Centre for Public Health

Liverpool John Moores University

Public Health Institute - Liverpool John Moores University

World Health Organization Collaborating Centre for Violence Prevention

Part of the Liverpool John Moores University

Beyond what we eat and weigh: A concept of ‘kindful’ eating and addressing the wider determinants of health

30 March 2016 | Marissa Pendlebury

Is health and wellbeing really just about what we weigh on the scale, or the amount and type of food and specific nutrients we place into our bodies? Are we really just a robot that needs to be programmed to calculate our input and output of energy, i.e. calories in equates to an output of weight gain or loss and related health consequences? If we don’t eat ‘clean’ and become a ‘healthy weight’, will we inevitably be destined to a life of chronic illness and being stigmatised for not being able to optimally self-regulate our behaviour? After much time working and volunteering in the field of public health, while having an avid interest into the psychology of eating and body image, I would argue that the health and wellbeing of any individual is so much more than this. In other words, health is a dynamic concept that does not just materialise as a result of what we eat or what we weigh, although these elements do play a role in many more ways that we might initially think.

Despite the bombardment of messages that are often promoted about losing weight as one of the best ways to promote optimal health, there are some notable harms that can come with advocating dieting and weight-loss as a means to health and wellness, including how these ambitions can lead individuals down a lonely road to poor self-esteem and developing an unhealthy relationship with food. On average, longitudinal research shows that only around 1% of individuals maintain a ‘healthy weight’ after losing it, while the rest are more likely to get caught up in a cycle of weight fluctuation, constant dieting and overall poor physical, psychological and social wellbeing. Moreover, what we define as a ‘healthy weight’ in terms of BMI is strongly critiqued for being an inaccurate and unreliable indicator of health. Still, much of society, including health professionals and the many types of social media we are exposed to, place a primary focus on healthy eating and losing weight as a key to promoting health.

The thing is, as biologically and socially complex human beings, health is more than just what we eat and weigh. In order to reach our full potential and experience happiness, this requires more than a focus on food, weight, physical activity or other health-related behaviours – including the likes of alcohol intake, although I am not disregarding the important role they play. We happen to be social creatures who thrive off being able to connect with others and sense that we have a greater meaning and purpose throughout our lives, and food can play a positive role in our sense of connection, identity and ability to integrate ourselves within a particular culture. However, most of us happen to live in a culture where we are bombarded with messages that the globe is suffering from an obesity crisis, with the risk of experiencing chronic illnesses going through the roof, such as type 2 diabetes and heart disease.

We are largely told that these negative circumstances mainly result from individual behaviours or the type of food environments we live in. However, what we are rarely informed about is the contribution of social inequality and stress, which not only contribute to poor health behaviours, but also independently act to diminish health, regardless of what people eat or weigh. Notably, the experience of isolation, poor self-worth and stress (all which can be influenced by socioeconomic status and inequality) impact health at a visceral level. For example, the political, social and financial state of our external environment can create a very toxic internal environment – even to the extent that it triggers poor mental health and chronic illness. Chronic dieting in order to live up to societal expectations around food and eating can also lead to frequent episodes of restriction and binge eating, as well as life threatening eating disorders such as anorexia nervosa and bulimia – widespread public health issues which come at a cost to individuals and society

In one of my most recent professional development workshops that I attended, called ‘kindful Eating’ which was delivered in two parts across a whole weekend in Manchester, our small group had the opportunity to really critique how we normally go about promoting health via losing weight and going on a diet. Similar to what I have just talked about, we discussed at length how we may be doing more harm than good by promoting weight loss and following certain dietary restrictions – unless of course you happen to suffer from a certain dietary allergy. We also learnt a unique concept of ‘kindful’ eating, which involves being able to enjoy food without guilt, love ourselves regardless of what we eat or weigh, be mindful of how it contributes to more than just nutrition, and eat in ways that don’t view food in black and white terms of ‘good’ or ‘bad’. This approach can be really helpful for helping individuals to accept and love who they are now, as well as individuals with eating disorders or the general public to develop a positive relationship with food. In other words, ‘kindful’ eating is an empowering way of eating that focusses on more that the exact nutrients or calories we put into our bodies – controversial to what many of us had been taught over several years in the field of nutrition and dietetics!

Over the interactive and engaging weekend, our group enjoyed being able to become critical of what we had been taught in our nutrition and dietetic courses (myself included) which often uses a model of ‘we are what we eat’ and that we should closely monitor almost every morsel and calorie of food we consume (despite the unrealistic nature of this task for the average individual!). As a public health researcher, I was also impressed by how the ‘kindful’ eating workshop placed an emphasis on the social determinants of health (e.g. outlined in the Marmot review) and that our society needs to view our overall health in light of these factors – not just what or how much we eat and weigh.

Being someone with an understanding of mental illnesses such as eating disorders and body dysmorphia, I know that even the healthiest ways of eating will not promote health if the social and psychological wellbeing of the person eating that way is poor. What is not always emphasised in nutrition, even when being trained as a dietician, is the importance of recognising that each of us have a psychological relationship with food, and that food should ideally be an enjoyable part of our social lives – not something to rigidly monitor, restrict or feel guilty about. In fact, relating to food in such a way is yet another step towards experiencing poor self-esteem and stress, which we know from many research studies have a very negative impact on health and wellbeing.

Overall, I found the ‘kindful’ eating workshop very enlightening and, as well as allowing me to gain a certificate of professional development by the Association for Nutrition, it positively resonated with many of my core values as a public health researcher and someone who acknowledges food as contributing to our wellbeing in more ways than nutrition and weight alone. It also reinstated my understanding of the importance of acknowledging wider determinants of health, including societal inequalities, rather than viewing health as an output of what or how much individuals have eaten. As I go on into my professional career, I would like to conduct further research about the way individuals relate to food, and how this influences the relationship they have with themselves.

For me, health and wellbeing involves being able to live in an environment where we feel safe and loved, and are able to show compassion to ourselves and others. If we can empower individuals to experience this, and not just place a focus on what or how much we eat, then perhaps as a society we can begin to place a greater focus on the wider determinants of public and individual health, tackle inequalities and enable as many individuals as possible to experience optimal physical, social and psychological wellbeing.