The Effect of Mediterranean Diet and Mindfulness Eating on Depression Severity in People With Obesity and Major Depressive Disorder

Inclusion Criteria:

• Age ≥ 18 years

• Presence of clinically diagnosed major depression

• At least moderate depression severity: BDI-II ≥ 20

• obesity: BMI ≥ 30 kg/m2

• Stable co-intervention: no change in the type, dosage or frequency of antidepressantmedication and/or psychotherapy four weeks before and during the study

• Low adherence to the mediterranean diet: MEDAS < 10

• Low adherence to mindful eating: MEI < 5.13

Exclusion Criteria:

• Diseases of the gastrointestinal tract that do not allow adequate implementation ofthe intervention (e.g. irritable bowel syndrome, post-bariatric surgery, colorectalcarcinoma)

• Metabolic diseases with strong impact on intervention (e.g. type 1 diabetesmellitus, chronic kidney disease)

• Severe food allergies and intolerances, that do not allow adequate implementation ofthe intervention

• Diagnosed, current psychological comorbidities (bipolar disorder, eating disorder,personality disorder, psychosis)

• intake of antibiotics in the last three months current substance abuse

• Pregnancy and breatfeeding

• Suicidal ideation

• unable to participate or complete questionnaires

Healthy Volunteers:

samples of 32 healthy volunteers are included for microbiome analysis only (

inclusion criteria:

• age ≥ 18 years

• BMI 20 - 30 kg/m^2

exclusion criteria:

• depression or other psychological comorbidities (bipolar disorder, eating disorder,personality disorder, psychosis)

• high adhernece to mediterranean diet: MEDAS ≥ 10

• high adherence to mindful eating: MEI ≥ 5.13

• Diseases of the gastrointestinal tract or metabilic diseases (e.g. irritable bowelsyndrome, post-bariatric surgery, colorectal carcinoma, type 1 diabetes mellitus)

-- intake of antibiotics in the last three months current substance abuse

• pregnancy or breastfeeding