Received: 27 November 2023 Revised: 10 October 2024 Accepted: 13 October 2024

DOI: 10.1111/obr.13860

REVIEW
Obesity Management / Intervention

Effects of mindfulness-based interventions on obesogenic

eating behaviors: A systematic review and meta-analysis

Tsui-Sui Annie Kao 1 | Jiying Ling 1 | Mohammed Alanazi 2 | Ahmed Atwa 3,4 |
Stephanie Liu 5

1
College of Nursing, Michigan State University,
East Lansing, Michigan, USA Summary
2
University of Bisha, Bisha, Saudi Arabia This systematic review and meta-analysis examined the effects of mindful-based
3
Department of Translational Neuroscience,
interventions (MBIs) on changes in obesogenic eating behaviors. Seven databases
College of Human Medicine, Michigan State
University, Grand Rapids, Michigan, USA (CINAHL, PubMed, PsycINFO, Cochrane, Web of Science Core Collection, Embase,
4
Neuroscience Program, Michigan State Sociological Abstracts) were searched. Random-effects models were performed to
University, East Lansing, Michigan, USA
5
estimate the pooled effects, and mixed-effects models were used to explore potential
Department of Family Medicine, University of
Michigan Medical School, Ann Arbor, moderators of MBIs on eating behavioral changes. The significant effects on mindless
Michigan, USA eating habits included controlled eating (Hedge's g = 0.23, p = 0.005), external
Correspondence eating (g =
0.62, p = 0.001), fullness awareness (g = 0.64, p < 0.001), hunger
Tsui-Sui Annie Kao, College of Nursing, eating (g =
0.69, p = 0.032), energy intake (g =
0.60, p = 0.003), sweet intake
Michigan State University, East Lansing, 1355
Bogue St. C342, East Lansing, MI48824, MI, (g =
0.39, p < 0.001), and impulsive food choice (g =
0.43, p = 0.002). However,
USA. small and insignificant effects were noted for stress-related eating habits like
Email: kaotsuis@msu.edu
emotional eating (g =
0.27; p = 0.070) and binge eating (g =
0.35, p = 0.136).
Funding information The long-term effects were significantly sustained on hunger eating (g =
0.50,
This research did not receive any specific grant
from funding agencies in the public, p = 0.007) but insignificant on emotional eating (g =
0.22, p = 0.809). MBIs
commercial, or not-for-profit sectors. delivered in clinical settings were more effective for decreasing emotional eating
[Correction added on 3 January 2025, after compared with those in school settings. Our findings support the effectiveness of
first online publication: An affiliation to MBIs. The pooled effects on improving mindless eating habits were stronger than the
Michigan State University has been removed
for Mohammed Alanazi.] modification of stress-related eating habits.

KEYWORDS
controlled eating, mindful eating, mindless eating, stress-related eating

1 | I N T RO DU CT I O N MBIs on eating behavioral outcomes remain relatively obscure.

Mindless and autopilot eating habits/styles (#control, #fullness
Using mindfulness-based interventions (MBIs) to target obesity- awareness, "external eating, "hunger, "energy intake, "sweet intake,
related eating behaviors has demonstrated some promising results "unhealthy food choice)4 and stress-related habits (emotional and
and been increasingly implemented to prevent or treat overweight binge eating) can position individuals at a greater risk for overweight
or obesity.1,2 The significant effects of MBIs on anthropometric and obesity.1,5,6 Thus, this systematic review and meta-analysis
outcomes (BMI: g =
0.36, waist circumference: g =
1.20) have examined the effects of MBIs on changes in various obesogenic eating
been delineated in our previous meta-analysis,3 but the effects of behaviors including controlled, external, hunger, binge, and emotional

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any
medium, provided the original work is properly cited and is not used for commercial purposes.
© 2024 The Author(s). Obesity Reviews published by John Wiley & Sons Ltd on behalf of World Obesity Federation.

Obesity Reviews. 2025;26:e13860. wileyonlinelibrary.com/journal/obr 1 of 11

https://doi.org/10.1111/obr.13860
2 of 11 KAO ET AL.

eating as well as fullness awareness, sweet and energy intake, and Because MBIs are designed to increase individuals' awareness of
impulsive food choice. their actions by bringing their attention to the present moment,
mindful eating training can help turn off individuals' autopilot eating
mode by training them to really savor foods and establish a positive
1.1 | MBIs and healthy relationship with food. In addition, MBIs have provided
strategies to improve physical movement and stress management and
Over the past few decades, MBIs for obesity prevention or treatment potentially can be used to mitigate stress-related eating behaviors
have been used with promising results.1–3 MBIs typically are designed (e.g., emotional and binge eating).
to improve individuals' psychological adaptation through enhanced Currently, few systematic reviews or meta-analysis have
awareness of their own emotions, acceptance, and cognitive comprehensively and explicitly examined the effects of MBIs on these
processes. MBI techniques have been shown to support individuals' mindless eating habits including enhancing awareness of fullness (the
nonjudgmental self-motivation and self-awareness.7 Mindful eating recognition of the unpleasant full sensation after eating),2 physical
training, in particular, is designed to heighten individuals' awareness hunger,6 and minimizing external eating (in response to external cues
of the present moment, with a focus on their body's sensations when rather than internal cues of fullness).15 MBIs, particularly mindfulness
eating, as well as their thoughts and feelings about food. This training, can help decrease individuals' energy intake,16 sweet intake
approach has been frequently employed to overcome obesogenic (as a coping mechanism),17,18 and impulsive food choices.6
eating behaviors such as mindless and stress-related eating styles/
habits.8,9 Existing relevant reviews and meta-analyses on the effects
of MBIs mostly targeted populations suffering from overweight/ 1.3 | Obesogenic behavior: Stress-related eating
obesity10,11 or eating disorders12 and assessed anthropometric out- habits
comes.3,11 Of the few systematic reviews that investigated the effects
of MBIs on eating behaviors, many of them aggregated various eating Many individuals eat as a reaction to stress. In fact, increased
behavioral outcomes to reflect the improvements in healthy perceived stress is a known obesogenic risk factor for emotional or
eating (r = 0.14),13 overall eating behavior (g = 1.08),11 or eating binge eating behaviors and indirectly impacts individuals' weight
attitude ( g = 0.57).11 Various aspects of mindful eating habits ("eating status.22 Emotional eating is defined as a tendency to overeat in
control or disinhibition,14 "fullness awareness,2 #external eating response to negative emotions, such as anxiety or irritability,23 while
[#reactive to external cues], 15
#physical hunger, 9
#energy16
and binge eating refers to eating a large amount of food within a short
#sweet intake,17,18 or #impulsive food choices6) were not explicitly amount of time and is associated with a sense of loss of control.24
examined. Understanding specific impact of MBIs on various obeso- Emotional eating, for example, is highly prevalent among individuals
genic eating habits can shed lights on how to better tailor MBIs and who struggle with their weight; this may progress to binge eating
more effectively prevent or treat overweight or obesity. Currently, without timely and effective interventions. MBIs are recognized as a
stress-related eating habits ("emotional or "binge eating) often were promising approach to reduce stress-related eating behaviors,2,5,25,26
assessed when MBIs were implemented with populations diagnosed and improve mental health outcomes.27 Currently, the benefits of
with eating disorders.11,19 There is scarce understanding about how MBIs on emotional and binge eating are better understood among
4
MBIs may have an impact on mindless or stress-related eating individuals who have suffered from mental health problems such as
habits20 that can contribute to what is known about obesogenic anxiety/depression27 and eating disorders.12 However, the results of
eating behaviors, particularly among individuals who do not have an these studies may not be applicable to emotional and binge eating
eating disorder. Bridging this knowledge gap in literature has potential behaviors manifested by people without mental health problems or
to broaden the implementation of MBIs. eating disorders, and the benefits of MBIs on emotional and binge
eating among the general population remain relatively unclear.
Understanding the effects of MBIs on emotional and binge eating
1.2 | Obesogenic behaviors: Mindless eating habits behaviors is essential because many individuals use eating to cope
with excessive stress.20,22
Mindless (or autopilot) eating refers to the absence of conscious The aim of this review and meta-analysis was to separate obeso-
awareness when consuming snacks and meals and often leads to genic eating behaviors into mindless or stress-related eating habits to
overeating behaviors because it can reduce individuals' ability better understand the effect of MBIs on each domain. The result of
to respond adequately to internal/external cues and/or physical this review will help develop interventions tailored toward improving
hunger and to monitor the amount (or quality) of food intake.4,15 In obesogenic eating habits. Furthermore, the present review seeks to
fact, individuals whose behavior includes mindless eating may not be provide insights about potential moderators (e.g., MBI type and focus,
able to discern the internal/external triggers to eat, the source of their sessions, duration, setting, age, treatment fidelity) on the effects of
hunger, and/or the level of fullness while eating. Subsequently, mind- MBIs on various eating habits. The moderation analysis will delineate
less eating can result in overweight and obesity, which puts them at the role of potential confounders on the pooled effects of MBI with
higher risk for type 2 diabetes, cardiovascular diseases, and cancer.21 various eating habits.
KAO ET AL. 3 of 11

2 | METHODS OR eats OR food OR “eating behavior” OR “feeding behavior” OR

“feeding behaviors” OR “food habit” OR “food habits” OR diet). To
2.1 | Literature search some extent, the search strings were modified for each database to
enhance the search and meet some of the databases' formatting
The current systematic review was undertaken to identify experimen- requirements.
tal studies that investigated the effects of MBIs on obesogenic
eating behaviors. The study report was developed according to the
Preferred Reporting Items for Systematic Reviews and Meta-analyses 2.2 | Eligibility criteria
statement (PRISMA).28 Figure 1 illustrates our search process. With
the help of the university librarian, studies were identified from the The inclusion criteria were experimental studies with general partici-
following databases: CINAHL Plus with Full Text, PubMed, PsycINFO, pants, had a comparison group, included any of the eating behavioral
Cochrane, Web of Science Core Collection, Embase, and Sociological measurements (i.e., hunger, fullness awareness, external eating, con-
Abstracts. The search also included gray literature, such as trolled [or disinhibited] eating, emotional eating, binge eating, energy
ClinicalTrials.gov, MedRxiv, and a manual search of reference lists. and sweet intake, and impulsive food choice), and the intervention
The following keywords and phrases were used in this search: that included components of mindful eating, mindful movement, or
(Mindful OR yoga OR meditate OR Mindfulness) AND (Eat OR eating mindful meditation. Exclusion criteria were studies that explicitly

F I G U R E 1 PRISMA flow diagram. Source: Adopted from: Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The
PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021; 372:n71. doi: 10.1136/bmj.n71
4 of 11 KAO ET AL.

targeted participants with acute or chronic medical conditions, who within 6 weeks, we calculated the mean or SD from the reported
had eating disorders or mental health problems, or those were not median, sample size, interquartile range, and confidence intervals if
published in English. applicable.26,27 Influential outliers were defined as having residual
>2.56 and I2 being decreased by ≥10% after removing each potential
outlier.28 Hedge's g was calculated using random-effects models as
2.3 | Data screening and extraction the effect size in order to examine each study's sample size and was
interpreted as small = 0.20, medium = 0.50, or large = 0.80.30 A
A two-step screening approach was used to code and extract data. In negative Hedge's g indicated that the intervention group had a greater
the initial step, the first author created the inclusion/exclusion criteria decrease in the targeted eating habits than the control group. The
for data extraction and evaluation. Two of the authors (MA and AA) pre- and post-intervention correlation was fixed at 0.50.31 The effects
independently performed the eligibility assessment in a standardized of long-term sustainability from baseline to follow-up and post-
manner using Covidence software. After removing duplicates, these intervention to follow-up assessment were also evaluated for the
authors reviewed the title and abstract for all studies to determine articles with follow-up data. Subgroup and meta regression analyses
eligibility. Then, a full-text review was conducted on all potentially with mixed-effects models were applied to conduct exploratory
eligible studies. Finally, those studies that met the inclusion and moderation analyses. Heterogeneity among studies was evaluated
exclusion criteria were included in the review and meta-analysis. Any using the Q test and I2 statistics: low heterogeneity = 25%, moderate
disagreements between the authors were resolved by consensus. The heterogeneity = 50%, and high heterogeneity = 75%. There was no
search was completed in June 2023. The data extraction included the strong evidence of publication bias when the results from the Begg
author's name, year of publication, country, design, sample size, partic- and Mazumdar rank correlation test and the Egger's regression
ipants' characteristics, type and focus of MBIs, duration, type of eating asymmetry test were nonsignificant, and the funnel plot32 was
habits (outcomes), and key findings. The second step included multiple symmetric. When publication bias existed, the Duval and Tweedie's
discussions among the two independent coders during the evaluation; trim and fill method were applied to adjust the effect size. Sensitivity
consensus then was reached after resolving any discrepancies with analyses were performed to examine the robustness of the results
the first author. according to each study's quality score.

2.4 | Quality appraisal and risk of bias 3 | RE SU LT S

The two independent raters (MA and AA) scored eligible articles using 3.1 | Study characteristics
the Alberta Heritage Foundation of Medical Research tool.29 This tool
has 14 items that address five domains of quantitative study design, As illustrated in Table S1, of 32 included studies, 31 (97%)15,16,30–58
including study design (five items, sampling selection and data analy- were randomized controlled trials (RCT); 11 (34%)16,33,35–
37,39,41,45,55,57,58
sis), selection bias (two items), randomization procedure (one item), were conducted in the United States, followed by
concealment procedure (two items), and reporting/overall synthesis the United Kingdom (k = 8, 25%),38,40,43,46,52–54,56 the Netherlands
(four items, internal/external validity). Each item was scored as one of (k = 4, 13%),31,32,34,44 Spain (k = 3, 9%),15,47,59 and Brazil (k = 2,
the following: 0 (Not met), 1 (Partially met), and 2 (Met). A quality 6%),49,50 as well as one each from Austria,51 Denmark,42 Greece,30
appraisal score (QA range = 0 to 1) for each article was calculated and and Portugal.48 A total of 2431 participants (78% female) were
averaged by using the total sum score of the 14 items divided by included, with ages ranging from 959 to 5847 years (overall
28 (Table S2). Following the tool guideline, a quality score lower than Mage = 36.72). Sample sizes ranged from 1932 to 257,34 with three
0.55 was considered low quality and consequently excluded from this studies (9%)33,54,59 targeting children (Mage = 11.96).
review. Inter-rater consistency was evaluated using Cohen's kappa
before averaging the quality score between these two raters.
3.2 | Intervention characteristics

2.5 | Statistical data analysis Interventions were mostly delivered at a clinic (k = 27;
84%)15,16,30–32,34–38,40–43,45–54,56–58 followed by school settings
The Comprehensive Meta-Analysis program (version 3.0) was used to (k = 5; 16%).33,39,44,55,59 Mean intervention length was 8.2 weeks
perform all meta-analyses. To calculate the pooled effect size for each (range: 1–24 weeks), with 20 studies (63%) having a minimal length of
study outcome, we used the mean, standard deviation (SD), and the 7 weeks and nine (28%) having a maximum length of 3 weeks.
sample size in the experimental and control groups at each data About 47% (k = 15) of studies targeted participants with BMIs greater
assessment (baseline, post-intervention, and follow-up). If the mean or than 25.30,32,35,36,42,45–50,55,56,58,60 Although mindful eating was
SD was not reported in the article, we contacted the corresponding introduced in all included studies to various degrees, the mindfulness
author twice (2–3 weeks apart). If we did not receive a response components can be demarcated into mindful eating [k = 20], mindful
KAO ET AL. 5 of 11

movement [k = 4], and mindfulness-based stress reduction [k = 8]. delivered by a certified intervenor (g = 0.32 vs. 0.10). Moreover, MM
About 59% of studies (k = 19) used mindfulness strategies as the as an add-on had smaller effects than MM-focused interventions
primary intervention component, while the remaining 41% (g = 0.16 vs. 0.34). Interventions delivered remotely that focused on
(k = 13)30,44–48,50,51,54–56,58,60 incorporated other health promotion older children or that were community-based tended to have better
programs to support healthy eating behaviors. effects on improving controlled eating.
Of the 32 selected studies, nine (28%) utilized certified mindful-
ness practitioners as intervenors, while the rest trained their own Impulsive food choices
intervenors. Most control conditions were waitlist or no-intervention One significant outlier was identified (z = 3.32).55 After removing the
control (k = 11, 34%), while others applied attention control including outlier, the heterogeneity decreased from 83.40% ( p < 0.001) to
standardized weight-loss program (k = 4), existing care program 71.05% ( p < 0.001). The pooled effects on decreasing impulsive food
(k = 3), reading (k = 3), PA (k = 2), PA/diet (k = 1), nutrition (k = 2), choices increased from
0.28 to
0.43 (see Figure 3A). There was no
education (k = 2); and non-mindful eating (k = 1). Furthermore, strong evidence of publication bias based on the results from the
27 studies (84%) reported immediate post-intervention effects and six Begg and Mazumdar rank correlation test (p = 0.055) and the Egger's
(19%) had follow-up assessments (T3)15,45,47,51,54,55 to evaluate long- regression intercept test ( p = 0.072) as well as the funnel plot (see
term effects. Treatment fidelity was described in two studies Figure 3B).
(6%).41,54 While most studies (k = 31) delivered the intervention
through in-person contacts, one study35 delivered mindfulness Moderators. As demonstrated in Table S4, no significant moderator
training remotely (using phone calls). was identified. When comparing the different effect sizes, the
interventions had better effects when focusing on mindful eating
(g =
0.53), with female participants ( g =
0.63), not assessing treat-
3.3 | Risk of bias ment fidelity ( g =
0.53), being an add-on component to another
program (g =
0.81) or targeting OW/OB participants (g =
0.81).
Of the 32 included studies (see Table S2), no study was identified
as having a high risk of bias (QA ≤0.55), while 15 studies (47%) had External eating
a moderate risk (QA = 0.56–0.74),30–33,36,39,42,46,48,51,53–55,57 and After removing one influential outlier (z =
5.32),60 the heterogeneity
17 studies (52%) had a low risk of bias (QA ≥0.75). The moderate risks decreased from 93.13% ( p < 0.001) to 61.66% ( p = 0.011). The
of bias were mostly due to selection bias (random sequence or alloca- pooled effect size decreased from
1.29 to
0.62 (see Figure S1a).
tion concealment), performance bias (blind outcome assessment), and Results from the Begg and Mazumdar rank correlation test
attrition bias (incomplete data). No study was excluded as a result of (p = 0.138), the Egger's regression intercept test ( p = 0.554), and the
high risk of bias. The inter-rater agreement between the two raters funnel plot (see Figure S1b) showed no evidence of publication bias.
was acceptable (Cohen's Kappa = 0.83).
Fullness awareness and hunger
The heterogeneity was small for fullness awareness (k = 4,
3.4 | Intervention pooled effects I2 = 5.52%; Q = 3.18, p = 0.365) and high for hunger (k = 4,
I2 = 78.42%, Q = 13.90, p = 0.003). The pooled intervention effects
3.4.1 | Mindless eating habits were 0.64 on improving fullness awareness (see Figure S2a) and

0.69 on reducing hunger (see Figure S3a). Long-term sustained
Controlled eating effects from post-intervention to follow-up were noted (k = 2;
Among the 17 comparisons, one influential outlier 32
was identified g =
0.50, 95%CI:
0.87,
0.13; p = 0.007) on hunger. As shown in
(z = 3.70), and I2 decreased from 58.70% (p = 0.001) to 29.23% Figures S2b and S3b, there was no strong evidence of publication
( p = 0.131) after removing the outlier. Similarly, the pooled effects bias. This was supported by the results from the Begg and Mazumdar
on increasing controlled eating decreased from 0.30 to 0.23 (see rank correlation test (Tau = 1.00, p = 0.042; Tau = 0, p = 1.00) and
Figure 2A). Results from the Begg and Mazumdar rank correlation the Egger's regression intercept test (β = 5.70, p = 0.295; β = 16.96,
test (Tau = 0.12, p = 0.528), the Egger's regression intercept p = 0.342).
test ( p = 0.304), and the funnel plot (see Figure 2B) showed no
evidence of publication bias. Energy and sweet intake
The heterogeneity was moderate for energy intake (I2 = 55.56%;
Moderators. As shown in Table S3, MM type was a significant modera- Q = 13.50, p = 0.036) and small for sweet intake (I2 = 0%; Q = 1.94,
tor for the immediate intervention effects ( p = 0.010). Programs that p = 0.585). The pooled intervention effects were
0.60 and
0.39 on
incorporated mindful movements and stress reduction interventions reducing energy and sweet intake, respectively (see Figure S4a, S5a).
resulted in better effects than those that used mindful eating alone Results from the Begg and Mazumdar rank correlation test
( g = 0.50, 0.28 vs.
0.01). Although not significant, interventions (Tau =
0.05, p = 0.881; Tau =
0.33, p = 0.497), the Egger's
delivered by trained research assistants had greater effects than those regression intercept test (β = 16.96, p = 0.342; β = 0.17, p = 0.970),
6 of 11 KAO ET AL.

F I G U R E 2 Mindless-related eating habits: controlled eating. (A) Forest plot for controlled eating. (B) Funnel plot for the controlled eating.
Note. Begg and Mazumdar rank correlation test (Tau = 0.12, p = 0.528), the Egger's regression intercept test (β = 1.26, p = 0.304).

and the funnel plot (see Figure S4b, S5b) showed no evidence of p = 0.809). Results from both the Begg and Mazumdar rank correla-
publication bias. tion test (Tau =
0.28, p = 0.053) and the Egger's regression inter-
cept test (β =
3.68, p = 0.123) as well as the funnel plot (see
Figure S6b) indicated no evidence of publication bias.
3.4.2 | Stress-related eating habits
Moderators. Community-based interventions had significantly better
Emotional eating effects than school-based interventions ( g =
0.32 vs. 0.96,
The pooled immediate intervention effects on reducing emotional eat- p = 0.038; see Table S5). In addition, interventions that focused on
ing were
0.27 (see Figure S6a). The long-term sustained effects from stress reduction ( g =
0.61), among females ( g =
0.41), with young
post-intervention to follow-up were
0.22 (95%CI:
2.04, 1.59; children ( g =
0.32), and were delivered in-person (g =
0.31) or by
KAO ET AL. 7 of 11

F I G U R E 3 Mindless-related eating habits: impulsive food choices. (A) Forest plot for impulsive food choices. (B) Funnel plot for the impulsive
food choices. Note. Begg and Mazumdar rank correlation test (Tau =
0.42, p = 0.055), the Egger's regression intercept test (β =
2.28,
p = 0.072).

trained research assistants ( g =
0.37) resulted in more positive publication bias. In addition, the funnel plot of standard error by
effects, but the results were not significant. Hedges' g was symmetric (Figure S7b).

Binge eating
The heterogeneity was moderate (Q = 14.12, p = 0.007, 3.5 | Sensitivity analysis results
I2 = 71.68%). The pooled effects on reducing binge eating were

0.35 (Figure S7a). Results from both the Begg and Mazumdar rank Studies with a moderate quality had significantly greater effects on
correlation test (Tau = 0.60, p = 0.142) and the Egger's regression decreasing impulsive food choices than those with a high quality
intercept test (β = 11.72, p = 0.200) indicated no evidence of (g =
0.81 vs.
0.20, p = 0.012). Other outcomes were not
8 of 11 KAO ET AL.

significantly related to study quality. However, high-quality studies In terms of the effects on stress-related eating habits (binge and
were more likely to have larger effects on decreasing binge emotional eating), the effect sizes were small (
0.27 and
0.35,
eating ( g =
0.51 vs.
0.09, p = 0.434), energy intake ( g =
0.70 respectively) and insignificant. Our effect size on binge eating is much
vs.
0.51, p = 0.663), and increasing controlled eating ( g = 0.29 lower than outdated meta-analyses (>6 years) conducted with over-
vs. 0.13, p = 0.348) than moderate-quality studies. In contrast, studies weight/obese adults (g =
0.90)10 or with adults who needed psy-
with a moderate quality tended to have greater effects on decreasing chological interventions to reduce their problematic eating behaviors
emotional eating ( g =
0.35 vs.
0.20, p = 0.603) than those that (g =
0.70).12 For the more recent meta-analysis (conducted in 2023)
were of high quality. targeting adults living with overweight or obesity, MBIs had a com-
bined effect size (percentage change) of
2.37% on emotional eat-
ing.62 In another recent systematic review focused on adults with
4 | DISCUSSION problem eating behaviors, the positive effects of MBIs were con-
cluded, but no pooled effect size was available for comparison.63
To the best of our knowledge, this is the first systematic review and Overall, the effects of MBIs on emotional or binge eating habits
meta-analysis that has explicitly evaluated the effects of MBIs for remain relatively obscure, particularly among the general population
improving eating behaviors. Obesogenic eating habits can increase (those people with or without weight concerns). However, our pre-
energy intake and contribute to elevated adiposity and obeisty.61 This sent findings in improving emotional eating do provide some insights
systematic review summarized the range of MBIs designed for into how MBIs may be utilized to handle stress-related eating habits.
preventing and treating obesogenic eating habits as well as the effec- Most importantly, the small effects on stress-related eating habits
tiveness of MBIs on various mindless and stress-related eating habits. have some clinical significance, particularly when delivered in clinical
Results from this meta-analysis revealed significant small-to-moderate settings, because our moderation analysis showed that the effects
pooled effects ( g = 0.23 to
0.69) on improving mindless eating were significantly stronger in clinical settings than in school settings.
habits. These results are comparable to the effect sizes displayed This finding suggests that clinically tailored MBIs may be more useful
conjointly in other studies, such as healthy eating (r = 0.14), 13
eating for meeting participants' psychological needs and consequently have
attitudes ( g = 0.57), and overall eating behaviors (g = 0.53).11 Subse- greater potential for improving participants' emotional and binge
quently, MBIs can be utilized to increase individuals' awareness with eating habits. Unfortunately. our study did not find a significant long-
eating ("awareness of fullness, physical hunger, and external/internal term sustained effect on reducing emotional eating ( g =
0.22). Addi-
cues) and help them realize why, what, and how much they should tional efforts are needed to understand how MBIs can be modified to
eat. Additionally, mindful eating training can be used to successfully improve stress-related eating habits over short- and long-term
mitigate an autopilot eating style and help to re-establish a healthy periods, particularly among those who do not yet have severe eating
and satisfactory relationship with food (#impulsive food choices). Our or mental health problems.
results endorse the possibility of increasing participants' physical Only two studies (6.25%) in this review reported on treatment
senses (satiety) to the eating experience and enable them to enjoy the fidelity, which may affect studies' reproducibility. Assessing, monitor-
food choices they have made ("gratitude). ing, and reporting treatment fidelity (i.e., the degree to which an
In addition, the significant increases in controlled eating and intervention has been implemented as intended) is essential because
fullness awareness as well as the decreases in external eating and it is impossible to know the actual effects of the intervention if the
physical hunger are unique. It is possible that MBIs can be used to intervention is not consistently delivered. This gap can seriously com-
significantly connect individuals' sense of awareness with food and promise the evolution of practical applications for MBIs (e.g., scaling
repurpose the meaning of eating. Mindful eating training might be a up in the real world).64 This concern is also reflected in the result of
better approach for weight reduction than traditional dieting (dietary our sensitivity analysis in which study quality (moderate and high QA
restriction for weight loss purpose) because MBIs help individuals score) seemed to play a role on the effects of decreasing impulsive
purposefully pay attention to their food without judgment. As a result, food choices. Future MBI studies should consistently and rigorously
MBI practitioners are more connected to their physical senses evaluate treatment fidelity to enhance intervention programs' replica-
(hunger, fullness) and more appreciative of their food (satiety, grati- bility and scalability.
tude, and enjoyment). Consequently, mindful eating practitioners are
less likely to be concerned about restricting their food intake. Since
mindfulness is a nonjudgmental approach, mindfulness practitioners 4.1 | Limitations
are encouraged to choose what and how much they want to consume
and are more likely to select foods that are beneficial to their health. There were some limitations noted. First, there was high heterogene-
For example, our findings in decreased energy/sweet intakes and ity (78.42%) in hunger eating habits, which could impact the reliability
impulsive food choices further authenticate the promise of using MBIs of the result. Second, because different measurement tools were
to tackle awareness-related mindless eating habits. Moreover, the utilized to assess eating habits, not all tools were equally validated for
significant long-term sustained effects on physical hunger further people of all genders, ages, and BMIs. Moreover, only two studies
validate the benefits of using MBIs to improve mindless eating habits. (6.25%) in this review assessed treatment fidelity, which may have an
KAO ET AL. 9 of 11

impact on interventions' reproducibility. Finally, while we reported on 6. Hendrickson KL, Rasmussen EB. Mindful eating reduces impulsive
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Very few studies investigated the long-term, sustained effects of
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AUTHOR CONTRIBUTIONS doi:10.1080/17437199.2019.1650290
14. Bennett BL, Latner JD. Mindful eating, intuitive eating, and the loss of
All authors contributed to the design of the study and writing of the
control over eating. Eat Behav. 2022;47:101680. doi:10.1016/j.
manuscript. All authors have approved the final manuscript. eatbeh.2022.101680
15. Allirot X, Miragall M, Perdices I, Baños RM, Urdaneta E, Cebolla A.
ACKNOWLEDGMENTS Effects of a brief mindful eating induction on food choices and energy
intake: external eating and mindfulness state as moderators. Mind.
We would like to acknowledge Jessica Sender, a master-prepared
2018;9(3):750-760.
health sciences librarian at Michigan State University, for conducting 16. Simonson AP, Davis KK, Barone Gibbs B, Venditti EM, Jakicic JM.
the systematic literature review search for the study. Comparison of mindful and slow eating strategies on acute
energy intake. Obes Sci Pract. 2020;6(6):668-676. doi:10.1002/
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