Title: A Mindful Eating Program Can Be Successfully Delivered at the County Level

Author: Kathryn Kolasa, PhD, RD, LD, Professor Emerita, East Carolina University, kolaskak@ecu.edu; Sheree Vodicka, North Carolina Division of Public Health; Carolyn Dunn, Professor, North Carolina State University

Section/SPIG: Food and Nutrition

Issue Date:

The partners in North Carolina’s Eat Smart Move More movement asked the question, “How can you reach the more than 2 million overweight and obese adults in the state with an effective and affordable weight management program?”  More than 60 organizations collaborate to implement the state’s obesity plan, including ensuring equitable access for overweight and obese residents to prevention and treatment services to reduce health disparities.  At the same time, Cooperative Extension agents, who had a 25 year history of providing weight management classes, were asking for updated tools.  Health department health educators, too, often in collaboration with extension agents at the local level, were encouraged to include weight management efforts in their “plan of work.”

The Eat Smart, Move More, Weigh Less (ESMMWL) weight-management curriculum was created by a team of interagency professionals with expertise in nutrition, physical activity, and behavior change.  The program uses evidence-based weight control strategies and is enhanced with techniques on mindfulness. The program was piloted in 2008-2009 to determine reach, effectiveness and acceptability to instructors and consumers.  The strategies incorporated included: eating fewer calories; including more fruits, vegetables, and whole grains in meals; eating breakfast regularly; controlling/decreasing portion sizes; eating more meals at home; drinking fewer caloric beverages; keeping a food/physical activity record; increasing physical activity; and watching less television.  Participants are asked to eat with awareness, be attentive to how they move, and to do things consciously rather than out of habit. Participants are asked to track their mindfulness, physical activity, weight, and the food and beverages consumed. The instructors, who have been trained in-person or through online modules and webinars, retain some flexibility as they implement the program in their local communities. A full description of the curriculum is available at the program website and in the Journal of Extension (1, 2).  A report of the pilot is in press (3) and was presented at a conference in November 2010 (4).

In the first 18 months of the program, 101 ESMMWL courses were delivered in 48 of 100 North Carolina counties (about half in worksites) by local educators with 1,162 participants (54 percent of those enrolled)  completing the course.  Most (92 percent) were female and white (75 percent), with a mean age of 52 years and an average starting BMI of 32.7.   About 59 percent had struggled with their weight all their lives; 33 percent had never taken a class (especially African Americans).  Most (83.4 percent) moved toward or attained their goal, with 86.8 percent losing weight -- on average 8.4 pounds. Most participants lost weight at a safe rate and reported changes in mindfulness and in eating and physical activity behaviors.  Most experienced a change in eating confidence: 92 percent increased mindfulness of what and how much they ate; 81 percent ate smaller portions; 81 percent ate fewer calories; 73 percent ate 1.5 - 2 cups of fruit on most days; 72 percent ate less fast food; 72 percent ate 2 – 3 cups of vegetables on most days.  Confidence in physical activity changed, with 70 percent being physically active for at least 30 minutes per day and 71 percent doing strength training. ESMMWL had a positive and significant short term impact without the use of a prescribed, calorie-controlled diet.

ESMMWL groups usually met once weekly for a 45- to 60-minute educational/motivational program and personal goal assessment. There were 79 instructors in 48 of the 100 counties delivering courses. Some included physical activity time. A program fee, ranging from $0-$50 and averaging $23 was charged. Each participant set a healthy weight goal of .5 - 2 pounds/week of weight loss or maintenance of current weight. Incentives such as receiving a portion of their registration fee back for successful completion, employer approved time off from work, water bottles, t-shirts, or other small giveaways were used in some programs to encourage weekly attendance and completion of the program and did positively impact weight loss results.

The traditional weight management curriculum taught by many community health educators and extension agents have focused on caloric restriction.  This curriculum, designed to use the concept of mindfulness, helped participants achieve a safe weight loss without restrictive dieting.   This work demonstrates that professionals from an existing infrastructure (public health and Cooperative Extension) can be recruited to incorporate weight management programming into their plan of work.  The curriculum was revised based on the pilot and is currently being used across the state.

(1) Dunn C, et al. (2010). Eat Smart, Move More, and Weigh Less: a weight management program for adults. Journal of Extension [On-line], 48(1) Article 1TOT1.

(2) Dunn C, et al. (2011). Eat Smart, Move More, Weigh Less a Weight Management Program for Adults – Revision of Curriculum Based on First Year Pilot.  Journal of Extension, in Press.

(3) Whetstone LM, et al. Eat Smart Move More Weigh Less: Delivering an Affordable Weight Loss/Weight Maintenance Program at the Community Level.  Preventing Chronic Disease, in press.

(4)  Kolasa KM, Vodicka S, Dunn C.  Disengaging Auto Pilot: Empower Weight Management Clients with Mindfulness.  Presented at Food and Nutrition Conference, November 9, 2010. Boston.