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Better Eating through Mindfulness

By Jill Suttie | June 27, 2012 | 12 comments

Obesity has become a public health issue. New research suggests moment-to-moment awareness does a better job of helping people control their weight than any diet.

Deborah Hill used to think she was skinny. Her 5 foot 9 inch frame could take on a lot of weight without making her look out of shape. But last year she was shocked to discover that she weighed over 210 pounds, which classified her as medically obese.

“It was just crazy,” says Hill. “I’d never had a problem with weight.”

Danny Hellman

Hill is one of a growing number of Americans—over 35 percent, according to the Center for Disease Control—who are considered obese, having a body mass index of 30 or greater. Obesity increases health risks like heart disease, stroke, and diabetes, to name a few, and the health care costs to treat obesity-related illness are skyrocketing, with CDC estimates in 2008 reaching $147 billion dollars.

But now there is a new prescription for combating obesity, one that goes beyond ubiquitous diet and exercise regimens: mindfulness, the moment-to-moment awareness of our thoughts, feelings, and surroundings.

Researchers are learning that teaching obese individuals mindful eating skills—like paying closer attention to their bodies’ hunger cues and learning to savor their food—can help them change unhealthy eating patterns and lose weight. And, unlike other forms of treatment, mindfulness may get at the underlying causes of overeating—like craving, stress, and emotional eating—which make it so hard to defeat.

Mindfulness has definitely helped Hill. In the last year, she has lost 40 pounds and developed a much healthier relationship to food and eating.

“Mindfulness has been huge for me,” she says.

Why mindfulness?

Jean Kristeller, a professor emeritus of psychology at Indiana State University, is a pioneer in the field. She first became interested in applying mindfulness to eating issues when working as a clinician with overweight college students who were compulsively eating large quantities of food—or “binging.” She thought her students had an underlying dysfunctional relationship to food that was being ignored in the clinical community in favor of dieting, which “didn’t mesh” for her.

But when she encountered Jon Kabat-Zinn’s Mindfulness-Based Stress Reduction (MBSR) program, she says, “more than a light bulb” went off for her. She wondered if it could be possible to teach people with eating disorders to become refocused on their internal hunger and signs that they were full—and develop a more accepting approach to food and eating.

“He was taking a tradition of cultivating awareness and an accepting way of our experiences—both inner and outer—and encouraging people to bring themselves into better balance,” says Kristeller. “This fit with my theoretical model of reconnecting people with their inner experiences.”


With the help of a doctoral student, she created a program called Mindfulness-Based Eating Awareness Training—or MB-EAT, based on Kabat-Zinn’s MBSR—that teaches people how to taste their food, recognize their levels of hunger and fullness, and be more accepting of their food preferences. One exercise involves eating a few raisins slowly, paying close attention to their flavor sensations and how they change with time.

“When most people do the raisin exercise, they are stunned by it,” says Kristeller. “They see that if they eat a few raisins mindfully they can enjoy them as much or more than if they eat a whole box.”

Of course, even Kristeller admits that it’s easier to get people to regulate their intake with health foods, like raisins, than “problem foods,” like chocolate brownies. So, the program doesn’t stop with raisins—it teaches people that, once they learn to pay attention, brownies can be best experienced and savored in a smaller number of bites.

Many obese people, says Kristeller, have developed a particular pattern: They try to control their eating through avoidance or limit-setting, thinking “willpower” is what they need. Then, when their plans go awry—as they inevitably do—they tell themselves that they’ve “blown it” and give up.

From a mindfulness perspective, she says, there is never a point of no return: One can choose to eat mindfully at anytime, even after “blowing it.” In addition, since the program teaches people not to avoid foods but to savor them, people don’t feel as deprived. Kristeller tries to take the guilt out of enjoying food and to help people honor their food preferences.

“We try to help people cultivate their inner gourmet,” she says.

Jean Kristeller, Ph.D: “Mindfulness Based Eating” from Omega Institute on Vimeo.

What the research says

Kristeller tested her MB-EAT program in a pilot study with a group of 18 binge eaters. The women participated in seven sessions of a group treatment program, which included assessments prior to and following treatment.

At the end of treatment, binges dropped from slightly over four to about 1.5 per week, with only four participants still meeting criteria for Binge Eating Disorder when the researchers followed up with questions after treatment. In addition, the women demonstrated a better relationship to food and eating, and their depression and anxiety decreased.

In a second study, conducted with Ruth Quillian-Wolever of Duke University, Kristeller tested the MB-EAT program on a group of obese binge eaters, comparing the group at one month and four months post-treatment to two control groups, one of which went through another educational program.

Although both the educational and MB-EAT groups reduced their binging behavior, those in the MB-EAT group showed signs of greater overall self-regulation and balance around eating, and sustained improvement in binge eating. Plus, the degree to which the women incorporated mindfulness practices into their lives predicted much of this improvement and the degree of weight loss they experienced.

“This study showed that success wasn’t just about group work and getting support,“ says Kristeller, “but that their success at losing weight was directly related to the degree to which they used mindfulness techniques.”

Currently there is no data that shows what is happening in the brain when people practice mindful eating. But Kristeller points to the large body of research on MBSR showing that people who use mindfulness increase the size and function of their pre-frontal cortex, the area of the brain connected to decision making and long-range planning. She hypothesizes that mindful eating strengthens this same area of the brain, making it easier for people to cognitively process their desire to eat, rather than feeling victim to the emotional center that often drives eating.

“We are interrupting the reactivity cycle,” says Kristeller.

Stress in eating and obesity

Elissa Epel, the founder and director of the Center for Obesity Assessment, Study, and Treatment at the University of California, San Francisco, has been researching the role of stress in overeating. One of the biggest, most reliable paths to obesity, she says, is high stress, because it changes our appetite, stimulates overeating, and makes us more insulin-resistant, a factor that elevates blood sugar and can put as at risk for Type 2 diabetes.

“Stress affects the same signals as famine does. It turns on the brain pathways that make us crave dense calories—we’ll choose high fat, high sweet foods, or high salt,” says Epel. “When we have a ‘stress brain,’ food is even more rewarding.”

Elissa Epel, founder and director of the UCSF Center for Obesity Assessment, Study, and Treatment. Elissa Epel, founder and director of the UCSF Center for Obesity Assessment, Study, and Treatment.

Epel notes that surveys show 50-60 percent of women eat for emotional reasons rather than because of hunger. The stress of difficult emotions dampens the reward response in the brain and causes craving, which is what drives overeating—as well as drug use—in some people. According to Epel, the hunger and reward drives are the strongest drives in the human body and very difficult to change.

“When the obese brain tricks you into thinking that you’re starving, it’s hard to fight that,” she says.

Her lab has studied the impact of mindfulness training on people’s stress metabolism. Normally, fat distribution in women is concentrated in the hips; but women who release high levels of cortisol, the stress-related hormone, tend to store fat in the deep belly tissue—fat that is very difficult to take off. Epel and post-doctoral fellow Jennifer Daubenmier decided to test a program similar to Kristeller’s MB-EAT program but with added stress reduction exercises on obese women to see how it would impact the women’s cortisol levels and fat distribution.

Results showed that the more mindfulness the women practiced, the greater their anxiety, chronic stress, and deep belly fat decreased. In addition, the women in the mindfulness program maintained their body weight while the women in the control group increased their weight over the same period of time.

“This is what we call a proof of concept study,” says Epel. “We didn’t ask people to change how many calories they ate; we just wanted to know if decreasing stress would have an impact by changing fat distribution, and it did.”

In a more recent study, of which Deborah Hill is a participant, Epel and colleagues are looking at how mindfulness techniques affect weight loss. The program aims to reduce stress, increase awareness of external and internal cues for eating (like being in a party situation or feeling bored), and foster more self-acceptance around food, while teaching people about nutrition. While data from the study is still being evaluated, Epel expresses surprise by the promising results so far.

“Mindfulness has turned out to be much more powerful than I thought, in its ability to affect weight,” she says.

Not a panacea

Still, the research on mindful eating is relatively young, and it is not without its critics. One concern is that the mindfulness approach is too weak to be effective, given the overwhelming problems with our current food environment, such as the prevalence and cheapness of unhealthy, high calorie foods, and the marketing that pushes convenience foods on an overly stressed population.

Michele Mietus-Snyder, co-director of the Obesity Institute at Children’s National Medical Center in Washington, D.C., has been studying childhood obesity in highly stressed communities, where obesity levels tend to be highest.

Michele Mietus-Snyder, co-director of the Obesity Institute at Children’s National Medical Center. Michele Mietus-Snyder, co-director of the Obesity Institute at Children’s National Medical Center.

As part of a study funded by the American Heart Association, Mietus-Snyder taught mindfulness, as well as nutrition and healthy eating, to a group of inner-city kids and their parents in Northern California to see what impact it would have on the kids’ levels of stress, cortisol, and c-reactive protein, a risk factor in heart disease.

She quickly learned how “naïve” she was to think that these tools could make a significant impact. Because of the chaotic environment in which the study families lived, it was hard for them to participate consistently, even though the parents and kids both seemed receptive to the program. 

“The tool of mindfulness, as valuable as it is, could just not take root in these kids’ lives,” says Mietus-Snyder. “The entropy of life took over.”

Results from her study found that neither the mindfulness group nor a control group—who received exercise in place of the mindfulness class—changed their metabolic profile by much, though both groups did have overall reductions in anxiety and in the kids’ body mass index scores. She hypothesizes that just bringing the parents and kids together once a week to learn about healthy eating may have been at least partly responsible for the positive results in both groups.

But what was most discouraging to Mietus-Snyder was the paucity of nutrition she found in the kids’ diets, which caused their metabolic systems to become inefficient and dysfunctional. She wonders if this, more than anything, impacted the effectiveness of the mindfulness intervention.

“We’re just climbing uphill with these kids,” she says.

Mietus-Snyder believes the most important thing society can do to eliminate obesity is to improve the food environment for these kids. The government should intercede and more closely regulate food production and distribution, especially in schools, she says.

Epel shares that concern, but still sees the need for a two-pronged approach.

“We need to change food policies, not just focus on how people change their response to it,” she agrees. “But we need to work from both sides of this issue.”

No more food fights

Before Deborah Hill entered Epel’s mindfulness treatment program, her doctor had warned her that her cholesterol and triglyceride levels were high, a risk factor for diabetes, heart disease, and stroke. She’d tried diets and programs like Weight Watchers, but felt that they weren’t helping her with the emotional side of her eating.

“I’m an emotional eater,” says Hill. “I eat because I’m bored, stressed, or just because.”

Through the mindful eating program, she has learned how to slow down, evaluate how she’s feeling, and make better choices.

“Now if I want a piece of cake, I really taste it,” she says. “After four to five bites, I re-evaluate and ask myself: Do I really want it?”

Although doing the daily mindfulness meditation has been hard for her, she finds other ways to de-stress, and has become more “adventurous” around eating, sometimes choosing arugula salad over fried chicken and mashed potatoes, for example. But, she doesn’t deny herself anything, she claims, even eating a burger when she wants to, as long as she stays aware of making the choice and not because “it’s there.”

“I’m not on a diet; I’m on a lifestyle change,” says Hill. “I eat what I want. I don’t fight food anymore.”

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About The Author

Jill Suttie, Psy.D., is Greater Good‘s book review editor and a frequent contributor to the magazine.

  

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Hiya, thanks for all your amazing work grin
I’m here in Australia, feeling very galvinised by this article & the videos re links btw mindfulness & eating, & I have just downloaded your Guide, which I look forward to devouring, mindfully wink
I have both a personal & professional interest in these subject areas, & have just tried to use the link you’ve included for the MBSR program in your Notes, but it didn’t work from here….which I thought you may want to check from your end as well, in case it’s an obsolete URL?
In the meantime, I’ve tried to email the admin section of the University of Mass., but cos my email address looks a bit suss to many filters, it may not get through…
What I specifically keen to know is, if there is any way of accessing any of these programs/research projects online from here in Australia? is it necessary to be physically present to complete the week course?
I have a psychologist colleague who I think could be very interested in integrating the program into his practise, & I want to be in the first group to try it out grin
Hope you can help, with a direct email contact for the right person to connect with re this grin
Warm Regards,
Maree Robertson

Maree Robertson | 4:34 pm, June 27, 2012 | Link

 

I guess part of the problem stems from the fact that people turn to food for anything and everything - be it happiness or sadness. They tend to use food as a medium of expression.

Praveen Kumar | 5:11 am, July 1, 2012 | Link

 

As the co-founder of The Body Positive, an organization that helps people create positive relationships with their bodies, eating, and exercise through the development of intuitive listening and self-love, I am concerned about the link between mindful eating and weight loss promoted in your article. Mindful (we call it intuitive) eating is a wonderful thing to cultivate, and leads people to greater health and happiness. To associate it with weight loss is damaging to the entire purpose of being mindful, and to people of all sizes. Yes, some people will lose weight when they eat mindfully, but some won’t. Others will put on weight when they become mindful eaters (this was my experience after ending my eating disorder thirty years ago). For the people who have been yo-yo dieting their entire lives and damaged their metabolism, there is little chance that any form of eating will help them to lose weight.

People of all sizes will benefit from mindful eating. By linking it with weight loss, the association is made that the only people who need to be mindful when eating are people who are over their genetic set point weight or binge eaters. It also doesn’t take into consideration the fact that humans come in many shapes and sizes and not all people are able to become thin, even if they never over eat and only eat nutritious foods.

One of The Body Positive’s goals is to shift conversations about healthful eating and exercise away from associations with weight and weight loss towards simply talking about eating and exercise as means to improving health and greater longevity—and to having more pleasure in life. Telling people they can lose weight by being mindful sets them up for failure in creating long term healthy habits because if they don’t lose weight, or don’t lose a certain amount of weight, they stop the positive behaviors thinking they are not working. The article offers your readers the usual double binds we see when discussions revolve around weight loss. I’m all for promoting mindful eating. I just wish to see it done without a link to “obesity” or weight loss.

I recommend a great book called Health at Every Size: The Surprising Truth About Your Weight by Linda Bacon, PhD to learn more about the physiology of weight and why a weight neutral approach to eating and health leads to long term positive changes for people of all sizes.

Connie Sobczak | 2:28 pm, July 5, 2012 | Link

 

This is an interesting perspective, and I thank you
for sharing it.

I agree that the goals of mindful eating are not to
lose weight, per se—the goals are to teach people
to listen to their inner hunger and satiety cues,
accept their food preferences, and savor their food
choices. In fact, many people of average weight
and size enjoy mindful eating because of the
pleasure it brings to their everyday life, not with
any goals of weight loss in mind.

But weight loss can occur with mindful eating, as
the research attests to. And for those who suffer
from obesity, I would still argue that weight loss is
a positive goal, primarily for health reasons. As I
mention in the article, the CDC has identified many
health risks for people who are obese, and these
should not be ignored. And, in some cases, people
can avoid costly medications and their potential
negative side effects simply by losing weight.

Interventions like mindfulness—which can help
people become more aware of what drives their
behavior and to make more positive choices in their
everyday lives, eating included—are beneficial to
one’s health even just from a stress reduction
perspective. [See GGSC’s prior articles on Jon Kabat
Zinn’s Mindfulness-Based Stress Reduction
program.]

But, many who are obese need more than stress
reduction—they need effective programs that help
them to eat healthier and to lose weight, so that
they reduce their risk of heart disease, stroke, and
diabetes. And since mindful eating seems to help
people do that while avoiding diets—which are
often ineffective in the long run—I think it’s worth
mentioning as a treatment option, especially
because of its self-compassionate approach.

So while I agree that promoting healthy eating for
its own sake is a laudable goal, and that the goal
of mindful eating is not thinness, weight loss is a
reasonable goal for some people. Yes, weight loss
is contraindicated for certain eating disorders—
anorexia nervosa and bulimia, for example—and I
don’t cover those cases in this article. But, weight
loss for someone who is obese could prolong his or
her life and, in my mind, that doesn’t contradict
the goal of learning to love oneself.

Jill Suttie | 9:53 pm, July 5, 2012 | Link

 

Thank you, Connie Sobczak for raising these important criticisms, I know that the work you are doing with The Body Positive has been truly transformative for many. I also am a big fan of mindful or intuitive eating, and know that value of incorporating it. Jill Suttie, I’d encourage you to reexamine the research. Sure, there are short-term studies that show intuitive eaters may lose weight - just like there are short term studies that show millions of other “successful” methods for short term weight loss. But I challenge you to find one study that demonstrates that this weight loss is sustained. As a researcher who knows the field, I’ve done that literature review and can assure you: it doesn’t exist. Which doesn’t surprise me, given the well-established biological mechanisms that resist sustained weight loss. Your assumption about the health risks due to obesity is also spurious and not supported by the data - yes, heavier people are more likely to have several diseases, but when you tease out the research, these are more closely associated with behaviors than weight itself - and there is little evidence that weight loss itself solves the health problems, even if we knew how to accomplish it. I encourage you to consider the damage you do in promoting mindful eating as a weight loss solution, and how much more valuable and supportive you can be by switching your messaging. There are many people who try intuitive eating for weight loss, and when it’s not successful, give up on it and feel like they’ve failed. However, it is a valuable practice, regardless of weight outcome. Why not support it for health and well-being instead? Then everyone can be successful, regardless of whether they lose weight, and you don’t do all the damage imposed by instilling false hopes and weight stigmatization. For scientific support and more detail on all that I write, see this peer-reviewed article: Weight Science: Evaluating the Evidence for a Paradigm Shift: http://www.nutritionj.com/content/10/1/9.

Linda Bacon | 6:15 am, July 9, 2012 | Link

 

I appreciate your following up on this argument
and providing evidence for your viewpoint on
mindful eating and weight loss.

I’m not a researcher, nor an advocate; I’m merely
reporting on the research being conducted in this
area. The researchers I spoke with consider weight
loss (as well as many other variables, including fat
distribution) in their studies on mindful eating,
because they think excess weight is a health risk
for obese people, and that mindful eating may
help. It sounds like you disagree with that premise;
so thanks for sharing your perspective. I encourage
interested readers to look further into this.

The information about health risks for obesity came
from the Center for Disease Control—a reputable
source. You could be right about there being
evidence that these risks are due to behavioral
issues more than weight; but that wasn’t part of
the CDC report I saw. Thanks for pointing out the
controversy.

As far as I know, there are no studies on the
effectiveness of mindful eating for weight loss in
the long term. Much of the research is new; so we
will have to wait to see whether or not this type of
intervention will have long-term benefits. The hope
is that it will, since it doesn’t target weight loss, per
se, but unhealthy eating habits, especially
emotional eating. And whether or not weight loss
occurs, there is much to be said about the other
benefits of mindful eating, including a more
positive relationship with food and eating.

Promoting mindful eating for its own sake, as the
Body Positive does, is a worthy goal. In fact, there
is evidence that practicing mindfulness in general is
associated with many positive health outcomes.
Whether or not it correlates with weight loss,
mindful eating does appear to help people become
aware of their physical and emotional cues around
eating and to learn to savor their food more. I hope
our readers will consider this when deciding
whether or not they want to pursue mindful eating
for themselves.

Jill Suttie | 4:18 pm, July 9, 2012 | Link

 

I agree that we all must eat mindfully and that
mindful eating also means that we must pay careful
attention to WHO, not WHAT, winds up in our
mouth - many many food animals are formerly
sentient beings and not objects, and we must
remember that when we choose our meal plans—
http://www.theatlantic.com/health/archive/2011
/12/dead-cow-walking-the-case-against-born-
again-carnivorism/250506/

http://www.psychologytoday.com/blog/animal-
emotions/200912/who-we-eat-is-moral-question-
vegans-have-nothing-defend

Marc Bekoff | 8:31 am, July 10, 2012 | Link

 

How wonderful to see a _civilised_ difference of opinion in an online forum!

The art and practice of good manners - which stems, at root, from thoughtful consideration of others’ needs - still lives. grin

Yahya | 10:11 am, July 10, 2012 | Link

 

I think that in practicing mindful eating we can try and move away from seeing food as a reward. We often say ‘Oh Let’s treat ourselves to a .....’ or when a child is upset sweets/cakes are used to ‘cheer’ the child up. In this way, if we feel bad in anyway we use food as an emotional crutch. eg I will often crave certain foods when I feel anxious or bored. The more consistently I practice Mindfullness then the less I crave.

Ellie | 4:07 pm, July 10, 2012 | Link

 

There is a free youtube video taking you through a full mindful eating meditation with the sultana here: http://www.youtube.com/watch?v=jsqVUKPICdA&feature=plcp

Rachel Green | 8:20 pm, July 10, 2012 | Link

 

I find this to be very interesting research concerning
who we choose to eat and perhaps who we are as
individuals - we need much more work in this area ...

http://www.psychologytoday.com/blog/animal-
emotions/201207/brain-scans-show-vegetarians-and-
vegans-are-more-empathic-omnivores

Marc Bekoff | 6:23 am, July 13, 2012 | Link

 
Jeremy Adam Smith's avatar

Folks interested in this issue will also be interested in
this piece by Rodolfo Mendoza-Denton, which covers
new research into anti-fat prejudice, as well as the
relationship between obesity and willpower:
http://greatergood.berkeley.edu/article/item/how_t
o_pass_the_marshmallow_test

Jeremy Adam Smith | 4:35 pm, August 13, 2012 | Link

 
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