This brief narrative review aims to give an up-to-date overview of intuitive and mindful eating (I/ME) interventions with specific focus on cardiometabolic risk factors, including glucose, lipid profile, blood pressure and inflammatory markers.
I/ME intervention studies in adults which measured at least one physiological parameter other than weight were identified from PubMed. The clinical trial/randomized controlled trial filters and publication dates 2001 through April 2021 with variations of the following keywords were applied: intuitive eating, mindful eating, weight neutral. Ten articles were identified.
Of the 10 studies, seven showed I/ME interventions were more effective than control in at least one cardiometabolic outcome, two showed significant I/ME within-group improvements but no between-group differences, and one showed neither within-group nor between-group differences. Specifically, I/ME improved glucose levels among pregnant women with or without gestational diabetes, lipid profile among adults with overweight or obesity, blood pressure among participants with overweight and inflammatory markers among post-menopausal women with obesity. However, the positive impact of I/ME on each of these cardiometabolic parameters was not consistent across studies: of the six studies that examined glucose regulation, two demonstrated positive outcomes for I/ME group, whereas four found no effect compared to control. Three out of five studies had positive lipid effects, one out of five demonstrated systolic blood pressure (SBP) improvements and one of two showed improvements in inflammatory markers. Given these mixed results, more research is needed to understand the possible effectiveness of I/ME to improve cardiometabolic health.
Funding source: American Heart Association
Award Identifier / Grant number: 16SFRN27950012
Award Identifier / Grant number: 16SFRN27960011
Award Identifier / Grant number: AHA811531
Funding source: National Heart, Lung, and Blood Institute
Award Identifier / Grant number: NIH R01HL128226
Award Identifier / Grant number: NIH R01HL142648
Research funding: Drs. Aggarwal and St-Onge are supported by American Heart Association Go Red for Women Strategically Focused Research Network Awards: 16SFRN27960011 (PI: BA) and 16SFRN27950012 (PI: MPSO) and AHA811531 (PI: BA), and the National Institutes of Health NIH R01HL142648 (PI: MPSO), and NIH R01HL128226 (PI: MPSO).
Author contributions: LH wrote the first draft of the manuscript; GB, MPSO and BA revised the manuscript and provided intellectual input. All authors read and approved the final manuscript. All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: Authors state no conflict of interest.
Informed consent: Not applicable.
Ethical approval: Not applicable.
1. Visscher, TL, Seidell, JC. The public health impact of obesity. Annu Rev Publ Health 2001;22:355–75. https://doi.org/10.1146/annurev.publhealth.22.1.355.Search in Google Scholar
3. Mann, T, Tomiyama, AJ, Westling, E, Lew, A-M, Samuels, B, Chatman, J. Medicare’s search for effective obesity treatments: diets are not the answer. Am Psychol 2007;62:220. https://doi.org/10.1037/0003-066x.62.3.220.Search in Google Scholar
4. Montani, J-P, Schutz, Y, Dulloo, AG. Dieting and weight cycling as risk factors for cardiometabolic diseases: who is really at risk? Obes Rev 2015;16:7–18. https://doi.org/10.1111/obr.12251.Search in Google Scholar
5. Byun, SS, Bello, NA, Liao, M, Makarem, N, Aggarwal, B. Associations of weight cycling with cardiovascular health using American Heart Association’s Life’s Simple 7 in a diverse sample of women. Prev Med Rep 2019;16:100991. https://doi.org/10.1016/j.pmedr.2019.100991.Search in Google Scholar
8. Gast, J, Hawks, SR. Weight loss education: the challenge of a new paradigm. Health Educ Behav Off Publ Soc Public Health Educ 1998;25:464–73. https://doi.org/10.1177/109019819802500405.Search in Google Scholar
9. McFarlane, T, Polivy, J, McCabe, RE. Help, not harm: psychological foundation for a nondieting approach toward health. J Soc Issues 1999;55:261–76. https://doi.org/10.1111/0022-4537.00115.Search in Google Scholar
10. Palascha, A, van Kleef, E, de Vet, E, van Trijp, HCM. Internally regulated eating style: a comprehensive theoretical framework. Br J Nutr 2021;126:138–50. https://doi.org/10.1017/s0007114520003840.Search in Google Scholar
11. Tylka, TL, Kroon Van Diest, AM. The intuitive eating scale-2: item refinement and psychometric evaluation with college women and men. J Counsel Psychol 2013;60:137–53. https://doi.org/10.1037/a0030893.Search in Google Scholar
12. Van Dyke, N, Drinkwater, EJ. Review article relationships between intuitive eating and health indicators: literature review. Publ Health Nutr 2014;17:1757–66. https://doi.org/10.1017/s1368980013002139.Search in Google Scholar
13. Warren, JM, Smith, N, Ashwell, M. A structured literature review on the role of mindfulness, mindful eating and intuitive eating in changing eating behaviours: effectiveness and associated potential mechanisms. Nutr Res Rev 2017;30:272–83. https://doi.org/10.1017/s0954422417000154.Search in Google Scholar
14. Grider, HS, Douglas, SM, Raynor, HA. The influence of mindful eating and/or intuitive eating approaches on dietary intake: a systematic review. J Acad Nutr Diet 2021;121:709–27.e1. https://doi.org/10.1016/j.jand.2020.10.019.Search in Google Scholar
15. Artiles, RF, Staub, K, Aldakak, L, Eppenberger, P, Rühli, F, Bender, N. Mindful eating and common diet programs lower body weight similarly: systematic review and meta-analysis. Obes Rev 2019;20:1619–27. https://doi.org/10.1111/obr.12918.Search in Google Scholar
17. Linardon, J, Tylka, TL, Fuller-Tyszkiewicz, M. Intuitive eating and its psychological correlates: a meta-analysis. Int J Eat Disord 2021;54:1073–98. https://doi.org/10.1002/eat.23509.Search in Google Scholar
18. Godfrey, KM, Gallo, LC, Afari, N. Mindfulness-based interventions for binge eating: a systematic review and meta-analysis. J Behav Med 2015;38:348–62. https://doi.org/10.1007/s10865-014-9610-5.Search in Google Scholar
19. Gale, SM, Castracane, VD, Mantzoros, CS. Energy homeostasis, obesity and eating disorders: recent advances in endocrinology. J Nutr 2004;134:295–8. https://doi.org/10.1093/jn/134.2.295.Search in Google Scholar
20. Chaput, J-P, Klingenberg, L, Astrup, A, Sjödin, AM. Modern sedentary activities promote overconsumption of food in our current obesogenic environment. Obes Rev 2011;12:e12–20. https://doi.org/10.1111/j.1467-789x.2010.00772.x.Search in Google Scholar
22. Moodie, R, Stuckler, D, Monteiro, C, Sheron, N, Neal, B, Thamarangsi, T, et al.. Profits and pandemics: prevention of harmful effects of tobacco, alcohol, and ultra-processed food and drink industries. Lancet 2013;381:670–9. https://doi.org/10.1016/s0140-6736(12)62089-3.Search in Google Scholar
23. Lattimore, P. Mindfulness-based emotional eating awareness training: taking the emotional out of eating. Eat Weight Disord 2019;25:649–57. https://doi.org/10.1007/s40519-019-00667-y.Search in Google Scholar
27. Denny, K, Loth, K, Eisenberg, ME, Neumark-Sztainer, D. Intuitive eating in young adults. Who is doing it, and how is it related to disordered eating behaviors? Appetite 2013;60:13–9. https://doi.org/10.1016/j.appet.2012.09.029.Search in Google Scholar
28. Begin, C, Carbonneau, E, Gagnon-Girouard, MP, Mongeau, L, Paquette, MC, Turcott, M, et al.. Eating-related and psychological outcomes of health at every size intervention in health and social services centers across the province of Quebec. Am J Health Promot 2019;33:248–58. https://doi.org/10.1177/0890117118786326.Search in Google Scholar
29. Gagnon-Girouard, M-P, Bégin, C, Provencher, V, Tremblay, A, Mongeau, L, Boivin, S, et al.. Psychological impact of a “health-at-every-size” intervention on weight-preoccupied overweight/obese women. J Obes 2010;928097:1–13. https://doi.org/10.1155/2010/928097.Search in Google Scholar
30. Carroll, S, Borkoles, E, Polman, R. Short-term effects of a non-dieting lifestyle intervention program on weight management, fitness, metabolic risk, and psychological well-being in obese premenopausal females with the metabolic syndrome. Appl Physiol Nutr Metab Physiol Appl Nutr Metab 2007;32:125–42. https://doi.org/10.1139/h06-093.Search in Google Scholar
31. Dalen, J, Smith, BW, Shelley, BM, Sloan, AL, Leahigh, L, Begay, D. Pilot study: mindful eating and living (MEAL): weight, eating behavior, and psychological outcomes associated with a mindfulness-based intervention for people with obesity. Compl Ther Med 2010;18:260–4. https://doi.org/10.1016/j.ctim.2010.09.008.Search in Google Scholar
32. Cherpak, CE, Lare, SV. Mindful eating: a review of how the stress-digestion- mindfulness triad may modulate and improve gastrointestinal and digestive function. Integr Med 2019;18:48–53.Search in Google Scholar
33. Dunn, C, Haubenreiser, M, Johnson, M, Nordby, K, Aggarwal, S, Myer, S, et al.. Mindfulness approaches and weight loss, weight maintenance, and weight regain. Curr Obes Rep 2018;7:37–49. https://doi.org/10.1007/s13679-018-0299-6.Search in Google Scholar
34. Khasteganan, N, Lycett, D, Furze, G, Turner, AP. Health, not weight loss, focused programmes versus conventional weight loss programmes for cardiovascular risk factors: a systematic review and meta-analysis. Syst Rev 2019;8:200. https://doi.org/10.1186/s13643-019-1083-8.Search in Google Scholar
35. Bacon, L, Stern, JS, Van Loan, MD, Keim, NL. Size acceptance and intuitive eating improve health for obese, female chronic dieters. J Am Diet Assoc 2005;105:929–36. https://doi.org/10.1016/j.jada.2005.03.011.Search in Google Scholar
36. Provencher, V, Bégin, C, Tremblay, A, Mongeau, L, Corneau, L, Dodin, S, et al.. Health-at-every-size and eating behaviors: 1-year follow-up results of a size acceptance intervention. J Am Diet Assoc 2009;109:1854–61. https://doi.org/10.1016/j.jada.2009.08.017.Search in Google Scholar
37. Miller, CK, Kristeller, JL, Headings, A, Nagaraja, H, Miser, WF. Comparative effectiveness of a mindful eating intervention to a diabetes self-management intervention among adults with type 2 diabetes: a pilot study. J Acad Nutr Diet 2012;112:1835–42. https://doi.org/10.1016/j.jand.2012.07.036.Search in Google Scholar
38. Youngwanichsetha, S, Phumdoung, S, Ingkathawornwong, T. The effects of mindfulness eating and yoga exercise on blood sugar levels of pregnant women with gestational diabetes mellitus. Appl Nurs Res 2014;27:227–30. https://doi.org/10.1016/j.apnr.2014.02.002.Search in Google Scholar
39. Daubenmier, J, Moran, PJ, Kristeller, J, Acree, M, Bacchetti, P, Kemeny, ME, et al.. Effects of a mindfulness‐based weight loss intervention in adults with obesity: a randomized clinical trial. Obesity 2016;24:794–804. https://doi.org/10.1002/oby.21396.Search in Google Scholar
40. Mensinger, JL, Calogero, RM, Stranges, S, Tylka, TL. A weight-neutral versus weight-loss approach for health promotion in women with high BMI: a randomized-controlled trial. Appetite 2016;105:364–74. https://doi.org/10.1016/j.appet.2016.06.006.Search in Google Scholar
41. Ingraham, N, Harbatkin, D, Lorvick, J, Plumb, M, Minnis, AM. Women’s health and mindfulness (WHAM): a randomized intervention among older lesbian/bisexual women. Health Promot Pract 2017;18:348–57. https://doi.org/10.1177/1524839916670874.Search in Google Scholar
42. Smith, BW, Shelley, BM, Sloan, AL, Colleran, K, Erickson, K. A preliminary randomized controlled trial of a mindful eating intervention for post-menopausal obese women. Mindfulness 2018;9:836–49. https://doi.org/10.1007/s12671-017-0824-9.Search in Google Scholar
43. Alamout, MM, Rahmanian, M, Aghamohammadi, V, Mohammadi, E, Nasiri, K. Effectiveness of mindfulness based cognitive therapy on weight loss, improvement of hypertension and attentional bias to eating cues in overweight people. Int J Nurs Sci 2020;7:35–40. https://doi.org/10.1016/j.ijnss.2019.12.010.Search in Google Scholar
44. Epel, E, Laraia, B, Coleman-Phox, K, Leung, C, Vieten, C, Mellin, L, et al.. Effects of a mindfulness-based intervention on distress, weight gain, and glucose control for pregnant low-income women: a quasi-experimental trial using the ORBIT model. Int J Behav Med 2019;26:461–73. https://doi.org/10.1007/s12529-019-09779-2.Search in Google Scholar
45. HAPO Follow-up Study Cooperative Research Group, Lowe, WL, Lowe, LP, Kuang, A, Catalano, PM, Nodzenski, M, et al.. Maternal glucose levels during pregnancy and childhood adiposity in the hyperglycemia and adverse pregnancy outcome follow-up study. Diabetologia 2019;62:598–610. https://doi.org/10.1007/s00125-018-4809-6.Search in Google Scholar
46. Knowler, WC, Barrett-Connor, E, Fowler, SE, Walker, EA, Nathan, DM. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002;346:393–403. https://doi.org/10.1056/NEJMoa012512.Search in Google Scholar
47. Franceschi, C, Campisi, J. Chronic inflammation (inflammaging) and its potential contribution to age-associated diseases. J Gerontol A Biol Sci Med Sci 2014;69(Suppl 1):S4–9. https://doi.org/10.1093/gerona/glu057.Search in Google Scholar
48. Rådmark, S, Osika, N. A systematic review and meta-analysis of the impact of mindfulness based interventions on heart rate variability and inflammatory markers. J Clin Med 2019;8:1638.10.3390/jcm8101638Search in Google Scholar
49. Daubenmier, J, Kristeller, J, Hecht, FM, Maninger, N, Kuwata, M, Jhaveri, K, et al.. Mindfulness intervention for stress eating to reduce cortisol and abdominal fat among overweight and obese women: an exploratory randomized controlled study. J Obes 2011;2011:1–13. https://doi.org/10.1155/2011/651936.Search in Google Scholar
50. Levine, GN, Cohen, BE, Commodore-Mensah, Y, Fleury, J, Huffman, JC, Khalid, U, et al.. Psychological health, well-being, and the mind-heart-body connection: a scientific statement from the American Heart Association. Circulation 2021;143. https://doi.org/10.1161/cir.0000000000000947.Search in Google Scholar
51. Karyadi, KA, VanderVeen, JD, Cyders, MA. A meta-analysis of the relationship between trait mindfulness and substance use behaviors. Drug Alcohol Depend 2014;143:1–10. https://doi.org/10.1016/j.drugalcdep.2014.07.014.Search in Google Scholar
52. Loucks, EB, Britton, WB, Howe, CJ, Eaton, CB, Buka, SL. Positive associations of dispositional mindfulness with cardiovascular health: the New England family study. Int J Behav Med 2015;22:540–50. https://doi.org/10.1007/s12529-014-9448-9.Search in Google Scholar
53. Loucks, EB, Schuman-Olivier, Z, Britton, WB, Fresco, DM, Desbordes, G, Brewer, JA, et al.. Mindfulness and cardiovascular disease risk: state of the evidence, plausible mechanisms, and theoretical framework. Curr Cardiol Rep 2015;17:112. https://doi.org/10.1007/s11886-015-0668-7.Search in Google Scholar
54. Nardi, WR, Harrison, A, Saadeh, FB, Webb, J, Wentz, AE, Loucks, EB. Mindfulness and cardiovascular health: qualitative findings on mechanisms from the mindfulness-based blood pressure reduction (MB-BP) study. PLoS One 2020;15:e0239533. https://doi.org/10.1371/journal.pone.0239533.Search in Google Scholar
55. Alsubaie, M, Abbott, R, Dunn, B, Dickens, C, Keil, TF, Henley, W, et al.. Mechanisms of action in mindfulness-based cognitive therapy (MBCT) and mindfulness-based stress reduction (MBSR) in people with physical and/or psychological conditions: a systematic review. Clin Psychol Rev 2017;55:74–91. https://doi.org/10.1016/j.cpr.2017.04.008.Search in Google Scholar
© 2021 Walter de Gruyter GmbH, Berlin/Boston