1. Mindfulness for Eating Disorders,
Overeating and Obesity
Douglas Ziedonis, MD, MPH

3.  Only 8 Research Studies, including different approaches to Mindful
Eating (MBI, DBT, ACT, CEBT, CBMI, etc)
 All non-randomized and without a control group
 All relatively small sample sizes
– Leahey et al., 2008 – Cognitive-Behavioral Mindfulness Intervention
(CBMI); N=7
– Proulx (2008)- Mindfulness-Based Intervention (MBI); N=6
– Safer et al. (2007) – Dialectical Behavior Therapy (DBT); N=1
– Corstorphine (2006) – Cognitive-Emotional-Behavioral Therapy (CEBT);
N= 1
– Baer et al. (2005) – Mindfulness-based Cognitive Therapy (MBCT); N=1
– Heffner et al. (2002) – Acceptance and Commitment Therapy; N=1
– Safer et al. (2001) – Dialectical Behavior Therapy (DBT); N=1
– Kristeller et al. (1999) – Mindfulness-Based Intervention (MBI); N=18
 Application of mindfulness-based treatments is becoming more
common in clinical practice; however empirical evidence on
efficacy is still needed

4.  Assess forAddiction
– What are the trigger foods / situations / behaviors
 Understand the Craving (obsessions), Binging (compulsions), and Stinking
Thinking
 Denial, minimization, and rationalization
– PhysicalAddiction – tolerance and withdrawal
 What are the immediateAbstinence Goals?
 Food Plan / Monitoring
 What are the long-term Recovery Goals?
– Stage I, II, and III - personal responsibilities & plan
– Fellowship and Support
 Disease of Isolation
– Alternative healthy highs & healthier choices
 Check for Psychiatric Co-morbidities
– Depression and Sweet Cravings
 Public Health Orientation
– Role of Marketing / Culture Change / Drug Dealers, etc

5.  “The awareness that emerges through paying
attention on purpose, in the present moment,
and non-judgmentally to the unfolding of
experience moment to moment”
– Jon Kabat-Zinn

6. 1) Self-regulation of attention so that it is maintained on
immediate experience, thereby allowing for increased
recognition of mental events in the present moment.
– Body sensations, Feelings, &Thoughts
1) Adopting a particular orientation toward one’s
experiences in the present moment, characterized by
curiosity, openness, and acceptance.
– Compassion
Bishop 2004

7.  Mind and health: Developing a neural marker for
mindfulness, a pathway to health. (NCAM; PI: C. Fulwiler;
Co-I: D. Ziedonis)
– Using MRI to characterize changes in neural circuitry
of emotion regulation and relationship to recovery
from obesity.
 Amygdala connectivity correlates with mindfulness
(reduced amygdala volume & increased hippocampus volume)
 Decreased Default Mode Network activity during
meditation

8.  Present moment vs Mindless
Eating
– Slow down - “Raisin Exercise”
– Attend to Body, Emotions,
Thoughts
– Avoid self-judgment
 Many Models: MBSR, MB-
EATS, DBT, ACT, etc.
 Linking with Spiritual Health

9. Jean Kristeller, Ph.D., Professor of Psychology,
President/Co-Founder, The Center for Mindful Eating, Indiana State University
Kristeller & Wolever (2011) Eating Disorders
10-week course
Used in the treatment of binge eating disorder, compulsive eating, depression,
weight loss, etc.
Blends mindful eating exercises, CBT, MBSR, and general mindfulness meditation
practice
“Mindful eating” exercises – e.g.,
 Tune into body’s signals – become aware of physical hunger & notice fullness
 Chew slowly and savor your food
 Observe the sensory experience of taste
 Mindful food choices
Mindfulness meditation practice (general self-awareness, -acceptance, and –
compassion; and emotional regulation)

10. 8 week program (2.5 hrs / week) & 6 hour weekend
retreat
Explore mindfulness practice & discussion of
topics related to stress in daily life (50%)
Living on automatic-pilot
Learning to stop
Coming back to the breath
Relationship of stress to illness
Problem focus and emotion focus coping
Assertiveness in communications
Learn Formal & Informal Practices (50%)
Homework

11.  Formal Practices of Meditation & Gentle Yoga Exercises:
– Ex: Awareness of Breathing, Sitting Meditation, Slow Walking Meditation,
Body-scan, Raisin Exercise (mindful eating), Gentle Yoga Exercises,
Mountain/Lake Meditation, Loving-kindness Meditation, etc
• Informal Practice: many opportunities all day to enhance awareness:
– Any moment – perhaps when you catch yourself being mindless and gently
redirect to the present moment
– Consciously increase awareness to current thoughts, feelings, & body sensations
 How the weather affects us physically
– Pleasant experiences & unpleasant experiences
– Reactivity to stressful situations or events
– While communicating with others
 Homework
– Consider journal / log of your experiences.

12.  Albers, S. (2008). Eating Mindfully: How to End Mindless Eating and Enjoy a Balanced
Relationship with Food. New Harbinger Publications, Inc.
 Bishop, S. R., Lau, M., Shapiro, S., Carlson, L.,Anderson, N. D., Carmody, J. . . Devins, G.
(2004). Mindfulness:A proposed operational definition. Clinical Psychology:Science & Practice,
11(3):230-241. doi:10.1093/clipsy.bph077
 Chozen Bays, J. (2009). Mindful Eating:A Guide to Rediscovering a Healthy and Joyful
RelationshipWith Food. Boston, MA: Shambhala Publications, Inc.
 Kabat-Zinn, J. (2003). Mindfulness-based interventions in context: past, present, and future.
Clinical Psychology:Science & Practice 10(2): 144-156.
 Kristeller, J. L., &Wolever, R. Q. (2011). Mindfulness-based eating awareness training for
treating binge eating disorder: the conceptual foundation. Eat Disord,19(1),49-61.doi:
10.1080/10640266.2011.533605
 Nhat Hanh,T. & Cheung, L. (2011) Savor: Mindful Eating, Mindful Life. Harper One.
 Wanden-Berghe, R. G., Sanz-Valero, J., &Wanden-Berghe, C. (2011).The application of
mindfulness to eating disorders treatment: a systematic review. Eating Disorders, 19, 1.