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9/14/2017Cheryl Harris, MPH, RDSeptember 15, 2017 Mindful eating definitionMindful eating researchMindful eating practice! How to incorporate mindful eating Many mindful eating practices have roots invipassna or insight “seeing clearly” meditationpracticesMany meditation practices now are taughtwithout any religious component.1

9/14/2017Eating with non-judgmentalINTENTIONandATTENTION Allowing yourself to become aware of thepositive and nurturing opportunities that areavailable through food preparation andconsumption by respecting your own innerwisdom. Choosing to eat food that is both pleasing toyou and nourishing to your body by using allyour senses to explore, savor and taste. Acknowledging responses to food (likes,neutral or dislikes) without judgment. Learning to be aware of physical hunger andsatiety cues to guide your decision to begineating and to stop onNon-eating phaseEatingPause before the mealReturn to theNon-eating phaseEnd of MealClean upMegrette Fletcher, MEd, RDFrom TCME2

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9/14/2017 What do you notice in your body At 0 At 10 When you don’t eat until you’re at a 0 or 1,what is the next meal like? 0SizeSpeedContentSatisfaction5104

9/14/2017What you notice @ 0 5What you notice @ 10What physical cues prompt you to starteating?What cues prompt you to stop eating?Physical hungerSense hungerHeart hungerMind hungerCelebration hunger5

9/14/2017 Several studies done, training in recognizing“initial hunger” and comparing untrained withcontrolsImprovements see in HgbA1C, insulinsensitivity, weight, energy balance.Ciampolini, M., D. Lovell, Smith, R. et al. 2010. “Sustained Self Regulation of EnergyIntake: Initial Hunger Improves Insulin Sensitivity. J of Nutrition and Metabolism.Ciampolini M, Lovell-Smith HD, Kenealy T, Bianchi R. Hunger can be taught: HungerRecognition regulates eating and improves energy balance. Int J Gen Med. 2013 Jun17;6:465-78. MB-EAT-focused on BEDMB-EAT w/ weight loss componentMB-EAT to affect cortisol levelsMB-EAT-D adaptation for diabetesMEAL (adapted from MSBR)MSBR adapted to use with food for patientswith pancreatic cancerACT (Acceptance and Commitment therapy,mindfulness based)-several small studiesMindful eating without a mindfulnesscomponent6

9/14/2017 Adaptation of MBSR by Jean Kristeller, PhDSeveral studies on binge eating disorder withsignificant decreases in binging, decreases indepression scoresThe study that focused on weight additionallysaw a significant weight decrease inparticipantsRecurrent and persistent episodes of binge eatingBinge eating episodes are associated with three (ormore) of the following: Eating much more rapidly than normal Eating until feeling uncomfortably full Eating large amounts of food when not feeling physicallyhungry Eating alone because of being embarrassed by how muchone is eating Feeling disgusted with oneself, depressed, or very guiltyafter overeating Marked distress regarding binge eatingAbsence of regular compensatory behaviors (suchas purging).DSM-VKristeller, JL, Baer, RA, Quillian, RW. (2006). Mindfulness-Based approaches to eating disorders. In Baer, R.A. (Ed.). Mindfulness and acceptance-based interventions: Conceptualization, application, and empiricalsupport. San Diego, CA: Elsevier. Pp. 75-91.7

9/14/2017 Looked at 19 studiesMost were adaptations of MBSR/MBCT, fewerwere DBT or ACT“Overall, mindfulness-based interventionswere associated with effects on binge eatingof large or medium-large magnitude and canbe considered effective.”Godfrey KM, Gallo LC, Afari N. Mindfulness-based interventions forbinge eating: a systematic review and meta-analysis. J Behav Med.2015 Apr;38(2):348-62. doi: 10.1007/s10865-014-9610-5 Reviewed 21 studies, 18 (86%) showingimprovement in eating-related behaviors. Binge eating Emotional eating CravingsO'Reilly GA, Cook L, Spruijt-Metz D, Black DS. Mindfulness-basedinterventions for obesity-related eating behaviours: a literature review.Obes Rev. 2014 Jun;15(6):453-61. doi: 10.1111/obr.12156.8

9/14/2017 Nutrition/diet intervention, VSNutrition/diet/mindful eating interventionMindful eating group had statisticallysignificant greater improvements in fastingblood sugars and lipids @ 18 monthsThose in the mindful eating intervention lostmore weight (avg 3.7 lbs more, but it was notstatistically significant)Daubenmier, J, Moran, PJ, Kristeller, J et al. Effects of a mindfulnessbased weight loss intervention in adults with obesity: A randomizedclinical trial. Obesity, 2016; DOI: 10.1002/oby.21396What nutrition-related conditions may respondto decreases in stress, depression or anxiety? Significant link with stressful events, chronicstress and level of body fat, weight and BMISinha R, Jastreboff AM. Stress as a common risk factor for obesityand addiction. Biol Psychiatry. 2013 May 1;73(9):827-35.9

9/14/2017Sinha R, Jastreboff AM. Stress as a common risk factor for obesityand addiction. Biol Psychiatry. 2013 May 1;73(9):827-35. MBSR pilot w/ Type 2 Decrease depression, anxiety, general distress .48% decrease in HgbA1CRCT w/57 in MBSR groups, 53 controls Significantly lower depression, significantly improvedhealth status at 1 year Significantly lower stress in people who attended thegroupMBCT study: reports of significantly lessstress, depression, anxiety, and higher qualityof life. Non-significant trend toward higher A1C in thecontrol but not the MBCT group10

9/14/2017Rosenzweig S, Reibel DK, Greeson JM, et al. Mindfulness-based stressreduction is associated with improved glycemic control in type 2 diabetesmellitus: a pilot study. Altern Ther Health Med 2007;13:36–38Hartmann M, Kopf S, Kircher C, et al. Sustained effects of a mindfulnessbased stress-reduction intervention in type 2 diabetic patients: designand first results of a randomized controlled trial (the HeidelbergerDiabetes and Stress-study). Diabetes Care 2012;35:945–947.van Son J, Nyklicek I, Pop VJ, et al. The effects of a mindfulness-basedintervention on emotional distress, quality of life, and HbA(1c) inoutpatients with diabetes (DiaMind): a randomized controlled trial.Diabetes Care 2013;36:823–830.Schroevers, M. J., Tovote, K. A., Keers, J. C., et al. (2013). IndividualMindfulness-Based Cognitive Therapy for People with Diabetes: a PilotRandomized Controlled Trial. Mindfulness, 1-12. Irritable bowel syndrome (IBS)Inflammatory bowel disease (IBD)GastroparesisRefluxControlled study of a mindfulnessintervention tailored to IBD“Compared with the control group, the MIIBD group reported significantly greaterimprovements in anxiety, quality of life, andmindfulness at after intervention, withreduction in depression and improvements inquality of life and mindfulness maintained at6 months after intervention.”Neilson K, Ftanou M, Monshat K, et al. A Controlled Study of a Group Mindfulness Intervention for IndividualsLiving With Inflammatory Bowel Disease. Inflammatory Bowel Diseases, 22(3):694-701, March 2016. DOI:10.1097/MIB.000000000000062911

9/14/2017 Comparison of MBSR vs treatment as usual. Significant decreases in IBS symptom Symptom severity went from constant occasionalBenefits maintained 6 months postintervention Zernicke KA, Campbell TS, Blustein PK, Fung TS, Johnson JA, Bacon SL, Carlson LE.Mindfulness-based stress reduction for the treatment of irritable bowel syndromesymptoms: a randomized wait-list controlled trial. Int J Behav Med. 2013 Sep;20(3):38596. doi: 10.1007/s12529-012-9241-6.Did you ever stop to taste a carrot? Not justeat it, but taste it? You can't taste the beautyand energy of the earth in a Twinkie. Astrid Alauda. Many ways to practice! Saying graceFamily traditionsCultural or spiritual customsAppreciating everything and everyone thatgot your food to your table12

9/14/2017 Saying grace or a religious blessingGive thanks to Mother Earth, Father skyand to the four directions Native American prayer I offer my gratitude for the nourishingblessings of this earth that I’ve beengiven to partake in. Traditional mindfulness saying In this food I see clearly the presenceof the entire universe supporting myexistence. Thích Nhất HạnhItadakimasu: Japanese saying beforemeals, means “I am receiving.”When you eat fruit, think of the person whoplanted the tree- Vietnamese saying13

9/14/2017Saying grace/blessingGive thanks to mother earth and father sky, tothe four directions-Native American prayer When you eat fruit, think of the person whoplanted the tree- Vietnamese saying I offer my gratitude for the nourishingblessings of this earth that I’ve been given topartake in Traditional Buddhist saying In this food I see clearly the presence of theentire universe supporting my existence. Thích Nhất Hạnh Awareness of all aspects of eatingNot about charts, tables, grams of xyzIn the spirit of curiosityGuidelines not rulesNot about food restriction, and weight lossnot necessarily a goalStudies on MB-EAT & adaptations showeffectiveness for nutrition conditions (BED,weight loss)Mindfulness may help with stress-relatedconditions, such as diabetes, IBS and IBDMore research needed!14

9/14/2017 Active anorexia or bulimiaPTSDSevere anxiety Work in conjunction with a team Marek RJ, Ben-Porath DD, Federici A, Wisniewski L, Warren M. Targetingpremeal anxiety in eating disordered clients and normal controls: apreliminary investigation into the use of mindful vs. distraction duringfood exposure. Int J Eat Disord. 2013 Sep;46(6):582-5. Start with YOU!!!Are there pieces in the process of eating thatare challenging?PausingUsing the hunger scaleEating with awarenessPracticing gratitudeFood journaling with emotions (before or aftereating)Discover Mindful Eating from MegretteFletcher, MEd, RDEat, Savor Satisfy from Donald Altman, MA,LPCMB-EAT www.mindfuleatingtraining.comMichelle May, MD: trainings and books forclients and professionalsThe Center for Mindful Eating free newsletter,classes and workshops (some free, somewith membership), handouts, etc.15

9/14/2017 Eating Mindfully: How to End Mindless Eating andEnjoy a Balanced Relationship With Food by SusanAlbers, PsyD, and Lilian Cheung, DSc, RD Every Bite Is Divine by Annie Kay, MS, RD, RYTMindful Eating: A Guide to Rediscovering a Healthyand Joyful Relationship With Food by Jan Chozen Savor: Mindful Eating, Mindful Life by Thich Nhat Bays, MD Hanh and Lilian Cheung DSc, RDEat What You Love, Love What You Eat by MichelleMay, MD (versions for diabetes, bariatric & BED)Am I hungry?Eat right nowEating mindfullyRecovery recordMindful eating trackerFor yourself?With clients?16

9/14/2017 If you have questions afterwards, feel free toemail om@CherylHarrisRDParticipants had a BMI over 27 and HgbA1Cof 7% or more2 groups—In-depth diet info classes ormindful eating with basic diet infoBoth groups ate fewer calories and hadsignificant improvement for intake of transfats, fiber, and improved glycemic loadImprovements maintained at 3 months postinterventionMiller CK, Kristeller JL, Headings A, et al. Comparative effectiveness of amindful eating intervention to a diabetes self-management interventionamong adults with type 2 diabetes: a pilot study. J Acad Nutr Diet. 2012Nov;112(11):1835-42.17