Emotional eating interventions for adults living with overweight and obesity: A systematic review and meta-analysis of behaviour change techniques

Background
Emotional eating (EE) is a barrier to the long-term success of weight loss interventions. Psychological interventions targeting EE have been shown to reduce EE scores and weight (kg), though the mechanisms remain unclear. This review and meta-analysis aimed to identify the specific behaviour change techniques (BCTs) associated with improved outcomes.

Methods
This is a review update and extension, with new studies extracted from searches of CINAHL, PsycINFO, MEDLINE and EMBASE 1 January 2022 to 31 April 2023. EE interventions for adults with BMI > 25 kg/m2 were considered for inclusion. Paper screening, extraction, BCT-coding and risk of bias were completed using the Template for Intervention Description and Replication (TIDieR) checklist, Behaviour Change Taxonomy v1 (BCTTv1) and Risk of Bias2 (RoB2)/Risk of Bias In Non-randomised Studies (ROBINS-I) tool. Narrative syntheses and random effects multi-level meta-analyses were conducted.

Results
In total, 6729 participants were included across 47 studies (13 identified in the update). Forty-two studies contributed to the pooled estimate for the impact of interventions on EE (SMD = −0.99 [95% CI: −0.73 to −1.25], p < 0.001). Thirty-two studies contributed to the pooled estimate for the impact of interventions on weight (−4.09 kg [95% CI: −2.76 to −5.43 kg], p < 0.001). Five BCTs related to identity, values and self-regulation were associated with notable improvements to both weight and EE (‘incompatible beliefs’, ‘goal setting outcome’. ‘review outcome goals’, ‘feedback on behaviour’ and ‘pros/cons’).

Conclusion
Implementation and evaluation of the highlighted BCTs are required. Weight management services should consider screening patients for EE to tailor interventions to individual needs.