Evaluation of the Relationships Among Mindful Eating, Environmental Beliefs, Adherence to the Mediterranean Diet, and Obesity in Children

Abstract

Objective:

This study aimed to evaluate the relationship between adherence to the Mediterranean diet (MD), mindful eating, environmental beliefs, and obesity in children.

Materials and Methods:

The study included 318 children (50.6% male, 49.4% female, 10.0 ± 0.73 years old). Data were obtained using survey and a face-to-face interview method. The questionnaire includes general information, anthropometric measurements, the New Ecological Paradigm Scale for Children (NEP), the Mediterranean Diet Quality Index for children and adolescents (KIDMED), and the Mindful Eating Questionnaire for Children.

Results:

According to the KIDMED classification, 52.5% of the children were in the group that needs improvement, 35.2% were in the low diet quality group, and 12.3% were in the optimal MD group. The Mindless score was higher in overweight/obese children compared to the normal body mass index (BMI) group (P < .05). Awareness, NEP, and KIDMED scores were the lowest in overweight/obese children (P < .05). In regression analysis, the father’s age, KIDMED, and Awareness scores related to NEP scores positively (R ²: 0.545, P < .001). Also, children’s body mass index-related KIDMED scores negatively, and awareness and NEP scores related KIDMED scores positively (R ²: 0.276, P < .001).

Conclusion:

Our results show that higher adherence to the MD is associated with higher environmental beliefs. Children with higher mindful eating have higher environmental beliefs and adherence to the MD, and these scores are lower in obese children. Therefore, raising generations that adopt sustainable diet models and have high environmental awareness is necessary. This research provides significant findings for future clinical studies on children’s body weight maintenance and sustainability.

What is already known on this topic?

• The relationship between the Mediterranean diet and obesity is well known. In addition, the association between mindful eating and obesity has been established in the literature. Previous studies have shown that higher environmental beliefs are associated with sustainable and healthy eating behaviors. However, most of these studies were conducted on adults. No study evaluated the relationship between adherence to the Mediterranean diet, environmental beliefs, mindful eating, and obesity in children in detail.

What this study adds on this topic?

• It is one of the first studies in which the relationship among mindful eating, environmental beliefs, adherence to the Mediterranean diet, and obesity in children is indicated, and the factors (age, sex, and parental factors) that are related to them are also clarified. It has been shown that higher adherence to the Mediterranean diet is associated with higher environmental beliefs and higher mindful eating in children. This study provides significant findings for future clinical studies on children’s body weight maintenance and sustainability.

Introduction

Childhood obesity is a significant public health concern today due to its chronic and detrimental effects.¹ Globally, the prevalence of obesity in children aged 5-9 years and 10-19 years is 11% and 7%, respectively. In 2030, the rate is expected to increase to 15% for children aged 5-9 years and 11% for those aged 10-19 years.² In 33 European countries, 29% of children aged 7-9 had excessive weight (overweight or obese).³ As a result, obesity is a worldwide public health problem that adversely impacts children’s health and is linked to both immediate and long-term health problems, including high blood pressure, chronic fatty liver disease, type 2 diabetes, cancer, sleep apnea, cardiovascular disease, and gastrointestinal, musculoskeletal, and orthopedic complications.^4,5

Obesity results from an imbalance favoring energy intake over expenditure. It can be brought on by poor lifestyle choices, eating habits, environmental exposures during childhood, and interactions during the prenatal period.^6,7 Obesity is a multifaceted condition influenced by several factors, including an individual’s dietary and exercise patterns, obesogenic behaviors, genetic background, gut microbiota composition, and epigenetic and metabolomic mechanisms that account for interindividual variations. Common obesogenic behaviors in children encompass excessive consumption of unhealthy foods, low physical activity levels, elevated mental stress, excessive screen time, and inadequate sleep patterns. The impact of exposure to various variables contributing to childhood obesity has implications for the individual’s quality of life into adulthood.^8,9

Childhood eating behaviors, portion size preferences, and dietary patterns indicate future overweight and obesity. Nutritional strategies should encompass adequate energy and essential macro- and micronutrients while being sustainable and culturally suitable.^10,11 Enhancing the nutritional literacy of children and their parents through disseminating theoretical knowledge about agriculture, food industries, food safety, cooking techniques, energy balance, nutrition, and dietary practices would play a crucial part in promoting healthy eating habits and facilitating long-term sustainable changes. The optimal diet for preventing excessive body weight and obesity should be both safe and sufficient, considering cultural and economic factors.^12,13 In this context, the Mediterranean diet (MD) and its effects on health and the environment draw attention.

The MD, one of the sustainable diet models, is defined as consuming low-refined, fiber-rich plant-based foods such as vegetables, fruits, whole grains, legumes, nuts, and seeds. This dietary approach is complemented by a moderate-to-high intake of fish, seafood products, chicken, eggs, and dairy products while reducing the consumption of red meat.¹⁴ It also promotes family meals and helps prevent overeating. Maintaining a healthy body weight while preventing obesity is possible by following the MD beginning in early childhood.^15,16 Interventions based on the MD have been found to significantly decrease the body mass index (BMI) and decrease obesity among individuals aged 3 to 18 years, children, and adolescents.⁶ A meta-analysis of randomized controlled trials found that MD-based interventions were effective in reducing BMI and the rate of obesity in children and adolescents.¹⁷ The MD is considered sustainable due to its relatively lower environmental impact, provision of adequate nutritional quality, and respect for biodiversity compared to alternative nutritional models.^18,19 The significance of nutrition is crucial throughout every stage of an individual’s lifespan. The dietary patterns and eating behaviors adopted during childhood have a lasting influence on individuals’ food choices and nutritional habits in adulthood, subsequently affecting their long-term health outcomes.^20,21

The importance of an approach called “the new ecological paradigm” in creating ecological awareness/beliefs and its availability in environmental education to contribute to countries’ sustainable development is increasing day by day.²² Mindfulness is a multifaceted construct that centers on cultivating attentiveness to present-moment experience, on purpose, without judgment.²³ Accordingly, mindfulness, especially mindful eating, may be important for a sustainable environment. A recent study shows a relationship between mindful eating and sustainable nutrition.²⁴

The MD emphasizes mindful eating, socializing during meals, physical activity, and people–environment interaction.^25-27 While many studies have examined adherence to the MD, the potential influence of mindfulness levels and environmental paradigms on this dietary pattern has yet to be investigated. This study aimed to assess the relationship between adherence to the MD, mindful eating, beliefs about the environment, and obesity in children. This is the first study to evaluate the relationship between adherence to the MD, mindful eating, environmental beliefs, and obesity in children.

Materials and Methods

Study Design and Participants

This cross-sectional study was carried out in primary and secondary schools in Erzurum, Turkey, with 318 fourth and fifth-grade school children. The sample size calculation was performed using G*Power 3.1.9.7 (Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany). Based on Kawasaki et al’s²⁴ study, it was estimated that 111 children were required for correlation analysis with anticipated effect size = 0.30 and power (1−β) = 0.95 at α = 0.05.²⁴ The data were gathered through face-to-face interviews using a survey between December 2022 and June 2023. Participants were selected using simple random sampling from randomly selected schools in Erzurum (one of the metropolitan cities of Turkey). The inclusion criteria for children with no chronic and/or psychological issues and no diagnosis of eating disorders who complied with joining the study were included in the research.

Approval was obtained from the Erzurum Technical University Ethics Committee (meeting number:11, decision number: 21, and date November 17, 2022) and Erzurum Provincial Directorate of National Education (December 9, 2022) to conduct the research. The research was carried out in compliance with the Declaration of Helsinki. Informed consent in written form was obtained from the parents, and child assent was obtained.

Measures

Data were obtained using the survey and a face-to-face interview with children. The questionnaire included general information, anthropometric measurements, the New Ecological Paradigm Scale for Children (NEP), the MD Quality Index for children and adolescents (KIDMED), and the Mindful Eating Questionnaire for Children.

The New Ecological Paradigm Scale for Children

The importance of an approach called “the new ecological paradigm” in creating ecological awareness and its availability in environmental education to contribute to countries’ sustainable development is increasing day by day.²² For this reason, the NEP, a self-assessment tool for children, was developed by Manoli et al²⁸ to evaluate environmental values in children. The Turkish validity and reliability of this scale were conducted by Şahin et al.²² It comprises 10 items and 3 subscales (Rights of Nature, Eco-Crisis, and Human Exemptionalism). The scale is a 5-point Likert type. As a total score can be obtained from the scale, points can also be obtained according to the subscales. Items 3, 6, 7, and 9 are reverse coded.

The Mediterranean Diet Quality Index for Children and Adolescents

The KIDMED was developed by Serra-Majem et al²⁹ to evaluate adherence to MD in children and adolescents. The Turkish reliability and validity study of the scale was conducted by Şahingöz et al.³⁰ The index ranged from 0 to 12 and was based on 16 questions. The 6th, 12th, 14th, and 16th item are scored −1, and the remaining 12 are scored +1. The total score is calculated by summing: ≥8, optimal; 4-7, improvement needed; ≤3, low diet quality.²⁹

The Mindful Eating Questionnaire for Children

The MEQ was developed by Framson et al³¹ and was adapted for children by Hart et al.³² The Turkish reliability and validity study of the scale was conducted by Kocaadam-Bozkurt et al.³³ The scale includes Mindless eating (Cronbach’s alpha = 0.82) and Awareness (Cronbach’s alpha = 0.80). The scale is scored on a 4-likert type scale. Increased scores on the Awareness subscale show a higher frequency of “mindful” eating habits. For the Mindless eating subscale, higher scores on this factor indicate more “mindless” eating behaviors. For each factor, the scores for each item are calculated and divided by the number of items to obtain a mean score.³³

Anthropometric Measurements

The researchers conducted measurements regarding the height and weight following the techniques described by Lohman et al.³⁴ The body weights were assessed with the Tanita BC 601 Inner Scan (Balance TM) device under conditions when the participants were hungry, barefoot, and wearing lightweight clothes. The weight was measured with 0.5 kg accuracy. The height was assessed using a portable Leicester stadiometer and noted with a precision of 0.1 cm.³⁴ The World Health Organization (WHO, 2007) growth standards and the WHO AnthroPlus software (version 1.0.4, February 2011) program were used to calculate Z-scores.³⁵

Statistical Analysis

Statistical analysis was performed using Statistical Package for the Social Sciences Statistics software, version 22.0 (IBM Corp., Armonk, NY, USA). The variables were evaluated using visual (histogram and probability graphs), and skewness and kurtosis, and Kolmogorov–Smirnov tests to determine whether or not they are normally distributed. For data evaluation, continuous variables were given as mean (x̄) and SD, and categorical variables were given as number (n) and percentage (%). Independent sample t-test, Mann–Whitney U-test, ANOVA, or Kruskal–Wallis test were employed to assess the differences in measurement results between the groups. The Pearson correlation coefficient was used to examine the mutual association between 2 measurement values following a normal distribution. Conversely, the Spearman correlation coefficient was used when at least 1 measurement data did not exhibit a normal distribution. The chi-square (χ ²) test was employed to examine the association between 2 categorical variables based on their predicted frequency levels. Multiple linear regression analyses were used to evaluate factors associated with NEP and KIDMED total scores. The most common indicator of a linear model’s quality of fit is R ². When the value of R ² = 0, the model is categorized as being unable of accurately predicting the outcome. In the case when R ² ranges from 0 to 1, the model is considered to only partially predict the outcome. Lastly, when R ² = 1, the model is classed as having the ability to precisely predict the outcome.³⁶ The results were assessed within a 95% CI and determined to be statistically significant at a significance level of P < .05.

Results

General Characteristics of the Participants

The study included 318 children (50.6% male, 49.4% female) with a mean age of 10.0 ± 0.73 years. While 50.6% of children had normal BMI, 45.6% were overweight or obese. According to the KIDMED classification, 52.5% of the children needed improvement, 35.2% were in the low-diet quality group, and 12.3% were in the optimal MD group. The scores of the children on Mindless eating, Awareness, NEP, and KIDMED were determined as 2.0 ± 0.81, 3.0 ± 0.73, 29.4 ± 8.87, and 7.2 ± 2.59, respectively (Table 1).

Table 1.

General Characteristics of the Participants (n = 318)

	n	%
Sex
Male	161	50.6
Female	157	49.4
Children BMI classification
Underweight	12	3.8
Normal	161	50.6
Overweight/obese	145	45.6
KIDMED
≥8, optimal	39	12.3
4-7, improvement needed	167	52.5
≤3, low diet quality	112	35.2
Mother education
≤8 years	111	34.9
>8 years	207	65.1
Father education
≤8 years	99	31.1
>8 years	219	68.9
	X̅ ± SD
Child’s age	10.0 ± 0.73
Mother’s age	35.6 ± 7.46
Father’s age	38.5 ± 6.3
Mother education duration	11.6 ± 4.89
Father education duration	12.2 ± 4.60
NEP total score	29.4 ± 8.87
Rights of nature	9.6 ± 3.23
Eco-crisis	10.9 ± 5.20
Human exemptionalism	8.9 ± 3.02
KIDMED	7.2 ± 2.59
Mindless eating scale	2.0 ± 0.81
Awareness scale	3.0 ± 0.73

BMI, body mass index; KIDMED, Mediterranean Diet Quality Index for Children and Adolescents; NEP, New Ecological Paradigm Scale for Children.

A Comparative Analysis of Scores Derived from Mindful Eating Questionnaire for Children, New Ecological Paradigm Scale for Children, and Mediterranean Diet Quality Index for Children and Adolescents Assessments Across Different Groups

The Mindless score was higher in overweight/obese children compared to the normal BMI group (P < .05). Awareness, NEP, and KIDMED scores were the lowest in overweight/obese children (P < .05). These scale scores did not differ according to sex and the educational status of the parents (P > .05) (Table 2).

Table 2.

Comparison of the Scores Obtained from Mindful Eating Questionnaire for Children, New Ecological Paradigm Scale for Children, and Mediterranean Diet Quality Index for Children and Adolescents Scores by Groups

	Mindless Eating	P	Awareness	P	NEP	P	KIDMED	P
Sex
Male	2.1 ± 0.88	.061	2.9 ± 0.76	.264	29.0 ± 8.85	.482	7.3 ± 2.45	.589
Female	2.0 ± 0.72		3.0 ± 0.71		29.7 ± 8.91		7.2 ± 2.73
Years of education of the mother
≤8 years	2.0 ± 0.81	.278	2.9 ± 0.78	.843	30.1 ± 8.61	.275	7.0 ± 2.45	.064
>8 years	1.8 ± 0.61		3.0 ± 0.71		29.0 ± 8.98		7.6 ± 2.80
Years of education of the father
≤8 years	2.0 ± 0.73	.094	2.9 ± 0.75	.882	29.4 ± 9.40	.925	7.1 ± 2.78	.476
>8 years	1.8 ± 0.84		3.0 ± 0.73		29.3 ± 8.70		7.3 ± 2.5
Children’s BMI classification
Underweight	2.1 ± 0.77a,b	.008	3.2 ± 0.57a	<.001	31.8 ± 8.76a,b	.001	8.8 ± 2.52a	<.001
Normal	1.7 ± 0.64a		3.1 ± 0.66a		30.1 ± 9.36a		8.0 ± 2.62a
Overweight/obese	2.0 ± 0.95b		2.6 ± 0.73b		27.4 ± 7.91b		6.4 ± 2.26b

BMI, body mass index;KIDMED, Mediterranean Diet Quality Index for children and adolescents; NEP, New Ecological Paradigm Scale for Children.

^a,bThe groups with the same letters within a column are not significantly different according to pairwise comparisons.

The bold values indicate significant at P < .05.

Assessment of Children’s Adherence to the Mediterranean Diet

Table 3 shows the factors associated with the children’s adherence to the MD. Accordingly, it was determined that the NEP total score, sub-scales score, and awareness score were statistically significantly higher in those in the optimal MD-adherence group (P < .05). Children’s BMI classification differed according to the KIDMED classification (P < .05).

Table 3.

Evaluation of Children’s Adherence to the Mediterranean Diet

	KIDMED		Optimal	P
	Low Diet Quality	Improvement Needed
Age (years)	9.8 ± 0.73	10.0 ± 0.66	9.8 ± 0.84	.341
Mother’s age	33.8 ± 8.45	36.1 ± 7.37	35.7 ± 7.20	.224
Father’s age	37.8 ± 5.12	38.8 ± 7.63	38.4 ± 7.56	.689
Sex n (%)
Male	17 (43.6)	86 (51.5)	58 (51.8)	.486
Female	22 (56.4)	81 (48.5)	54 (48.2)
Children’ BMI classification n (%)
Underweight	13 (33.3)	5 (3.0)	7 (6.3)	.001
Normal	26 (66.7)	79 (47.3)	69 (61.6)
Overweight/obese	-	83 (49.7)	36 (32.1)
Mother education duration (years)	11.4 ± 4.95	11.9 ± 4.55	11.1 ± 5.35	.365
Father education duration (years)	11.4 ± 4.42	12.2 ± 4.68	12.4 ± 4.55	.488
NEP total score	23.5 ± 7.75a	27.6 ± 8.58b	34.0 ± 7.47c	<.001
Rights of nature	8.3 ± 4.59a	8.9 ± 3.07a	11.2 ± 2.11b	<.001
Eco-crisis	8.6 ± 4.53a	10.7 ± 5.07a,b	12.0 ± 5.36b	.002
Human exemptionalism	6.7 ± 4.31a	8.1 ± 2.57b	10.9 ± 1.82c	<.001
Mindless eating	1.9 ± 0.76	1.9 ± 0.84	1.8 ± 0.78	.519
Awareness	2.6 ± 0.78a	2.8 ± 0.75a	3.1 ± 0.63b	<.001

BMI, body mass index; KIDMED, Mediterranean Diet Quality Index for children and adolescents; NEP, New Ecological Paradigm Scale for Children.

^a,b,cThe groups with the same letters within a row are not significantly different according to pairwise comparisons.

The bold values indicate significant at P < .05.

Assessment of the factors related the scores obtained from New Ecological Paradigm Scale for Children and Mediterranean Diet Quality Index for children and adolescents

When the factors related to the scores obtained from NEP were evaluated with multiple linear regression analysis (R ²: 0.545, P < .001), it was determined that the father’s age, KIDMED, and Awareness scores related to NEP scores positively (Table 4). Also, children’s BMI related to KIDMED scores negatively, and Awareness and NEP scores related to KIDMED scores positively (R ²: 0.276, P < .001) (Table 4).

Table 4.

Linear Regression Analysis for New Ecological Paradigm Scale for Children and Mediterranean Diet Quality Index Prediction

Model	Beta	t	P
NEP
Age (years)	0.009	0.018	.986
Sex	−0.273	−0.384	.702
BMI (kg/m2)	0.190	1.912	.057
Mother’s age	−0.069	−1.275	.203
Father’s age	0.179	3.181	.002
Mother education duration	−0.020	−0.260	.795
Father education duration	−0.042	−0.512	.609
KIDMED	1.170	8.359	<.001
Mindless eating	−0.091	−0.210	.833
Awareness	7.033	14.150	<.001
R 2: 0.545, P < .001
KIDMED
Age (years)	0.119	0.656	.512
Sex	0.411	1.576	.116
BMI (kg/m2)	−0.150	−4.200	<.001
Mother’s age	0.001	0.047	.963
Father’s age	−0.011	−0.518	.605
Mother education duration	−0.036	−1.272	.204
Father education duration	0.051	1.698	.091
NEP	0.158	8.359	<.001
Mindless eating	−0.107	−0.672	.502
Awareness	0.615	2.644	.009
R 2: 0.276, P < .001

Sex is coded as follows: 0: female, 1: male.

BMI, body mass index; KIDMED, Mediterranean Diet Quality Index for children and adolescents; NEP, New Ecological Paradigm Scale for Children.

The bold values indicate significant at P < .05.

Discussion

The results of this study show that while the Mindless eating score is higher in overweight/obese children, Awareness, NEP, and KIDMED scores were found to be the lowest. The children with the highest adherence to the MD had the highest NEP and Awareness scores. Moreover, the father’s age, KIDMED, and Awareness scores related the NEP score; the KIDMED score was related by the children’s BMI, Awareness, and NEP scores.

Children’s Body Mass Index

It has been observed that the prevalence of obesity in children has increased in the last 40 years.^1,37 In addition, the World Obesity Federation predicts that 206 million children will be obese by 2025.³⁸ In a study conducted in the USA, the obesity rate was 45% in children aged 5-14 years.³⁹ The prevalence of overweight or obesity in children aged 7-9 years living in the European region was 31%.⁴⁰ In a study of Greek children, the rate of overweight and obesity was reported to be 36.6%.⁴¹ In this study, the obesity rate was found to be 45.6%. Among the preventable factors for the increase in childhood obesity are unhealthy eating habits, decreased physical activity, and the effects of parents on children’s eating habits.^42,43 In order to prevent these factors, education should be applied to gain healthy eating habits at an early age.

Adherence to Mediterranean Diet

Sustainability refers to maintaining or continuing existence over time while staying ahead of potential challenges and being present in the current moment.⁴⁴ Throughout the life course, there are links between nutrition, health, and the environment. Over time, sustainability has emerged as a guiding concept and the primary objective for human growth.⁴⁵ Sustainable healthy diets refer to dietary patterns that value the entire health and well-being of people while also exhibiting minimal environmental pressure and impact. These diets are characterized by their accessibility, affordability, safety, and equitable distribution and are culturally acceptable.⁴⁶ The MD is one of the leading sustainable diet models with a low environmental impact.⁴⁷ It is stated that the MD is suitable for children’s physical and cognitive healthy development.⁴⁸ In a study of Spanish children’s adherence to the MD, 28.4% had optimal, 55.9% needed improvement, and 15.7% had low adherence.⁴⁹ The study on the adherence of Turkish children to the MD found that 34.1% of them showed optimal, 57.0% improvement needed, and 8.9% very low adherence.⁵⁰ It is also stated that only some Mediterranean countries can show optimal adherence.⁵¹ According to the WHO,⁵² the abandonment of the MD is causing children in the Mediterranean region to be obese and typically less healthy than their Swedish peers, who, from an early age, get accustomed to a diet consisting of more fish and vegetables. In this study, children’s adherence to the MD was optimal at 12.3%, improvement needed at 52.5%, and low adherence at 35.2%. The results may differ due to nutritional habits and cultural differences in the regions where the study was conducted.

Mindful Eating, Adherence to Mediterranean Diet, and Obesity

Recent studies highlight the effects of mindful eating programs on body weight maintenance. With mindful eating, it is tried to give children the ability to control their unhealthy eating behaviors and food intake. In addition, children's high environmental awareness and healthy food choices contribute positively to sustainable eating habits.⁵³ Mindfulness eating practices may be more effective for weight maintenance in overweight and obese children, mainly when applied to family members.⁵⁴

It was stated that with more mindful eating in children, healthy food preferences increased and palatable food preferences decreased.⁵⁵ In a study conducted with Latino children, the BMI of the children who received mindful eating training was lower than that of the control group.⁵⁶ The primary purpose of mindful eating is not to reduce body weight but to make individuals choose healthier foods and get more flavor from foods. In this way, mindful eating will indirectly affect body weight.⁵⁷ A systematic review observed that mindful eating education improved the obesity rate in children and adolescents.⁵⁸ It has been stated that mindless eating habits are more common, especially in obese children.⁵⁹ This situation is thought to be caused by the mindless consumption of foods, especially in front of the screen, insufficient physical activity, and too many unhealthy food stimuli in the environment. In this study, the Awareness scores for overweight and obese children were low. Increasing mindful eating in children is thought to be important in preventing obesity.

In recent years, Western-style eating has become more common in Mediterranean nations, linked to lower adherence to the MD and increased chronic non-communicable illnesses in children. The increasing prevalence of pediatric obesity has attracted attention due to its association with increased vulnerability to cardiovascular diseases, type 2 diabetes, and chronic diseases, particularly in later stages of life.⁶⁰ Decreased adherence to the MD has resulted in adopting dietary patterns less conducive to optimal health, leading to a decline in nutritional quality.^61,62 In a population-based and observational study in Greece, adhering to the MD may have a protective effect against childhood overweight or obesity.⁶³ Research indicates a positive association between physical activity and other health-promoting behaviors, such as appropriate dietary intake and adherence to MD, among children and adolescents.^60,64,65 In another study, a decrease in the prevalence of obesity and waist circumference was observed in children who adhered to the MD.⁶⁶ In addition, a systematic review claimed a relationship exists between adherence to the MD in the prevention or treatment of obesity in children.⁶⁷ This study found that compliance with the MD was lower in obese children, supporting these results. For this reason, the MD should be encouraged to maintain body weight in children.

The factors related with New Ecological Paradigm Scale for Children and Mediterranean Diet Quality Index for children and adolescents

Mediterranean Diet is aimed at aiding in the prevention of various forms of malnutrition, including micronutrient deficiency, undernutrition, and obesity, while decreasing the likelihood of diet-related non-communicable diseases.⁶⁸ Furthermore, MD is one of the sustainable healthy diets that aim to make a difference in preserving ecological diversity and the wellness of the planet.⁶⁹ The NEP is used to evaluate ecological concerns.²⁸ This study found a positive correlation between adherence to the MD and NEP scores. The high NEP scores of the children participating in the study and their high adherence to the MD show that they have less impact on ecology by healthy eating. Furthermore, our study found that children with high awareness scores also had high NEP and KIDMED scores. These results show that children with more mindful eating skills may know they need to protect their physical and environmental health. Similar studies in adults found that awareness of ecological footprint increased as adherence to the MD increased.^70,71 It is stated that it is possible to protect human health and the sustainability of the environment by reducing the ecological footprint.⁷⁰ Therefore, raising generations that adopt sustainable diet models and have high environmental awareness is necessary.

The strength of this study is that it is one of the first studies in which the relationship among mindful eating, environmental beliefs, adherence to the MD, and obesity in children is indicated, and the factors (age, sex, and parental factors) that relate to them are also clarified. Also, there are some limitations to the study. First, the findings were based on a cross-sectional study, which makes it difficult to determine whether mindful eating, environmental beliefs, and adherence to the MD affect obesity in a causal manner. Furthermore, a diagnosis cannot be made with the evaluated scales’ findings. Second, the data were based on a Turkish sample of children in Erzurum city, which limits the generalizability of the study’s results. It is suggested to replicate the study in other cities in Turkey.

In conclusion, our results support that higher adherence to the MD is linked with higher environmental beliefs because it is a sustainable diet with low environmental impact and has a low effect on ecological factors. Children with higher eating awareness have higher environmental beliefs and adherence to the MD; these scores are lower in obese children. These results show that children with higher eating awareness may be conscious that they must protect their physical and environmental health through healthy and sustainable eating behaviors. Therefore, raising generations that adopt sustainable diet models and have high environmental awareness is necessary. This is the first study to evaluate the relationship between adherence to the MD, mindful eating, environmental beliefs, and obesity in children. This research provides significant findings for future clinical studies on children’s body weight maintenance and sustainability. It is very important for families to be educated about sustainable nutrition, mindful eating, and children’s healthy eating habits for a sustainable life.

Funding Statement

This study received no funding.