DISCUSSION
drug abuse, anxiety, ’, Braden, weight reduction, psychiatric, overweight, overweight or obesity, schizophrenia, depression, reductions in emotional eating
OBESE, DISORDERS
Our findings support the main hypothesis of the present study: the ‘mindful eating’ programme, added to TAU, was effective for reducing emotional eating in adults with overweight or obesity in a PC setting, compared to TAU alone. Posttreatment, the effect of the intervention was small, although significant when compared to the control group, as corroborated by the adjusted models and the significant NNT that was calculated. In the follow‐up, the effect presented a medium effect size, even after controlling variables such as sex and baseline levels of anxiety and depression that have been reported to play a role on emotional eating patterns (Braden et al., These results go in line with the ones reported in previous studies regarding the efficacy of mindfulness‐based and, particularly, ‘mindful eating’ programs on changing eating behaviours such as emotional eating. Different systematic reviews have concluded that these interventions have the potential to address problematic eating behaviours (Carrière et al., Although the focus of the present study was the emotional eating pattern, other eating behaviours were assessed and some of them were also improved by the ‘mindful eating’ programme. That was the case of external eating, defined as the tendency towards eating more in the presence of certain external stimuli such as the sight or smell of food (Karlsson et al., According to our results, the ‘mindful eating’ programme achieved notably higher effects in the follow‐up assessment than in the posttreatment evaluation. We hypothesise that these findings could be at least partially justified by the well‐known difficulties for implementing changes in health‐related daily habits in the short‐term (Kelly & Barker, On the other hand, short‐term effects of the ‘mindful eating’ programme were found for the mindfulness facet of ‘Observing’, which were maintained in the follow‐up assessment. ‘Observing’ is defined as the tendency to noticing or attending to internal and external experiences such as sensations, thoughts, or emotions (Baer et al., Despite achieving significant changes in eating patterns, the sample who underwent the ‘mindful eating’ programme did not show a significant change in weight: while it was reduced in the 1‐year follow‐up assessment, this change was not significant compared to the control group, and the same happened with the reduction in waist circumference. It was expected that reductions in emotional eating would lead to reductions in weight (Stojek et al., Nevertheless, evidence regarding the efficacy of ‘mindful eating’ programs or, generally, mindfulness‐based interventions for reducing BMI is unclear; our results go in line with some previous research (Daubenmier et al., Some limitations of this study need to be acknowledged; first, regarding the study sample, the external validity of our findings is limited considering the relatively small sample size, which probably hindered the observation of expected changes such as reductions in the BMI, and the demographic and geographic profile of our sample. Also, patients who presented severe psychiatric disorders (e.g., schizophrenia, acute‐phase depression, drug abuse) were excluded, which could have led to a not completely representative sample of the obese and overweight patients that are treated in Spanish PC centres. Second, many of the measures that we used were self‐reported and the Spanish version of the MES was not previously validated. Regarding the interventions, the participants knew the study arm they were assigned, which may have affected their expectancies, and TAU was clearly less effective than expected, at least in terms of weight reduction. Patients in the intervention group were more exposed to treatment (i.e., ‘mindful eating’ and TAU) than those in the control group (only TAU). Participants presented low baseline levels of different outcomes, which hindered observing effects of the intervention due to potential floor effects, and participants in the ‘mindful eating’ + TAU group showed less favourable scores in emotional eating at baseline, and thus presenting a greater range of possible improvements than the control group. In addition, our study did not register the frequency of mindfulness practice during the intervention or in the follow‐up period; therefore, a hypothesis regarding the impact of home‐based mindfulness practice on the maintenance of improvements could not be tested.In conclusion, the ‘mindful eating’ programme added to TAU seems effective for reducing the emotional eating behaviour, along with improving the external eating, the severity of bulimic behaviours, the frequency of binge episodes and some mindfulness and self‐compassion facets in adults with overweight or obesity in a PC setting. However, the changes observed in the sample's eating patterns were not matched with significant reductions in their weight. To overcome potential methodological shortcomings of the present study, future works should use larger samples and compare the ‘mindful eating’ programme with others which also address emotional eating using different strategies. If the aim is weight reduction of patients with overweight or obesity, these programs should be complemented with other strategies such as dieting and physical activity.