Within the last decades, obesity rates grow significantly among adults and adolescents. As a chronic condition, obesity can be characterized by excessive bodyweight, which a medical problem that correlates with many health problems. Considering that obesity is caused by a variety of social, cultural, and environmental factors, along with its impact on different body systems, an integrative approach should be applied. Many patients with excessive weight struggle with impulsive eating and practice moment-to-moment awareness, which prioritizes the need for mindfulness interventions (Goble et al., 2017). In this connection, mindfulness practices can contribute to integrative care, including whole-person engagement, patient self-awareness and self-acceptance, and relationships between care providers and patients to effectively manage obesity.
Obesity as a Chronic Health Condition
Obesity is considered to be an epidemic among chronic diseases as it is widespread and has serious health impacts. According to data from the National Health and Nutrition Examination Survey, the rate of obesity among adults increased from 33.7% in 2007 to 39.6% in 2016 in the US (Hales et al., 2018). As for the youth, obesity prevalence also raised from 16.8% to 18.5% in the same period (Hales et al., 2018). Some ethnic and racial groups are disproportionately impacted by this condition, namely, African-Americans and Hispanics have the highest prevalence, while adults aged between 49 and 59 ages are the most vulnerable group (Adult obesity facts, 2021). A lack of education and low income are the factors that increase the risk of developing obesity.
A method of body mass index (BMI) is used to classify a person’s weight. According to this method, overweight is scored from 25 to 29.9, obesity – 30 to 39.9, and severe obesity – 40 or above (El Ghoch & Fakhoury, 2019). The evaluation of waist circumference, muscles, and body fat are also used to define obesity. Among the comorbid diseases, it is possible to mention diabetes, stroke, coronary heart disease, hypertension, and cancer. The causes of this disease are related to a complex of hereditary, lifestyle, and environmental factors. Traditional treatment options include dieting and exercising, which can be supported by medications such as Metformin, Orlistat, and other drugs that control appetite and impact metabolism (El Ghoch & Fakhoury, 2019). As for progression, weight loss programs and surgeries confirmed their effectiveness, even though they take commitment and time to achieve and maintain health, while difficulties with maintaining and weight and constant regains remain the main problems.
Core Tenets of Mindfulness Practices for Obesity
Stress Response vs. the Relaxation Response
In case of obesity, people are often prone to stress-induced eating, which is complicated by high-calorie food preferences, a lack of physical activity, and psychological stress. Masih et al. (2017) state that food choice is characterized by stress, which induces the preference towards high-fat and high-sugar beverages and foods. The metabolic syndrome that appears in response to stress-eating contributes to obesity and further psychological tension, called a stress response. On the contrary, a relaxation response can serve as an antidote to reduce impulsive eating. The study by Masih et al. (2017) revealed that a mental focus, relaxed body, and a non-judgmental attitude to the self are the key components of the relaxation response. However, it remains critical to ensure holistic care and pay attention to a variety of methods to manage obesity.
Advantages of Mindfulness
Mindfulness practices are devoted to working with various dimensions of human health, such as physical, emotional, and cognitive. The practices of mindful thinking have a great potential in decreasing the hormone of stress, cortisol, which increases during stressful periods (O’Leary et al., 2016). With adequate levels of cortisol, people tend to be more sensitive to recognizing and understanding their hunger and eat consciously. This effect is caused by developing the ability to focus on food color, smell, flavor, and texture to feel better what exactly one eats. In this case, a person with obesity fosters his or her emotional eating awareness (Hanson et al., 2019). In turn, it improves appetite traits and eating patterns, making them healthier and more controllable.
The benefits of mindfulness for the cognitive well-being of people with obesity refer to practicing attention to personal thoughts and feelings. Alamout et al. (2020) suggest that mindfulness-based cognitive therapy contributes to addressing an attentional bias to eating. Cognitive flexibility is another advantage that implies acting not according to behavioral patterns but based on relevant data. In terms of the physical dimension, mindfulness practices positively impact on building and following a dietary regimen. It prevents binge eating by allowing people to cope with stressful feelings of anxiety, irritation, and depression. Meditation also allows becoming more aware of lifestyle choices, including physical activity (Dunn et al., 2018). Accordingly, the mechanisms that caused obesity become less pronounced, excessive weight decreases, and patients receive an opportunity to improve not only their bodies but also their self-perception.
Research on the Benefits of Mindfulness for Overcoming and Preventing Obesity 2.5
Evidence-Based Practices
The review of the research studies published within recent years shows that there is a great variety of practices that can be used to exercise mindfulness for obesity management. Alamout et al. (2020) applied Mindfulness-based cognitive therapy (MBCT) to patients with excessive weight, offering them to engage in the sequence of eight training sessions. The practices involved conscious breathing training, scanning the body, mental imaging of healthy eating, sitting meditation, and conscious hearing techniques. In addition, this program directed the attention of participants to approaching their painful thoughts from the point of relaxation. The results of the study indicate that the MBCT program allowed significantly reducing participants’ weight, while their eating behaviors also improved. These results are consistent with those of Dalen et al., who experimented with a Mindful Eating and Living (MEAL) program (Alamout et al., 2020). In other words, the programs that comprise several mindfulness techniques are beneficial.
Group sessions compose another type of practice that was explored by Hanson et al. (2019) and Spadaro et al. (2017). The above authors claim that during a group session, a person becomes more likely to feel accepted, trusted, cared for, and able to help. In such an atmosphere of mutual understanding and interaction, the process of managing obesity is facilitated. A person tries and learns new eating and behavioral skills, having the opportunity to experiment with different styles of interpersonal relationships (Spadaro et al., 2017). The group leader’s task is to help the group realize itself as a unity and a powerful tool for change.
Hanson et al. (2019) report that the overall eating styles of participants improved by 4%, and the mean baseline weight of the group reduced by 3.1kg within an 8-week period. In turn, Spadaro et al. (2017) state that a median 2.8 kg weight decrease was achieved within a 6-month intervention period. Dynamic processes in the group are built in such a way that everyone has the opportunity to go through their own path of self-discovery and take responsibility for their actions and those changes in behavior that they will undertake in their private life outside the group.
Considering a rapid development of technologies in healthcare, mHealth is one more practice that can be used by sending mindfulness-based text messages to patients with obesity. As clarified by Lyzwinski et al. (2018), such practice was applied to university students who experienced problems with obesity that was induced by stress. The authors set such goals as understanding the participants’ perspective on mindfulness, their preferences, and barriers in reducing weight. The messages that were sent included guidelines about the importance of physical activity and mindful eating, paying more attention to food characteristics, and a mindful moment spot (Lyzwinski et al., 2018). Similar recommendations are noted by Alamout et al. (2020), who emphasize the positive role of food and body awareness. For example, patients can be taught about the number of bones, muscle functions, or digestion basics to feel their bodies better.
Engaging in the Mindfulness Practice
To engage patients in the process of mindfulness, it is critical to begin by explaining to them the value and purpose of such practices (Spadaro et al., 2017). For example, for changing nutrition patterns, mindfulness can be defined as eating with full attention, being attentive to the feelings caused by food and beverages. The happiness of sensory experience should be targeted by offering clients to see, smell, touch, taste, and even “hear” (for example, in a frying pan) their favorite food (Goble et al., 2017). Accordingly, positive emotions caused by such attention should be carefully observed to appreciate the state of joy, pleasure, and satisfaction that arise when one eats (link to a guide: https://www.health.harvard.edu/staying-healthy/8-steps-to-mindful-eating). Conscious eating can combine a variety of components, such as the awareness of hunger, the choice of food, visiting a supermarket and cafes, and so on.
From the first seconds of chewing, it can be recommended to concentrate on how the bouquet of flavor gradually unfolds to feel its slightest shades: the degree of sweetness, astringency, and/or sourness. By deliberately straining all their senses to taste each bite of food, one will significantly increase his or her satisfaction from meals and turn it into a joyful ritual (Barbosa et al., 2020). At the same time, it is critical to let one’s body catch up with the brain and recognize personal hunger signals. For example, it is possible to refer to this guide (https://www.mindful.org/6-ways-practice-mindful-eating/) that mentions the significance of knowing what is needed for the body, distinguishing between emotional hunger triggers and actual hunger. The development of a closer connection to the food by thinking about its origin, the process of cultivation, and other details is another way to engage in mindfulness.
Self-Evaluation and Success Measurement
Self-reflection is a key method of self-evaluation when it comes to assessing the success of mindfulness practices in managing obesity. Patients should take a mindful pause and think about their food-related behaviors, considering their initial goals and changes achieved (Dunn et al., 2018). The ability to concentrate on meditation techniques would indicate some extent of progress. It is important to engage in self-evaluation since meditation largely relies on self-awareness, and a patient himself or herself becomes the object of change. Román and Urbán (2019) mention the Mindful Eating Questionnaire (MEQ) that can be used for self-assessment, which is based on the following dimensions: disinhibition, emotional response, external cues, awareness, and distraction. Even though weight reduction was minimal, mindfulness adoption means that a person gradually changes his or her attitude towards conscious eating. Therefore, even small steps should be considered as beneficial on the path of health improvement.
Barriers and Tools for Sustainable Practice
Challenges to Implementing Practices
The barriers to implementing mindfulness practices can be associated with attitudinal factors, such as low self-confidence, a lack of motivation, and negative experiences. This can be complicated by unhealthy lifestyles, of which sedentary work, a lack of physical activity, and an overall preference for passive leisure time dominate among people with obesity (El Ghoch & Fakhoury, 2019). In addition, the environment can contribute to difficulties with mindfulness, namely, expensive healthy foods, the prevalence of fast food in communities, friends and family with unhealthy eating patterns, and media promoting a rapid pace of life (Lyzwinski et al., 2018). Multi-tasking and skipping meals are two more contributing factors that complicate obesity management.
Strategies to Address Challenges and Resources
To address the above challenges, clients need to understand that the process of integrating mindfulness in their lives can be quite difficult since their attitudes should change. The environmental obstacles can be minimized by creating shop lists, visiting certain stores, and discussing with friends and family the value of meditation. Food portions should be gradually reduced, pieces should be chewed thoroughly, and eating should be slow in general. These strategies would provide more time to think about what, how, and where a person eats. By bringing the senses to the food, a client would become more sensitive to his or her preferences, reflecting on how food impacts his or her body, self-perception, and overall health. In case of questions and concerns, patients should be welcomed to refer to a physician, dietician, or psychotherapist for help.
The following resources can be offered to clients:
- “Mindful Eating: A Guide to Rediscovering a Healthy and Joyful Relationship with Food” by Bays (2017);
- “The Mindful Eating Workbook: Simple Mindfulness Practices to Nurture a Healthy Relationship with Food” by Tsui (2018);
- “How Mindfulness Helps You Lose Weight” article by Stephens (2019) with simple guidelines.
Conclusion
To conclude, mindfulness practices can be defined as promising interventions that focus on a patient’s health from psychological, physical, emotional, and cognitive perspectives. One should state that mindfulness offers an integrative approach to managing obesity and preventing further weight regains. Compared to traditional obesity treatment options, such as pharmacotherapy, training, and surgery, mindfulness seems to be more effective in a long-term period as it teaches patients to be at the moment, practicing self-awareness and controlling their stress. In clinical settings, mindfulness should be adopted as a part of holistic care, where a patient should receive a set of interventions, including medication, lifestyle improvement guidelines, and meditation techniques, and any other necessary services. Care providers should be ready to recognize a patient’s unique challenges and offer relevant strategies to handle them. The next steps are to be taken to extend the current research by exploring the links between obesity and comorbid disease in the context of using mindfulness therapies. Another area of research is developing self-assessment tools for patients so that they can use them to remain aware of their progress.
References
Adult obesity facts. (2021). Web.
Alamout, M. M., Rahmanian, M., Aghamohammadi, V., Mohammadi, E., & Nasiri, K. (2020). Effectiveness of mindfulness based cognitive therapy on weight loss, improvement of hypertension and attentional bias to eating cues in overweight people. International Journal of Nursing Sciences, 7(1), 35-40.
Barbosa, M. R., Penaforte, F. R. D. O., & Silva, A. F. D. S. (2020). Mindfulness, mindful eating and intuitive eating in the approach to obesity and eating disorders. SMAD Revista Electronica Salud Mental, Alcohol y Drogas, 16(3), 118-135.
Dunn, C., Haubenreiser, M., Johnson, M., Nordby, K., Aggarwal, S., Myer, S., & Thomas, C. (2018). Mindfulness approaches and weight loss, weight maintenance, and weight regain. Current Obesity Reports, 7(1), 37-49.
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Hanson, P., Shuttlewood, E., Halder, L., Shah, N., Lam, F. T., Menon, V., & Barber, T. M. (2019). Application of mindfulness in a tier 3 obesity service improves eating behavior and facilitates successful weight loss. The Journal of Clinical Endocrinology & Metabolism, 104(3), 793-800.
Lyzwinski, L. N., Caffery, L., Bambling, M., & Edirippulige, S. (2018). University students’ perspectives on mindfulness and mHealth: A qualitative exploratory study. American Journal of Health Education, 49(6), 341-353.
Masih, T., Dimmock, J. A., Epel, E. S., & Guelfi, K. J. (2017). Stress-induced eating and the relaxation response as a potential antidote: A review and hypothesis. Appetite, 118, 136-143.
O’Leary, K., O’Neill, S., & Dockray, S. (2016). A systematic review of the effects of mindfulness interventions on cortisol. Journal of Health Psychology, 21(9), 2108-2121.
Román, N., & Urbán, R. (2019). Mindful awareness or self-regulation in eating: An investigation into the underlying dimensions of mindful eating. Mindfulness, 10(10), 2110-2120.
Spadaro, K. C., Davis, K. K., Sereika, S. M., Gibbs, B. B., Jakicic, J. M., & Cohen, S. M. (2017). Effect of mindfulness meditation on short-term weight loss and eating behaviors in overweight and obese adults: A randomized controlled trial. Journal of Complementary and Integrative Medicine, 15(2), 1-14.