From The Eating Lab: Diets Don’t Work, But Why?

By Jean Fain
Guest Contributor

As soon as Traci Mann’s new book, “Secrets From The Eating Lab,” hit bookstores shelves, I ordered my copy. Not only because the University of Minnesota psychology professor is one of the leading researchers on the psychology of eating, dieting and self-control, but her 2007 Medicare study on effective obesity treatments was the irrefutable evidence I needed in writing about how diets don’t work — at least not as dieters expect — in my own book on eating with self-compassion.

Diets fail to facilitate significant or sustainable weight loss, Mann argues. What’s more, diets are unnecessary for optimal health.

Diets don’t work for a variety of reasons, from biology to psychology. After two decades of studying the scientific literature as well as her own diet subjects, Mann points the finger, first and foremost, at human biology. “Genes,” she argues, “play an indisputable role in regulating an individual’s weight: most of us have a genetically set weight range. When we try to live above or below that range, our body struggles mightily to adapt.”

Second to biology, Mann blames a combination of neuroscience and psychology. Our brains are hardwired to want food for survival, she explains, so restricting calories creates a psychological stress response, which facilitates weight gain, not loss. Also, she adds: “Studies show that willpower, the thing we all blame ourselves for not having enough of, is in many ways a mythical quality and certainly not something that can be relied upon for weight loss.”

Whether you’re interested in boosting your health or losing weight, Mann’s best advice is to ditch the diet and adopt her 12 “Smart Regulation Strategies,” her proven mental strategies for reaching your “leanest, livable weight.” Instead of counting calories, for example, she advocates penalizing yourself for succumbing to temptation as well as thinking about tempting foods in the abstract. So instead of thinking about the specific qualities of a glazed donut with chocolate icing, think of a donut as a generic dessert or just one of many breakfast foods.

Mann’s views come as no surprise to me, a therapist who specializes in eating disorders. The big surprise for me in her new book is that I only loved the first half — the half that pinpoints the problem with dieting. The other half, which focuses on her “no-diet” plan, well, I liked it only half as much. Turns out, a good bit of Mann’s plan calls for external changes, like using smaller plates and taking smaller portions, a la Brian Wansink’s Mindless Eating. Mann prescribes internal changes, too, but none are what I’d describe as truly mindful.

I was tempted to dismiss Mann’s plan as a collection of mental tricks, then I thought better of it. Instead, I set up a mini-interview via email with the professor turned author and I’m glad I did. Not only did Mann have some interesting things to say about dieting — her own experience and that of determined dieters –- but her answers reminded me that there’s no right way to address eating problems. In fact, there are many ways to go. To see if Mann’s way of reaching your leanest livable weight is a way you might want to go, read on.

JF: You’re pretty unusual in that you ditched dieting after just one diet. And yet, you’ve devoted your career to proving diets don’t work. Why is that?

TM: I ditched dieting because the diet I went on made me miserable, and I watched both of my parents cycle through diets and re-gain, diets and re-gain, ad nauseam. Continue reading

Study: For Sleep Problems In Older Age, Try Mindful Meditation

(Fairy Heart/flickr)

(Fairy Heart/flickr)

Insomnia is insidious, infuriating and often debilitating.

For anyone who has suffered with eyes-wide-open at 4 a.m. it’s not terribly surprising that more and more Americans (particularly older people and women) are being prescribed serious drugs to help them sleep.

But these medications, known as benzodiazepines, have been linked to numerous health problems, ranging from an increased risk of dementia, to car crashes and falls. And once you’re on them, it’s hard to stop, as I can attest from personal experience. While debate continues over the safety and effectiveness of these medications, a small study suggests that an alternative approach may offer some relief.

Research published online by JAMA Internal Medicine found that a practice of mindful meditation — basically just focusing on breathing and remaining in the present moment while observing your thoughts easily drift by — may help certain people with sleep problems. “Mindfulness meditation practices resulted in improved sleep quality for older adults with moderate sleep disturbance…” the report concludes.

The study, by researchers at the University of Southern California in Los Angeles, reflects a growing body of evidence showing that the practice of “mindful meditation” can be used as a low-cost, non-drug intervention that can, in certain cases, reduce stress and help with other physical and mental health woes.

Here’s more from the JAMA release:

Sleep disturbances are a medical and public health concern for our nation’s aging population. An estimated 50 percent of individuals 55 years and older have some sort of sleep problem. Moderate sleep disturbances in older adults are associated with higher levels of fatigue, disturbed mood, such as depressive symptoms, and a reduced quality of life… Continue reading

A Miracle Drug For Binge Eating? Not So Fast, Says Therapist

(Bloody Marty/Flickr)

(Bloody Marty/Flickr)

By Jean Fain
Guest Contributor

For more than 20 years, my binge-eating patients have wished for a magic wand. And for all that time I told them there is no wand — there are only strategies that require awareness and effort to get a handle on their eating.

Last week, when the FDA announced it had approved Vyvanse for the treatment of binge eating disorder (BED), I found myself at an uncharacteristic loss for words. With headlines touting a magical cure for this most common adult eating disorder, I feared there was nothing I could say to stop the stampede for this next, new drug.

The news, in and of itself, is hopeful. Vyvanse (lisdexamfetamine dimesylate) has been the subject of rigorous research, first for ADHD, and now for BED. In two good-sized studies with more than 700 adult participants diagnosed with moderate to severe binge eating, this central nervous system stimulant proved more effective at reducing binge days per week than placebo for three months.

What’s more, the FDA’s approval has proven a good opportunity for a drugmaker, U.S-based Shire, and leading eating disorder associations — the National Eating Disorder Association and Binge Eating Disorder Association — to coordinate a nationwide educational campaign. If even a fraction of the estimated 2.8 million Americans diagnosed with the disorder get help as a result of the campaign’s public service announcements and new website, there’s reason to be hopeful.

There’s also reason to be cautious. Consider some of the issues before you take tennis great and Shire spokesperson Monica Seles’ advice to “talk with your doctor.” To help you do that, here are the pros and cons in my clinical experience and that of my colleagues.

But first, if you’re unclear on what constitutes binge eating disorder, here’s how the Binge Eating Disorder Association defines it:

“Routinely eating far more food than most adults would in a similar time period under similar circumstances.” Binge eaters typically feel out of control during a binge, and afterward, they’re consumed with guilt, self-disgust and embarrassment. Other hallmarks of the disorder: eating extremely fast, in secret, to the point of uncomfortable fullness, even when not hungry. Unlike other eating disorders, people with BED don’t try to “undo” excessive eating by throwing up, taking laxatives and other excessive actions.

OK, so here are a few points to consider…


•More Treatment Options

With the FDA’s first and only approved medication for BED, patients now have another way into treatment: their family doctor. Rather than seeking out a psychotherapist or a nutritionist, which many are reluctant to do, they might feel more comfortable asking their physician about a prescription and other treatment options for this lesser-known eating disorder, which was only recognized two years ago as a distinct disorder by the American Psychiatric Association.

•Fewer Binge Days

Vyvanse has been shown to markedly reduce, if not eliminate, binge episodes in two studies, both funded by Shire. According to last month’s JAMA Psychiatry study, participants who got a daily dose of 50-70 mg, reduced the frequency of binge days per week from about five to less than one over the course of 12 weeks. By comparison, those taking placebo continued to binge more than two days per week. What’s more, half the participants taking the 70 mg dose stopped binging after four weeks, compared to one fifth of those taking placebo.

•Possible Weight Loss

Because Vyvanse has yet to be studied as a weight loss aid, it’s approved only in the treatment of binge eaters, not the overweight or the obese. That said, study subjects who took Vyvanse lost about 10 pounds. The potential weight loss may come as welcome news to bingers taking an off-label prescription for an antidepressant or anti-seizure medication. A common side effect of most antidepressants is weight gain. While binge eaters are often thrilled with the weight loss that the anti-seizure drug Topomax can facilitate, they’re none too pleased by the mental impairment.


•Greater Risk of Abuse/Dependency

There’s a reason Vyvanse is a controlled substance with a black box warning. The potential for abuse and dependence is a real risk. Take it from psychiatrist Daniel Carlat, editor in chief of The Carlat Psychiatry Report, who expressed his reservations in a recent email exchange:

“I’m concerned that the FDA’s approval of Vyvanse for binge eating disorder is going to worsen our problems with stimulant abuse,” Carlat says. Continue reading

Embrace The Eggnog, And Other Tips To Curb Holiday Eating (And Guilt)

(Theen Moy/Flickr)

(Theen Moy/Flickr)

It’s peak season for overeating — and then beating yourself up for doing it.

Clearly, you’re not the only one treating yourself to pumpkin and pecan pie, egg nog and, yes, fruitcake. Yet it’s no comfort that everyone else and their Weight Watchers’ leader is also riddled with guilt and enduring a personal thrashing for the extra calories and potential weight gain. While this self-flagellation goes on, you’re missing out on enjoying the holidays.

If only there were a better approach to holiday eating, maybe then you’d be able to stop beating yourself up, enjoy eating what you love and savor everything else you really do love about this season.

Happily, you don’t need an emergency gastric bypass to stop the vicious cycle: putting an end to both overeating and self-criticism might be easier than you think. It might be as easy as reviewing some research-based strategies honed from a group training I lead for people with eating issues. It revolves around practicing a variety of mindful eating and self-compassion meditations.

Here are five proven tips for happier, healthier holiday eating:

1. Redefine Holiday Eating

You’ll need a better working definition of “normal holiday eating” if your definition sounds anything like my esteemed colleague and family eating expert Ellyn Satter’s:

Most people get caught up in what they should and shouldn’t eat. They’re anxious and ambivalent about eating. They might try to resist at holiday parties, but the table is laden with ‘forbidden food,’ and they throw away all control and overdo it. Many times they’re over-hungry because they’re trying to restrict themselves and lose weight. So the standard definition of holiday eating becomes eating way too much.

If you’d prefer to take fewer bites and ease the anxiety and ambivalence, now’s the time to do the exact the opposite, starting with eating regular meals and snacks. Then, come party-time, permit yourself to eat the foods you enjoy. You’re probably going to eat them anyway, so you might as well as enjoy them, without the guilt and other uncomfortable emotions that predictably fuel emotional eating.

2. Go Easier On Yourself

If, like most dieters, you’re hoping that feeding yourself a steady diet of self-criticism will inspire you to rein in your eating, think again. You’ve actually got it backward. Self-criticism — calling yourself fat, disgusting and other mean, nasty names — is really a recipe for emotional overeating and holiday weight gain. Continue reading

When Shrinks Put Mindfulness On The Couch

By Alexandra Morris
CommonHealth intern

Can medications and meditation co-exist?

Or, put another way, does mindfulness — the deliberate act of paying attention to the present moment and observing your thoughts drift by — have a place in psychiatric care?

The answer, according to some doctors: yes, maybe, at least for some patients.

At a conference held earlier this month at the University of Massachusetts Medical School, psychiatrists David Lovas of Dalhousie University and Zev Schuman-Olivier of Harvard Medical School and the Cambridge Health Alliance made the case for and against mindfulness and psychiatric drugs in treating patients with depression, anxiety, schizophrenia, bipolar disorder, and other mental illnesses.

Over the past twenty years or so, the number of patients taking antidepressants and antipsychotics has increased substantially. And in many cases, patients are on multiple drugs at once: one third of psychiatric outpatients are on three or more drugs, according to one study.

(Synergy by Jasmine/flickr)

(Synergy by Jasmine/flickr)

So researchers have begun to examine whether mindfulness, which can include walking meditation, body scan meditation (to bring awareness to each part of the body in turn), mindful eating or yoga, or mindful listening can significantly reduce some of the anxiety and distress associated with such illnesses.

“We’re witnessing a culture that is focused and organized in some ways around medication as a primary form of treatment,” said Schuman-Olivier. “On the other hand, people can overstate the power of mindfulness intervention.”

It’s a careful balancing act, they say: for some, mindfulness-based therapy may be more effective at relieving stress and addressing mental health symptoms, while others may benefit more from medications or a combination of medication and meditation.

In some cases, mindfulness can produce negative side effects – it has been shown to draw out negative memories of past events.

Still, mindfulness meditation is being adopted more and more as a practice to improve health and mental well-being. The U.S. Marines, for example, are using these meditation practices to improve their attention and working memory, according to a recent New York Times report.

Earlier this year, JAMA Internal Medicine published a paper that looked at how mindfulness meditation programs affect stress and well-being. Continue reading