Learning to make healthier food choices

Sophie Waldron | 3 MAY 2018

If you haven’t already, read Sophie’s first article ‘Learn, eat, repeat: how food advertising works’!

You are sitting down at a desk and a huge burger comes floating towards you. It gets bigger and bigger as it advances, faster and faster. Luckily, you know what you have to do. Don’t press anything on your computer, and the burger will go away.

This isn’t some dystopian reality where burgers are our new overlords. It’s a computer task that can help people make healthier food choices. In the task, which people can also engage with on their smartphones as an app, participants have to prevent a learnt response to unhealthy food items.

People are first trained to press certain computer keys every time certain images of healthy and unhealthy food come on screen. Then in a subsequent phase participants have to press keys to every picture on screen except to pictures of unhealthy food. Helpfully, a prompt comes with pictures of healthy food, warning people not to respond.

This task may seem simple, but it is designed to help people mentally tackle automatically activated learnt responses to obtain unhealthy food. We live in what scientists call an ‘obesogenic’ environment, where high calorie food is abundant and pushed on us through advertising. Research has shown that learnt associations between pictures (such as a brand logo) and tasty food can make us reach for that food even when we are full (Watson et al., 2014)! In such a world we learn to respond to the attractively colored logo-dripping packets of fast food and eat them, rather than thinking carefully about which foods benefit us. Inhibiting learnt key press responses to food might give us the cognitive skills to think twice about automatically reaching for a chocolate bar.

The unhealthy food inhibition task was designed by Lawrence and her team in 2015. They investigated whether preventing an automatic key press response to unhealthy food pictures would reduce consumption of unhealthy foods in people’s everyday lives. It was found that the task reduced self-reported snacking for up to 6 weeks. This holds many possibilities. If people can make healthier choices based on one lab session, it is likely that they can be healthier for much longer if they could carry on with the task on a regular basis as part of a smartphone app.

Another avenue for treating overeating is mindfulness. Mindfulness practice cultivates experiencing the present external and internal environment, including sensory influx and the thoughts and feelings we have. Mindfulness eating practice focuses on the experiential qualities of food, taste, texture, and our feelings of satiety. There has been evidence that incorporating mindfulness eating into one’s life reduces self reported measures of binge and emotional eating (Alberts et al 2012), consumption of sweets (Mason et al., 2015), and BMI (Tapper et al., 2009).

Currently the mechanism by which mindfulness eating leads to healthier food consumption is unknown. Mindfulness has been found to decrease self-reported body image concern in healthy women with disordered eating (Alberts et al 2012), which may lead these women to eat healthier. However there is a problem that runs through this research: self-report.

Self-report is practical, experimenters could not follow around participants every day for 6 weeks prior to testing and write down exactly what they ate, so instead they ask them to keep a food diary. However self-report studies give an indirect measurement of the dimension experimenters are focusing on, and thus conflate actual changes in behaviour with changes in reporting about a certain behaviour. For example in the study on body image and mindfulness eating, it could be that reduced body image concern actually results in healthier and more natural eating. Yet it also could be that women eat the same but interpret this eating as healthier because of their more positive self-image. Self-report cannot distinguish these possibilities.

Another way in which mindfulness eating may trigger healthier choices is by increasing the flexibility of learning about reward and punishment. It has been claimed that obesity might be due to an inflexibility in this kind of learning, as once people have learned that a food is tasty (and thus rewarding) they may eat too much of it despite the undesirable consequences overeating brings, such as feeling too full or being overweight. In other words, they fail to change their overeating behaviour even when it leads to something unpleasant, a punishment. Janessen and colleagues (2018) found that time invested in mindfulness eating correlated positively with good performance on a task where participants had to quickly learn that a previously rewarded item was now punished, and vice versa. This hints that mindfulness eating could arm people with the cognitive flexibility required to overcome compulsive automatic eating patterns.

Further research will have to look at the long-term health consequences of mindfulness eating practice, and apps that train us to inhibit automatically reaching for unhealthy food. Yet studies so far are promising! Both these tools, and others, will be essential in catching up with the explosion of accessible high calorie food and food advertisement in the modern world.

Interested in the science of obesity and how we can tackle it? A recent BBC documentary ‘The Truth About Obesity‘ covers some strategies, including a study looking at the effectiveness of using apps to train better eating behaviours, filmed at CUBRIC

Interested in the effect of mindfulness on the brain? Check out our previous article: ‘The Neuroscience of Mindfulness: What Happens When We Mediate?’

Edited by Jonathan Fagg

References:

  • Alberts, H. J. E. M., 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.
  • Janssen, L. K., Duif, I., Loon, I., dv Vries, J. H. M., Speckens, A. E. M., Cools, R & Aarts, E. (2018). Greater mindful eating practice is associated with better reversal learning. Scientific Reports, 5702.
  • Lawrence, N. S., O’Sullivan, J., Parslow, D., Javaid, M., Adams, R. C., Chambers, C. D., Kos, K., Verbruggen, F. (2015). Training response inhibition to food is associated with weight loss and reduced energy intake. Appetite, 17-28.
  • Mason, A. E. et al. (2015). Effects of a mindfulness-based intervention on mindful eating, sweets consumption, and fasting glucose levels in obese adults: data from the SHINE randomized controlled trial. J. Behav. Med. 1–13.
  • Tapper, K. et al. (2009). Exploratory randomised controlled trial of a mindfulness-based weight loss intervention for women. Appetite 52, 396–404.
  • Watson, P., Wiers, R. W., Hommel, B., & Wit, S. (2014). Working for food you don’t desire. Cues interfere with goal-directed food-seeking. Appetite, 139 -148.

The Neuroscience of Mindfulness: What Happens When We Meditate?

Joseph Holloway | 3 APR 2017

Joe is a guest writer for The Brain Domain, and is currently pursuing an MSc in Mindfulness-based Cognitive Therapies and Approaches, as well as an MA in 18th Century Literary Studies, at the University of Exeter.

‘Mindfulness’ is a word that has gathered momentum over the last decade. It has grown beyond associations of yoga and alternative therapies and moved into the realms of corporate culture, education, and mental health. Mindfulness has become such a prevalent aspect of our culture that there was even a Ladybird Books for Grown-Ups dedicated to it. When a phenomenon becomes this prominent and when it enters such fundamental spheres of our lives it is good to review its evidence base. What is Mindfulness meditation? How is it employed in a therapy context? What happens in the brain when we meditate? What evidence do we have that it is effective? This article attempts to answer these questions.

A Brief History of Mindfulness and Therapy

Firstly, what is Mindfulness? The term has an interesting history of development (Analayo, 2006, pp. 15-41) that is beyond the scope of this article, but a commonly accepted contemporary definition is: “moment-to-moment awareness” (Kabat-Zinn, 1990, p.2). Participants deliberately pay attention to thoughts, feelings, and sensations in the body, bringing their mind back to the task at hand when it wanders. This form of meditation is entrenched in many of the oldest religions and can be traced back to early canonical buddhist texts such as the Satipaṭṭhāna-sutta and the Mahāsatipatṭhāna Sutta. Contemporary Western understandings of Mindfulness meditation are a repackaging of the teachings of these texts in a secular context. They focus on the insights about the workings of the mind and the teachings on how to reduce the amount of distress that we cause ourselves.

A key example of such repackaging was Jon Kabat-Zinn’s Mindfulness Based Stress Reduction (MBSR) course originally developed at MIT in the 1970’s. This is an 8 week group course teaching participants how to engage with Mindfulness meditation and is open to all that feel (i) that they have too much stress in their lives, or (ii) that they are not relating to their stress healthily. In the 1990’s Mark Williams, John Teasdale and Zindel Segal combined Kabat-Zinn’s successful model with Beck’s Cognitive Behavior Therapy (CBT) to create a more specialised programme called Mindfulness-based Cognitive Therapy (MBCT). This programme is specifically designed to treat recurrent depression, and largely only open to those referred by their primary medical consultant. These two arms, the general MBSR and the specific MBCT, are the constituents of the Mindfulness-based interventions available on the NHS in the UK and through other providers around the world. They are widely used both as complementary and sole treatments for a variety of mental and physical health diagnoses including depression, generalised anxiety disorder, post-traumatic stress disorder, insomnia and eating disorders.

What evidence is there that Mindfulness is effective?

The effectiveness of Mindfulness-based interventions has been demonstrated through longitudinal studies, tracking the same people over time. An important early example found depressive participants in the MBCT programme to have half the amount of relapses one year after treatment compared to depressive participants that had treatment as usual (Teasdale et al, 2000). This finding was reinforced by the replication trial (Ma and Teasdale, 2004) concluding that there is ‘further evidence that MBCT is a cost-efficient and efficacious intervention to reduce relapse/recurrence in patients with recurrent major depressive disorder’ (ibid, p. 39). In these studies, the pool of participants in recovery from depression were randomly allocated into either the experimental or the control group. This was done by an external statistician and participants were matched for ‘age, gender, date of assessment, number of previous episodes of depression, and severity of last episode’ (ibid, p. 32). The results were important confirmation for the effectiveness of Mindfulness-based Interventions as therapy.

Whilst this was great news, it wasn’t until 2008 that Mindfulness-based interventions were compared to the gold standard for treatment of recurrent depression (Kuyken et al, 2008). This is maintenance antidepressive medication (m-ADM), requiring the participant to take antidepressive medication even when there are no indications of a relapse. Importantly, the 2008 study found that patients treated with MBCT were less likely to relapse than those treated with the gold standard after 15 months (47% compared to 60% of the m-ADM group). This was also replicated in a follow up study (Segle et al, 2010) where MBCT was compared against m-ADM and also against a placebo. Once participants were in remission they were given either MBCT, m-ADM or discontinued their active medication and given a placebo. Participants for all groups were randomly distributed by an external statistician, ensuring a close control on factors not being investigated. The MBCT and m-ADM group here showed the same levels of prevention from recurrence (73%), both much higher than the placebo group. Over a short term (15 months) Mindfulness-based interventions were thus shown to be better than m-ADM, and equally effective over an even longer period. In addition, it is arguably cheaper to administer Mindfulness-based interventions than m-ADM, there are no issues with drug tolerance, and unlike many antidepressants Mindfulness meditation can be utilised whilst pregnant or breastfeeding.

How does Mindfulness work?

When the brain is not responding to any particular task and is ‘at rest’, areas collectively known as the Default Mode Network (DMN) are activated (Berger, 1929), (Ingvar, 1974), (Andreasen et al, 1995).  This was found to be closely associated with mind wandering (Mason et al, 2007). It was also found it to be consistent with “internally focused tasks including autobiographical memory retrieval, envisioning the future, and conceiving the perspectives of others ” (Bruckner, 2008, p. 1). When our mind is wandering and not focused on a task we are normally either lost in personal memories or running through a scenario in our head, predicting, anticipating or worrying.

More frequent and more automatic activation of this network is associated with depressed individuals (Greicius et al, 2007); (Zhang et al, 2010) (Berman et al, 2011). Regularly wallowing in old memories or worrying about the future are perfect foundations for conditions that may lead to depression. These two functions, conducive to ‘living on autopilot’’, are the exact opposite to the definition of Mindfulness meditation given above: “moment-to-moment awareness.” Indeed, studies have shown that activation of the DMN can be regulated by Mindfulness meditation (Hasenkamp et al, 2012). Participants were observed meditating, and whenever they noticed their mind wandering they had to press a button. Immediately before this action the participants were unconsciously mind wandering. When the participants noticed that their mind had wandered, (indicated by the button press) the researchers regularly observed a deactivation of the DMN. The act of practising mindfulness-meditation was here regularly associated with a deactivation of the DMN.  A correlation between self-reported meditation experience and lower levels of DMN activation was also observed (Way et al, 2010).

Of course, the brain is never ‘doing nothing’ and a counter-network was regularly activated when participants weren’t mind-wandering: when they were paying attention to a task. This network in part consists of the anterior cingulate cortex (ACC), which is known to be instrumental in task monitoring (Carter et al, 1998). Activation of the ACC is closely associated with ‘executive control’ (Van Veen & Carter, 2002, p. 593) which detects incompatibilities or conflicts between a predicted outcome, and the observed reality. In this way the ACC functions as error-reporting or quality management. The ACC does not attempt to remedy the situation, but instead highlights it to other areas of the brain. This all happens before the subject is cognitively aware that there is a conflict.

Crucially, an association has been shown between meditation and activation of the ACC. A positive correlation between AAC thickness and meditation experience (Grant et al, 2010) and between mindfulness meditation and activation of the ACC (Zeidan et al, 2013), has been demonstrated. Mindfulness meditation is reliably shown to activate the ACC and improve the relative ease and likelihood of it being activated. Activation of the ACC prevents the mind from wandering, and prevents activation of the DMN. Mind wandering and activation of the DMN is related to depressive symptoms either developing or recurring. This is how Mindfulness-based interventions are thought to help those at a neurological level.

Conclusions

Mindfulness meditation has been around for 3500 years. It has been utilised in the West for nearly 40 years. We have had good evidence that it works for nearly 20 years but we are only just starting to explore how it works. The recent findings above help outline the process of change that the brain goes through whilst a regular Mindfulness-meditation practise is established, but they are by no means the full picture. We are also investigating how Mindfulness meditation facilitates people to more regularly respond instead of instinctively react. We are investigating how Mindfulness meditation enables decentering, and how it reduces the connectivity to the emotional areas of the brain. Research into the nuts and bolts of Mindfulness has never been so intense, and exciting results just like those depicted in this article are sure to arise soon.

Joe teaches a 10 week course devised by the Mindfulness in Schools Project (see details here). He teaches all levels and abilities, from College to University, and finds that it has had an overwhelmingly positive impact on level of well-being, achievement, and attendance of his students. If this is something that interests you, he can be contacted at joseph.c.holloway@gmail.com is now taking bookings for autumn term 2017, and for 2018.

Edited by Jonathan Fagg and Rachael Stickland

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