6/12/16: Debra Gill, Ph.D.

Dr. Debra Gill on Mindful, Responsive Eating

By Lynn Mollick

On June 12, Livingston psychologist and NJ-ACT member Debra Gill, Ph.D. presented “Mindfulness-Based CBT for Weight Management and Binge Eating.” This approach includes three components:

1. Mindfulness of hunger/fullness sensati-4ons
2. Responsive eating: Stopping and starting eating in response to hunger/fullness sensations
3. Mindfulness of the food in your mouth: Debra began by reminding her audience that “diets don’t work.”

People lose weight on any diet, but a few years later they almost always gain it back. But when people observe the three components of mindful, responsive eating, their weight gravitates toward its natural level.

Mindfulness of hunger/fullness sensations

Debra teaches patients to use a 9-point continuum to monitor their appetite, from hunger at one end of the continuum through fullness at the other end.

1 = Sick from extreme hunger
2 = Very hungry, uncomfortable
3 = Hungry, still comfortable
4 = Slightly hungry
5 = Not hungry, not full
6 = Slightly full
7 = Comfortably full
8 = Very full, uncomfortable
9 = Sick from extreme fullness

Patients should be mindful of their sensations of hunger/fullness and commit to eating in response to them. Here are some signs that will help patients distinguish real hunger from false, emotional hunger:

1. In the belly, there is pulling, growling, pressure, churning.
2. Energy levels are diminished.
3. Mood may become irritable and thinking somewhat confused.
4. Any food seems appealing when you’re hungry, but only unhealthy foods are appealing when you’re not hungry.

Responsive eating: Patients should start eating at level 3 and stop at level 7.

Learning to eat in response to hunger takes about 15 to 20 meals. Training techniques include:

1. Practice when hungry.
2. Sample tasty foods or foods that are usually eaten to excess, but start with half of a normal portion.
3. Put utensils down after each bite.
4. Be mindful of appetite before and after each mouthful.

Debra emphasized that responsive eating is a form of self-compassion; eating to excess elicits guilt and disgust.

Mindful eating

Before eating, take 6 to 10 mindful breaths to relax and be ready to eat mindfully.

How does the food look? What colors do you see? Enjoy the presentation. Smell each mouthful before you put it in your mouth. Smelling food enhances flavor and increases pleasure.

Observe sensations, thoughts and feelings before, during and after each mouthful.
How does the food feel in your mouth?
How does the food taste? Is it sweet, salty, bitter or sour, hot or cold. Most important: slow down. savor, and obtain pleasure from every bite.

If you have limited time, don’t rush to finish. Instead, eat only as much as you can eat slowly and mindfully. Put the remainder of your food aside for later.

To eat mindfully in the company of others, alternate between social interaction and mindful eating. Do not eat while you are talking or listening.

If your attention wanders, bring it back to sensations in the mouth.

Mindfulness meditation teaches the foundational skill of present awareness without judgment. Eating mindfully and enjoying your food eventually leads to eating less and making better food choices.

What prevents mindful, responsive eating?

1. Distractions. Reading, watching TV, talking, and using the computer all prevent mindful, responsive eating and should be limited.

2. Environmental cues that increase amounts eaten: too many food choices available, food being in sight or easily available, large portion sizes, large plates and utensils, companions who put a lot of food on their plates. All of these environmental influences are out of awareness but increase food intake.

3. Emotional eating. Use mindfulness to manage non-hunger urges to eat (emotional eating). Overeating is sometimes a way to escape and/or avoid unpleasant feelings. Wanting a lot of a particular calorie-dense food is an indication of emotional eating. One should be able to eat one or two cookies and be satisfied.

Addressing binge eating:

Society’s overemphasis on shape and weight suggests that everyone can achieve their desired, slender size.

Restrictive dieting and rule-bound eating lead to bingeing and sometimes to purging as well. When people violate their dieting rules, they may lose all control.

1. Practice the STOP method: S=Stop; T=Take Three mindful breaths; O=Observe sensations of the urge, hunger and fullness; P=Pay attention to sensations.

2. Choose a competing activity and practice DBT’s “One-Mindfully” technique: Perform an activity that competes with eating and notice sensations created in all 5 senses – for example, brush your hair, listen to music, put on hand lotion, or play with silly putty.

3. Engage in physical activities that change sensations in the body, e.g. do one minute of intense exercise, stretching, rocking, or leaning over and touching the floor with bent knees. This directs blood to the head and reduces emotional urges to eat.

4. Shock the body into a different physical state. Hold a frozen orange or ice cube, splash cold water on your face.

5. Engage in social or recreational activities.

6. Clean, organize or shop. Be prepared to cope with urges by making a list of possible alternate activities.

7. Leave the triggering situation.

8. Eat every 3 or 4 hours even when unaware of hunger to avoid becoming ravenous and bingeing.

Exercise: Regular physical exercise is one of the best things for physical and emotional health. Debra encourages exercise, but separates it from weight loss.

Regarding weight, Debra asserted that a person’s healthiest weight is where the body settles after an extended period (6 to 36 months) of mindful, responsive eating and regular, enjoyable exercise (4 to 6 times per week.) Diets just don’t work.

Continuing Education in Empirically-Supported Psychotherapy