From “mind full” to “mindful” eating
The problem of obesity and how (not) to tackle it
Eating chocolate when being sad, having ice cream after a break-up, eating more than originally planned, and having problems with losing weight –these are situations probably every one of us has experienced some time in our life. Likely, many of us are struggling with weight concerns, set ourselves on a diet, and are frustrated by food cravings and occasional over-eating. Typical weight loss programs are not always effective in reducing weight and alleviating common eating-related behavioral problems. However, novel alternative approaches using mindfulness strategies to combat eating-related health issues give a reason for optimism.
While not everyone with overweight is necessarily unhealthy in modern society, obesity is one of the most common health issues. It is linked to serious illnesses such as cardiovascular diseases or cancer and can reduce one’s life expectancy (Afshin et al., 2017). Unfortunately, most weight-loss interventions have only modest effects (Lv et al., 2017), and most people regain weight within a few years after dieting (Godfrey, Gallo, & Afari, 2015). This can be partly blamed on two separate issues: (1) the environment we live in and (2) the aim of popular weight-loss interventions and trendy diets.
So, why is weight loss so difficult?
First, an obesogenic environment predisposes us to buy energy-dense, tasty foods: It is readily available at every corner, it is rigorously marketed and advertised, and it is often even cheaper than healthy foods (Swinburn et al., 2011). Further, our bodies are evolutionary designed to take on and store as much energy as possible to cope with times of food shortage. So, who could blame us for wanting fries rather than a salad? With this in mind, it is not surprising that an increasing number of people suffer from weight problems and obesity (Afshin et al., 2017; Swinburn et al., 2011).
The second issue surrounds common eating-related problems and the nature of weight reduction programs themselves. Various problematic eating behaviours are linked to weight gain and regain, including binge eating, emotional eating, external eating, and food cravings (O’Reilly, Cook, Spruijt-Metz, & Black, 2014). Binge eating involves losing control over eating and consuming abnormally large amounts of food – imagine a pizza, 2 pieces of cake, a large soft drink, and a bag of crisps – within relatively short periods of time such as one hour (O’Reilly et al., 2014). It is a very common issue among obese people, with about 70% experiencing binges. Emotional eating constitutes eating in response to emotions (positive or negative) and relates to unhealthy dieting (O’Reilly et al., 2014). It is suggested to arise from maladaptive emotion regulation strategies in which individuals eat as an attempt to suppress their feelings. Supporting that, low tolerance of distress and difficulty managing negative emotions are linked to binge eating and dietary violation (see Forman et al., 2009). Similarly, eating in response to food-related cues such as smell or sight rather than hunger, called external eating, is more common in obese than normal-weight individuals (O’Reilly et al., 2014). According to the so-called externality theory, overeating or external eating occurs because individuals pay increased attention to external food cues (Schachter & Rodin, 1974 as cited by O’Reilly et al., 2014). Lastly, food cravings, that is intense urges to eat specific foods, often co-occur obsessive thinking about and impulsive eating of craved foods (O’Reilly et al., 2014). Although cravings are not necessarily always pathological or problematic, they can lead to weight gain and various other negative outcomes (Alberts, Mulkens, Smeets, & Thewissen, 2010).
Dieting and why it’s usually less effective than you think
We’ll come straight to the main issue: None of the problematic eating behaviors are typically addressed in popular diets and weight reduction programs. Strange, right? This may explain why these approaches often yield neither short- nor long-term successes and why so many people fail to lose and maintain weight. Typically, weight loss interventions involve nutritional advice and behavioral strategies for self-regulation and -control. More recently, also cognitive components are integrated, aimed at reducing dietary restraint, changing or reducing maladaptive thoughts about shape and weight, and establishing healthier dieting (Godfrey et al., 2015; O’Reilly et al., 2014). However, these approaches only yield moderate weight loss and neglect problematic behaviors such as external and emotional eating (Lv et al., 2017; O’Reilly et al., 2014). As a result, participants usually only lose 5-10% of their initial body weight and half of all weight loss participants regain their weight within only five years (Wadden & Butryn, 2003 as cited by Forman et al., 2009). This is rather disappointing and leaves considerable room for improvement, doesn’t it?
Mindfulness: The reason for optimism
Now to the more optimistic part: mindfulness approaches currently present promising new alternatives for weight reduction. Broadly speaking, mindfulness is a non-judgemental and open attention to thoughts, experiences, and feelings in the present moment, which can be practiced with purposeful exercises and meditations. Mindfulness-based approaches have been shown to be effective treatments for a variety of psychological and physiological health issues, including anxiety and substance use (Dalen et al., 2010; Godfrey et al., 2015; O’Reilly et al., 2014).
Important in mindfulness and similar approaches is the “cognitive defusion” skill. The general aim is to enhance self-regulation by making individuals aware of their automatic behaviours. In other words, mindfulness teaches us to “take a step back” from our thoughts, feelings, and experiences in an effort to reduce maladaptive, impulsive, or automatic responses and behaviours (Forman et al., 2009; Jenkins & Tapper, 2014). Hence, by keeping feelings/thoughts and actions separate, we can remain aware of our experiences and goals, thereby engaging in less mindless eating.
Reflect on your experience & listen to your gut
Following the principle of mindfulness, mindful eating directly targets eating-related automatic behaviours. Therefore, it might be especially valuable for treating obese people and people with eating disorders such as binge-eating disorder or bulimia nervosa (characterised by overeating, fear of weight gain, and engaging in compensatory behaviour such as actively vomiting or excessive exercising; American Psychiatric Association, 2013; Godfrey et al., 2015; Mathieu, 2009; O’Reilly et al., 2014). Specifically, mindful eating approaches involve these seven guidelines:
(1) eat more slowly,
(2) continuously pay attention to your hunger and fullness levels to eat only when you are actually hungry and to stop when you’re full,
(3) eat without distractions such as TVs, computers, or while doing other tasks (with Netflix around, this can be tough, I know),
(4) non-judgementally acknowledge food dislikes and likes,
(5) use all senses while eating to choose foods that are both tasty and nourishing,
(6) be aware of and reflect upon mindless and emotional eating habits, and
(7) practice meditation (Mathieu, 2009).
By adhering to these guidelines, mindful and intuitive eaters are expected to perceive food as a wellness factor rather than being preoccupied with “forbidden” foods, strict dieting rules, and frustrations of unsuccessful weight loss (Donovan, 2018; Mathieu, 2009). Sounds much better than “I am not allowed to eat cake”, if you ask me.
How does it work?
How does mindful eating help to tackle problematic behaviours such as external and emotional eating, bingeing, and food cravings? First, mindfulness aims to teach us to attend to our negative feelings rather than suppressing or avoiding them by eating (Dalen et al., 2010; O’Reilly et al., 2014). Thus, emotional coping skills can be enhanced, and emotional eating is reduced. Second, by teaching us to acknowledge but not act on experiences and impulses (e.g., sight or smell of food), mindfulness training can reduce external eating (Alberts et al., 2010; O’Reilly et al., 2014). Third, while “forbidden” foods and strict dietary restraint can increase over-eating especially for people who are dissatisfied with their body (Johnson & Wardle, 2005; Polivy & Herman, 1985; Stice, Presnell, & Spangler, 2002), mindfulness approaches can help to develop more positive attitudes towards food. Thereby, mindfulness alleviates maladaptive eating behaviours and supports weight loss (O’Reilly et al., 2014).
Additionally, mindfulness training aims to re-introduce us to our (possibly) lost ability to recognise and respond to hunger, satiety, and fullness cues (Dalen et al., 2010; Warren, Smith, & Ashwell, 2017). Thereby, mindfulness improves our ability to notice and use food-related signals. This ability was suggested to be not only disrupted in obese people, but also responsible for their excessive food intake (see Craighead & Allen, 1995 as cited by Dalen et al., 2010). In summary, mindful eating approaches aim to tackle those dysfunctional eating behaviours and commonly neglected habits in dieting interventions and popular diets based on self-control and dietary restraint.
What has science found so far?
Although research in this area is only starting to bloom, several studies already demonstrated the effectiveness of mindful eating. Recent studies and meta-analyses (i.e., investigations looking at the effects across multiple separate studies) reported that mindfulness-based interventions can be especially effective in reducing binge eating (Giannopoulou, Kotopoulea-Nikolaidi, Daskou, Martyn, & Patel, 2020), emotional eating, and external eating when they are specifically targeting these behaviours (O’Reilly et al., 2014; Warren et al., 2017). For example, a 6-week mindfulness meditation training with mindful eating exercises and group discussions (one 2-hour session per week) improved obese participants’ mindfulness and self-discipline concerning eating (Dalen et al., 2010). Further it reduced their maladaptive eating behaviours (i.e., eating disinhibition, binge eating) and psychological distress (i.e., perceived stress, negative affect, and depressive symptoms).
Additionally, findings support the idea that mindfulness can promote weight loss and maintenance (O’Reilly et al., 2014) and even prevent weight gain (Warren et al., 2017). What is interesting though is that mindfulness strategies appear to also be beneficial in reducing body dissatisfaction (Keng & Ang, 2019; Warren et al., 2017), which is consistently associated with over-eating and dietary violation (Johnson & Wardle, 2005). Moreover, a brief mindfulness exercise lead to lower negative emotional state, suggesting that it can be beneficial for more general well-being (Keng & Ang, 2019).
Notably, we do not necessarily have to do a full 6-weeks intervention. Even single components of the mindful eating approach can have valuable effects. In a study by Jenkins and Tapper (2014) participants received a brief introduction to cognitive defusion combined with a practice exercise and instructions for the following week. Compared to participants that received no or a different training, participants of the cognitive defusion task consumed less chocolate over a 5-day period and were more aware of their automatic behaviours (Jenkins & Tapper, 2014).
What could go wrong?
As with all interventions, mindful eating can pose challenges for participants. Probably the biggest issue is that our environment rarely encourages mindful eating. In fact, mindless eating in front of the television or quickly in between meetings fits much better within our tight schedules (Mathieu, 2009; Swinburn et al., 2011). Further, fast foods and snacks are readily available and affordable, which makes them even harder to resist. Additionally, some people have difficulty perceiving their natural cues of hunger and satiety (e.g., Pollatos et al., 2008 as cited by Mathieu, 2009). While recognizing these cues can be relatively quickly re-learned it still requires practicing mindful eating (Mathieu, 2009). The last issue is that people who learned to avoid negative emotions, thoughts, or bodily sensations might need more extensive training to be successful in accepting their experiences without attempting to change them impulsively (Alberts et al., 2010).
Why we should still do it
Despite these challenges, there are considerable advantages of mindfulness approaches to eating behaviour. For example, it can be applied everywhere and to everyone. Since there are many different forms of training, it can be tailored to your specific needs (Mathieu, 2009). It can give you a sense of empowerment and increased self-esteem. It can improve your diet when realising that tempting “forbidden” foods are not as satisfying as previously experienced. And it can bring back a more positive relation towards food, thereby improving your health, your well-being, and your satisfaction from food. To conclude, mindfulness interventions can be very helpful for overweight and obese people (O’Reilly et al., 2014; Spadaro & Provident, 2020; Warren et al., 2017). Moreover, mindful eating is likely to be beneficial for every one of us. So: forget about your restricted diet plan! Eat slowly, be aware of your eating behaviour, and practice mindful eating instead of having your mind full of eating!
About the author
Saskia Denecke wrote this blogpost as part of the eating disorders module during her Research Master in Neuroscience with specialisation in Psychopathology at Maastricht University. Since her teenage years she is interested in mindfulness and regularly practiced yoga. During her studies she discovered her passion for the intersection of clinical practice and scientific research. After having graduated in 2021, she is currently doing a PhD on the development of paranoia and its differences and commonalities with conspiracy beliefs at Hamburg University.
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