By Jean Fain
Mindfulness is all the rage. But does mindful eating — paying very close attention to your food and to your body's signs of true hunger and satiety — really help you lose weight or stop binging?
On the one hand, paying closer attention to how you eat and why seems like a no-brainer for improved health. But in fact, mindful eating is steeped in controversy -- pitting doctors against nutritionists, parents against children, therapists against clients, even colleagues against one another.
Proponents of mindful eating (also known as intuitive eating) like nutrition researcher Linda Bacon and other advocates of "Health at Every Size" — a self-described political movement promoting healthy habits and self-acceptance, rather than diets — recite a lengthy list of benefits related to mindful eating.
Critics of mindful eating offer a number of negatives: some say such navel-gazing about food makes it unappetizing, while others say mindful eating is superficial and ineffective, even irresponsible when it supplants traditional treatments for life-threatening eating issues.
Still others, like many who posted comments on my recent NPR interview with Jean Kristeller, author of the book, "The Joy of Half a Cookie," dismiss mindful eating as a joke. One example: "Yes, let's add more dietary neurosis to the babel of nutritional advice. How about this: eat the whole cookie. Have two, even. Just eat cookies less often, and eat nutritious food as the rule rather than the exception."
According to Dr. James Greenblatt, an eating disorder expert, chief medical officer of Walden Behavioral Care and the author of "Answers to Binge Eating," mindful eating is not only pointless in some cases, it’s potentially dangerous.
“Mindful eating clearly has a place in our treatment plans,” Greenblatt explained in a recent email exchange. “But, as a sole intervention for some of our patients, it is like asking opiate abusers to utilize mindful heroin detox. Many eating disorders reflect a severe neurochemical abnormality that needs to be addressed with biological interventions first, before adding other psychotherapeutic strategies and mindfulness."
Given the growing popularity of mindfulness-based interventions for the range of eating problems, the question of whether mindfulness works either for weight loss or to alleviate other eating disorders is a fair question. Based on an analysis of recent research, I'll conclude that the truth lies somewhere in between.
One 2014 comprehensive review, published in the journal Eating Behaviors, provides preliminary answers about which eating issues are more or less responsive to mindfulness interventions. In reviewing the best research to date on the effectiveness of mindfulness meditation for eating issues, psychologist Shawn Katterman and colleagues concentrated on studies about binge eating, emotional eating and weight loss (not anorexia or bulimia) in which mindfulness was the primary intervention. The 14 studies that met their criteria included some popular programs, notably, mindfulness-based stress reduction and mindfulness-based eating awareness training, but excluded others, such as dialectical behavior therapy and acceptance and commitment therapy.
After careful analysis, Katterman’s team concluded that mindfulness training effectively decreases binge eating and emotional eating in people who engage in these eating behaviors, but it’s not all that effective as a stand-alone intervention for significant or consistent weight loss. If these general conclusions leave you slightly peckish and wanting more, read on.
The conclusion — that mindfulness training effectively decreases emotional eating for those who struggle with it — is based on five studies. Turns out, the evidence is actually mixed: Two studies showed statistically significant improvements; three failed to find such improvements. Despite the mixed evidence, the researchers concluded mindfulness is an effective intervention for emotional eating because of the limitations of the non-supporting studies. So, not so convincing, really.
Most notably, in two of the three studies that failed to show statistically significant improvements, the subjects weren’t recruited to address emotional eating and they reported low baseline levels of emotional eating. Apparently, emotional eating was neither a concern for the participants nor a focus of those interventions.
Of the seven studies on mindfulness-based interventions for binge eating disorder, all the studies found significant reductions in binge eating. What’s more, these interventions proved equally effective in reducing binge eating in bariatric surgery patients and participants diagnosed with both substance abuse and binge eating, among other populations. Because mindfulness proved effective in reducing binge eating across a range of populations, the researchers concluded that “it may be a powerful tool” regardless of a client’s characteristics or diagnoses.
Before you jump to the disheartening conclusion that mindful eating doesn’t really “work” for weight loss, hold on. While it’s true that after reviewing 10 studies on mindfulness training and weight researchers found the effects on weight to be small and insignificant, that’s not the full story. In fact, the researchers found the evidence on weight to be mixed. Mindfulness training did facilitate significant weight loss when losing weight was the focus of training as it was in three studies.
Conversely, mindfulness training produced a small weight gain in the two studies in which stress reduction was the focus. In other words, the focus of the training makes a real difference. So does the total package of interventions. When participants did lose a significant amount of weight, the mindfulness program included either nutrition education, or standard psychotherapy techniques or both. That is what led researchers to conclude that mindfulness training alone may not produce significant or consistent weight loss.
That said, an encouraging 2009 study that did not meet the researchers’ criteria (comparing standard weight-loss treatment to acceptance-based behavioral treatment, an intervention for accepting thoughts and feelings while pursuing behaviors consistent with one’s values) suggests a combination of behavioral strategies and mindfulness training may, in fact, lead to greater weight loss than traditional behavioral weight-loss treatment.
Honestly, I’m not all that surprised by Katterman’s findings, which reflect what I’ve found in my own practice. Clients who practice mindful eating and other mindfulness strategies generally decrease binge eating and emotional eating, but they don’t necessarily lose a significant amount of weight.
Which raises two more important questions. First, does focusing exclusively on weight loss really work? Although the question is beyond the scope of this article, it’s within the scope of a recent study on the effectiveness of regular weigh-ins as a weight-loss intervention. Second: Is a short-term mindfulness intervention long enough to facilitate significant weight loss?
Maybe not, Katterman and colleagues conclude that maybe mindfulness is a process that takes some time: “Mindfulness is one mechanism utilized for developing intrinsic or autonomous motivation, and given that this type of motivation is most strongly associated with long-term behavior change, it is possible that the positive effect of mindfulness on weight would be more delayed.”
Clearly more research is needed to examine the long-term effects of mindfulness training on the range of eating issues. In the meantime, while we wait for researchers to determine what’s most effective, now is the time to try it yourself, then draw your own conclusions.
Finally, one last word from Kristeller, the "Half a Cookie" author, Indiana State psychology professor emeritus and senior research scientist: “The latest scientific review of mindfulness for eating issues concludes that mindfulness decreases binge eating and emotional eating, but evidence for its effect on weight loss is mixed. That said,” Kristeller concluded via email, “with adding in mindful awareness of nutrition information and mindful ways to reduce calories, mindfulness-based approaches may become more effective for both losing and maintaining weight.”
Correction: The organization Health At Every Size discourages people from focusing on weight loss and going on any kind of diet. An earlier version of this story mischaracterized the organizations's position. We regret the error.
Jean Fain, MSW, LICSW, is a Harvard Medical School-affiliated psychotherapist and the author of “The Self-Compassion Diet.” In addition to seeing individual clients in her Concord private practice, she writes for newspapers, magazines and online publications.