A peer-reviewed, evidence-based journal that promotes clinical development and metabolic insights in total bariatric patient care for the healthcare professional
Issue link: https://bariatrictimes.epubxp.com/i/260356
8 Review Bariatric Times • February 2014 Continued from Page 1 Examples of this can be found in a 12-month study of 129 bariatric patients that looked at uncontrolled eating and grazing. One year post- laproscopic adjustable band surgery (LAGB), 22.5 percent of the subjects reported feelings of loss of control during the consumption of a subjectively or objectively large amount of food. They had significantly lower weight loss, consumed a higher than usual energy intake and percentage of energy as fat, and ate more often over the period of a day. They reported less dietary restraint and greater hunger and disinhibition. They reported eating in response to emotional triggers, ignoring satiety cues, and difficulty maintaining behavior change. Symptoms of depression were higher, and mental health-related quality of life was poorer compared to the remainder of the cohort. Additionally, 94 percent of patients with preoperative grazing continued to report this eating pattern after surgery. 10 In a small study measuring patient adherence, of patients "who failed to modify their eating behavior on the advice of two or more health professionals," 89 percent reported overeating in response to emotional triggers and 78 percent reported grazing. 11 Some patients may believe that if they have bariatric surgery they will not need to think about their eating anymore. 11 In fact, long-term success after bariatric surgery requires just the opposite: patients need to become very mindful about eating in order to use their surgery optimally to develop and maintain a healthy lifestyle. If they are not mindful, they may suffer from uncomfortable, even serious consequences—and are less likely to achieve the expected results. Even patients who have a more realistic understanding of the complexities of life after bariatric surgery may find that their postoperative meal plan feels like a permanent diet that continues to consume their attention and energy. MINDFUL EATING Mindful eating is emerging as a universal approach for addressing various eating-related issues including binge eating, diabetes, and obesity. 12–17 The ancient concept of mindful eating may help prevent, identify, and resolve maladaptive eating and other problems in people who are having difficulty adjusting to life after bariatric surgery. A simple definition of mindful eating is eating with intention and attention—or eating with purpose and awareness. Mindfulness is beneficial because it teaches individuals to focus their intention and attention on what is happening in the present moment, which, in turn, helps them disengage from habitual, unsatisfying, and unskillful h abits and behaviors. 1 8 Mindful eating skills may address many of the behavioral problems commonly seen after bariatric surgery. 9 These problems include the following: • Eating too quickly, taking large bites, not chewing thoroughly • Eating while distracted, leading to overconsumption • Not savoring food and, therefore, having difficulty feeling satisfied with small volumes of food • Eating too much, leading to discomfort, vomiting, and/or distention of the pouch • Grazing or frequently eating small amounts of food • Consuming high-calorie soft foods and liquids that do not provide satiety • Emotional eating or eating for affect regulation • Continuing to consume certain foods despite dumping syndrome • Preoccupation with food • Not consuming enough protein and other nutrient-rich foods • Struggling to establish consistent physical activity • Feeling deprived, guilty, or left- out in social situations • Weight regain and weight cycling THE MINDFUL EATING CYCLE The Mindful Eating Cycle incorporates the essential elements of mindful eating and offers a structure that is helpful for the clinician and patient alike. 19 The remainder of this article describes six specific questions that guide the patient through the entire decision- making process. This structure can be used in pre- and postoperative educational and support settings. Why do I eat? Understanding why individuals make certain decisions about eating is essential because although patients may initially lack awareness or insight, the underlying reason they are eating will affect every decision that follows. For example, if a person is e ating in response to environmental or emotional cues, such as stress, boredom, or socializing, he or she is more likely to choose foods that are convenient, energy dense, and highly palatable. 20 He or she may be more likely to eat an excessive amount of food or graze continuously because eating does not adequately address the underlying trigger. A study of 40 women examined the role of experimentally induced stress on food choice. Highly stressed women were shown to prefer sweet and high-fat foods, while those in the low-stress condition ate more low-fat foods. 20 When do I eat? Research has demonstrated that normal-weight individuals are more likely to eat in response to internal cues like hunger, whereas people who are overweight tend to eat in response to other cues. 21 Hunger is a primitive yet reliable method of regulating dietary intake and awareness of hunger cues can be relearned. 2 2 Immediately after bariatric surgery, hunger signals may be absent for a period of time, requiring the patient to follow external cues for eating and reminders. As hunger cues return, they can begin to use hunger like a fuel gauge to let them know when to eat. It is important to differentiate true physical hunger from other environmental and emotional cues by identifying physical symptoms, such as a growling stomach, difficulty concentrating, and irritability. 16 Patients often discover that waiting to eat until they are sufficiently hungry increases satisfaction, while grazing or waiting until they are overly hungry may lead to overeating. Environmental and emotional cues can also trigger an urge to eat ABSTRACT The challenges posed by a food-abundant environment, social and emotional connections to food, chronic ineffective dieting, and disordered eating may not resolve with bariatric s urgery. Offering a structured approach for learning mindful eating skills using the Mindful Eating Cycle may help bariatric surgery patients gain insight into why, when, what, how, and how much they eat and where they invest their energy. The addition of mindful eating skills to the clinicians' and patients' toolbox provides conscious decision- making strategies and sustainable lifestyle changes over time. KEYWORDS bariatric surgery, emotional eating, grazing, maladaptive eating, mindful eating The Mindful Eating Cycle: Preventing and Resolving Maladaptive Eating after Bariatric Surgery by MICHELLE MAY, MD; MARGARET M. FURTADO, MS, RD, LDN; and LISBETH B. ORNSTEIN, PhD Bariatric Times. 2014;11(2):8–12. May_Template 2/12/14 2:32 PM Page 8