Recent reviews have concluded that mindfulness approaches can improve outcomes in individuals with problem eating [50, 51]. In interventions ranging from 1 to 24 sessions and with 7–150 participants, mindfulness practice effectively decreased binge eating and emotional eating in populations engaging in this behavior. These interventions have been used with both patient and non-patient participants and with overweight and obese participants.

In any early outcome study, Kristeller and Hallett [47] used MB-EAT with 18 overweight/obese women (average BMI = 40) with binge eating disorder. They found a significant improvement in participants’ perceived control of eating and awareness of hunger and satiety cues. After the seven session intervention run over 6 weeks, only four participants still met criteria for BED and remaining binges decreased substantially in size. There were no significant changes in weight however, prompting the authors to incorporate more information and skill building regarding nutrition and food choices in future groups. The amount of time participants practiced mindfulness was related to outcomes. Since the publication of this study, several others have been run and disseminated.

For example, Daubenmier et al. [52] investigated the use of a mindful eating intervention with 47 overweight/obese women who were randomly assigned to a 4-month intervention or a wait list group to explore effects of a mindful eating program for stress eating. Participants improved in mindfulness, anxiety, and externally based eating but did not differ on average cortisol awakening response (CAR) , weight, or abdominal fat over time. However, obese treatment participants showed significant reductions in CAR and maintained body weight while obese control participants had stable CAR and gained weight. Improvements in mindfulness, chronic stress, and CAR were associated with reductions in abdominal fat.

In a follow-up study, Kristeller et al. [53] conducted an RCT of MB-EAT for 150 individuals with an average BMI of 40.3, 66 % of whom met DSM-IV-TR criteria for BED. The comparison groups were a psychoeducational/cognitive behavior intervention and a wait list control. Weight management was briefly discussed in both the psychoeducation and MB-EAT groups but were not the focus of either treatment. The MB-EAT and psychoeducation participants showed comparable improvement after 1 and 4 months post-intervention on bingeing and depression. At 4 months posttreatment, 5 % of those who had met criteria for BED in the MB-EAT continued to meet criteria for BED, compared with 24 % of those in the psychoeducation group. Amount of mindfulness practice predicted improvement on weight loss and other variables. In terms of weight loss, 29 % in the psychoeducation group and 38 % in the MB-EAT group lost 5 lbs or more during the course of the study. There was an overall pattern of larger effect sizes for the MB-EAT group as compared to the psychoeducation group on measures of reactivity to food including disinhibition and hunger, indicating greater self-regulation and behavioral control in the MB-EAT group.

Bush et al. [54] developed a 10-week group intervention integrating mindfulness and intuitive eating skills for 124 female employees at a university. Participants with anorexia and bulimia were excluded. The goal of the intervention was to reduce body dissatisfaction and decrease problematic eating behaviors. Participants in the treatment condition in comparison to wait list controls reported higher levels of body appreciation and lower levels of problem eating. In addition, mindfulness scores served as a partial mediator of change in outcomes.

Finally, Kidd et al. [55] used an 8-week mindful eating group intervention to investigate changes in mindful eating, self-efficacy for weight loss, depression, weight loss, body fat, and blood pressure in 12 obese women who lived in an urban area. A focus group was conducted afterwards to understand the participants’ experiences with mindful eating. The only measured variable that improved statistically was self-efficacy over weight loss. Thematic analyses of the focus group content confirmed increased self-efficacy over weight loss, and the participants described improvements in mood, food choices, and eating behavior. Those who reported applying mindfulness skills reported the greatest change in BMI, mental health, and decreased emotional eating .

While evidence that mindful eating improves problem eating is consistent across studies and various participant populations, evidence for weight loss is mixed. Mindfulness interventions that do not integrate nutrition information or weight management guidance tend not to produce weight loss. Not surprisingly, of those mindful eating studies that did incorporate weight-loss strategies and where weight loss is a goal, participants lost weight [56, 57].

For example, Dalen et al. [56] developed a 6-week group protocol that combined mindfulness meditation, nutrition information, light yoga, walking meditation, group eating exercises, and group discussion along with brief daily meditation and mindful eating practice for homework. They assessed changes in BMI, eating behavior, psychological distress, and the physiological makers of cardiovascular risk in their ten participants. Post-intervention, participants reported statistically significant increases in mindfulness and cognitive restraint around eating as well as statistically significant decreases in weight, binge eating, depression, and C-reactive protein.

Out of the ten intervention studies on mindful eating reviewed by Katterman et al. [50] that measured weight as an outcome, six provided education on energy balance, nutrition, or exercise, and only one included behavioral weight loss techniques such as problem-solving and encouraging behavioral goal-setting [58]. Among the interventions where weight loss was observed, weight loss served as a primary outcome of the intervention and treatment included either nutrition education alone [56, 57] or nutrition education plus teaching behavioral strategies [58]. Thus, while weight loss may occur when it was a primary outcome, there is no evidence that weight loss occurs in response to mindfulness training in the absence of a specific focus on weight .

Obese individuals who pursue bariatric surgery report high rates of problem eating including loss of control over eating, binge eating, and chronic overeating [59, 60]. Even when individuals do not meet full criteria for an eating disorder, these disordered eating patterns can prevent optimal adherence to postsurgical eating guidelines, thus contributing to eventual weight regain [61–63]. While the first year after surgery for most patients is characterized by rapid weight loss, once patients transition to weight maintenance, presurgery eating problems may recur. About 20 % of postoperative patients experience insufficient weight loss [64], frequently defined as less than 50 % excess weight loss [65–67].

Given that weight loss with bariatric surgery is associated with the improvement or resolution of medical comorbidities as well as improvements in patient-reported quality of life [68], weight regain is of primary concern for these patients, their families and health care providers. In one study following gastric bypass patients over an average of 28 months, 79 % regained some weight after reaching their lowest weight and 15 % experienced a weight increase of 15 % of more from their lowest weight [69]. Eating-related factors associated with weight regain include binge eating [27], lack of control over food urges, [69] and eating in response to painful affect [70, 71], making mindful eating appropriate for this population too. Indeed, Levin et al. [72] investigated mindfulness and problematic eating in 820 patients seeking bariatric surgery and found that greater mindfulness was related to less binge and emotional eating, as well as less habitual overeating and grazing. Acting with awareness, a facet of mindfulness, was consistently related to eating behavior.

One mindful eating group intervention study has so far been published with post-bariatric surgery patients. The group was conducted in a hospital setting for ten weekly sessions of 75 min each and incorporated CBT strategies such as regular eating, keeping an eating journal that included associated thoughts and feelings, controlling portion sizes, and removing triggering foods from the home. Mindful eating practices were facilitated in each session to improve awareness of reactions to food and eating. The group was composed of seven patients who had either undergone gastric bypass or banding and who reported subjective binges with loss of control and eating to manage emotions. Post-intervention, patients reported improvements in eating, emotion regulation, and depression, changes that theoretically should help patients reduce problem eating and thus prevent weight regain. There was a modest reduction in the participants’ overall weight [73].

While the majority of research studies investigating mindful eating have been on group interventions, it is also possible to integrate mindful eating practices into individual therapy sessions. Indeed, Martin [74] proposed that mindfulness is the core of psychotherapy process.

A growing body of literature has examined the benefits [75–77]. In many MBIs, such as MBSR , MBCT and MB-EAT, “The Raisin Exercise ” [2] is commonly used to introduce participants to the practice of mindfulness and to engage fully with all of their five senses. Other mindful eating exercises can be incorporated into individual therapy sessions such as rating hunger levels, fullness and taste satiety [21, 48, 78–80]. Please see Script 1 for a mindful eating script that may be used with individuals or groups.

As with the delivery of all MBIs, it is imperative that mindful eating interventions be facilitated by clinicians trained in the principles of mindfulness, specifically mindful eating, and that clinicians develop and maintain a formal and informal mindfulness practice of their own [81]. More importantly, mindfulness can cultivate clinically beneficial qualities in psychotherapists, such as self-attunement, affect tolerance, empathy, openness, acceptance, and compassion [82, 83]. The role of the psychotherapist’s mindfulness practice, therefore, would optimize the therapeutic relationship/alliance and produce better outcomes (e.g., symptom reduction) for the client .

Betty attended all ten sessions of MB-EAT and participated well by sharing her mindful eating experiences, insights, and challenges to the bigger group. She completed her homework daily, which included formal (e.g., Body Scan, Sitting) and informal (e.g., Mindful Walking, Eating) mindfulness meditations exercises which lasted between 15 and 30 min and other pleasurable activities that did not involve food.

Betty’s binge eating and overall intake of food decreased gradually over the course of the program. Her self-reported frequency of binge eating episodes decreased from eight per month to two per month at 4 months posttreatment. Grazing and emotional eating also declined from 5 times per week to a maximum of 2 per week. She lost 5 kg (to 75.91 kg) within 3 months following posttreatment, bringing her BMI to 29.6 and her diabetes improved.

At 4 months posttreatment, Betty indicated that since participating in MB-EAT she has noticed positive changes in the way she appreciates food. She reported taking the time prior to eating a snack or meal to briefly meditate and attend to her hunger signals. This has helped her to decrease her portion sizes and to savor her meals by slowing down/chewing thoroughly while eating. Betty stated that instead of purchasing foods impulsively at the supermarket, she has developed more awareness and outer wisdom in making healthier nutritional choices. She has also become less critical of herself when she does overeat and takes the time to gently observe her experiences rather than catastrophizing. Her family commented on her ability to be more assertive, calmer, and less reactive in stressful situations. Betty stated, “I used to cry uncontrollably when I was stressed but now I totally bypass the crying fit and just breathe!”