mindfulness-based approaches to eating and weight loss · emotional eating •associated with...
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Carl Fulwiler MD PhD Director, Systems and Psychosocial Advances Research Center
Department of Psychiatry University of Massachusetts Medical School
Mindfulness-Based Approaches to Eating and Weight Loss
SPARC webinar series June 9, 2015
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68.5% of U.S. adults are overweight or obese Ogden, CL et al. 2014 JAMA 311: 806-14
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Existing interventions yield modest results …
Franz, MJ et al. 2007 J Am Diet Assoc 107: 1755 - 1767
… and most weight is regained
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Emotional eating
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Brainstem
Hypothalamus
Homeostatic Hedonic
Hunger Palatability
Food intake
PFC
VTA
Amygdala
Peripheral signals Leptin Insulin Ghrelin
Emotional Distress
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Many adults report engaging in unhealthy eating as a result of stress
overeaten or eatenunhealthy foods
eat to manage stress
skip a meal
38%
27%
30%
APA, Stress in America 2013 apa.org
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Lifetime stressful events and chronic stressors are associated with higher BMI
Community sample (N= 588)
Sinha and Jastreboff 2013 Biol Psychiatry 73: 827-835
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Sinha R, Jastreboff AM 2013 Biol Psychiatry 73, 827-835
Obese subjects show increased reactivity to
and stress cues
food cues
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Emotional eating
• Associated with chronic exposure to high levels of stress 1
• Better predictor of weight gain than lifestyle factors and other eating behaviors 2
• Predicts less weight loss and less weight loss maintenance in weight loss studies 3
1. Tomiyama AJ 2011 Psychoneuroendocrinology 36:1513-1519
2. Koenders & van Strien 2011 J Occup Environ Med 53:1287–1293
3. Niemeier HM 2007 Obesity 15:2485-2494
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Bohon, Stice & Spoor 2009 Int J Eat Disord 42: 210–221
Comfort food activates brain reward center in emotional eaters during negative mood state
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Individual and social factors
Stressors
Challenge Coping Action
Distress
Physiological dysregulation
Physical Health
Negative emotions
Unhealthy behaviors
Unhealthy habits
Mental Health
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Mindfulness
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A definition of Mindfulness
The awareness that emerges from paying attention
on purpose and non-judgmentally
to things as they are
Williams, Teasdale, Segal and Kabat-Zinn 2007
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Mindfulness – based interventions
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Components of Mindfulness-Based Interventions
• Daily practice 30-45 min.
• Informal practices
Classroom format Teaching formal meditation practices
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Mindfulness is effective for emotional distress
• Anxiety (d = .38)
• Depression (d = .30)
• Chronic pain (d = .33)
• Stress reactivity1
• Anxiety and depression2
• Depression3 and substance abuse4 relapse
1. Grossman P, et al. 2004 J Psychosomatic Research 57:35–43
2. Khoury B, et al. 2013. Clin Psychol Rev 33:763–71
3. Segal Z, et al. 2010 Arch Gen Psychiatry 67:1256-64
4. Bowen,S, et al. 2014 JAMA Psychiatry 71:547-556
Goyal M, et al.. 2014
JAMA Intern Med 174:357-368
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S
Farb N. et al. 2010 Emotion 10:25-33
Mindfulness training reduces emotional reactivity
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8-week MBSR training reduces amygdala volume1…
… and increases hippocampus volume2
1. Holzel B et al. 2010 SCAN 5:11-17; 2. Holzel B et al 2011 Psychiatry Res 191:36-40
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A role for mindfulness in health behaviors
• Mindfulness helps us to accept things as they are, including difficult emotions
• By becoming more aware we can be less reactive and better able to make healthy choices in line with our goals and values
• We become more aware of thoughts and emotions, habits of mind we’ve developed in relation to food, and how they trigger unhealthy behaviors
• Prevention of relapse to unhealthy behaviors
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Interventions for eating and weight loss
Mindfulness-based
• Mindfulness-Based Stress Reduction (MBSR)
• Adaptations of MBSR and MBCT that incorporate behavioral and psychoeducational components
• Mindful eating
Incorporate brief mindfulness skills training
• Traditional behavioral interventions
• Acceptance-based interventions
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Mindless eating
Mindful eating
MBSR
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MBSR reduces emotional eating
N = 333 consecutive participants in UMass MBSR program
Emotional eating questions:
• When I feel anxious I find myself eating
• When I feel blue I often overeat
• When I feel lonely I console myself by eating
0.0000
0.5000
1.0000
1.5000
2.0000
2.5000
3.0000
3.5000
Em
oti
on
al E
ati
ng
Sc
ore
Pre Post 0.000
0.200
0.400
0.600
0.800
1.000
1.200
1.400
1.600
Em
oti
on
al
Ea
tin
g
Pre
-Po
st
Ch
an
ge
BMI > 25 BMI < 25
P < .001
P < .001
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Adaptations of MBSR/MBCT
• Focus on mindfulness training in each session
• Incorporate elements of mindful eating
• Additional educational components:
• Nutrition or energy balance education
• Exercise
• Behavioral goal setting and problem-solving
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Mindful eating
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Gratitude
Awareness of thoughts and feelings
Hunger
Mindful eating
Eating slowly Savoring
Self-acceptance
Fullness
Kristeller, JL 2011 Eating Disorders, 19:49–61
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Systematic reviews – mindfulness-based interventions for eating behaviors
1. O’Reilly GA, et al. 2014 Obesity Reviews 15: 453–461
2. Katterman SN, et al. 2014 Eating Behaviors 15: 197–204
• MBI’s are effective for emotional eating and binge eating
• Largest effect size for binge eating
• Not superior to cognitive-behavioral interventions in short term
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Systematic reviews – mindfulness interventions for weight loss
• MBSR alone has not been shown to be effective*
• Mindfulness appears to be effective when nutrition and energy balance and/or behavioral components are included
1. Katterman SN, et al. 2014 Eating Behaviors 15: 197–204
2. Olson and Emery 2015 Psychosom Med.77:59-67
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Summary
• Mindfulness-based interventions are effective for emotional eating and binge eating
• For weight loss, combining mindfulness training with behavioral strategies holds most promise
• Directions for future research
• Longer follow-up
• Effectiveness compared to cognitive-behavioral approaches
• Diverse populations
• Weight loss maintenance?
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Thank You!
Questions?