The role of emotional eating in the links between racial discrimination and physical and mental health

Weight stigma is uniquely tied to maladaptive eating across different racial, ethnic, and gender groups

Weight stigma, racism, and sexism (social devaluation due to body weight, race or ethnicity, and sex or gender), have been linked to increased maladaptive eating behaviors; however, no research has investigated the unique associations between different forms of stigma and eating concurrently. We analyzed within-group (by race/ethnicity and sex) effects of different forms of stigma on maladaptive eating behaviors to test whether there is some unique relationship between weight stigma and maladaptive eating across identities. Additionally, we explored differences by racial/ethnic group and sex, as well as BMI category, in levels of reported weight stigma, racism, sexism, and maladaptive eating. Participants (N = 1051) were recruited so that there were approximately even numbers of participants identifying as Black (33.3%), Hispanic or Latino (32.8%), and White (33.9%). Overall, participants reported similar amounts of weight stigma by race/ethnicity and sex, but different levels of racism and sexism. Weight stigma, but not racism or sexism consistently predicted binge eating and eating to cope across groups, controlling for education, income, BMI, and age. Restricted dieting, however, was only predicted by weight stigma for Hispanic/Latino and Black men. These findings suggest that weight stigma is a unique predictor of maladaptive eating, even when considering the effects of racism and sexism. This study provides evidence of a more focused model of weight stigma and eating outcomes, rather than a more general model of the effect of stigma on eating outcomes due to overall stress. Future research should investigate when and why weight stigma drives restricted dieting, since this relationship seems strongest in men, going against many common inclinations about weight stigma.

Examining Indirect and Direct Effects of Risk and Resilience on the Relation Between Perceived Discrimination and Eating Disorder Symptoms in Ethnic Minority American Women

Direct relationships between perceived discrimination and eating pathology in ethnic minorities are well-documented. However, theoretical work examining unique risk and resilience factors that strengthen or weaken the relation between these constructs in ethnic minorities is lacking. The current study aims to address this gap by incorporating stress-process and tripartite frameworks to examine social and personal resources as they relate to perceived discrimination and eating pathology. In a sample of Black, Asian, and Latine women (N = 296, M age = 30.82), social support did not mediate the relationship between perceived discrimination and eating pathology. A significant interaction effect was observed for thin-ideal internalization strengthening the relation between perceived discrimination and negative emotional eating. Thin-ideal internalization moderated the relation between perceived discrimination and negative emotional eating in Latine Women, and disordered eating in Black Women. Overall, findings suggest ethnic minority Women have both personal and social resources that may influence the strength of effect on the relation between perceived discrimination on eating pathology.

Intersections of Racial/Ethnic and Religious Identities on Bodily Well-Being for Black College-Attending Emerging Adults

Black undergraduates face threats to healthy weight and body image (i.e., bodily well-being). Having a strong racial/ethnic identity can promote health during emerging adulthood. However, less is known about the intersections of racial/ethnic and religious identities on the bodily well-being of Black college-attending emerging adults, despite evidence to indicate that aspects of religiosity are also associated with health. We use quantitative data from 767 Black college-attending emerging adults in the Multi-University Study of Identity and Culture to examine the independent contributions of racial/ethnic and religious identity for bodily health, and test a potential interaction between racial/ethnic and religious identity on bodily health outcomes. Results from a multivariate linear regression model indicate that Black college-attending emerging adults with both high religious identity and high racial/ethnic identity exploration had higher body mass index and less positive body image. Findings suggest ways to strengthen the development of culturally appropriate public health prevention and intervention efforts that target body image and weight for Black college-attending emerging adults. IMPACT STATEMENT: Black college-attending emerging adults face challenges to their health, particularly threats to healthy weight and body image during this period of psychosocial transitions. The developmental process of navigating racial/ethnic and religious identities during this time raises challenges and opportunities for health promotion for this population. Yet, research that explores the role of these identities remains scarce. We found that Black college-attending emerging adults had higher body mass index and more negative body image when they reported more racial/ethnic identity exploration coupled with higher religious identities. Results shed light on the complex ways that navigating both racial/ethnic and religious identities may put some Black college-attending emerging adults at greater health risk. Health education and promotion practice focused on improving Black emerging adult health in college contexts should ensure that behavioral interventions are appropriately nuanced and situated in these populations' developmental and cultural considerations.

Sexual, gendered, and internalized racism's associations with disordered eating among sexual minority Asian American men: Emotional eating as mediator

Research related to disordered eating among sexual minority Asian American men is scarce. Thus, the present study utilized an intersectional framework to examine how three different forms of racism (i.e. sexual racism, gendered racism, and internalized racism) are associated with disordered eating among sexual minority Asian American men, as well as the mediating role of emotional eating. A cross-sectional survey containing the study's measures of interest were administered to participants. The final sample consisted of 180 sexual minority Asian American men. Both sexual racism and internalized racism were positively associated with disordered eating whereas gendered racism was not associated with disordered eating Emotional eating mediated the association between internalized racism and disordered eating, though it did not mediate the association between sexual racism and disordered eating. Researchers and practitioners are encouraged to utilize an intersectional framework that takes into account multiple forms of racism, especially sexual racism and internalized racism, when considering this underrepresented population's disordered eating. Results also demonstrate the importance of addressing racism in eating disorder prevention efforts among sexual minority Asian American men.

"Now I just need something sweet": Racism, emotional eating, and health among African Americans

BACKGROUND

The Environmental Affordances Model theorizes that systemic racism disproportionately exposes African Americans in the United States to chronic everyday stressors (e.g., individual racism) while simultaneously shaping the availability of coping resources (e.g., fast food outlets) and engagement in self-regulatory strategies (e.g., emotional eating). Greater engagement in self-regulatory strategies is theorized to preserve mental health while contributing to medical morbidities and mortality.

OBJECTIVE

However, few studies have tested the Environmental Affordances Model, limiting our understanding of how the proposed pathways operate in the lives of African Americans.

METHODS

In the present study, the associations between systemic racism (institutional racism, cultural racism, neighborhood disadvantage), chronic everyday stressors (exposure to individual racism), emotional eating, and mental (anxiety symptomatology) and physical (self-rated overall physical health) health are assessed in a sample of 751 African Americans aged 18 to 88.

RESULTS

The path analysis reveals that institutional and cultural racism are both positively associated with individual racism. Neighborhood disadvantage is inversely associated with individual racism. Individual racism is significantly associated with greater anxiety symptomatology but is unrelated to self-rated overall physical health. Institutional and cultural racism are associated with emotional eating although individual racism and neighborhood disadvantage are not. Moreover, engagement in emotional eating exacerbates, rather than mitigates, the impacts of individual racism on anxiety symptomatology.

CONCLUSIONS

We conclude that institutional and cultural racism contribute to individual racism experiences and emotional eating whereas emotional eating exacerbates associations among individual racism and anxiety symptomatology.

Influences of Child Temperament and Household Chaos on Preschoolers' Emotional Eating

Background: Emotional eating has been linked to child temperament and family environment factors, such as household chaos. However, few studies have examined how child and home characteristics independently and together influence children's overeating and undereating in response to negative emotions. Objective: The current study examined associations among child temperament, household chaos, and emotional eating in children 18-24 months of age, and interaction effects were also tested. Methods: The study included an analysis sample of 371 families participating in the larger STRONG Kids2 longitudinal birth cohort study (N = 468). The Early Childhood Behavior Questionnaire was used to assess child temperament at 18 months, and the Confusion, Hubbub, and Order Scale was used to assess disorganization in the household at 24 months. Child emotional eating at 24 months was assessed using parental reports of the Child Eating Behavior Questionnaire. Results: Negative affectivity and household chaos were independently associated with child emotional overeating. Negative affectivity, effortful control, and household chaos were significantly associated with emotional undereating. No significant interactions were found. Conclusions: Child temperament and household environment independently influence emotional eating in young children, highlighting the need to consider these factors in early prevention. Longitudinal studies are warranted to determine mechanisms that may be involved in these relations.

Racial/Ethnic Discrimination and Food Consumption: Examination in Diverse Samples

Background

Racial/ethnic discrimination has been linked to poor health outcomes. Effects of discrimination on health behaviors, including patterns of food consumption, may contribute to health outcomes.

Purpose

We examined relations of discrimination to consumption of healthy and unhealthy foods in two diverse samples. Structural equation modeling was used to examine variations in associations of discrimination to consumption by the timing and type of discrimination, for healthy vs. unhealthy food, and by sample.

Methods

Study 1 included a racially and ethnically diverse sample of adults from New York City (NYC: N = 157); Study 2 included a sample of American Indian and Alaska Native (AI/AN) adults from the Denver metro area (N = 303), many of whom also identified with other racial/ethnic groups. Participants completed self-report measures of racial/ethnic discrimination, food consumption, life stressors, and sociodemographic variables.

Results

Structural equation models indicated discrimination was associated with food consumption. Tests of model invariance indicated that the model of discrimination to food consumption can be applied to both samples. Discrimination within the past-week was associated with more frequent consumption of both unhealthy and healthy foods, whereas lifetime discrimination was associated with more frequent consumption only of unhealthy foods.

Conclusions

The data were limited to self-report measures and only the frequency of consumption was assessed. The findings suggest discrimination may contribute to health disparities through effects on food consumption. Differential effects for past-week and lifetime discrimination suggest that multiple mechanisms may be involved.

Social Determinants of Health and Depression among African American Adults: A Scoping Review of Current Research

Depression in the United States (US) is increasing across all races and ethnicities and is attributed to multiple social determinants of health (SDOH). For members of historically marginalized races and ethnicities, depression is often underreported and undertreated, and can present as more severe. Limited research explores multiple SDOH and depression among African American adults in the US. Guided by Healthy People (HP) 2030, and using cross-disciplinary mental health terminology, we conducted a comprehensive search to capture studies specific to African American adults in the US published after 2016. We applied known scoping review methodology and followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. From 12,315 initial results, 60 studies were included in our final sample. Most studies explored the HP 2030 Social and Community Context domain, with a heavy focus on discrimination and social support; no studies examined Health Care Access and Quality. Researchers typically utilized cross-sectional, secondary datasets; no qualitative studies were included. We recommend research that comprehensively examines mental health risk and protective factors over the life course within, not just between, populations to inform tailored health promotion and public policy interventions for improving SDOH and reducing racial and ethnic health disparities.

Coping styles moderate the relationship between perceived discrimination and eating behaviors during the transition to college

The transition to college is a critical developmental window during which eating behaviors are susceptible to dysregulation. Changes in exposure to discrimination contribute to alterations in eating behaviors, which may be exacerbated or attenuated by coping styles. The present longitudinal study examines whether increases in perceived discrimination predict increases in overeating and decreases in eating well during the transition to college. We expect that adaptive coping styles will buffer against, while maladaptive coping styles will exacerbate, the effects of increases in perceived discrimination on increases in overeating and decreases in eating well. First year students (n = 804) were assessed at two time points: the spring before freshman year (Time 1) and one year later during the spring semester of freshman year (Time 2). Two distinct coping styles emerged from a factor analysis: adaptive (active coping, planning, emotional support, positive reframing, acceptance, instrumental support) and maladaptive coping (denial, venting, self-blame, self-distraction). Increases in perceived discrimination, lower adaptive coping, and higher maladaptive coping had main effects for predicting more overeating at Time 2. Among students who reported increases in perceived discrimination, higher use of adaptive coping was associated with less overeating at Time 2 while higher use of maladaptive coping was associated with more overeating. While adaptive and maladaptive coping styles had main effects on eating well, change in perceived discrimination did not. Neither adaptive nor maladaptive coping styles interacted with change in perceived discrimination to predict eating well. Findings inform a gap in the literature about the relationship between discrimination and eating behaviors from a developmental perspective by demonstrating that adaptive and maladaptive coping styles influence the effects of changes in perceived discrimination on overeating during the college transition.

Stress-Induced Eating Among Racial/Ethnic Groups in the United States: a Systematic Review

OBJECTIVE

Racial/ethnic disparities in obesity may be due, in part, to minority groups consuming more energy-rich diets in response to greater stress exposure. The present study systematically reviewed the literature describing the effects of stress on food consumption among various racial/ethnic groups in the US.

METHODS

PubMed and PsycINFO databases were searched for studies reporting associations between stress and food consumption by different racial/ethnic groups, conducted between January 1, 1999 to November 25, 2019. The search included terms related to food consumption, stress, and race/ethnicity. After screening 3660 records, 30 studies were included for review.

RESULTS

The selected studies assessed diverse stressors and eating constructs; African-American and Hispanic/Latinx were the most commonly studied minority groups. Studies generally supported that diverse forms of stress exposure are associated with reduced healthy eating patterns and increased obesogenic eating patterns across racial/ethnic groups. However, studies that directly compared stress-eating associations among multiple racial/ethnic groups showed mixed results.

CONCLUSION

Members of diverse racial/ethnic groups are susceptible to stress-induced unhealthy eating patterns, though evidence is insufficient to conclude whether the degree of susceptibility differs among groups. Additional studies utilizing observational measures of food intake and culturally sensitive measures of stress are needed to identify the most influential stressors on dietary behaviors, to assess whether some stressors are more salient for given racial/ethnic groups, and to examine the extent to which stress-induced eating contributes to racial/ethnic disparities in obesity and obesity-related diseases.

Evaluating hypothesized explanations for the Black-white depression paradox: A critical review of the extant evidence

The Black-white Depression paradox, the lower prevalence of major depression among non-Hispanic Black (relative to non-Hispanic white) individuals despite their greater exposure to major life stressors, is a phenomenon that remains unexplained. Despite a decade plus of research, there is little clarity as to whether the paradoxical observations are an invalid finding, spuriously produced by selection bias, information bias, or confounding, or are a valid finding, representative of a true racial patterning of depression in the population. Though both artefactual and etiologic mechanisms have been tested, a lack of synthesis of the extant evidence has contributed towards an unclear picture of the validity of the paradox and produced challenges for researchers in determining which proposed mechanisms show promise, which have been debunked, and which require further study. The objective of this critical review is to assess the state of the literature regarding explanations for the Black-white depression paradox by examining some of the more prominent hypothesized explanatory mechanisms that have been proposed and assessing the state of the evidence in support of them. Included mechanisms were selected for their perceived dominance in the literature and the existence of at least one, direct empirical test using DSM major depression as the outcome. This review highlights the very limited evidence in support of any of the extant putative mechanisms, suggesting that investigators should redirect efforts towards identifying novel mechanisms, and/or empirically testing those which show promise but to date have been relatively understudied. We conclude with a discussion of the broader implications of the evidence for well-accepted social theories and raise questions regarding the use of DSM major depression to assess mental health burden in Black communities.

A Qualitative Study of Stress and Coping to Inform the LEADS Health Promotion Trial for African American Adolescents with Overweight and Obesity

The purpose of this study was to conduct in-depth individual interviews with 30 African American adolescents with overweight and obesity and their families (caregiver/adolescent dyads) to gain a better understanding of how to integrate stress and coping essential elements into an existing family-based health promotion program for weight loss. Interview data from 30 African American adolescents with overweight and obesity (Mage = 15.30 ± 2.18; MBMI%-ile = 96.7 ± 3.90) were transcribed and coded for themes using inductive and deductive approaches by two independent coders. Inter-rater reliability was acceptable (r = 0.70–0.80) and discrepancies were resolved to 100% agreement. The themes were guided by the Relapse Prevention Model, which focuses on assessing barriers of overall coping capacity in high stress situations that may undermine health behavior change (physical activity, diet, weight loss). Prominent themes included feeling stressed primarily in response to relationship conflicts within the family and among peers, school responsibilities, and negative emotions (anxiety, depression, anger). A mix of themes emerged related to coping strategies ranging from cognitive reframing and distraction to avoidant coping. Recommendations for future programs include addressing sources of stress and providing supportive resources, as well as embracing broader systems such as neighborhoods and communities. Implications for future intervention studies are discussed.

Race, Lifetime SES, and Allostatic Load among Older Adults

BACKGROUND

Prior research demonstrates that Black Americans receive fewer health benefits at high levels of SES relative to Whites. Yet, few studies have considered the role of lifetime SES (i.e. changes in SES from childhood to adulthood) in shaping these patterns among older adults. This study investigates the extent to which racial disparities in allostatic load (AL), an indicator of accelerated physiological aging, vary across levels of lifetime SES among Black and White adults aged 50+.

METHODS

With data from the Nashville Stress and Health Study, modified Poisson regression models were used to assess racial differences in the odds of high AL (4+ high-risk biomarkers) among Black and White older adults (N=518) within each level of lifetime SES (i.e., stable low SES, upward mobility, downward mobility, stable high SES).

RESULTS

Stable high SES was associated with greater odds of high AL; there was not a significant association between other lifetime SES trajectories and AL. However, the magnitude of racial disparities varied across levels of lifetime SES, with a significant Black-White difference in AL observed only among upwardly mobile (OR=1.76, 95% CI=1.24-2.51) and high SES groups (OR=2.22, 95% CI=1.37-3.58).

CONCLUSIONS

Our study demonstrates that racial disparities in AL among older adults depends on individuals' lifetime SES trajectories, and that older Black Americans receive fewer health benefits for achieving higher SES. These findings underscore the need to evaluate socioeconomic resources across the life course to clarify the extent of racial disparities among aging populations.

Moderating Effects of Parental Feeding Practices and Emotional Eating on Dietary Intake among Overweight African American Adolescents

This study examined the effects of parental feeding practices and adolescent emotional eating (EE) on dietary outcomes among overweight African American adolescents. Based on Family Systems Theory, it was hypothesized that parental feeding practices, such as parental monitoring and responsibility, would buffer the effects of EE on poor dietary quality, whereas practices such as concern about a child’s weight, restriction, and pressure-to-eat would exacerbate this relationship. Adolescents (N = 127; Mage = 12.83 ± 1.74; MBMI% = 96.61 ± 4.14) provided baseline data from the Families Improving Together (FIT) for Weight Loss trial and an ancillary study. Dietary outcomes (fruit and vegetables (F&Vs), energy intake, sweetened beverage, total fat, and saturated fat) were assessed using random 24-h dietary recalls. Validated surveys were used to assess adolescent-reported EE and parental feeding practices. Results demonstrated a significant interaction between EE and parental monitoring (adjusted analyses; B = 0.524, SE = 0.176, p = 0.004), restriction (B = −0.331, SE = 0.162, p = 0.043), and concern (B = −0.602, SE = 0.171, p = 0.001) on F&V intake; under high monitoring, low restriction, and low concern, EE was positively associated with F&V intake. There were no significant effects for the other dietary outcomes. These findings indicate that parental feeding practices and EE may be important factors to consider for dietary interventions, specifically for F&V intake, among overweight African American adolescents.

Explaining the Black-white depression paradox: Interrogating the Environmental Affordances Model

The Environmental Affordances (EA) model posits that Black Americans' engagement with unhealthy behaviors (i.e. smoking, alcohol use, eating calorie-dense foods) to cope with stressor exposure may simultaneously account for their observed greater risk of chronic physical illness, and their observed equal or lesser prevalence of depression, relative to white Americans - the so-called "Black-white depression paradox." However, the specific mechanisms through which such effects might arise have been theorized and analyzed inconsistently across studies, raising concerns regarding the appropriateness of existing empirical tests of the model as well as the validity of the conclusions. We specify the two mechanisms most consistent with the EA model - 'Mediation-only' and 'Mediation and Modification' - and derive a priori predictions based on each. We systematically test these pathways using a subset of 559 participants of the Child Health and Development Study who were included in an adult follow-up study between 2010 and 2012 and self-identified as Black or white. Results failed to support either of the two mechanisms derived from the EA model, challenging the validity and utility of the model for explaining racial differences in depression; efforts to develop alternative hypotheses to explain the paradox are needed.

The effect of smoking on depressive symptoms

BACKGROUND

People who smoke tend to report higher levels of psychological distress than those who do not smoke. However, studies suggest that smoking reduces many sub-dimensions of distress, including depressive symptoms. A negative (i.e. depression reducing) effect of smoking on depressive symptoms might be observed in survey panel data only after adjustment for the effect of depressive symptoms on smoking. Results from analyses that make that adjustment are presented within groups jointly defined by race and gender, and for all respondents in a representative sample of the U.S.

POPULATION

METHOD

Reciprocal effects of smoking and depressive symptoms (DSx) are estimated with dynamic panel models. Data are from the Americans' Changing Lives study which assessed smoking and depressive symptoms five times over 25 years. Additional analyses provide estimates of effect of continuing to smoke versus quitting.

RESULTS

The estimated effect of smoking on DSx after adjustment for the simultaneous effect of DSx on smoking and unobserved confounders is negative among women. The estimated effect among men is not statistically significant, and no race difference is observed.

CONCLUSIONS

The tendency for smoking to reduce depressive symptoms among American women is masked in analyses that fail to account for the reciprocal effect of depressive symptoms on smoking.

Sex Differences in the Impact of Racial Discrimination on Mental Health Among Black Americans

PURPOSE OF REVIEW

Greater racial discrimination is associated with poorer mental health among Black Americans; yet, there remains an incomplete understanding of sex differences in exposure to racial discrimination, and further, of how sex differences in coping with racial discrimination may heighten or diminish risk for poorer mental health.

RECENT FINDINGS

Black men may experience greater exposure to both structural and communal forms of racial discrimination, whereas Black women may face both a wider range of potential sources, as well as encounter greater variability in the subjective experience of racial discrimination. For both Black women and men, racial discrimination may be similarly associated with maladaptive coping strategies (i.e., emotional eating, rumination) that also are linked to poorer mental health; however, emerging findings suggest that mindfulness may partially buffer these deleterious effects. Overall, the recent literature reveals mixed findings with respect to sex differences in the experience and negative mental health impact of racial discrimination. Despite this heterogeneity, evidence documents sex differences in the settings, type, and qualitative experience of racial discrimination among Black Americans. Additionally, growing evidence indicating that racial discrimination is associated with physiological markers of stress reactivity and psychopathology risk further bolsters its characterization as a unique form of chronic stress among Black Americans and other minority groups in the USA.