Integrating Mindfulness Into Eating Behaviors

Abstract

Food choices and eating behaviors are influenced by a wide variety of factors. However, traditional dietary advice primarily addresses health-related reasons for eating. Lifestyle medicine outcomes may be improved by helping individuals become more aware of why they eat and support individuals to increase their skills in reconciling eating for health and nonhealth purposes. Intuitive eating aims to increase individuals’ awareness of why, what, and how much they eat through mindfulness. This framework and concepts such as flexible restraint can be used to teach individuals skills that may help them improve psychological well-being and manage their weight.

‘Conceptually, drawing awareness to the intricacies associated with eating can improve eating experiences and health simultaneously.’

People have been encouraged to consider their health when making eating decisions for centuries. The ubiquitous saying “you are what you eat” has been traced back to as early as 1826. This phrase was first used to imply that one’s diet revealed the character of individuals. In the early 1900s, the book You Are What You Eat shifted the meaning of this phrase to associate inexpensive food with disease. ¹ Today, similar phrases such as “food is fuel” and “food is medicine” are used to encourage individuals to make eating decisions that promote health. Although this messaging has helpful intentions, it may oversimplify the human relationship with food and likely has limited effects on actual food choice.

As discussed by Mantzios and Giannou ² in this issue, mindfulness has emerged as a novel lifestyle medicine technique to help individuals manage weight. The underlying concept of mindfulness is to have individuals be more intentional about food choices because many food choices are reactionary to the environment rather than internal cues for hunger and satiety. Conceptually, drawing awareness to the intricacies associated with eating can improve eating experiences and health simultaneously. It is likely that more healthful eating choices will be made if skills to increase awareness are implemented.

Factors Associated With Food Choice

Much of the messaging provided in lifestyle medicine about food focuses on health, making it easy to assume that people primarily eat for health reasons. However, several other factors drive dietary decisions. The most important factors that influence food choice include taste and cost.^3,4 Other motives include affect regulation (eg, minimizing stress, increasing positive feelings), convenience (eg, proximity to home, time required to prepare food), and weight control.^4,5 Eating to make a good impression or to be sociable also greatly influence a person’s decision to eat. ⁵ The importance of these motives vary depending on individual characteristics such as age and gender.^6,7 For example, young adults tend to prioritize palatable food, hunger, pleasure, convenience, visual appeal, and affect regulation, whereas older adults are more likely to make eating choices based on health. ⁶

In addition, dietary choices are influenced by environmental triggers. Hunger to combat energy deprivation is the most fundamental biological trigger to eat. However, external forces can influence and alter physiological responses, making individuals want to eat in the absence of hunger, a concept known as hedonic hunger (ie, eating for pleasure, psychological hunger). ⁸ Numerous environmental pressures lead individuals to eat in the absence of hunger.^8,9 For example, irrespective of hunger levels, individuals watching food advertising consume greater amounts of food than those watching nonfood advertising. ¹⁰ Perhaps most troubling is that few individuals report being consciously aware of such triggers.^5,10 Clinicians are in a unique position to help individuals recognize the various factors influencing their eating choices and help them use this information to make healthier choices.

Intuitive Eating

Intuitive eating is an eating framework that may be of particular importance in the field of lifestyle medicine because it can influence an individual’s awareness of why they make specific food choices. Intuitive eating has been shown to be negatively related to disordered eating, body mass index, weight cycling, serum cholesterol, blood pressure, and several inflammation markers, and it is positively associated with psychological health, weight stability, and body satisfaction.^11,12 Interventions that emphasize eating intuitively have improved body esteem and psychological health and have stabilized weight.^12,13 Intuitive eating consists of 10 core principles that revolve around physical and emotional awareness, as well as making peace with food and the body. ¹⁴ The concepts of intuitive eating were initially developed to treat chronic dieters. Intuitive eating posits that weight cycling and a preoccupation with food arises when individuals rely on dietary rules and conditions rather than their biological cues for hunger and satiety to inform what, when, and how much to eat. When individuals give themselves unconditional permission to eat in response to hunger and satiety, body weight and eating can stabilize. A goal of intuitive eating is also to disentangle weight preoccupation from behavioral changes, with a focus on overall well-being and creating positive relationships with food. ¹⁴ When this occurs, it is hypothesized that weight loss maintenance can be achieved.^11,15 However, long-term research on intuitive eating and weight loss is lacking.

Adaptations to intuitive eating are likely needed when addressing obesity if the goal is weight loss. For example, under intuitive eating, individuals are granted unconditional permission to eat. This could be problematic because unconditional permission to eat is not associated with lower energy intake or improved diet quality.^16,17 However, teaching people flexible restraint, an idea consistent with intuitive eating principles, holds considerable promise in addressing how individuals respond to their hunger or desires to eat. ¹⁸

Flexible restraint has been associated with reduced binge eating and weight loss.^19,20 Individuals with flexible restraint are more concerned with the overall quality of their diet rather than rigid adherence to dietary rules and conditions at every eating occasion. Flexible restraint allows for less healthy food choices by compensating at subsequent meals over time. ²¹ This can help reduce feelings of guilt experienced by those with rigid restraint when they make less healthy choices. Recent research has increased the understanding of flexible restraint on body image and disordered eating, noting that flexible restraint is only predictive of body image and disordered eating outcomes when rigid restraint is accounted for in the model.^22,23 In contrast, intuitive eating directly predicts body image and disordered eating outcomes, possibly because intuitive eating promotes simultaneous increases in flexible restraint and decreases in flexible rigidity.^22,23 These findings provide support for the use of intuitive eating as an overall framework to increase individuals’ awareness of why they are eating and skills to balance eating for health with all the many nonhealth reasons people eat.

Conclusion

Americans spend more than an hour each day consuming food and drink. ²⁴ Eating can be both enjoyable and health promoting. Clinicians can help individuals learn to balance eating for health with the hedonic, social, and environmental reasons they eat. The intuitive eating framework is one potential way clinicians can help individuals reconnect with their hunger and satiety signals while still appreciating and accepting the many factors that influence eating behaviors. As a clinician, it is easy to discuss eating behaviors in relation to health. However, messages that imply that the only reason people eat is for health may be unrelatable and unintentionally promote unsustainable restrictive eating practices. Conversely, inclusive messages (eg, “every food fits”) are unlikely to result in improved health unless coupled with guidance on how to make every food fit. Although not a catchy phrase, the most meaningful health message a clinician can offer in lifestyle medicine is likely one that nonjudgmentally acknowledges that many factors influence eating decisions and conveys clinician support in prioritizing these factors without sacrificing health.