Understanding and improving Chinese adolescent snacking using behaviour change and a mindfulness-based approach

Background: Despite the dramatic increase in the prevalence of childhood overweight/obesity in China, there is a lack of high-quality evidence for effective intervention strategies to tackle this issue. Unhealthy snacking has been suggested as a major part of unhealthy diets contributing to overweight/obesity, which is a potential target of weight-loss interventions for Chinese adolescents. Evidence suggests that mindfulness-based approaches have potentials in improving dietary intakes and promoting weight loss. Aim: To generate a better understanding of adolescent snacking, and based on this, to develop and feasibility test a mindfulness-based behaviour change intervention to promote weight loss among overweight Chinese adolescents. Method: Multiple approaches were employed, including a cross-cultural survey and a focus group study aiming at understanding adolescent snacking; a think-aloud study and a validation study aiming at producing a culturally appropriate measure of mindful eating in the Chinese population; and intervention development and a feasibility study to evaluate its feasibility, acceptability and preliminary effects. Findings and Conclusions: This research suggested the importance of mindful eating in predicting and improving adolescent snacking. The theory of planned behaviour showed efficient in explaining adolescent snacking, and cultural context should be taken into account applying this theory. Chinese adolescent snacking is greatly influenced by subjective norms, while snacking of UK adolescents are largely habitual and less influenced by cognitive beliefs. The cultural differences suggest different intervention strategies for each group. A revised Chinese version of Mindful Eating Questionnaire was developed, which exhibited good psychometric properties in a sample of Chinese college students. Finally, a mindfulness-based snacking intervention was developed incorporating components of nutrition education, mindful eating and planning. A feasibility test provided evidence supporting the feasibility, acceptability and preliminary effects of this intervention on decreasing unhealthy snacking and promoting weight loss among overweight Chinese adolescents. A full-scale RCT to examine intervention effectiveness is warranted.