569684

research-articleXXXX
AJLXXX10.1177/1559827615569684American Journal of Lifestyle MedicineAmerican Journal of Lifestyle Medicine

vol. XX • no X American Journal of Lifestyle Medicine

Ingrid Elizabeth Lofgren, PhD, MPH, RD

Mindful Eating: An Emerging

Approach for Healthy Weight
Management
Abstract: Excess weight continues healthy weight regulation. Mindful American spends $2741 annually and
to exact high costs at the individual, eating is an emerging healthy weight that the United States spends over $209
national, and global levels. regulation approach that has the billion on obesity-related illness such as
Traditional methods used to reduce potential to address the challenges diabetes, coronary heart disease, and
excess weight and promote healthy clients and patients experience cancer. Younger generations may for
weight regulation have not been with healthy weight regulation, but the first time have a shorter life
overly successful. Therefore, rigorous additional research is needed to expectancy than their parents due to
quantitative and qualitative research confirm which health outcomes will be negative health outcomes from
is needed to assess emerging and consistently affected. unhealthy, excess weight.3,4 Most
alternative approaches to determine
effective strategies to confront this
public health challenge. One such
Younger generations may for the
approach is applying mindfulness, or a
nonjudgmental acceptance of living in
first time have a shorter life
the moment, to eating. Mindful eating expectancy than their parents due to
is a nonjudgmental acceptance of
physical and emotional feelings while negative health outcomes from
eating or in an eating environment.
Mindful eating constructs include unhealthy, excess weight.
recognizing one’s own cues of physical
hunger and satiety in order to make
decisions about what food and how traditional approaches to healthy
Keywords: mindfulness; mindful
much to eat, choosing foods that weight regulation focus on which foods
eating; weight regulation
are nutritious and pleasurable, not and amounts to eat but suffer from low
participating in other activities while success rates.5,6 The practice of

H
eating, and knowing the consequences ealthy weight regulation mindfulness has been proposed as an
of unmindful eating. The nascent continues to challenge the emerging and alternative approach to
mindful eating literature shows domestic and global public address healthy weight regulation7-9
success in increasing mindfulness and health systems with high economic and because it takes into account
promising but less robust outcomes personal costs.1 Cawley and maladaptive responses to internal and
with anthropometric biomarkers of Meyerhoefer2 estimated that each obese external signals5 and people feel more

DOI: 10.1177/1559827615569684. From the University of Rhode Island, Kingston, Rhode Island. Address correspondence to Ingrid Elizabeth Lofgren, PhD, MPH, RD, 10
Ranger Road, Ranger Hall 302, Kingston, RI 02881; e-mail: ingridlofgren@uri.edu.
For reprints and permissions queries, please visit SAGE’s Web site at http://www.sagepub.com/journalsPermissions.nav.
Copyright © 2015 The Author(s)

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 American Journal of Lifestyle Medicine Mon • Mon XXXX

Table 1.
Mindful Eating Is24

•• Recognizing one’s own hunger and satiety cues and following them to make decisions about when, what, and how much to eat
•• Choosing foods that are nutritious and enjoyable
•• Slowing down one’s eating rate
•• Eating as the only activity (eg, not in front of the TV or in the car)
•• Using of all of the senses when eating
•• Responding nonjudgmentally to food
•• Increasing awareness of unmindful eating and its consequences
•• Practicing meditation

in control of their food- and beverage-
related decisions.10
Introduction to
Mindfulness
Mindfulness is maintaining a
nonjudgmental, nondeliberative
awareness of physical feelings, thoughts,
and perceptions in the present
moment.8,11,12 Though its origins come
from meditation rituals of Eastern
religions,13 one can learn and practice
mindfulness skills5,8,14 without
participating in the religious
component.12,15 A primary goal of
mindfulness is reducing the “automatic
pilot” state, or times when humans are
normally unaware of life’s individual
moments.11 Mindfulness, or decreasing
time on “automatic pilot,” enhances
awareness of internal, physical cues that
can optimize health8 via higher levels of
perceived control for lifestyle behavior
choices that result in better health
outcomes.11 Mindfulness programs, like
Jon Kabat-Zinn’s mindfulness-based
stress reduction program, have been
used to improve health outcomes8 of
those suffering from stress,13 chronic
pain,16 anxiety disorders,17 and cancer.6,11
Since practicing mindfulness promotes
self-regulation,12 applying mindful eating
skills could help with healthy weight
regulation through healthier food choices
and recognizing the internal, physical
cues of when one has eaten enough.8
Introduction to
Mindful Eating
Mindful eating is an emerging and
alternative approach to address
unhealthy eating behaviors, healthy
weight regulation,14,18,19 and weight
loss.20 The practice takes into account
responses to internal and external cues
to reduce automatic pilot.5 Mindless
eating, or making food- and beverage-
related decisions while on automatic
pilot, may contribute to overeating and
increased caloric intake,10,21 since it
results in a significant underestimation
and/or no monitoring of how much one
has eaten.9,22 In a cross-sectional study
by Wansink and Sobal,22 participants (n =
139, 75% female, and mean age of 42.9
years) estimated they made 14.4 food-
and beverage-related decisions per day.
However, the actual mean number of just
food-related decisions made by
participants was 59 per day while the
mean number of food- and beverage-
related decisions was 226.7 per day.22 In
another study by Wansink, Painter, and
North,23 participants served soup from
“bottomless” bowls ate 73% more than
participants who ate soup from
traditional bowls but estimated that they
only ate ~5 calories more.
Mindful eating is a nonjudgmental
awareness of physical (hunger and
satiety cues) and emotional (ie, stress,
boredom) feelings when eating or in
situations that have environmental eating
triggers.14,19 The increased awareness and
response to internal, physical cues rather
than emotions or environmental triggers
partially explains how mindfulness
promotes healthy weight regulation14 and
better diet quality.19 A summary of the
main constructs of mindful eating are
presented in Table 1.
These constructs of mindful eating
target consistently identified factors that
contribute to overeating and therefore
weight gain. These factors include
increased consumption norms, such as
bigger portion sizes at home and when
eating out,23,25,26 less monitoring of
consumption,26,27 and being on automatic
pilot or responding to emotional and
environmental cues when eating.14
While the terms mindful eating and
intuitive eating are sometimes used
interchangeably,28 there are significant
differences. Though similar and
complementary,24,28 compared with
mindful eating, intuitive eating (a) does
not include meditation practice,24 (b)
encourages weight acceptance at any
size without a weight loss focus,29 and
(c) promotes unconditional eating.30
Intuitive eating may be another emerging
approach to healthy weight regulation,

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 vol. XX • no X
since initial research has shown its
constructs to be helpful in maintaining a
healthy weight,30 as well as resulting in
longer, significant weight loss compared
with traditional dieting methods.29
However, the differences are significant
enough and this article will deal
exclusively with mindful eating, though
not all the studies discussed will have
addressed every construct listed above
for mindful eating, for example, not all
studies incorporated mediation. For
additional information about intuitive
eating, please see the book Intuitive
Eating by Evelyn Tribole, MS, RD, and
Elyse Resch, MS, RD, FADA, and the
review of intuitive eating literature by
Van Dyke and Drinkwater.31
Previous Research
on Mindful Eating:
Highlighting Weight
Regulation
Traditional weight loss and healthy
weight regulation methods have not
been overly successful; therefore,
emerging and alternative approaches are
needed.29,32 While mindful eating has
been proposed as one of these emerging
approaches, it is still in its infancy of
robust scientific testing. However, the
nascent research does provide evidence
that mindful eating may be successful in
healthy weight regulation via changes in
mindfulness and resulting associations
with negative eating behaviors and
anthropometric biomarkers.
Jacobs et al33 completed a cross-
sectional study examining the impact of
a 1-hour mindful eating education
session on mindfulness and food
consumption. After the training,
participants reported more mindfulness
(as measured by 3 different surveys
including the Toronto Mindfulness
Scale34) and just over 85% of the
participants had healthy food intake
during the lunch provided by the
investigators.33 Though only one point in
time, the results suggest that mindfulness
training can affect dietary intake and
therefore may support healthy weight
regulation.33 Another cross-sectional
study was completed by Beshara et al9 in
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which they reported that mindfulness
enhanced one’s feeling of control and
decision-making process with regard to
portion size. Participants who self-
reported as more mindful eaters as
measured by the Mindful Eating
Questionnaire, moderated their portion
sizes better, ate less energy dense foods,
and reported less emotional and stress
eating.9
Grinnell et al35 reported on a mindful
eating intervention with first-year college
students. The 3 sessions delivered over 8
weeks during a regularly schedule course
introducing the students to the university
resulted in increased mindfulness, as
measured by the Mindful Attention
Awareness Scale.12 The increased
mindfulness was positively associated
with self-regulation and negatively
associated with external and emotional
eating.35 Additionally, at postintervention,
those who received the mindful
intervention had significantly smaller
waist circumferences than participants
who received a traditional dietary
intervention.35 Unfortunately, the study’s
short intervention period did not permit
examination of more robust changes in
additional anthropometric measures.
Tapper et al36 examined the impact of a
randomized, controlled trial of a
mindfulness-based weight loss
intervention versus a nontreatment
control group in women trying to lose
weight. The participants met with study
staff for 3 weekly sessions and then a
follow-up 3 months later. While the
intent-to-treat analysis did not show a
significant difference in weight
parameters, the efficacy analysis showed
that those who attended the mindfulness
sessions lost ~3 pounds.36 As speculated,
changes in emotional eating were
significantly associated with changes in
body mass index.36 Kidd et al10
completed an 8-week intervention as
well, but the participants met with study
staff weekly. They examined the impact
of a mindful eating program on eating
behaviors, biomarkers of weight, and
weight loss self-efficacy in urban, obese
women. Though there was a significant
improvement in reported self-efficacy for
weight loss among participants trained in
American Journal of Lifestyle Medicine
mindful eating, contradictory to other
mindfulness and mindful eating research,
there were no improvements in mindful
eating or any anthropometric
biomarkers.10
The study by Miller et al19 had a more
intensive and lengthy intervention (10
sessions delivered over 3 months) than
did Tapper et al36 (intensity) or Grinnell
et al35 and Kidd et al10 (intensity and
length). Miller et al19 enhanced diabetes
self-management education sessions with
mindful eating constructs and reported
significant increases in mindfulness and
weight loss and less overeating
compared with traditional diabetes
self-management. Additionally, these
changes at postintervention were also
observed at follow-up 3 months later.19
Collectively, the outcomes from these
cross-sectional, quasi-experimental, and
randomized clinical trials are promising
in light of the challenges seen with
traditional methods for healthy weight
regulation. Further research on the
applicability of mindful eating constructs,
as well as the use of valid assessment
tools, is warranted and will help inform
clinicians aiming to support patients’
weight management goals.
Measuring Mindful Eating
Identifying effective and reliable
measures of mindful eating are critical for
researchers and clinicians.37 Currently
available mindful eating assessments are
based on surveys that measure general
mindfulness14 as a trait34: such as the
15-item Mindful Attention Awareness
Scale,12 The Freiburg Mindfulness
Inventory (30 items and 14 items),38 and
the 39-item Kentucky Inventory of
Mindfulness Skills15; or a state, such as the
Toronto Mindfulness Scale.34 For reviews
of various mindfulness assessment tools,
including strengths and limitations, see
Baer et al37 and Park et al.39
One of the most commonly used
mindful eating assessments is the Mindful
Eating Questionnaire with 28 items that
measures the major constructs of mindful
eating (disinhibition, awareness, external
cues, distraction, and emotional
response) and can be used in clinical
 American Journal of Lifestyle Medicine
and research settings.14 However, the
sample sizes used in the development
and validation of the Mindful Eating
Questionnaire have been small.14
Therefore, researchers have used
additional measures in conjunction with
the Mindful Eating Questionnaire.9,10
Some of these other measures include
the Weight Efficacy Lifestyle
Questionnaire, which produces a more
focused measure of mindfulness10; the
Dutch Eating Behavior Questionnaire,
which assesses emotional eating18; the
Weight Efficacy Lifestyle Questionnaire,
which assesses one’s ability to control
eating in various situations40; and the
Three-Factor Eating Questionnaire,41
which measures hunger, susceptibility to
nonphysical hunger and dietary restraint,
and disinhibition.19 Measuring mindful
eating suffers from the same limitations
as measuring general mindfulness:
additional, rigorous research, quantitative
and qualitative, is needed to improve
psychometric properties and construct
validity.39 As research and assessment
methodologies in mindfulness advances,
clinicians will have additional
instruments that are valid and reliable to
use while implementing the mindful
constructs with their clients and patients.
Conclusion
When deciding on an approach to help
a client or patient maintain a healthy
weight, mindful eating is one such
option to consider. While mindful eating
is an emerging technique that needs
further study,14,24,33 clinicians may find
that this noninvasive approach works
well with clients and patients who are
open to the constructs of mindful eating.
The literature does suggest, as with most
behaviorally based dietary interventions,
that it is important to incorporate
mindfulness in incremental steps,10 since
some participants reported having
difficulty with incorporating all the
constructs at once.36 In order for research
to provide a robust assessment of
mindful eating, an accepted, operational
definition of mindful eating is
needed,8,15,34 as well as validated and
clinically applicable assessment tools.
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This will help researchers with
reproducibility and clinicians to interpret
the results. Additionally, more
randomized, clinical trials with larger
participant populations and more
diversity are needed to increase the
generalizability of results/outcomes and
reproducibility of the research.7,8,14
Health care professionals, including
registered dietitians,24 nurses,10 and
primary care providers,8 may find
mindful eating practices a strategy to
promote healthy weight regulation with
clients and patients.10 AJLM
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