The Mindful Diet E-Book

Ruth Wolever

• Herausgeber: Atlantic Books
• Kategorie: Lebensstil
• Sprache: Englisch

Veröffentlichungsjahr: 2015

Beschreibung

The Mindful Diet is the first book to combine health psychology with cutting-edge nutrition research to deliver an up-to-the-minute method for eating mindfully and breaking the yo-yo diet cycle. Loaded with meditation exercises, behavioural techniques, nutrition advice and meal-planning charts, this book provides the tools to avoid cravings, stop emotional overeating and figure out when you are full. Lasting weight loss and healthy living begin in the mind: now you can learn how to reprogram your body, make healthy choices, lose weight and keep it off for life.

Leseprobe

The Mindful Diet

HOW TO TRANSFORM YOUR RELATIONSHIP

WITH FOOD FOR LASTING WEIGHT LOSS

AND VIBRANT HEALTH

Proven Strategies to Change Your Habits from

Duke Integrative Medicine

Ruth Quillian Wolever, Ph.D., and

Beth Reardon, M.S., R.D., L.D.N.

with Tania Hannan

Copyright page

First published in the United States in 2015 by Scribner,an imprint of Simon & Schuster, Inc.

First published in Great Britain in 2015 by Atlantic Books,an imprint of Atlantic Books Ltd.

Copyright © 2015 by Duke University, on behalf of Duke Integrative Medicine

The moral right of Ruth Quillian Wolever, Beth Reardon and Tania Hannanto be identified as the authors of this work has been asserted by them in accordancewith the Copyright, Designs and Patents Act of 1988.

All rights reserved. No part of this publication may be reproduced,stored in a retrieval system, or transmitted in any form or by any means,electronic, mechanical, photocopying, recording, or otherwise,without the prior permission of both the copyright ownerand the above publisher of this book.

1 2 3 4 5 6 7 8 9

A CIP catalogue record for this book is available from the British Library.

Trade paperback ISBN: 978-1-78239-649-9E-book ISBN: 978-1-78239-650-5Paperback ISBN: 978-1-78239-666-6

Printed in Great Britain

Atlantic BooksAn Imprint of Atlantic Books LtdOrmond House26–27 Boswell StreetLondonWC1N 3JZ

www.atlantic-books.co.uk

Epigraphs

For the gifted practitioners at Duke Integrative Medicine who opened my mind, the clients who opened my heart, and my family—near, far, and farther—who fill it with love. May you be happy, may you be healthy, may you be safe, and may you find joy along the way.

—B.R.

For my “Best Guys,” Mark and Emma, who nourish me and sustain me, and for all the amazing clients who have generously shared their journeys with me.

—R.W.

For my mom, Evon Tefft, whose wisdom about food and health inspired a lifelong passion for both, and for my greatest joy, Stella.

—T.H.

Contents

The Mindful Diet

Copyright page

Epigraphs

Introduction

PART I – Setting the Stage for Change

1Why We Overeat

2What’s on Your Plate?

3Getting Off the Roller Coaster

PART II – Building Your Foundation

4The Practice of Change

5The Goldilocks Principle

6The Pleasure Principle

7A Cure for Emotional Eating

8A Body to Love

9Know Your Triggers

PART III – Eating for Total Health

10The Four Pillars of Healthy Eating

11How Much Food Do You Really Need?

12Reconnecting with Your Food

Conclusion: Making Change Last

Acknowledgments

Notes

Introduction

Every year, millions of Americans embark on the same quest: to lose weight and get healthy. We want more energy, we want to feel better about ourselves, and we want to live life more fully. And we know that at the core of all these changes is one roadblock: deeply ingrained eating habits. We know we need to make changes—the question is how.

There’s no shortage of simple answers out there. But simple, quick-fix solutions—in the form of conventional diets—take people on roller coaster rides that do more harm than good, damaging both health and self-esteem.

At Duke Integrative Medicine, we’ve developed a revolutionary approach to managing weight that offers real answers and leads to sustainable change. As part of the Duke University Health System and as a national leader in integrative medicine, our clinic offers a new approach to health care. People come to Duke IM from all over the country to experience world-class medicine and complementary therapies—in a model that puts our clients at the center of their own care, and ultimately their own healing. Instead of focusing on isolated conditions and symptoms, we focus on “whole-person” health, looking at all the variables that can contribute to illness and to healing—including stress levels, nutrition and exercise, relationships, and even spirituality.

As a clinical health psychologist and as an integrative nutritionist, we’ve seen in our work with hundreds of clients that changing eating habits and losing weight isn’t a simple equation of calories, pounds, and inches—and it’s not about willpower. It’s about our relationship with food, with our bodies, and with ourselves. Authentic change must come from within, and that’s the guiding ethos of our work. The content? An innovative approach that combines proven behavior-change strategies with cutting-edge nutrition research to reprogram both the mind and the body, transforming eating habits from the inside out. Instead of skim­ming the surface, the way typical diets do, our programs tap into peo­ple’s core values, the things that give them a sense of joy and satisfaction, and the goals they want to reach. And that’s why they work. People in our programs change their eating habits, lose weight, and improve their health—not just for the short term, but over time. Such lasting change is possible because people experience a new commitment to their health and to their lives—and because the skills and wisdom they gain become part of who they are.

Using a foundation of mindfulness—a meditation-based approach demonstrated to help change behavior—we guide people to practice pay­ing attention to what’s happening in their minds and bodies, moment by moment. Because we live in a culture that discourages this self-awareness, gaining it is a revelation. People in our programs learn what true physical hunger feels like, and also what they’re really hungry for. (Hint: It’s not Cheez-Its.) Instead of the culturally ingrained all-or-nothing approach to eating—in which we restrict food, “fall off the wagon,” beat ourselves up, and give up—people in our programs learn a nonjudgmental mind-set in which every moment and every meal is new. Rather than treating their bodies as objects to be criticized and whipped into shape, they learn to treat them as worthy of care. And in place of the willpower myth that diets promote, they learn concrete skills to navigate our food-filled world and make better choices.

Laura is typical of the amazing people we’ve worked with who’ve shown us that lasting change is indeed possible—with the right intention, skills, motivation, and practice. Long overweight, she had tried commercial diets for years but always boomeranged back to her starting weight, blaming herself for lacking willpower. She came to our clinic for a con­sultation after her doctor advised her to go on medication—her blood-sugar and insulin levels, which had been creeping up for two years, had moved into the danger zone.

We didn’t begin by asking Laura about her eating habits; we began by asking about her life. As with many of our clients, her life was very full— overflowing—and she liked it that way. She was an ob-gyn nurse, had two teenage daughters, and spent a lot of time helping her elderly mom. When she talked about her family and her work, there was warmth in her eyes, and it was obvious that she took pride in being the strong, car­ing center of her world—the person everyone leaned on. But her own health and well-being had been on the back burner for as long as she could remember. To keep up with her commitments, she had long ago settled into a pattern of eating “whatever’s easiest”—the glazed cinna­mon buns in the hospital cafeteria for breakfast, burritos and frozen piz­zas for lunch and dinner, and diet soda as a quick pick-me-up during her long days. She had a nagging fear of what the road ahead would look like if she didn’t change her habits—diabetes and heart disease—and when her doctor delivered the inevitable news, she was scared. As a nurse, she knew the devastating toll those conditions would take, not only on her but also on the people she loved. She wanted to change—really change— but she knew that dieting was not the answer.

While the diet industry corrals millions of women and men every year with seductive plans that promise to knock off pounds quickly and easily, most diets are counterproductive. Research shows that while people often lose weight through dieting in the short term, the vast ma­jority of dieters regain the weight—and many keep gaining. In fact, di­eting is a known predictor of weight gain. Dieting also takes people on a downward spiral emotionally, creating a cycle of success–relapse–weight gain that, when repeated, damages self-worth—which in turn under­mines healthy habits.

The four-month program we designed for Laura was unlike any diet plan she’d ever tried. We didn’t give her an eating plan and send her on her way. There were no weigh-ins, points, or calorie tracking. Instead, Laura and the rest of the participants in her group took the first step to­ward genuine change—the practice of mindfulness. By learning a med­itation practice and a set of related skills that helped them pay attention to what was happening within themselves—one that cultivated curiosity and compassion in place of judgment and self-criticism—Laura and her group were able to explore the root causes of their eating patterns: not what they ate, but why.

Laura realized, for the first time, that she had to look at her eating habits in the context of her whole life. Instead of perpetually focusing outward—on her job, on her family, on her to-do list, on a diet book, on the cinnamon rolls—she carved out time to slow down and focus on what was happening in her body and her mind. As it turned out, they had a lot to say. She practiced tuning in to her body’s hunger and fullness sig­nals, noticing her pattern of eating while stressed or exhausted, and pay­ing attention to how different foods affected her energy levels. Instead of berating herself for making “bad” choices, she simply noticed them—and was amazed to find that this didn’t amount to letting herself off the hook, but actually helped her to make better choices. She began to question the underlying thoughts that held her habits in place—including beliefs about herself (“weak-willed”), her weight (“never going to change”), and her life (“taking time for myself means letting other people down”).

We’ve seen that our mindfulness-based programs help orient our clients to a new paradigm for eating and health—one that dismantles old patterns, provides new tools for making choices, and fosters deep, internal motivation. Armed with new skills and motivation, Laura felt her relationship to food shift. Instead of viewing food as simply fuel, or using it for comfort, she began to realize how deeply her choices im­pacted her health, for better or worse, and changed her eating accord­ingly. And rather than focusing on the quantity of food she ate—calories and portions—she began focusing on the quality.

Our nutritionists teach people what different foods and beverages do in the body on a biochemical level—and how everything we consume moves us toward health or illness. As it turns out, eating for a balanced weight and eating for overall health are one and the same. If your body’s cells could talk, we like to say, they’d make their menu choices loud and clear: a whole-foods, plant-based diet—the template of global cuisines celebrated for their health benefits. Such an eating plan is the body’s best defense against obesity and the chronic illnesses that we’re susceptible to as a result of our genetics and our environment.

Laura started keeping her values and her inner wisdom at the fore­front of her mind and using those internal resources as guides when she made decisions about eating and exercise. She started eating more veg­etables, whole grains, and fish—which had the effect of “crowding out” her intake of processed foods, soda, and sweets. Once she stopped eating those former standbys, she began to lose her taste for them. Instead of grabbing whatever was easiest, she made time to plan, shop for, and cook meals—and realized that even when she had to eat on the run, she had choices. She also started choosing to walk on her lunch break, instead of working through it; she’d never felt like she had the time before, but now she made the time.

Laura stuck with these changes and her mindfulness practices long past the program’s ending—not because someone was telling her to, but because she could feel the difference it was making in her body and in her life. The changes became her new habits—who she was and how she lived. Just as steadily as they had risen, her blood-sugar and insulin levels started to drop, along with her weight, and she was able to stop taking medication. In a year and a half, she had lost 25 pounds, and her blood-sugar and insulin levels had normalized.

Our Stories: Ruth Wolever, Ph.D.

As a clinical health psychologist and Duke Integrative Medicine’s director of research, I have been working with people individually and in groups on changing their habits for more than twenty years—and studying what works best. It’s a given in my field that changing deeply ingrained habits such as overeating requires looking at our internal landscapes— thoughts, beliefs, and emotions—as opposed to following an “external” approach like dieting. But the question is, how do we shift that internal landscape? While traditional cognitive behavioral therapy—which fo­cuses on changing thoughts in order to change behavior—is enormously helpful, I’ve found that it doesn’t go far enough for many people.

My doctoral research on mind-body health, the burgeoning research on the power of mindfulness meditation, and my own experience with meditation led me to begin incorporating mindfulness into my work with individual clients and in groups—and I was amazed at how power­ful it was in helping people change their eating patterns. It takes work to recognize what drives our habits, but that’s what people in our programs figure out: what really drives their eating habits, what their minds make up, what they choose to believe, and how to align their behavior with what they most care about.

Across my twenty years of practice, I have had the incredible oppor­tunity to work closely with, and learn from, hundreds of remarkable cli­ents. I share their aggravation with a society that presents a very mixed message: eat, consume, buy more—but somehow get yourself to look like an Athleta model. One of the universal lessons I see in my work is that when we expend our energy looking outward and trying to keep up with life, it’s easy to forget that we are creating that very life—that we actually have a great deal of power in shaping our worlds. Forgetting our inter­nal world—not paying attention to our deepest selves—is a byproduct of the cultural messages of immediate gratification and “quick fixes” that surround us. There is no quick fix for the complex eating patterns we’ve developed over years, but there are ways to “fix them well.” What people need are the tools to get in touch with their own deep wisdom—and that’s what our programs offer.

Our Stories: Beth Reardon, M.S., R.D., L.D.N.

The science of what I do as an integrative nutritionist is rooted in nutri­tional biochemistry and functional medicine. The heart of what I do is to help people get in touch with who they are as they’re moving through this world—physically, emotionally, and spiritually—and how changing their relationship with food can help them achieve their goals.

Shifting that relationship is often not a linear path. When I came to Duke Integrative Medicine in 2007, I began to understand why not all my clients heeded my advice and “got better.” I had believed that if people knew the right information—the biochemistry of food, the health statistics—they would change. But the integrative model helped me to understand that changing behavior is rarely about the information; it’s about figuring out what’s keeping us stuck and unable to make shifts in our lives. Often it has to do with our family food histories. In one case, a client had trouble giving up her nightly slice of pie after dinner. As it turned out, the pie was part of a ritual she had shared with her father. How could I ask her to change that? What I could do, I realized, was to help her see that there were other ways to nurture memories of that lov­ing relationship—while guiding her in implementing an eating plan that supported her health and helped her achieve her goals.

Clients I see who’ve been overweight for a long time or have a seri­ous health condition are sometimes fatalistic. But everyone can improve their health by nourishing themselves well. Food affects our very DNA, and every bite matters—it really does. I’ve worked with so many clients who’ve changed their health trajectories by changing their habits. It takes a committed effort because of the food culture we’re living in and our entrenched patterns. But eating well is simpler than most people think. In fact, in general, the simpler we eat, the better. It begins with setting the intention to choose foods that matter—foods that are worthy of us.

In scores of patients who’ve gone through our programs, we’ve seen that the negative spiral of eating, weight, and health can become a positive one. And our research supports this. We’ve tested our mindfulness-based approach in several NIH-funded studies and a large industry study. Re­sults show that our programs helped people decrease overeating, lose weight gradually, and maintain that weight loss over time. The most re­markable part is that participants reported losing weight and maintaining weight loss without a struggle. Mindfulness training has also been shown to improve metabolism irrespective of weight loss; in one study, two groups received the same eating advice, but one of the groups received training in mindfulness. Those who practiced mindfulness digested and absorbed food—especially carbohydrates—more efficiently. They also reported being less likely to overeat sweets and high-fat foods—and being satisfied with far smaller portions than they had previously eaten. These results underscore that our mindfulness-based approach can help people connect with the innate feedback systems that naturally regulate eating and weight—in other words, make authentic change from within.

People who follow our program start to care deeply about what they put in their bodies, often for the first time in their lives. We’ve found that when people start nourishing themselves with the right foods, even after decades of not doing so, their very taste buds change. A ripe nectar­ine, for instance, becomes the perfect dessert. By reprogramming their minds, they’re able to reprogram their bodies.

For the first time, we are offering our approach in book form so that people everywhere can reap the benefits. The Mindful Diet, an antidote to both unhealthy eating patterns and the diet roller coaster, takes you through a step-by-step program that will help you transform your rela­tionship with food, lose excess weight if you need to (and keep it off), and eat in a way that deeply supports your body’s health—while keeping your taste buds happy and feeding your spirit.

The Mindful Diet is divided into three parts, with concepts, skills, and tools that build on one another. It’s best to work through the chapters in sequence instead of skipping around. Because you’ll be learning new skills and implementing changes throughout, spend about a week on each chapter—and take more time if you need it. Slow, incremental progress is much more effective and sustainable than sudden, wholesale overhauls.

In Part I, Setting the Stage for Change, we’ll shine a light on three powerful factors that make unhealthy eating almost automatic: our food culture, the lack of balance in our lives, and the influence of the diet in­dustry. You’ll learn about how both food companies and our oversched­uled lives encourage eating for the wrong reasons and why getting in touch with your values will help you eat for the right ones. You’ll also find out why the diet mentality that permeates our culture is built on false promises that set people up to fail—and how to break free from it. In Part II, Building Your Foundation, you’ll begin a meditation practice and learn how to apply mindful awareness to your eating habits. You’ll learn the difference between true hunger and its many imposters, dis­cover your unique “stress profile” and how it affects your eating habits, and begin to stop judging your body and start inhabiting it. The skills you’ll develop in this section—your mindfulness toolkit—will work to dismantle unhealthy patterns and build a solid foundation for healthy, sustainable habits.

With your foundation in place, you’ll be ready to build a way of eat­ing that truly supports your health. In Part III, Eating for Total Health, you will learn how different foods affect your body on the cellular level, either encouraging or discouraging conditions like obesity, insulin re­sistance, and diabetes—and how to crowd out unhealthy choices with simple, delicious, health-promoting food. We’ll guide you in getting a handle on your portions and reorganizing your kitchen and your life for healthy eating—with help from shopping lists, mix-and-match meal charts, dining-out advice, and healthy cooking techniques.

What You’ll Need to Start

A journal. The program involves written exercises and reflection, so you’ll need a notebook or journal. It doesn’t have to be fancy or large—in fact, you’ll want something that you can easily carry with you, but with ample space to write. A 5-by-7-inch notebook would work well.Time. The exercises and meditations in the program will require fifteen to thirty minutes per day. To help ensure that you’ll follow through, set aside a specific time, in the same way you’d do for an appointment.Support. Round up a few people close to you, family or friends, and tell them you’re embarking on a program to change the way you live and would like their support.

The Mindful Diet will help you reconnect (or connect for the first time)— to your food, and to your body and mind. That might sound like a tall order, but all of those factors are inextricably linked, whether they’re functioning in unhealthy ways or in harmony. The payoff? Long-term changes in habits that lead to better balance—on your plate, for your health, and in your life.

Once you start to reap the rewards of listening to your body and nourishing it, healthy eating will no longer be something you should do; it will be something you want to do, and can do naturally, because it feels good and because you feel good—about yourself, and about what, how, and why you’re eating. And that’s powerful medicine.

PART I

Setting the Stage for Change

CHAPTER 1

Why We Overeat

“When walking, walk. When eating, eat.”

—Zen proverb

Picture this: A woman sits down at a table to eat, closing her eyes for a moment to take a long, deep breath. She’s hungry, but not stomach-growling, light-headed famished. On her plate are sautéed Swiss chard, roasted winter squash, wild salmon with ginger, and a salad. She takes a moment to consider all it took to create this moment, from the farmers who grew the vegetables to herself for making time to shop for the groceries and thoughtfully prepare the meal, and feels grateful. She eats slowly, savoring the earthy flavor of the greens, the salad’s tangy crunch, and the creamy sweetness of the squash. She pauses to put her fork down between bites, sips a mug of green tea, and checks in with her body. When she senses that she’s had enough food—feeling satisfied but nowhere near stuffed—she stops.

That’s lovely, you might be thinking, but that’s not real life. Real-life eating is often the polar opposite of the scene above.

In real life, you’re trying to get a frozen pizza in the oven with one child pulling at your leg and the other needing help with homework. Or you’re alone, and who wants to go to the trouble of slicing vegetables when ordering Chinese takeout is so easy? In real life, “breakfast” was coffee on the way to work, the staff meeting starts in five minutes, and the bag of Doritos on your desk is looking good. In real life, you aren’t hungry, but not eating your mother-in-law’s chicken potpie feels rude, so you stuff it down. In real life, talking to your critical older sister triggers a Pavlovian response for dulce de leche ice cream. In real life, you blew your diet last night at your best friend’s birthday bash, so all bets are off, and the fluorescent Taco Bell sign up the road is beckoning like a siren. In real life, you ordered a veggie sub for lunch and it’s a foot long, and while you didn’t ask for potato chips, here they are. In real life, chocolate is the most reliable, consistent pleasure you know. In real life, every diet you’ve tried has left you feeling two things: hungry and unhappy.

You can probably think of a dozen other examples of how real life seems to undermine your desire to be a healthy eater. What seems on one level like a simple, straightforward act—nourishing our bodies—is often complicated by forces that feel beyond our control.

The New Status Quo: Mindless, Automatic Eating

It’s normal to eat too much, eat too quickly, eat for comfort, or choose unhealthy food on occasion. But for increasing numbers of people, these habits are not the exception; they’re the norm. There are many reasons this is so, which we’ll explore, but the underlying reality is that we often engage in the incredibly important act of nourishing our bodies without fully recognizing what we’re doing, and this has serious consequences. Consider the common habit of eating while doing other things—whether that’s driving, checking email, walking through the grocery store, or watching TV. Research shows that when people eat while they’re dis­tracted or multitasking, they eat faster, eat a bigger portion, don’t re­member what they consumed, feel significantly less full, and continue to eat more throughout the day.

In this book, we refer to unconscious eating—driven by habit and convenience rather than our wisest selves—as mindless eating. Does that mean you sleepwalk to the kitchen and wake up with the taste of French fries or chocolate cake in your mouth, remembering noth­ing? No, though for some people, eating feels like that. For most of us, though, eating is often what psychologists call an automatic behavior, akin to walking or driving (once we’ve learned those skills). Automatic behaviors are activities that have become so second nature to us that we do them on autopilot, without paying full attention and often while doing other things.

Automatic behaviors aren’t unhealthy by definition. If you’ve watched a baby learn how to walk, you know that the task consumes all of her at­tention. But eventually it becomes automatic, and that frees her up to do other things while walking. That’s why as adults we can walk and talk, or walk and think, or walk and listen to music. The autopilot nature of eat­ing, however, tends to get us into trouble when our environment is rife with unhealthy eating options and distractions. For many of us, it takes a great deal of attention and effort to make healthy choices. Autopilot eating also makes it too easy to eat for reasons other than hunger, and to not even notice we’re doing so.

Very often it’s a combination of limited time, stress, opportunity, and our own emotional landscape that prompts us to take that first bite and keep eating. Our culture, along with the nature of our brains, has created a perfect storm that encourages us to automatically eat, overeat, or eat unhealthy food.

Mindless-Eating Checklist

Mindless eating comes in many forms. You may not have a clear sense of your eating behavior at this point, and that’s okay. This checklist can help you begin to tune in to your own eating patterns and habits.

I do the following . . .

rarely sometmes often

Eat until I’m uncomfortably full

Eat until I’m stuffed

Eat very quickly, consuming a meal in less than

ten minutes

Eat while standing up or walking

Eat while driving

Eat when I’m not hungry

Eat because food “is there”

Eat while watching television

Eat in front of the computer

Wait until I’m extremely hungry to eat

Eat in response to stress or anxiety

Eat in response to depression, loneliness, or sadness

Eat in response to anger or frustration

Eat in response to boredom

Eat fast food and convenience food because

I haven’t planned

Eat just because others are eating

Eat because the clock says it’s time to eat

Know I’m finished when the plate or package is empty

Take a look at any areas that you answered as “often” and “sometimes,” and pay attention to these habits as you go through the program. It’s nor­mal to do all of these once in a while, but they undermine your health when done with any regularity. Shifting to “rarely” for all the areas above is ideal—but getting there is a process. You’ll be learning more about all of these patterns throughout the book.

Our Food Culture: Fast, Cheap, and Out of Control

We all know the cliché that we’re products of our environment, and nu­merous studies over the past decade have shown how true this is for eat­ing in particular. Research shows that human beings tend to eat food we see that’s within reach, regardless of our level of hunger or how the food truly tastes.

And oh, the food we see! Our surroundings are filled with food or im­ages of food—our refrigerators, that candy bowl at work, billboards and food stands on the streets we drive and walk down, cooking shows, food blogs. The quantity that bombards us is unprecedented, and our brains were not designed to resist it. In fact, seeing food makes our brain secrete chemicals that cause cravings, even if our bodies aren’t truly hungry.

What the Science Says: What You See Is What You Eat

A Cornell University study compared people who had a clear bowl containing candy on their desk with people who had a white bowl. The candy in the clear bowl was visible; the candy in the white bowl was not. People with a clear candy bowl ate 71 percent more candy than those with a white bowl. As animals whose primary sense is vi­sual, human beings have a physiological response to seeing food or pictures of food. Neurochemically, we anticipate eating it, and our brains start secreting chemicals that cause cravings and can lead to overeating. In addition, people who are obese tend to be more vulnerable to visual cues than normal-weight people.

Food companies know this. In the last several decades, fast food and unhealthy but alluring convenience foods have flourished. The United States leads the world in processed-food consumption. By some esti­mates, processed foods now make up some 70 percent of Americans’ diet, on average. What’s more, the quality of American packaged food is exceptionally grim, a landscape of frozen meals, boxed cereals, and sweet and salty snacks that are highly processed, lacking in nutrients, and laden with refined carbohydrates and sugar, unhealthy fats, and chemical additives. (By comparison, many packaged foods in Japan and parts of Europe are less processed, with fewer additives.) The beverage landscape is no better, with Americans consuming sweetened drinks in greater quantities than ever.

Eating convenience food every now and then isn’t a problem, but when done regularly, it’s extremely harmful to our health. There’s a direct link between overconsuming convenience foods and beverages and the epidemics of our day: obesity, insulin resistance, type 2 diabetes, heart disease, and even depression.

While resisting any food within reach is difficult, many of today’s highly processed foods are addictive by design. Beverage and snack-food flavors like “salted caramel mocha” and “cheddar poppin’ pretzel” exist nowhere in nature. These products are developed by taste-and-smell re­searchers, tweaked for flavor, smell, mouthfeel, and appearance, tested on focus groups, refined by market research, and advertised to the hilt.

Here’s what the ads leave out: most food companies are not focused on their customers’ weight, health, or emotional well-being; they’re fo­cused on selling their products. “No one can eat just one . . .” isn’t just a slogan—it’s the goal of food companies everywhere, and they spend mil­lions to achieve it. That’s good for their profits—and bad for our col­lective health and well-being. Taking advantage of our bodies’ innate wiring for carbohydrates, fat, and salt—all necessary for survival when consumed in natural forms and amounts—food companies create prod­ucts designed to hit what’s known as the “bliss point,” the combination of flavors and texture that makes a food nearly impossible to stop eating. For them, the less you stop and think, the better. And it’s working. One survey found that the amount Americans spend on these highly pro­cessed foods nearly doubled from 1982 to 2012, from 11.6 percent to 22.9 percent of our grocery money.

The result of being bombarded by all this packaged food? In terms of sheer availability, eating unhealthy food has never been easier. And healthy eating has never been more elusive.

Profits versus Health

An article published in the journal Diabetes Care showed that nine leading brands spent $3.5 billion in a single year to advertise fast food in print and on billboards, TV, and radio. Another $5.8 bil­lion was spent on advertising sweetened drinks, candy, and other food. That’s $9.3 billion total—just on advertising. For the same year, the entire budgets for the Centers for Disease Control and Prevention and the Food and Drug Administration were $5.1 bil­lion and $1.3 billion, respectively.

Modifying our immediate environments, to the extent that we can, can help to reduce mindless eating and encourage healthier food choices—you’ll learn those strategies here. But to really get a handle on your habits, it’s crucial to consider your inner landscape, too.

The Chemistry of Comfort Eating

Food isn’t simply physical fuel, nor should it be. We eat to celebrate, we eat for comfort, we eat for pleasure. This has been true throughout his­tory. But in an environment where food abounds and stress levels soar, eating for emotional reasons has become a daily pattern for many people. We use food to fill voids, to obtain instant gratification or stimulation, and to soothe unpleasant feelings such as anxiety, anger, sadness, and stress—whether consciously or unconsciously. For many people, food is a quick fix for emotional pain and a quick filler for emptiness.

We’re not just talking about fuzzy feelings; biochemical reactions un­derpin these cravings. When we feel prolonged stress, our bodies churn out hormones such as cortisol, which cause cravings—for high-sugar and high-fat foods, in particular. These foods—potato chips, chocolate, cookies, candy, and sweet drinks—trigger a near-immediate calming ef­fect by raising serotonin and dopamine levels. But this eating pattern, over time, sets the stage for weight gain and chronic illness. You’ll learn about the chemistry of comfort eating—and how to break the cycle— throughout the book.

A Road Map for Change: Attention + Intention

In working with hundreds of patients on losing weight and changing their eating habits, we’ve found that two big pieces of the puzzle are often missing from conventional approaches: attention and intention, both in­fused with the qualities of curiosity and kindness.

Both our culture and our internal selves lead us to automatic, in­attentive eating. Attention is one of the keys to stopping that vicious cycle. Paying attention on purpose—tuning in to what’s going on in your body, and in your mind, and in the world around you—is at the heart of mindfulness practice, which you’ll be learning a lot more about as you progress through the program.

People who have repeatedly tried to lose weight or change eating hab­its are very familiar with wanting to change but may not be familiar with deep intention. We can spend years, even decades, on the surface layer of change—that basic impulse to “be different, now,” with all of our energy tentacles reaching outside ourselves for motivation, for a plan, and for a reward: I need to eat better in order to look like that blond, willowy beauty over there; I’m going to follow so-and-so’s lose-10-pounds-by-bikini-season eating plan; others will find me attractive when I lose the weight. While external rewards can help people try new things, true, lasting change is different. It emerges from the inside out, not the outside in. This requires reeling in those tentacles and looking within. Lasting change begins with deep intention, alignment between what we deeply value and what we do on a moment-to-moment basis each day of our lives.

In chapter 3, you’ll begin a daily mindfulness practice that will help you cultivate both your attention and intention. But today, start with the simple exercises below that introduce these two core concepts. The focus of the first exercise is attention—using your senses and your awareness to notice what is happening around you and within you. This process will prime your brain to create new pathways for behaving differently.

Exercise: Cultivating Attention

As you go about your day, check in with your senses and your mind as described below, as if you were a detective. Hold a curious at­titude, looking for clues in your own experiences without criticizing what you observe.

1. Look around. What do you see? Imagine that you have never been in the space you are in right now. How would you describe it to someone who has never been there? Meditators call this “beginner’s mind.” It involves taking a brand-new perspective.

2. Now close your eyes and listen. What do you hear going on around you? Anything else?

3. Now breathe in deeply. What do you smell?

4. Now, move to the sensations in your body. How does your body feel overall? How do your feet feel? How about your shoulders? How does your stomach feel?

5. And what about your mind? What is it doing right now? Thinking? Planning? Worrying? Making judgments?

Do this three times each day for the next four to five days— morning, afternoon, and night—and pay attention to what you are experiencing. Don’t try to change anything; just notice what you see, hear, smell, feel, and think. At the end of each day, write in your journal about your experience. You are beginning to train your mind in how to find important information within yourself.

After you’ve spent a few days practicing attention, do the next exercise. In this one, you’ll begin to cultivate intention by developing a positive image—a “best self.” As you progress through the program, you’ll be drawn toward it like a magnet.

Exercise: Cultivating Intention

Figuring out what you really want—your deep intention—is a pro­cess. If the prospect of deep change is scary to you, that’s okay and very common. For now, just notice it and try to get curious about it, keeping in mind that fear can be a form of excitement. To begin, start with this exercise on visualizing your best self, writing your observations down in your journal.

1. Imagine that you are sitting high on a hill, looking out through the distance of time, into the future. You see a shape that looks familiar. As you allow your focus to im­prove, you slowly realize that this shape is you, five years from now, as your very best self. As the picture becomes clearer, what do you notice? Where are you? What are you doing? How are you feeling? Who else, if anyone, is there with you?

2. When you are done imagining your best self, wave “see you soon” and allow the image to fade. Take a moment now to note your observations:

What did you notice about your best self?

What did you notice about the environment around your best self?

How does your best self feel emotionally?

How does your best self feel physically?

What has your best self done to get where it is?

How do you take care of your best self?

Not Perfect, but Present

It’s important to note that your best self does not mean your “perfect” self. The goal of this program isn’t to learn to eat “perfectly.” Not only is per­fection a myth that’s unattainable in real life; perfectionism is counter­productive to change. When your goal is perfection, anything less is a failure. So let’s trade in all our ideas about perfection—a perfect diet, a perfect body, a perfect life—for something attainable, real, and useful.

At our clinic, and in this book, we focus not on being perfect, but on being present. What does that mean? When you’re present, you’re not on autopilot. You begin to understand the cascade of external and in­ternal triggers—everything from food advertising, to being overly hun­gry, to feeling stressed or lonely—that normally lead to overeating or eating unhealthy food. You’re aware of how your body feels, what your thoughts are, and how you’re feeling emotionally. Being present means you’re able to consciously choose what to eat, when to eat, and how much to eat—and you’re aware of why you’re eating. Once you establish that inner foundation of presence, you’re able to build a sustainable diet that fuels good health, a balanced weight, and happiness.

CHAPTER 2

What’s on Your Plate?

“Freedom from obsession is not about something you do;

it’s about knowing who you are. It’s about recognizing

what sustains you and what exhausts you.”

—Geneen Roth, Women, Food, and God

After a decade of “weight creep” in which she gained about 5 pounds a year, Jessica’s blood pressure had risen to the point that it was compromising her health. She was determined to lose weight when she made an appointment with one of our nutritionists— she had a legal pad out and was ready to take notes on what and how much to eat. “My doctor says I need to lose 40 pounds,” she said. “How long do you think that will take?”

When we did our intake with Jessica, we asked not only about her eating habits, but also about her life. We learned that she had three boys—ages 4 to 12—and that she worked as a reading specialist in the school system. She was a valued employee who was always asked to do more—on committees and projects and fundraisers—and she always said yes, even when it meant skimping on sleep or canceling plans with friends. She was also very involved in her church and her community. “I love my life,” she said. But she also said she was “tired all the time” and that all of her commitments got in the way of eating well and exercising.

The fact that Jessica had come to a nutritionist instead of jumping on a diet bandwagon was great. But like a lot of people, she had tunnel vision. When people are focused like a laser beam on the numbers on the scale, we encourage them to step back and widen their gaze, because there’s always a bigger picture at work. We’ve seen in our clinic, again and again, that unhealthy eating habits and excessive weight are never a person’s main problem. They’re a symptom of some other issue or im­balance.

Our eating habits don’t exist in isolation; they exist in the context of our lives. What’s on your plate at mealtimes has a lot to do with “what’s on your plate”—what’s going on in your life. For people like Jessica and so many others, the first step is realizing that those metaphorical plates— their lives—are piled way too high. Taking a step back and assessing the big picture of your life—the whole you—can provide essential perspec­tive about what’s going on and what needs to change.

So Much to Do, So Little Time

For many of us, time is in short supply. Life seems to move faster than ever within the same stubborn twenty-four hours, and we’re in a constant state of struggling to keep up. We’re always multitasking. In a culture that celebrates being “crazy busy” and seems to expect it, we juggle jobs and families, caretaking for children and parents, involvement with commu­nity organizations, socializing with friends, and maintaining homes and cars and calendars.

Over the last decade, we’ve pushed the envelope even further. Stay­ing constantly connected to our jobs and our social circles through our phones and computers has profoundly affected our sense of free time—to say nothing of the social-media explosion. We now feel pressure to stay in touch with not only our families, friends, and coworkers, but also our high-school friends, first loves, far-flung relatives, former colleagues— essentially everyone we’ve ever known. Whether you find this increasing interconnectedness miraculous or disastrous, or both, it’s important to realize how much time—and attention—it requires.

When we look at all the demands on our time and attention, is it any wonder that healthy eating often gets lost in the shuffle? When you’re stressed and frazzled, it’s hard to pay attention to what’s going on in your body—we’ll delve into that in chapter 5. But on a more basic level, unless you’re blessed with a personal chef, eating well takes time: planning time, shopping time, cooking time, and time to eat slowly and consciously. When you’re trying to change your habits, you also need time to get to know yourself.

Making space for eating better, then, requires reckoning with the fact that you are a human being with a finite amount of time and energy. You might have to remind yourself of this reality repeatedly, since so many aspects of our lives push against it. The next step is seeing how you cur­rently allocate those precious resources—your time and energy—and how different aspects of your life affect your eating habits.

Connecting the Dots

Determining what in your life needs changing and how to make those changes is not always obvious. And even when it becomes clear, the pros­pect of making changes can be overwhelming. At Duke IM we’ve devel­oped an illustrative tool that’s helped thousands of people gain clarity about the changes they wish to make. Called the Wheel of Health (see page 28 for an illustration), it’s based on the idea that health—including eating and exercise habits—does not exist in isolation. Health is not something that exists only in our bodies, separate from our lives. Rather, health is deeply intertwined with every aspect of our lives.

If your work life is busy and stressful, for instance, you may opt for takeout more and postpone your exercise plans. If you don’t have a lot of intimacy in your life, you might use food as a substitute for close re­lationships. If you’ve been overweight for a long time, you might experi­ence back pain or joint pain, which makes you reluctant to exercise. You might have negative feelings about your body, which affect your relation­ships, or you might feel stigmatized at work—53 percent of overweight people say they do.

Normally, the different aspects of our lives are swirling so fast we aren’t aware of which parts are functioning well and which aren’t, let alone how they affect one another. Weight gain and unhealthy habits such as chronic overeating occur for many reasons, but most have to do with having too many commitments elsewhere in life that trump taking care of your body. The Wheel of Health—divided into seven domains, with mindful awareness at the center (described on page 34)—helps you step back and assess those commitments, to pause and really look at how you spend your time and energy. Very often, some areas of the wheel are overflowing while others are empty; such imbalances drain our energy.

Adapted from the Self-Care portion of the Wheel of Health, copyright 2014 Duke Integrative Medicine/Duke University Medical Center.

Time and again, patients in our clinic have “a-ha” moments as they assess different areas of their lives and see how issues or imbalances may be affecting their eating habits. Many people realize that they’re spending so much time working, there’s little left for healthy eating and exercise (to say nothing of the biochemical effects of chronic stress, which often ac­companies overwork). Relationship issues, ranging from marriage prob­lems to loneliness to difficulty communicating one’s feelings, are another common thread.

For some people, taking stock of their personal Wheel of Health is not as much of an “a-ha” moment as a reckoning. They might know full well what areas of their life are affecting their eating habits but feel un­able to change them. Melissa, a young woman who visited our clinic, had gradually gained about 15 pounds over the last three years. Her diet was fairly healthy, but she had developed a habit of eating a large bowl of ice cream after dinner every night before bed. When asked if she knew how that habit started, she nodded and said, “Every Saturday night when I was a kid, my dad and I would watch a movie and eat ice cream. Butter pecan.” Her dad had died three years ago unexpectedly, and eating ice cream comforted her and helped her feel connected to him. She didn’t want to lose that connection. It made a lot of sense. We worked with her on how to cherish the memories of her dad in a way that supported her health goals instead of undermining them. As it turned out, he had been an avid hiker, and Melissa liked the idea of incorporating a hike into her weekend routine. She also decided to cut back on her ice-cream habit but not eliminate it—having a small bowl once a week.

Exploring your Wheel of Health forces you to slow down and get a bird’s-eye view of your life.