Whole-person Integrative Eating: A Program for Treating Overeating, Overweight, and Obesity.

The whole-person integrative eating (WPIE) model and program provides insights into the underlying causes of overeating as well as a comprehensive program for treating overeating, overweight, and obesity. A wide range of guidelines on food and eating from ancient food wisdom from Eastern healing systems, world religions, and cultural traditions, as well as Western nutritional science, were distilled into 6 principles: (1) eat fresh, whole foods; (2) eat with positive feelings; (3) eat with mindfulness; (4) eat with gratitude; (5) eat with loving regard; and (6) eat while dining with others. To assess how well individuals follow these guidelines, an 80-item questionnaire was developed and administered to a large sample of 5256 Americans who participated in a 6-wk, 18-lesson online e-course on integrative eating. Based on a factor analysis of the items, 7 distinct overeating styles emerged that are opposite of the perennial principles: (1) emotional eating, (2) fast foodism, (3) food fretting, (4) task snacking, (5) sensory disregard, (6) unappetizing atmosphere, and (7) solo dining. All were significantly and independently related to overeating frequency, and 5 of the 7 were significantly related to being overweight or obese. The case study presented here demonstrates how a 64-y-old woman who struggled with obesity throughout adolescence and adulthood was able to replace her 7 overeating styles with the 6 perennial integrative-eating guidelines for optimal eating. At the beginning of the year's coaching intervention, Barbara weighed 107 kg and wore a size 3×; 1 y later, she weighed approximately 75 kg and wears a medium, size 12. She has attributed her weight loss to the wholeness of the integrative-eating program she practices.

Social support group attendance is related to blood pressure, health behaviours, and quality of life in the Multicenter Lifestyle Demonstration Project.

Changes in coronary risk factors, health behaviours, and health-related quality of life (HRQOL) were examined by tertiles of social support group attendance in 440 patients (21% females) with coronary artery disease. All patients participated in the Multicenter Lifestyle Demonstration Project (MLDP; eight hospital sites in the USA), an insurance-covered multi-component cardiac prevention program including dietary changes, stress management, exercise and group support for 1 year. Significant improvements in coronary risk factors, health behaviours, and HRQOL were noted at 1 year. Several of these improvements (i.e. systolic blood pressure, health behaviours, HRQOL) were related to social support group attendance, favoring those who attended more sessions. The associations between support group attendance to systolic blood pressure and to four HRQOL subscales (bodily pain, social functioning, mental health, and the mental health summary score) remained significant when controlling for changes in health behaviours, but dropped to a non-significant level for the HRQOL subscales 'physical functioning', 'general health' and 'role-emotional'. These results suggest an independent relationship of social support group attendance to systolic blood pressure while improvements in quality of life may be in part due to improved health behaviours facilitated by increased social support group attendance.

Long-term effects of lifestyle changes on well-being and cardiac variables among coronary heart disease patients.

OBJECTIVE: To focus on psychological well-being in the Lifestyle Heart Trial (LHT), an intensive lifestyle intervention including diet, exercise, stress management, and group support that previously demonstrated maintenance of comprehensive lifestyle changes and reversal of coronary artery stenosis at 1 and 5 years. DESIGN AND MAIN OUTCOME MEASURES: The LHT was a randomized controlled trial using an invitational design. The authors compared psychological distress, anger, hostility, and perceived social support by group (intervention group, n = 28; control group, n = 20) and time (baseline, 1 year, 5 years) and examined the relationships of lifestyle changes to cardiac variables. RESULTS: Reductions in psychological distress and hostility in the experimental group (compared with controls) were observed after 1 year (p < .05). By 5 years, improvements in hostility tended to be maintained relative to the control group, but reductions in psychological distress were reported only by experimental patients with very high 5-year program adherence. Improvements in diet were related to weight reduction and decreases in percent diameter stenosis, and improvements in stress management were related to decreases in percent diameter stenosis at both follow-ups (all p < .05). CONCLUSION: These findings illustrate the importance of targeting multiple health behaviors in secondary prevention of coronary heart disease.

In vitro and in vivo antioxidant and anti-inflammatory capacities of an antioxidant-rich fruit and berry juice blend. Results of a pilot and randomized, double-blinded, placebo-controlled, crossover study.

This study investigated the in vitro and in vivo antioxidant and anti-inflammatory properties of a juice blend (JB), MonaVie Active, containing a mixture of fruits and berries with known antioxidant activity, including acai, a palm fruit, as the predominant ingredient. The phytochemical antioxidants in the JB are primarily in the form of anthocyanins, predominantly cyanidin 3-rutoside, cyanidin 3-diglycoside, and cyanidin 3-glucoside. The cell-based antioxidant protection of erythrocytes (CAP-e) assay demonstrated that antioxidants in the JB penetrated and protected cells from oxidative damage ( p < 0.001), whereas polymorphonuclear cells showed reduced formation of reactive oxygen species ( p < 0.003) and reduced migration toward three different pro-inflammatory chemoattractants: fmlp ( p < 0.001), leukotriene B4 ( p < 0.05), and IL-8 ( p < 0.03). A randomized, double-blinded, placebo-controlled, crossover trial with 12 healthy subjects examined the JB's antioxidant activity in vivo. Blood samples at baseline, 1 h, and 2 h following consumption of the JB or placebo were tested for antioxidant capacity using several antioxidant assays and the TBARS assay, a measure of lipid peroxidation. A within subject comparison showed an increase in serum antioxidants at 1 h ( p < 0.03) and 2 h ( p < 0.015), as well as inhibition of lipid peroxidation at 2 h ( p < 0.01) postconsumption.

A contemplative care approach to training and supporting hospice volunteers: a prospective study of spiritual practice, well-being, and fear of death.

BACKGROUND: Inspired by a 2,500-year-old Buddhist tradition, the Zen Hospice Project (ZHP) provides residential hospice care, volunteer programs, and educational efforts that cultivate wisdom and compassion in service. OBJECTIVE: The present study was designed to understand how being with dying hospice residents affects hospice volunteers well-being and the role of spiritual practice in ameliorating the fear of death. DESIGN: A one-year longitudinal study of two volunteer cohorts (N = 24 and N = 22) with repeated measures of spiritual practice, well-being, and hospice performance during one-year service as volunteers. SETTING: The Zen Hospice Guest House and Laguna Honda Residential Hospital of San Francisco, CA. PARTICIPANTS: All 46 individuals who became ZHP volunteers during two years. INTERVENTIONS: A 40-hour training program for beginning hospice volunteers stressing compassion, equanimity, mindfulness, and practical bedside care; a one-year caregiver assignment five hours per week; and monthly group meeting. MAIN OUTCOME MEASURES: Self-report FACIT spiritual well-being, general well-being, self-transcendence scale, and a volunteer coordinator-rated ZHP performance scale. RESULTS: The volunteers had a high level of self-care and well-being at baseline and maintained both throughout the year; they increased compassion and decreased fear of death. Those (n = 20) practicing yoga were found to have consistently lower fear of death than the group average (P = .04, P = .008, respectively). All rated the training and program highly, and 63% continued to volunteer after the first year's commitment. The results suggest that this approach to training and supporting hospice volunteers fosters emotional well-being and spiritual growth.

Comparison of coronary risk factors and quality of life in coronary artery disease patients with versus without diabetes mellitus.

It is unclear whether patients with coronary artery disease (CAD) and diabetes mellitus (DM) can make comprehensive lifestyle changes that produce similar changes in coronary risk factors and quality of life compared with patients with CAD and without DM. We examined medical characteristics, lifestyle, and quality of life by diabetic status and gender in the Multicenter Lifestyle Demonstration Project (MLDP), a study of 440 nonsmoking patients with CAD (347 men, 55 with DM; 15.9%; 93 women, 36 with DM; 38.7%). Patients met in groups to improve lifestyle (plant-based, low-fat diet; exercise; stress management) for 1 year. Follow-ups were conducted at 3 and 12 months. At baseline, body mass and systolic blood pressure were significantly higher among patients with DM. Men with DM had a worse medical history (e.g., hypertension, hyperlipidemia, and family history of CAD) than did those without DM. Patients with DM, especially women, reported poorer quality of life than did patients without DM. The 2 groups of patients were able to adhere to the recommended lifestyle, as demonstrated by significant improvements in weight (mean -5 kg), body fat, low-density lipoprotein cholesterol, exercise capacity, and quality of life. No significant changes in triglycerides and high-density lipoprotein cholesterol were noted. By the end of 12 months, improvements in glucose-lowering medications (i.e., discontinuation or a change from insulin to oral hypoglycemic agents) were noted for 19.8% (n = 18) of patients with DM. In conclusion, patients with CAD and DM are able to follow a comprehensive lifestyle change program and show similar improvements in coronary risk factors and quality of life as those without DM.

Interactive Guided Imagery therapy with medical patients: predictors of health outcomes.

OBJECTIVES: To assess whether Interactive Guided Imagery (IGI) is helpful to medical patients and to identify factors that contribute to positive outcomes. DESIGN: A prospective cohort study of 323 medical patients who received 6 IGI sessions on a weekly basis. Patients and practitioners completed questionnaires at the beginning, middle, and end of the 6 IGI sessions. The questionnaires assessed the patients' ability to do IGI, the quality of the practitioner-patient interaction, possible confounding variables, and enabling factors. The hypothesis was that measures of the process of doing IGI and the practitioner-patient relationship would predict outcomes. SUBJECTS/SETTING: The subjects were all patients seeking treatment at California Pacific Medical Center in San Francisco, and Marin General Hospital in Greenbrae, CA. INTERVENTION: Using IGI interactively is a cognitive-behavioral intervention designed to help patients relax by using mental images to discover and cultivate healing intentions, and to reflect on the meaning of these images. MEASURES: The individual measures to assess the patients' ability to do IGI and measures of the practitioner-patient relationship were factor-analyzed to use as predictor variables in a multiple regression. Similarly, the questionnaire items measuring cognitive, emotional, behavioral, and spiritual benefits of IGI were factor-analyzed into factors representing "insight" and "all other" benefits. RESULTS: The multiple regression shows that both process and practitioner-patient interaction factors significantly contributed to a combined 40% of the variance in patients' ratings of insight into the nature of their problem and to becoming aware of an aspect of self, F(4,56) = 9.4, p < 0.005. The same process and interaction factors were less strongly related to the other outcomes, r2 = 0.14, F(4,56) = 2.3, p = 0.06. None of the demographic, confounding, or enabling factors was related to the outcome measures. CONCLUSIONS: The process of doing IGI and the relationship with the practitioner were both independently associated with the patients' insight into their health problems.

Seven eating styles linked to overeating, overweight, and obesity.

OBJECTIVE: To broaden the perspective on the causes of overeating, overweight, and obesity and provide cross-cultural, comprehensive treatment approaches. BACKGROUND: Through food-related research into the world's wisdom traditions, cultural traditions, Eastern healing systems, and Western nutritional science, the authors present recurrent themes derived from ways in which cultures regarded, experienced, prepared, and shared food for millennia. DESIGN: An 80-item questionnaire, designed to measure food, nutrition, and eating themes was administered to 5,256 participants who registered for a Web-based integrative nutrition e-course. When the 80-items were factor analyzed separately in two randomly split halves of the sample as well as within age and sex categories, seven coherent and consistent factors or eating styles emerged. These eating styles were entered into a multiple regression analysis to predict overeating frequency and body mass index (BMI). RESULTS: Each of the newly identified eating styles was independently related to self-reports of overeating frequency; five of the seven were significantly related to overweight and obesity. The eating styles include the following: (1) "Emotional Eating" (eating to manage feelings); (2) "Fresh Food, Fast Food" (eating mostly processed, high-calorie food; less fresh food); (3) "Food Fretting" (judgmental thoughts and overconcern about food); (4) "Task Snacking" (eating while doing other activities); (5) "Sensory, Spiritual Nourishment" ("flavoring" food with meaning); (6) "Eating Atmosphere" (dining aesthetics and surroundings); (7) "Social Fare" (eating alone vs with others). CONCLUSIONS: Further research is needed to assess the degree to which practicing and implementing these eating styles integratively will decrease overeating, overweight, and obesity.

A descriptive analysis of an integrative medicine clinic.

OBJECTIVE: To evaluate and describe an integrative medicine clinic including its patients; their presenting problems, medical objectives, treatment recommendations; whether recommendations were recalled and adhered to; and patients' self-reported health outcomes. DESIGN: A prospective cohort study of 160 new clinic patients were treated using a wide range of integrative medicine therapies. Patients were interviewed at intervals of 1, 3, and 6 months after their initial visit. SETTING: The study was conducted at the Institute for Health and Healing clinic, at California Pacific Medical Center located in San Francisco, CA. SUBJECTS: The subjects were new clinic patients seeking care for a variety of symptoms and diagnoses. INTERVENTION: Patients presented with an average of 4.0 symptoms and 2.9 diagnoses; physicians recommended 9.5 "treatments" per patient. RESULTS: At 6-month follow-up, symptom intensity decreased from 6.5 to 4.2 (on a 10-point scale; p < 0.005); and 57% of the patients had made "substantial" progress or had completely achieved their health objectives (p < 0.005). The Short Form 12 (SF-12) measure of mental and physical functioning improved significantly from baseline to one month (p = 0.05; p = 0.001, respectively) and maintained this improvement at 3 (p = 0.01; p = 0.01) and 6 months (p = 0.001; p = .001). At 1-month follow-up, patients recalled 57% of the actionable statements from the physician without a prompt and they followed 55% of all recommendations well (90% or above). Over the follow-up period, patients increasingly attributed the reductions in symptoms (p = 0.01) and achieving their health objectives (p = 0.01) to the treatment plan. Self-reported measures of days ill and days missed at work/school did not differ significantly from the year before coming to the clinic. CONCLUSION: The results indicate that patients can recall and follow a complex treatment regimen. Subjective and objective measures of patients' health status improved after one month and this effect was sustained or improved further at 6 months follow-up. Further study is needed to determine whether patients' improvement was the result of the treatment regimen.

Improvement in medical risk factors and quality of life in women and men with coronary artery disease in the Multicenter Lifestyle Demonstration Project.

This study examined medical and psychosocial characteristics of 440 patients (mean age 58 years, 21% women) with coronary artery disease at baseline and at 3-month and 12-month follow-ups. All patients were participants in the Multicenter Lifestyle Demonstration Project, aimed at improving diet (low fat, whole foods, plant-based), exercise, stress management, and social support. Spousal participation was encouraged. Both genders evidenced significant improvements in their diet, exercise, and stress management practices, which they maintained over the course of the study. Both women and men also showed significant medical (e.g., plasma lipids, blood pressure, body weight, exercise capacity) and psychosocial (e.g., quality of life) improvement. Despite their worse medical, psychosocial, and sociodemographic status at baseline, women's improvement was similar to that of men's. These results demonstrate that a multi-component lifestyle change program focusing on diet, exercise, stress management, and social support can be successfully implemented at hospitals in diverse regions of the United States. Furthermore, this program may be particularly beneficial for women with coronary artery disease who generally have higher mortality and morbidity than men after a heart attack, angioplasty, or bypass surgery.

An integrative medicine clinic in a community hospital.

We report on the creation of an integrative medicine clinic within the setting of a medical research and tertiary care hospital. The clinical audit used a prospective case series of 160 new patients who were followed by telephone interviews over a 6-month period. Patients' demographic characteristics, presenting symptoms and diagnoses, physician treatment recommendations, extent of understanding and adherence to treatment recommendations, changes in symptom intensity, and progress toward achieving health objectives were recorded. Patients at the clinic showed significant reductions in the severity of symptoms and made significant progress toward achieving their health objectives at the 6-month follow-up. Thus far, the clinic's experience suggests that an integrative medicine clinic can face current health care financial challenges and thrive in a conventional medical center.