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For weight loss that lasts, eat mindfully

In our complex, fast-paced world, mindfulness meditation and similar techniques have been recommended to reduce stress, enhance immunity, boost learning, increase productivity and more. New research suggests an important addition to the list: At least three recent studies have suggested that mindful eating can improve weight-loss efforts and combat obesity.

Mindfulness may work, the papers propose, because it strengthens the weakest link in most diets: The adherence or compliance problem. Many people can lose roughly 5 percent of their weight by strictly following a weight-loss program for three to six months. But then the tide inevitably turns, and the pounds return. It's maintaining weight-loss that presents the biggest obstacle.

The regain happens in part for metabolic and hormonal reasons, but mainly because few can follow restrictive eating patterns for long. As with New Year's resolutions that last a month or two, most people return to their former habits. They stop adhering to the plan.

Thus, successful dieting may be less about the math - calories in and calories out - and more about the mind. Any behavioral trick that helps you stick to the original plan will enhance your long-term success. That's where mindful-eating strategies come in.

In the journal Current Obesity Reports, nutritionist Carolyn Dunn and colleagues from North Carolina State University performed the first review of research papers on mindful eating and weight loss. "All studies showed weight loss results" with mindful eating, they reported. In addition, four of five studies over a follow-up period found continued weight loss. The expected regain occurred in only one of the five studies.

The review concluded, "Increased mindful eating has been shown to help participants gain awareness of their bodies, be more in tune to hunger and satiety, recognize external cues to eat, gain self compassion, decrease food cravings, decrease problematic eating, and decrease reward-driven eating."

Dunn has been part of an "Eat Smart, Move More" educational campaign begun in North Carolina in 2002. Its mission is to help residents fight obesity with evidence-backed information and action plans.

"Our participants have told us that mindfulness is one of the most powerful tools we give them," Dunn notes. "We help them become aware of the eating experience by weaving mindful eating into every eating strategy we cover."

A simple document titled "12 Mindful Eating Strategies" is among the guides provided to participants. It includes such advice as:

- Make eating an exclusive event - don't watch TV.

- Appreciate food - acknowledge the gift with gratitude.

- Eat slowly to recognize your hunger and fullness cues. Put your fork down between bites, chew your food well and make each meal last at least 20 minutes.

Independent nutrition researcher Brenda Davy from Virginia Tech says such approaches hold potential for weight management. "Mindful-eating strategies may be helpful when trying to lose or even maintain body weight," says Davy, who was not associated with any of the reported studies. "Paying attention to how hungry or full you feel, and being aware of situations that may lead to eating in the absence of hunger - such as boredom or other emotions - can help with dietary adherence."

Eating more slowly may have an especially powerful effect. In BMJ Open, a research team reported on the eating habits of 59,000 mostly obese subjects with Type 2 diabetes. Specifically, the investigators wanted to know what would happen if the subjects changed their eating speed - fast, normal, slow - during the six-year study.

As it turned out, those who moved from the fast to the slow category had a 42 percent lower rate of obesity than those who continued to eat quickly. Those who moved from fast to normal had a 29 percent lower rate. The researchers speculated that fast eaters consume calories more quickly than the body can register fullness, while slow eaters will notice "feelings of satiety before an excessive amount of food is ingested."

They concluded, "The control of eating speed may therefore be a possible means of regulating body fat and preventing obesity."

Even the highly publicized DIETFITS report that appeared in the Feb. 20 issue of the Journal of the American Medical Association provided support for mindful eating.

The randomized, controlled trial was mainly designed to compare the weight-loss effectiveness of low-fat diets vs. low-carb diets. The results showed no differences between the two after 12 months.

However, this doesn't mean the diets failed. In fact, they succeeded, giving subjects an average 12-pound weight loss. This reduction occurred because many subjects were able to stick to their diets - both groups consumed roughly 500 fewer calories per day - for 12 months. There was little loss of adherence.

Why? Probably because the Stanford investigators did an excellent job educating both groups with 22 instructional sessions and a simple, repetitive message: Reduce added sugars, while eating more vegetables and fewer highly processed foods.

"On both sides, we heard from people who had lost the most weight that we helped them change their relationship to food," said lead researcher Chris Gardner. "And that now they were more thoughtful about how they ate."

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