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Mindfulness-Based Eating Interventions for children and adolescents Caroline Baerten Dietitian - Psychotherapist ME-CL/MB-EAT / MBSR trainer The Center for Mindful eating and Nutrition (MeNu), Brussels Member of Eu. Association of Integrative

  1. Mindfulness-Based Eating Interventions for children and adolescents Caroline Baerten Dietitian - Psychotherapist ME-CL/MB-EAT / MBSR trainer The Center for Mindful eating and Nutrition (MeNu), Brussels Member of Eu. Association of Integrative Psychotherapy (EAIP) Vice-president The Center of Mindful Eating (TCME), USA MeNu. Centre for Mindful eating and Nutrition Brussels, Belgium Mobile: +32 (0)499 72 68 76 Mail: info@me-nu.org Web: www.me-nu.org

  2. Objectives  Different focal points between traditional and mindfulness-based eating interventions  What is mindfulness/mindful eating?  Rationale for mindfulness-based eating interventions  Working mechanisms of mindfulness (tools)  Family-Based Mindful Eating Program in obesitas treatment MeNu. Centre for Mindful eating and Nutrition Brussels, Belgium Mobile: +32 (0)499 72 68 76 Mail: info@me-nu.org Web: www.me-nu.org

  3. Different focal points between traditional and mindfulness-based eating interventions MeNu. Centre for Mindful eating and Nutrition Brussels, Belgium Mobile: +32 (0)499 72 68 76 Mail: info@me-nu.org Web: www.me-nu.org

  4. Question 1: Focal points of health care providers? Causes: Qualities and faculties of the mind Inner wisdom Cognitions, emotions, body awareness Eating behavior Physical expenditure Foods/nutriments -high/low caloric Outer wisdom Symptoms : weight, fat%, BMI MeNu. Centre for Mindful eating and Nutrition Brussels, Belgium Mobile: +32 (0)499 72 68 76 Mail: info@me-nu.org Web: www.me-nu.org

  5. Question 1: Focal points of health care providers? External • Dietary interventions, physical activity motivation • Cognitive behavioral approaches • Mindfulness based interventions Intrinsic • (Mindful Eating, Conscious Living program, motivation Mindfulness-Based Stress Reduction, Mindful Self- Compassion) MeNu. Centre for Mindful eating and Nutrition Brussels, Belgium Mobile: +32 (0)499 72 68 76 Mail: info@me-nu.org Web: www.me-nu.org

  6. 2e question: Why shifting the focus? Traditional weight loss interventions show gaps Healthcare providers practice evidence-based medicine => decrease the incidence of obesity and its co-morbidities -> BUT benefits have been extremely limited in youth (12-18y); Modest effect sizes (long-term), high attrition rates, low levels of compliance, regaining weight quickly • Jeffrey RW, Drewnowski A, Epstein LH, et al. Long-term maintenance of weight loss: Current status. Health Psychol 2000;19:5 – 16. • Bacon L, Stern JS, Van Loan MD, et al. Size acceptance and intuitive eating improve health for obese, female chronic dieters. J Am Diet Assoc 2005;105:929 – 936 MeNu. Centre for Mindful eating and Nutrition Brussels, Belgium Mobile: +32 (0)499 72 68 76 Mail: info@me-nu.org Web: www.me-nu.org

  7. 2e question: Why shifting the focus? Three primary psychosocial factors highly correlated with disordered eating behaviors and overweight in youth (12-18y): Psychological distress - Body dissatisfaction - Physiological distress Traditional weight loss interventions may not adequately address these important risk factors . • Neumark-Sztainer D, Wall M, Larson NI, et al. Dieting and disordered eating behaviors from adolescence to young adulthood: Findings from a 10-year longitudinal study. J Am Diet Assoc 2011;111:1004 – 1011. • Neumark-Sztainer D. Integrating messages from the eating disorders field into obesity prevention. Adolesc Med State Art Rev 2012;23:529 – 543. MeNu. Centre for Mindful eating and Nutrition Brussels, Belgium Mobile: +32 (0)499 72 68 76 Mail: info@me-nu.org Web: www.me-nu.org

  8. Mindfulness? MeNu. Centre for Mindful eating and Nutrition Brussels, Belgium Mobile: +32 (0)499 72 68 76 Mail: info@me-nu.org Web: www.me-nu.org

  9. Mindfulness “… a way of paying attention that is taught through the practice of meditation or other exercises , in which participants learn to regulate their attention by focusing non-judgmentally on stimuli such as thoughts, emotions, and physical sensations. ” Jon Kabat-Zinn (MBSR) MeNu. Centre for Mindful eating and Nutrition Brussels, Belgium Mobile: +32 (0)499 72 68 76 Mail: info@me-nu.org Web: www.me-nu.org

  10. Mindful eating is … Intentional, non-judgmental and caring awareness of our moment to moment experience before, during and after eating. Jan Chozen Bays, M.D. (ME-CL) MeNu. Centre for Mindful eating and Nutrition Brussels, Belgium Mobile: +32 (0)499 72 68 76 Mail: info@me-nu.org Web: www.me-nu.org

  11. INTENTION ATTENTION ATTITUDE MeNu. Centre for Mindful eating and Nutrition Brussels, Belgium Mobile: +32 (0)499 72 68 76 Mail: info@me-nu.org Web: www.me-nu.org

  12. Cradled at the Table MeNu. Centre for Mindful eating and Nutrition Brussels, Belgium Mobile: +32 (0)499 72 68 76 Mail: info@me-nu.org Web: www.me-nu.org

  13. Mindful Eating is… bringing attention & awareness to all aspects of eating MeNu. Centre for Mindful eating and Nutrition Brussels, Belgium Mobile: +32 (0)499 72 68 76 Mail: info@me-nu.org Web: www.me-nu.org

  14. Mindful Eating Paradigm Shift Traditional weight interventions Mindfulness-based Food, nutritional facts All aspects of eating Individual Relational Weight focus Mind focus Outcome focused Process Quick fix Slowing down Emotions less included Connect with mind-body /feelings Numbers Seeing the reality as it is, holistic Anxiety/stress/guilt Acceptance + compassionate MeNu. Centre for Mindful eating and Nutrition Brussels, Belgium Focus on what is wrong Focus on what is working Mobile: +32 (0)499 72 68 76 Mail: info@me-nu.org Web: www.me-nu.org

  15. Rationale for mindfulness-based interventions The mind-body gap  Many factors out of our control ( Genetical, hormonal, neurological, obesogene environment)  However, we can change the relationship children have with foods, body and weight MeNu. Centre for Mindful eating and Nutrition Brussels, Belgium Mobile: +32 (0)499 72 68 76 Mail: info@me-nu.org Web: www.me-nu.org

  16. ‘Release’ by Julie Bayer Salzman & Josh Salzman https://vimeo.com/170687659 “Mindfulness helps us to choose how to respond instead of to react” MeNu. Centre for Mindful eating and Nutrition Brussels, Belgium Mobile: +32 (0)499 72 68 76 Mail: info@me-nu.org Web: www.me-nu.org

  17. Dysregulation model = basis for mindful eating interventions Energy Caloric intake expenditure Physical too high too low Dysregulation Environmental Emotional model Cognitive MeNu. Centre for Mindful eating and Nutrition Brussels, Belgium Mobile: +32 (0)499 72 68 76 Mail: info@me-nu.org Web: www.me-nu.org

  18. Expand the focus on WHAT (food intake) to HOW (eating behavior) Children: 1.6 – 6.5 years Baby-led approach = effective to regulate food intake  Lower BMI – more satiety responsiveness  Preference for foods like carbohydrates (potatoes, bread) Versus spoon-fed infants  Higher BMI  Preference for sweet foods • Brown A, Lee M. Early influences on child satiety responsiveness: the role of weaning style. Pediatr Obes. 2015;10:57-66. • Townsend E et al., Baby knows best? The impact of weaning style on food preferences and body mass index in early, BMJ Open Nutr & metabolism,2012 MeNu. Centre for Mindful eating and Nutrition Brussels, Belgium Mobile: +32 (0)499 72 68 76 Mail: info@me-nu.org Web: www.me-nu.org

  19. Sensory exploration with foods Challenges • Developing a “relationship” with new foods (10-15 times) • Exploring tastes & textures • Tastes can change over time and then change back again.. MeNu. Centre for Mindful eating and Nutrition Brussels, Belgium Mobile: +32 (0)499 72 68 76 Mail: info@me-nu.org Web: www.me-nu.org

  20. Young children are natural mindful beings… Supportive conditions  Trust in their self-regulation (and cellular hunger): • Eating when hungry, stopping when full and food choices  Division of Responsibility (Ellyn Satter) • The parent is responsible for what, when, where . • The child is responsible for how much and whether .  Setting a good example • Parental modeling more powerful than parental control • Dickens, E and Ogden, J. (2014). The role of parental control and modelling in predicting a child’s relationship with food after they leave home: a prospective study. Appetite, 76; 23-29. MeNu. Centre for Mindful eating and Nutrition Brussels, Belgium Mobile: +32 (0)499 72 68 76 Mail: info@me-nu.org Web: www.me-nu.org

  21. Working mechanisms of mindfulness for children and adolescents (tools) ‘Release’ by Julie Bayer Salzman & Josh Salzman https://vimeo.com/170687659 “Mindfulness helps us to choose how to respond instead of to react” MeNu. Centre for Mindful eating and Nutrition Brussels, Belgium Mobile: +32 (0)499 72 68 76 Mail: info@me-nu.org Web: www.me-nu.org

  22. 3 key therapeutic factors with mindfulness • Experiential acceptance as a positive coping skill for controlling responses to psychological distress; • self-regulation through developed awareness of the emotional and physical cues to eat; • compassion as a way to cultivate self-acceptance and body satisfaction. MeNu. Centre for Mindful eating and Nutrition Brussels, Belgium Mobile: +32 (0)499 72 68 76 Mail: info@me-nu.org Web: www.me-nu.org

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