Deborah Da Costa, Ph.D Associate Professor, McGill University

1. Deborah Da Costa, Ph.D Associate Professor, McGill University Psychologist, Comprehensive Health Improvement Program (CHIP) Applying Mindfulness to Manage EmotionalEating WHHI Info Session 20/11/18 deborah.dacosta@mcgill.ca

2. Presentation Overview • What is Emotional Eating? • Function of Emotional Eating • Where does it come from? • Can Mindful Eating Help? • Why practice mindful eating? • Mindful Eating Practices: BASICS Overview

3. What is Emotional Eating? Eating in response to emotions and feelings – soothe unpleasant emotions or increase pleasant emotions • Emotional eaters attempt to manage their mood with food. • Foods consumed: high in fat, sugar, and calories • At least 60% of overweight/obese persons are also emotional eaters (Ganley 1989) • Not all emotional eaters have a mood disorder • Not all emotional eaters binge Abramson, 2011

4. Emotional Eating Scale? (Arnow et al.,1995) Depression 1. When I am feeling “down” or “blue” a little snack will lift my mood. 2. When I’m depressed I have more desire to eat. 3. If someone disappoints me I want to eat something. Anxiety/stress 4. When I am pressured or working under a deadline I have the urge to snack. 5. I eat more when I am stressed than when I am calm. 6. If I am worried or afraid of something I tend to eat. Anger 7. Sometimes when people irritate me I want to get something to eat. 8. I have had something to eat “just to teach him/her a lesson”. 9. When I get angry, eating will make me feel better. Boredom 10. I look forward to eating something when I’m bored. 11. I eat more than usual when there is nothing to do. 12. If time is passing slowly, I look forward to having a snack.

5. Emotional Eating Scale? (Arnow et al.,1995) Loneliness 13. Being alone increases my appetite. 14. I am less likely to eat when other people are around as I am when I’m by myself. 15. Eating makes me feel better when I am lonely. Happiness 16. I celebrate with food when I’m in a good mood. 17. If I’m feeling really good, I don’t worry about my diet. 18. When I’m happy, having a favorite snack makes me feel even better.

6. FUNCTIONS OF EMOTIONAL EATING • Comfort, Soothing, Nurturance • Numbing, Sedation, Distraction • Escape from Painful Emotions • Releases Tension, Anger or Frustration Trigger BEHAVIOUR Reward Self-Medicating – increasing carbs, increases serotonin – improved mood Doesn’t really address the underlying emotions and trigger

7. EMOTIONAL EATING – Where does it come from? • Childhood eating experiences • Food used as comfort or reward • Relationship Issues • Adverse Sexual Experiences/History of Trauma • Low self esteem and body dissatisfaction • Social and Cultural components Abramson, 2006

8. Emotional Eating: How to Overcome it? • Premise: Emotional eaters have lost their innate ability to self‐regulate their hunger and satiation. • Important Step - relearn to accurately listen to and trust your bodies’ signals. • Instead of trying to suppress or avoid negative emotions, staying in-tune and learn to tolerate and accept your emotions rather than turning to food to escape.

9. Mindful Eating

10. Reflect for a Moment Whatdid you eat in your last meal? Were you present with your food or distracted by other things? Did you eat because of the time on the clock or were you actually hungry?

11. Mindful Eating • Mindful eating involves making conscious food choices - awareness of present moment when making food choices - paying close attention to the effect of the food on the senses3 • Developing an awareness of physical v. psychological hunger and satiety cues1 • Eating healthfully in response to those cues2 • Observing physical and emotional sensations, including our thoughts, in a non-judgemental way in response to eating4 1Dalen et al., 2010; 2Miller et al., 2014; 3Hendrickson et al., 2013; 4Kristeller et al., 2014

12. Mindful Eating • Mindful eating is based on the notion that our relationship to food can be improved by using all of your senses to: i) Choose satisfying and nourishing ii) Recognizing our responses to food (likes, dislikes or neutral) without judgment iii) Being aware of physical hunger and fullness signals to help us decide when to begin and end eating.

13. Mindful Eating “Mindful eating includes all of our choices, from the time we first feel like eating, through to completing our meal or snack, and afterwards as well.” Source: S. Pisk, 2017 www.eatingforyou.com.au

14. Why Practice Mindful Eating? • Mindfulness & mindful eating interventions appear to be most successful in reducing: • binge eating regardless of weight status. • emotional eating & eating in response to external cues - important behaviours related to obesity • In overweight individuals impact on reducing weight mixed; • may play role in prevention of weight gain. • Positive shift in food habits, quantity of food consumed in • some studies. Warren et al., 2017

15. Why Practice Mindful Eating? We repeatedly eat meal after meal, snack after snack, hardly aware of what and how much we’re eating. Think about how frequently this happens to you…. You start eating, get distracted by your tablet, work, a book or TV, and before you know it your food is gone and you hardly remember eating it?

16. Mindful Eating Practices/Tips SLOW DOWN Eating too fast does not allow our body to have time to recognize the signals telling us we are full and have had enough to eat 20 minutes for food to reach the first part of the small intestine which then results in chemical signals to the brain to tell the body, " Stop eating, I am full!"

17. BASICS of Mindful Eating (Dr. Rossy) B – Breathe and Belly Check for hunger and satiety before you eat. • Take a few deep breaths as you begin to check in with your belly. Ask yourself: - Are these sensations of physical hunger? - How hungry are you? - What are you hungry for? Is there a particular type of food you’d like to have? You might want food or you might be thirsty. Listen to what your body is telling you. www.umsystem.edu/newscentral/mindfuleating/basics-of-mindful-eating/ www.thecenterformindfuleating.org/

18. The Hunger-Satiety Scale When It’s Time to Start Eating • Best to eat when you reach a 3-4, try not to get to a 1-2. • If you get too hungry, more likely to overeat & make poor choices. • Always keep healthy snacks available, especially when on the go Source: https://uhs.berkeley.edu/sites/default/files/wellness-hungersatietyscale.pdf

19. The Hunger-Satiety Scale When It’s Time to Stop Eating • Best to stop eating when you reach a 6. Within 15-20 minutes, you will likely be at a 7, full but not uncomfortable. • To reduce the temptation of overeating, • serve dishes on the counter rather than table • ask for a to-go box at restaurants with large portions • keep checking in on where you are on the hunger scale before going for seconds or grabbing a snack. Source: uhs.berkeley.edu/wellness

20. Eating When Not Hungry? Ask yourself Why? Seeking comfort for negative emotions? • Find healthier alternatives to learn to better manage negative emotions. • activities bring you pleasure/a sense of enjoyment or accomplishment? (simple pleasures can go along way) • (e.g. go for a walk, listen to music/podcast, call a friend etc..) Abramson, 2006

21. BASICS of Mindful Eating A - Assess your Food • - What does it look like? Does it look appealing? • - Where does it come from? • Is it a food you can recognize or is it a food-like substance (e.g. highly processed)? • Briefly be aware of the sun, rain & all other processes by which this food arrived in front of you today. - Is this the food you really want? A brief pause to assess your food can give you lots of information about it. www.umsystem.edu/newscentral/mindfuleating/basics-of-mindful-eating/

22. BASICS of Mindful Eating S - Slow Down • Helps you enjoy your food more fully and become aware of when you’re getting full. • Simple strategies to help you slow down • putting down your fork or spoon between bites • pausing and taking a breath between bites • chewing your food completely • Remind yourself, and your family, that eating is not a race www.umsystem.edu/newscentral/mindfuleating/basics-of-mindful-eating/

23. BASICS of Mindful Eating I - Investigate your hunger throughout the meal • Be aware distractions, bring your attention back to eating, tasting, & assessing your hunger and satiety throughout the meal. • You may find you’re no longer hungry even though there’s food on your plate or that you don’t even like what you’re eating • . • Allow yourself to stop or to continue based on your assessment. www.umsystem.edu/newscentral/mindfuleating/basics-of-mindful-eating/

24. BASICS of Mindful Eating I - Investigate your hunger throughout the meal • When assessing your hunger throughout your mealask yourself: • - “Has my body had enough?” • - “Am I eating just because there’s more food?” • “Can I stop before I get full?” • The feelings of hunger and satiety may be hard to determine at first. • Don’t give-up. • Keep checking, gradually you will learn more about your body, what it needs and wants. www.umsystem.edu/newscentral/mindfuleating/basics-of-mindful-eating/

25. BASICS of Mindful Eating C – Chew Your Food Thoroughly • Helps you to slow down & your body to digest the nutrients from your food more efficiently. • Allows you to really taste your food and be tuned into the signals that you are getting satisfied. • The sooner you are aware of satiety, the • less likely it will be that you will over-eat. www.umsystem.edu/newscentral/mindfuleating/basics-of-mindful-eating/

26. BASICS of Mindful Eating S – Savor Your Food • Involves taking time to choose food you really like and food that would satisfy you right now. • Become fully present for the experience of eating and the pleasure that it can bring. • Allow your attention be on the complete range of sensations available in each bite and feel the pleasure. If your not enjoying it, why eat it? www.umsystem.edu/newscentral/mindfuleating/basics-of-mindful-eating/

27. Mindful Eating Practices How does it feel? In your hand /Through your knife & fork / In your mouth – is it hard, soft, rough, smooth, crunchy, melting? How does the food look? Shape /Colour/ Shade How does it smell? What sort of aromas can you pick up? How does it taste? Sweet, sour, bitter, salty, tangy? How does it sound? This might feel a little strange at first but will help you to really appreciate the entire eating experience. How does it feel in your body? Physical sensations / Emotions / Hunger / Satisfaction Source: Mindful Eating, healthyfutures.nhs.uk/llb

28. Mindful Eating Tips • Do not skip meals • Plan meals and snacks ahead of time • Keep a mindful eating journal • Eat sitting down • Limit distractions. Eat without Tablet, smartphone, computer, TV or work • Our daily lives are full of distractions. Consider making family mealtime an electronics-free zone. • Watch the clock; try to make the meal last at least 20 minutes.

29. Mindful Eating Takes Practice • These are guidelines not inflexible rules • helps you become more aware about how, what, when and why you eat. • Follow them as best you can, as often as possible. • Accept that there will be times when it will be impossible to eat this way. • Mindful eating takes practice. • There are books and on-line sources to help you in this journey. www.umsystem.edu/newscentral/mindfuleating/basics-of-mindful-eating/

30. Resources • The Center for Mindful Eating www.thecenterformindfuleating.org/ • The CAMP system • www.mindfuleating.org Books • Eat What You Love, Love What YouEat, an easily understood guide by Michelle May (2013) • Mindful Eating by Jan Chozen Bays (2009). Takesa more detailed meditative approach and includes a CD withguided meditation exercises.

31. Resources • Mindful Eating Diary • https://medical.mit.edu/sites/default/files/mindful_eating_journal.pdf Recommended Mindful Eating Apps • EAt Right Now- developed by Dr. Brewer from the Center for Mindfulness from U Mass, has some initial positive findings showing reductions in craving & weight loss. • YouAte Food Diary– Encourages taking photos of food eaten, documenting the time of your meals, time between meals, why you ate and your enjoyment from the meal. Mindful Eating Tracker– allows you to notice a food idea or thought (and decide what to do with the thought), rate and track levels of gratitude, hunger, thirst and satisfaction and food enjoyment. • Am I Hungry? – Based on Dr. May’s Am I Hungry Mindful Eating cycle. Every time you would like to eat, the app takes you through a series of decisions to make mindful choices. • Eat Drink and Be Mindful– By Dr. Albers allows you to record your hunger level and kind of hunger. It also shows how you respond to food (mind, body, thoughts & feelings), with reminders to eat mindfully.

33. References Abramson, E. (1993). Emotional Eating: What you need to know before starting another diet. Jossey -Bass Publishers (San Franciso).  Abramson, E. (2006). Body Intelligence: Lose weight, keep it off and feel great about your body without dieting. McGraw-Hill. Arnow, B., Kenardy, J., & Agras, W. S. (1995). The Emotional Eating Scale: the development of a measure to assess coping with negative affect by eating. International Journal of Eating Disorders, 18(1), 79-90 Bays, J. (2009).“Mindful Eating: How to Really Enjoy Your Meal.” Psychology Today. Retrieved from: http://www.psychologytoday.com/experts/jan-chozen-bays-md Brewer J. Mindfulness in the Military. Am J Psychiatry 2014; 171 (8); 803-806. Dalen J, Smith BW, Shelley BM, et al. (2010) Pilot study:Mindful Eating and Living (MEAL): weight, eating behavior, and psychological outcomes associated with a mindfulnessbased intervention for people with obesity. Complement Ther Med 18, 260–264. Gotink RA, Chu P, Busschbach JJ et al.,. Standardised Mindfulness-Based Interventions in Healthcare: An Overview of Systematic Reviews and Meta-Analyses of RCTs. PLoS One 2015;10(4):e0124344. Hendrickson KL & Rasmussen EB (2013) Effects of mindful eating training on delay and probability discounting for food and money in obese and healthy-weight individuals. Behav Res Ther 51, 399–409. Jha AP, Morrison AB, Dainer-Best J, Parker S, Rostrup N, Stanley EA . Minds “At Attention”: Mindfulness Training Curbs Attentional Lapses in Military Cohorts. PLoS ONE. 2015;10(2):e0116889. doi:10.1371/journal.pone.0116889 Kristeller JL, Wolever RQ & Sheets V (2014) Mindfulness-Based Eating Awareness Training (MB-EAT) for binge eating: a randomized clinical trial. Mindfulness 5, 282–297. May, M. (2012). “Mindful eating: Get out of Autopilot.” Am I Hungry? Retrieved from: http://amihungry.com/mindful-eating.shtml Matz J, Frankel E. (2004) Beyond A Shadow of A Diet: The Therapist’s Guide to Treating Compulsive Eating Miller CK, Kristeller JL, Headings A, et al. (2014) Comparison of a mindful eating intervention to a diabetes self-management intervention among adults with type 2 diabetes: a randomized controlled trial. Health Educ Behav 41, 145–154. Mindful Eating: Enjoying Your Food with All Your Senses Retrieved from http://www2.ca.uky.edu/agc/pubs/FCS3/FCS3561/FCS3561.pdf Ong JC, et al. A randomized controlled trial of mindfulness meditation for chronic insomnia. Sleep. 2014; 37(9):1553-63. L. Rossy. Basics of Mindful Eating. https://www.umsystem.edu/newscentral/mindfuleating/basics-of-mindful-eating/ Van Gordon W, Shonin E, Zangeneh M. Griffiths MD. Work-Related Mental Health and Job Performance: Can Mindfulness Help? Int J Ment Health Addiction. 2014; 12:129–137. Warren, J.M., Smith, N. and Ashwell, M., 2017. A structured literature review on the role of mindfulness, mindful eating and intuitive eating in changing eating behaviours: effectiveness and associated potential mechanisms. Nutrition research reviews, 30(2), pp.272-283.