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Mindfulness & Weight Loss

Mindfulness & Weight Loss

By Kelly McGonigal, PhD

June 2010

Kelly McGonigal, PhD, is a health psychologist and lecturer at Stanford University, and a leading expert in the new field of “science-help.” A long-time practitioner of yoga and meditation, Dr. McGonigal is a founding member of the Yoga Service Council.

Imagine this: you’re staring at your favorite forbidden food—the one thing that threatens to topple your diet. You pick it up, studying its color, shape and texture. You lift it to your nose and welcome its tempting aroma. Finally, you take a bite and savor its taste.

In any other moment, you might be feeling guilty for giving in. It could even be the start of a binge. But not tonight. That’s because the food isn’t forbidden—it’s an assignment. This is a weight loss group, and you and all the other participants have brought in your trigger foods. Chocolate, potato chips, doughnuts, you name it. You’re learning how to experience these foods in the moment, without judgment and without guilt. You’re learning to notice whether foods that promise sweet satisfaction actually deliver anything more than a greasy aftertaste. And you’re learning how to handle cravings for these foods without freaking out or falling apart.

Welcome to mindful eating, a growing trend designed to address both the rising rates of obesity and the well-documented fact that most diets don’t work (Katan 2009). A growing body of research reveals how this approach can support weight loss and improve health.

Mindless Eating

In an ideal world, the natural cues of hunger, fullness and pleasure would guide us toward what the body needs, and our knowledge of nutrition would steer us toward our long-term health goals. In reality, what we eat is shaped by countless cues outside our conscious awareness, and even the best food plan can be derailed by stress.

The result? Mindless eating: what, when and how much we eat runs counter to both the body’s true needs and our own health goals.

Brian Wansink, director of the Cornell University Food and Brand Laboratory, has made his career pointing out the mindless (and often mind-blowing) mistakes we make when choosing what, when and how much to eat. Wansink’s research has shown that our food choices are typically influenced by many factors that we don’t usually pay attention to, such as room temperature and lighting, how much the people we eat with consume, whether we are watching television, how visible snack foods are, the variety of food choices at a meal, and even the shape and size of plates or cups (Wansink 2004).

In one of his best-known studies, Wansink gave moviegoers at a Philadelphia theater 14-day-old popcorn instead of a fresh batch (Wansink & Kim 2005). As rated by the participants themselves after the movie, this popcorn was nasty stuff: stale, soggy, verging on disgusting. But did the moviegoers storm the popcorn stand demanding refunds? No, they ate it up. And if they were given a large container instead of the medium size, they ate 34% more. The unsuspecting participants made their eating choices based on external cues (container size, the sound of others eating) and the expectation that the popcorn would taste good. They even ate about 60% as much popcorn as those who received a fresh batch.

This may be an embarrassing finding for the popcorn eaters, but it’s one to which few of us are immune. Even eating “experts” are susceptible to the power of external cues, as demonstrated by another of Wansink’s studies (Wansink, van Ittersum & Painter 2006). Eighty-five faculty, graduate students and staff at the University of Illinois department of food science and human nutrition were lured to a buffet-style ice cream social. Unbeknownst to them, half were given bowls nearly twice the size of the other bowls given to attendees.

Did bigger bowls lead these nutritional experts to load up on extra ice cream? Yep. They served themselves and ate 31% more ice cream than those given small bowls. And if they were also using a larger serving spoon, they served themselves 57% more than those using small bowls and a smaller serving spoon. But most interesting, those with small bowls and those with large bowls estimated that they had served themselves the same number of ounces. The experts were unable to consciously adjust their estimates, because they were unaware that bowl and spoon size might be influencing their consumption.

Why are we so easily influenced by external factors? According to Wansink, most of our eating decisions are automatic. To demonstrate this, Wansink asked people to guess how many food-related decisions they make each day (Wansink & Sobal 2007). Consider the question yourself. Do you have any idea? If you’re like most people, you don’t: participants guessed an average of 14.4 choices. In reality, when the participants carefully tracked their decisions, the average was 226.7. That’s more than 200 choices that participants were unaware of initially. And without awareness, it is hard to listen to the body’s wisdom or make conscious choices.

From Mindless to Mindful Eating

According to Susan Albers, PsyD, author of Eat, Drink and Be Mindful (New Harbinger 2009), mindless eating is a major factor in weight gain and a saboteur of weight loss. “In many cases, it’s not the meals we eat that cause weight gain. It’s the snacking, the mindless eating while watching television, when we’re on autopilot and not really aware of what we’re eating.” And it’s not just the environment or distractions that trigger automatic eating. Emotions play a big role. “The majority of food decisions people make have nothing to do with hunger. They have to do with stress, anxiety, sadness or frustration.”

This is where mindfulness comes in. Mindfulness is the process of paying attention, both to inner cues (thoughts, emotions and sensations) and to your environment. When applied to eating, this can mean the difference between one more failed diet and lasting change you can live with. “When clients address their mindless eating, they often naturally lose weight,” Albers says.

Albers breaks mindful eating into three components:

Mindful Eating in the Moment. This means getting rid of distractions like reading, watching television or eating on the go. It also means being aware of the sensations of eating—really tasting, smelling and enjoying the food as you eat it. Finally, it means knowing what it feels like to be hungry or full, and learning to honor those signals. “Mindless eaters have so lost touch with the feeling of fullness. But with practice you start to realize, if I eat any more, I’m not going to feel good. ”
Nonjudgmental Awareness of Eating Habits and Beliefs. Albers encourages her clients to keep a food journal to get a clear sense of their eating habits, and to pay attention to habits like where they keep food in the house or office and how they go about food shopping. It’s also important to notice how you talk to yourself about food. “Be mindful of the voices in your head, the messages Mom might have given you about food.” Common self-defeating beliefs include not wanting to waste food, putting foods into black-and-white “good” and “bad” categories or trying to show people you love them by sharing rich comfort foods.

Nonjudgmental Awareness of Environmental and Emotional Triggers for Eating. A bakery case full of French pastries may trigger a craving that was not there a moment ago. That craving has nothing to do with the body’s true needs and everything to do with the eating environment. A mindful approach can help you become aware of the difference between hunger and craving. And when you are aware of your personal triggers, it is easier to avoid them or to pause and make a conscious choice. Stress is another common trigger for overeating, but it’s not just negative feelings that trigger mindless eating. “Positive feelings can prompt automatic eating, too,” Albers says. “You want the happy feeling to continue, so you celebrate with food to hold on to the joy.” Mindfulness can help you recognize when you are eating for emotional reasons and can allow you to develop other strategies for self-soothing or celebrating.

Mindfulness-Based Weight Loss Programs

Mindfulness-based weight loss programs are a recent arrival to the scene, but research suggests they have much to offer chronically unsuccessful dieters. One such program is the Mindful Eating and Living (MEAL) program at the University of New Mexico Center for Life Integrative Medicine Specialty Clinic.

MEAL was developed by Brian Shelley, MD, who noticed that standard mindfulness-based stress reduction programs were changing participants’ eating behaviors. He wondered whether a mindfulness program focusing specifically on eating could help people who were overweight or obese and trying to lose weight.

The MEAL program is 6 weeks long, with a weekly group meeting and practical homework. Each meeting consists of sitting meditation, gentle yoga and walking meditation. However, participants also engage in mindful eating exercises and discussions about food, hunger and weight.

Shelley says the program’s success lies in its ability to address specific issues that would not come up in a general mindfulness program—topics like foods that trigger binges, how to shop mindfully for food and how to deal with environmental pressures to overeat. “The MEAL program provides a cohesive group that shares the same overall goal, and mindfulness is the bridge from goal to action.”

The program uses experiential exercises to help participants apply mindfulness to everyday eating decisions; for example:

-eating a single raisin (or other simple food) slowly, exploring its visual appearance, smell, texture and taste
-eating typical trigger foods, like potato chips and cookies, mindfully, to distinguish between -expectation and experience of enjoyment and satisfaction
-noticing the effect of drinking water on hunger and fullness
-sharing a potluck meal where each participant brings one healthy item and one less healthy item, and everyone practices making food choices and leaving food on the plate.

As reported in 2006 in Complementary Health Practice Review, participants in the MEAL program experienced reductions in binge eating, anxiety and depression, as well as an increase in self-acceptance (Smith et al. 2006). Statistical analyses showed that the decrease in binge eating was most strongly related to participants’ greater self-acceptance.

This first study of the MEAL program did not look at body mass index (BMI) or weight loss. However, a second study, reported in 2009 in the journal Explore, found that obese women lost a moderate amount of weight during the program (Shelley 2009). At a 1-year follow-up, the women had sustained an average weight loss of 10–12 pounds. They also showed improvements in two important health indexes: waist-hip ratio and C-reactive protein, a marker for inflammation in the body. The weight loss was comparable to that of a control group, who participated in a weight loss support group led by a physician, a nutritionist and a psychologist. However, the changes in waist-hip ratio and C-reactive protein were greater in MEAL program participants than in those enrolled in the traditional weight loss program.

Mindful Movement

For people who have been ignoring their bodies’ signals through chronic dieting or mindless overeating, mindful movement can provide a much-needed opportunity to reconnect with the body.

One recent study examined how a yoga-based mindfulness program can support the health of obese women who struggle with binge eating (McIver, McGartland & O’Halloran 2009; McIver, O’Halloran & McGartland 2009). The 12-week yoga program included postures, breath awareness, relaxation and meditation. No instructions or rules were given around what, when and how much to eat. Participants attended one 60-minute yoga class per week and were encouraged to practice at home for 30 minutes a day. They were also given instructions for mindful eating as a meditation practice and were encouraged to eat mindfully whenever possible. The women kept daily journals, recording their emotions, thoughts and experiences with food, weight and exercise.

When the researchers analyzed these journals, they discovered several key themes. At first, the mindfulness practices were a little disturbing. Participants became aware of issues—such as eating in response to anxiety or realizing that they had neglected their bodies—that had been present for some time, but had not been clearly looked at. Gradually, however, these insights—and the related discomfort—became a catalyst for change. By the end of the 12-week program, many of the women felt liberated from these patterns. As a whole, the group reported less binge-eating, higher self-esteem and a more positive body image. The group also showed statistically significant decreases in BMI as well as hip and waist measurements.

The program also changed participants’ minds about exercise. Most walked into the study viewing exercise as an unpleasant punishment. Yoga offered a new way to think about moving their bodies, and many found themselves enjoying exercise for the first time in their lives. The researchers quoted one participant as reporting, “[Yoga] makes me feel better, rather than it needs to be done in order to be better.”

The Power of Mindful Compassion

Ask people what the number-one barrier to a healthy weight is, and guilt probably won’t top the list. But guilt—along with shame, self-criticism and disappointment about minor diet lapses (“Oh no, I ate a cookie!”)—is one of the leading causes of major lapses (“What the hell, I might as well eat the whole box.”). Appropriately dubbed the “what-the-hell effect” by dieting researchers, this cycle turns a manageable setback into self-defeating sabotage (Heatherton, Polivy & Herman 1990). Although it contradicts our instincts, a better way to deal with setbacks is to be easier on ourselves, not harder.

Mindful approaches to health and weight loss emphasize self-compassion. This means accepting your current weight and body as it is, even if you have goals to improve your health. It also means forgiving yourself for setbacks and not falling prey to the what-the-hell effect. To the uninitiated, self-compassion might sound like excuse-making. But research shows just the opposite: self-compassion increases a sense of personal responsibility, without the typical guilt of self-blame (Leary et al. 2007). When you don’t have to deal with feeling bad about yourself, it is easier to get back on track.

Several studies demonstrate the importance of self-compassion in supporting healthy eating and weight. One such study looked at whether a single message of self-compassion could interrupt the what-the-hell cycle among restrained eaters (Adams & Leary 2007). Female college students who had previously filled out questionnaires about restrained eating were invited to participate in a “taste test” study. They were asked not to eat for 2 hours before the experiment. The taste test started with drinking a full glass of water to induce a feeling of fullness. The women were then asked to eat an entire doughnut, a forbidden food for most dieters.

After eating the doughnuts, half of the participants received a special set of “self-compassion” comments from the experimenter. These comments acknowledged that participants sometimes felt bad about eating doughnuts in the study. The experimenter urged the women not to be hard on themselves and to remember that everyone eats unhealthily sometimes. These comments were designed to tap into three elements of self-compassion: mindfulness (recognizing any feelings of guilt), self-kindness (not being hard on yourself) and common humanity (recognizing that everyone indulges). Other participants received no such comments before moving on to the next part of the taste test.

The participants were then given three large bowls of candy (fruity, chocolate-mint and peanut butter–chocolate). They were asked to rate the taste, texture and appeal of the candies, eating at least one piece from each bowl, and as much as they liked. After the taste test was finished, participants answered a survey about the study that included questions about feelings of guilt, shame, loss of control and self-compassion. The researchers left the candy out while participants answered the survey, and some of them continued to eat.

The results were impressive: the brief reminder to be compassionate toward themselves interrupted the typical what-the-hell effect in highly restrained eaters. Highly restrained eaters who did not receive the compassion comments ate almost three times as much candy as those who were reminded to be compassionate. The researchers pointed out that the compassion condition essentially turned restrained eaters into mindful eaters: they showed the natural and healthy response of reducing caloric intake after the small indulgence of the doughnut.

Other research, including studies of an approach called “Health at Every Size” (HAES), has shown that self-compassion improves the long-term health of people who are overweight or obese. The HAES approach starts with acceptance of the body as it is now, whatever its size and shape, and with taking care of it through physical activity and good nutrition. By asking participants to create health, not lose weight, the process of change becomes more about self-care and self-love than about self-control and self-hate. As Deb Lemire, president of the Association for Size Diversity and Health, explains, “Self-hate does not perpetuate self-care. If shame worked, there’d be no fat people.”

The philosophy behind HAES is simple: the body knows what it needs, and diets ask us to ignore those signals. In the long run, trying to override or ignore the body backfires, leading to weight gain and worse health. The HAES program strives to turn lifelong cyclical dieters into mindful eaters. Instead of setting up strict rules about good foods and bad foods, HAES helps participants realize—through mindful attention to how they feel when they eat different foods—that some foods serve their body’s needs better than others. “When you see deep-fried food, it smells good, and your mouth might go, ‘That would taste good!’ But if you pause, and listen with the whole body, it remembers what you feel like after you eat something deep-fried,” Lemire says. “Then it’s not as difficult to choose not to eat something that will make you feel sick.” It’s not about being “good” and avoiding what’s “bad”—it’s about being good to yourself and your body.

The HAES approach also encourages participants to know through direct experience—not numbers on a scale—whether what they’re doing is improving their health. According to Lemire, “If you are not successful in losing the goal number of pounds, you feel like a failure, even though you have succeeded in doing a wonderful thing for your body.” So rather than focusing on weight loss, HAES asks participants to pay attention to energy level, how well they’re sleeping and broader indicators of health, including blood sugar, blood pressure and cholesterol.

In one study of the HAES approach, 78 obese women who were chronic dieters participated in either a HAES intervention or a standard behavior-based weight loss program (Bacon et al. 2005). Both groups met weekly for 6 months and were followed for 2 years. HAES participants showed significant improvements in depression and self-esteem. They also became less susceptible to guilt-induced loss of control around food, and despite having not lost any weight, they showed positive changes in cholesterol and blood pressure. In contrast, the traditional dieting group lost weight but regained it, felt worse about themselves and did not maintain initial diet-related improvements in cholesterol and blood pressure.

Other research on the HAES approach has shown that gradual, modest weight loss can occur, even without a focus on restricting food intake. A 2009 report in the Journal of the American Dietetic Association found that two-thirds of overweight or obese women who participated in a 4-month HAES program weighed less at a 1-year follow-up (Provencher et. al 2009). How much weight a participant lost was related to two key changes: decreased susceptibility to environmental and emotional triggers of overeating, and more flexible, self-compassionate attitudes about weight and food control. The more mindful participants became, the more likely they were to lose weight.
Making Mindfulness the New Habit

Mindfulness is a powerful tool for creating health, but it’s not a quick solution. The mindful eater must learn to make conscious choices, again and again, that go against the loudest messages and the most convenient options in our society.

This may seem daunting at first, but proponents of mindfulness argue that it is possible. “I’m optimistic and hopeful, because I see it everyday,” says Albers. “It would be nice if the environment made it easier to be a mindful eater. Every day we’re struggling against fast food, packaged food and the need to multitask. It’s hard at first, but once you get the hang of mindful eating, it gets easier. The more you do it, the more natural it becomes, and mindful eating becomes the new habit.”

Read the complete original article here

Article first published June, 2010 in the IDEA Fitness Journal

Kelly McGonigal, Food, Health and Wellness, Cultivating Compassion, Key Words/Phrases
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