Participation in mindfulness-based stress reduction is not associated with reductions in emotional eating or uncontrolled eating

Abstract

The adverse health effects and increasing prevalence of obesity in the United States make interventions for obesity a priority in health research. Diet-focused interventions generally do not result in lasting reductions in weight. Behavioral interventions that increase awareness of eating cues and satiety have been postulated to result in healthier eating habits. We hypothesized that participation in a program called mindfulness-based stress reduction (MBSR) would positively influence the eating behaviors and nutritional intake of participants through changes in emotional eating (EE), uncontrolled eating (UE), and type and quantity of food consumed. Forty-eight veterans at a large urban Veterans Administration medical center were assessed before MBSR, after MBSR, and 4 months later. For all participants (N = 48), MBSR participation was not associated with significant changes in EE or UE. In addition, there were no significant differences in the intake of energy, fat, sugar, fruit, or vegetables at either follow-up time point as compared with baseline. Enhanced mindfulness skills and reduced depressive symptoms were seen over time with medium to large effect sizes. Changes in mindfulness skills were significantly and negatively correlated with changes in EE and UE over time. Overall, there was no evidence that participation in MBSR was associated with beneficial changes in eating through reductions in disinhibited eating or significant changes in dietary intake. Randomized studies are needed to further define the relationship between mindfulness program participation and eating behaviors.

Introduction

The prevalence of obesity has increased dramatically in the United States over the past 3 decades [1]. Overweight individuals are at increased risk for cardiovascular disease and stroke as well as increased overall mortality [2], [3], [4]. As a result, overweight and obese persons are generally counseled to lose weight. Weight loss interventions that include diet and exercise [5] as well as cognitive-behavioral approaches [6] may result in weight loss, but recurrent weight gain after initial weight loss is common [7]. A meta-analysis of weight loss interventions suggests that 5 years after completion of a structured weight loss program, three-fourths of the lost weight is regained [8]. Additional interventions with better long-term maintenance are needed.

Prior studies show higher levels of disinhibited eating (eating in response to external cues or emotional states) and susceptibility to hunger among obese persons [9], [10], [11]. Disinhibited eating has been correlated with weight regain after weight loss [7] and a general tendency to act impulsively [12], [13]. One form of disinhibited eating is termed emotional eating (EE), which refers to the tendency to eat in response to emotional states rather than hunger cues [10], [14]. Emotional eating usually involves the consumption of high-energy or high-carbohydrate “comfort foods” [15]. Research indicates that persons who decrease EE are more successful at weight loss [16], but obese persons may be less likely to incorporate alternate methods of dealing with stress because of lower appraisals of their ability to cope with stress and use resources [14]. These findings suggest that incorporation of behavioral interventions that teach methods to deal with stress may help to maintain or achieve weight loss or prevent weight gain.

Recently, there has been interest in the application of mindfulness and acceptance-based approaches to disordered eating [17], [18], [19], [20]. Mindfulness has been defined as “the awareness that emerges by way of paying attention on purpose, in the present moment, and non-judgmentally to the unfolding of experience moment by moment” [21]. A theoretical model of mindfulness practice suggests that the key components are intention, attention, and attitude, which lead to reperceiving [22]. Mindfulness is hypothesized to promote curiosity about responses to food and cues of hunger and satisfaction [23], perhaps leading to greater enjoyment and appreciation of food, and heightening awareness of internal emotional and external environmental triggers that prompt food consumption. Thus, greater mindfulness may facilitate use of healthier, nonconsumptive coping mechanisms [20]. Enhanced mindfulness also holds the possibility of reducing depressive symptoms that commonly precede disordered eating [24].

Most prior studies of mindful eating interventions examined patients with eating disorders and have shown reductions in binge eating [17], [18], [19], [20]. The curriculum in the interventions for eating disorders placed a focus on eating meditations in addition to other mindfulness practices intended to develop awareness of emotions, thoughts, and bodily states. Additional studies applied other acceptance-based approaches, including dialectical behavioral therapy [25], [26], [27], [28] and acceptance and commitment therapy [29] to eating disorders with evidence of benefit. More recently, the relationship of mindfulness to eating habits for persons without eating disorders has received study. In a cross-sectional study of adult women, dispositional mindfulness correlated significantly with uncontrolled eating (UE) and EE but not cognitive restraint (CR) [13]. There are very few interventional studies of mindfulness programs for eating-related outcomes in populations without eating disorders, and most of the existing literature has included a predominantly female study population. A randomized, controlled trial compared a mindful restaurant eating intervention (6 weekly 2-hour sessions) with no treatment for women (n = 35) who ate out frequently and found evidence that those randomized to the intervention lost more weight and had lower total energy and fat intake [30]. Another study assessed a 6-week mindful eating intervention in 10 obese adults (7 women) and found that all experienced weight reduction [31], and a randomized trial of 62 women who underwent a 4-session intervention based on acceptance and commitment therapy found evidence of benefit for those who complied with the intervention [32]. Additional study of the influence of mindfulness programs on the eating behaviors for obese and overweight persons is needed.

A widely available program to teach mindfulness is an 8-week class called mindfulness-based stress reduction (MBSR) [33], [34]. Prior evidence indicates that mindfulness skills are enhanced in association with participation in MBSR [35]. Although MBSR includes a mindful eating exercise and homework related to diet, the primary focus is not on eating [33]. No prior studies have assessed whether participation in a “general” MBSR course (ie, without modification to place an emphasis on mindful eating) is associated with a change in eating behaviors. The purpose of this study was to examine the relationship between MBSR participation and eating habits to assess whether this widely available program influences eating. The study provided the opportunity to collect data regarding whether a general stress reduction approach influences eating behaviors and to collect data in a predominantly male study population. We hypothesized that participation in MBSR would be associated with a decrease in EE and UE; a decrease in the intake of energies, fat, and sugar; and an increase in the number of daily servings of fruit and vegetables.