April 2024 Issue

Mindful Eating
By Carrie Dennett, MPH, RDN
Today’s Dietitian
Vol. 26 No. 4 P. 20

Learn how and when to discuss this practice with clients.

Mindful eating has been incorporated into a variety of behavior change programs as an adjunct to dietary recommendations,1 and research has found that mindfulness-based interventions can decrease dysregulated eating, including emotional eating and eating in response to external cues, as well as reduce body dissatisfaction while increasing body appreciation.2-4 But not all “mindful eating” research involves actual mindful eating.5

“A lot of the research that we have comes more from the benefits of mindfulness,” says Vincci Tsui, RD, a Calgary, Alberta-based certified Intuitive Eating counselor and author of The Mindful Eating Workbook: Simple Practices for Nurturing a Positive Relationship With Food. “Then there’s an assumption that mindful eating is a way to practice mindfulness, so the benefits of mindfulness can translate to mindful eating as well.”

The mainstreaming of mindfulness and mindful eating has led to a watering down of what mindful eating is and some misunderstanding about what it does. Does the evidence support all the common uses of mindful eating, and is mindful eating a useful and appropriate tool for all clients?

Mindful Eating Defined
The term “mindfulness” was defined by Jon Kabat-Zinn, creator of the Mindfulness-Based Stress Reduction program, as “paying attention in a particular way, on purpose, in the present moment, and nonjudgmentally.”6 Similarly, mindful eating is an approach to food that focuses on individuals’ sensory awareness of, and their experience of, the food, which is a process-driven rather than outcome-driven behavior.7 More specifically, The Center for Mindful Eating defines mindful eating as8:

• allowing yourself to become aware of the positive and nurturing opportunities that are available through food selection and preparation by respecting your own inner wisdom;

• using all your senses in choosing to eat food that’s both satisfying to you and nourishing to your body;

• acknowledging responses to food (likes, dislikes, or neutral) without judgment; and

• becoming aware of physical hunger and satiety cues to guide your decisions to begin and end eating.

While this definition is grounded in mindfulness, many researchers, clinicians, and clients view mindful eating differently. For example, the authors of one 2017 review wrote that mindful eating consists of conscious food choices, awareness of physical vs psychological hunger and satiety cues, and eating healthfully in response to those cues.9 However, a 2020 systematic review of 13 randomized controlled trials found that mindful and intuitive eating interventions didn’t significantly improve diet quality or lower energy intake, but the authors noted that because most of the studies didn’t use validated measurement tools, it’s unclear whether the interventions were effective at increasing mindful or intuitive eating.10

One scale for measuring mindful eating—the Mindful Eating Behavior Scale,11 which includes subscales for eating with awareness, focused eating, hunger and satiety, and eating without distractions—has been criticized for being more about attentive eating than mindful eating because it doesn’t include nonjudgment, a key element of mindfulness. In fact, eating without distractions has become a shorthand definition of mindful eating, even though eliminating external distractions isn’t part of mindfulness or definitions of mindful eating that are grounded in mindfulness.

Is It Practical to Eat Without Distractions?
“Mindful eating is often presented as turning off the TV and eating without distraction and eating really slowly and putting your fork down between bites and being super present with the full sensory experience of eating,” says Dana Notte, MS, RD, CD, CEDS-C, a South Burlington, Vermont, certified intuitive eating counselor and owner of ThrivInspired Nutrition. “I think it is that in some ways, but it’s also more than that.”

Alexis Conason, PsyD, CEDS-C, a New York City-based clinical psychologist in private practice and author of The Diet Free Revolution, says the distillation of mindful eating as the idea of putting food on a pretty plate and sitting down to eat in silence without distractions is a disservice. “Mindful eating could look that way, but it also could be bringing your awareness to your eating as you’re scarfing down a sandwich in the three minutes you have to get from one meeting to another. Mindful eating is just about bringing our awareness to the eating experience.”

Notte says the idea that there’s one specific way to eat mindfully is pervasive. “People start to hold a lot of shame that they’re not eating the way that they’re ‘supposed’ to be eating, that they’re not doing mindful eating right,” she says. “To me, that’s not the spirit of mindfulness or mindful eating at all. And it feels really unfortunate that that’s how people come to know it.”

Attempting to eat without distractions may be counterproductive for certain types of clients, including neurodivergent clients, says Newtown, Pennsylvania-based therapist Shira Collings, MS, LPC, NCC. “Neurodivergent people often need distractions with eating or daily tasks or just existing. A lot of neurodivergent people need to stim,” using self-stimulatory behavior to manage emotions or overwhelming sensory information,12 “and stimming is just like the need for food or water. It’s part of our neurophysiology, and that helps us regulate and feel calmer and more centered and be better able to function. And so, of course, that would apply to eating.”

Collings has written about why being intentionally present also may not be neurodiversity-affirming (ie, affirming the fact everyone’s brain develops uniquely) because for people who are neurodivergent or have other marginalized identities, the “present” often isn’t a safe place.13 Tsui also says that before introducing mindfulness or mindful eating to clients who have experienced trauma, it’s important to ask if being in their body or having to be really present is triggering.

Notte says that while mindful eating can enhance food pleasure and satisfaction, that’s not applicable to everyone. “Our most basic nutritional need is getting ourselves fed adequately, and being super aware of that eating experience may interfere with that goal,” she says. “Not all people find a ton of pleasure in eating and food, and for some people food is really going to be about nourishment. Mindful eating may not be very useful to those folks that don’t find eating to be a very enjoyable experience to begin with.”

Mindful Eating and Interoceptive Awareness
Building awareness of, and trust in, hunger and fullness cues can help people eat in a way that feels physiologically comfortable, reduce mindless eating in response to external food cues, and provide an opening for them to distinguish between biological and emotional hunger. However, while this can be a valuable skill for many clients and patients, it may not be appropriate for everyone.

Josée Sovinski, RD, RP, Ottowa, Ontario-based owner of Blossom Counseling Centre, says many neurodivergent people experience differences in interoception—the brain’s perception of sensations from inside the body—that may make assessing hunger and fullness difficult or even distressing and that focusing on external cues to eat may be more appropriate.14 “While embodiment can be empowering for some, it may leave others feeling confused,” she says. “When hunger and fullness are promoted as the most ‘valid’ way to determine when and how much to eat, many neurodivergent people are left feeling like they are failing.”

Collings says neurodivergent people may have experienced significant amounts of shaming around their preferred foods, often from a young age, making them less likely to trust their bodies. “I don’t think it’s fair to bombard neurodivergent people with the message, ‘Your cues don’t matter, and I know your body better than you do,’ then turn around and say, ‘But you need to listen to your body.’ ”

Awareness of hunger and fullness—along with mindful eating itself—is frequently framed as a tool to lose weight. “Often, when I ask people what they know about mindful eating, they say, ‘I’m mindful of how many calories that I take in’ or ‘I’m mindful of the types of food that I’m eating,’ ” Tsui says. “So, there’s this idea that mindful eating is really about being careful and ‘watching’ what you eat when it’s not about that at all. Setting an expectation that mindful eating leads to certain outcomes is pulling you away from the present moment and also adds an element of judgment, which are two things that are not the intention of mindfulness and mindful eating.”

Notte says she often hears clients interpret mindful eating as, “If I’m being thoughtful about my food choices, it means that I’m only choosing specific types of food,” which demonstrates a misunderstanding of mindful eating. “There are no foods that are mindful eating foods, and if we’re not allowing ourselves to eat foods that we really want, that isn’t actually mindful eating. I hear a lot of people describe mindful eating basically as a restrictive diet. It’s kind of like they just relabeled it.”

The Center for Mindful Eating has a position statement that rejects the use of mindful eating for intentional weight loss.15 “Mindful eating is a weight-inclusive practice,” Conason says. “When we prescribe mindful eating for weight loss, we really get away from what the true essence of mindful eating is about. Mindful eating is about being fully aware of our eating experiences with a sense of nonjudgmental observation, curiosity, and acceptance. It’s in many ways about repairing the relationship with our body.”

A 2015 systematic review of 19 studies—13 randomized controlled trials and six observational studies—evaluated the effects of mindfulness-based interventions on weight among individuals attempting weight loss. Participants in 13 of the 19 studies experienced statistically significant weight loss, but the studies couldn’t establish a causal relationship between mindfulness and the observed weight loss.16 A 2019 systematic review and meta-analysis of 10 studies found that weight loss programs based on mindful or intuitive eating had the same outcomes as conventional diet programs.17

Results of a 2023 randomized controlled trial involving 76 participants aged 45 to 75 with BMIs in the overweight or obese range found that adding a seven-week mindful eating program to treatment as usual in a primary care setting was more effective than treatment as usual alone for reducing emotional and external eating, severity of bulimia symptoms, and frequency of binge episodes, but didn’t result in a significant reduction in BMI.18

Mindful Eating and Eating Disorders
Conason says that while she’s a huge proponent of mindful eating and uses it regularly in her work, she doesn’t believe in a one-size-fits-all model. For example, while mindfulness practices can be helpful across the spectrum of eating disorders, they may look very different from person to person. “Mindful eating is helpful for people struggling with binge eating in that it brings more awareness to the eating experience,” Conason says, adding that it also helps bring awareness to the body’s signals throughout the day. “Very commonly, people with binge eating disorder ignore or don’t hear lower-level hunger cues and wait until they’re very, very hungry to eat. So that can be really important.”

However, she says some people with binge eating disorder also engage in restrictive eating behaviors, and mindful eating can feel overwhelming by putting too much focus on the act of eating. Similarly, some patients with anorexia benefit from mindful eating, while for others it’s not a good fit based on where they are in recovery. They may benefit more from working with a dietitian and finding ways to follow a meal plan, which may involve distractions during meals. “For folks like that, I wouldn’t say that mindfulness isn’t helpful at all because I think there’s a certain element of mindfulness that’s involved in even recognizing when you need to distract yourself to be able to get through an eating experience.”

A 2020 study of university students found that having an eating disorder was associated with lower levels of mindfulness,19 which suggests mindfulness could be a protective factor. Another 2020 study found that a mindfulness intervention was associated with reduced binge eating and disordered eating patterns in participants preparing for bariatric surgery,20 while a 2022 study found that mindfulness in eating was inversely related to binge eating and mood disturbances in university students in health-related disciplines.21

Food for Thought
What might dietitians want to consider before recommending mindful eating to clients or patients? Tsui says it’s rare for her to enter into a client session and suggest mindful eating. “For me, it’s more about the mindfulness and observation piece. If we’re talking about their eating patterns and eating habits and there are gaps in their answers, then that’s where I might ask, ‘What would it be like to bring some awareness around that or focus on observing that for a while?’ ” When Tsui does talk about mindful eating, she frames it as simply a different way to engage with eating. “And not just eating itself but also what purchasing or acquiring food looks like, and preparing it, and then the actual eating experience and what it feels like afterward. I think that’s the big benefit, that it’s about engaging with the whole experience of eating in a way that might be different.”

Collings says the part of The Center for Mindful Eating’s definition about acknowledging responses to food, including likes, dislikes, or neutral, without judgment, is applicable to neurodivergent clients. “Neurodivergent people often have food preferences that may look different than people who aren’t neurodivergent, and that is OK. All foods fit, all foods have nutrients that we need, and if we can just nourish ourselves with the foods that we like, including preferred sensory foods and not pressuring ourselves to have foods that we’re averse to, that’s great,” she says. “I think that actually is a lot more neurodiversity-affirming than what most neurodivergent people have experienced.”

Sovinsky says that tenet removes morality from responses to food, especially in a culture that often pathologizes selective eating (often known as “picky” eating). “There are many valid reasons people may respond negatively to a food, including sensory differences, trauma, and medical conditions. Increasing variety isn’t always an accessible goal, nor should it be upheld as a requirement,” she says.

Notte says when a client tells her, “I know that that’s not mindful eating” or “I know I should be eating mindfully,” she’ll ask them where that belief comes from and what they hope they’ll get from mindful eating. “What do we think is going to be different about our eating experiences if we’re more mindful during them. And is that something that would actually be supportive? For some people, maybe yes, and for some people, maybe no. “We need to figure out for the individual what’s going to be the most supportive path to getting their nutrition needs met, whatever those are. I come back to mindfully choosing to be mindless, mindfully choosing to eat with distraction because I know that’s going to be the thing that’s going to help me nourish my body adequately. We can bring mindfulness to eating experiences, even if we’re not being mindful with the eating experience.”

— Carrie Dennett, MPH, RDN, is the nutrition columnist for The Seattle Times, owner of Nutrition By Carrie, author of Healthy for Your Life: A Non-Diet Approach to Optimal Well-Being, and creator of the Audible Original course Mindful Eating.

References
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2. Yu J, Song P, Zhang Y, Wei Z. Effects of mindfulness-based intervention on the treatment of problematic eating behaviors: a systematic review. J Altern Complement Med. 2020;26(8):666-679.

3. Sala M, Shankar Ram S, Vanzhula IA, Levinson CA. Mindfulness and eating disorder psychopathology: a meta-analysis. Int J Eat Disord. 2020;53(6):834-851.

4. Bush HE, Rossy L, Mintz LB, Schopp L. Eat for life: a work site feasibility study of a novel mindfulness-based intuitive eating intervention. Am J Health Promot. 2014;28(6):380-388.

5. Tapper K. Mindful eating: what we know so far. Nutr Bull. 2022;47(2):168-185.

6. Kabat-Zinn J. Full Catastrophe Living. New York, NY: Dell Publishing; 1991.

7. Nelson JB. Mindful eating: the art of presence while you eat. Diabetes Spectr. 2017;30(3):171-174.

8. The principles of mindful eating. The Center For Mindful Eating website. https://www.thecenterformindfuleating.org/Principles-Mindful-Eating

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11. Winkens LHH, van Strien T, Barrada JR, Brouwer IA, Penninx BWJH, Visser M. The mindful eating behavior scale: development and psychometric properties in a sample of Dutch adults aged 55 years and older. J Acad Nutr Diet. 2018;118(7):1277-1290.e4.

12. Kapp SK, Steward R, Crane L, et al. 'People should be allowed to do what they like': autistic adults' views and experiences of stimming. Autism. 2019;23(7):1782-1792.

13. Collings S. Why approaches that focus on the “present” may not be neurodiversity affirming. RDs for Neurodiversity website. https://www.rdsforneurodiversity.com/blog/why-approaches-that-focus-on-the-present-may-not-be-neurodiversity-affirming

14. Price CJ, Hooven C. Interoceptive awareness skills for emotion regulation: theory and approach of mindful awareness in body-oriented therapy (MABT). Front Psychol. 2018;9:798.

15. Position statements on topics related to mindful eating. The Center for Mindful Eating website. https://thecenterformindfuleating.org/Position-Statements

16. Olson KL, Emery CF. Mindfulness and weight loss: a systematic review. Psychosom Med. 2015;77(1):59-67.

17. Fuentes Artiles R, Staub K, Aldakak L, Eppenberger P, Rühli F, Bender N. Mindful eating and common diet programs lower body weight similarly: systematic review and meta-analysis. Obes Rev. 2019;20(11):1619-1627.

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19. Ebrahim Essa H, Abo-Elyazeed S, Abdelaty Hassan L. Eating disorders among female university students and its relation with their body attitudes and mindful eating. Tanta Scientific Nursing Journal. 2020;19(1): 8-32.

20. Giannopoulou I, Kotopoulea-Nikolaidi M, Daskou S, Martyn K, Patel A. Mindfulness in eating is inversely related to binge eating and mood disturbances in university students in health-related disciplines. Nutrients. 2020;12(2):396.

21. Felske AN, Williamson TM, Rash JA, Telfer JA, Toivonen KI, Campbell T. Proof of concept for a mindfulness-informed intervention for eating disorder symptoms, self-efficacy, and emotion regulation among bariatric surgery candidates. Behav Med. 2022;48(3):216-229.