Staying the Course Mindfulness and Long-Term Weight Management

Losing weight is hard. Keeping it off is even harder. Despite decades of advancement in our understanding of weight loss, scientists are still perplexed by how to sustain weight loss over time. Mindfulness, an ancient awareness practice originating from Asian Buddhist practices, is now being explored as a novel way to enhance efforts at long-term behavioral change.

Although lifestyle interventions including diet, exercise and behavioral strategies, such as regular weighing and keeping a food log, have proven effective for weight loss in the short term, weight regain is common. The majority of patients who lose weight gain it back within three years; in fact, according to studies, fewer than 20 percent of overweight adults in the U.S. have reported success with long-term weight loss.

This is not only a question of willpower — pervasive environmental and biological factors make it more difficult. But those who have successfully maintained weight loss, as recorded in the National Weight Control Registry, report clear behavioral changes including eating breakfast every day, regular weighing, minimal TV watching and exercising, on average, for an hour every day.

Yet sustaining these types of changes remains elusive for the majority. A recent report from a panel of obesity experts convened at the National Institutes of Health highlighted a major issue of behavioral fatigue — dieters grow weary of strict behavioral regimens, especially when weight loss declines over time.

Obesity and behavioral scientists grappling with this question are now exploring strategies incorporating mindfulness, or "awareness" in the Pali language. Mindfulness is the art of paying attention to present-moment experience with acceptance and non-reactivity. It can be cultivated through a systematic training of the mind using formal meditative exercises like sitting, sitting meditation, walking meditation and yoga.

Mindfulness training has been shown to improve chronic pain, depression, stress, and addictive behaviors. Emerging research suggests it may hold promise for weight management; specifically, mindfulness may help patients identify internal and external eating triggers, tolerate food cravings, and improve coping ability and resilience — all factors important to sticking with long-term change.

Setbacks and slow change are par for the course when trying to sustain weight loss. Some behavioral researchers have suggested the difficulty may be partially due to gradual declines in weight loss over time. Unrealistic expectations regarding the number of pounds lost and expected benefits could also be a factor. Demoralization and frustration can lead patients to abandon attempts at change; stress only makes it worse and can increase cravings for unhealthy foods.

Mindfulness may be one way to break these patterns. By learning to cultivate a calm response to what is actually happening in our life (versus what we wish was happening) in place of automatic, habitual, and unconscious reactions, it becomes possible to make healthier, more adaptive choices.

Although "acceptance of what is" may sound counterintuitive, it's actually the first step toward behavioral change. We waste tremendous amounts of mental energy on resistance to our lives and circumstances. Mindfulness teaches that if we can learn, through practice, to bring a friendly awareness to our experience, no matter how difficult, we can make choices more closely aligned with our values and health.

Although the field is still new, mindfulness-based approaches to weight management are gaining traction in both research and clinical settings. The most promising approaches appear to be those that specifically focus on weight loss as a stated goal and incorporate standard behavioral and nutrition strategies. Although mindfulness-based interventions have not been consistently successful at producing weight loss thus far, mindfulness training has been shown to reduce emotional and binge eating — maladaptive eating patterns that make keeping the weight off more difficult.

However, it's important to note that research in this area is still preliminary. Rigorous, well-designed studies are needed to clearly determine the impact of mindfulness on long-term weight outcomes. To date, no study has examined weight more than four months post-intervention and many studies lack control groups. Randomized studies of well-designed interventions with longer follow-up times and active comparison groups of standard behavioral therapy are needed. A critical question facing scientists is how to best apply and implement mindfulness to harness its potential for long-term weight management.

While much work remains, many patients report significant benefits from practicing mindfulness alongside their weight loss efforts. Clinical programs, such as the Weight Management and Wellness Program at Beth Israel Deaconess Medical Center, are now offering mindfulness classes to help patients with long-term efforts at sustaining weight loss. Mindfulness classes focusing on practices such as sitting meditation, walking meditation, and mindful eating are taught in conjunction with topics including nutrition and goal setting.

If you're interested in learning to practice mindfulness, the best way to start is to find a local class or meditation center where you can be guided. If you prefer to start at home, find a quiet space and try listening to guided audio recordings of meditations, many of which can be found online. Nature is also a beautiful place to practice.

Sara Chacko is an Integrative Medicine Fellow at BIDMC.

To learn more about BIDMC's Weight Management and Wellness Program, contact Liz Preczewski at 617-667-1793 or epreczew@bidmc.harvard.edu.

Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.

Posted February 2015