RESEARCH on MINDFUL EATING - PowerPoint Presentation

1. RESEARCH on MINDFUL EATING

2. REVIEW of LITERATURE RELEVANT to MINDFUL EATINGMeta Analyses of Mindful Eating research2. One recent study3. Summary of findings

3. APPROACHES to MINDFUL EATINGRESEARCH APPROACHEvidence BasedResearch protocolReproducibleLess flexibleTested on othersPositive results importantGrant or government funding more likelyGranting agency may have a say in what is taught and outcome measures desiredNot evidence basedResponsive to client needsNew aspects can be added (Eg compassion training)Experience based – tested on ourselvesLess demand for obvious or quick resultsGrant or government funding less likelyTEACHING SKILLS APPROACH

4. Remember that research involves:volunteers who are (often) paid to do what the researcher wants them to do,for a short period of time,and there is usually no long-term follow-up. Experimental results are interesting, but are not the same as the results of long term practice and do not tell us much about fundamental change.

5. ME RESEARCH STUDIES

6. ME RESEARCH STUDIES (continued) Limitations: - small numbers (av. 21 women)one to ten sessionsno long-term follow-up (typically 3 months)* *(Daubenmier et al – 18 months weight loss)drop out rate is high (10-25%)attendance is low (7/10 sessions)many measures rely on self-report , and . . .

7. This is what we hope they are doing . . .Subjects don’t like to do meditation ( 10-20 minutes max) . Does this all sound familiar? And they are getting paid!This might be what is actually happening!

8. Meta- analyses “Attentive eating can improve healthy eating behaviors and reduce the risk of overeating without the need for conscious calorie counting.”Robinson (2013) 24 studies

9. Meta-analyses

10. Meta-analysesAmong the eight randomized controlled trials published in peer-reviewed journals, six documented significant weight loss among participants in the mindfulness condition, one reported no significant change, and one failed to report body mass index at program completion.  None of the studies documented a relationship between changes in mindfulness and weight loss.Olson, KayLoni L. MA; Emery, Charles F. PhD Mindfulness and Weight Loss, Psychosomatic Medicine: January 2015 - Volume 77 - Issue 1 - p 59-67 doi: 10.1097/PSY.0000000000000127Olson et al (2015) 8 studies

11. Meta-analyses - Mindfulness-based approaches (MBA) most effective in addressing binge eating, emotional eating and eating in response to external cues. - Lack of compelling evidence for the effectiveness in weight management. May prevent weight gain. - MBAs seem to work by increasing awareness of internal, rather than external, cues to eat. Mindfulness and mindful eating have the potential to address problematic eating behaviors and the challenges many face with controlling their food intake. - Encouraging a mindful eating seems a positive message to be included in general weight management advice to the public.. Warren et al. (2017) A structured literature review on the role of mindfulness, mindful eating and intuitive eating in changing eating behaviours: effectiveness and associated potential mechanisms. Nutr Res Rev.;30(2):272-283Warren (2017) 68 publications (overweight and normal weight)

12. Meta-analyses --- A systematic review and meta-analysis on randomized controlled trials on weight loss programs based on mindful or intuitive eating.--- We found a significant weight loss effect of mindful/intuitive eating strategies compared with nonintervention controls (−0.348 kg, P = 0.005). However, there was no difference compared with conventional diet programs.). Reduction of BMI or waist circumference (−0.358 cm, 95% CI: −0.916 to 0.200, P = 0.209) were not statistically significant.--- Mindful/intuitive eating could be a practical approach to weight control. Future research should aim at investigating long-term effects and a more heterogeneous population (= not all women). Fuentes Artiles R, Staub K, Aldakak L, Eppenberger P, Rühli F, Bender N. Mindful eating and common diet programs lower body weight similarly: Systematic review and meta-analysis. Obes Rev. 2019 Nov;20(11):1619-1627. doi: 10.1111/obr.12918. Epub 2019 Aug 1. PMID: 31368631.Artiles et al (2019) 10 studies

13. Meta-analysesMean weight loss for MBIs at post-treatment was 6.8 and 7.5 lb at follow-up. In pre–post comparisons, effect-size estimates suggest that MBIs are moderately effective for weight loss (N=16) and largely effective in reducing obesity-related eating behaviours (N=10). Larger effects on weight loss were found in studies that used a combination of informal and formal meditation practice compared with formal meditation practice alone (N=4). Results suggest that MBIs are effective in reducing weight and improving obesity-related eating behaviours among individuals with overweight and obesity. Further research is needed to examine their efficacy for weight loss maintenance.Carrière, K., Khoury, B., Günak, M. M., and Knäuper, B. (2018) Mindfulness-based interventions for weight loss: a systematic review and meta-analysis. Obesity Reviews, 19: 164– 177. doi: 10.1111/obr.12623.Carrier et al (2017) 19 studies

14. Systematic reviewThe most recent systematic review on the influences of Mindful or intuitive eating approaches on dietary intake draws a different conclusion. They looked at randomised control trials of Mindful or intuitive eating approaches on dietary intake, including energy intake or diet quality in overweight and normal weight adults without a diagnosis of an eating disorder. They found little evidence to suggest that Mindful or intuitive eating interventions influence energy intake or diet quality and that to provide adequate evidence better quality research is required.Grinder et al, 2021  (13 studies)

15. Review of Meta-analysesSo, while the jury is out, the consensus of evidence seems to be that a Mindful approach to eating might assist weight loss, especially in overweight or obese people and those who overeat in response to emotional triggers. The evidence also suggests that a mindful approach might be sustainable in the longer term and at least that it might help reduce weight gain!Heather Regan-Addis, (2021) Mindful Eating, a Review of the Research. https://www.mindfulnessassociation.net/science-of-mindfulness-blog/mindful-eating-a-review-of-the-research/ (Univ. Bangor, Univ. Aberdeen – Masters program in Studies in Mindfulness --- Mindfulness Based Living Course ) Regan-Addis (2021)

16. A review of a recent study

17. Daubenmier et al (Kristeller), (2017) Effects of mindfulness-based weight-loss intervention in adults with obesity. 194 obese adults (out of 1485), identical diet-exercise guidelines, with or without mindfulness training. Mindfulness training consisted of: Meditation practices, based on MBSR: sitting meditation, loving kindness, and yoga postures. Mindful eating practices, based on MB- Eat: enhance awareness and self-regulation of physical hunger, stomach fullness, taste satisfaction, food cravings, emotions, and other eating triggers in the context of reduced caloric intake. Mindful walking included awareness of sensory experience, posture, and alignment . Home practice guidelines included meditation practice for up to 30 min a day/6 days a week, eating meals mindfully, and use of mini-meditations.Both interventions included 16 sessions lasting 2 to 2.5 h (12 weekly, 3 biweekly, and 1 monthly) and one all-day session (6.5 and 5 h in the mindfulness and control interventions, respectively) over 5.5 months. Primary outcome measure was weight loss at 18 months.

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19. Conclusions from Daubenmier et al (Kristeller)Mindfulness enhancements to a diet-exercise program did not show substantial weight loss benefit but may promote long-term improvement in some aspects of metabolic health in obesity that requires further study.There were three instructors and they found that the teacher did make a difference in outcome!Weight loss at 6 months: -5.2 kg vs. 3.3 kg (Not Significant) at 18 months: - 5 vs. – 3.2 (Not Significant) Blood sugar at start: 86.6 vs. 85.5 at 18 months: -0.5 vs. + 3 **(**NB This is not a clinically relevant change in blood sugar. It is within the error of the lab test itself.)

20. Evidence-Based? ME isn’t there yetMantzios, M., & Wilson, J. C. (2015). Mindfulness, Eating Behaviours, and Obesity: A Review and Reflection on Current Findings. Current Obesity Reports, 1-6. (An excellent review article that points out that although mindfulness is a promising tool for weight loss, the results of mindful eating interventions are not clear-cut. Suggest adding element of self-compassion.)

21. Evidence-Based? Not Quite The research on mindful eating is being born.It shows that ME increases mindfulness.It does not show (yet) that ME affects people’s weight.ME has the potential to help people with weight or other health outcomes, but more research is needed.

22. What else could ME affect?Self confidenceHappinessCompassion (for self and others)Stability of mood (equanimity)Out-look on life DepressionFeelings of ease with eatingFeelings of inter-connection

23. WHAT DOES WORK?Slowing down and chewing morePaying attention while eating = not being distracted * without judgement * with curiosity

24. SALIVAInitiation of starch digestion: In most species, the serous and acinar cells secrete an alpha amylase which can begin to digest dietary starch into maltose.Lubrication and binding: The mucus in saliva is extremely effective in binding masticated food into a slippery bolus that (usually) slides easily through the esophagus without inflicting damage to the mucosa.Solubilization of dry food: In order to be tasted, the molecules in food must be solubilized.

25. SALIVAJust a few of the many health issues and diseases that can be diagnosed through saliva and helped, resolved, or prevented through supplementation include: acne, cholesterol, male pattern baldness, cancer, stress, heart problems, heart palpitations, allergies, cold body temperature, sleep problems, inability to absorb calcium, and difficulties in conceiving.

26. SALIVASaliva is not merely an ultrafiltrate of plasma; it contains the entire library of proteins, hormones, antibodies, and other molecular compounds which are typically measured in routine blood tests.Thus, saliva functions as a diagnostic window to the body, both in health and in disease. Using a single saliva sample from a healthy, nonsmoking male subject, the researchers were able to identify 102 proteinsAs research evidence accumulates, saliva-based diagnostics are being widely accepted by clinicians and patients.

27. The Power of the Mind107 participants exercised and ate a meal. Blood draw to measure satiety hormone and genes associated with protection from obesity.A week later, half the group was told they had the gene for low risk of obesity and thus would feel fuller earlier and Half was told they had the gene for a higher risk of obesity. Random in terms of actual genes they carried. Read information about the gene. Ate another meal. Turnwald et al (2019) Learning one’s genetic risk changes physiology independent of actual genetic risk, Nature Human Behaviour, 3: 48–56

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29. The Power of the MindPeople told they had the anti-obesity gene ate less, even when it was a lie. They produced two and a half times more of the fullness hormone, even though the meal was identical to the one they’d eaten the week before. PHYSIOLOGIC EFFECT!People who were told they were genetically prone to obesity saw little or no change in how full they felt or in their hormone levels.Those differences between groups were in some cases even stronger than the real differences seen as a result of people’s actual genetic results. People told they had the anti-exercise gene did worse in an exercise test, even when it was a lie. Their lung capacity was reduced, they were less efficient at removing carbon dioxide, and they quit the treadmill test sooner. PHYSIOLOGIC EFFECT !This underscores the fact that the act of receiving genetic information and the resulting mindset can have as much of an impact as the genes themselves in some instances.

30. More Turnwald ResearchQuestion: Does taste-focused labeling increase vegetable consumption in a multi-site replication experiment?What we learned: This large experiment showed that labeling vegetables as tasty and enjoyable, instead of as health-focused, increased vegetable intake by 29% across 138,000 diner decisions from 5 university dining halls. Why it matters: Changing healthy food labels to emphasize taste and enjoyment is a scalable, low-cost intervention to increase healthy eating.Twisted Citrus Glazed Carrots and Sizzlin’ Szechuan Green Beans versus Healthy Carrots and Nutritious Green Beans versus Carrots and Green Beans

31. Cross Modal or Multisensory Researchon Food and BeveragesCharles Spence - Oxford

32. Flavor of Beverages Depends Upon the ContainerCOFFEE FLAVOR affected by cheap vs. expensive container, flimsy vs. strong, eco-friendly labelling, whether the coffee came from a brown (= too strong), red (rich, full aroma), blue (mild) or yellow (weak) container. Coffee served in a transparent mug perceived as sweeter than coffee from a white mug. Coffee in a (3D printed) rounded surface mug rated sweeter versus angular surface, more intense. Van Doorn, G.H., Wuillemin, D. & Spence, C. Does the colour of the mug influence the taste of the coffee?. Flavour 3, 10 (2014). https://doi.org/10.1186/2044-7248-3-10

33. Multisensory Research * A well-known Western proverb relating to the food industry, “You eat with your eyes” clearly points to the influence of visual cues on the perception of food.  * Tea experts rated tea on strength of taste, bitterness, astringency, sweet after taste, overall presentation. * Touch also influences taste --- how the cup feels in the hand, and on the lips. Su-Chiu Yan et al, The influence of teacup shape on the cognitive perception of tea, Sustainability (2019), 20 pages.

34. The search for a pill to take to lose weightFDA Approves Wegovy for Weight LossThe FDA approved Wegovy (semaglutide) weekly injections for chronic weight management in adults with obesity or overweight with at least one weight-related condition – such as high blood pressure, type 2 diabetes, or high cholesterol – for use in addition to a reduced calorie diet and increased physical activity.In the FDA’s announcement, they state that losing 5-10% of body weight through diet and exercise has been associated with a reduced risk of cardiovascular disease in patients with obesity or overweight.

35. Oh, wait, there are side effects?The approved drug label features several warning and precautions, including those tied to:Thyroid C-cell tumorsAcute pancreatitisAcute gallbladder diseaseHypoglycemiaAcute kidney injuryHypersensitivityDiabetic retinopathy complications in patients with type 2 diabetesHeart rate increaseSuicidal behavior and ideationCommon side effects of Wegovy include nausea, diarrhea, vomiting, constipation, abdominal (stomach) pain, headache, fatigue, dyspepsia (indigestion), dizziness, abdominal distension, eructation (belching), hypoglycemia (low blood sugar) in patients with type 2 diabetes, flatulence (gas buildup), gastroenteritis (an intestinal infection) and gastroesophageal reflux disease (a type of digestive disorder).

36. Mindful Eating as a Way to Improve Gut HealthThis is a very interesting new way to look at the benefits of Mindfulness and Mindful Eating. It moves us away from the obsession with weight loss.The author talks about mindfulness as a way to counteract the harmful effect of stress on the gut, and to switch from the Sympathetic Nervous System’s adverse effects to the Parasympathetic Nervous System’s beneficial effects on gut health. Cherpak CE. Mindful Eating: A Review Of How The Stress-Digestion-Mindfulness Triad May Modulate And Improve Gastrointestinal And Digestive Function. Integr Med (Encinitas). 2019;18(4):48-53.

37.        Stress—Digestion—Mindfulness TriadaMotility: decreased motility increases risk of dysbiosis; increased motility impairs nutrient absorptionbInflammation: increases pro-inflammatory cytokines, resistance to cortisol’s initial anti-inflammatory effectcCNS innervation: dysregulated motility, stomach pain, nausea, vomiting, diarrheadENS innervation: disrupted small segmentation contractions, peristalsis, and Migrating Motor Complex (MMC)

38. Table 1.Clinical ApplicationHelp patients identify stressors, along with antecedents and triggers, and frequency using a mindful-eating journalHave patients complete the Mindfulness Eating Questionnaire (MEQ) to identify strengths that can be leveraged and areas to develop furtherUtilizing motivational interviewing techniques, partner with patients to select mindful-eating practices from the chart on the next slide, a practice that aligns with their needs and readiness for change.Cherpak CE. Mindful Eating: A Review Of How The Stress-Digestion-Mindfulness Triad May Modulate And Improve Gastrointestinal And Digestive Function. Integr Med (Encinitas). 2019;18(4):48-53.

39. InterventionBenefitsSample ExercisesEating Slowly:Thoroughly chewing food aids breaking down food into absorbable components via mechanical and enzymatic actions. Simultaneously, increased time spent on chewing fosters awareness of chewing, while also promoting identification and response to internal signals.Mechanically breaks down food54Salivary α-amylase begins starch digestion55Lingual lipase begins dietary fat digestion56”Helps mucous in saliva bind broken down food constituents, forming bolus & lubricating it for esophageal passage57Promotes salivary enzymes involved in PSNS activity, provoking downstream digestive processes (e.g., pancreatic enzymes, peristalsis)Part of cephalic phase of digestion—involves neural regulation of downstream gastric acid secretion—via cholinergic neurons, gastric distension, and intestinal peptides58Chew each mouthful 30 timesPlace fork down between bitesTake deep breaths between bitesMeditation:Meditation and diaphragmatic breathing modulate the stress response.Shifts nervous system toward PSNS dominance, supporting rest-and-digest state12,59,60Listen to a guided meditation and engage in breath work before meals (Free videos are available online)Hunger and Satiety:Food choices and eating driven by hunger and satiety signals influence digestion.Appreciate internal and external factors influencing awareness,61 food choices, and hunger-scale ratingsUse a hunger scale before eatingAnswer self-inquiry questions (See Appendix A) in mindful-eating journal before meals to increase awareness of internal and external milieuEngaging Senses:Tasting food is one component of mindful eating. As sentient beings, all of the senses (e.g., smelling food, seeing food, touching food) are equally important.61,62Distinguish food compounds that stimulate digestive secretions (e.g., saliva, gastric juices)Identify emotions (e.g., fear of foods linked to previous experience of suboptimal digestion)Suck on fresh lemon half to appreciate its sournessHold dark chocolate in mouth to appreciate its bitternessExternal Environment:The external environment characterizes emotions about eating and influences the nervous system.62Foster a mindful-eating environment to help shift nervous system toward PSNS dominance.Use attractive plates, glasses, utensilsClear table of items unrelated to mealsRemove electronic devices from roomLight a candle(See Appendix A for gradual implementation process)Ways to partner with patients to select mindful-eating practices that aligns with their needs and readiness for change.

40. THANK YOU for YOUR DEDICATIONtoMINDFUL EATING-CONSCIOUS LIVING!