Despite the significant time, energy, and money spent by employers on weight-focused programs, little sustainable, large-scale change has been demonstrated to date. This article will summarize the reasons weight-focused interventions fail and lay the foundation for a non-diet, weight-neutral, mindfulness-based approach to eating, health, and self-care.
Weight loss interventions are ineffective
Studies have proven that weight loss programs do not create lasting changes in weight or health. A comprehensive review published in the Journal of Obesity titled "The Weight-Inclusive versus Weight-Normative Approach to Health" concluded that no weight loss initiatives to date have generated long term results for the majority of participants.1
Results from a 2013 RAND study sponsored by the U.S. Departments of Labor and Health and Human Services show that participation in a one-year weight control program in the workplace would be associated with a weight reduction of approximately one pound for an average adult at the end of the first year.
By the fourth year, this would be reduced to only one-quarter of one pound.2 Recent studies investigating the effect of intentional weight loss in people with Type 2 diabetes found no reduction in cardiovascular morbidity and mortality or all-cause mortality compared to control groups where weight loss was not prescribed or achieved.3,4
Weight loss interventions are counterproductive
Intentional weight loss results in "adaptive thermogenesis"-coordinated biological, physiological, and psychological responses designed to maintain body fat stores at an ideal established by the central nervous system-leading to weight regain in the majority of those attempting to sustain a reduced body weight.5
In addition to metabolic changes, other biological adaptations that result from food restriction make it more difficult to maintain the restrictive behaviors that most weight loss interventions require. For example, cravings to eat increase, while hormones that promote a sense of satiety, such as leptin, decrease.6
Other research has shown that food restriction results not only in preoccupation with food and eating, but in distractibility, increased emotional responsiveness, dysphoria, increased eating in the absence of hunger, and bingeing.7 In addition, most weight loss interventions are based on an external locus of control.
In other words, an external authority sets rules about when, what, and how much to eat, and how much to exercise. This teaches participants to disregard and even distrust their innate cues of hunger and satiety. This decreases self-efficacy and moves them further from their ability to interpret what their body needs.8
A focus on weight can be harmful
Adverse consequences from a focus on weight loss include weight cycling, disordered eating, and weight stigma, all of which have significant negative repercussions for individuals, organizations, and societies as a whole.1,9,10,11
Although the prevailing messages equate weight loss and being thin with greater health, happiness, and success, the data indicate that the weight focus and prizing of thinness has done more harm than good.
Weight loss interventions do not produce a return on investment
In a 2010 interview, long-time health promotion pioneer and researcher Dee Eddington said, "Weight loss money is money down the toilet."12 A 2015 article published in the American Journal of Managed Care concluded that employers should completely disband weight management programs, stating, "No corporate weight control program has ever reported savings or even sustained weight loss using valid metrics across a sizeable population for two years or more, accounting for dropouts and nonparticipants. Further, these programs can harm morale and even the health of the employees themselves."13
What Now?
There is a growing trans-disciplinary movement away from restrictive, weight-focused programs toward a non-diet, weight-neutral approach to healthy lifestyles. Simultaneously, mindfulness, has been shown to be a viable approach to improving health in the workplace.
A variety of organizations, programs, and authors are advocating for a non-diet, weight neutral, mindfulness-based approach; evidence in support of this paradigm shift is accumulating rapidly.8, 9, 10, 11, 14, 15, 16, 17
Non-Diet Defined
A non-diet approach encourages a more natural, instinctive way of eating by re-learning to manage food intake using internal cues of hunger and satiety, rather than external restrictive rules that are often confusing and difficult to follow indefinitely.
A non-diet approach rejects the concept of "good" and "bad" foods in favor of an "all foods fit" model based on the principles of balance, variety, and moderation. Instead of a rigid eating plan, this approach promotes a balance of eating for nourishment with eating for enjoyment.
Research indicates that non-diet programs have positive and lasting effects on many dimensions of well-being, including improvements in total cholesterol, LDL, blood pressure, depression15,17, improved nutrient intake18, reduced eating disorder symptomology,17,19, 20 reduction of food cravings21 and improvements in psychological and behavior outcomes, including self-esteem and eating behavior.14,17,22
Weight-Neutral
Weight-neutral interventions embrace the fact that a person's health status or risk level cannot be assumed based on a number on a scale. The weight-neutral approach recognizes that body weight is determined by a complex set of genetic, metabolic, physiological, cultural, social, and behavioral determinants other than energy intake and output, many of which are beyond an individual's control.1
Instead of focusing on a weight-oriented outcome, participants in weight-neutral interventions learn to take charge of their thoughts, feelings, and behaviors, which ultimately leads to improved well-being, regardless of weight. Much of the research on weight-neutral interventions to date has focused on a model called Health at Every Size (HAES), testing it against standard weight-focused approaches.
Results indicate that this model results in "both statistically and clinically significant improvements for the participants on physiological measures (e.g., blood pressure), health practices (e.g., physical activity), and psychological measures (e.g., self-esteem and disordered eating)."
It is also noteworthy that weight-neutral models demonstrate lower dropout rates with none of the adverse outcomes found with dieting.1 Weight-neutral interventions in the workplace can help employers avoid the negative consequences of weight-focused programs, including weight cycling, disordered eating, weight stigma, possible legal ramifications and the exclusion of employees who are not overweight but would benefit from engagement in lifestyle interventions.
Mindfulness-Based
Mindfulness is an ancient practice with profound applications in modern life. Mindfulness is purposefully paying attention to the present moment, cultivating awareness of both internal and external experiences, observing and accepting experiences as non-judgmentally as possible, choosing responses, and making intentional decisions.
Three decades of research support the effectiveness of mindfulness training to improve many facets of physical and emotional well-being, including depression, anxiety, coping style, medical symptoms, pain, physical impairment;23 sleep and perceived stress;24 relaxation and greater life satisfaction.25
Mindfulness training is considered a viable intervention for the workplace24 and many large, well-known employers including Apple, Google, and General Mills now offer mindfulness-based programs to their employees.26 Mindful eating is the application of mindfulness principles to eating behaviors and one's relationship with food.
A simple definition of mindful eating is eating with intention and attention. Eating with purpose and awareness has powerful benefits because it helps people disengage from habitual and self-defeating behaviors and replace them with more skillful and supportive behaviors.
Mindfulness training has been shown to decrease food cravings21 and emotional eating27, reduce psychological distress28, and decrease eating disorder symptomology29, particularly binge eating episodes.19,29,30 Studies in diabetes show improved dietary intake and improved glycemic control. 27, 31
The Mindful Eating Cycle
The Mindful Eating Cycle is a decision-making model developed by Michelle May, M.D. that integrates mindfulness with the non-diet, weight-neutral approach. This model provides a practical but powerful structure that helps individuals identify and resolve the underlying drivers of problematic eating and sedentary lifestyles, regardless of size or health status. There are six decisions points in the Mindful Eating Cycle.
Why do I eat?
Many people lack awareness of and understanding about why they make their choices about eating, though the underlying reason affects every decision that follows. For example, if a person is eating for fuel and nourishment, they may be interested in energy balance and nutrition.
If they're eating in response to environmental or emotional cues such as stress, boredom, or a need for reward, they're more likely to choose foods that are convenient, energy dense, and highly palatable.32 When eating doesn't adequately address the underlying trigger, they are more likely to eat food in excess.
Since traditional weight-focused interventions teach what and how much people "should" eat without addressing why they are eating in the first place, participants don't learn to recognize and effectively cope with their triggers or meet their true bio-psycho-social needs.33,34,35
When do I feel like eating?
Restrictive, weight-focused programs often give participants rules to follow, such as eating on a particular schedule. However, hunger is a primitive yet reliable method of regulating dietary intake.36,37 Pausing to ask the question, "Am I hungry?" whenever they feel like eating helps individuals re-establish hunger as their primary cue for eating.
This simple but powerful question, and the process of discovery that follows, helps them differentiate their fuel needs from environmental and emotional cues. Once individuals are able to accurately identify hunger, they can fine tune their awareness, gauge how hungry they are, and make intentional decisions about how much to order, prepare, or serve themselves. When they recognize that the desire to eat was fueled by a non-hunger trigger, they can identify options for responding in more effective ways than eating.
What do I eat?
Restrictive eating requires individuals to maintain willpower indefinitely in order to comply with the rules. Research has shown that dieters exhibit increased preoccupation with food, feelings of deprivation and guilt, and resignation when they "break the rules."
These feelings of failure and decreased self-efficacy, combined with increased hunger and cravings, often lead to more overeating. May calls this pattern the "eat-repent-repeat cycle."8 This cycle is one of the primary reasons conventional interventions do not produce lasting change and lead to weight cycling.
Approaching the question "What do I eat?" from a non-diet perspective acknowledges that "normal" eating includes a variety of foods, including those eaten for pleasure. When favorite foods are no longer forbidden and can be enjoyed without guilt, there is less drive to overeat them.
When deprivation is no longer a factor, participants naturally gravitate toward balanced eating when supported by education and personal experience regarding the effects that different foods have on their body, mood, and energy level.8
How do I eat?
Many people eat quickly and/or while distracted by other activities such as watching television, driving, or working, setting the stage for overeating. Individuals who practice eating mindfully using the Mindful Eating Cycle model learn to eat with more purpose and awareness.
This often includes setting an intention for how full they want to be when they're finished and devoting the necessary attention to eating required to notice the food and its effects on their body.
By exploring the relationship between the many decisions that are made about eating, participants learn strategies for becoming more mindful before, during, and after eating. In addition, as they experience the benefits of eating mindfully, they often transfer these concepts to other areas of their lives including their work, relationships, and self-care.
How much do I eat?
In our modern food-abundant environment, deciding how much food to eat is a critical skill. Most weight loss programs use external, control-based methods such as measuring food and counting calories or points. These behaviors consume an unsustainable amount of time and energy and transform eating into a mechanical experience that feels disconnected from one's internal signals.
Through mindfulness training, individuals learn to determine the appropriate amount to eat by paying attention to internal cues and clarifying situational goals. They learn that when the amount of food they eat aligns with the amount of fuel their body needs, they feel better, more satisfied, and are able to more effectively meet their long term health and quality of life goals.
Where do I invest my energy?
Widespread messages about "calories in, calories out" lead many individuals to equate exercise with punishment for eating or earning the right to eat. In addition, other factors such as lack of time, low energy, or physical discomfort contribute to negative associations and avoidance of physical activity.
The non-diet approach incorporates a personalized, small steps approach to physical activity with the goal of rediscovering joy and vitality in movement. Beyond eating and movement, mindfulness and the weight-neutral paradigm foster a comprehensive approach to well-being that includes emotional, spiritual, intellectual, and physical health.
As individuals are liberated from a consuming focus on food and weight and develop mindfulness skills, their energy is free to invest in their lives and their work.
About the Authors
Michelle May, M.D. is the founder and CEO of Am I Hungry? Mindful Eating Programs and Training (www.AmIHungry.com), an innovative company that empowers individuals to take charge of their decisions about eating, physical activity, health, and self-care. She is the award-winning author of the Eat What You Love, Love What You Eat book series.
She will be a featured speaker at Employer Healthcare Congress in Washington, D.C. in September 2016.Rebecca Johnson M.S. is the Director of Workplace Wellness for Am I Hungry? Mindful Eating Programs and Training (www.AmIHungry.com).
Spanning more than two decades, her career in the wellness industry has included roles in coaching, health education, corporate wellness management, business development, and consulting.
References
1. Tylka, T., et al. (2014). The Weight-Inclusive versus Weight-Normative Approach to Health: Evaluating the Evidence for Prioritizing Well-Being over Weight Loss. Journal of Obesity. doi:10.1155/2014/983495
2. Mattke, S., et al. (2013). Workplace Wellness Programs Study. RAND Corporation, Santa Monica, CA.
3. The Look AHEAD Research Group (2013). Cardiovascular Effects of Intensive Lifestyle Intervention in Type 2 Diabetes. New England Journal of Medicine, 369, 145-154. doi: 1056/NEJMoa1212914
4. Koster-Rasmussen, R., et al. (2016). Intentional Weight Loss and Longevity in Overweight Patient with Type 2 Diabetes: A Population-Based Cohort Study. http://dx.doi.org/10.1371/journal.pone.0146889
5. Rosenbaum, M. & Leibel, R. (2010). Adaptive thermogenesis in humans. International Journal of Obesity, 34, S47 S55.
6. Sumithran, M., et al. (2011). Long-Term Persistence of Hormonal Adaptations to Weight Loss. New England Journal of Medicine, 365, 1597-1604.
7. Polivy, J. (1996). Psychological consequences of food restriction. Journal of the American Dietetic Association, 96(6), 589-92.
8. A Non-Diet Approach to a Sustainable Healthy Lifestyle. Available at: http://www.amihungry.com/pdf/Non-Diet-Approach-to-Sustainable-Healthy-Lifestyles.pdf
9. Bush, H., Mintz, L., Rossy, L. & Schopp, L. (2014). Eat for Life: A Work Site Feasibility Study of a Novel Mindfulness-Based Intuitive Eating Intervention. American Journal of Health Promotion, 28, 380-388.
10. Am I Hungry Mindful Eating Programs and Training. (2014). Mindful Eating: Shifting the Focus from Weight to Well-being. Phoenix, AZ: Am I Hungry? Publishing. Available at http://amihungry.com/mindful-eating-white-papers/
11. Robision, J. (2014). Weight at the Workplace, Part 1: Shifting the Paradigm: Health For Every Body�. Available at: https://salveopartners.com/free-resources/
12. Grossman, R. (2004). Countering a Weight Crisis. Available at: http://www.shrm.org/publications/hrmagazine/editorialcontent/pages/0304covstory.aspx
13. Lewis, A., Khanna, V. & Montrose, S. (2015). Employers Should Disband Employee Weight Control Programs. American Journal of Managed Care, 21(2), e91-e94.
14. Bacon, L. & Aphramor, L. (2011). Weight Science: Evaluating the Evidence for a Paradigm Shift. Nutrition Journal, 10:9.
15. Bacon, L., Stern, J., Van Loan, M. & Keim, N. (2005). Size acceptance and intuitive eating improve health for obese, female chronic dieters. Journal of American Dietetic Association, 105, 929-936.
16. Mann, T., et al. Medicare�s search for effective obesity treatments: Diets are not the answer. American Psychologist, 62, 220-233.
17. Schaefer, J. & Magnuson, A. (2014). A Review of Interventions that Promote Eating by Internal Cues. Journal of the Academy of Nutrition and Dietetics, 114, 734-760.
18. Smith, T. & Hawks, S. (2006). Intuitive eating, diet composition and the meaning of food in healthy weight promotion. American Journal of Healthy Education, 37, 130-136.
19. Kristeller, J.L., Hallet, C.B. (1999). An exploratory study of a meditation-based intervention for binge eating disorder. Journal of Health Psychology, 4, 357-363.
20. Smith, B., Shelley, B., Leahigh, L., & Vanleit, B. (2006). Preliminary study of the effects of a modified mindfulness intervention on binge eating. Complimentary Health Practice Review, 11,
21. Alberts, H., et al. (2010). Coping with food cravings: Investigating the potential of a mindfulness-based intervention. Appetite, 55, 160-163.
22. Keyworth, C. Knopp, J. & Roughley, K. (2014). A Mixed-Method Pilot Study of the Acceptability and Effectiveness of a Brief Meditation and Mindfulness Intervention for People with Diabetes and Coronary Heart Disease.� Behavioral Medicine: 40:53-64.
23. Grossman, P., Niemann, L., Schmidt, S. & Walach, H. (2004). Mindfulness-based stress reduction and health benefits: a meta-analysis. J Psychosom Res., 57, 35-43.
24. Wolever, R., et al. (2012). Effective and Viable Mind-Body Stress Reduction in the Workplace: A Randomized Controlled Trial. Journal of Occupational Health Psychology, 17, 246-258.
25. Harnett, P., et al. (2010). The short term impact of a brief group-based mindfulness therapy program on depression and life satisfaction. Mindfulness, 4, 183-188.
26. A Guide to Mindfulness at Work. Retrieved November 10, 2014 from Forbes Website: http://www.forbes.com/sites/drewhansen/2012/10/31/a-guide-to-mindfulness-at-work/
27. Alberts, H., Thewissen, R., & Raes, L. (2012). Dealing with problematic eating behaviour. The effects of a mindfulness-based intervention on eating behaviour, food cravings, dichotomous thinking and body image concern. Appetite, 58, 847-851
28. Dalen, J., Smith, B., Shelley, B., Sloan, A., Leahigh, L., & Begay, D. (2010). Pilot study: Mindful eating and living (MEAL): Weight, eating behavior and psychological outcomes associated with a mindfulness-based intervention for people with obesity. Complementary Theories in Medicine, 18(6), 260-264.
29. Kristeller, J., Sheets, V., & Wolever, R. (2013). Mindfulness-Based Eating Awareness Training (MB-EAT) for binge eating: a randomized clinical trial. Mindfulness, 5, 282-297.
30. Anderson, K. & May, M. (2012). The Mindful Eating Cycle: Treatment for Binge Eating Disorder. Doctoral Culminating Project. Arizona State University.
31. Miller, C., et al. (2012). Comparative effectiveness of a mindful eating intervention to a diabetes self-management intervention among adults with type 2 diabetes: a pilot study. Journal of the Academy of Nutrition and Dietetics, 112, 1835-42.
32. Oliver, G., Wardle, J., & Gibson, L. (2000). Stress and food choice: A laboratory study. Psychosomatic Medicine, 62, 853-865.
33. Hill, A., Weaver, C. & Blundell, J. (1991). Food craving, dietary restraint and mood. Appetite, 17, 187-197.
34. Heatherton, T., Herman, C. & Polivy, J. (1992). Effects of distress on eating: The importance of ego-involvement. Journal of Personality and Social Psychology, 62, 801-803.
35. Kayman, S., Bruvold, W. & Stern, J. (1990). Maintenance and relapse after weight loss in women: behavior aspects. American Journal of Clinical Nutrition, 52, 800-807.
36. Magnen, J. Great Britain, UK: Press Syndicate of the University of Cambridge; 1985.
37. Ciampolini, M. & Bianchi, R. (2006). Training to estimate blood glucose and to form associations with initial hunger. Nutrition and Metabolism, 3, 42.
