Is mindfulness a legitimate tool for fat loss?

Written By Jeb Johnston

We all want to feel better, look better, be better. It is not a lack of knowledge that holds us back from reaching our goals. It is not a lack of ability or skill. In fact, we as Americans are really freakin good at losing weight. We just suck at keeping it off. This is evidenced by a $72 billion industry targeted at helping people lose the same weight over and over again. The numbers aren’t good. According to the CDC, American obesity rates for 2017-2018 were 42.4%. The annual medical cost of obesity was $147 billion dollars in 2008. 12 years ago. What might that look like now? We are on a path to greater prevalence of obesity each year and our current prescription of “eat less, move more” has failed us. So might there be another way?

Perhaps. We see the trappings of mindfulness everywhere we turn. From the sexy lithe bodies draped in the latest yoga athleisure wear to the woke-ness of every meditative moment of the movie-star-turned-guru. It is all around us and portrayed as a way to both slow life down and to achieve greater success. While there is a lot of hype and hyperbole around the selling of a more mindful you, there is also some real evidence behind the science of mindfulness. 

What is mindfulness?

First, let’s define our terms. What is mindfulness? What is this panacea of problem solving that has been pitched to us in the form of apps and lifestyle and more? What exactly does mindfulness mean?

Well to start, the term itself is very broad. A quick google search brings up this definition: 

1) a mental state achieved by focusing one's awareness on the present moment, while calmly acknowledging and accepting one's feelings, thoughts, and bodily sensations, used as a therapeutic technique.

So we can surmise that anything that helps us to initiate this state of active presence falls under the umbrella of mindfulness. This could mean training in jiu jitsu to partaking in walking meditation. There are really no limits to things that fall under this realm but for matters of consistency let us at first separate things into four main categories. These are the methods of mindfulness practice that I choose to focus on with my weight management clients.

Acceptance

“Life is a series of natural and spontaneous changes. Don't resist them; that only creates sorrow. Let reality be reality. Let things flow naturally forward in whatever way they like.”

― Lao Tzu

Acceptance as a form of mindfulness is about taking the world at face value. It is accepting things as they are versus as we wish them to be. We must come to terms with the reality that we may not see the world as fair or just but that doesn’t change the reality of the situation. In order to elicit change we must first work to accept reality as it is and not as we wish it to be.

It is important to note that acceptance is not passive. It is not “laying down” or “approval”. It is instead an action based move towards understanding reality and not ignoring it.

Awareness

“Look at everything always as though you were seeing it either for the first or last time: Thus is your time on earth filled with glory.”

― Betty Smith, A Tree Grows in Brooklyn

Mindfulness centers around being present, attuned to the moment around you and not deliberating the past or forecasting the future. In order to be present we must attempt to look at both our environment and ourselves and the interactions that accompany them. Awareness as a practice is about using our senses to observe and words to describe our environment, thoughts, behaviors, and actions. Being present in the moment is about focusing on all of our interactions.

Meditation

“Meditation is like a gym in which you develop the powerful mental muscles of calm and insight.”

– Ajahn Brahm

We train with weights or run through streets or read to flex the muscles of both the body and those of our intellect. We must also train our attention and focus. Meditation is the action of mindfulness that creates a more powerful mind. One that is capable of observing thoughts without judgement or calming racing thoughts. It is both flexible and strong, creating stability through malleability.

Mindful Eating

“Refrain from discussing subjects that can destroy your awareness of the people around you and the food. If someone is thinking about something other than the good food on the table, such as his difficulties in the office or with friends, it means he is losing the present moment and the food. You can help by returning his attention to the meal.”

― Thich Nhat Hanh, How to Eat

The final aspect of mindfulness that I like to incorporate is that of mindful eating. This is where we can start to incorporate our mindfulness skills with the practice of eating. We develop the senses around eating. Many would argue that overeating stems from a hedonic desire for food. That the overwhelming scent and taste and mouthfeel drives these episodes. However, overeating, emotional eating, binge-like behaviors; these all occur in a state of mindlessness. Creating a more accurate sense of the hedonic aspects of food can work to prevent the onset of these mindless episodes rather than spur them on.

Mindfulness based therapies

Mindfulness is not just the realm of Buddhist monks and members of the Beatles; it is a legitimate therapeutic tool that has gained acceptance in the behavioral sciences. It is utilized in many different aspects and variants and can be as simple as a tool within a greater therapeutic system or even on it’s own. Most of the common mindfulness based therapies have some relation to cognitive behavior therapy and incorporate mindfulness as a core tenet.

Mindfulness based cognitive therapy is one such methodology. It consists of mindfulness based stress reduction which has been shown to help people suffering from chronic pain, hyper-tension, and heart disease. The mindfulness based model was then applied to help patients suffering from depression to strong effect. The links between mood disorders and chronic overeating are many so MBCT is a tool that has been studied as well for its potential effects on eating behaviors.

Acceptance and commitment therapy is another therapeutic tool that has been well researched for its effects on both mood and eating behaviors. It is also based on tenets of CBT and prompts participants to avoid denying or avoiding their emotions, instead encouraging acceptance of their existence and the realities of the world as a whole. Accept that our feelings are simply responses to the world around us and that they should not hold us back from initiating change.

Dialectical behavior therapy is a third methodology that fits into this realm of cognitive approaches utilizing mindfulness as a tool. The origins of DBT are in treatment of borderline personality disorder among (primarily) adolescent and teenage women. It soon found favor in treatment of addiction and other maladaptive behaviors. The primary focus of DBT is the idea that two seemingly opposing truths can simultaneously exist. Mindfulness plays a large role in the structure of DBT treatment.

Effects on maladaptive eating behaviors

Mindfulness as a tool seems to have the greatest effect on treating maladaptive eating behaviors versus being used as a traditional weight loss tool. From a therapeutic perspective, this is where we can expect to see the biggest application. Within the realm of maladaptive eating behaviors we look to what we believe to be contributing factors and can be indicative of potential for disordered eating. Among them are three that I find to be of particular importance when dealing with general population clients. These are emotional eating, body image, and dichotomous thinking.

Emotional eating is generally referred to as any eating that occurs as a response to a “negative” emotion. It is a more broad form of maladaptive eating patterns along with external eating and restrained eating.

Body image concern is a multifactorial issue that can stem from any number of sources. It can play a large role in the formation of disordered or maladaptive eating and is often a strong indicator of potential concern. The mitigation of concerns of body image could well be a platform to build more conducive and health promoting behaviors around food.

Dichotomous thinking tends to be a behavior that is more prevalent in all populations, not just those considered to face the potential of disordered eating. However, when applied to food it does create an environment of maladaptive behaviors that could potentially lead to disordered eating behaviors. 

What does the research say?

One of the first studies to catch my attention was Alberts et al 2012. This study showed a significant finding in utilizing a mindfulness based technique to work on correcting maladaptive eating behaviors. The study itself consisted of 26 women with an avg age of 48.5 years, an avg weight of 94.6kg and BMI of 37.5. They were split into two groups, the first group of 12 was given a weekly mindfulness based cognitive therapy course over 8 weeks while the second group of 14 was used as a control group and waitlisted for the study to begin when the MBCT group concluded. The program was an 8 week long MBCT course consisting of a 2.5 hour session one time per week. Participants were encouraged to practice skills at home for 45-60 minutes per day. At the end of 8 weeks a reassessment was done and the control group then participated in the MBCT program.

At the conclusion of the study the control group saw slight increases in most maladaptive behaviors across the board while the MBCT group saw improvements in all areas apart from restrained eating and weight. The authors posited that since restraint is based upon an external stimulus while the mindfulness based techniques are internally focused it may have caused a difference in expected results. Results are shown in table 1 below. Of particular note are the highlighted regions showing improvements in the 3 categories indicated previously.

Alberts, et al 2012

“DBT’s emphasis on mindfulness may act indirectly to help reduce the restrictive mindset often found in chronic dieters who, after breaking cognitive barriers, tend to eat more” (Heatherton & Polivy, 1992, Polivy & Herman, 1995)

In the case of Safer et al 2010, the study authors went about researching the efficacy of Dialectical Behavior Therapy on maladaptive eating behaviors, particularly the methodology of DBT-BED which was developed to target binge eating disorder. In addition, the authors developed a therapeutic model for comparison (Active Comparison Group Therapy) that would deliver many of the same therapeutic benefits of DBT-BED but would not employ the same specific skills as the DBT program. 

It comprised 101 participants; 50 in the DBT group and 51 in the ACGT group. The study was 20 weekly 2 hour sessions delivering either the DBT or ACGT models. There was no nutritional intervention given as this was a therapeutic model to achieve a lessening or abstinence of binge episodes.

Both therapeutic models showed efficacy, with minimal deviations at a 12 month period. However, the DBT model, with its emphasis on mindfulness, did show better results in the immediate post treatment window. This could be due to the consistent practice of the DBT skills that may have waned in subsequent weeks. The figures below show the rates of abstinence and lessening of binge episodes, respectively. 

Safer, et al 2010

So what about fat loss?

The earlier studies on effects of mindfulness on maladaptive eating behaviors showed no statistically significant differences in weight or BMI at the conclusion of the study. While weight and BMI are both measures that are taken and observed in these studies, weight is not the main measure of success when dealing with behaviors such as binge eating, rather the measure is of efficacy at removing said behaviors. So in order to examine if there can be a relationship between a mindfulness practice and weight control, that would need to be the primary focus. 

There is usually some sort of cognitive element to any weight loss program, whether it be counting calories or macros or points or even an awareness of food values. So while a study involving fat loss and mindfulness will have an element of mindfulness, there will also be some sort of system enacted to at least educate the study participants on what things they can focus on to prompt a change in body weight.

The main study that I looked at in regards to weight loss and mindfulness was “An Acceptance Based Behavioral Intervention for Weight Loss” by Neimeier, et al 2012. This was a smaller sample size, just 21 participants with a mean weight of 88.8kgs, split into two groups of 11 and 10 respectively. This was a 24 week study where the participants were taught “standard behavioral weight control tactics” in addition to an acceptance based behavioral intervention. The standard weight control was to eat 12-1500cals per day, get  <25% cals from fat, and an increase of activity from 10min-40min per day. These protocols were gleaned from the LOOK AHEAD study 2007 Pretty generic and pretty difficult for an average weight person, let alone someone who is 195lbs. The acceptance based portion of the intervention was teaching from ABBI which is a set standard of acceptance based techniques designed to minimize maladaptive behaviors. In this case around food.

The results of this study differed from the others in that a significant amount of weight was lost by participants. The participants lost an average of 12kgs and saw a maintenance of that loss at the 3 month follow up with no contact in between completion of the study and the follow up appointment. This is extremely rare as there is most often a weight rebound at the conclusion of weight loss studies. The amount of loss was also significant. In the typical weight loss intervention study the avg weight loss is in the realm of 8kgs so the result here is favorable.

The main drawbacks of the Neimeier study is that there was no further follow up after the 3 months. In examining the efficacy of a long term weight management strategy I would like to see a follow up at the 6 month and 1 year points.

What could be the connection?

There are many possible links between mindfulness and emotional eating but there isn’t any definitive proof out there joining the two. However there are quite a few possibilities that I am willing to explore.

So much of the connection seems to be happening in the brain (shocking I know). From the outset we see an increase in oxytocin production when engaged in mindfulness practice. Oxytocin production can result in an increase in prosocial behavior which is stress-reducing and may in turn lead to a lessened response in emotional eating by creating contentment. (Ito et al 2019)

Mindfulness practice has also shown to increase white matter in the brain. An increase in white matter has been linked to learning new skills and habits. The process of myelination is an increase in the myelin, the outer sheath of axons in the brain. An increase in both myelin and, in turn white matter, increases the speed at which the brain can process information. By increasing white matter in the brain, we can rewire our habits around food. If utilizing a mindfulness approach around food behaviors can increase myelin production in the process, we can create new habits that overpower older ones. (Laneri et al 2016)

We also see a change in the hippocampus. This is important because the hippocampus has a major role in how we determine goal focused behavior. If we can create a change in hippocampal function we may be able to improve how we approach goals related to food. (Lardone et al 2018)

Last, there may be changes in the dorsolateral prefrontal cortex region of the brain that occur with a mindfulness practice. This is potentially important as the DLPFC has roles in things such as planning and inhibition. By seeing a positive change in the DLPFC we may better our impulsivity around food and therefore see more sustainable and consistent results. (Taren et al 2018)

So what are the downsides?

In reality, there really aren’t many downsides to adopting a mindfulness practice. Do I think it completely replaces a cognitive approach to weight management? No. But it may be a more malleable and flexible choice for those who feel overly constrained by a traditional model of counting calories and tracking intake. As an additive measure I believe that it could provide exponential benefit.

For some people, some aspects of mindfulness may not yield as drastic results. For instance, mindful eating may not help someone who already eats slowly. Mindfulness practice also takes time to develop and requires practice. In our world of quick fix solutions, many people will not be willing to put in the effort required to see the eventual weight loss.

In terms of benefit vs potential downsides, I find that adding a mindfulness approach to weight loss may be one of the safest behavioral adaptations we can utilize.

Where do we go from here?

The biggest struggle of the weight loss industry is not the actual weight loss; it is the management after the fact. We continually see a rebound from weight loss and it is estimated that only 20% of dieters who have lost 10% or more of their original bodyweight will keep it off. Those are not inspiring numbers.

In addition, the cognitive approach to dieting (points or macro or calorie counting) on its own has serious potential ramifications on both behavioral and metabolic health. We see severe metabolic adaptations from chronic dieters, increased health risks from yo-yo dieters, and an increased potential for maladaptive and disordered eating patterns from dieters of all kinds. These things worry me as a nutrition professional and coach and human.

Does mindfulness hold the keys to preventing these occurrences? No, but it does have the potential to mitigate many maladaptive behaviors from forming. We must, as an industry, better understand the potential downsides and risks of what we do so that we can be aware of the warning signs. By increasing our understanding of risk, we can also apply deterrents along the way. Mindfulness is one such tool.

One of the biggest concerns fitness professionals have about working with fat loss is staying in their lane. They don’t want to become therapists, nor should they. We are not equipped to counsel anyone on complex emotions. However, helping a potential client develop skills such as mindfulness gives them the tools to be their own counselor. After all, they are the greatest expert on themselves.

Don’t be afraid to incorporate mindfulness skills into your practice. There are few if any downsides, there are a lot of benefits, and these skills crossover to all aspects of life. And don’t worry too much about the woowoo factor, there is plenty of research to support the efficacy of mindfulness in improving eating behaviors. It may not be the panacea we are all searching for but it does have the potential to help us all be better. 

References:

Jeb Johnston
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