Depressive Symptoms and Emotional Eating: Mediated by Mindfulness?

Emotional eating is highly prevalent among adult populations and has been related to eating disorders (Heatherton and Baumeister 1991; Macht 2008; Stice et al. 2002) and weight gain over time (Hübner et al. 2016; Koenders and Van Strien 2011). There is robust cross-sectional evidence that depressive symptoms are positively linked to emotional eating (Konttinen et al. 2010a, b; Ouwens et al. 2009; Pidgeon et al. 2013; Stice 2002; Van Strien et al. 2016a, b), and recent longitudinal research suggests that depressive symptoms predict future emotional eating (Kidwell et al. 2017). Mindfulness may be a prominent mechanism explaining the link between depressive symptoms and emotional eating.

Mindfulness has often been described as the non-judgemental awareness of current experience and acceptance toward moments of experience (Bishop et al. 2004). Mindfulness as defined by Baer et al. consists of five subcomponents: “acting with awareness,” “non-reactivity,” “non-judgment,” “describing,” and “observing” (Baer et al. 2006), and is theorized to decrease impulsive eating, rumination, and increase healthy, internal coping mechanisms (Alberts et al. 2012; Kristeller and Wolever 2011; O'Reilly et al. 2014; Tak et al. 2015; Teasdale et al. 1995). It is therefore considered a promising innovative emotion regulation tool to decrease emotional eating (Daubenmier et al. 2011; Leahey et al. 2008; Kristeller and Wolever 2011; Mantzios and Wilson 2015; Ouwens et al. 2015). Surprisingly, less is known about the general association between mindfulness and emotional eating. To date, one survey study in an obese population found that more mindfulness was associated with less emotional eating (Ouwens et al. 2015). Another survey study in a non-clinical sample found that mindfulness moderated the association between depressive symptoms and emotional eating, with more mindfulness linked to less emotional eating only among individuals with low depressive symptoms (Pidgeon et al. 2013). However, this study used a unidimensional opeationalization of mindfulness (i.e., “attentional focus”). High attentional focus might be ineffective among individuals with high depressive symptoms. Two recent survey studies found evidence for the idea that “acting with awareness” was the most important mindfulness component being associated with emotional eating (Tak et al. 2015; Levin et al. 2014). Tak et al. (2015) found that acting with awareness was most strongly associated with emotional eating in people with diabetes. The same was found by Levin et al. (2014) among individuals who had undergone bariatric surgery for morbid obesity. Acting with awareness constitutes an awareness of emotions and present events, which may be a key factor in counteracting food-intake, particularly in response to depressive symptoms.

Notably, in most studies examining the association between depressive symptoms and mindfulness, a lack of mindfulness is considered as the antecedent of later depressive symptoms (Raphiphatthana et al. 2016). However, some recent findings on the temporal order of this association suggest that depressive symptoms also precede the development of mindfulness (Gotink et al. 2016; Raphiphatthana et al. 2016). According to well-supported cognitive models of depression, depressive symptoms may induce all sorts of negative cognitive biases (Beck 1976), which increase the chance of negative interpretations and less mindful thoughts or actions (i.e., acting without awareness). These decreasing mindful thoughts or actions may particularly be harmful in our current obesogenic environment, explaining the link from depressive symptoms to emotional eating through decreasing acts of mindfulness.

The main aim of the current study is to examine whether specific mindfulness components mediate the association between depressive symptoms and emotional eating. We hypothesize that depressive symptoms are positively related to emotional eating and that this association is mediated by the mindfulness subcomponents, particularly by acting with awareness.

The main aim of the current study was to examine whether the association between depressive symptoms and emotional eating would be mediated by any of the mindfulness subcomponents. Previous studies have already shown negative associations between mindfulness and particularly the subcomponent “acting with awareness” and emotional eating in specific subpopulations, including obese people and people with diabetes (Tak et al. 2015; Ouwens et al. 2015; Levin et al. 2014). Our study adds to these studies in that the negative association between acting with awareness and emotional eating was replicated in a general adult population, suggesting that this association does not only exist among specific subpopulations but also among more general adult populations. Moreover, we found that of the five mindfulness subcomponents, only the subcomponent “acting with awareness” mediated the association between depressive symptoms and emotional eating. This indicates the potential importance of this construct, explaining why depressive symptoms would be associated with emotional eating. Consistent with previous studies, we found that females and participants with higher BMIs showed higher emotional eating (Geliebter and Aversa 2003; Larsen et al. 2006). Older participants were less likely to report emotional eating, a finding that has been reported before (Kessler et al. 2013). Older participants were also more likely to act with awareness, which in turn was related to less emotional eating. Further examining possible mediation of acting with awareness explaining the inverse relation between age and emotional eating was beyond the scope of this manuscript, but might be an interesting avenue for future research. Future prospective research should examine whether, why, and for whom acting with awareness may mediate the prospective link from depressive symptoms to emotional eating.

The mediating role of acting with awareness may be explained through the escape theory, which states that emotional eating occurs as a means to escape ones negative thoughts and feelings by narrowing ones focus to concrete acts and not to higher-abstract thought (Haedt-Matt and Keel 2011; Heatherton and Baumeister 1991). One previous study showed that avoidance of internal events mediated the relationship between negative emotions and emotional eating (Litwin et al. 2016). This same avoidance phenomenon may also explain our mediating findings for acting with awareness.

However, it is also possible that people act (i.e., eat) with less awareness because they are absorbed by depression induced cognitive biases and related ruminative thoughts (Beck 1976; Williams 2008). Notably, a meta-analysis of mindfulness intervention studies suggests that people may be trained in being more mindful (and act with more awareness) and that this might decrease depression induced ruminative thoughts (Gu et al. 2015). Moreover, particularly acting with awareness, through reduced automaticity, is related to less impulsivity (Brown and Ryan 2003; Levesque and Brown 2007), including impulsivity in maladaptive eating behaviors (Tak et al. 2015; Kristeller and Wolever 2011). Future work may examine whether and why a decrease in ruminative thoughts might facilitate more acting (i.e., eating) with awareness and, thus, decreased automaticity in eating and emotional eating.

Finally, the mediating role of acting with awareness in the depressive symptoms-emotional eating link may also be explained through difficulty identifying feelings, a subcomponent of alexithymia (Ciarrochi et al. 2011). Difficulty identifying feelings has been negatively linked to acting with awareness (Baer et al. 2006; Ciarrochi et al. 2011; Dekeyser et al. 2008) and positively linked to emotional eating (Carano et al. 2006; Hund and Espelage 2006; Larsen et al. 2006; Mazzeo and Espelage 2002; Moon and Berenbaum 2009; Pinaquy et al. 2003) and depressive symptoms (Ouwens et al. 2009). Similar to acting with awareness, difficulty identifying feelings has also been suggested to be a mediator of the association between depressive symptoms and emotional eating (Ouwens et al. 2009). Future longitudinal research should incorporate both mindfulness and alexithymia (e.g., difficulty identifying feelings) components to see which ones are most important in explaining the link between depressive symptoms and emotional eating.

Our findings for “acting without awareness” being the sole mindfulness component mediating the link between depressive symptoms and emotional eating is in line with previous intervention research. To date, a systematic review has shown that mindfulness-based interventions focusing on eating behaviors (i.e., eating with awareness) are more effective at achieving weight loss than general mindfulness interventions (Katterman et al. 2014). Another review underwrites this: programs that include or focus on eating-specific tasks are more effective in reducing emotional eating than interventions that do not include these practices (Kristeller and Wolever 2011). It is possible that these effective eating-specific tasks are similar to the subcomponent acting with awareness, in the sense that participants learn to “eat with awareness.” Future research should examine mechanisms explaining this association between acting with awareness and emotional eating, yielding further guidance for intervention research on whether and how acting with awareness can best be stimulated. We would also like to note the positive correlation between observing and both emotional eating and depression, which is in line with previous results in non-meditating participants (Baer et al. 2006; Levin et al. 2014).