MINDFULNESS WHEN EATING

Jean L. Kristeller, PhD, Indiana State University, Terre Haute, Indiana, USA, presented components of Mindfulness-Based Eating Awareness Training (MB-EAT) and discussed results of several studies examining its effectiveness. She emphasized that mindfulness makes a difference because it allows people to pause to consider automatic reactions, allowing them to use higher-level thought for decision making. As Dr Forman also emphasized, this type of approach provides skills that can be used to maintain weight loss. Dr Kristeller noted that patients are used to high-calorie diets and very restrictive diets, but often do not know how to maintain a flexible, healthy diet that is intermediate between those extremes.

MB-EAT involves consideration of the knowledge about nutrition and exercise combined with research into food intake regulation, weight loss (including CBT approaches), disordered eating, and hunger and satiety regulation. Dr Kristeller explained the 3 stages of mindfulness meditation (heightened awareness, reduced automatic reactivity, and emergence of appropriate self-care and response) [Kristeller JL. Mindfulness meditation. In: Lehrer P et al. Principles and Practice of Stress Management. New York: Guilford; 2007]. She then discussed the skills that can be developed in MB-EAT, including the ability to recognize responses to food and heightening interoceptive awareness of physical hunger and satiety cues, both taste satiety and fullness. By paying attention to taste satisfaction, patients can consider whether it is worth continuing to eat as the satisfaction level decreases. Additionally, patients develop awareness, acceptance, and a better attitude toward eating and food.

Dr Kristeller continued by reviewing empirical support for mindfulness-based approaches. Studies included patients with binge-eating disorders and over-eaters, as populations have different eating patterns that must be considered. The first trial [NCT00032760] found obese individuals with binge eating disorder had significant improvement, equivalent to a CBT-based program, in decrease in binge eating, and greater improvement overall in a sense of control around eating. Increased engagement in mindfulness and meditation correlates with overall improvement and greater weight loss [Kristeller JL et al. Mindfulness. 2012]. Dr Kristeller said that in another trial currently under review, these positive benefits were shown to be similar for those with or without BED, and with moderate to morbid obesity. The unpublished SHINE study [NCT00960414] comparing a treatment group undergoing mindfulness treatment (MB-EAT, exercise, and stress reduction) with a control group (receiving nutrition information and exercise) found a greater percentage of weight loss, a decrease in fasting glucose levels, and a decrease in triglycerides/HDL level in the mindfulness group.

CHILDHOOD OBESITY RISK FACTORS

Melinda S. Sothern, PhD, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA, addressed modifiable risk factors for obesity in children and barriers to having a healthy weight, strategies to improve nutrition and physical activity to modify risk for obesity, and solutions to some of the potential barriers.

Modifiable risk factors for childhood obesity are numerous, including poor family role modeling, use of sugary beverages, large portion sizes, use of food as a reward, excessive media time, and lack of opportunities for outdoor play. Dr Sothern provided information for addressing a range of these risk factors. For example, parents can improve their own food choices, improve family sleep habits, increase the frequency of family meals, decrease snacking, and provide water (between meals) or milk (for mealtimes) instead of sugar-sweetened beverages among other practices [Pan L et al. Pediatrics. 2014; Anderson SE, Whitaker RC. Pediatrics. 2010; O'Connor TM et al. Pediatrics. 2006]. Praising children for physical activity and serving a healthy breakfast are also helpful approaches [O'Dea JA, Wilson R. Health Educ Res. 2006; Alexander KE et al. Obesity (Silver Spring). 2009].

Because children may resist healthy food, Dr Sothern suggests gradually replacing non-nutritious foods with better options and making nutritious food easily accessible in the home (within reach of children). She also noted that children should be encouraged to leave food on their plates when finished, allowing them to choose to eat the right amount for their appetite [Spruijt-Metz D et al. Am J Clin Nutr. 2002; Entin A et al. J Am Coll Nutr. 2014]. Additionally, children should not be taught to label foods as good or bad or given food as a reward.

In addition to giving detailed recommendations for multiple risk factors and barriers, Dr Sothern emphasized that children have different needs than adults. For example, they have immature metabolic systems, need movement and play, cannot focus for long time periods, and have lower oxygen uptake [Sothern M. Profile of the Overweight Child. In: Safe and Effective Exercise for Overweight Youth. Boca Raton, FL: CRC Press; 2014]. These factors need to be considered in making recommendations to improve their health.