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Mindfulness Training and Meditation to Combat Obesity?



Regular readers of these pages may recall previous posts on how “mindless” eating may well be contributing to the current obesity epidemic.

It may therefore be logical to presume that increasing “mindfulness” may help modify and improve eating behaviours.

But what does it take to actually help clients become more mindful of their eating behaviours?

This interesting issue is the topic of a paper by Jean Kristeller and Ruth Wolever just published in Eating Disorders, in which they describe a conceptual framework and the preliminary results of an approach that they call Mindfulness-Based Eating Awareness Training (MB-EAT).

As the authors explain:

The MB-EAT program is designed to help individuals cultivate awareness of both internal and external triggers to eating, interrupt dysfunctional cycles of binging, self-recrimination and over-restraint, and re-engage the natural physiological processes of eating regulation. Furthermore, the program emphasizes the pleasure and nurturing aspects of eating, while encouraging healthier patterns of food choice, in terms of both types and amount of food eaten. MB-EAT is further designed to do so in a way that is effective in internalizing and maintaining change.

Specifically, the MB-EAT program includes strategies such as meditation practice to cultivate attention and awareness.

In addition, participants are encouraged to recognize their own internal strengths, and be open to their own understanding and solutions to challenging situations, rather than reacting judgmentally to self-perceived variances from internalized norms of eating behavior or weight.

The 10-session treatment program uses a range of strategies and exercises to cultivate mindfulness, mindful eating, emotional balance, and self-acceptance.

The authors present preliminary findings from studies in patients with and without binge eating disorder suggesting significant improvements in eating behaviours and mood.

Certainly a paper that I would recommend to anyone who believes that helping patients change their eating behaviour requires more than simply “educating” them about healthy choices.

I wonder what my readers have to say about this approach to weight management, which is so very different from the “kick-in-the-butt” approach that I blogged about yesterday.

AMS
Chicago, IL

Kristeller JL, & Wolever RQ (2011). Mindfulness-based eating awareness training for treating binge eating disorder: the conceptual foundation. Eating disorders, 19 (1), 49-61 PMID: 21181579

15 Comments

  1. I’m interested in this approach — I think it is likely to lead to improved health in individuals who are interested in trying this kind of approach, and I would think the results would be better long-term than most weight loss approaches.
    I don’t know if I would use the phrase “combat obesity” for such a non-violent approach, though.

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  2. This program is being offered through the Mind/Body portion of a local hospital around here. When I looked into it, though, it seemed a bit to woo-wooey to be taken seriously. (It didn’t help that they were offering it alongside some real BS).

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  3. Craving Change is a Canadian program created by a dietitian and psychologist which can be used by any health professional and it is also designed to help people become more aware of their food struggles and how to manage them.
    http://www.cravingchange.ca/

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  4. If you you have binge eating disorder and need to “interrupt dysfunctional cycles of binging, self recrimination and over-restraint” etc, this program would suit better than a kick-the-butt approach, which would just make you feel worse.

    On the other hand, consider a guy who quit training hard and playing hockey, switched to a truck driving job which is mostly sedentary, but kept eating the quantities required by a very active athlete,

    and also changed eating a decent type of food to eating easily available pizza, fast food and junk food –

    for him the kick-the-butt approach would probably be way better.

    The exercise program, complete with yelling and competition, would be like getting back to the hockey training he liked.
    As he probably never thought much about nutrition other than as fuel for a gruelling hockey schedule, education in what food is good for him and also is available, would be a big help.

    For this guy, a kick-the-butt-approach matches his character – goal oriented, competitive, willing to use expert knowledge (in exercise and nutrition), and eager to train hard.

    I am agreeing with you, Dr Sharma, when you say weight loss is not one-program-fits-all.

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  5. I agree. I use a lot of these concepts in my work with overweight clients. It helps prevent mindless eating but even more so is the effect on reducing anxiety about overeating and developing ways to calm oneself without resorting to food for that purpose.

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  6. Provided mindfulness is intended to attune the person to their own cues of hunger and satiation, this is good. This is wonderful.

    If, as so much of diet culture seems to promote, “mindfulness” is merely a way to cope with being hungry all the time, not so good. There’s also the mistaken assumption that people who are heavy cannot be eating mindfully and this becomes one more way to blame and shame, not so good. I realize, Dr. Sharma (and thank you for), that you don’t come from these latter perspectives, but many people do.

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  7. Thanks Dr Sharma,

    True that “weight loss is not one-program-fits-all” but this approach to me seems necessary first step for all those who are overweight and yet not aware as many are. Looking at the recent Canadian Poll showing “Many Canadians are deluding themselves about their weight” with only 44% said yes when they were asked if they were overweight, it seems the state of awareness about the overweight and obesity is not yet there. I believe if programs such as “Mindfulness-Based Eating Awareness Training” can help people understand that they indeed are in danger of being overweight and obese the chances to seek help and pay attention to calorie overload will be more likely.

    MB- Eating Awareness Training in a sense to provide awareness on eating habit and weight issues as well as stress relieve seems to have a potential to serve an important and necessary part of any weight management program but certainly not sufficient to combat the weight issues!

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  8. I lead clients through a mindful eating exercise. They all agree that when they really slow down and pay full attention to what they are eating with all their senses it is an entirely different experience. Overeating and mindful eating are incompatible. This is a process that takes time to master, but is very heartening to overeaters of all kinds. For people who can’t control their eating, what they eat is of less significance. And when they start to eat mindfully their “go to” foods often lose their appeal anyway.
    Yes, self-acceptance is integral to success.
    Claudette Pelletier-Hannah

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  9. I think this approach is far more helpful, and will even increase health in people who don’t end up losing weight. Once I let go of weight-loss as my prime goal and started thinking about food differently, I noticed a drastic change in the way I ate and how it satisfied me. I have lost some weight, but not intentionally. My new philosophy is to enjoy food more, not less. So I turn off the tv and focus on the food I’m enjoying. Because of this, I can be satisfied on much less. Because I know that I can have the good-tasting food again later if I want it, I don’t feel the need to cram in as much as possible while I’m still “allowed” to have it. And I have also started enjoying a larger variety of foods, because I can notice the subtle flavors more. I recently actually craved lettuce, and nothing like that had ever happened before. And there’s not guilt, morality, or punishment attached to any foods so I can really focus on the flavor of it.

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  10. Thanks Arya and Happy New Year.

    Put me in the category of those physicians who think mindfulness is critical to weight loss. I’m now firmly in the camp of Ken Berridge who suggests that cravings for “Mood Altering Foods” can be described as dynamically generated – primarily dopamine mediated – events that are a response to cues in the environment or within an individual which have been associated repeatedly in a pavlovian sense in the past enough times that “incentive salience” has been associated to these cues. I find patients that struggle with obesity often/always have certain sets of circumstances (cues) where wanting is generated consistently, classics being dinner tables, home at night post dinner, restaurants, social events etc. An initial step in a patient arriving into these cue embedded circumstances prepared and capable of resisting/minimizing the power of the cues is to be aware or “mindful” of the craving and the circumstances in which it is generated. mindfulness of the moment and the “drive” being generated within I find is a prerequisite to long-term change to highest risk eating circumstances. Those who do not have the sensitivity or mindfulness to the generation of cravings for example in front of the TV at night after dinner are much more vulnerable to the next steps in overeating which in my mind include the disordered thoughts such as “I’ll just have a little” or “I worked out today so I can eat some”. Recognizing or being mindful of the incentive salience generated by eating cues and mindfulness to the disordered thinking that follows are critical and necessary.

    Thanks for the article.

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  11. I’ve tried this “eating mindfully” approach and I find it really irritating.
    I do better when I eat what I need, leave the table, and find something interesting to do.

    The obsessing and drooling over every bite just reinforces the idea that food is supposed to provide some deep satisfaction way beyond providing nutrition – which will kick in 20 minutes after you eat anyway, whether or not you have lingered every bite.

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  12. Only through awareness can there be meaningful change. Yet, it’s hard for people to be self-aware if they have the shame-kick-butt-mentality.

    One of the biggest challenges I see with my patients in pursuit of mindful eating–is eating without distraction–television, checking email, texting….all of which, interview with mindfulness.

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  13. Being a weight loss surgery patient for 10 months now and after losing 110 pounds I have to say that this is key to success to keeping the weight off. We go thru this process after surgery, mindful thinking re what gets put into the gullet. This was not an easy way out and it teaches us to be mindful each and every day! Great article Dr. =D

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  14. I think it is a great approach, partly because because of what it says about itself, partly because of what it does not state in the article (but to my mind is crucial) but is nonetheless true as I see it: If I eat mindfully, and you eat mindfully, and the person beside us eats mindfully, each of us will choose different foods and combinations that please and satisfy our tastes, interests, and needs.

    The fact that mindfulness-based eating is not a “diet” but a lifestyle change in that it does not approve, recommend or restrict any particular food group is an essential part of the beauty of it. It is the how of eating, not the what, even though the what is likely to shift at least somewhat over time.

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