J Behav Med (2015) 38:348–362

DOI 10.1007/s10865-014-9610-5

Mindfulness-based interventions for binge eating: a systematic

review and meta-analysis
Kathryn M. Godfrey • Linda C. Gallo •

Niloofar Afari

Received: April 2, 2014 / Accepted: November 12, 2014 / Published online: November 23, 2014
Ó Springer Science+Business Media New York (outside the USA) 2014

Abstract Mindfulness-based interventions are increas- group I2 = 93 %; between-group I2 = 90 %). Limitations

ingly used to treat binge eating. The effects of these and future research directions are discussed.
interventions have not been reviewed comprehensively.
This systematic review and meta-analysis sought to sum- Keywords Mindfulness
Dialectical behavior therapy

marize the literature on mindfulness-based interventions Acceptance and commitment therapy
Binge eating
and determine their impact on binge eating behavior.
PubMED, Web of Science, and PsycINFO were searched
using keywords binge eating, overeating, objective bulimic Background
episodes, acceptance and commitment therapy, dialectical
behavior therapy, mindfulness, meditation, mindful eating. Growing research on Cognitive Behavioral Therapy (CBT)
Of 151 records screened, 19 studies met inclusion criteria. has demonstrated its effectiveness in reducing binge eating
Most studies showed effects of large magnitude. Results of (Brownley et al., 2007), and CBT protocols have been
random effects meta-analyses supported large or medium- further developed into guided self-help (Wilson et al.,
large effects of these interventions on binge eating (within- 2010) and transdiagnostic versions (Murphy et al., 2010),
group random effects mean Hedge’s g = -1.12, 95 % CI which are considered first line or gold standard treatments
-1.67, -0.80, k = 18; between-group mean Hedge’s g = for binge eating disorder (BED). CBT for binge eating is
-0.70, 95 % CI -1.16, -0.24, k = 7). However, there was based on the restraint model where over-evaluation of
high statistical heterogeneity among the studies (within- shape and weight are believed to lead to a cycle of dietary
restraint and binge eating in attempt to control weight
(Iacovino et al., 2012; Telch et al., 2001). Therefore, CBT
aims to decrease dietary restraint and establish healthy
K. M. Godfrey
San Diego State University/University of California, San Diego eating patterns. Despite moderate treatment outcomes,
Joint Doctoral Program in Clinical Psychology, San Diego, CA, CBT remains ineffective for many patients with BED, and
USA remission rates typically range between 40 and 60 % (Grilo
et al., 2011). Further, these interventions have not been
K. M. Godfrey
N. Afari
VA Center of Excellence for Stress and Mental Health, successful in promoting weight loss (Wilson et al., 2007),
San Diego, CA, USA which is often a significant problem in this population. A
need to further improve treatment outcomes and an interest
L. C. Gallo
in mindfulness has inspired a newly burgeoning literature
San Diego State University, San Diego, CA, USA
on mindfulness-based interventions for binge eating.
N. Afari (&) Mindfulness is a process defined by two central com-
University of California, San Diego, La Jolla, CA, USA ponents: attention to present-moment experiences and a
e-mail: nafari@ucsd.edu
stance of acceptance or openness towards these experi-
N. Afari ences (Bishop et al., 2004). Mindfulness-based interven-
VA San Diego Healthcare System, San Diego, CA, USA tions work on building a present-focused attentional state

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J Behav Med (2015) 38:348–362 349

that emphasizes observing and experiencing rather than on binge eating. The review includes both UCSs that
evaluating and changing experiences such as thoughts, examine binge eating changes in single groups in response
sensations, feelings, or urges. Interventions including to mindfulness-based interventions and RCTs that compare
Dialectical Behavior Therapy (DBT), Acceptance and relative changes in binge eating in response these inter-
Commitment Therapy (ACT), and Mindfulness-Based ventions versus a waitlist, treatment as usual, or control
Stress Reduction (MBSR) use mindfulness practice to build group. This systematic review will describe the studies
awareness, acceptance, and distress tolerance and reduce conducted and examine the overall evidence for the
emotional and cognitive reactivity, automatic behavioral effectiveness of these interventions in reducing binge eat-
patterns, and avoidance of unwanted experiences (Baer, ing.
2005). In addition, many of these therapies reorient the
individual to his or her values, which guides new and more
adaptive behavioral patterns. Mindfulness-based treatments Methods
can be conceptualized with the dual pathway model (Stice,
2001; Van Strien et al., 2005). This model proposes that Search strategy
dietary restraint is one pathway to binge eating while
negative affect, interoceptive awareness, and emotional PubMED (from 1953 to December 1, 2013), PsycINFO
eating represent another pathway, consideration of which (from 1806 to December 1, 2013), and Web of Science
might improve our knowledge about the causes and (from 1900 to December 1, 2013) were searched using the
potential treatment targets for binge eating. This second following terms: binge eating OR binge eating disorder OR
pathway conceptualizes binge eating as a way to regulate overeating OR objective bulimic episodes AND acceptance
emotion, to avoid unwanted, negative experiences, or as a and commitment therapy OR dialectical behavior therapy
failure to recognize physical sensations (Van Strien et al., OR mindfulness OR meditation OR mindful eating. To
2005). Thus, the dual pathway model provides a theoretical minimize publication bias, listservs associated with the
basis for the increasing interest in using mindfulness-based Society of Behavioral Medicine, the American Psycho-
therapies for binge eating (Wonderlich et al., 2003). logical Association’s Division 38 (Health Psychology), and
Observational studies and experimental paradigms of Academy for Eating Disorders were utilized to collect
emotion regulation or experiential avoidance and eating unpublished data. Additionally, the National Institutes of
have provided some support for mindfulness-based thera- Health clinicaltrials.gov website was searched for any
pies for binge eating in clinical and non-clinical samples relevant studies. The Preferred Reporting Items for Sys-
(Barnes & Tantleff-Dunn, 2010; Epel et al., 2001; Forman tematic Reviews and Meta-Analyses (PRISMA) guidelines
et al., 2013; Laessle & Schulz, 2009; Wallis & Hethe- were used to perform this systematic review (Liberati et al.,
rington, 2009). Clinically, mindfulness-based interventions 2009).
have been used to treat binge eating (Baer et al., 2005a;
Safer et al., 2001, 2007). Mindful eating has also gained
popularity in the self-help literature (Albers, 2012; Bays, Inclusion and exclusion criteria
2009; Somov, 2008). Despite increased interest in applying
mindfulness-based methods for binge eating, much of the Studies that met the following criteria were included in the
support for these approaches is based in theory, experi- screening process for the review: written in English, pub-
mental studies, or observational studies, although the lit- lished in peer-reviewed scholarly journals, RCTs or UCSs
erature from uncontrolled cohort studies (UCS) and of group or individual psychological interventions using
randomized controlled trials (RCT) is growing. Two recent DBT, ACT, mindfulness-based therapies such as MBSR,
systematic reviews (Katterman et al., 2014b; O’Reilly mindfulness meditation, and mindful eating, or an adapted
et al., 2014) examined studies using mindfulness inter- intervention related to these therapies, and assessed binge
ventions to address binge eating and related outcomes such eating as an outcome variable, but not necessarily the
as weight, glycemic control, cravings, and emotional eat- primary target, of treatment. For example, a study that
ing. However, there remains a gap in the literature assessed weekly binge eating days before and after an ACT
regarding the systematic review and meta-analysis syn- intervention targeting eating, body image, or self-stigma
thesizing the evidence from studies examining the effec- without a singular treatment emphasis on binge eating
tiveness of all mindfulness-based interventions on binge (Lillis et al., 2011) was included in the review because it
eating specifically. still examined the impact of the ACT intervention on binge
The aim of the current systematic review and meta- eating. Many mindfulness-based interventions are based on
analysis was to summarize the literature and examine the therapeutic philosophies or treatment approaches that do
impact of mindfulness-based psychological interventions not emphasize reducing symptoms or changing disorders

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but rather focus on cultivating awareness and improving guidelines or manuals. Observational studies, case studies,
quality of life. Therefore, including studies that did not single case experiments, and RCTs studying the efficacy of
specifically target changing binge eating during treatment pharmacotherapy for binge eating were also excluded.
was considered necessary in order to comprehensively Studies that only examined binge eating in the context of
represent the mindfulness-based treatment literature. bulimia nervosa (BN) and those using treatments that are
For the purpose of this review binge eating was defined related to ACT or DBT but did not include a mindfulness
as eating a large or excessive amount of food at one time component (e.g., building emotion regulation skills only)
and having a sense of loss of control; however, exceptions were excluded. Finally, studies were excluded if they only
were made for studies assessing binge eating in individuals measured constructs related to binge eating (e.g., emotional
in whom eating excessive amounts was not possible. For eating, emotional overeating, external eating, coping with
example, a study of a mindfulness-based intervention with cravings to eat), assessed a history of binge eating but not
post-bariatric surgery patients assessed binge eating with current binge episodes or symptoms, or only reported
only the loss of control and guilt after eating items from the subscales of assessments that may be correlated with, but
Eating Disorder Examination self-report questionnaire did not directly assess, binge eating (e.g., restraint subscale,
(EDE-Q) as these individuals are not physically able to eat external eating subscale).
large quantities of food (Leahey et al., 2008). There were
no inclusion or exclusion criteria regarding sample char- Search results, effect size, and quality of evidence
acteristics so study samples could demonstrate a range of assessment
binge eating severity, from clinical samples with a BED
diagnosis to community samples without BED or signifi- Figure 1 shows the flow of documents through the identi-
cant binge eating pathology. Publications were excluded if fication, screening, eligibility, and inclusion stages of the
they were book reviews, books, book chapters, published systematic review. Data were extracted from these studies
abstracts, conference proceedings, theses and dissertations, by the first author (KG) into a data collection table that
review articles, proof of concept papers, or treatment included study design, recruitment protocols, sample

37 Records 81 Records 79 Records

4 Unpublished
Identification identified in identified in Web identified in
studies identified
PubMed of Science PsycInfo

151 Records after

duplicates
removed
Screening

151 Records 97 Records

screened excluded

Reasons not eligible:

54 Full-text or Conference abstracts (n=6),
35 Records dissertations (n=11), observational
Eligibility unpublished
ineligible studies (n=11), qualitative study (n=1),
articles assessed
binge eating not assessed (n=2), paper
using data from a study included in the
review, duplicate data
(n=2), clinical pilot study without
sufficient standardization of treatment
19 Studies (n=1), study had combination of DBT
Included and CBT without mindfulness (n=1)
included in review

Fig. 1 Flow of documents through the systematic review. BED binge eating disorder. BPD borderline personality disorder. DBT dialectical
behavior therapy. CBT cognitive behavior therapy

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characteristics, intervention characteristics, binge eating Excel according to standard procedures (Borenstein et al.,
outcome measures, follow up periods, means and standard 2009).
deviations for outcomes of interest, and a statement of
overall findings. An independent rater trained on the
extraction protocol collected data from a random sample of Results
6 of the 19 included studies. There was 100 % agreement
of the two raters for all data points for the dual-coded Study characteristics
studies. Nine authors of the included studies were con-
tacted to request additional study information. Due to the Table 1 provides the descriptions and details from the
small sample sizes in many of the included studies, included studies. Of the 19 studies, 8 were RCTs, 10 were
Hedges’ g effect sizes were calculated using means and UCSs, and one was a two group, non-randomized cohort
standard deviations, as appropriate and with the data pro- study. Studies were published from 1999 to 2014. Fourteen
vided or obtained. Within-group effect sizes used the dif- studies were conducted in the USA, and the remaining 5
ference from baseline to post-treatment or follow up period were from Canada, Sweden, the UK, and Australia. Ten of
only. Between-group effect sizes compared study groups the studies recruited participants who were binge eating
(e.g., ACT vs waitlist) at post-treatment or follow up. As and/or met criteria for BED. Four publications studied
our focus was on the effectiveness of mindfulness-based individuals from the community without specifically
interventions per se rather than how they compare to other requiring binge eating as inclusion criteria. Three studies
psychological interventions (e.g., CBT), between group recruited individuals who were concerned about control-
effect sizes were only included in the calculation of mean ling their weight or had been attempting to lose weight.
study effect size if they compared a mindfulness-based Two studies obtained their samples from a post-bariatric
intervention to waitlist, control, or treatment as usual. surgery population. The studies were typically comprised
Separate meta-analyses were performed for within-group of samples that were mostly female (min percent
effect sizes and between-group effect sizes. To perform the female = 70; max percent female = 100), adult-aged (min
meta-analyses using one effect per study, a mean effect mean age = 22; max mean age = 54), and overweight or
size was calculated for each study by averaging effects obese (min mean BMI = 27; max mean BMI = 41).
across all time points. Variance of the mean effect sizes
was calculated with an assumed correlation of r = 0.70, in Quality of evidence
line with previous meta-analyses on binge eating (Vocks
et al., 2010). Variance of mean effect sizes was calculated Table 2 presents the component and global ratings of
using equations from Borenstein et al., (2009). Each study quality assessment for each study. Eight of the 19 studies
was assessed for quality of evidence using the Effective received weak global quality ratings, mostly due to weak
Public Health Practice Project Quality Assessment Tool scores on the selection bias (e.g., low percent of eligible
(EPHPP; available online at http://www.ephpp.ca/tools. participants decide to enroll in the study) and rating of
html), which has demonstrated lower risk of bias than the confounders (e.g., no mention of including covariates in the
Cochrane Collaboration Risk of Bias Tool, another com- analyses to control for confounders) criteria. The remaining
monly used assessment of study quality for systematic 11 studies received moderate ratings of global quality, with
reviews (Armijo-Olivo et al., 2012). Another consideration but one study receiving weak scores on the selection bias
for analysis of bias was the number of studies arising from section. Taken together, the overall rating of quality for the
the same research group. studies reviewed was moderate (modal Global Rat-
ing = 2). Four (Masson et al., 2013; Safer et al., 2010;
Statistical analysis Telch et al., 2000, 2001) of the 6 DBT studies were con-
ducted by or in collaboration with researchers at Stanford
A meta-analysis was performed on the mean effect sizes University Medical Center. Three (Dalen et al., 2010;
calculated for each study to examine the effectiveness of Smith et al., 2008; Smith et al., 2006) of the 9 mindfulness-
the mindfulness-based interventions compared to baseline based studies were from a group out of the University of
or control conditions. As studies in this review had clinical New Mexico, and 2 (Kristeller & Hallett, 1999; Kristeller
and methodological heterogeneity a random effects model et al., 2013) other mindfulness-based studies were con-
was used to combine effect sizes in the meta-analysis. ducted by researchers at the University of Indiana. Thus,
Overall I2 statistics were calculated to examine the degree the research using DBT and the other mindfulness-based
of heterogeneity (Higgins & Thompson, 2002) among interventions is limited by the small number of research
included studies. Analyses were conducted using Microsoft groups publishing the studies.

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Table 1 Information extracted from the studies on mindfulness- and acceptance-based interventions
Authors Study type and setting Sample Treatment and group size Comparison(s) and Key findings
(Year) group size

Katterman RCT; Psychology N = 58; Interested in ACT and behavioral weight Control: n = 29; no OBE days M (SD)
et al., department, Drexel weight control; 100 % control treatment Baseline: ACT 0 (0);
(2014a) University, Philadelphia, women; mean age 22.4 Focus: healthy eating and Control 0.5 (1.7)
PA (SD = 2.9); mean BMI exercise behaviors promoting
26.6 (SD = 2.2) Mid-tx: ACT 0.2 (1.0);
long-term weight control Control 0 (0)
n = 29; 8 session (first 4–5 Post-tx: ACT 0.1 (0.2);
weekly, rest monthly), Control 0.1 (0.6)
75 min
# OBEs M (SD)
Baseline: ACT 0 (0);
Control 0.52 (1.7)
Mid-tx: ACT 0.2 (1.0);
Control 0 (0)
Post-tx: ACT 0.1 (0.2);
Control 0.1 (0.6)
Kristeller RCT; Psychology N = 140; 111 met DSM-IV MB-EAT WL: n = 42; later offered OBE days M (SD)
et al., department, University or DSM-5 BED criteria; Focus: awareness of access to active Baseline: MB-EAT 14.8
(2013) of Indiana, Terre Haute, 88 % women; mean age inappropriate eating patterns, treatments (5.7); WL 14.0 (6.3)
IN and Duke University 46.6; mean BMI 40.3 tools and support to make
Medical Center, Post-tx: MB-EAT 4.8 (5.8);
sustainable changes WL 12.8 (8.4)
Durham, NC
n = 50; group tx; 9 weekly 4 or 6mfu: MB-EAT 3.8
sessions then 3 monthly (5.2); WL 11.4 (9.3)
booster sessions for 12
sessions total. Sessions 1 and BES M (SD)
6 were 2 h, rest were 1.5 h Baseline: MB-EAT 29.0
(7.8); WL 28.1 (7.8)
Post-tx: MB-EAT 15.2
(8.1); WL 25.9 (9.0)
4 or 6mfu: MB-EAT 13.5
(9.1); WL 25.1 (7.0)
Masson RCT; Department of N = 60; all with DSM-5 DBT WL: n = 30; given DBT tx # OBEs M (SD)
et al., psychology, University BED; 88 % women; Focus: reduce binge eating by after 13 weeks on WL Baseline: DBT 18.7 (13.2);
(2013) of Calgary, Calgary, mean age 42.8 teaching emotion regulation WL 19.6 (11.9)
Alberta, Canada (SD = 10.5); mean BMI
38.0 n = 30; guided self-help tx; Post-tx: DBT 6.0 (9.4); WL
One 45 min in-person 14.4 (11.9)
session, 6 biweekly 20 min 6mfu: 9.5 (11.9)
support phone calls over
13 weeks of guided self-help
tx
Woolhouse UCS; University N = 30; 50 % had Mindful MEG MAEDS binge eating
et al., psychology clinic, symptoms of DSM-IV Focus: better understand and M (SD)
(2012) Swinburne University, BED; 31 % had BN control eating behavior Baseline: 4.5 (0.9)
Victoria, Australia symptoms, 19 % had
sub-clinical symptoms; n = 30; group tx; 10 weekly Post-tx: 2.9 (1.2)
100 % women; mean sessions of 3 h duration 3mfu: 2.9 (1.3)
age 32.2 (SD = 7.9)
Klein et al., UCS; University N = 10; all reported binge DBT Self-reported weekly
(2012) psychology clinic, eating; 80 % met full or Focus: group DBT for binge binges M (SD)
United States partial criteria for BED; eating Baseline: 3.4 (1.8)
20 % BN; 100 %
women; mean age 39.6 n = 5; treatment completers; Post-tx: 0.5 (0.6)
(SD = 5.6) group tx; 16 weekly sessions
over 18 weeks (2 week break
at midway point) each
2–2.5 h, coaching calls
between sessions

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Table 1 continued
Authors Study type and setting Sample Treatment and group size Comparison(s) and Key findings
(Year) group size

Weineland RCT; Medical center for N = 39; all post-bariatric ACT TAU: n = 20; dietary DEBS M (SD)
et al., minimally invasive surgery patients; 90 % Focus: increase conscious guidelines, follow up Baseline: ACT 4.1 (4.1);
(2012b) surgery and psychology female; mean age 43.1; valued life quality and in person telephone TAU 5.2 (5.2)
department at the mean BMI preoperative sessions as needed,
University of Uppsala, 37.1, mean BMI at study n = 19; 2 in-person sessions conducted by bariatric Post-tx: ACT 1.6 (2.4);
Sweden baseline 27.2 (1.5 h) at start and end of tx, team (surgeon, nurse, TAU 5.54 (5.9)
6 week self-help tx via dietician)
internet modules, weekly
30 min support phone session
Courbasson N = 38; 79 % women; all MACBT # OBEs M (SD)
et al., met criteria for SUD; Focus: build skills in Baseline: 19.1 (4.5)
(2011) mean age 42 mindfulness including
(SD = 11.0) Post-tx: 8.1 (2.6)
emotion regulation and
mindful eating,
psychoeducation, balanced
physical activity, focusing on
individual strengths
n = 38; 16 weekly 2 h group
sessions
Lillis et al., RCT; University of N = 83; all completed at ACT WL: n = 43; completed the Weekly binge days M (SD)
(2011) Nevada, Reno least 6 months of Focus: living a more fulfilling ACT workshop after the Baseline: ACT 1.8 (1.4);
structured weight loss life consistent with chosen follow up WL 1.8 (1.4)
programs; 90 % women; values
mean age 50.8 3mfu: ACT 1.4 (1.5); WL
(SD = 11.3); mean BMI n = 40; 1 workshop session of 2.2 (1.9)
33.0 (SD = 7.1) 6h

Dalen UCS; local YMCA N = 10; 70 % women; MEAL BES M (SD)

et al., Albuquerque, NM mean age 44 Focus: cultivate awareness of Baseline: 16.2 (5.4)
(2010) (SD = 8.7); mean BMI behaviors and reduce
36.9 (SD = 6.3) Post-tx: 9.2 (5.1)
automatic eating to reduce
binge-type eating and 3mfu: 7.2 (2.3)
improve psychological
functioning
n = 10; group tx; 6 weekly
sessions lasting 2 h each
Safer et al., RCT; Stanford University N = 101 all with DSM-IV DBT OBE days M (SD)
(2010) Medical Center, BED; 85 % women, Focus: eliminate binge eating Baseline: DBT 15.3 (6.1)
Stanford, CA mean age 52.2 by improving emotion
(SD = 10.6); mean BMI Post-tx: DBT 1.4 (2.8)
regulation
36.4 (SD = 6.6) 12mfu: DBT 2.6 (5.0)
n = 50; group tx; 20 weekly
in-person sessions of 2 h
each over 21 weeks (2 weeks
between sessions 19 and 20)
Tapper RCT; Cardiff University, N = 62; all actively ACT TAU: n = 31; continue Shortened BES M (SD)
et al., Cardiff, Wales, United attempting to lose Focus: enhance motivation, weight loss attempts, Baseline: ACT 7.9 (3.9);
(2009) Kingdom weight; 100 % women, reduce associations between given a chance to attend TAU 9.1 (3.5)
mean age 41 (SD = 13), food- and exercise-related a 1 day weight loss
mean BMI 31.7 workshop at end of study 4mfu: ACT 6.7 (3.6); TAU
thoughts and behaviors, build 9.4 (3.8)
(SD = 6.1) tolerance of negative feelings
6mfu: ACT 5.4 (3.5); TAU
n = 31; 4 2-h in-person 10.1 (4.4)
workshop sessions total:
3 weeks consecutive then 1
follow up session 3 months
later
Chen et al., UCS: University of N = 8; all had BPD; n = 5 DBT # OBEs M (SD)
(2008) Washington had BED; n = 3 had Focus: standard DBT modified Baseline: 16.0 (10.4)
BN; all women; median to address binge eating
age 31; mean BMI 35.8 Post-tx: 5.3 (10.1)
(SD = 6.4) n = 8; weekly DBT (skills 6mfu: 5.8 (9.9)
group, individual therapy,
24 h telephone access) for
6 months

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Table 1 continued
Authors Study type and setting Sample Treatment and group size Comparison(s) and Key findings
(Year) group size

Leahey UCS; Kent State N = 7; all post-bariatric CB mindfulness-based Loss of control M (SD)
et al., University, Kent, Ohio surgery patients; 85 % intervention Baseline: 9.1 (7.7)
(2008) women; mean age 54; Focus: decrease binge eating
mean BMI 40.8 Post-tx: 0.4 (0.7)
and emotional eating;
(SD = 5.4) enhance well-being and Guilt after eating
postsurgical adjustment Baseline: 2.3 (1.6)
n = 7; group tx; 10 weekly Post-tx: 0.6 (0.5)
sessions lasting 75 min each
Smith CA; University of New N = 50; community MBSR CBSR: n = 14; group BES M (SD)
et al., Mexico, Albuquerque, sample choosing one of Focus: increase mindfulness course; Baseline: MBSR 1.8 (0.6);
(2008) NM two fee-based stress with a focus on eating 8 weekly sessions each CBSR 1.5 (0.5)
reduction courses; 80 % lasting 3 h
women; mean age 44.9 n = 36; group course; 8 weekly Post-tx: MBSR 1.6 (0.4);
(SD = 13.7) sessions each lasting 3 h with CBSR 1.4 (0. 5)
a 1 day full retreat on week 6
Smith UCS; University of New N = 25; community MBSR BES M (SD)
et al., Mexico, Albuquerque, sample signing up for a Focus: increase mindfulness Baseline: 10.1 (9.6)
(2006) NM fee-based stress with a focus on eating
reduction course; 80 % Post-tx: 7.1 (7.1)
women; mean age 47.8 n = 25; group course; 8 weekly
(SD = 13.1); mean BMI sessions each lasting 3 h with
27.9 (SD = 7.4) a one day full retreat

Baer et al., UCS; University of N = 10; 60 % met DSM- MBCT # OBEs M

(2005b) Kentucky, Lexington, IV BED criteria 40 % Focus: mindfulness and Baseline: 15.7
KY met criteria except for cognitive-based skills to
frequency of binges Post-tx: 4.0
reduce binge eating
(only 3–5 in past BES M
month); 20 % previous n = 6 completers; group tx;
10 weekly sessions, 2 h in Baseline: 25.8
BN symptoms; 100 %
length Post-tx: 18.4
women; age range
23–65; BMI range
22–40
Telch et al., RCT; Stanford University N = 44; all with DSM-IV DBT WL: n = 16; given a OBE days M (SD)
(2001) Medical Center, BED; 100 % women, Focus: eliminate binge eating chance to complete DBT Baseline: DBT 10.5 (9.0);
Stanford, CA mean age 50 by improving emotion intervention at post-tx WL 14.0 (5.0)
(SD = 9.1); mean BMI regulation
36.4 (SD = 6.6) Post-tx: DBT 0 (0); WL 8.5
n = 18; group tx; 20 weekly (10)
in-person sessions of 2 h # OBEs M (SD)
each
Baseline: DBT 11.5 (10.8);
WL 14.5 (7.5)
Post-tx: DBT 0 (0); WL 10
(14)
BES M (SD)
Baseline: 28.8 (6.1); WL
31.8 (6.0)
Post-tx: DBT 15.7 (9.4);
WL 28.2 (8.3)
Telch et al., UCS; Stanford University N = 11; all met DSM-IV DBT OBE days M (SD)
(2000) Medical Center, criteria for BED; 100 % Focus: eliminate binge eating Baseline: 11.8 (6.0)
Stanford, CA women; mean age 45 by improving emotion
(SD = 11.7); Post-tx: 1.8 (4.7)
regulation
# OBEs M (SD)
n = 18; group tx; 20 weekly
in-person sessions of 2 h Baseline: 15.2 (12.3)
each Post-tx: 3.2 (7.6)
BES M (SD)
Baseline: 32.4 (8.5)
Post-tx: 17.2 (9.6)

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Table 1 continued
Authors Study type and setting Sample Treatment and group size Comparison(s) and Key findings
(Year) group size

Kristeller UCS; Psychology N = 18; all met DSM-IV MB-EAT Self-reported weekly
& department, University BED criteria; 100 % Focus: use of general binges M (SD)
Hallett of Indiana, Terre Haute, women; mean age 46.5 mindfulness meditation, Baseline: 4.0 (1.4)
(1999) IN (SD = 10.5); mean BMI eating meditation, and mini-
40.3 Post-tx: 1.6 (1.5)
meditation
BES M (SD)
n = 18; group tx; 7 sessions
over 6 weeks Baseline: 31.7 (7. 7)
Post-tx: 15.1 (8.1)

RCT randomized controlled trial, UCS uncontrolled cohort study, CA cohort analytic study (two non-randomized groups assessed pre- and post-
tx), ACT Acceptance and Commitment Therapy, MEAL mindful eating and living, CB cognitive behavioral, MBSR mindfulness-based stress
reduction, CBSR cognitive-based stress reduction, MB-EAT mindfulness-based eating awareness training, MBCT mindfulness-based cognitive
therapy, DBT Dialectical Behavior Therapy, BED binge eating disorder, BN bulimia nervosa, MEG the moderate eating program, PECB psycho-
educational cognitive behavioral, WL waitlist, TAU treatment as usual, Tx treatment, Mfu is month follow up, TAU treatment as usual, OBE
objective bulimic episode, BES the binge eating scale, EDI-3 SC the eating disorders inventory-3 symptom checklist, MAEDS multifactorial
assessment of eating disorders scale, DEBS disorder eating after bariatric surgery self-report questionnaire, SUD substance use disorder, MACBT
Mindfulness-action based Cognitive Behavioral Therapy, BPD borderline personality disorder

Interventions education, and balanced physical activity taught in a group

setting and practiced at-home through experiential exer-
Mindfulness-based therapies cises, behavior chain analysis, self-monitoring, goal set-
ting, focusing on strengths (Courbasson et al., 2011).
Nine of the 19 studies used mindfulness-based interven- Although there were differences between these 4 MBCTs,
tions. These studies typically used either Mindfulness- they all contained CBT elements for binge eating that
based Cognitive Therapies (MBCT) or MBSR in original target dietary restraint such as self-monitoring and recog-
format or adapted to address binge eating behaviors. Four nizing cognitive and emotional triggers for binge eating or
of these studies examined the effects of MBCT on binge overeating in addition to building mindfulness skills
eating. Baer et al., (2005b) modified MBCT for binge through exercises in group and as homework.
eating (Segal et al., 2002). The protocol included mind- Five studies used an adaptation of MBSR (Kabat-Zinn,
fulness exercises, being accepting and non-judgmental, 1990) as a mindfulness-based intervention using meditation
realizing that thoughts are not facts, increasing activities practice, breathing exercises, body scans, and gentle yoga
related to pleasure and mastery, reducing activities related to build mindfulness through group discussion, workbook
to negative thoughts and moods, and observing and expe- activities, and at-home assignments. Two of the 5 studies
riencing sensations, thoughts, and feelings while making a used Mindfulness-based Eating Awareness Training (MB-
choice of behaviors to engage in. One group used an EAT), a modified MBSR intervention for BED to improve
MBCT protocol adapted for the post-bariatric surgery responses to emotions, conscious food choices, hunger and
population, emphasizing self-monitoring and modifying satiety awareness, and self-acceptance (Kristeller & Wo-
eating to be consistent with post-surgery recommendations, lever, 2011). MB-EAT employs general meditation prac-
identifying and coping with external and internal triggers to tice, guided eating meditations, and mini-meditations to be
overeating, practicing mindful eating, and emotion regu- used at meals and throughout the day. The other three
lation techniques (Leahey et al., 2008). Woolhouse et al., studies (Dalen et al., 2010; Smith et al., 2006, 2008)
(2012) employed a MBCT called Mindful Moderate Eating modified MBSR for mindful eating, exploring relationships
Group (MMEG), which added mindfulness exercises to with common foods, taste awareness, and choices around
CBT for binge eating (Crafti, 1994; Crafti & Peyton, 2005). food similar to the MB-EAT protocol. Five studies from 2
The CBT component of the intervention involved regular separate research groups, one based in Indiana and the
and planned meals, self-monitoring, and identifying trig- other in New Mexico, adapted the MBSR intervention to
gers for binge episodes. Courbasson et al., (2011) devel- integrate eating awareness and choices around food. These
oped Mindfulness-Action based Cognitive Behavioral 5 studies were fairly similar and contained some overlap-
Therapy (MACBT) group treatment for individuals with ping content with the MBCT protocols without the focus
concurrent BED and Substance Use Disorder (SUD). on self-monitoring, problem solving to increase adherence
MACBT contained components of mindfulness, psycho- to dietary rules, or identifying maladaptive cognitions.

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Table 2 Component and global ratings of quality of evidence using EPHPP

Authors (Year) Selection Study Confounders Blinding Data Collection Withdrawals and Global
Bias Design Method Dropouts Rating

Katterman et al., (2014a) 3 1 1 2 1 2 2

Kristeller et al., (2013) 3 1 3 2 1 2 3
Masson et al., (2013) 3 1 3 1 1 2 3
Woolhouse et al., (2012) 3 2 N/A 2 1 2 2
Klein et al., (2012) 3 2 N/A 2 3 3 3
Weineland et al., (2012b) 2 1 3 2 1 2 2
Courbasson et al., (2011) 3 2 N/A 2 1 2 2
Lillis et al., (2011) 3 1 1 2 3 1 3
Dalen et al., (2010) 3 2 N/A 2 1 1 2
Safer et al., (2010) 3 1 3 2 1 2 3
Tapper et al., (2009) 3 1 3 1 1 1 3
Chen et al., (2008) 3 2 N/A 2 1 2 2
Leahey et al., (2008) 3 2 N/A 2 3 3 3
Smith et al., (2008) 3 2 N/A 2 1 2 2
Smith et al., (2006) 3 2 N/A 2 1 1 2
Baer et al., (2005b) 3 2 N/A 2 1 2 2
Telch et al., (2001) 3 1 3 2 1 2 3
Telch et al., (2000) 3 2 N/A 2 1 1 2
Kristeller & Hallett (1999) 3 2 N/A 2 1 1 2
EPHPP Effective Public Health Practice Project Quality Assessment. Ratings are as follows: 1-Strong; 2-Moderate; 3-Weak. N/A means not
applicable and was given to uncontrolled cohort studies that only had one group indicating that identifying and controlling for confounders across
groups does not apply

Dialectical behavior therapy vidual psychotherapy, consultation teams, and 24-h tele-
phone access to staff. Thus, 5 of the 6 studies using DBT
Six studies implemented DBT interventions. Five of these applied versions of the same treatment protocol originally
studies conducted in-person group therapy, and one used a devised by Telch et al., (2000, 2001), and one study used
guided self-help version of DBT. Telch et al., (2000, 2001) the standard DBT modified to treat binge eating.
used a version of the DBT treatment manual (Linehan,
1993a, b) modified for women with BED. In this protocol, Acceptance and commitment therapy
participants were told that binge eating often occurs to
reduce negative emotions so noticing and regulating emo- Unlike the studies that used DBT, there was considerable
tions would help them stop binge eating. The main mod- variability in the delivery and content of the 4 ACT pro-
ules included skill building in mindfulness (e.g., observing tocols. One study (Tapper et al., 2009) used ACT exercises
the present without judgment), emotion regulation (e.g., and metaphors adapted to teach values, cognitive ‘‘defu-
feeling identification and opposite action), and distress sion’’ (i.e., recognizing thoughts as internal events not
tolerance (e.g., enduring discomfort without binge eating). facts), and acceptance relevant to weight-loss through
Participants performed behavior chain analysis and self- workshops and at-home practice. Participants gained
monitoring of mood and binge eating, comparable to CBT awareness that eating had been used as a way to avoid
methods to reduce dietary restraint. This same DBT treat- negative emotions, and acceptance and mindfulness were
ment protocol was later used by the authors of two other used to tolerate feelings and sensations related to diet like
studies (Klein et al., 2012; Safer et al., 2010), with an hunger and cravings. Lillis et al., (2011) also employed an
adaptation by Masson et al., (2013) into a self-help manual. ACT workshop intervention modified to address concerns
For the joint treatment of BED or BN and Borderline around weight loss and maintenance with an emphasis on
Personality Disorder (BPD), Chen et al., (2008) modified acceptance, mindfulness, and cognitive defusion. The
the standard DBT for BPD to add an emphasis treating information, exercises, and group processing activities
eating-related problems with weekly skills groups, indi- targeted thoughts and feelings surrounding eating, body

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image, and self-stigma, values regarding health and rela- used a shortened, 6-item version of the scale assessing the
tionships, and barriers and commitments to valued living. central symptoms of binge eating, which they reported had
Another ACT study (Weineland et al., 2012b) covered good internal reliability at baseline in their sample
similar content (values, acceptance, mindfulness, defusion, (alpha = 0.74).
and committed action) for a post-bariatric surgery popu-
lation delivered through a combination of in-person, Other measures of binge eating
online, telephone, and recorded media information and
exercises. This intervention targeted emotional eating, Three studies assessed binge eating with self-reported
healthy behaviors, thoughts about shape and self-image, number of weekly binges by diary card (Klein et al., 2012),
behavioral analysis, and barriers to valued change. The phone, or in person (Kristeller & Hallett, 1999; Lillis et al.,
most recent ACT study (Katterman et al., 2014a) was 2011). Less commonly used measures of binge eating
unique in combining the core ACT exercises and topics included the Eating Disorders Inventory-3 symptom
with behavioral lifestyle changes (e.g., monitoring food, checklist (EDI-3 SC; Garner, 2004), the Multifactorial
calories, and physical activity, and stress management) to Assessment of Eating Disorders Scale (MAEDS; Anderson
control weight in group sessions with young adult women. & Williamson, 1999), and the Disordered Eating after
Despite the varied methods of delivery, duration, and Bariatric Surgery (DEBS) questionnaire (Weineland et al.,
patient population, the 4 ACT intervention studies all 2012a). One study assessed the percent of participants who
included coverage of the core ACT processes as applied to binged using the EDI-3 SC and the binge eating subscale of
specific targets of interest including weight loss, emotional the MAEDS (Woolhouse et al., 2012). Weineland et al.,
eating, self-stigma, and quality of life. (2012a, b) used the DEBS, formerly called the Subjective
Binge Eating Questionnaire for Bariatric Surgery Patients,
Outcome measures which is a self-report measure they developed for assessing
binge eating behavior in a post-bariatric surgery population
Eating disorder examination that they report had reasonable psychometric properties
(Weineland et al., 2012a).
Ten studies used the Eating Disorder Examination (EDE),
the gold standard for assessing binge episodes, called Effect sizes and meta-analysis
objective bulimic episodes (OBEs), and for diagnosing
BED (Cooper & Fairburn, 1987). The EDE assesses The 19 studies yielded 52 effect sizes for the mindfulness-
number of binge episodes and number of days in which based interventions. One study (Baer et al., 2005b) did not
binge episodes occur. Two items (loss of control and guilt provide sufficient information to calculate an effect size;
after eating) from the EDE-Q were used by Leahey et al., the authors responded to a request for information but no
(2008) to assess binge eating in a post-bariatric surgery longer had access to the data. Four studies only provided
sample. The other 9 studies using the EDE assessed for sufficient information to calculate a single effect size. Two
BED. Most used the DSM-IV research criteria for BED effect sizes were calculated for 8 of the studies, and 3 effect
(American Psychiatric Association, 2000) included in the sizes could be extracted from 2 studies. The remaining 4
EDE version 12 (Fairburn & Cooper, 1993) and later in studies yielded 4–8 separate effect size calculations.
version 16 of the EDE (Fairburn et al., 2008). Two of the Within-group effect sizes comprised 36 of the 52 effect
studies also assessed BED with DSM-5 diagnostic criteria, sizes, whereas only 16 were from between-group effects
which reduces the frequency of binge days to only once per calculations. Using 0.3, 0.5, and 0.8 to interpret small,
week over the past 3 months and retains all other DSM-IV medium, and large effects (Cohen, 1992), 34 of the 52
BED criteria (American Psychiatric Association, 2013). calculated effect sizes were large, 5 were medium, and 4
were small. Eight effect sizes from the same study (Kat-
Binge eating scale terman et al., 2014a) were either of negligible magnitude (2
effect sizes: Hedge’s g = -0.15) or positive in magnitude,
Eight studies used the Binge Eating Scale (BES), a 16 item suggesting an increase in binge eating in response to
self-report questionnaire assessing the severity of binge the intervention (6 effect sizes: Hedge’s g = 0.27,
eating behavior in individuals with obesity (Gormally Hedge’s g = 0.33). Another study (Lillis et al., 2011) had
et al., 1982). The BES produces a severity score with nearly a small effect (Hedge’s g = -0.29)
ranges of 0–17 indicating no binge eating (none), 18–26 Figure 2 displays effect sizes and forest plot for the 18
demonstrating moderate binge eating severity, and greater studies comprising the within-group meta-analysis.
than 26 indicating severe binge eating. Tapper et al., (2009) Results from the within-group random effects meta-analysis

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Authors (Year) Mean ES 95% CI

Katterman et al., (2014a) 0.27 -0.05, 0.60

Kristeller et al., (2013) -1.74 -2.04, -1.45
Masson et al., (2013) -0.91 -1.39, -0.42
Woolhouse et al., (2012) -1.50 -2.03, -0.98
Klein et al., (2012) -1.98 -3.39, -0.56
Weineland et al., (2012b) -0.74 -1.39, -0.10
Courbasson et al., (2011) -2.96 -3.61, -2.31
Lillis et al., (2011) -0.29 -0.73, 0.14
Dalen et al. (2010) -1.68 -2.59, -0.76
Safer et al., (2010) -2.59 -3.07, -2.10
Tapper et al. (2009) -0.49 -0.96, -0.03
Chen et al., (2008) -0.97 -1.88, -0.06
Leahey et al., (2008) -1.43 -2.46, -0.41
Smith et al., (2008) -0.42 -0.88, 0.04
Smith et al., (2006) -0.47 -1.02, 0.09
Telch et al., (2001) -1.48 -2.03, -0.94
Telch et al., (2000) -1.53 -2.11, -0.97
Kristeller & Hallett (1999) -1.87 -2.58, -1.16

-4 -3 -2 -1 0 1
Hedge's g

Fig. 2 Within-group effect sizes and forest plot. Squares are mean study effect size; error bars are 95 % confidence intervals; dashed line is
mean effect size from the random effects meta-analysis (mean Hedge’s g = -1.12, 95 % CI -1.67, -0.80, k = 18)

supported large effects of mindfulness-based interventions their sample, and the majority of participants in these
in reducing binge eating (mean Hedge’s g = -1.12, 95 % CI studies met criteria for BED. Two studies had inclusion
-1.67, -0.80, k = 18). Figure 3 presents effect sizes and criteria requiring participants have BED comorbid with
forest plot for the 7 studies involved in the between-group another disorder such as BPD (Chen et al., 2008) or SUD
meta-analysis. Results from this between-group random (Courbasson et al., 2011). Three studies required that the
effects meta-analysis supported medium-large effects of participants be interested in or attempting to lose weight,
mindfulness-based treatments to reduce binge eating (mean and another 2 studies had a post-bariatric surgery sample.
Hedge’s g = -0.70, 95 % CI -1.16, -0.24, k = 7). There Binge eating measures from the EDE, BES, MAEDS, and
was high statistical heterogeneity among these studies weekly self-reports of binges were used to calculate effect
(within-group I2 = 93 %; between-group I2 = 90 %). The sizes for the studies, with the majority of studies demon-
heterogeneity limits the overall conclusions that can be strating large effect sizes and the results of the within-
drawn from the current research, and therefore results of group and between-group random effects meta-analyses
this meta-analysis should be interpreted with caution. supporting large and medium-large mean effect sizes.
Overall, mindfulness-based interventions were associated
with effects on binge eating of large or medium-large
Discussion magnitude and can be considered effective. The research
and popular psychology literature on these interventions is
Overall findings relatively small but growing, which underscores the
importance of conducting high quality studies to examine
To our knowledge, this is the first systematic review and efficacy. Results from this systematic review and meta-
meta-analysis to examine the effects of mindfulness-based analyses offer several considerations, limitations, and
psychological interventions for binge eating. Nineteen future directions for continued work in the field of mind-
unique studies were identified, published between 1999 and fulness-based treatments for binge eating.
2014. Although many of the early studies were UCSs, some There are several issues to consider with respect to the
more recent studies were RCTs. MBSR or MBCT adapted effects included in these meta-analyses. Relatively larger
for eating were the most common approaches, followed by effects were found in the within-group effect sizes and
DBT and ACT. Eleven of the 19 studies assessed BED in meta-analysis compared to effects from the between-group

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Authors (Year) Mean ES 95% CI

Katterman et al., (2014a) 0.27 -0.05, 0.60

Kristeller et al., (2013) -1.11 -1.38, -0.84
Masson et al., (2013) -0.77 -1.29, -0.26
Weineland et al., (2012b) -0.85 -1.49, -0.21
Lillis et al., (2011) -0.48 -0.91, -0.05
Tapper et al. (2009) -0.86 -1.33, -0.38
Telch et al., (2001) -1.20 -1.74, -0.66

-2 -1.5 -1 -0.5 0 0.5 1

Hedge's g
Fig. 3 Between-group effect sizes and forest plot. Squares are mean study effect size; error bars are 95 % confidence intervals; dashed line is
mean effect size from the random effects meta-analysis (mean Hedge’s g = -0.70, 95 % CI -1.16, -0.24, k = 7)

effect sizes and meta-analysis, which is consistent with the et al., ((2006, 2008)) studies, the courses were made up of
differential within- and between-group effects found in 26 and 45 participants, which is larger than traditional
CBT for binge eating (Vocks et al., 2010) and in meta- psychotherapy groups. It is possible that the treatment
analyses on the efficacy of ACT and DBT for other con- effectiveness was limited by the size of the groups. The
ditions (Öst, 2008). The effects from a meta-analysis of same treatment protocol that yielded small effects for
CBT on binge eating were of similar magnitude with large Smith et al., (2006, 2008) was used in a smaller group by
effects for within-group effects and medium-large effects Dalen et al., (2010) with large effects. Thus the same
for between-group effect sizes (Vocks et al., 2010). The treatment protocol may have worked better at reducing
attenuated effect of between-group effect sizes may speak binge eating in a small group treatment setting. However,
to the fluctuating nature of binge eating symptoms over more evidence is needed to compare the effectiveness of
time or unintentional effects of binge eating assessment on course-style intervention delivery compared to traditional
behavior, possibly resulting in symptom reduction in the psychotherapy groups. Finally, the specific focus of treat-
control groups at follow up time points (Kristeller et al., ment in these studies was not binge eating but instead the
2013; Telch et al., 2001). The effect sizes in the present interventions targeted weight-related stigma and distress
meta-analyses were relatively larger than effect sizes found (Lillis et al., 2011), eating (Smith et al., 2006, 2008),
for mindfulness-based interventions generally (Khoury emotional eating (Tapper et al., 2009), or weight control
et al., 2013; Öst, 2008), which may indicate that mindful- (Katterman et al., 2014a). Although dietary restraint was
ness-based interventions are particularly well-suited to not formally assessed, treatment emphasis on weight con-
treating binge eating. trol, self-monitoring, and energy intake in Katterman et al.,
(2014a, b) study may have limited the effects on reducing
Studies with small or medium effects binge eating, which is consistent with the CBT model of
binge eating. These studies with smaller effects demon-
Effects of mindfulness-based interventions on reducing strate the need to carefully consider the intervention sam-
binge eating were generally large or medium-large, but ple, method of treatment delivery, and focus of treatment.
there were several characteristics of studies with small
effect sizes that deserve mention. Findings from the studies Limitations and future directions for research
by Lillis et al., (2011), Tapper et al., (2009), Smith et al.,
(2006, 2008), and Katterman et al., (2014a, b) suggest that There were several limitations in the literature. First, the
mindfulness-based interventions for binge eating may quality of evidence was limited by selection bias, not
produce negligible, small, medium, or reverse effects in including covariates in statistical analyses, and high drop-
community-recruited samples without substantial binge out rates from treatment. These weaknesses and others such
eating behavior at baseline. Smith et al., (2006) showed as inconsistent use of intent-to-treat analyses and reporting
that individuals with scores of 0–8 on the BES showed the only selective outcomes at various study time points should
smallest effect sizes, and participants in the mild, moder- be addressed to strengthen the available evidence. Mea-
ate, and severe groups demonstrated large effect sizes, suring effects of interventions is dependent upon the
supporting that smaller effects are expected in samples who quality of the assessment metric so studies not using the
do not have binge eating behavior at baseline. In Smith’s EDE or assessing binge eating with novel or modified

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measures could be limited by the reliability and validity of matching treatment type to binge eating subtype might
the assessment instruments used. Assessment becomes provide clinical utility. Future studies should also begin to
especially difficult when working with a post-bariatric examine the mechanisms of change to determine the active
surgery population as the standard definition of binge eat- ingredients (e.g., emotion regulation, slowed and length-
ing cannot apply due to limits in how much a participant ened periods of eating, awareness of hunger and satiety
can physically eat at one time. Thus, future research con- cues, tolerating distress of hunger, acting in line with val-
cerning in bariatric surgery populations will need to ues) of these interventions on binge eating. Finally, as the
improve and standardize assessment of binge eating in this research literature on mindfulness-based interventions for
population. Another assessment issue arises with the arrival binge eating grows future meta-analyses can be performed
of the DSM-5 (American Psychiatric Association, 2013) to quantitatively determine the relative performance of
and its modified BED criteria. The revised BED diagnostic each mindfulness based intervention (e.g., DBT vs ACT)
criteria may impact future work in this area as individuals and the impact of certain treatment characteristics (e.g.,
with less frequent binge episodes over a shorter time period online vs in-person; workshop vs multiple sessions;
may now receive a BED diagnosis. directly targeting binge eating vs focusing on building
The results from this systematic review and meta-ana- mindfulness skills) on the effectiveness of these treatments.
lysis are also limited by the substantial methodological and
statistical heterogeneity between studies. Studies included
in this review were comprised of different samples with
Conclusion
varying levels of binge eating symptom severity, varied
types of treatment delivery and focus, and diverse assess-
This systematic review and meta-analysis found that
ment instruments. Similarly, two studies included had
mindfulness-based psychological interventions for reduc-
samples with comorbid BED and other diagnoses. These
ing binge eating have large or medium-large effects over-
methodological differences, though they may contribute to
all. Although based on a small number of studies, it also
statistical heterogeneity, are important to recognize as they
appears that the interventions appear to be less effective in
likely represent the true variety of samples, methods, and
individuals without significant reported binge eating at
measures employed with mindfulness-based treatments.
baseline and when delivered in larger workshop or course-
This systematic review and meta-analysis has important
style settings that do not target binge eating directly.
implications for future research as the literature on mind-
Limitations of the literature include the quality of evidence
fulness-based interventions for binge eating grows. More
and the assessment of binge eating. Future research should
RCTs are needed to examine the effectiveness of these
implement RCT designs, determine the long term effects,
treatments compared to no treatment in order to account for
compare the effectiveness of mindfulness-based treatments
fluctuations in binge eating over follow up periods or the
to gold standard CBT interventions, explore moderators of
effects of assessment. Longer follow up periods are needed
treatment, and uncover mechanisms of these interventions.
to examine the long-term effects of mindfulness-based
interventions on binge eating, as most of the reviewed Acknowledgments The authors would like to thank Desmond
studies followed their samples for only 3–6 months. Ide- Leung for his work as an independent reviewer for data extraction.
ally, these follow up periods will include waitlist or other
inactive control conditions to examine if changes in binge Conflicts of interest Kathryn Godfrey, Linda Gallo, and Niloofar
Afari have no conflicts of interest to report.
eating seen over longer periods are part of the natural
course or are due to interventions. Future work should also
Human and Animal Rights and Informed Consent All proce-
perform more detailed comparisons of treatment protocols dures followed were in accordance with ethical standards of the
and theoretical models supporting the use of various responsible committee on human experimentation (institutional and
mindfulness-based treatments for binge eating. Another national) and with the Helsinki Declaration of 1975, as revised in
2000. Informed consent was obtained from all patients for being
critical question that remains unanswered is how effective
included in the study.
mindfulness-based interventions are compared to gold
standard CBT treatments. As some of the studies included
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