NDNR

Mindful Eating

Mindful Eating

June 03
11:51 2014



Using Our Relationship With Food to Promote Greater Cohesion Between Mind, Body, and Spirit

Brian A. Plante
Andrew Erlandsen, ND

There has been a considerable amount of research in the past 3 decades on the health benefits of mindfulness meditation.1 Aiming to foster a non-judgmental awareness of the present moment, regular mindfulness-meditation practice is associated with decreases in anxiety, depression, and other types of negative affect; decreases in physical pain; and increases in both psychological and physical quality-of-life measures.1 Because mindfulness can be learned, those suffering from chronic disease, as well as individuals facing everyday stressors, can be taught to integrate mindful awareness exercises into their daily lives.2

A relatively new clinical application of mindfulness has emerged called “mindful eating,” which brings a non-judgmental attitude right to the dinner table.3 With training, individuals become more attuned to hunger and satiety cues from their bodies and use these to gauge how often and how much to eat. They bring full attention to the present moment by using all of their senses in the dining experience, and observe their mental and emotional responses to different foods without judgment. By slowing down the pace of eating to savor foods and assess levels of fullness, mindful eaters also develop an awareness of “mindless” eating behaviors, such as unconsciously eating when depressed or bored.2,3

Mindful eating differs from calorie-counting and other quantitative approaches to nutrition, instead focusing on our bodies’ natural ability to assess how much food we need.3 It is not specifically concerned with what individuals eat, but how. Relating to food in this way can reduce the stress caused by strict quantity-regulating eating strategies for individuals that struggle to lose weight, keep weight off, or are challenged by binge eating behaviors.3

Other benefits of mindful eating include greater awareness of hunger and fullness; less weight regain that often follows periods of dieting; greater self-esteem; and the development of a more active, empowered relationship to food and eating.3 As a clinical intervention, mindful eating demonstrates potential in the treatment of obesity and binge eating disorder (BED) because it addresses both physical and psychological barriers to healthy eating behaviors.2,4

Mindful eating may have additional benefits, including spiritual aspects. Mindfulness meditation is traditionally a Buddhist spiritual practice aimed at cultivating a greater sense of connection to all aspects of life.1 Clinical mindfulness programs are often secular in nature and do not focus on lasting meaning. For some, this more secular approach to eating may not have optimal health benefits.

In her article Spiritual Engagement as a Mechanism of Change in Mindfulness- and Acceptance-Based Therapies, Jean Kristeller outlines the initial research that has examined the roles of spirituality and meditation in human health.5 Although spirituality has been associated with greater psychological well-being, much is yet to be understood about how this association operates and how health-related outcomes differ between the meditation styles of various spiritual traditions.5,6,7 Furthermore, doctors are often unsure how to address the spiritual aspects of care because patients and doctors vary greatly in their beliefs, practices, and degree of interest in spirituality.6

The philosophy of whole-person care often includes healing on the levels of mind, body, and spirit.7 As more research probes the nature of this spirituality-health association, as well as how different forms of meditation (secular, spiritual) operate neuro-physiologically, it is possible that mindfulness-training programs may begin to incorporate more elements that heal patients on the spiritual level.8 In the most general sense, this means helping patients to engage in deep reflection, understand what gives them purpose and meaning, develop compassion for themselves and others, and live their lives with joy and inner peace.5,7 It is possible that, because of its focus on food, which is both physically and psychologically nourishing, mindful eating could serve as an ideal starting point to bridge this clinical gap.

The Role of Mindfulness in Weight Loss and Eating Control

Obesity and BED are complex disorders that involve multiple metabolic and psychological factors; fortunately, researchers have begun to explore how mindfulness is related to weight loss and control of eating behaviors.4,9 One of the greatest barriers to effective weight loss is the tendency of many individuals to quickly regain the pounds they worked so hard to shed.4 As Elizabeth Sutherland, ND, describes, initial weight loss is mostly due to muscle, organ, bone, and cell structure breakdown when one consumes fewer calories than the body is burning.10 The body eventually enters a starvation state in which metabolic activity slows, often causing an individual to gain weight, even while dieting.

According to Sutherland, balancing one’s metabolism and healing this tissue damage requires a combination of whole-foods nutrition, sleep, and stress management.10 Oftentimes, management of stress includes exploring the emotional components of eating. Consistent with the naturopathic approach, effective long-term weight loss demands a holistic treatment plan that involves multiple levels of intervention. A key component often overlooked by conventional clinicians is the mind-body connection, which mediates hormone production and eating behaviors.4,10

A 2011 study examined the effects of a 4-month mindfulness program for “stress eating” on cortisol levels and abdominal fat in obese women.4 The results indicated that the obese intervention group maintained body weight and showed reduced cortisol awakening response (CAR), while the obese control group showed weight gain and stable CAR.4 Abdominal fat loss was significantly associated with improved mindfulness, less chronic stress, and reductions in CAR.4

A year later, a neuroscience study explored possible associations between mindfulness scores and regional brain activity by looking at functional MRI scans of older, obese adults receiving food cues following a brief period of food deprivation; subjects were divided into 2 groups, based on Mindful Attention Awareness Scale (MAAS) scores.9 Although both groups reported similar hunger and craving levels, the high-mindfulness group was able to return to a resting-brain state – associated with greater self-regulation – more quickly than the low-mindfulness group.9 The authors concluded that because self-regulation behavior is influenced by a host of factors, mindfulness interventions alone may not be enough to reduce overeating, but that mindfulness-training as a component of treatment may greatly improve the effectiveness of weight loss interventions.9

Other key research findings relating mindfulness and eating behaviors include positive associations between food intake and high trait anxiety among obese individuals, suggesting trait anxiety as a possible risk factor for emotional eating in obese populations.11 A study by Kristeller and Wolever found that the amount of time spent practicing eating-related meditations strongly predicted increased control of eating behaviors.2 This empirical research has led to the development of mindful eating intervention models that address the psychological components of obesity and BED.

Mindful Eating Interventions

Many mindfulness eating programs have been developed. One particular mindfulness training program for obese individuals, called Mindful Eating and Living (MEAL), consists of 2-hour weekly classes for 6 weeks, and 2 monthly follow-up classes.12 The curriculum is composed of mindfulness meditation training, mindful eating exercises, light yoga, walking meditation, and group discussion – all aimed toward cultivating greater awareness of physical sensations, emotions, and thought processes involved in eating and in triggering eating behavior. Participants are also encouraged to practice meditation daily and to pair meditation with eating as frequently as possible. Empirical support for MEAL includes increases in mindfulness and control of mental and behavioral processes while eating, as well as decreases in weight, binge-eating episodes, depression, self-reported stress, negative emotions, and levels of C-reactive protein.12

Another 6-week program, Mindful Restaurant Eating, was developed specifically for individuals who eat out frequently.13 The program teaches its participants awareness of calorie and fat content in restaurant foods, strategies for behavioral change related to eating, and mindful-eating meditations. The program does not seek to reduce the frequency that individuals eat out, but rather to maximize their enjoyment of eating healthy and appropriate amounts of restaurant foods. Class sessions cover topics in weight management, individualized goal-setting, and eating meditations focused on sensory awareness and greater attention to hunger and fullness. Although the goal is to prevent weight gain, a 2012 study actually demonstrated an average loss of 1.7 kg over the course of the program, while the average number of restaurant visits remained constant.13

A third mindful eating program, Mindfulness-Based Eating Awareness Training (MB-EAT), is designed to treat BED by addressing the interaction of food-related emotions and behavioral regulation.2 Since mindfulness meditation affects multiple cognitive and physiological processes, Kristeller and Wolever suggest that it may be an appropriate intervention for disorders that disrupt many aspects of psychological and behavioral function, including BED.2 The MB-EAT program is composed of 10 sessions that focus on mindfulness meditation, mindful-eating exercises, and cultivating self-awareness and self-acceptance. Class sessions involve a variety of food exercises designed to bring attention to specific sensations and aspects of eating, with a particular focus on the emotions that trigger binge episodes and how to find healthier ways to meet emotional needs. MB-EAT participants have shown dramatic improvement, as measured by the Binge Eating Scale, as well as decreases in depression.2 Interestingly, eating-related meditations and short mindfulness exercises throughout the day were more responsible for these improvements than sitting meditation.2

Mindful Eating & Whole-Person Care

The empirical research and treatment models described above establish mindful eating as a promising intervention for weight loss and control of eating behaviors. These models, when coupled with nutrition and exercise counseling, address both the metabolic and psychological components of complex disorders such as obesity and BED. Mindfulness meditation may also serve to foster spirituality, which may further promote healing.

Although some research into what constitutes spiritual experience and how this relates to human health has been conducted, very little has been revealed about how spirituality can be incorporated into behavioral and nutrition/exercise interventions to create optimal whole-person care. Nevertheless, one study suggests that increases in spirituality may not only offer mental health benefits, but may also be a mechanism underlying these benefits after clinical mindfulness interventions.8 Therefore, despite the secular nature of these programs, their training may provide a comfortable starting point for patients wishing to explore deeper avenues of spiritual discovery.

This spiritual discovery need not be religious or associated with specific belief systems. Although many definitions of spirituality have been offered, the essential components of several spiritual traditions overlap, suggesting a universal human potential to engage life in meaningful ways.5 These include developing inner peace, compassion, a sense of connectedness, and connection to a deeper purpose or meaning.5 A functional definition of spirituality could be the sense of universal significance that inspires an individual to compassionately connect with other members of the human family and with life’s many mysteries.

To promote weight loss and maintain that loss, physicians can encourage patients to approach eating curiously and openly, with gentleness and self-acceptance, thereby creating a more healthful and nourishing relationship with food and with oneself. This is the essence of healing: doctors providing the necessary tools so that patients themselves both desire and work toward lasting improvements in health.14 In terms of treating obesity and binge eating disorder, mindful eating may play an integral role because it opens the doorway for this deeper participation in the healing process and helps provide the tools a person needs for creating long-term change.

Plante_June_2014Brian A. Plante is a senior chemistry student at St Olaf College in Northfield, MN. He conducted research this last summer at NCNM’s Helfgott Research Institute, examining mindfulness-based treatment models and performing chemical analysis on traditional Chinese herbs. With a variety of research experiences and interests, he is passionate about the relationship between the rapidly emerging field of integrative medicine research and traditional naturopathic practice. He is eager to pursue a career in naturopathic medicine following graduation. Contact Brian A. Plante on LinkedIn.

 

 

Erlandsen_Headshot_June_2014Andrew Erlandsen, ND earned his degree as a Doctor of Naturopathic Medicine from the National College of Natural Medicine (NCNM) in Portland, Oregon. Dr Erlandsen is the chair of the Master of Science in Nutrition (MScN) program at NCNM. As an assistant professor, Dr Erlandsen teaches a variety of nutrition courses in all of the academic programs at NCNM. He also teaches courses in clinical research and mentors students on their thesis projects. Dr Erlandsen also works at NCNM with the Ending Childhood Obesity (ECO) Project – a program that includes community-based nutrition education and a series of 12 hands-on cooking workshops that are free to the public. The mission of the ECO Project is to reduce chronic disease and morbidity associated with childhood obesity by empowering children, families, and communities through education to make and have access to healthy food choices. In addition to teaching at NCNM, Dr Erlandsen maintains a private clinical practice in Beaverton, OR.

References

  1. Grossman P, Niemann L, Schmidt S, Walach H. Mindfulness-based stress reduction and health benefits. A meta-analysis. J Psychosom Res. 2004;57(1):35-43.
  2. Kristeller JL, Wolever RQ. Mindfulness-based eating awareness training for treating binge eating disorder: the conceptual foundation. Eat Disord. 2011;19(1):49-61.
  3. Mathieu J. What should you know about mindful and intuitive eating? J Am Diet Assoc. 2009;109(12):1982-1987.
  4. Daubenmier J, Kristeller J, Hecht FM, et al. Mindfulness Intervention for Stress Eating to Reduce Cortisol and Abdominal Fat among Overweight and Obese Women: An Exploratory Randomized Controlled Study. J Obes. 2011;2011:651936.
  5. Kristeller J. Spiritual Engagement as a Mechanism of Change in Mindfulness- and Acceptance-Based Therapies. In: Baer RA, ed. Assessing Mindfulness and Acceptance Processes in Clients, Illuminating the Theory and Practice of Change. Oakland, CA: New Harbinger Publications; 2010:155-184.
  6. D’souza R. The importance of spirituality in medicine and its application to clinical practice. Med J Aust. 2007;186(10 Suppl):S57-S59.
  7. Anandarajah G. The 3 H and BMSEST models for spirituality in multicultural whole-person medicine. Ann Fam Med. 2008;6(5):448-458.
  8. Greeson JM, Webber DM, Smoski MJ, et al. Changes in spirituality partly explain health-related quality of life outcomes after Mindfulness-Based Stress Reduction. J Behav Med. 2011;34(6):508-518.
  9. Paolini B, Burdette JH, Laurienti PJ, et al. Coping with brief periods of food restriction: mindfulness matters. Front Aging Neurosci. 2012;4:13.
  10. Sutherland E. Healing metabolism: a naturopathic medicine perspective on achieving weight loss and long-term balance. Perm J. 2005;9(3):16-18.
  11. Schneider KL, Appelhans BM, Whited MC, et al. Trait anxiety, but not trait anger, predisposes obese individuals to emotional eating. Appetite. 2010;55(3):701-706.
  12. Dalen J, Smith BW, Shelley BM, et al. Pilot study: Mindful Eating and Living (MEAL): weight, eating behavior, and psychological outcomes associated with a mindfulness-based intervention for people with obesity. Complement Ther Med. 2010;18(6):260-264.
  13. Timmerman GM, Brown A. The effect of a mindful restaurant eating intervention on weight management in women. J Nutr Educ Behav. 2012;44(1):22-28.
  14. Hutchinson TA, Hutchinson N, Arnaert A. Whole person care: encompassing the two faces of medicine. CMAJ. 2009;180(8):845-846.
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