MINDFUL
EATING AND EATING PATHOLOGY: CORRELATION BETWEEN THE MINDFUL EATING
QUESTIONNAIRE AND EATING DISORDER INVENTORY-3^RD EDITION

Literature Review

Recently, several mindfulness-based interventions have been developed and tested to treat eating disorders, and eating-related psychological problems, and to aid in weight loss (L. Hulbert-Williams, Nicholls, Joy, & N. Hulbert-Williams, 2013).  However, there is limited research on the relationship between mindful eating and eating pathology. Mindful eating is defined as the non-judgmental awareness of physical and emotional sensations associated with eating (Framson et al., 2009). Previous studies have focused on the relationship between mindful eating and weight-related issues and the development and validation of the Mindful Eating Questionnaire. The present study seeks to examine the relationship between mindful eating and eating pathology.

Eating
Disorders

According to the National Eating Disorder Association, approximately 20 million women and 10 million men suffer from a clinically significant eating disorder at some point during their lifetimes (Wade, Keski-Rahkonen, & Hudson, 2011). The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (5^th ed.; DSM-5; American Psychiatric Association, 2013) states that the lifetime prevalence of Anorexia Nervosa (AN) is approximately 0.4%, Bulimia Nervosa (BN) is approximately 1% to 1.5%, and Binge Eating Disorder (BED) is 1.6% (American Psychiatric Association, 2013). Despite the small point-prevalence of the aforementioned eating disorders, related symptoms such as disordered eating and disordered body image affect a growing number of individuals, particularly young women (Mantinolli et al., 2016). AN and BN share characteristics such as avoiding weight gain and having a strong desire to maintain control over eating-related behaviors, urges, thoughts, and feelings (Butryn et al., 2013). BED is characterized by having recurrent episodes of binge eating occurring once a week for at least three months, lack of control over eating during an episode, marked distress during an episode, and feelings of disgust, depression, or guilt after an episode (APA, 2013). Additionally, all eating disorders are associated with extreme emotions, attitudes, and behaviors; thus, they can result in many psychological and life-threatening medical consequences (Fan et al., 2010).

Anorexia
Nervosa

According to the DSM-5, there are three diagnostic criteria for
Anorexia Nervosa (AN). The first criterion states that an individual’s caloric
intake is significantly below the daily caloric requirement, leading to a
considerably low body weight based on age, gender, development, and physical
health condition (American Psychiatric Association, 2013). A body mass index
(BMI) below 18.5 kg/m² is considered a low body weight (APA, 2013).
The second criterion states that an individual must experience extreme fear of
gaining weight and must engage in behaviors that help him or her avoid weight
gain, despite being dangerously underweight (APA, 2013). Additionally, weight
loss in these individuals does not decrease the intense fear of weight gain;
instead it may increase it (APA, 2013). Thethird criterion involves an individual’s indifference to his or her
significantly low body weight and distortion of how he or she views and
understands body weight or shape (APA, 2013). These individuals believe they
are overweight and can be concerned with specific body parts such as the
abdomen, buttocks and thighs (APA, 2013). 
They engage in behaviors such as constantly weighing themselves, frequently
looking in mirrors or measuring different body parts, and excessively worrying
about feeling fat (APA, 2013). Their self-esteem is significantly dependent on
their perceptions of their bodies. These individuals perceive weight loss as a
great achievement and indicative of self-control (APA, 2013). These criteria
must be met to be diagnosed with AN.

In addition, there are two subtypes within the diagnosis of AN, Restricting
type and Binge-Eating/Purging type (APA, 2013). Individuals with Restricting
type do not engage in binge eating or purging behavior (APA, 2013). Their
weight loss is through dieting, fasting, and/or excessive exercise (APA, 2013).
Binge eating occurs when an individual consumes an amount of food that exceeds
what most individuals consider normal in a given period of time, such as two
hours. Purging behavior includes self-induced vomiting, or misuse of laxatives,
diuretics, or enemas (APA, 2013). Individuals with Binge-Eating/Purging type
engage in recurrent episodes of binge eating or purging behaviors. The
distinction between AN Binge-Eating/Purging subtype and Bulimia Nervosa is that
individuals within this subtype of AN are significantly below normal body
weight (APA, 2013). 

Bulimia Nervosa

Individuals with Bulimia Nervosa (BN) commonly fall within the
normal weight or overweight range (BMI ≥ 18.5 and < 30 in
adults; APA, 2013).  According to DSM-5, there
are five diagnostic criteria for BN. The first criterion states that an
individual must have recurrent episodes of binge eating (APA, 2013). An episode
of binge eating is not restricted to one setting (APA, 2013). An individual may
begin a binge in a public place and continue eating upon returning home (APA,
2013). During episodes, individuals believe that they lack control over their
eating and have an inability to avoid eating or stop eating once started (APA,
2013). Binge eating is not restricted to certain types of food, but individuals
most commonly binge on foods that they may avoid at other times (APA, 2013).
The second criterion states that an individual engages in recurrent
inappropriate compensatory behaviors to avoid weight gain such as: self-induced
vomiting; misuse of laxatives, diuretics, or other medications; fasting; or
excessive exercise (APA, 2013). The third criterion states that, on average,
the binge eating and compensatory behaviors must occur at least once a week for
three months (APA, 2013). The fourth criterion states that the individual’s
self-esteem is negatively influenced by body shape and weight (APA, 2013).
Finally, the fifth criterion states that these disturbances do not
exclusively occur during episodes of Anorexia Nervosa. This is because
individuals with BN are similar to individuals with AN in that they fear weight
gain, desire to lose weight, and are dissatisfied with their bodies (APA,
2013).

Binge Eating Disorder

Individuals with Binge-Eating Disorder (BED) fall within the normal-weight,
overweight, and obese ranges BMI (≥ 18.5, < 30 and > 30
in adults; APA, 2013). According to the DSM-5, there
are five diagnostic criteria for BED. The first criterion states that an
individual must have recurrent episodes of binge eating and experience a loss
of control over eating during the episodes (APA, 2013). The second criterion
states that the binge-eating episodes must fall within three or more of the
following categories: eating
significantly faster than normal; eating even when feeling very full; eating
large amounts of food despite not feeling hungry physically; eating alone to
avoid the feeling of embarrassment by the amount of food eaten; and feeling disgusted,
depressed, or extremely guilty with oneself after eating (APA, 2013).
The third criterion states that the individual experience marked distress
regarding binge eating (APA, 2013).  The
fourth criterion states that the binge eating, on average, occurs at least once
a week for three months (APA, 2013). Lastly, the fifth criterion states that
the binge eating must not be associated with the recurrent use of improper
compensatory behaviors seen in Bulimia Nervosa, and does not exclusively occur
during a period of Bulimia Nervosa or Anorexia Nervosa (APA, 2013).

Eating Disorder Not Otherwise Specified

This category includes individuals who have symptoms of eating disorders that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning; however, they do not meet the full criteria for any of the specific eating disorders (APA, 2013). The DSM-5 provides five examples of the otherwise specified category. The first type is Atypical Anorexia Nervosa (AN), in which all the criteria for AN are met, except significant weight loss (APA, 2013). Individuals in this category fall within the normal or above normal weight range (APA, 2013).

The second type is
Bulimia Nervosa (of low frequency and/or limited duration), in which all of the
criteria for BN are met, except that binge eating and improper compensatory
behaviors occur less than once a week and/or for less than three months (APA,
2013). The third type is Binge-Eating Disorder (of low frequency and/or limited
duration), in which all criteria for BED are met, except binge eating occurs
less than once a week and/or for less than three months (APA, 2013). The fourth
type is Purging disorder, in which recurrent purging behaviors such as
self-induced vomiting and misuse of laxatives, diuretics, or other medications
are used to influence weight or shape without binge eating (APA, 2013). The
fifth type is Night Eating Syndrome, which involves recurrent episodes of night
eating. Individuals with this disorder consume excessive amounts of food after
the evening meal or eat after awakening from sleep (APA, 2013). Individuals are
aware of and can recall eating (APA, 2013). The night eating is not better
explained by external factors such as changes in sleep-wake cycle or by local
social norms (APA, 2013). Also, the night eating must cause significant
distress and/or impairment in the functioning of the individual (APA, 2013).
Additionally, the disordered pattern of eating is not better explained by BED
or other mental disorders, medical disorders, or effects of medication (APA,
2013).

Problems Associated with Eating Disorders

There are several medical
and psychological problems associated with eating disorders. Some of the known medical consequences associated with eating disorders include, but
are not limited to, amenorrhea, loss of bone mineral density, hypertrophy
(enlargement) of salivary glands, dental erosion, scars or calluses on the
dorsal surface of the hand, lack of nutrients, abdominal pain, esophageal
tears, gastric rupture, lanugo (soft, downy hair), hypotension, and
hypertension (APA, 2013). Psychological problems associated with eating
disorders include, but are not limited to depressed mood, social withdrawal,
irritability, insomnia, and anxiety (APA, 2013). Furthermore, AN has the
highest mortality rate among psychiatric disorders (Arcelus, Mithchell, Wales,
& Nielsen, 2011). Individuals with AN have an elevated suicide risk, with
approximately 12 suicides per 100,000 cases of AN per year (APA, 2013).
Additionally, eating disorders cause significant impairments in cognitive
functioning, judgment, emotional stability, and ability to engage in daily life
activities (Wagner et al., 2016). Approximately one third of past patients relapse
or develop another eating disorder diagnosis (Nyman-Carlsson, Engstrom,
Norring, & Nevonen, 2014).  These
individuals have a high level of co-morbidity of both psychological and
physiological problems, such as depression and anxiety disorders, and sleep
deprivation and cardiovascular and gastrointestinal complications
(Nyman-Carlsson et al., 2014).

Mindfulness

Mindfulness is defined as an “awareness that emerges through paying
attention on purpose, in the present moment, and non-judgmentally to the unfolding
experience moment by moment” (Kabat-Zinn, 2003, p.145). In other words, the
general emphasis of mindfulness is focusing on the present moment, and
acknowledging and accepting one’s feelings, thoughts, and bodily sensations
(Khan & Zadeh., 2014). Furthermore, mindfulness is associated with many
positive health outcomes, such as decreasing depression, anxiety, and chronic
pain, and increasing in immune functioning (Framson et al., 2009).

Research on Mindfulness and Eating Disorders 

What is the connection between eating disorders and mindfulness?
Research has shown that individuals with eating disorders have deficits in
emotion recognition and emotional awareness, two concepts that are emphasized
in mindfulness (Butryn et al., 2013). As a result, mindfulness-based treatments
can be useful in treating eating disorders. Mindfulness-based treatments for
eating disorders are developed using cognitive-behavioral, dialectical
behavior, and acceptance and commitment approaches (Kristeller, Baer &
Quillian-Wolever, 2006).

Research has examined the relationship between mindfulness and
eating disorder symptomatology. A study by Butryn, Juarascio, Kerrigan, Clark,
O’Planick, and Forman (2013) studied this relationship in women receiving
residential treatment. The sample consisted of 105 patients who were diagnosed
with either Bulimia Nervosa, Anorexia Nervosa, or Eating Disorder Not Otherwise
Specifiedaccording to the DSM-IV.
The patients were given several measures that included the Eating Disorder
Examination-Questionnaire (EDE-Q; Fairburn &Beglin, 1994), the Eating
Disorders Inventory-3^rd edition (EDI-3; Garner, 2004), the Body
Image Acceptance and Awareness Questionnaire (BI-AAQ; Sandoz, 2010), the
Philadelphia Mindfulness Scale (PHLMS; Cardaciotto, Herbert, Forman, Moitra,
& Farrow, 2008), the Emotional Avoidance Questionnaire (EAQ; Taylor,
Laposa, & Alden, 2004), and The Eating Attitudes Thoughts and Defusion
Scale (EATDS; Shaw, Butryn, Juarasico, Kerrigan, & Matteucci, unpublished
manuscript). Participant responses to the measures were evaluated at
pre-treatment and post-treatment. The researchers found that eating disorder
symptomatology was associated with lower awareness, acceptance, and cognitive
defusion. Additionally, they found that eating disorder symptomatology was
associated with higher emotional avoidance. The researchers concluded that
improvements in these variables were related to improvements in eating disorder
symptomatology (Butryn et al., 2013). This study provides evidence that practicing
mindfulness can be beneficial for patients suffering from eating disorders.

A systematic review by Olson and Emery (2015) examined the effectiveness of mindfulness training in weight loss programs. The researchers searched for published studies through online databases, and reviewed and evaluated them for methodological strengths and weaknesses. The search yielded a total of 19 studies on the effects of mindfulness-based-interventions on weight loss. The studies included 13 randomized controlled trials and six observational. From the 19 articles, six randomized controlled trials showed significant weight loss among individuals in the mindfulness condition. Overall, 13 of the 19 studies found a relationship between significant weight loss and mindfulness interventions. However, there was no clarity regarding the degree to which mindfulness is responsible for weight loss. The researchers concluded that further research is needed to determine the relationship between mindfulness and weight loss (Olson et al., 2015).

Therapeutic Interventions Using Mindfulness

Mindfulness-based interventions are commonly used to address
different types of dysregulation disorders, such as anxiety, depression, and
addictions (Kristeller, Wolever & Sheets, 2013). A variety of
mindfulness-based approaches have been used to treat clinical eating disorders.
These approaches include Dialectical Behavior Therapy to treat BED and BN (DBT;
Linehan, 1993), Mindfulness-Based Cognitive Therapy to treat BED (MBCT; Segal,
Williamns, & Teasdale, 2002), Acceptance and Commitment Therapy to treat AN
(ACT; Hayes, Strosahl & Wilson, 1999), and Mindfulness-Based Eating Awareness
Training to treat BED (MB-EAT; Kristeller & Hallett, 1999).
Mindfulness-based interventions are believed to result in improvements in
eating pathology by allowing individuals to choose to respond to distress in a
positive manner instead of engaging in negative eating behaviors or restricting
eating (Prowse, Bore & Dyer, 2013).

Despite its origin in treating personality disorders, DBT has
recently been used to treat individuals with BED and BN. Both BED and BN are
associated with emotional regulation; therefore, DBT is a good solution because
it focuses on improving an individuals’ ability to manage negative emotions
adaptively by using skill modules that focus on mindfulness, emotional
regulation, and distress tolerance (Kristeller et al., 2006). The mindfulness
skills in particular are used to teach increased nonjudgmental awareness of
one’s emotional states in the present moment without immediate behavioral
reaction (Kristeller et al., 2006). This promotes emotional regulation because
it teaches individuals to identify their emotions without focusing on changing
or criticizing them, and engaging in impulsive reactions (Kristeller et al.,
2006). 

MBCT can be used to treat individuals with BED. These individuals
typically avoid self-awareness and experience frequent negative thoughts and
emotions due to not meeting their own personal standards (Kristeller et al.,
2006). The focus of MBCT is to help individuals develop nonjudgmental and
nonreactive recognition and acceptance of their bodily sensations, perceptions,
cognitions, and emotions (Kristeller et al., 2006). There are four key purposes
of this training in treating BED: 1) to improve individuals’ ability to
identify hunger and satiety (feeling full) cues, 2) to increase willingness to
experience negative emotional experiences related to the triggers of binge
eating, 3) to decrease focus on negative thoughts, and 4) to train individuals
to engage in positive behaviors in stressful situations (Kristeller et al.,
2006).

ACT can be used to treat individuals with AN. Act is focused on
mindfulness and acceptance-based strategies, and can be used to help
individuals with AN address fat-related thoughts, body image issues, and fears
of  being overweight (Kristeller et al.,
2006). ACT uses various analogies to help individuals visualize their thoughts
and feelings as physical objects they can see and manipulate. One analogy used
is called “thought parade,” which teaches individuals to observe thoughts
nonjudgmentally and accept them, rather than acting on them by engaging in
negative eating behaviors (Kristeller et al., 2006). In this analogy, individuals
are asked to imagine their “fat-related” thoughts written on cards and carried
by participants in a parade. Their goal is to observe the parade of thoughts without
believing or reacting to them (Kristeller et al., 2006). Another strategy used
is called “bus driver,” which teaches individuals to experience “fat-related”
thoughts in the present without acting towards them, and work towards their
most valued goals (Kristeller et al., 2006). In “bus driver”, individuals are
asked to imagine that they are bus drivers driving towards their most valued
goals while their thoughts act as the passengers (Kristeller et al., 2006). In
this case, their goal is to experience these thoughts and continue driving
towards to their most valued goals, instead of changing directions based on
their thoughts (Kristeller et al., 2006).

MB-EAT was specifically developed to treat BED (Kristeller et al.,
2006). MB-EAT includes traditional mindfulness meditation techniques and guided
meditation, which focuses on specific issues regarding shape, weight, and
eating-related self-regulatory processes (Kristeller et al., 2006). MB-EAT
sessions encourage individuals to use eating-related meditations, which help
individuals develop nonjudgmental attention to sensations, thoughts, and
emotions related to binge triggers, hunger, and satiety (Kristeller et al.,
2006). The overall goal is to increase psychological and physiological self-regulation
(Kristeller et al., 2006).

A study by Wallace (2017) examined the effectiveness of an
intervention using techniques from ACT in addition to activities from The Body
Project to decrease negative body image concerns and increase mindfulness
skills in college females.  The Body
Project is a program designed for adolescent females that involves using
dissonance-based activities and discussions to decrease eating disorder
symptomology and prevent the development of future symptoms. Interventions used
from ACT focused on teaching individuals how to separate who they are or their
core beliefs from their maladaptive thoughts. Participants completed The Body
Assessment (BA; Lorenzen, Grieve, & Thomas, 2004) and The Five Facet
Mindfulness Questionnaire Short Form (FFMQ-SF; Bohlmeijer, ten Klooster,
Fledderus, Veehof, & Baer, 2011) both before and after the combined ACT and
The Body Project intervention. Results from this study revealed a significant
difference in body image in participants after receiving the combined
intervention. The researcher concluded that using specific ACT techniques and
The Body Project activities can help reduce and prevent negative body image.

Mindful Eating

Mindful eating is defined as the non judgmental awareness of physical and emotional sensations associated with eating (Framson et al., 2009). Mindful eating was originally introduced to dieting for weight management; however, the focus of mindful eating is not on what is being eaten. Instead, the focus is on the process of eating (Khan & Zadeh, 2014). According to Albers (2008), the first step of mindful eating is to notice the taste, smell, and texture of the food being eaten. The second step is to identify daily habits such as eating while multitasking or eating subconsciously (Albers, 2008). The third step is to be aware of triggers that both initiate and stop eating (Albers, 2008). Mindful eating may help individuals use mindfulness-based strategies to identify and respond to hunger and satiety (Clementi, Casu & Gremigni, 2017). Mindful eating-based interventions have been effective in decreasing obesity-related behaviors, promoting weight loss, and reducing psychological distress in patients with BED (Clementi et al., 2017).

Results from a recent study by Prowse et al (2013) on mindfulness and eating disorder symptomatology indicated that the mindfulness skill described as “observing” was associated with higher reports of eating disorder symptoms. Furthermore, results indicated that the mindfulness skills of “acceptance without judgement” and “acting with awareness” were associated with lower levels of eating disorder symptoms (Prowse et al., 2013). Additionally, there was evidence that these skills are associated with greater resiliency against eating pathology. Another study by Khan and Zadeh (2014) revealed that mindful eating was positively correlated with overall mental well-being. The results of this study were consistent with previous research findings that individuals with high scores in psychopathology have lower levels of mindfulness skills, with the exception of skills related to “observing” (Baer, Smith, Hopkins, Krietemeyer, & Toney., 2006).

Mindful Eating Questionnaire

Previous studies have investigated both the development and
validation of the Mindful Eating Questionnaire (MEQ; Framson et al., 2009). The
MEQ has five indices, which are Disinhibition, Awareness, External Cues,
Emotional Response, and Distraction (Framson et al., 2009).  The Disinhibition index examines the
inability to stop eating even when one is full (Framson et al., 2009). The
Awareness index examines the ability to be aware of how the food looks, tastes,
and smells (Framson et al., 2009).  The
External Cues index evaluates eating in response to environmental cues (Framson
et al, 2009). The Emotional Response index examines eating in response to
negative emotional states (Framson et al., 2009). The Distraction index examines
the inability to focus on  eating and
being distracted by other things (Framson et al., 2009). 

A study by Framson et al. (2009) evaluated the development and
validation of the MEQ. The researchers selected a list of constructs for the
MEQ through previously published studies on both eating behavior and
mindfulness. Based on the results, they selected the Disinhibition index, External
Cues index, and Emotional Response index. The final questionnaire included 28
items and five subscales. The questionnaire was distributed by mail to 510
participants who came from seven different convenience samples. Samples
included 200 individuals from a yoga studio, 100 students from a university
fitness facility, 40 individuals from a weight loss program, 40 individuals
from a women’s weight loss and fitness facility, 40 individuals from a software
development company, 40 individuals from a non-profit company, and 50 teachers
and administrators from a preparatory school. Participants were also required
to self-report their weight, height, age, sex, race/ethnicity, highest level of
education achieved, yoga practice, walking for exercise or transportation, and
whether they took part in moderate or strenuous exercise. The researchers
examined the MEQ in relation to demographic characteristics, and concluded that
the MEQ had good measurement characteristics. The subscales in the MEQ had good
internal consistency reliability, ranging from 
r = .64 to r = .83. The reliability of the MEQ summary score (mean of 5
subscale scores) was r = .64. The correlations among all the subscales ranged
from r = .14 to r = .47. The correlations between subscales and the MEQ summary
scores ranged from r = .57 to r = .71.

A recent study by Clementi et al. in Italy (2017) also assessed the psychometric properties of the MEQ. In this study, 15 experts evaluated the 28 items and the fives indices of the MEQ. The sample consisted of 1,067 Italian adults of which 61.4% were women. The participants completed the MEQ and the Freiburg Mindfulness Inventory (FMI; Buchheld, Buttenmuller, Kleinknecht, & Schmidt, 2006), and reported their gender, age, education, height and weight. Additionally, 62 participants completed a four-week test-retest.  The content analysis limited the MEQ to 20 items. The researchers found adequate internal consistency, and test-retest reliability. The researchers concluded that there is good validity and reliability for the 20-item MEQ, and that this questionnaire can be used for evaluating eating-related issues. This study and the previously discussed study both show that the MEQ is a valid measure to examine eating-related issues such as eating behaviors and eating pathology.

Limitations of Existing Research

Research has been conducted to evaluate the development and validation of the Mindful Eating Questionnaire (MEQ). Studies have shown that there is a relationship between mindfulness and eating disorder symptoms. However, most studies have focused on the effectiveness of mindfulness-based interventions for treating eating disorders. There is a lack of research in examining whether deficits in the various indices of the MEQ are correlated with the risk of developing an eating disorder. Improving clinicians’ ability to identify those at risk for eating disorders would allow them to recognize and eradicate negative eating behaviors before the development of an eating disorder.  

The Current Study

The purpose of the present study is to examine the relationship
between mindful eating and eating pathology and to determine whether a
mindful-eating questionnaire is a good predictor for eating disorder
symptomology and disordered eating behavior. The current study will examine the
correlations between the ME      Q (MEQ; Framson
et al., 2009) and the EDI- 3^rd Edition (EDI-3; Garner, 2004). The
study will specifically focus on examining the correlations between the overall
MEQ score and the Eating Disorder Risk Composite score (EDRC) from the EDI-3^rd
Edition. The EDRC is a global measure of eating and weight-related concerns.
The EDRC score is comprised of three scales, which are Drive for Thinness (DT),
Bulimia (B), and Body Dissatisfaction (BD). The DT scale assesses an individual’s desire to be thin,
concern with dieting, preoccupation with weight, and an intense fear of weight
gain. The B scale assesses an individual’s tendency to think about or engage in
overeating. The DB scale assesses an individual’s dissatisfaction with overall
shape and size of different areas of the body (i.e., stomach, hips, and
thighs). As discussed in the previous sections, individuals with AN are
preoccupied with an intense fear of gaining weight and engage in bheaviors that
help them avoid weight gain (APA, 2013). Individuals with BN lack control over
their eating and engage in dangerous compensatory behaviors (APA, 2013).
Indivdiauls with BED also have a loss of control over eating and they are
unaware of hunger or satiety cues (APA, 2013). With this knowledge, it is
evident that these individuals are not focused on the process of eating which
is the essential feature of Mindful Eating.

The primary hypothesis is that there will be a negative correlation
between the MEQ overall score and the EDI-3 eating disorder risk composite
score. The secondary hypotheses are that there will be a negative correlation
between MEQ overall score and Drive for Thinness, a negative correlation
between MEQ overall score and Bulimia, and a negative correlation between MEQ
overall score and Body Dissatisfaction. 

Method

Participants and Design

Participants from this study will consist of male and female undergraduate students.  Participants will be at least 18 years old and will vary in ethnicity, year in college, and age. A power analysis using nine studies found a mean effect size (Cohen’s d) of 0.63, which is a medium effect size. Using a within-subjects design, 80 participants per group yields a power of 88, which means that a true difference can be detected, if one is present, 88 percent of the time. There is one group in this study; therefore the total number of participants should be at least 80.

Measures  

Demographics: Participants will be asked to report their age, gender, race/ethnicity, year in college, height, and weight. The height and weight will be used to calculate the participant’s body mass index (BMI). See appendix A.

Mindful Eating Questionnaire (MEQ; Framson et al., 2009): The MEQ consists of 28 items that assess Mindful Eating. The 28 items are divided into five subscales: Disinhibition, Awareness, External Cues, Emotional Response, and Distraction. Each subscale has three to eight questions. The five subscales evaluate an individual’s ability to stop eating when full; awareness of how the food looks, tastes, and smells; inclination to eat in response to external cues; tendency to eat in response to negative emotional states; and level of distraction while eating (Framson et al., 2009). An example item consists of, “I eat so quickly that I don’t taste what I’m eating.” The 28 items are rated on a four-point Likert-type scale ranging from 1 (never/rarely)to 4 (usually/always). Specific items are reversed before scoring (1, 6, 28, 2, 5, 7, 9, 11, 18, 13, 17, 19, 27 ). Scores from each subscale are determined by dividing the sum of the response value by the number of questions answered. The MEQ overall score is determined by calculating the mean of the five subscale scores. Higher scores indicate more mindful eating. The MEQ has moderate reliability. Each subscale has good internal consistency reliability: Disinhibition (.83), Awareness (.74), External cues (.70), Emotional response (.71), and Distraction (.64) (Framson et al., 2009). See Appendix B.

Eating Disorder Inventory 3^rd Edition (EDI-3; Garner, 2004):  The EDI-3 assesses the behavioral and psychological traits commonly found in individuals with Bulimia Nervosa, Anorexia Nervosa, Other Specified Feeding and Eating Disorder, and Binge Eating Disorder. The EDI-3 consists of 91 items organized into 12 primary scales, which are as follows: Drive for Thinness (DT), Bulimia(B), Body Dissatisfaction(BD), Low Self-Esteem(LSE), Personal Alienation(PA), Interpersonal Insecurity(II), Interpersonal Alienation(IA), Interoceptive Deficits(ID), Emotional Dysregulation(ED), Perfectionism(P), Asceticism(A), and Maturity Fears(MT). An example item says “I exaggerate or magnify the importance of weight.” The items are rated on a six-point Likert-type scale from Always to Never. While the participants will complete the entire EDI-3, for the purposes of the current study, only the DT, B, and BD scales will be considered. Scores for these three subscales are calculated by summing the response value for the questions answered in that subscale. Each subscale raw score is translated into a T-score. The three T-scores summed will provide an Eating Disorder Risk Composite score.Higher scores indicate higher levels of eating disorder symptomology and higher risks of developing an eating disorder. The EDI-3 has good internal consistency reliability ranging from .80 to .90 and test-retest reliability ranging from .93 to .98 (Garner, 2004). See Appendix C.

Procedure

After receiving Institutional Review Board approval, participants
will be recruited at Western Kentucky University through the Department of
Psychology Study Board system. The Study Board is an online program that allows
participants to schedule to participate in active research studies. The
recruiting message will inform participants that they must at least be 18 years
old to participate. Upon arrival to the lab, participants will be given an
informed consent form to complete, which will notify them of the confidentially
of their results and their right to discontinue their participation at any
time. Participants will receive a brief description of the study. Participants
will also be made aware of any potential benefits or harms in this study, and
in this case, there is minimal harm. Additionally, participants will be given a
list of mental health resources available to help them in the event that they
should experience any difficulties after the study.

The participants will complete the demographics questionnaire, the MEQ, and the EDI-3. The last two measures will be counterbalanced to avoid order effects. The study will take between 30 to 45 minutes to complete. These questionnaires will be scored and stored safely in a filing cabinet in Dr. Grieve’s office where only the research investigators will have access. After completing this study, the participants will be debriefed and sincerely thanked for their participation.

Proposed Data Analysis

Data will be analyzed and interpreted using the IBM’s SPSS 24
software. To calculate the MEQ subscale scores, questions answered within each
subscale will be added according to the response value and the total sum for
each scale will be divided by the number of questions answered. The MEQ overall
score will be determined by adding all the subscale scores together and
dividing it by 5. To calculate the Eating Disorder Risk composite score, the
scores for the DT, B, and BD scales have to be calculated. The DT, B, and BD
scores will be calculated by summing
the response value for the questions answered in each subscale. The raw score
from each subscale will be translated into T- scores. The three T-scores summed
will provide an Eating Disorder Risk composite score.

Hypothesis Testing

The primary hypothesis states that there will be a negative correlation between the overall MEQ score and the Eating Disorder Risk composite score. To test this hypothesis, a correlation and a regression analysis will be conducted. The bivariate Pearson correlation coefficient (r) will help determine and measure the strength of the linear relationship between the two questionnaires used in the study. The regression analysis will examine if scores from one variable can be predicted by the scores on a second variable. A 1 X 3 one-way Analysis of Variance (ANOVA) will be conducted to determine whether there are any statistically significant differences in the MEQ overall scores between participants who have elevated clinical, typical clinical, and low clinical Eating Disorder Risk composite scores. A 1 X 3 ANOVA will be conducted to determine whether there are any statistically significant differences in the Eating Disorder Risk composite scores between participants who have high, medium, and low MEQ overall scores. The secondary hypotheses states that there will be a negative correlation between MEQ overall score and Drive for Thinness, a negative correlation between MEQ overall score and Bulimia, and a negative correlation between MEQ overall score and Body Dissatisfaction. To test these hypotheses a correlation and a regression analysis will be conducted.

References

Albers, S. (2008). Eat, drink, and be mindful: How to end your
struggle with mindless eating and start savoring
food with intention and joy. Oakland, CA: New Harbringer
Publications.

American Psychiatric
Association. (2013). Diagnostic and
statistical manual of mental disorders (5^th ed.). Arlington, VA: American Psychiatric
Publishing.

Arcelus, J., Mitchell, A. J.,
Wales, J., & Nielsen, S. (2011). Mortality rates in patients with Anorexia Nervosa and other eating disorders. Archives of General Psychiatry, 68, 724- 731

 Baer, R.A., Smith, G. T., Hopkins, J.,
Krietemeyer, J., & Toney, L. (2006). Using self-report assessment methods to explore facets of mindfulness. Assessment, 12, 27-45. doi: 10.1177/1073191105283504

Bohlmejer, E., ten Klooster,
P. M., Fledderus, M., Veehof, M., & Baer, R. (2011). Psychometric properties of the five facet mindfulness
questionnaire in depressed adults and development of a short form. Assessment, 18, 308-320.

Buchheld N, Grossman P,
Walach H. Measuring mindfulness in insight meditation (Vipassana) and meditation-based psychotherapy: the
development of the Freiburg Mindfulness Inventory (FMI). J Medit Medit Res. 2001; 1:11-34

Butryn, M. L., Juarascio, A.,
Shaw, J., Kerrigan, S. G., Clark, V., O’Planick, A., & Forman, E. M. (2013). Mindfulness and its relationship with
eating disorders symptomatology in women receiving residential treatment. Eating
behaviors, 14, 13-16. doi: 10.1016/j/eatbeh.2012.10/005

Cardaciotto, L., Herbert, J. D., Forman, E.M.,
Moitra, E., & Farrow, V. (2008). The assessment of present-moment awareness and acceptance: The
Philadelphia mindfulness scale. Assessment,
87, 116-117.

Clementi, C., Casu, G., &
Gremigni, P. (2017). An abbreviated version of the mindful eating questionnaire. Journal
of Nutrition Education and Behavior, 49,
352-356. doi: 10.1016/j.jneb.2017.01.016.

Fairburn, C. G.,
& Beglin, S. J. (1994). Assessment of eating disorders: Interview or self-report questionnaire? International Journal of Eating Disorders, 16,
363-370.

Fan, Y., Li, Y., Liu, A., Hu,
X., Ma, G., & Xu, G. (2010). Associations between body mass index, weight control concerns and behaviors, and eating
disorder symptoms among non-clinical Chinese adolescents. BMC Public Health, 10, 314. doi: 10.1186/1471-2458-10-314

Framson, C., Kristal, A.,
Schenk, J., Littman, A., Zeliadt, S., & Benitez, D. (2009). Development and validation of the mindful eating
questionnaire. Journal of the American Dietetic Association, 109,
1439-1444. doi: 10.1016/j.jada.2009.05.006

Garner, D. M. (2004). The Eating Disorder Inventory-3: Professional manual. Odessa, FL: Psychological Assessment Resources, Inc.

Hayes, S. C., Strosahl, K. D., & Wilson, K.G. (1999). Acceptance and commitment therapy: An experimental approach to behavior change. New York: Guliford Press.

Hulbert-Williams,
L., Nicholls, W., Joy, J., & Hulbert-Williams, N. (2013). Initial validations of the mindful eating scale. Mindfulness, 5, 719-729. http://dx.doi.org.libsrv.wku.edu/10.1007/s12671-013-0227-5

Kabat-Zinn, J. (2003).
Mindfulness-based interventions in context: Past, present and future. Clinical
Psychology: Science and Practice, 10, 144-156. doi: 10.1093/clipsy.bpg016

Khan, Z., & Zadeh, Z. F.
(2014). Mindful eating and its relationship with mental well- being. Procedia-Social
and Behavioral Sciences, 159,
69-73 https://doi.org/10.1016/j.sbspro.2014.12.330

Kristeller, J. L., Baer, R. A., & Quillian-Wolever, R. (2006). Mindfulness-based approaches to eating disorders. In R. A. Baer, R. A. Baer (Eds.), Mindfulness-based treatment approaches: Clinician’s guide to evidence base and applications, 75, 76-91. San Diego, CA, US: Elsevier Academic Press. doi: 10.1016/B978-012088519-0/50005-8 http://dx.doi.org.libsrv.wku.edu/10.1016/B978-012088519-0/50005-8

Kristeller, J L., &
Hallett, C. B. (1999). An exploaratory study of a meditation-based intervention for binge eating disorder. Journal of Health Psychology, 4, 357 – 363. doi:10.1177/135910539900400305

Kristeller, J., Wolever,
R.Q., & Sheets, V. (2013). Mindfulness based eating awareness training (MB-EAT) for binge eating; A randomized clinical
trial. Mindfulness, 5, 282-297. doi:
10.1007/s12671-012-0179-1

 Linehan, M. M. (1993). Cognitive-bheavioral treatment of borderline personality disorder. New York: Guliford.

 Lorenzen, L. A., Grieve, F.G. & Thomas, A.
(2004). Exposure to muscular male models decreases men’s body satisfaction. Sex Roles, 51, 743-748.

Mantinolli, H.M., Mannisto, S., Siploa-Leppanen, M., Tikanmaki, M.,
Heinonen, K., Lahti, J., … & Lano, A. (2016). Body image and eating
behavior in young adults born preterm. International
Journal of Eating Disorders., 49, 572. doi:10.1002/eat.22553

Nyman-Carlsson, E., Engstrom, I., Norring, C., & Nevonen, L. (2015). Eating Disorder Inventory-3, validation in Swedish patients with eating disorders, psychiatric outpatients and normal control sample. Nordic Journal of Psychiatry, 69, 142 doi:10.3109/08039488.2014.949305

Olson, K. L., & Emery, C. F. (2015). Mindfulness and weight loss: A systematic review. Psychosomatic medicine, 77, 59-67. http://dx.doi.org.libsrv.wku.edu/10.1097/PSY.0000000000000127

Prowse, E., Bore, M., Dyer,
S. (2013). Eating disorder symptomatology, body image, and mindfulness: Findings in a non-clinical sample. Clinical Psychologist, 17, 77-87. doi: 10.1111/cp.12008

Sandoz, E. K. (2010). Assessment of body image flexibility: An
evaluation of the body image acceptance and action questionnaire. (unpublished doctoral dissertation.) University of Mississippi,
Oxford, Mississippi. 

Segal, Z. B., Williams, J.M. G., & Tesdale, J.D. (2002). Mindfulness-based cognitive therapy of depression: A new approach to preventing relapse. New York: Guliford.

Shaw, J., Butryn, M. L.,
Juarascio, A. J., Kerrigan, S. G., & Matteucci, A. J. (unpublished). Eating
attitudes thoughts and defusion scale.

Taylor, C. T., Laposa, J.
M., & Alden, L.E. (2004). Is avoidant personality disorder more than just
social avoidance? Journal of Personality Disorders, 18, 571 – 594.

Wallace, S.
(2017). Acceptance and commitment therapy
as an eating disorder intervention. (unpublished master’s
thesis.) Western Kentucky University, Bowling Green, KY.

Wade,
T. D., Keski-Rahkonen A., & Hudson J. (2011). Epidemiology of eating
disorders. In M. Tsuang & M. Tohen (Eds.), Textbook in psychiatric
epidemiology (3rd ed.) (pp. 343-360). New York: Wiley.

Wagner, R., MacCaughelty,
C., Rufino, K., Pack, T., Poplack, J., George, K., & Ruscitti, C. (2016). Effectivenes of a track-based
model for treating eating disorders in a general psychiatric hospital. Bulletin
of the Menninger Clinic, 80, 49-59. doi: http://dx.doi.org/101521bumc201680149

Appendix
A: Demographics

1. Age:
_______________

2. Race/Ethnicity:

            a. African American

            b. Asian American

            c. White, non-Hispanic

            d. White, Hispanic

            e. Middle Eastern

            f. Other: _______________

3. Current
Academic Status:

            a. First-year college student

            b. Second-year college student

            c. Third-year college student

            d. Fourth-year college student

            e. Fifth (or higher)-year college
student

4. College Academic
Major: _______________

5. Weight: ­­­­­_________

6. Height:
__________

7. Gender:

            a. Male _______

            b. Female _____

            c. Other ________

Appendix B: The Mindful Eating Questionnaire

Appendix C

The Eating
Disorder Inventory-3 (EDI-3) is not attached to this document due to copyright
issues. The publishing company states that the EDI-3 may not be reproduced in
whole or in part in any form.