A structured literature review on the role of mindfulness, mindful eating and intuitive eating in changing eating behaviours: effectiveness and associated potential mechanisms

Abstract

The role of mindfulness, mindful eating and a newer concept of intuitive eating in modulating eating habits is an area of increasing interest. In this structured literature review, a summary of the current evidence is presented, together with details of interventions undertaken and the tools to measure outcomes. It is broad in scope given the emerging evidence base in this area. The review yielded sixty-eight publications: twenty-three interventions in obese/overweight populations; twenty-nine interventions in normal-weight populations; sixteen observational studies, three of which were carried out in overweight/obese populations. Mindfulness-based approaches appear most effective in addressing binge eating, emotional eating and eating in response to external cues. There is a lack of compelling evidence for the effectiveness of mindfulness and mindful eating in weight management. Mindfulness-based approaches may prevent weight gain. Reduced food intake was seen in some of the studies in overweight and obese populations, but this was less apparent in the studies in normal-weight populations. The evidence base for intuitive eating is limited to date and further research is needed to examine its potential in altering eating behaviours. Mindfulness appears to work by an increased awareness of internal, rather than external, cues to eat. Mindfulness and mindful eating have the potential to address problematic eating behaviours and the challenges many face with controlling their food intake. Encouraging a mindful eating approach would seem to be a positive message to be included in general weight management advice to the public.

Greater mindful eating practice is associated with better reversal learning

“…As a consequence of the heterogeneity as well as the limited sample size, the study might have been underpowered to reveal effects of mindfulness on secondary outcome measures. However, note that in general the evidence on the effectiveness of mindfulness for specifically weight loss is relatively scarce despite larger sample sizes 55,56 , in particular when it comes to long-term maintenance 57 . In fact, the few studies that have shown such an effect of mindfulness on weight loss were those with a focus on weight loss (as reviewed by 56 ), in contrast to the aim of the mindful eating intervention employed in the current study.…”

Mindfulness-based emotional eating awareness training: taking the emotional out of eating

“…Mindfulness-based interventions for weight loss have shown mixed success [28,[44][45][46][47]. Eating-related mindfulness interventions have mainly focused on weight and caloric intake as outcomes, rather than appetitive precursors of overeating [48].…”

“…The range of interventions used to date have varied in quality (lack of control groups), choice of primary outcomes (primarily weight and food intake), and curriculum configuration. Predominately the interventions have used modified MBSR and MBCT approaches and varied in the extent to which they embed a focus on eating behaviour [47]. Although a small number of these intervention studies have shown reduction in emotional eating scores, they have varied considerably in how they measured this construct.…”

“…Although a small number of these intervention studies have shown reduction in emotional eating scores, they have varied considerably in how they measured this construct. Emotional eating was neither a primary outcome measure nor a strong focus in intervention curricula [47]. An observational study of participants taking the MBSR programme for stress reduction demonstrated a clear reduction in emotional eating scores despite no focus on eating behaviour as part of the intervention [44], though the scale used to assess emotional eating was not validated.…”

“…Experimental studies indicate that enhancement of attention with a mindful attitude (taking a non-reactive and non-judgmental stance toward thoughts and 1 3 emotions) can reduce food craving [56], chocolate consumption [57], and attenuate reactivity to rewarding food-cues [58,59]. Research on the mechanisms by which mindfulness alters food-cue reactivity is ongoing, but it is likely to work by altering internal processes such as heightened awareness of hunger and satiety signals and decreasing the influence of emotional cues to eat [47]. The variation in outcomes observed in reviews suggest that mindfulness approaches should be tailored to the experience of emotional eating and its correlates to determine clearer evaluation of interventions [28,46,47].…”