook).
Most (17 of 18) participants reported the messages as slightly to extremely
helpful in enhancing their awareness in food choices as an effort in decreasing
mindless eating. Discussion—Interventions utilizing social media and text
messaging may encourage individuals to increase mindfulness via convenient
and accessible technologies. Study limitations included no control group or
randomization and short-term impact without follow-up.
 Mindless eating cont.
Self Control and Strength Model
● Making decisions directing
behavior and exerting control
requires self control
● Stress has been known to affect
self control strength
● Coping mechanisms for stress can
lead to excessive smoking,
drinking and eating
● Stress has been linked to obesity
and developing maladaptive
coping behaviors
:

Review of
Literature
Mindfulness: A Long-Term Solution for Mindless Eating in
College Students
Objective- Adapt a scale regarding mindfulness traits and test the relationship between mindfulness
and unhealthy eating behaviors among college students who report various levels of stress during
school

Methods: Measured levels of students mindfulness traits and their relationship with mindless eating
habits using various scales, measuring the five dimensions of mindfulness (acting with awareness,
non reactivity to inner experience, non judgement of experience, describing and observing) in
relation with eating habits. Then repeated the same with population of students who practice
mindfulness principles. (college students)

Conclusion: Found that mindfulness is negatively related to overeating and skipping meals, males
are less likely to overeat; mindfulness results in a lower propensity to overeat and to skip meals

Shalini Bahl, George R. Milne, Spencer M. Ross, and Kwong Chan (2013) Mindfulness: A Long-Term Solution for
Mindless Eating by College Students. Journal of Public Policy & Marketing: Fall 2013, Vol. 32, No. 2, pp. 173-184.
 Adapting Behavioral Interventions for Social
Media Delivery
Purpose: Be able to explore the opportunity that exists with social media as a modularity to
deliver behavioral interventions and provide supplemental information about behavioral
strategies to maximize attendance and retention of the intervention

→ Create a process and a set of guidelines for adapting a behavioral intervention for social
media delivery

Conclusion: Social Network delivered interventions requires an understanding of the target

platform. Want to be able to know how to utilize that platform and the role it has in the
intervention. Content from traditional interventions must be translated to the social network
format in order to be effective

Pagoto, S., Waring, M. E., May, C. N., Ding, E. Y., Kunz, W. H., Hayes, R., & Oleski, J. L. (2016). Adapting Behavioral
Interventions for Social Media Delivery. Journal of Medical Internet Research, 18(1), e24. http://doi.org/10.2196/jmir.5086
Twitter- delivered Behavioral weight- loss interventions: A pilot
series
Objective- Purpose was to use an online social network: twitter to reduce the burden of lifestyle
interventions to the extent that they displace in person visits and may enhance opportunities for
social support for weight loss

Methods: Conducted an iterative series of pilot studies (3) to evaluate the feasibility and
acceptability of using online social networks to deliver a lifestyle intervention

Conclusion: Using social networks ( twitter) to deliver weight loss counseling may be less
expensive and more convenient alternative to traditional modalities that require numerous clinic
visits.

Pagoto, S. L Waring M.E Schneider, K. L. Oleski,, J. L Olendzki, E. , Haye, R.B., Lemon, S.C. ( 2015). Twitter- delivered Behavioral Weight loss
interventions: A pilot series. JMIR. Research protocols, 4 (4), e123. http://.org/10.2196/resprot. 4864
Pagoto, S. L Waring M.E Schneider, K. L. Oleski,, J. L Olendzki, E. , Haye, R.B., Lemon, S.C. (2015). Twitter-
delivered Behavioral Weight loss interventions: A pilot series. JMIR. Research protocols, 4 (4), e123.
http://.org/10.2196/resprot. 4864
Text Messaging as Adjunct to Community-Based Weight
Management Program
Purpose: Evaluate the effect of SMS texts on
overweight adults enrolled in a weight
management program (WeightWatchers)

Methods: Participants received biweekly texts

over 12 weeks. The texts encouraged them to
adopt healthy eating behaviors and overcome
related barriers. The control group received no
texts.

Outcome: The intervention group scored higher

in exercise and nutrition self-efficacy. 79%
participants reported that the texts helped them
adopt healthier eating behaviors. Weight loss was
significant in the intervention group (mostly
related to Weight Watchers). Claudia M. Bouhaidar, PhD, RN, MSN, Jonathan P. Deshazo, PhD, MPH, Puneet Puri, MD, Patricia Gray,
PhD, RN, Jo Lynne W. Robins, PhD, RN, ANP-BC, and Jeanne Salyer, PhD, RN
 Need and the Significance of the Study
New approach to deliver
Why use social media/Texting→
Behavioral Interventions → ● Health communication using technology is a new
Shaping an intervention that looks at form and innovative way of interacting with not
enhancing mindfulness and promoting just patients but also the public
appropriate eating habits, this may ● Facebook accounts for almost 70% of social media
show potential to encourage weight users
loss ● 77% of Americans own a smartphone
● The common trend associated with these
The lack of success of interventions display a cost benefit in that there is
interventions→ Creating no cost associated
interventions targeting weight loss and ● These technologies provide quick and easy way to
communicate with a target audience
healthy eating behaviors continues to be a
struggle in terms of feasibility
 Pilot test a technology-delivered mindful
Objective eating intervention on short-term self-
reported mindful eating behaviors.
:
 1. Participants will have significant
improvements in the overall score of
Hypothesi mindful across the 4-weeks

s: 1. The intervention can be feasibly delivered

through technology (text messages or
Facebook).
 •Approval from UCONN’s Institutional Review
Board (IRB).
•UCONN Faculty & staff recruited via
UCONN’s Daily Digest.
•Interested participants completed a
screening questionnaire -

Inclusion Criteria:
Methods Individuals who are staff or alumni of UCONN, individuals
who have experience with social media (Facebook) or be
comfortable receiving text messages, subjects may be
male/female

Exclusion Criteria:
pregnant or lactating women, mental health issues, anyone
with an eating disorder (SCOFF Questionnaire)
 Participants that passed the screening questionnaire-->
•Pre-survey which included demographic questionnaire
and MEQ. MEQ is a validated tool to assess
disinhibition, awareness, external cues, emotional
response, and distractions on a 4-pt scale (1-least, 4-
most mindful). 5
•Participants self-selected into the Facebook or Text

Methods: messaging group.

•The messages/posts had brief information on the
following weekly topics: Increasing fruit and vegetable

Protocol, data collection plan

consumption, weight loss and maintenance, and mindful
eating.
•Participants were sent a post-survey which evaluated
MEQ once again, as well as questions which analyzed
overall aspects of the intervention.
 Study Design

Figure 1. Study Design. Pilot study

allowing for self selection of
intervention group (n=18); 4-week
duration with pre and post MEQ
administration.
Mindful Eating 4- Topic Discussion of
Each Week
Week 1: Increasing Fruit and Vegetable consumption

Week 2: Maintain Weight/Lose Weight

Week 3: Mindless Eating I: Eating Pattern

Week 4: Mindless Eating II: Distractions

Study Demographics
Characteristic
s of
Study
Population
BMI Distribution in Overall Study
Sample Nutrition
Posts/Messages
Facebook
Group
Text Message Group
Data Analysis
Comparison of Pre-Post MEQ scores within
Groups
Text Messaging -
Results
Facebook- Results
Figure 5. Participant Overall Pre-Post ● Participants who decline from
MEQ pre to post intervention had
significantly higher baseline
MEQ scores (p<0.01)

● 8 of 13 participants improved
from pre to post-testing which
is significant by sign testing
(one-way, p<0.05).
 •Most (17 of 18) participants reported
the messages as slightly to extremely
helpful in enhancing their awareness in
food choices as an effort in decreasing

Feasibility of mindless eating

•Most participants (15/18) reported the

Study Information provided through the

Posts/Messages as being easily
accessible, while (3/17) reported them
as being sometimes easily accessible
•Most participants (12/18) reported that
their current eating pattern has
improved in some extent since the start
as the study
 •These findings demonstrate that an
intervention targeting mindful eating may be
effective and feasible through convenient,
cost-effective and easily accessible
technological platforms
Limitations:

•This pilot study included a small sample size

that reflected a lack of diversity within
Discussion participants which may not allow for
generalization
•Pre/Post analysis was completed based on
self-reported data
•This study did not include a control group or
randomization
•Study design only allows for short–term
impact with no follow-up
 Future
Implications
•More studies are needed to determine the feasibility of technology-based health
and wellness programs 6

•The MEQ questionnaire may be helpful in identifying problem areas in an

individual’s mindful eating habits 4,5

•Correcting for limitations can allow for interventions that first target mindful eating
as a step towards weight loss 7,8
 Referenc
es
1. Junghans, A. F., Evers, C., & De Ridder, D. T. D. (2013). Eat Me If You Can: Cognitive Mechanisms Underlying the Distance
Effect. PLoS ONE, 8(12), e84643. http://doi.org/10.1371/journal.pone.0084643

2. Valdez, R. S., Holden, R. J., Novak, L. L., & Veinot, T. C. (2015). Transforming consumer health informatics through a patient
work framework: connecting patients to context. Journal of the American Medical Informatics Association : JAMIA, 22(1), 2–10.
http://doi.org/10.1136/amiajnl-2014-002826

3. Kaipainen, K., Payne, C. R., & Wansink, B. (2012). Mindless Eating Challenge: Retention, Weight Outcomes, and Barriers for
Changes in a Public Web-Based Healthy Eating and Weight Loss Program. Journal of Medical Internet Research, 14(6), e168.
http://doi.org/10.2196/jmir.2218

4. Pagoto, S., Waring, M. E., May, C. N., Ding, E. Y., Kunz, W. H., Hayes, R., & Oleski, J. L. (2016). Adapting Behavioral Interventions
for Social Media Delivery. Journal of Medical Internet Research, 18(1), e24. http://doi.org/10.2196/jmir.5086

5. Pagoto, S. L., Waring, M. E., Schneider, K. L., Oleski, J. L., Olendzki, E., Hayes, R. B., … Lemon, S. C. (2015). Twitter-Delivered
Behavioral Weight-Loss Interventions: A Pilot Series. JMIR Research Protocols, 4(4), e123. http://doi.org/10.2196/resprot.4864

6. Shalini Bahl, George R. Milne, Spencer M. Ross, and Kwong Chan (2013) Mindfulness: A Long-Term Solution for Mindless
Eating by College Students. Journal of Public Policy & Marketing: Fall 2013, Vol. 32, No. 2, pp. 173-184.