Mindfulness-Based Interventions for Weight Loss

Mindfulness-based treatment for obesity and binge eating disorder can promote self-regulation and yield significant results, according to Jean Kristeller, PhD, emerita Professor of Psychology at Indiana State University. Further, a dose-response effect may yield better results for those who practice the approach more intensively. Kristeller reviewed her group’s 15 year history with the technique, highlighted some recent findings, and spoke to future directions on November 7, 2014 during Obesity Week in Boston, MA.

Mindfulness-based eating awareness training (MB-EAT) has its foundation in Jon Kabat-Zinn’s mindfulness theory. Quoting its originator, Kristeller defined mindfulness as “moment to moment non-judgmental awareness cultivated by paying attention.” In the context of MB-EAT, this approach allows participants to disengage habitual reactions and rebalance an unhealthy approach to food and eating, Kristeller said.

Conceptually, techniques and strategies to overcome unhealthy eating can be divided into those representing “outer wisdom” and “inner wisdom.” Outer wisdom strategies might involve challenging fallacies about restrictive eating practices, as well as learning about energy requirements and expenditures, education about nutrition, acquiring and using a pedometer, and learning how to tailor this information to personal preferences and needs.

Inner wisdom about healthy eating, by contrast, is characterized by Kristeller as allowing the emergence of self-care through increasing awareness and acceptance of hunger and eating triggers, and by learning to recognize and respect taste and physical fullness satiety cues. The MB-EAT program uses a variety of techniques in this effort.

In addition to using mindfulness techniques to encourage quiet awareness of physical and mental state when eating or thinking of food, MB-EAT also encourages “mindful eating.” Participants practice eating small quantities of increasingly tempting food ranging from raisins or fruits to high-calorie sweet and savory foods, and including tempting scenarios like a large pot-luck meal. In these settings, participants rate hunger and fullness on a 10-point Likert scale, and note taste satisfaction at various points in eating (satisfaction tends to diminish sharply after the first few bites).

The largest study examining MB-EAT for weight loss enrolled 117 subjects with a body mass index (BMI) greater than 34 kg/m2 either to participate in an MB-EAT intervention, or to remain on a wait list. The 12-week intervention added nutrition education and the “500 calorie challenge”—asking participants to cut 500 Kcal/day from their diets -- to MB-EAT techniques. The mostly female participants, whose mean age was 50, were well matched between groups. Mean weight at enrollment was 256 pounds, and 27% of participants had binge eating disorder (BED).

The MB-EAT group saw significant weight loss of 6 pounds at the end of the intervention and 7 pounds at the one and six month follow-up points. Responses to the Three Factor Eating Questionnaire (TFEQ, measuring cognitive restraint of eating, disinhibition, and hunger) also showed significant and sustained improvement when compared to the wait list group. Overall, the incidence of binge eating was halved, a sustained response that was greatest in those with diagnosed BED.

Further analysis showed that the magnitude of effect that MB-EAT has on weight and eating behaviors is related to the extent to which the various cognitive tools are used; that is, a dose-response effect exists. This may provide a promising avenue for further study.