1. Sandy Arner, RD, LDN Clinical Dietitian/Nutritionist James H. Quillen VA Medical Center Primary Care Conference, March 28, 2012

2. Unapproved/Investigative Drugs Financial Interest  I, Sandra Arner, DO NOT anticipate discussing the unapproved/investigative use of a commercial product/device during this activity or presentation.  I, Sandra Arner, DO NOT have a financial interest/arrangement or affiliation with one or more organizations that could be perceived as real or apparent conflict of interest in the context of the subject of this presentation.

3.  Define mindful eating  Describe two domains of mindful eating  Explain two benefits of mindful eating  State one way to incorporate mindful eating in a visit with a patient

4.  Deliberately paying attention  Being fully aware of what is happening  Awareness without judgment or criticism

5.  Improves overall mindfulness  Is ancient mind-body practice  Helps lead to more awareness of the present moment

7.  Eating with awareness ◦ Being present for each sensation of the experience of eating ◦ Having a nonjudgmental awareness of physical and emotional sensations associated with eating Source: Eat, Drink, and Be Mindful by Susan Albers

8.  Acknowledges there is no right or wrong way to eat  Accepts one’s eating experiences are unique  Directs awareness to all aspects of food and eating  Looks at immediate choices and direct experiences associated with food and eating  Experiences insights about how one can act to achieve specific health goals, as is more attuned to the direct experience of eating and feelings of health

9.  Disinhibition  Awareness  External Cues  Emotional Responses  Distraction Source: Journal of the Academy of Nutrition and Dietetics. 2009,109:1439-44

10.  Inability to stop eating when full  Hunger/Fullness scales

11. Source: Megrette Fletcher, The Center for Mindful Eating

12. Source: www.move.va.gov

13.  Being aware of effects of food on senses  Being aware of how food affects internal states

14.  Environmental triggers that promote overeating ◦ Plate/glass size ◦ Eating from bag/box/container ◦ Eating in a group ◦ “Family-style” and buffet meal eating ◦ Having plates on or removed from table ◦ Advertising

15.  Eating in response to feelings ◦ Stress ◦ Sadness ◦ Happiness ◦ Loneliness

16.  Focusing on other things while eating ◦ Watching TV ◦ Working on the computer ◦ Talking on the phone ◦ Playing games (board games, on computer, on IPhone) ◦ Reading a book

17.  Awareness  Observation  Being in the moment  Being mindful of environment  Being nonjudgmental  Letting go  Acceptance Source Eat, Drink, and Be Mindful by Susan Albers

18. Eat, Drink & Be Mindful by Susan Albers www.choosemyplate.gov

19.  Eye  Nose  Mouth  Stomach  Cellular  Mind  Heart Source Mindful Eating by Dr. Jan Chozen Bays

20. Eating Cycle Source: Eat What You Love, Love What You Eat by Dr. Michelle May

24.  Sit comfortably in the chair.  Place a raisin in your hand.  Examine the raisin as if you had never seen it before.  Imagine it as its "plump self" growing on the vine surrounded by nature.  As you look at the raisin, become conscious of what you see: the shape, texture, color, size. Is it hard or soft?  Bring the raisin to your nose and smell it.  Are you anticipating eating the raisin? Is it difficult not to just pop it in your mouth? Kabat-Zinn, J. (2005). Coming to Our Senses. New York, NY: Hyperion

25.  How does the raisin feel? How small it is in your hand?  Place the raisin in your mouth. Become aware of what your tongue is doing.  Bite ever so lightly into the raisin. Feel its squishiness.  Chew three times and then stop.  Describe the flavor of the raisin. What is the texture?  As you complete chewing, swallow the raisin.  Sit quietly, breathing, aware of what you are sensing. Kabat-Zinn, J. (2005). Coming to Our Senses. New York, NY: Hyperion

26. Source: Using Mindful Eating to Promote Glycemic Control, Skelly Publishing

27.  A non-diet approach  Not scary  Realistic and doable  Advocates self- acceptance and body acceptance  Lasts  Compassionate and nonjudgmental  For everybody  Provides clarity  Holistic  Works

28. Weight Management Matters, Academy of Nutrition and Dietetics, Vol. 7, No. 4, Spring 2010 Using Mindful Eating in a Clinical Setting

29. Weight Management Matters, Academy of Nutrition and Dietetics, Vol. 7, No. 4, Spring 2010 Using Mindful Eating in a Clinical Setting

30.  Carolyn has diabetes. She has seen you for two visits. She has not had her A1c rechecked yet and it was 7.5% four months ago. Before, 32% of her SMBG levels were in target, and now 65% of her SMBG levels are at target. She is walking her dog for 30 minutes each day. She has lost two pounds.  Is Carolyn “successful”? ◦ What questions related to mindful eating and mindfulness could you ask her (or she ask herself) to know how she is doing?

32. What Can We Gain From Mindful Eating? From WHAT WILL YOU gain WHEN YOU LOSE WEIGHT?™ Kellogg’s Special K

33.  www.tcme.org www.tcme.org  www.mindfuleating.org www.mindfuleating.org  www.eatingmindfully.com www.eatingmindfully.com  www.comtemplativemind.org www.comtemplativemind.org  www.savorthebook.com www.savorthebook.com  www.vialean.com www.vialean.com  www.skellypublishing.com www.skellypublishing.com  www.mindfuleats.com www.mindfuleats.com  www.mindfuleating.net www.mindfuleating.net

34.  Albers, S. (2011) But I Deserve This Chocolate. Oakland, California: New Harbinger Publications, Inc.  Albers, S. (2009) Eat, Drink & Be Mindful. Oakland, California: New Harbinger Publications, Inc.  Albers, S. (2003) Eating Mindfully. Oakland, California: New Harbinger Publications, Inc.  Albers, S. (2006) Mindful Eating 101. New York, New York: Routledge Taylor & Francis Group.  Albers, S. (2009) 50 Ways to Soothe Yourself Without Food. Oakland, California: New Harbinger Publications, Inc.

35.  Bays, J.C. (2009) Mindful Eating. Boston, Massachusetts: Shambhala Publications, Inc.  May, M (2011) Eat What You Love, Love What You Eat. Oakland, California: New Harbinger Publications, Inc.  Nhat Hanh, T. (2011) Savor: Mindful Eating, Mindful Life. New York, New York: HarperOne Publishers.  Wansink, B. (2010) Mindless Eating. New York, New York: Random House, Inc.  Weil, A. (2011) The Joy of Eating Well. (CD) Boulder, Colorado: Sounds True, Inc.

38. Questions