Mindfulness Promotes Healthier Eating

Obesity has become into a public health problem. Recent research indicates that moment-to-moment awareness is more effective at assisting people in controlling their weight than any diet.

Deborah Hill used to believe she was quite slender. Her 5'9" body is capable of carrying a lot of weight without appearing out of shape. However, she was astonished to discover last year that she weighed more than 210 pounds, putting her in the medically obese category.

"It was insane," Hill recalls. "I'd never had a weight problem."

Hill is one of an increasing number of Americans—more than 35%, according to the Centers for Disease Control—who are classified as obese, defined as having a body mass index of 30 or more. Obesity increases health risks such as heart disease, stroke, and diabetes, to mention a few, and health care expenses associated with obesity-related sickness are growing, reaching $147 billion in 2008, according to the CDC.

However, a new prescription for obesity has emerged that goes beyond the omnipresent diet and exercise regimens: mindfulness, or present-moment awareness of our thoughts, feelings, and environment.

Researchers are discovering that training obese persons mindful eating skills—such as paying more attention to their body' hunger cues and learning to taste their food—can assist them in changing harmful eating behaviors and losing weight. Additionally, unlike other forms of treatment, mindfulness may address the root causes of overeating—such as appetite, stress, and emotional eating—that make it so difficult to overcome.

Hill has undoubtedly benefited from mindfulness. She has shed 40 pounds and formed a much healthier relationship with food and eating in the last year.

"Mindfulness has been enormously beneficial to me," she says.

Why is mindfulness necessary?

Jean Kristeller is a pioneer in the discipline. She is an emeritus professor of psychology at Indiana State University. She first became interested in applying mindfulness to eating issues while working as a clinician with obese college students who were compulsively eating large amounts of food—or "binging." She believed her students had an underlying dysfunctional relationship with food that was being overlooked by the clinical community in favor of dieting, which "didn't mesh" with her.

However, she claims that when she came across Jon Kabat-Mindfulness-Based Zinn's Stress Reduction (MBSR) method, "more than a light bulb" went off for her. She wondered if it may be possible to teach those suffering from eating disorders to refocus their attention on their internal hunger and symptoms of fullness—and to create a more receptive attitude toward food and eating.

"He was carrying on a legacy of promoting awareness and an accommodating attitude toward our experiences—both inner and outer—and urging people to rebalance themselves," Kristeller explains. "This corresponded to my theoretical model of reconnection between people with their inner experiences."

She developed a program called Mindfulness-Based Eating Awareness Training—or MB-EAT—with the assistance of a doctorate student. The program teaches people how to taste their food, detect their degrees of hunger and fullness, and be more accepting of their food preferences. One practice involves gently eating a few raisins and paying great attention to how their flavor perceptions alter over time.

"The majority of people are taken aback when they perform the raisin exercise," Kristeller explains. "They see that if they consciously have a few raisins, they can enjoy them just as much, if not more, than if they consume an entire box."

Of course, even Kristeller concedes that it's simpler to encourage individuals to limit their intake of nutritious foods such as raisins than it is with "problem foods" such as chocolate brownies. Thus, the program does not end with raisins; it teaches participants that, once they develop the ability to pay attention, brownies are best appreciated and relished in fewer portions.

According to Kristeller, many obese persons have evolved a unique pattern: they attempt to regulate their eating by avoidance or limit setting, believing that "willpower" is required. Then, when their plans go awry — which they always do — they convince themselves that they've "blown it" and give up.

According to her, there is never a point of no return from a mindfulness perspective: one can choose to eat thoughtfully at any time, even after "blowing it." Additionally, because the program encourages individuals to relish foods rather than avoid them, participants do not feel deprived. Kristeller aims to alleviate the guilt associated with food enjoyment and to assist individuals in honoring their eating choices.

"We strive to assist individuals in cultivating their inner gourmet," she explains.

What the study reveals

Kristeller piloted her MB-EAT program with 18 binge eaters. The women attended seven sessions of a group treatment program that included pre- and post-treatment assessments.

At the conclusion of treatment, binges decreased from somewhat more than four to roughly 1.5 per week, with just four people continuing to fulfill criteria for Binge Eating Disorder when the researchers asked follow-up questions. Additionally, the women indicated a more positive relationship with food and eating, as well as a decrease in melancholy and anxiety.

Kristeller evaluated the MB-EAT program on a group of obese binge eaters in a second research with Ruth Quillian-Wolever of Duke University, comparing the group one month and four months after treatment to two control groups, one of which received another educational program.

While both the educational and MB-EAT groups demonstrated reductions in binge eating, individuals in the MB-EAT group demonstrated increased general self-regulation and balance around food, as well as sustained improvement in binge eating. Additionally, the extent to which the women integrated mindfulness practices into their daily life predicted a large portion of this improvement and the amount of weight loss they experienced.

"This study demonstrated that success was not solely dependent on group work and receiving support," Kristeller explains, "but that their success in reducing weight was closely tied to their usage of mindfulness techniques."

There is currently no research demonstrating what happens in the brain when people practice mindful eating. However, Kristeller points to a growing body of research on MBSR that demonstrates that people who practice mindfulness enhance the size and function of their prefrontal cortex, the portion of the brain associated with decision-making and long-range planning. She hypothesizes that mindful eating improves this same region of the brain, allowing people to process their desire to eat logically rather than succumbing to the emotional center that frequently drives eating.

"We are breaking the loop of reactivity," Kristeller explains.

Consumption stress and obesity

Elissa Epel, founder and head of the University of California, San Francisco's Center for Obesity Assessment, Study, and Treatment, has been studying the impact of stress in overeating. High stress, she says, is one of the most significant and dependable predictors of obesity, as it alters our appetite, increases overeating, and makes us more insulin-resistant, a feature that raises blood sugar and puts us at risk for Type 2 diabetes.

"Stress has the same effect on signals as starvation has. It activates brain pathways that cause us to seek dense calories—we'll choose foods that are heavy in fat, sugar, or salt," Epel explains. "When we suffer from a'stress brain,' food becomes even more pleasurable."

Epel says that polls indicate that between 50% and 60% of women eat for emotional reasons rather than physical hunger. The stress of tough emotions suppresses the reward response in the brain and results in craving, which is what motivates some people to overeat—as well as to use drugs. According to Epel, the hunger and reward drives are the most powerful in the human body and are notoriously difficult to alter.

"It's difficult to combat the obese brain's deception that you're starving," she explains.

Her laboratory has investigated the effect of mindfulness training on individuals' stress metabolisms. Normally, women's fat distribution is focused in the hips; however, women who produce excessive amounts of cortisol, the stress hormone, tend to store fat in the deep abdominal tissue—fat that is extremely difficult to lose. Epel and post-doctoral fellow Jennifer Daubenmier chose to evaluate an obese women's cortisol levels and fat distribution using a regimen similar to Kristeller's MB-EAT but with extra stress reduction exercises.

The results indicated that the more mindfulness practiced by the women, the more anxiety, chronic stress, and deep belly fat were reduced. Additionally, the women in the mindfulness program maintained their body weight over time, but the women in the control group gained weight.

"This is referred to as a proof of concept research," Epel explains. "We did not ask anyone to alter their caloric intake; we simply wanted to see if reducing stress had an effect on fat distribution, which it did."

Epel and colleagues are currently investigating the effect of mindfulness techniques on weight loss in a more recent study, which Deborah Hill is a member of. The program attempts to alleviate stress, enhance awareness of external and internal cues to eat (such as being in a party atmosphere or feeling bored), and build a greater sense of self-acceptance surrounding food, all while educating participants about nutrition. While the study's findings are still being analyzed, Epel expresses astonishment at the study's early success.

"Mindfulness has proven to be significantly more strong than I anticipated in terms of its ability to affect weight," she says.

Not a cure-all

Nonetheless, the study on mindful eating is still in its infancy, and it is not without detractors. One concern is that the mindfulness approach is insufficiently strong to be effective in light of the overwhelming problems with our current food environment, such as the prevalence and affordability of unhealthy, high-calorie foods, and marketing that promotes convenience foods to an already stressed population.

Michele Mietus-Snyder, co-director of the Obesity Institute at Children's National Medical Center in Washington, D.C., has been conducting research on pediatric obesity in high-stress neighborhoods.

Mietus-Snyder taught mindfulness, as well as nutrition and healthy eating, to a group of inner-city children and their parents in Northern California as part of a study funded by the American Heart Association to determine the effect on the children's stress, cortisol, and c-reactive protein, a risk factor for heart disease.

She rapidly discovered how "naive" it was of her to believe these instruments might have a substantial impact. Due to the chaotic environment in which the study families lived, it was difficult for them to maintain constant participation, despite the fact that both parents and children appeared receptive to the program.

"As beneficial as mindfulness is, it may just not take root in these children's life," Mietus-Snyder explains. "Life's entropy took control."

According to her findings, neither the mindfulness group nor the control group—which got exercise in place of the mindfulness class—significantly altered their metabolic profiles, while both groups saw overall decreases in anxiety and body mass index scores. She hypothesizes that simply bringing parents and children together once a week to learn about healthy eating may have played a role in both groups' improved outcomes.

But what struck Mietus-Snyder the most was the nutritional deficiency she discovered in the children's meals, which resulted in their metabolic systems becoming inefficient and malfunctioning. She wonders if this, more than anything else, impacted the mindfulness intervention's success.

"With these children, we're simply climbing uphill," she says.

Mietus-Snyder feels that the most critical thing society can do to eradicate obesity is to enhance these children's dietary environment. The government should intervene and regulate food production and distribution more strictly, particularly in schools, she argues.

Epel shares this worry but believes that a two-pronged strategy is necessary.

"We need to reform food policies, not just people's responses," she agrees. "However, we must approach this subject from both sides."

There will be no more food battles

Deborah Hill's doctor had cautioned her before to enrolling in Epel's mindfulness therapy program that her cholesterol and triglyceride levels were abnormally high, a risk factor for diabetes, heart disease, and stroke. She'd tried several diets and programs, such as Weight Watchers, but felt they didn't address the emotional aspect of her eating.

"I am an emotional eater," Hill explains. "I eat when I'm bored, stressed, or just plain hungry."

She has learned how to calm down, assess her feelings, and make better food choices as a result of the mindful eating program.

"Now, when I desire a piece of cake, I truly taste it," she explains. "After four to five bites, I reassess and ask myself: Do I truly desire this?" ”

Although she has struggled with daily mindfulness meditation, she has discovered other ways to de-stress and has become more "adventurous" with food, occasionally opting for arugula salad over fried chicken and mashed potatoes. However, she states that she does not deprive herself of anything, including eating a burger when she desires, as long as she is conscious of making the choice and not simply because "it is there."

"I'm not on a diet; I'm changing my lifestyle," Hill explains. "I eat whatever I please. I am no longer opposed to food."