A Mindful Eating Program: Answer to Obesity and Cancer?

If you are not familiar with mindful eating, maybe it is time to familiarize yourself with this construct.

In this article, I am going to explain what mindful eating is. I am also going to introduce our six-week mindful eating program. You also learn about the relationship between obesity and cancer. The goal here is to give you enough information so you can make an educated decision if our mindful eating program is for.

Is this Six-Week Mindful Eating Program for Me?

• Have I lost the joy of eating?
• For me, every meal is an angst and anxiety-ridden struggle that makes me feel bad about myself?
• I am sick and tired of diets that eventually fail?
• Am I eating to meet the high-energy requirements of chronic stress?
• Do you want to bring sanity back to the dinner table? Splendid, hold that thought.

Diets Do Not Work

In the last 20 years, the incidence of obesity in the U.S. has increased 110%. This increase in obesity in the U.S. may be a cause for the first decline in life expectancy in 100 years. This is mostly due to obesity’s adverse health consequences that may include cardiovascular disease, Type 2 diabetes, and cancer. Obesity has a significant impact on psychological health as well. Obese people are four times more likely to meet the criteria for major depression than persons of average weight (Leahey, Crowther, & Irwin, 2008).

Making matters worse, treatments for obesity, such as behavior therapy, diets, exercise programs, and psychopharmacology all too often produce only moderate, temporary effects.

The amount of money the weigh-loss industry spends to get you to jump on the diet bandwagon is staggering. The following statistics are from an ABC News 20/20 piece that aired in 2012 (20/20: ABC News, 2012):

• $20 Billion: The U.S. weight-loss industry’s annual revenue from diet books, diet drugs, and weight-loss surgeries
• 108 Million Dieters: With the average dieter typically giving a diet or weight-loss program 4x to 5x a year a try
• $500,000 to $3 Million: The average salary of a celebrity who endorses a major weight-loss program
• $33,000: Said average celebrity endorser’s income per pound lost

It does not look like diets work. It also seems that the weight-loss industry is not doing such a stellar job getting American’s to lose excess weight, live healthier, and longer lives as well. Leahey and colleagues (2008) seem to agree. To reiterate, for the first time in 100 years, life expectancy in America might be on the decline because of the ill effects and comorbidities (such as cancer) of obesity?

The Relationship Between Obesity and Cancer

Cancer survivors have unique dietary needs of their own. Consider this data: Genetic factors account only for 5% of tumors. On the other hand, 95% of tumors are thought to develop due to environmental factors. That then makes lifestyle, environmental pollution, and diets primary targets for intervention. One-third (30-35%) of the environmental factors associated with the onset of cancer are dietary in nature (Baena Ruiz & Salinas Hernández, 2014).

Ruiz and Hernandez (2014) further write that the evidence is inconclusive to isolate single nutrients for their role to either increase or decrease cancer risk. Researchers, they reason, should focus on investigating dietary patterns since food and nutrients are not eaten separately, and there might be significant interaction between them.

Survivorship, to reiterate, is defined as the period of cancer diagnosis until the end of life, regardless of the time that elapses between these two events. Pérez-Hernández, Catalán, Gómez-Ambrosi, Rodriguez, and Frühbeck (2014) write that we can link 15-20% of all cancer deaths in the U.S. to being overweight and obesity.

It seems that the situation could not get any worse, but for obese women before a diagnosis of cancer and cancer survivors it does. Elevated body mass index presents a threefold increase in breast cancer for post-menopausal women. Being overweight and obese is associated with a worse response to chemotherapy and worse overall survival. There is also a correlation with other measures of obesity, such as weight-to-hip ratio, and an increased risk of death. According to Pérez-Hernández and colleagues (2014), abysmal prognosis and survival in obese women with breast cancer is a well known fact among researchers.

Overall, there is enough evidence to suggest significantly higher risks for leukemia, lymphoma, and myeloma with high body mass index in a dose-dependent manner. In other words, as body mass index increases, so does the risk for these cancers. Obesity also carries with it an increased risk for pancreatic, prostate, breast, colon, endometrial, liver, kidney, esophagus, gastric, and gallbladder cancer. Because childhood obesity rates continue to rise, children’s risks for cancers later in life are significantly elevated as well (Louie, Roberts, & Nomura, 2013).

Because of the correlation between obesity and cancer, it is desirable that obese persons reduce their body mass index and fat mass. Unfortunately, most people fail to cut excess body weight by dieting. A slightly different approach is warranted to restore balanced energy metabolism, as well as a healthy relationship with food.

Mindful Eating: Can it Bring Sanity Back to the Dinner Table?

Growing research suggests that distractions while eating, prevent you from enjoying the bite in your mouth. Coined “mindless eating,” it is a seemingly innocent behavior with grave health consequences. Mindless eating has been linked to overeating, stress, increased anxiety, and subsequently obesity.

• Did you practice mindful eating during your last meal?
• Can you recall what you had for lunch yesterday?
• Can you describe the flavor of the food?
• How about the texture of the food you ate?
• What did the food taste like?

What are some Principles of Mindfulness?

Mindfulness can best be summed up as non-judgmental moment-to-moment awareness, achieved through deliberately paying attention. The construct embraces both internal processes and external environments (Center for Mindful Eating, n.d.).

Mindfulness lets you become aware of thoughts, emotions, and physical sensations in the present moment.

Practicing mindfulness helps you to cultivate the possibility of liberating yourself from reactive, habitual patterns of thinking, feeling and acting (Center for Mindful Eating, n.d.).

A more technical description of the construct of mindfulness…

…a highly refined, systematic attentional strategy to reduce cognitive vulnerability to reactive modes of mind that might otherwise heighten stress and emotional distress” (Dalen et al., 2010, p. 2).

What is Mindful Eating?

Mindful eating allows you to become aware of the positive and nurturing opportunities that are available for food choice and preparation.

Mindful eating will enable you to use all of your senses in choosing to eat food that is both satisfying to you and nourishing to your body. Choosing food that is satisfying will allow you to acknowledge responses to food (likes, dislikes or neutral) without judgment. Eating mindfully will help you to become aware of physical hunger and satiety cues to guide your decisions to begin and end eating.

You are Someone who Eats Mindfully When…

• You acknowledge that there is no right or wrong way to eat, but varying degrees of awareness surrounding your experience of food.
• You accept that your eating experiences are unique.
• You, as an individual, by choice directs your attention to eating on a moment-by-moment basis.
• You gain awareness of how you can make choices that support health and well-being.
• You become aware of the interconnection of Earth, living beings, and cultural practices and the impact of your food choices on those systems.

What does the Research say About Mindful Eating?

I probably should start this section by writing about the Mindful Eating Questionnaire (MEQ) that has been developed and validated to support rigorous scientific research on this topic.

Framson and colleagues (2009) developed a 28-item scale to measure the construct of mindful eating. The scale is brief and has good internal consistency and reliability. Evidence suggests that the scale has good construct validity as well. More importantly, and very empowering for you, is that the (MEQ) is a scale that establishes that

mindful eating is a skill that can be learned.

The MEQ is a significant step toward exemplifying and quantifying mindful eating. It will be a handy tool, both in clinical practice and research to grasp and promote healthy dietary behavior.

Mindfulness and Binge Eating in Bariatric Surgery Patients

Leahey et al. (2008) report on the development and implementation of a 10-week cognitive-behavioral mindfulness-based group intervention that was designed to decrease binge eating and ease postsurgery adjustment of bariatric surgery patients.

To qualify for bariatric surgery, patients must have an elevated BMI and a history of failure to lose weight and/or maintain weight loss via traditional weight loss programs. Even after surgery, these patients continue to engage in eating patterns that likely weaken the long- term success of their operation.

The Leahey and colleagues’ (2008) findings are promising. Study participants reported reductions in binge eating and eating in response to emotions. Group members also reported decreased eating concern, increased eating self-efficacy, improvements in emotion regulation, and decreases in depression. A potential limitation of this study was that researchers relied heavily on self-report measures to assess binge eating and related psychopathology (Leahey et al., 2008).

The Mindful Eating and Living Pilot Study

While we considered all the research mentioned here, this study has been given the most weight to develop ACEF’s Mindful Eating Program.

The purpose of the study by Dalen and colleagues (2010) was to pilot a 6-week group program for providing mindfulness training to obese people. Researchers offered the program during six weekly two-hour group classes (with two monthly follow-up classes). The program was structured to included training in mindfulness meditation, mindful eating, and group discussion. The emphasis of group discussion was on awareness of body sensations, emotions, and triggers to overeating (Dalen et al., 2010).

The primary outcome measures were changes in weight, body mass index, eating behavior, and psychological distress. The researchers also measured levels of C-reactive protein (hsCRP), adiponectin, low-density lipoprotein (LDL), and plasminogen activator inhibitor-1 (PAI-1). All these markers are indicative of cardiovascular risk (Dalen et al., 2010).

Compared to baseline data, participants showed statistically significant increases in measures of mindfulness and cognitive restraint around eating. The research team also reports statistically significant decreases in weight, eating dis-inhibition, binge eating, depression, perceived stress, physical symptoms, negative affect, and C-reactive protein (Dalen et al., 2010).

Even though tiny (n=10), this study provides initial evidence that an eating focused mindfulness-based intervention can result in significant positive changes. Dalen et al. (2010) observed positive changes in weight, eating behavior, and psychological distress in obese people (Dalen et al., 2010).

Mindfulness-Based Eating Awareness Training for Binge Eating

Binge eating can be accompanied by a significant imbalance in food intake regulation. Binge eating is often concomitant with obesity and depression. The authors hypothesized that mindfulness-based training may reduce compulsive overeating, address associated behavioral and emotional dysregulation, and promote the internalization of change (Kristeller, Wolever, & Sheets, 2014).

Researchers explored mindfulness-based eating awareness, a 12-week group program. The team compared mindfulness-based eating to a psycho-educational/cognitive–behavioral intervention (PECB) and a wait list control. The mindfulness approach incorporated sitting and guided mindfulness practices to cultivate greater awareness of hunger and fullness cues, sensory-specific satiety, and emotional as well as other triggers for eating (Kristeller et al., 2014).

For this project, the investigators randomized 150 overweight or obese people. Compared to the wait list control, the mindfulness-based approach and PECB showed comparable improvement. Positive changes were observed after one and four months post-intervention on binge days per month, the Binge Eating Scale, and depression (Kristeller et al., 2014).

At four months post-intervention, 68% of those people with a binge eating disorder diagnosis (BED) in the mindful eating group, no longer met the BED criteria. The same can only be said about 46% receiving PECB and 36% of participants in the wait list control. Worthwhile to point out is that the amount of mindfulness practice predicted improvement on a range of variables, including weight loss. The results suggest that mindfulness-based eating awareness decreased binge eating and related symptoms at a clinically meaningful level, with improvement associated with the degree of mindfulness practice (Kristeller et al., 2014).

Everyday Mindfulness, Mindful Eating and Self-Reported Serving Size of Energy Dense Foods

Beshara, Hutchinson, and Wilson (2013) write that a serving size is a changeable factor of energy consumption, and an essential aspect to address the prevention and treatment of obesity.

With their study, the authors aimed to investigate negative association between individuals’ everyday mindfulness and self-reported serving size of energy dense foods. The investigators also sought to measure the role of mindful eating. Participants (n=171) completed self-report measures of everyday mindfulness and mindful eating. The dependent measure was participants’ self-reported average serving size of energy dense foods consumed in the preceding week (Beshara et al., 2013).

Participants who reported higher levels of everyday mindfulness were more mindful eaters and reported smaller serving size estimates of energy dense foods. Mindful eating mediated the negative association between everyday mindfulness and serving size. The domains of mindful eating most relevant to serving size included emotional and dis-inhibited eating. Results suggest that mindful eating may have a greater influence on serving size than daily mindfulness (Beshara et al., 2013).

ACEF’s Mindful Eating Program

We like the idea that the mindful eating approach to obesity is based on the “dysregulation model of obesity.” This model proposes that many obese people have lost the ability to recognize or respond to internal cues of hunger, taste, satiety, and fullness (Dalen et al., 2010).

Because of everyday stressors and negative emotions, people tend to cultivate avoidant or impulsive approaches to coping. Trying to avoid unpleasant feelings, as well as displaying hampered coping skills may contribute to unwanted eating behaviors. In turn, this undesirable eating behavior, due to automatic and dissociative eating, may result in excess calorie consumption (Dalen et al., 2010).

Most diets severely limit calorie consumption. However, they do not deliver a plan to recondition the body’s capacity to adjust eating behavior (Dalen et al., 2010).

A mindful eating program is different, because it addresses your emotional states and attunes you to feedback from your body. Mindful eating may thus potentially increase your ability to recognize and respond to normal satiety cues. Dalen and colleagues write

Mindfulness training involves purposeful and sustained attention to internal dialogs and bodily cues which could facilitate assessment and potential re-patterning of automatic behaviors (2014, p. 4).

A mindful eating program might be relevant in altering habituated patterns of food consumption, which characteristically have developed over years. Mindful eating, juxtaposed to cutting calories, may help you shrink your waistline by reconstructing your ability to detect, and respond to, natural cues of hunger and satiety (Dalen et al., 2010).

We are very excited to offer this 6-week mindful eating program and hope you will join us.

Now it is Your Turn!

Three steps you can take now to help us help you thrive:

Step 1: Share With Your Family and Friends

Did you find this article helpful for cancer survivors and their families? Feel free to share on Twitter and Facebook by using the super-easy share buttons on top or bottom of this article!

Step 2: Join Our “Weekly Smarts” Mailing List

Like what you’ve read? Join our mailing list by adding your email address to the form on the right. You’ll be the first to hear about updates once a week!

Everyone should be on your mailing list. Period.

-A woman named Jane, who’s probably just trying to bribe us

Step 3: Make the Leap to Better Health and Wellness

Fill out the short form below to get more information and learn more about or register for our mindful eating program.

References:

20/20: ABC News. (2012, May 8). 100 Million Dieters, $20 Billion: Weight-Loss Industry by the Numbers. Retrieved January 7, 2015, from http://abcnews.go.com/Health/100-million-dieters-20-billion-weight-loss-industry/story?id=16297197

Baena Ruiz, R., & Salinas Hernández, P. (2014). Diet and cancer: Risk factors and epidemiological evidence. Maturitas, 77(3), 202–208. doi:10.1016/j.maturitas.2013.11.010

Beshara, M., Hutchinson, A. D., & Wilson, C. (2013). Does mindfulness matter? Everyday mindfulness, mindful eating and self-reported serving size of energy dense foods among a sample of South Australian adults. Appetite, 67, 25–29. doi:10.1016/j.appet.2013.03.012

Center for Mindful Eating. (n.d.). The principles of mindful eating. Retrieved from the Center for Mindful Eating website at http://www.thecenterformindfuleating.org/principles

Dalen, J., Smith, B. W., Shelley, B. M., Sloan, A. L., Leahigh, L., & Begay, D. (2010). Pilot study: Mindful Eating and Living (MEAL): Weight, eating behavior, and psychological outcomes associated with a mindfulness-based intervention for people with obesity. Complementary Therapies in Medicine, 18(6), 260–264. doi:10.1016/j.ctim.2010.09.008

Framson, C., Kristal, A. R., Schenk, J. M., Littman, A. J., Zeliadt, S., & Benitez, D. (2009). Development and validation of the mindful eating questionnaire. Journal of the American Dietetic Association, 109(8), 1439–1444. doi:10.1016/j.jada.2009.05.006

Kristeller, J., Wolever, R. Q., & Sheets, V. (2014). Mindfulness-based eating awareness training (MB-EAT) for binge eating: A randomized clinical trial. Mindfulness, 5(3), 282–297. doi:10.1007/s12671-012-0179-1

Leahey, T. M., Crowther, J. H., & Irwin, S. R. (2008). A cognitive-behavioral mindfulness group therapy intervention for the treatment of binge eating in bariatric surgery patients. Cognitive and Behavioral Practice, 15(4), 364–375. doi:10.1016/j.cbpra.2008.01.004

Louie, S. M., Roberts, L. S., & Nomura, D. K. (2013). Mechanisms linking obesity and cancer. Biochimica et Biophysica Acta (BBA) – Molecular and Cell Biology of Lipids, 1831(10), 1499–1508. doi:10.1016/j.bbalip.2013.02.008

Pérez-Hernández A. I., Catalán, V., Gómez-Ambrosi, J., Rodriguez, A., & Frühbeck, G. (2014). Mechanisms linking excess adiposity and carcinogenesis promotion. Frontiers in Endocrinology, 5. doi:10.3389/fendo.2014.00065