Small Changes Yield Big Results

The research findings made headlines around the globe: Eating mindfully – paying attention to the foods you choose and eating with awareness – helps people lose weight.

But the headlines tell just one small part in a larger story of Eat Smart, Move More, Weigh Less (ESMMWL), a groundbreaking weight management program that has helped more than 17,000 people from North Carolina and beyond over the past 16 years.

NC State University and the state’s Division of Public Health developed the program in 2001 to help address a rise in obesity and its related health consequences – hypertension, type-two diabetes and heart disease. Their goal: to help participants learn and adopt healthy behaviors for eating and physical activity.

Planning + Tracking + Living Mindfully = Healthy Weight

Rather than prescribing a diet, the program emphasizes how simple changes can add up to enduring weight management results, according to Professor Carolyn Dunn, head of NC State University’s Department of Agricultural and Human Sciences and Extension nutrition specialist, who is the program’s lead author and principal investigator.

ESMMWL consists of 15 weekly one-hour lessons. The program encourages participants to plan their meals, track their exercise and eating, and to live mindfully.

Dunn and her colleagues had repeatedly found that the program helps individuals adopt healthy behaviors for eating and physical activity. “One issue, however, was how to reach more people than could be reached with traditional in-person delivery,” she said.

Reaching Out

About five years ago, they decided to see whether they could adapt the program for online use, so that more people could find classes that fit their schedules.

Previous research into the effectiveness of web-based delivery of obesity treatment had shown mixed results, but with ESMMWL Online, Dunn and her colleagues tried something that most online weight management programs hadn’t: They employed live instructors to lead interactive classes in real time.

The results surprised Dunn: In terms of weight loss and blood pressure reduction, online class participants lost an average of 7.5 pounds – about the same amount as those in the face-to-face classes.

“What we found was that people signed up, people came, people stayed, people loved it, and so did the instructors. The online delivery produced similar impacts when compared to in-person delivery, with positive outcomes related to weight, healthy eating and physical activity behaviors,” she said.

Building a Community

Dunn attributed the success of the online program to the fact that they incorporate best practices in online education and “mirror, as much as possible, what it would be like for the participants to be in an in-person class.”

“They see the instructor, and they go through the program with the same cohort of people,” she said. “So it’s not just that you get this password and you get these resources that are online. You have a cohort of people that are your classmates, just like you’d be doing in person.”

Dunn also pointed to the element of mindfulness incorporated into the program. ESMMWL encourages participants to pay more attention while eating and exercising, to listen to their bodies’ hunger and satiety cues, to plan their meals and snacks, and to avoid doing other things when eating.

When compared to a control group who did not participate in the program, ESMMWL participants scored significantly larger increases on a mindful eating questionnaire, and they lost significantly more weight.

“We wanted to see if we could help people eat mindfully, and if we did that, could we help them lose weight or manage their weight?” Dunn said. “The answer to both questions: Yes.”

‘A Powerful Tool’

Dunn reported on the findings at the European Congress on Obesity, held in May in Portugal, and that’s when newspapers and other publications around the world took note. While mindfulness has been suggested in recent years as a possible weight loss strategy, there hasn’t been a lot of research to back up that suggestion.

“Through this research, we really saw the power of teaching people to eat mindfully,” Dunn said. “It seems like such a simple thing, but it’s a really powerful tool that people who want to manage their weight have right at their fingertips.”