Eat when you're hungry, stop when you're full. It sounds simple, yet for many Americans, it's anything but, says clinical psychologist Jean Kristeller, PhD. Barraged by advertisements for high-fat, high-salt and high-sugar foods, and confronted with restaurant portions fit for two or three people, it's all too easy these days to forget what the experiences of hunger and satiety feel like, she says.
"We eat when it's time to eat, when food is put in front of us or because we need to handle feelings of anger, anxiety, depression or simple boredom," says Kristeller, a psychology professor at Indiana State University and president and co-founder of The Center for Mindful Eating.
Kristeller has developed an intervention called Mindfulness-Based Eating Awareness Training (MB-EAT) that blends "mindful eating" exercises, such as being aware of hunger, chewing food slowly, tuning in to taste and noticing fullness, with mindfulness meditation practice to cultivate more general moment-to-moment awareness of self. Psychologists around the country are using it to help binge and compulsive eaters, diabetics, and people who are mildly and moderately obese to regulate their eating and avoid weight gain.
"Traditional techniques for tackling the obesity epidemic often don't take into account the strong drivers of eating: negative emotions, cravings and impulsivity, particularly in the face of highly palatable food," says University of California, San Francisco, psychology professor Elissa Epel, PhD, who has collaborated with Kristeller on several research studies using MB-EAT. "Mindfulness training gives us more control over these strong drives and makes us more aware of the triggers of overeating that come from outside of us."
Kristeller advocates no particular diet — and no foods are off-limits. She teaches students to savor their food while eating, rather than mindlessly eating while watching television, surfing the Internet or reading the paper.
It's this everyday applicability that makes Kristeller's approach so valuable, says social psychologist Ronna Kabatznick, PhD, a former consultant to Weight Watchers International. "It's one thing to have these strategies in textbooks, but she's embodied them by teaching people very specific skills such as how to enjoy a buffet or restaurant meal," Kabatznick says. "She's simplified mindful eating for everyday living."
Saying goodbye to super-size
Kristeller's MB-EAT 10-week course teaches people that, once they pay attention to their body's signals, brownies and chocolate cake are best experienced and savored in just a few bites.
"Our taste buds are chemical sensors that tire quickly," she says. "The first few bites of a food taste better than the next few bites, and after a large amount, we may have very little taste experience left at all."
Participants in her training programs — those who struggle with food and weight issues and health-care professionals interested in helping them — focus on three mindfulness practices: awareness of hunger and what it feels like in the body, awareness of what it feels like to be full, and the practice of savoring — slowing down to truly taste food and be mindful of the various flavors and sensory experiences associated with each bite. A variety of foods — including chocolate — are used in the program, and Kristeller even assigns participants increasingly challenging homework assignments, such as going to a buffet. She teaches them that by attending to how much they are enjoying the food and recognizing the point at which it stops being as enjoyable, they can eat much smaller amounts, leave food on their plates and return for seconds if they still want more.
"It's about finding satisfaction in quality, not quantity," Kristeller says. She also teaches people not to beat themselves up if they overeat, but to see this as a learning experience.
With funding from the National Center for Complementary and Alternative Medicine at the National Institutes of Health, Kristeller has proven the program's effectiveness. She's completed two studies — one at Indiana State University, another with Ruth Wolever, PhD, at Duke University — with more than 100 binge eaters and obese non-bingers. She's found that binge eaters who take her MB-EAT program reduce their bingeing from four times per week, on average, to about once a week. When they do binge, she says, they report that the binges are much smaller and feel less out of control. Participants also report that their depression decreased (Journal of Health Psychology, 1999; Eating Disorders: The Journal of Treatment & Prevention, 2011). Both bingers and non-bingers also improve significantly on other indicators of more balanced eating and emotional regulation. Furthermore, these effects are proportional to the amount of mindfulness meditation practice that is reported.
Other researchers are testing her program as a treatment for obesity. Gayle Timmerman, PhD, RN, at the University of Texas at Austin, has successfully adapted it for use with eating restaurant meals, showing a significant impact on weight and dietary intake. Epel and her associate, Jennifer Daubenmier, PhD, recently paired MB-EAT with stress reduction exercises in an intervention with obese women. They found that the more mindfulness the women practiced, the more their anxiety, chronic stress and deep belly fat decreased. Obese participants in the mindfulness program also maintained their body weight while those in the control group increased their weight over the same period of time (Journal of Obesity, 2011). And in an ongoing study with overweight pregnant women, Kristeller, Epel, Daubenmier and Cassandra Vieten, PhD, director of research at the Institute of Noetic Sciences, are teaching participants similar mindful-eating techniques in an effort to help these mothers-to-be avoid excessive weight gain.
"One lesson we've learned is that with the effort and attention to eating taught in the MB-EAT program, people can change their relationship with food very quickly, and within a few sessions, they're often starting to eat differently," Epel says.
The three-minute raisin
Kristeller's interest in meditation began as an undergraduate at Swarthmore College, where she read about research on how meditation can help lower blood pressure and heart rate and reduce ruminative thinking. Kristeller began meditating to reduce the stress of college and immediately found that it calmed her "chattering mind," she says. Later, as a doctoral student at Yale studying food intake regulation with Judith Rodin, PhD, and self-regulation theory with Gary Schwartz, PhD, Kristeller began using meditation to treat eating disorders.
"Judy was identifying how a lot of the disregulation in eating behavior was from people's lack of tuning in to their hunger signals," Kristeller says. "I thought you could help people tune back into those experiences."
After graduating from Yale in 1983, she joined the faculty at the University of Massachusetts Medical School, where she met Jon Kabat-Zinn, PhD, and took part in his eight-week Mindfulness-Based Stress Reduction (MBSR) program. Kabat-Zinn introduced her to an exercise where participants slowly eat three raisins as a way to begin to cultivate mindful awareness.
"A light bulb, so to speak, went off for me during this exercise," Kristeller says. "I saw it as another way to help ground people in their experience of eating, and began thinking about how to do this more systematically, particularly around the kinds of foods that people eat that get them in trouble — the high-sweet, high-fat foods. I wondered what would happen if people started engaging with those foods this way." Now, thanks to her research and her clients' enthusiastic feedback, she knows.
Amy Novotney is a writer in Chicago.