Mind-Body Medicine and MB-EAT (Mindfulness Based Eating Awareness Training) Binge and stress eating disorder: Developing a balanced and peaceful relationship with food and eating Kathleen Sanders,FNP,MPH Family Nurse Practitioner Mind-Body Medicine Program Director- Center for Integrative Medicine and Wellness Fellowship in Integrative Medicine-class of 2006,University of Arizona Bravewell Fellow MPH, Columbia University Eating Disorders Team-Columbia University Objectives Describe how mind-body medicine helps patients change their relationship with food Discuss the key therapeutic components of Mindfulness Based Eating Awareness Training (MB-EAT) Describe the current research in weight loss and Binge Eating Disorder (BED) Discuss the importance of mind-body medicine for BED in lifelong healthy weight regulation Epidemic of Obesity In the U.S., about 66% of adult Americans are overweight, and over 30% are obese. Binge eating is the most prevalent eating disorder, increasing with degree of obesity. Prevalence of obesity in children has more than tripled in the last 25 years. Costs to our health care system and quality of life are sky rocketing 1
practices that focus on the interactions of the brain, mind, body and behavior, with the intent to use the mind to affect physical functioning and promote health The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health What is Mind-Body medicine? Mindfulness Based Stress Reduction Started in 1979 by Dr. Jon Kabat-Zinn, Mindfulness-Based Stress Reduction (MBSR) is the systematic application of mindfulness training to stress and to health problems related to stress. MBSR has proven highly effective in diminishing anxiety and depression, and in lessening the ill effects of stress on heart disease, cancer, chronic pain, skin ailments, asthma, and many other conditions. Dr. Jean Kristeller, who developed MB-EAT, worked with Dr Kabat Zinn for 6 yrs during the 1980 s and her program is informed by his work Mindfulness Based Eating Awareness Training (MB-EAT) MB-EAT assists you in changing your relationship to eating, overeating, binge eating, and weight management. By paying attention to what the body needs, such as when it is hungry and when it is satisfied, you learn to develop a more natural, balanced relationship with food. Develop your innate abilities to pay attention to what is happening with your emotions, thoughts, and body sensations and how they affect behavior. Learn to respond to emotional and physical "eating triggers" rather than reacting to This National Institute of Health funded program was developed by highly esteemed psychologists and researchers at Indiana State University, Duke University and the University of Pennsylvania. 2
NIH Trial (R21): Mindfulness-Based Eating Awareness Training (MB-EAT) Co-PI: Ruth Q. Wolever, Ph.D. NCCAM-funded d randomized d clinical i l trial with 3 groups: MB-EAT; Psycho-educational; Waiting List. Two-site design (ISU and Duke); Sample size: N = 150 evaluated on all baseline measures and randomized; 13% men;14% African-American. Average age = 46.55 (range: 20-74); Avg. Wt. = 240 lbs.; Avg. BMI = 39. 9 week manualized intervention including body awareness work 1 and 4 month follow-ups Extensive process measures, EDE assessment, biological markers of self-regulation (lipid and metabolic profiles) Changes in Number of Binge Days in Previous Month # of Binge Days 18 16 14 12 10 8 6 4 2 0 Base 1 Month 4 Months Control PschoEd MB-EAT Treatment Effects on the Stunkard & Messick Eating Inventory: Disinhibition Scale MB-EAT curriculum Disinhibition 15 14 13 12 11 10 9 8 Base 1 Month 4 Months Control PschoEd MB-EAT Assessment and Orientation Session 1: Introduction: Inner Wisdom/ Outer Wisdom Session 2: Mini-Meditation, Mindful Eating, and the 500 Calorie Challenge Session 3: Hunger Awareness, Emotional Eating and Body Awareness Session 4: Stomach Fullness, Satiety - Taste Satisfaction, Session 5: Making Food Choices, Forgiveness, and Introduction to Physical Activity Session 6: Becoming Mindful about Nutrition and MyPyramid Session 7: Mindful Eating and Pot Luck Session 8: Mindful Movement Session 9: Working More with Thoughts and Emotions Session 10: Breaking the Chain, Connecting to the Higher Self, and Relapse Prevention Session 11: One Month Follow-Up, Continue Change/Self Acceptance Session 12: Final Follow-Up Meeting 3
Case Discussion I spend most of my day thinking about food I feel like such a failure I have lost 50# 4 times in the last 10 years I am retired, have a wonderful wife, all the money I need and more and I am unhappy and not able to keep these 75 # off weight off 3 case studies-susan, 49 yr attorney, Ruth, 54 yr RN, John, 78 yr retired businessman Experiential Soft Belly Breathing Mini Meal Meditation Hunger Awareness Cheese and Crackers Exercise Mind-Body Medicine in Primary Care MB-EAT Clinical Hypnotherapy Guided Imagery MBSR Breath work Journaling 4
The Patient Experience Develop tools the are safe, inexpensive and effective as part of their treatment t t plan for weight management Learn and experience how mind-body medicine functions as a workhorse in achieving lifelong lifestyle change by: changing their awareness, slowing down, interrupting behavior patterns and cultivating joyful eating maintaining a healthy approach to nutrition, exercise, improved sleep, improved mood and energy Web-Based Resources Questions? Comments? Center for Mindful Eating-Dr Jean Kristeller Center for Mindfulness-Dr Jon Kabat-Zinn American Society for Clinical Hypnosis Health Journey s-guided imagery, Belleruth Naparstek Center for Mind-body Medicine-Dr James Gordon 5