Mindfulness-Based Interventions for Weight Loss

Transcription

1 Mindfulness-Based Interventions for Weight Loss Carl Fulwiler, MD, PhD Director, Systems and Psychosocial Advances Research Center Department of Psychiatry University of Massachusetts Medical School Thirteenth Annual Cardiovascular Disease Prevention Symposium Miami, FL February 20, 2015 Disclosure Grant support: NIH Grant number R34AT I have no actual or potential conflict of interest in relation to this program/presentation. 1

2 68.5% of U.S. adults are overweight or obese Ogden, CL et al JAMA 311: Existing interventions yield modest results and most weight is regained Franz, MJ et al J Am Diet Assoc 107: Reactivity stimulus-response Stimulus Response 2

3 Many adults report engaging in unhealthy eating as a result of stress skip a meal 30% eat to manage stress 27% overeaten or eaten unhealthy foods 38% APA, Stress in America 2013 apa.org Lifetime stressful events and chronic stressors are associated with higher BMI Community sample (N= 588) Singha and Jastreboff 2013 Biol Psychiatry 73:

4 Obese subjects show increased reactivity to food cues and stress cues Sinha R, Jastreboff AM 2013 Biol Psychiatry, 73, Emotional eating Comfort food activates brain reward center in emotional eaters during negative mood state Bohon, Stice & Spoor 2009 Int J Eat Disord 42:

5 Stimulus Response A definition of Mindfulness The awareness that emerges from paying attention on purpose and non-judgmentally to things as they are Williams, Teasdale, Segal and Kabat-Zinn

6 Components of Mindfulness-Based Interventions Guided practices Inquiry Handouts, worksheets or workbook, min practice Informal practices Mindfulness enhances emotion regulation Stress reactivity 1 Depression 2,3 Anxiety 2,3 Relapse 4,5 Neural circuits subserving emotion regulation 6,7 1. Grossman P, et al J Psychosomatic Research; 57: Khoury, et al Clin Psychol Rev, 33: Goyal M, et al JAMA Intern Med. 174: Segal Z, et al Arch Gen Psychiatry 67: Bowen,S., et al. (2014) JAMA Psychiatry 71(5): Holzel B et al SCAN 5: Holzel B et al 2011 Psychiatry Res 191:

7 Mindless eating Mindful eating Paying attention, on purpose, non-judgmentally Gratitude Eating slowly Savoring Fullness Awareness of thoughts and feelings Mindful eating programs highlights from individual studies Reduced weight 1, 3 Prevention of weight gain 1 Reduced emotional eating and external eating 2 Increased physical activity 3 1. Timmerman, GM 2012 J Nutr Educ Behav 44: Alberts HJ 2012 Appetite 58: Tapper, K 2009 Appetite 52:

8 Systematic reviews eating behavior Positive changes in eating behavior 18 of 21 studies 1 Improvements in binge eating (large effect size) 1,2 Not superior to cognitive-behavioral intervention 2 1. O Reilly GA, et al Obesity Reviews 15: Katterman SN, et al Eating Behaviors 15: Systematic review weight loss Significant weight loss 13 of 19 studies Methodological weaknesses limit strength of the evidence Insufficient evidence for mindfulness as the mechanism Olson and Emery 2015 Psychosom Med.77:59-67 Summary Mindfulness is a lifestyle change, not another diet Mindfulness-based weight loss programs are successful for Stress/emotional eating and binge eating Reducing weight Mechanism not understood Mindfulness? Reactivity to stress/negative affect? Weight loss maintenance? 8

9 Thank You! Questions? 9