Efficacy of a combined diving and mindfulness program on emotional eating in adults with obesity: randomised controlled trial with standard care

BACKGROUND: Emotional eating is considered as a mediator between depression and obesity. Combining mindfulness and sport activities can improve obesity‐related psychological disorders but inconsistencies in effect and duration have been reported. We aimed to evaluate the effects of a combined mindfulness‐diving Bathysmed® program on emotional eating scores in participants with obesity. METHODS: This unblinded randomized controlled trial was performed in the community setting, Montpellier, France. Adults with a BMI > 30 kg/m2 were randomly assigned (1:1) to a Bathysmed® 2‐month program (intervention group) therapeutic scuba‐diving protocol with mindfulness exercises plus standard care, or stand‐alone standard care including dietary and psychological support (control group). The primary outcome was the mean change in the emotional eating subscale of the Dutch Eating Behaviour Questionnaire (DEBQ‐EE) at 2‐months as intention to treat. FINDINGS: Between July‐August 2022, 63 participants were randomised, with 31 in the intervention group. One participant from each group were excluded. Fifty‐five (87·3%) were female, median age 46 [35.5;54] and BMI 35.46 [33.45;39.48]. There was a statistically significant reduction of DEBQ‐EE at 2 months in the intervention group (‐0·82 (SD 0·81)) versus control group (‐0·27 (SD 0·61) p = 0·004). This effect was maintained at 5 and 8‐month follow up. There was a significant reduction in weight self‐stigma, stress, and quality of life change scores in the intervention group. INTERPRETATION: This combined diving and mindfulness program effectively reduces emotional eating, self‐stigma and quality of life scores in participants with obesity, with sustained benefits. Health policies should integrate physical activity and psychological therapies for obesity management. TRIAL REGISTRATION: Clinicaltrials NCT06882200.