By SARA A. CHACKO, PhD MPH , Beth Israel Deaconess Medical Center Staff

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 lost weight in the long-term. 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.e

(Photo: iStockphoto)

(Photo: iStockphoto)

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 regain the weight within three years; in fact, 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 will power. 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 report3 from a panel of obesity experts convened at the National Institutes of Health highlighted a major issue to be behavioral fatigue – that is, 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, an ancient practice with roots in Asian Buddhist tradition. Mindfulness, or “awareness” in the Pali language, 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 (e.g., sitting meditation, walking meditation, yoga).

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

Sustaining weight loss is not easy – setbacks and slow change are par for the course. Zafra Cooper and Christopher Fairburn, behavioral researchers in obesity, have suggested the difficulty may be, in part, due to gradual declines in weight loss over time as well as unrealistic expectations regarding amount of weight lost and expected benefits. Demoralization and frustration can lead patients to abandon attempts at change. Stress only makes it worse and can also increase cravings for high-fat, high-sugar foods.

Mindfulness may be one way to break these patterns. By learning to cultivate a calm response to what is actually happening in life (vs. 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 to making change, 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. As Victor Frankl, psychiatrist and Holocaust survivor, famously said, “Between stimulus and response, there is a space. In that space is our power to choose our response. In our response lies our growth and freedom.” Mindfulness creates a space for us to choose.

Although the field is still new, mindfulness-based approaches to weight management are gaining traction, both in research settings and clinically. 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 thus far, mindfulness-based interventions have not been consistently successful at producing weight loss. Importantly, mindfulness training has been shown to reduce emotional and binge eating, maladaptive eating patterns that make sustaining weight loss more difficult.

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

January Month 2016