Nutrition Research Reviews (2017), 30, 272–283
doi:10.1017/S0954422417000154© The Authors 2017. This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://
creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided theoriginal work is properly cited.

A structured literature review on the role of mindfulness, mindful eating andintuitive eating in changing eating behaviours: effectiveness and associatedpotential mechanisms
Janet M. Warren1*, Nicola Smith2 and Margaret Ashwell3
1

FirstStop Nutrition Ltd, Oxford, UK
Oxford Clinical Psychology, Oxford, UK
3Ashwell Associates, Ashwell, UK

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2

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 thetools 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 wasseen 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 thepotential 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.
Key words: Mindful eating: Intuitive eating: Binge eating: Emotional eating: External eating: Obese: Overweight

Introduction
Excessive body weight is one of the most challenging publichealth issues of our time(1). Our relationship with food is important; a recent UK report on securing a positive ‘Food Future’
indicated that consumers feel a loss of connection with food thatshould be preserved(2). Problematic food and eating behaviours,for example binge and emotional eating, have been characterisedin obesity. In mindfulness, an individual observes their immediate
experience using an open and non-judgemental stance(3). One of
the modern-day pioneers of mindfulness is Jon Kabat Zinn who
developed the Mindfulness-Based Stress Reduction (MBSR) programme which is used in mainstream medicine internationally,
particularly in the management of depression(4). Recent reviews
have examined the evidence for mindfulness in the managementof pain(5,6), depression(7,8) and psychological well-being(9,10).
In relation to eating behaviours, research began into the useof mindfulness in binge eating with early interventions in thelate 1990s when Kristeller & Hallet(11) undertook a pilot study

among obese women with binge eating disorder using
Mindfulness-Based Eating Awareness Training (MB-EAT). This
intervention was later developed for obese populations with orwithout binge eating disorder(12). In recent years there has been
increased interest in using mindfulness and mindful eating inobese/overweight and normal-weight populations.
Mindful eating consists of making conscious food choices,developing an awareness of physical v. psychological hunger
and satiety cues(13), and eating healthfully in response to thosecues(14). It is conceptualised as being aware of the present
moment when one is eating(15), paying close attention to theeffect of the food on the senses, and noting the physical andemotional sensations in response to eating(16). There is nouniversal deﬁnition of mindful eating but these principles are
consistent in the literature.
Intuitive eating is a discreet, but complementary term, often
used interchangeably with mindful eating. Intuitive eating was
originally deﬁned by two US Registered Dietitians in 1995(17)who described ten aspects of intuitive eating including

Abbreviations: ACT, Acceptance and Commitment Therapy; fMRI, functional MRI; MB-EAT, Mindfulness-Based Eating Awareness Training; MBSR, MindfulnessBased Stress Reduction.
* Corresponding author: Dr Janet Warren, c/o INCA Central Ofﬁce, Cobweb Buildings, The Lane, Lyford, Wantage, Oxfordshire OX12 0EE, UK,email janet@ﬁrststopnutrition.co.uk

https://doi.org/10.1017/S0954422417000154 Published online by Cambridge University Press

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Impact of mindfulness on eating behaviours

a rejection of ‘diets’, a discouragement of labelling foods as‘bad’, an encouragement to honour hunger, and allow satisfaction with food intake. Both mindful eating and intuitiveeating concentrate on internally focused eating(18); intuitiveeating, however, does not involve meditation(17).
A number of recent systematic reviews have been publishedlooking at the effectiveness of mindful eating(19), and mindfulness interventions(20) in binge eating, and mindfulness-based
interventions for eating disorders and obesity and obesityrelated behaviours(21–23). The three reviews that looked at binge
eating showed a positive effect of mindfulness in reducing
this maladaptive eating behaviour; the effect sizes weremoderate(20). Furthermore, there was evidence of its efﬁcacy inemotional(20,23) and external(23) eating. The role of mindfulness
in weight management was less apparent(20,21). The high levelof heterogeneity between studies(20) and methodologicalweakness of many studies(22) were highlighted.
Mindfulness is a key component of interventions based ondialectical behaviour therapy and Acceptance and Commitment
Therapy (ACT), which are both third-wave therapies to promoteawareness, acceptance and distress tolerance(19).
The aim of this paper is to present the results of a structured
literature review looking at the outcomes of mindfulness,
including mindful eating and intuitive eating, in changing eating
behaviours (including binge eating, emotional eating and eatingin response to cues) in healthy populations of any age andweight status. As this is an emerging area of science, the review
includes both observational and intervention studies to provide
an indication of the direction of future research. The review
provides details of the tools used to measure outcomes and theinterventions themselves including their theoretical basis. The
review also includes a brief summary of potential associatedmechanisms that may explain the observed results.

Methodology
The structured review was carried out combining the following
search terms and within the three parameters: population,intervention and outcomes. Search terms were combined with‘or’ within parameters, and combined with ‘and’ across parameters. Only peer-reviewed interventions and observational
studies were included.

Population
Search terms were: healthy population or adult or child orobese or overweight or binge eating or problematic eating or
disordered eating or diabetes or diabetic.

Intervention
Search terms were: mindful eating or mindfulness or mindfulness based intervention or meditation or mindfulness based
cognitive behaviour therapy or mindfulness based stress
reduction or acceptance based practices or mindful body scanor intuitive eating.
These search terms were also searched in combination withcognitive behaviour/behavior therapy or acceptance and commitment therapy or weight intervention or weight program.

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273

Outcomes
Search terms were: weight or weight related eating behaviour/
behavior or overeating or eating behaviour/behavior or eating
pattern or dietary behaviour/behavior or dietary pattern or
snacking behaviour/behavior or diet quality or energy intake orenergy balance or meal frequency or external eating or selfregulation or intuitive eating or mindless eating or mindful
eating or distracted eating or appetite awareness or hunger
recognition or emotional eating or self-efﬁcacy for eating
behaviour/behavior or self-efﬁcacy for healthy eating or selfconﬁdence or wellness or well-being or quality of life.

Databases
The search was conducted using a University search engine
which searched multiple databases: AMED (Alternative MEDicine), ASSIA (Applied Social Sciences Index), BioMed central,
BMJ open, British Nursing Index, CINAHL (Nursing and Allied
Health), Clinical Evidence, Cochrane Library, Conference Proceedings Citations Index, Ebsco, Medline, NICE, PsycARTICLES,
PsycINFO, PubMed, Sage Journals Online and Science Direct.

Inclusion criteria
Included were papers consistent with the search strategy outlined above in the databases listed, and English articles published until August 2015.

Exclusion criterion
Excluded were non-English-language papers.

Coding and scoring of results
For both the intervention and observational studies, results
were ‘coded’ and summarised as follows. A ‘positive’ code
indicated the outcome demonstrated a beneﬁcial effect of
mindfulness (for example, decreased binge eating, weight loss,
and reduced energy intake). A ‘neutral’ code indicated that
there was no signiﬁcant effect from the intervention. A mixed
code indicated that there were some positive and neutral
results. ‘Negative’ codes indicated that the measured outcome
was in an opposite direction to the hypothesis.
Outcomes that were measured in three or more studies wereascribed a percentage score calculated by giving all positive
codes one point, negative results were given minus one point,and neutral or mixed codes were given no score. The points
were added per outcome, divided by the total number ofoutcomes and expressed as a percentage.
We acknowledge that this is not a conventional way ofsummarising the results of the studies and does not account foreffect size. However, it provides an overview of ﬁndings in thewide range of papers included in the review, and gives anindication of whether or not there is consistency in theliterature.

Search strategy results
The results of the structured literature review are shown in
Fig. 1 and resulted in sixty-eight papers.

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J. M. Warren et al.
Initial search yielded n 99 papers
Papers not intervention or
observational studies n 19
Systematic reviewsn5
Abstracts n 4
Not published in a peerreviewed journal n 3
Papers included in structured review
n 68 papers

Interventions inoverweight andobese populationsn 23 papers

Interventions innormal-weight
populations
n 29 papers

Observational
studiesn 16 papers

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Fig. 1. Literature search results.

Results – intervention studies
The search yielded twenty-three studies (twenty-four papers) inoverweight/obese subjects(11,13,14,16,24–43) and twenty-nine papers
describing interventions in normal-weight subjects(15,18,34,44–61).

Characteristics of the intervention studies
The majority of interventions have taken place in the last 5 years.
Most of the interventions in obese/overweight populations were
undertaken in female populations, while studies of normalweight populations included more men. Many of the interventions had small sample sizes of ﬁfty or fewer subjects: fourteen of
the overweight/obese studies(11,13,24,25,27–29,31–33,37,41,43), and tenof the studies in normal-weight populations(45,47–49,51,54,58–61).
Three of the studies in the overweight/obese populations werecarried out among children(28,29,40); one of these studies had asample size of more than 300 but the results of this study
were not clearly described(40). The majority of the studies(15)among normal-weight populations were performed withstudents(15,18,34,46–48,50–53).

Theoretical basis of the interventions in overweight andobese subjects
Mindfulness-based cognitive therapy/mindfulness action-based
cognitive therapy, and mindful eating were the most commonlyused approaches and were both used in four studies. Table 1
outlines the details of the theoretical basis of these studies.

Theoretical basis of the interventions in normal-weight
populations
Mindfulness was the most frequently cited basis in the studies
among normal-weight subjects and was reported in eight
papers which contained thirteen studies(34,46,51,53,56–59). Three
papers used mindful eating(15,48,50) and two intuitiveeating(18,47). One paper which contained three studies used
emotional awareness(55). Cognitive defusion(52) and ACT were
each used in one paper(49).

https://doi.org/10.1017/S0954422417000154 Published online by Cambridge University Press

Table 1. Theoretical basis of interventions in overweight and obese
subjects (n 23)
Theoretical basis

Studies

MBCT or mindfulness action-based therapy
Mindful eating
MBSR
Mindfulness
Mindful eating and MB-EAT
Mindfulness-based action committed therapy
Combination of MBSR, MBCT and MB-EAT
Acceptance-based behaviour intervention
Acceptance of cravings
Intuitive eating

Four studies(25,27,33,40)
Four studies(28,29,36,43)
Three studies(13,30,54)
Three studies(11,32,35,44)
Three studies(14,16,38,41)
Two studies(38,42)
One study(31)One study(37)One study(24)One study(26)

MBCT, mindfulness-based cognitive therapy; MBSR, Mindfulness-Based Stress
Reduction; MB-EAT, Mindfulness-Based Eating Awareness Training.

Intervention length, intensity and scope
The majority of interventions (n 18) in the overweight/obese
populations consisted of sustained weight-management programmes of medium to high intensity carried out for a medium
length of time, i.e. 6 weeks to 4 months. Two studies lasted
longer than 4 months and two were for a shorter duration with
one study not detailing its intervention length. In many of thesestudies mindfulness was the sole focus of the intervention
which often included mindful eating as a key element of the
programme. An example of a mindfulness intervention is theone developed by Alberts et al. in 2012, a programme with ﬁvecore components(25):(1) Mindful eating;(2) Awareness of physical sensations;(3) Awareness of thoughts and feelings related to eating;(4) Acceptance and non-judgement of sensations, thoughts,
feelings, and body;(5) Awareness and step-by-step change of daily patterns andeating habits.
In contrast, many of the interventions in normal-weight
populations were single-day laboratory-based studies such ascompletion of food tasks, rating of pleasure in food or observed
food intake after a test meal. Studies often looked only at a
speciﬁc practice of mindfulness such as the body scan, or
mindful eating of a raisin and were therefore lower-intensity
interventions than those in obese/overweight individuals.

Summary of the tools/methods used to measure outcomesin intervention studies
The following two tools were the most frequently used tomeasure individuals’ mindfulness state and awareness:(1) The Five Facet Mindfulness Questionnaire contained thirtynine items(27) It: (a) measures trait (rather than state)mindfulness across ﬁve subscales (observing, describing,acting with awareness, non-judging of inner experienceand non-reactivity to inner experience); and (b) reports
internal consistency of 0·87 (as measured by Cronbach’s α).
(2) The Mindfulness Awareness Attention Scale containedﬁfteen items(62). It: (a) measures trait or dispositional levels

Impact of mindfulness on eating behaviours

Nutrition Research Reviewsof mindfulness; (b) measures each item on a six-point
Likert scale and measures levels of day-to-day awareness,
attention and observation; (c) reports reliability of 0·82
(as measured by Cronbach’s α).
The Mindful Eating Questionnaire contained twenty-eightitems(63) and was the only tool used to measure mindful eating.
It: (a) assesses ﬁve domains of mindful eating (disinhibition,awareness, external cues, emotional response and distraction)
on a four-point Likert scale; and (b) reports reliability of 0·7–0·9(as measured by Cronbach’s α).
Intuitive eating, when measured, was evaluated using theIntuitive Eating Scale(64) which contains twenty-one items. It:(a) assesses each item on a ﬁve-point Likert scale; (b) measures
readiness to eat in response to internal cues to determine choiceand quantity of food; eating to satisfy physical rather thanemotional reasons; awareness and trust of internal cues; and(c) reports internal consistency of >0·70 (as measured by
Cronbach’s α) and test–retest reliability of 0·90 (as measured by
Cronbach’s α).

Tools used to measure eating-related behaviours
Eating behaviours were most frequently assessed using theDutch Eating Behaviour Questionnaire(65), the Eating Attitudes
Test(66) and the Eating Disorders Examination Questionnaire(67).
The studies reviewed used thirty-two measures of eating
behaviour assessing a broad range of eating behaviours, attitudes, cognitions about food and related issues. Some of thesewere previously validated tools, others adapted, and others
developed speciﬁcally for a study.

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populations, multiple related studies were reported in a single
paper and the results have been collated in Table 2(34,53,55,58,59).
Ten outcomes were given a percentage score as described
previously. In studies that measured weight, binge eating,emotional eating, food intake (in overweight and obese populations) and food choice (in normal-weight populations) the score
was 50 % or above, indicating that most of the results werepositive or neutral/mixed. Only two studies had negative results
related to weight gain(54) and an increase of energy intake(18).

Results of physiological health outcomes
Outcomes of weight management interventions. Weight loss
was seen in eight(13,16,28,30,31,37,40,43) of the sixteen studies inoverweight/obese population studies. However, the effect sizes
varied widely with only three studies reporting signiﬁcantweight loss(13,16,37); the latter of these reported a mean weightloss of 12 (SE 4) kg over 6 months. In two studies the weight loss
was minimal(28,30), and in two studies weight was stabilised orweight gain was less in the intervention group(31,43). In one
study results were not reported(40).
The duration of the eight studies in overweight/obese
populations that resulted in weight loss varied from 6 to
24 weeks and sample sizes varied from ten(13) to 300(40).

Summary of results from intervention studies

Weight-loss interventions. Of the eight studies that reported
weight loss in overweight/obese populations, ﬁve of them werecomprehensive mindfulness programmes(13,16,30,31,40) where
mindful eating was a component of the programme, althoughdetails of the intervention were not reported in one of thesestudies(40). The rest of these programmes taught the core elementsof mindfulness such as being present in the moment andself-acceptance of the current state. The study with the greatest
weight loss held group sessions for 24 weeks based on an
acceptance-based behavioural intervention for weight loss; thiswas a pilot study, which taught key components of this approach
including values, acceptance and cognitive defusion using
mindfulness(37).
Mindful eating in a restaurant setting was the sole focus of oneof the eight studies(43); the other two studies focused on the regulation of cues(28) and used an ACT approach where mindfulness
was a core component(37).
There was some variation between interventions but the following were key elements of the mindful eating components:

The results of the intervention studies are presented with resultsin overweight/obese populations being detailed before those innormal-weight populations. Most intervention effect was seen
in binge eating, emotional eating and external eating and moreemphasis is given to these interventions, alongside the weightmanagement interventions in overweight/obese populations.
Overall, the studies in overweight/obese populations wererelatively longer and more intense compared with those carriedout in normal-weight populations. Many of the observational
studies were short, day-long laboratory experiments, and theseare brieﬂy summarised after the intervention studies.
A summary of the results from the intervention studies ispresented in Table 2. In ﬁve of the papers in normal-weight(1) Mindful eating was taught by a speciﬁc exercise such as the‘mindful raisin’ exercise;(2) Mindfully attending to the eating experience by noticing
smell, texture and taste of the food;(3) Reducing the speed of eating;(4) Guided meditations that focused on awareness of hunger
and satiety;(5) Mediations to identify eating triggers including emotional
triggers;(6) Mediations to manage cravings.
An example of how these elements were delivered in a
mindfulness intervention is given in Table 3 from a nine-session
MB-EAT programme for binge eating(16).

Tools used to measure issues related to food consumption
and hunger
The majority of self-report measures involved 24 h recalls whichwere translated into energy intakes by the investigator. The
studies applying objective measures involved the investigatorweighing the amount of food consumed, usually within acontrolled laboratory environment. The assessment of hunger
was always via self-report rating scale, either on an analogue or
Likert scale. There were eleven measures of the quantity of foodconsumed via self-report and objectively weighed.

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J. M. Warren et al.
Table 2. Summary of coded results from intervention studies using mindfulness, mindful eating and intuitive eating techniques
Health outcome

Studies (n) (and population)

Coded results*

Physiological
Weight16 (overweight/obese)

8 positive(13,16,28,30,31,37,40,43)
8 neutral/mixed(14,24,26,29,34,35,41,42)
2 positive(34,55)
1 negative(54)2 positive(13,26)
1 neutral/mixed(14)50

9 positive(11,13,16,27,29,33,35,39,42)
4 positive(45,49,60,61)
7 positive(11,25,30,31,33,35,39)
3 neutral/mixed(29,42,43)
1 neutral/mixed(54)4 positive(25,28,31,38)
1 neutral/mixed(42)1 positive(61)1 positive(24)3 neutral/mixed(46,56,58)
1 positive(47)2 positive(11,28)
1 positive(48)2 positive(38,39)

100
100
70

3 positive(14,28,43)
1 neutral/mixed(29)
4 positive(48,52,53,55)
3 neutral/mixed(44,51,54,57)
2 negative(18)1 positive(41)3 positive(15,53,55)
2 neutral/mixed(50,59)

75

3 (normal weight)
Physiological risk factors‡
Glycaemic control
Eating behaviours
Binge eating
Emotional eating

9 (overweight/obese)
4 (normal weight)
10 (overweight/obese)

External eating

1 (normal weight)
5 (overweight/obese)

Cravings
Eating attitudes
Hunger awareness

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2 (overweight/obese)
1 (overweight/obese diabetics)

Body dissatisfaction
Food related
Food intake

1 (normal weight)
1 (overweight/obese)
3 (normal weight)
1 (normal weight)
2 (overweight/obese)
1 (normal weight)
2 (overweight/obese)
4 (overweight/obese)
9 (normal weight)

Food choice

1 (overweight/obese)
5 (normal weight)

Score as %*†

33

80

0

33

60

* Note that effect size is not accounted for in the coding of positive, negative and neutral and the code only provides an indicator of the direction of
results; it is not trying to assess overall evidence. The ‘score’ in the final column is merely a convenient summary tool in situations where there
have been three or more studies.
† Calculation of score. Only health outcomes with three or more studies are ‘scored’: a positive study scores +1 point; a negative study scores –1
point; a neutral study scores 0 points; a study with mixed results scores 0 points. The points are summed, divided by the number of studies andexpressed as a percentage. An example for effect of mindful eating on weight in overweight/obese: 8 × 1 = 8/16 = 0·5, giving a score = 50 %.
‡ Cholesterol and blood pressure.

Table 3. Example of how elements were delivered in a mindfulness intervention from a nine-session Mindfulness-Based Eating Awareness Training(MB-EAT) programme for binge eating(16)SessionnumberSession 1
Session 2
Session 3
Session 4
Session 5
Session 6
Session 7
Session 8
Session 9

Session content
Introduction to self-regulation model, raisin exercise, introduction to mindfulness meditation with practice in group
Brief meditation (continues all sessions), mindful eating; exercise (cheese and crackers); concept of mindful eating, body scan
Theme: Binge triggers – binge trigger meditation, mindful eating exercise (sweet, high-fat food, such as brownies)
Theme: Hunger cues – physiological v. emotional, hunger meditation, eating exercise, mindful food choices (cookies v. chips), healing,
self-touch
Theme: Taste satiety cues – type and level of cues, taste satiety meditation, seated yoga
Theme: Fullness cues – type and level of cues, fullness meditation, pot-luck meal
Theme: Forgiveness – forgiveness meditation
Theme: Inner wisdom – wisdom meditation, walking meditation
Theme: Have others noticed? Where do you go from here?

The studies that did not report weight loss or where there was
no intervention effect on weight were more variable in terms ofduration and intensity than the studies above. A couple of thestudies had a mindfulness component as part of an education
programme, with an ACT(42) and MB-EAT(36) basis and weresimilar to the studies where weight loss was observed. Other
studies had a narrower focus, for example internal cues(26),https://doi.org/10.1017/S0954422417000154 Published online by Cambridge University Press

mindful eating(29) and mindful breathing(41), and tended to haveshorter duration of 4–8 weeks.

Weight loss in normal-weight populations. In two of
the three normal population studies that measured weight(34,55),
weight loss was observed although effect sizes were small;these were short-term experimental studies. In one study

Impact of mindfulness on eating behaviours

undertaken among veterans with chronic conditions, weightincreased(54).

Other objective physiological measures. Three studies measured other objective physiological measures – with both
improvement and mixed results reported for cardiovascular risk
factors in overweight/obese populations(13,26), and improvementin glycaemic control in diabetics(14,36). This suggests that mindfulness interventions can create changes in physiological markers, most likely because of mindfulness-induced changes toeating habits rather than mindfulness per se having a direct effecton the physiological marker. This is an area of limited research.

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Eating behaviours and food-related outcomes
A range of eating behaviours that may be associated withweight status was measured across the intervention studies
including binge eating, emotional eating, external eating andcravings. Food intake and choices were also measured in somestudies. A number of the studies showed that mindfulness
enabled participants to become more aware of their internal
states of hunger and satiety alongside the recognition of speciﬁccues. Other studies showed that mindfulness generated more
overall internal awareness, for example thoughts and feelings(which could include satiety and hunger). More generic mindfulness techniques emerged strongly in the studies. These
included the body scan exercise and mindful breathing
exercises. Acceptance-based exercises were used in a numberof studies connected to recognition of emotions and thoughts.

Eating-related behaviours
Binge eating. Binge eating symptoms were measured in ninestudies in overweight/obese populations. All the studies reported
positive changes in binge eating symptoms over the course of thestudy, as evidenced by self-report measures. In four of the studies
binge eating was a speciﬁc target of the intervention(11,16,33,39).
The ﬁrst of these studies was the initial exploratory work withmindfulness and any eating-related behaviour(11).
Binge eating symptoms were assessed in four studies innormal-weight populations(45,49,60,61); three were undertaken
in binge-eating-disorder populations. Positive results were seen inall studies.
Collectively, these results suggest strong evidence for the efﬁcacy of mindfulness in reducing the frequency and intensity ofbinge eating symptoms. This is particularly notable given the highdegree of heterogeneity between the studies in terms of design
and intervention.

Binge eating interventions. Speciﬁc mindful eating strategies
were included in the majority of studies that measured binge
eating. In many cases, this was complemented with genericmindfulness meditations such as breathing techniques and bodyscans often as part of a mindfulness-based curriculum, forexample, MB-EAT(16), MBSR(39,60) or mindfulness-based cognitive
therapy(27,33). Mindfulness was also sometimes combined with
ACT(42,49) or action-based cognitive therapy(45). Awareness of

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internal hunger cues was not as prevalent in these studies. Theseﬁndings suggest that in the management of binge eating, theability to eat mindfully is a key technique.

Emotional eating. Ten studies measured emotional eating inoverweight/obese populations. Reductions in emotional eatingwere reported in seven of these studies(11,25,30,31,33,35,39) andthree studies showed no change(29,42,43). One of the studies
where there was no effect was undertaken among children(29),another was focused on restaurant eating only(43), and the third
was an ACT-based intervention where mindfulness was not thesole focus(42). These positive results provide support for the useof mindfulness-based interventions in reducing emotional
eating in overweight or obese populations.
Only one study measured emotional eating in a normal-weight
population(54) where no impact of the MBSR intervention wasseen; this population of veterans with chronic conditions may
not be generalisable.
External eating. External eating was measured in ﬁve of thestudies within an overweight/obese population. Four of thesestudies showed a positive change in external eating and were
undertaken in populations suffering from stress eating, problematic eating, disordered eating attitudes, and children
learning speciﬁcally about cues(25,28,31,38). One study, in thispopulation reported a neutral result(42). This was an ACTintervention study over 6 months among women. External
eating was measured in one study in a normal-weight population suffering from binge eating and the intervention reduced
binge eating episodes.
Taken together, these ﬁndings suggest that mindfulness canbe helpful in reducing external eating and reduce the responsiveness of individuals to external cues such as food packaging
and time of day. The evidence in normal-weight populations
appears to be limited.

External eating and emotional eating interventions. All
studies that looked at external and emotional eating used
speciﬁc mindful eating techniques in their interventions.
Mindfulness techniques such as body scans, breathing exercises
and awareness of bodily sensation were utilised in the studies toa varying extent. In the studies done in overweight and obese
populations the mindful practice was part of a wider
curriculum(11,25,30,31), or sometimes supported by a one-day
workshop(38). This suggests that in order to effect change inexternal and emotional eating, it is important to use techniquesthat increase awareness of internal states, combined withacceptance techniques. Combining these with mindful eating
seems to be important.
Cravings. Cravings were measured in one study in an overweight/obese population(24), which showed a positive response
to a mindfulness-based intervention, and in three studies innormal-weight populations, all of which showed mixed/neutral
results(46,56,58). These studies were all laboratory-based studies
and two of them were day-long studies only. Given the limited

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J. M. Warren et al.

number of studies and their short duration, the role of mindfulness in reducing cravings remains to be fully elucidated.

Results – observational studies

Hunger awareness. Hunger awareness was measured in two
overweight/obese populations and positive results werereported in both studies(11,28). In one of these studies a 12-weekcurriculum was developed which focused on ‘Regulation of
Cues’; children in this group had signiﬁcant reductions in eatingin response to external cues and negative states, and attending
to food responsiveness(28). A study in normal-weight students
which made one focus group concentrate on the sensory
experience of foods showed a lower pre-snack hunger rating
than either of the control groups(48). These results suggest that
mindfulness is effective in increasing hunger awareness,
although this was only measured in three studies, so the ﬁnding
should be considered preliminary.

Eight papers focused on intuitive eating(18,68–75), ﬁve papers
focused on mindfulness(76–80), two papers focused on mindful
eating(81,82) and one paper had a combined mindfulness andmindful eating approach(83).

Body dissatisfaction. Two studies measured body dissatisfaction in relation to mindfulness interventions in overweight/
obese populations(38,39). Both of these studies demonstrated
positive results, but this is a limited evidence base from which
to suggest that mindfulness can support improvements in body
dissatisfaction.
Food intake and choice
Food intake was measured in four studies in overweight/obese
populations and three of these reported a reduced energy
intake, as measured by self-report via 24 h recalls or
FFQ(28,36,43). The ﬁrst two of these studies were comprehensive
education programmes while the third focused on intake atlunchtime only. One study did not ﬁnd a reduction in energy
intake as a result of their intervention among children and theirparents(29).
Food intake was measured in nine studies in normal-weight
populations, with four studies reporting a reduction of foodintake(48,52,53,55), four reporting neutral results(44,51,54,57) and
one reporting negative results(18). One of these studies reported
that higher levels of intuitive eating was associated withincreased food intake in a permissive environment which wasan unexpected ﬁnding(18). No change in food intake was seen
in a study among veterans with chronic health problems(54). In
contrast to the studies in overweight/obese populations, in all
but one study(54), food intake was measured in short-duration,
low-intensity experiments in laboratory settings using test meals
or snacks rather than in a free-living situation.
These results suggest that more evidence is needed before it
is possible to say if mindfulness and/or mindful eating canreduce the quantity of food consumed.
Food choice was measured in one study in overweight/obese
populations which looked at lunches purchased and showed
positive trend in choosing healthier meals(41). Food wasmeasured in ﬁve studies in normal-weight populations. Threeof these studies reported positive food choices(15,53,55) as aresult of mindfulness intervention and two studies reported
mixed/neutral results(50,59). As per food intake, these were lowintensity, laboratory studies asking participants to make a snack
choice, with the healthier choice being determined as positive.

https://doi.org/10.1017/S0954422417000154 Published online by Cambridge University Press

Theoretical basis

Summary of results from observational studies
Sixteen observational studies were identiﬁed in the literaturesearch and a summary of the associations observed are shown in
the Table 4; it should be noted that some studies investigatedmore than one association. Many of the observational studies
looked at associations between an aspect of eating or mindfulness and related it to an outcome in an existing cohort, forexample level of mindfulness, or intuitive eating and BMI.
Associations were made using the tools and scales already outlined in the intervention studies.
Two of the cohorts were substantial, with 1000(72) and 2000(69)subjects, respectively. The cohort populations were diverse, with
six undertaken among university students(69–71,73,80,82) and twotaken among other young adult populations(68,71). The remaining
cohorts were spread across a wide age spectrum from middle
school(72) to older obese adults(78). Four of the cohorts werefrom overweight/obese populations of which two were waiting
for bariatric surgery(76,77).
Intuitive eating was associated with a lower BMI in fourstudies(68,70,74,75). Other observations included a decreased
emotional eating with higher levels of mindfulness(76,77,79) anda higher level of everyday mindfulness was related negatively
to self-report serve size of energy-dense food(83). In one of
Table 4. Summary of coded results from observational studies showing
the association between mindfulness, mindful eating and intuitive eating
and parameters related to health measures and eating behaviours

Associations
Intuitive eating and decreased BMI
Mindful eating and decreased BMI
Intuitive eating and blood markers ofcardiovascular risk
Mindfulness and decreased portion size
Intuitive eating and observing hunger cues
Mindfulness and decreased binge eating
Mindfulness and decreased emotional eating
Mindfulness and external eating
Mindfulness and reduced cravings
Mindfulness and restrained eating
Intuitive eating and freedom to eat
Intuitive eating and interoceptive sensitivity
Trait mindfulness and returning baseline
brain network post-food cue exposure
Mindful eating and mental well-being
Intuitive eating and more pleasureassociated with foodIntuitive eating and increased external andintrojection regulation in behaviour
questionnaireStudies(n)
Coded result*
4
1
1

Positive(68,70,74,75)
Positive(82)Positive(70)

1
1
2
3
1
1
1
1
1
1

Positive(83)Positive(72)Positive(76,80)
Positive(76,77,79)
Positive(77)Positive(78)Positive(75)Positive(73)Positive(71)Positive(78)11Positive(81)Positive(75)1Positive(69)* Note that effect size is not accounted for in the coding of positive. The code only
provides an indicator of direction of results and is not trying to assess overall
evidence.

Nutrition Research Reviews

Impact of mindfulness on eating behaviours

the large cohorts in young adults, there was no difference
in intuitive eating by age or sex(68) while another study
which compared males and females in a young adult population found higher levels of anti-dieting and self-care
subscales of the intuitive eating scale(69). One study foundmales trusting their bodies more than females on when toeat(68) but this was reversed in a second study(72). Anotherstudy looking at associations with intuitive eating showedthat those who consistently overrode fullness feelings weremore likely to use moderate to extreme effort to maintain theirweight(73).
Interoceptive sensitivity is a measure of awarenessof the subject’s bodily state; this was positively related to higher
levels of intuitive eating(71). An online survey in Pakistan
showed a signiﬁcantly positive relationship between
overall mindful eating and mental well-being(81). In one of thegroup of bariatric patients, greater mindfulness, particularly
awareness, was related to fewer binges and emotional
eating(76). Another observation in bariatric patients showed that
mindfulness was positively associated with restrained eating
behaviour(77).
These studies indicate that both mindfulness and intuitiveeating showed promise in positively inﬂuencing complex
relationships with food and eating behaviours.

Potential associated mechanisms
The literature search showed a growing evidence base formindfulness, mindful eating and intuitive eating, but the papers
retrieved generally did not discuss underlying mechanisms.
Therefore, a further search of the scientiﬁc literature wasundertaken to provide potential explanations for the observed
effects. We identiﬁed three separate hypothesised mechanismsthat were suggested by functional MRI (fMRI) results; fMRI
measures brain activity by detecting associated changes inblood ﬂow.

Increased awareness of, and increased responsiveness to,internal physical cues
Interoception can be measured by an individual’s ability toreport their heart rate. Interoception is connected with themindful awareness of an individual’s internal state, especially in
relation to physical factors such as hunger and satiety. Increased
awareness enables individuals to eat in response to these
physical cues of hunger and satiety.
Mindful eating has been shown to slow down consumptionof a meal and allows both registration of feelings of fullness andgreater control over eating(84,85). Additionally, a slower pace of
eating reduces overall energy consumption as individuals feelfull on a smaller quantity of food(86).
One study using fMRI showed a decrease in mid-line corticalstructures associated with interoception during a mindfulness
body scan. This suggests an increased awareness of internal
state(87). In another study, fMRI results showed reduced activation in the insula(88) which is the part of the cerebral cortex
implicated in self-awareness and perception and hence islinked with interoceptive awareness.

https://doi.org/10.1017/S0954422417000154 Published online by Cambridge University Press

279

Increased awareness of, and reduced responsiveness to,internal emotional cues
Mindfulness trains individuals to notice distressing thoughts,
emotions and sensations. By increasing awareness of thesecues, individuals are then able to tolerate their distress and notallow these non-physical cues make them eat more(77).
By learning to bring the experience fully into awareness many
types of distress that would have provoked an automatic reaction
can be tolerated. Thus, distress tolerance is increased and automaticity reduced. In relation to emotional eating, mindfulness
reduces misperception of emotions as hunger and therefore
stops increased eating in response to non-physical cues(77).
As defusion-reduced reactivity enhances tolerance to nonphysical emotional cues, the cultivation of mindfulness
becomes self-reinforcing(89). Further, mindfulness increases thecapability to relax when faced with negative events and emotion. This has been found to be especially true in reducing
impulsivity, which is associated with mindless overeating(77).
fMRI studies have shown altered activity levels in the
amygdala related to general emotional arousal/salience following mindfulness training. Decreased activation has beenfound in the amygdala, the parahippocampal area and theinsula during perception of negative stimuli in subjects but
these activity levels have been regulated following mindfulness
training(90). Others have used fMRI to show that mindfulness
makes an impact on the neural systems underlying emotional
regulation. It appears to regulate amygdala functioning via
functional connectivity from the medial prefrontal cortex(91).
fMRI studies conducted on individuals practising mindfulness
have found a signiﬁcant reduction in activity in the anterior cingulated cortex region which plays a role in the processing of
emotion. ‘Findings collectively show that mindfulness meditation
has an overall “quietening” effect on brain regions associated withsubjective and cognitive appraisal of emotions’(87). Signiﬁcant selfreported differences in awareness of emotion are unlikely to be
simply due to a blunting of the emotional experience but‘represent more fundamental change in regulatory response’(88).
Anatomical studies lend further support to changes in theareas of the brain associated with emotional regulation. Studies
conducted pre- and post-MRI on participants following an
8-week mindfulness programme found an increase in grey
matter concentration in the left hippocampus and posterior
cingulated cortex, temporo-parietal junction, and cerebellum –areas associated with learning and memory processes,
emotional regulation and self-referential processing(92).

Increased awareness of, and reduced responsiveness to,external cues
Overeating may reﬂect a non-mindful reliance on environmental
or external cues (for example, packaging size), so that the cues
destroy the subject’s ability to self-monitor the food they eat(83).
The use of mindfulness is designed to interrupt these automatic,
non-conscious external inﬂuences(93). Increasing awareness ofan individual’s reactions to attractive food items, and a recognition of these reactions as passing mental states rather than realexperiences, reduced the likelihood of individuals initiating

280

J. M. Warren et al.

purchasing and eating behaviours(59). Mindfulness practice(83)and mindful eating speciﬁcally reduced the impact of theexternal norms around consumption and enabled individuals to
reduce their food intake(34,94).
fMRI has been used to compare results of subjects who
received an 8-week mindfulness-based stress reduction coursewith those of a control group(95). When asked to pay attention
to the external sounds in the scanner environment, the mindfulness group showed increased functional connectivity inauditory and visual networks and the areas associated withattentional and self-referential processes.
These observations from fMRI studies are of interest but are
insufﬁcient on their own to explain the mechanism by which
mindfulness exerts its effects. More research is needed to fully
elucidate further mechanisms and these must explain otherinﬂuencing behavioural factors.

Nutrition Research Reviews

Discussion
From the papers reviewed there appears to be reasonable
evidence that mindfulness, including mindful eating techniques,
can help to change eating behaviours. The evidence for theeffectiveness of mindfulness and mindful eating in binge eating
disorders appears to be the strongest with consistently positive
results in both overweight/obese populations and those of
normal-weight status. There was also a positive effect onemotional eating as a result of mindfulness interventions and in
a lesser number of studies a positive result was seen for reducing eating in response to external cues. This is consistent withthe ﬁndings of O’Reilly et al. in 2014(23), who examined the roleof mindfulness with obesity-related behaviours and a review
looking at the effectiveness of mindfulness in binge eating(19,23).
Food cravings, eating attitudes and body dissatisfaction were
explored in only a limited number of studies. Although binge
eating and emotional eating are important obesity-related
behaviours, the results for the use of mindfulness in achieving
weight loss in overweight/obese individuals were mixed andgenerally effect sizes were small. This is not surprising given thecomplex and multifaceted nature of obesity, which requires amulti-pronged treatment approach. The diversity of the interventions makes it difﬁcult to identify the effective elements.
With regard to the interventions that did not report weight loss
there were no striking differences from the ones that weresuccessful, except that a couple of the studies were of lower
intensity and shorter duration. This diverse range of treatments
included mindfulness as part of a third-wave therapy such as
ACT, mindfulness curricula based on established programmes
in other conditions adapted for eating, for example MBSR and
mindfulness-based cognitive therapy, through to less intenseinterventions which employed mindfulness techniques asstand-alone interventions. However, the majority of successfulinterventions included mindful eating as part of a comprehensive mindfulness programme. These mindfulness programmes
contained core elements of mindfulness including meditation,awareness and being present. A recent review on the effectiveness of mindfulness in achieving weight loss found that the
majority of studies did result in weight loss but the extent towhich mindfulness could be attributed to the effect was nothttps://doi.org/10.1017/S0954422417000154 Published online by Cambridge University Press

apparent(22). This study also noted the wide variation in interventions and methodological weaknesses.
It is important to recognise that many of the studies in binge
eating and weight loss did not have a non-intervention
control group and did not measure changes in mindfulness.
Furthermore, few of the studies had a follow-up so it is notpossible to determine long-term success. Despite these methodological weaknesses, the use of mindfulness and mindful
eating in weight management and obesity-related behaviours
shows promise and the ﬁeld warrants further investigation.
In contrast to the intervention studies in overweight/obese studies, nearly half of the studies in normal-weight populations werelaboratory-based, day-long studies, many of which were carriedout among students. A small number of the studies were mediumlength interventions (i.e. 6–16 weeks’ duration), which highlights
the great variation in intensity of factors in the interventions innormal-weight subjects. The interventions were diverse andincluded teaching intuitive eating, providing mindfulness information, a mindfulness group intervention for 4 months, body scanguided imagery, mindful eating exercises and mindful awareness.
Furthermore, the outcomes varied widely, so comparison between
studies was not possible. The outcomes included food choices,
food intake, and the following eating behaviours: cravings, binge
eating, internal cues, and the relationship with food. Overall, theresults indicated a positive role for mindfulness and/or mindful
eating on inﬂuencing eating behaviours. This avenue of researchalso merits further research as this has the potential to be relevant
to public health nutrition messaging regarding food choices.
The observational studies also provide direction for future
research but, by their nature, are evidence of association only. It
is interesting to note that, in these observational studies, thefocus was on intuitive eating whereas only two interventions(26,47) were based on intuitive eating. This indicates that
intuitive eating is an emerging topic and further research isneeded to examine its potential in positively having an impact
on eating behaviours. The ﬁndings of the observational studies
were unanimously positive, demonstrating a beneﬁcial association of mindfulness/mindful eating or intuitive eating.
Overall, many studies were limited by small subject numbers
and were also predominately carried out among female populations, the majority of whom were from Caucasian backgrounds. Given the importance of weight reduction in the
management of type 2 diabetes and in CVD, it was surprising
not to ﬁnd more studies in these patient groups. This is likely tobe an area of study in the future.
While research into the mechanisms of action of mindfulness
is ongoing, particularly in relation to mindful eating, concomitant psychological and physiological ﬁndings have yielded
three key hypotheses about the associated processes involvedin the brain. Results from fMRI studies show that mindfulness is
associated with reduced amygdala activity and may reduce
emotional arousal. Mindfulness possibly works by increasing
inner physical cues to eat (hunger and satiety), and decreasing
the emotional and external cues to eat.
Only two studies reported negative results regarding themindfulness or mindful eating intervention (small increases inweight and food intake), and one of these was in a populationthat is not generalisable.

Impact of mindfulness on eating behaviours

Nutrition Research Reviews

Strengths and limitations of the present structured review
This structured review provides a literature review about thepotential of mindfulness, mindful eating, and intuitive eating to
make an impact on eating behaviours. It takes a broad
approach, which provides perspective on the state of current
research and direction of future research. It is common in
research for observational studies to precede interventions
where observed associations can be tested in experimental
conditions. The description of the interventions and the tools
used for outcome measures adds a new element to thesystematic reviews undertaken to date in this area.
The review was never intended to be a systematic review and,as such, cannot make categorical statements on the quality of theevidence base. Furthermore, a rigorous critical appraisal of theliterature is beyond the scope of this review. ‘Attention’ was notincluded in the search terms for the interventions undertaken
and it has since become apparent that this would have been a
relevant search term. Attentive eating is a similar concept to
mindful eating and has been shown to reduce food intake(96,97).

Conclusions
Mindfulness and mindful eating interventions appear to be mostsuccessful in the reduction of binge eating regardless of weightstatus. Mindfulness and mindful eating interventions also
reduced emotional eating and eating in response to externalcues which are important behaviours related to obesity.
In overweight individuals, the impact of mindfulness andmindful eating on reducing body weight was mixed; it might bethat mindfulness and mindful eating have a role to play in theprevention of weight gain. Mindfulness/mindful eating resulted
in a positive shift in food habits and in the quantities of foodconsumed in some studies. There is evidence both for the
efﬁcacy of one-off mindfulness interventions and also forthe beneﬁt of repeated practice on improving outcomes. On thebasis of this review, encouraging a mindful approach to eating
appears to be a positive message to be included in generalweight-management advice to the public.

Acknowledgements
The present review was funded by an unconditional grant from
Mondelez International. The authors are all independent freelance consultants and followed guidelines for scientiﬁc integrity
from the inception of the review to ﬁnal drafting of the manuscript. Mondelez International did not have any role in undertaking the review or interpreting the results.
The authors have no declarations of interest to declare.

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