Mindfulness, a capacity for enhanced and sustained moment-to-moment awareness of one’s own mental and emotional state of being in the context of one’s own immediate environment, is a term that has gained prominence in recent years. In our busy, stressful, hectic, and noisy lives typified by multiple demands and roles, deadlines to meet, bills to pay, cars to service, mouths to feed and TV to watch, our lives can seem at times like a rollercoaster. A rollercoaster that seems to limit or even preclude time for quiet reflection and mindfulness during waking hours in many of us.
And yet, many of us living in this same rollercoaster-world, are also striving to lose weight. We are told to eat more healthily and do more exercise. Many of us fail. To consider why, let us examine what is actually required for dietary change. Many of us eat three meals per day, and to effect and maintain successful weight-change requires a persistent effort over weeks, months and years. Coupled with this is that in our culture, food is often used for social purposes (with attendant peer-pressure) rather than for its survival purpose, to satiate appetite and mitigate against starvation. Food is also used by many of us as a pacifier for emotional distress. Finally, eating can simply become habituated when we engage in some other activity. When viewed from this perspective, we seem to have created in the 21st Century, a perfect storm for ‘mindless’ eating behaviours, with multiple cultural and socio-emotional drivers, and few if any opportunities to stop, reflect and be mindful of our eating-related behaviours.
In the UK, obesity management is broadly divided into community- and hospital-based services (the latter termed ‘tier 3’ service, which by definition is non-surgical hospital-based obesity management). At University Hospitals Coventry and Warwickshire (UHCW) in the UK, we have developed an excellent holistic approach to hospital (primarily out-patient) based obesity management, incorporating medical, dietetic, psychological and surgical aspects. Within our service, we have weekly group sessions for patients to attend in this context. We taught a group of 53 morbidly obese patients (including 33 who completed the program) mindfulness-based eating behaviour strategies over 4 separate group sessions. We demonstrated a statistically significant improvement in both self-reported eating behaviour and successful weight-loss compared with patients who did not undergo the mindfulness training.
It is possible that some of the benefits of our group sessions derive from social support from other members of the group. This was reflected in the positive feedback received from the patients involved in our study, many of whom valued the supportive socio-emotional environment that our group sessions provide, in a world where obesity is often stigmatized, discriminated or ridiculed. However, we believe that the taught mindfulness techniques themselves had a predominant effect on behaviour change and weight-loss success.
One of the problems of successful obesity management is that many options (such as bariatric surgery for example) are simply not scalable to the wider population. As a result, most weight-loss strategies that are offered within a hospital-based setting are only available to a small minority of people who could actually benefit. Although we haven’t yet explored this as an option, it is possible that mindfulness teaching on eating-related behaviours could be self-taught via an on-line portal, this approach therefore being potentially scalable to a population-level. In such a scenario, much of the populace could benefit from learning mindfulness techniques, and thereby develop more salutary eating-related behaviours to facilitate successful weight-loss.
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