Improve Eating Behavior with Mindfulness
By John M. de Castro, Ph.D.
“Mindful eating involves paying full attention to the experience of eating and drinking, both inside and outside the body. We pay attention to the colors, smells, textures, flavors, temperatures, and even the sounds (crunch!) of our food. We pay attention to the experience of the body. Where in the body do we feel hunger? Where do we feel satisfaction? What does half-full feel like, or three quarters full?” – Jan Chozen Bays
Eating is produced by two categories of signals. Homeostatic signals emerge from the body’s need for nutrients, is associated with feelings of hunger, and usually work to balance intake with expenditure. Non-homeostatic eating, on the other hand, is not tied to nutrient needs or hunger but rather to the environment and or to the pleasurable and rewarding qualities of food. These cues can be powerful signals to eat even when there is no physical need for food.
Mindful eating involves paying attention to eating while it is occurring, including attention to the sight, smell, flavors, and textures of food, to the process of chewing and may help reduce intake by affecting the individual’s response to non-homeostatic cues for eating. Indeed, high levels of mindfulness are associated with lower levels of obesity. Hence, mindful eating may counter non-homeostatic eating.
Acceptance and Commitment Therapy (ACT) is a mindfulness-based psychotherapy technique that is based upon Cognitive Behavioral Therapy (CBT). ACT focuses on the individual’s thoughts, feelings, and behavior and how they interact to impact their psychological and physical well-being. It then works to change thinking to alter the interaction and produce greater life satisfaction. ACT employs mindfulness practices to increase awareness and develop an attitude of acceptance and compassion in the presence of painful thoughts and feelings. Additionally, ACT helps people strengthen aspects of cognition such as in committing to valued living. ACT teaches individuals to “just notice”, accept and embrace private experiences and focus on behavioral responses that produce more desirable outcomes.
In today’s Research News article “The effects of acceptance and commitment therapy on eating behavior and diet delivered through face-to-face contact and a mobile app: a randomized controlled trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5828146/ ), Järvelä-Reijonen and colleagues examine the effectiveness of Acceptance and Commitment Therapy (ACT) on facilitating mindful eating and as a result improving eating behavior and diet. They recruited overweight and obese adults (aged 25-60 years) and randomly assigned them to receive ACT either face-to-face in a group setting or on line or to a no-treatment control. ACT was delivered for 90 minutes, once a week over 8 weeks.
The participants were measured before and 2 weeks and 28 weeks after the intervention for perceived stress, intuitive eating, including unconditional permission to eat, eating for physical rather than emotional reasons, and reliance on internal hunger/satiety cue. They were also measured for cognitive restraint of eating, uncontrolled eating, emotional eating, taste pleasure, using food as a reward, eating attitudes, food acceptance, internal regulation, contextual skills, and eating behaviors, including intrinsic motivation, integrated regulation, identified regulation, introjected regulation, external regulation, and amotivation. Finally, they were measured for food and nutrient intakes including alcohol.
They found that both the face-to-face and the on-line Acceptance and Commitment Therapy (ACT) training produced significant improvements in the reasons for eating from emotional or environmental triggers towards hunger and satiety cues, acceptance of a variety of foods, and perceptions of healthy eating. They also showed significant increases in eating for physical rather than emotional reasons while decreases in using food as a reward. In general, the face-to-face ACT training produced larger improvements than the on-line ACT training. But, both were effective. Even though there were many improvements in the psychological components surrounding eating produced by ACT training, there were no significant changes in actual dietary intake.
These results are interesting and suggest that ACT training, regardless of whether it occurs face-to-face or on-line, alters the psychology of eating toward more mindful eating and toward homeostatic eating. These are very healthy changes. The fact, however, that they were not reflected in actual changes in intake is disappointing. Perhaps if there was an active dietary reduction component, there might have been a change in intake. But, without this emphasis on intake reduction it is hard to see what the motivation might be for the participants to reduce the amounts of food ingested. It is also possible that given more time for the psychological changes to take hold, intake changes may have occurred. Finally, even though the participants were overweight and obese they were weight stable, neither increasing or decreasing intake. They were eating an appropriate amount for their metabolic needs, neither overeating nor undereating. So, changing then psychology of eating may not affect their intake as it is appropriate for the circumstances.
So, improve eating behavior with mindfulness.
“Mindless eating happens when you are distracted by something else so that all of your attention is not on what you are eating or how you are eating. When distracted, we are far more likely to shift into autopilot and overeat and this is one very common reason for weight gain.” – J. Marlin
CMCS – Center for Mindfulness and Contemplative Studies
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Järvelä-Reijonen, E., Karhunen, L., Sairanen, E., Muotka, J., Lindroos, S., Laitinen, J., … Kolehmainen, M. (2018). The effects of acceptance and commitment therapy on eating behavior and diet delivered through face-to-face contact and a mobile app: a randomized controlled trial. The International Journal of Behavioral Nutrition and Physical Activity, 15, 22. http://doi.org/10.1186/s12966-018-0654-8
Internal motivation and good psychological capabilities are important factors in successful eating-related behavior change. Thus, we investigated whether general acceptance and commitment therapy (ACT) affects reported eating behavior and diet quality and whether baseline perceived stress moderates the intervention effects.
Secondary analysis of unblinded randomized controlled trial in three Finnish cities. Working-aged adults with psychological distress and overweight or obesity in three parallel groups: (1) ACT-based Face-to-face (n = 70; six group sessions led by a psychologist), (2) ACT-based Mobile (n = 78; one group session and mobile app), and (3) Control (n = 71; only the measurements). At baseline, the participants’ (n = 219, 85% females) mean body mass index was 31.3 kg/m2 (SD = 2.9), and mean age was 49.5 years (SD = 7.4). The measurements conducted before the 8-week intervention period (baseline), 10 weeks after the baseline (post-intervention), and 36 weeks after the baseline (follow-up) included clinical measurements, questionnaires of eating behavior (IES-1, TFEQ-R18, HTAS, ecSI 2.0, REBS), diet quality (IDQ), alcohol consumption (AUDIT-C), perceived stress (PSS), and 48-h dietary recall. Hierarchical linear modeling (Wald test) was used to analyze the differences in changes between groups.
Group x time interactions showed that the subcomponent of intuitive eating (IES-1), i.e., Eating for physical rather than emotional reasons, increased in both ACT-based groups (p = .019); the subcomponent of TFEQ-R18, i.e., Uncontrolled eating, decreased in the Face-to-face group (p = .020); the subcomponent of health and taste attitudes (HTAS), i.e., Using food as a reward, decreased in the Mobile group (p = .048); and both subcomponent of eating competence (ecSI 2.0), i.e., Food acceptance (p = .048), and two subcomponents of regulation of eating behavior (REBS), i.e., Integrated and Identified regulation (p = .003, p = .023, respectively), increased in the Face-to-face group. Baseline perceived stress did not moderate effects on these particular features of eating behavior from baseline to follow-up. No statistically significant effects were found for dietary measures.
ACT-based interventions, delivered in group sessions or by mobile app, showed beneficial effects on reported eating behavior. Beneficial effects on eating behavior were, however, not accompanied by parallel changes in diet, which suggests that ACT-based interventions should include nutritional counseling if changes in diet are targeted.