“Mindfulness No Aid to Weight Loss in Trial” the headline in Medscape announces.
You might wonder what mindfulness means...then you might wonder what the research actually showed. Great questions!
It's important to read beyond the headlines. First of all, let’s look at the article. While mindfulness did not improve weight loss beyond what diet and exercise alone achieved, mindfulness did improve glucose control and triglyceride levels. “Action Points” bulleted for physicians in the article:
“Action Points
- Adding mindfulness-based eating and stress management techniques to a diet and exercise program was no more useful than diet and exercise alone in getting patients to lose weight.
- Note that those in the mindfulness-bases group had significant changes in fasting glucose at 18 months and also saw a slight advantage when it came to triglyceride/high-density lipoprotein cholesterol ratio at 12 months.”
Also interesting, although the program lasted only 5 ½ months, those who added mindfulness to diet and exercise actually lost about 4.1 pounds more at 12 months, and 3.75 pounds more at 18 months, compared to those who used only diet and exercise, although those numbers did not reach statistical significance. Almost 200 people were studied, who had BMI ranges of 30 and up (ranging from “Obesity Class 1” to “Obesity Class 3”). Medpage reports that one of the researchers emailed them: “In an email to MedPage Today, Daubenmier..pointed to some of her previous research, and wrote that, “These results altogether suggest mindfulness may especially be helpful for those people with obesity who tend to overeat foods high in fat and sugar and have a hard time cutting back on those foods when they try to lose weight.”
Daubner described mindfulness to Medscape : “mindfulness...involves a daily practice of focused attention to one’s experiences.” Both groups received extensive education on healthy diet and exercise, and according to Medscape: “there were 16 sessions that lasted 2 or more hours over the study, and diet and exercise guidelines were presented for about 45 minutes each session.” Both groups received food recommendations: decrease calories by 500 per day below baseline, decrease simple carbohydrates and empty calories (“nutrient-poor foods)”, decrease foods which have high calories-per-bite (“calorie-dense” foods), increase protein, fresh vegetables and fruit, whole grains, and healthy fats. The mindfulness group received additional instructions, according to Medscape: “The mindfulness intervention included meditation practices to deal with stress, eating, and exercise..designed to increase awareness and self-regulation of hunger, fullness, satisfaction of taste, cravings, and other emotions.” The mindfulness group also received instruction to walk for exercise, while being aware of, and noting the surroundings (this has been called “Forest Bathing’, or Shin Rin Yoku in Japan.) Recommendations to meditate were also made.
Mindfulness is a complicated topic, and when it comes to appetite control and weight control, mindfulness alone is not enough, but can be a helpful addition to a program. When people are overweight and have metabolic syndrome and inflammation, their brain chemical response is often abnormal and they do not get proper "fullness signals" registering in their brain, which makes mindfulness more difficult. Healthy diet, exercise, and weight loss , can actually restore normal function of these chemicals and make mindfulness easier, ironically!
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So what is mindfulness, anyway?
Every once in a while a word comes into use in the popular lexicon, works its way into public consciousness, and becomes not only a catchphrase, but also a widely accepted, even unquestioned idea. People may begin to endow the concept with additional power and then layer assumptions on top of it. I think mindfulness as a word and concept is entering that realm.
Mindfulness, for those who are not entirely familiar with the concept, roughly means living in the moment, being aware of your physical surroundings, your emotional state of being, your response to what is happening at this very time, both inside and outside of your body. The concept extends back to the 1960s or earlier, and was introduced to a wide audience in the book “Be Here Now”, by Ram Dass (a book which reportedly influenced Steve Jobs, Wayne Dyer, and others.)
I was first introduced to the concept during medical school at Tufts in the late 1980’s, when some of my fellow students were reading about meditation and health in a book called “The Relaxation Response” . Later in the early 1990’s I came across the concept again during my Family Medicine residency in Bangor, Maine. My residency was unique in that we had a full-time psychologist as a member of the teaching staff, to teach us about the bio-psycho-social model. We also each rotated through an unusual primary care office, and spent extended time training with a physician named Dr. Toby Atkins. His focus was patient-centered medicine, and he taught each resident one-to-one about mindfulness, and how to create a partnership with patients. It was a very different model than most physician offices; even if the doctor had an agenda, the patient's needs and wishes always came first. Since I had majored in Philosophy as an undergraduate, and my honors thesis addressed paternalism in medicine, and empowerment of patients, I was very impressed with his approach. Interestingly, he had an extremely busy practice, in his office, in the hospital, as medical director for numerous nursing homes. When he oversaw meetings with the staff, he empowered each individual at the table, and fostered a team approach that led to outstanding patient care. It was not only a fascinating and patient centered model, it was a very economically viable model, contrary to what some harsh authoritarians would expect.
I remember my first morning with Dr. Toby, and his first question to me was, "What was the air like in your room when you first woke up this morning? Was it dry, humid, cool, hot? How about when you went outside to your car? What did it feel like?" It was his first lesson in “mindfulness”, being aware of our immediate surroundings, our senses, paying attention to those, and how we were affected. His teaching, including mindfulness, respect, and patient-empowerment, has had a profound positive effect on graduates of the program and their patients.
I came across the concept of mindfulness again during an obesity medicine teaching conference around 2003. Each of the 500 or so physicians found ourselves sitting in front of a raisin on the table. We were instructed to look at the raisin, pick it up, smell it, think about it, put it in our mouth but not bite it, taste it, and then slowly chew it and note the texture and various sensations. It was a lesson in mindfulness, living in the moment and becoming aware of all aspects of the eating experience. We were told that a lack of mindfulness was endemic in eating in the Western world, and that this is connected to the tendency to overeat. We are too rushed, stressed, and eat too quickly to even notice what we are eating. It takes an average person 20 minutes to feel the “full signal” in the brain after eating, and those with obesity may take 45 minutes before their brain registers “fullness” or satiety. But fullness is not the only thing lacking in our eating patterns in the west; we also tend to miss out on the experienc of savoiring, really enjoying food. This lack of enjoyment, unconsciousness eating, lack of mindfulness, goes beyond food, but also extends to other experiences in our society now. We are missing out on connections with nature, with each other, with a greater purpose/working for greater good, as well missing out on the experiences with delicious food.
As a society we don't take vacations as often as other developed countries, we don't "slow down and smell the roses". This rushed, stressed, lack of mindfulness is leading to individual health problems and a sick society in general. Patients who have traveled to other countries note lovely traditions, such as the passagiata in Italy, which is essentially a community stroll in which everyone participates. In the late afternoon/early evening after work, everyone relaxes, changes their clothing, and strolls around the village for several hours talking to everyone and catching up with their neighbors. It is not just the healthy diet which makes Mediterranean countries healthier, it is this lifestyle of slowing down and enjoying life! While we may not be able to instantly introduce the passagiata to the United States, we certainly may try to add healthy mindfulness to our lives. There is extensive research into healthy living patterns around the world, including “The Blue Zones”, which may give us some ideas.
Mindfulness is certainly something we should think about, and attempt to add to our lives. While mindfulness alone may not yield weight loss, it may certainly contribute to our health, and is a great addition to healthy diet and exercise.
Read more about our program and approach: healthyweightcenter.com
Read more about our program and approach: healthyweightcenter.com
Call any time: (603) 379-6500
References:
http://onlinelibrary.wiley.com/doi/10.1002/oby.21396/abstract - 2016, Effects of a mindfulness-based weight loss intervention in adults with obesity: A randomized clinical trial. Obesity. doi: 10.1002/oby.21396
https://www.psychologytoday.com/blog/intimacy-path-toward-spirituality/201504/revisiting-be-here-now
https://www.bluezones.com/about-blue-zones/
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