Development and preliminary validation of the Salzburg Stress Eating Scale

The relation between questionnaire-measured self-reported emotional eating and disordered eating behaviors: A meta-analysis of nearly three decades of research

Extensive research exists on the association between self-reported emotional eating (EE) and disordered eating (DE) behaviors. Heterogeneity exists by type (e.g., unidimensional vs. multidimensional) and valence (e.g., negative vs. positive) of self-reported EE, and no previous meta-analyses have examined the association between self-reported EE and DE behaviors. A total of 67 studies (N = 26,289; 43 reporting relations in one model, and 24 reporting relations in more than one model) met inclusion criteria; ranges for age and publication date were 18.0-61.8 years old and 1995 to 2022. Five models quantified relations between DE behaviors and 1) broad negative EE, 2) EE in response to depression, 3) EE in response to anger and anxiety, 4) EE in response to boredom, and 5) EE in response to positive emotions. Using random-effects models, pooled Cohen's d effect sizes suggested small, positive relations between DE behaviors and self-reported broad negative EE (d = 0.40, p < 0.001), EE-depression (d = 0.41, p < 0.001), EE-anger/anxiety (d = 0.35, p < 0.001), and EE-boredom (d = 0.38, p < 0.001). A significant, but very small, positive relation was observed between DE behaviors and self-reported EE-positive (d = 0.08, p = 0.01). Subgroup analyses suggested a medium, positive relation between self-reported broad negative EE and binge eating (d = 0.53, p < 0.001) and a small, positive relation between self-reported broad negative EE and dietary restraint (d = 0.20, p < 0.001). Significant heterogeneity was identified across all models except for the EE-boredom and DE behaviors model. Higher BMI, but not age, clinical status, or type of DE behavior strengthened the positive relation between self-reported broad negative EE and DE behaviors. Findings support previous research suggesting that negative and positive EE are distinct constructs, with negatively valenced EE being more closely associated with DE behaviors, especially binge eating.

Emotion Regulation Training as an Add-on in the Treatment of Obesity in Young Adolescents: A Randomized Controlled Superiority Trial

In an inpatient treatment center for pediatric obesity, the effectiveness of an emotion regulation (ER) training on top of the multidisciplinary obesity treatment (MOT) was tested by means of an RCT. The ER training was evaluated on primary outcomes: ER and emotional eating, and secondary outcomes: well-being and weight loss, taking into account pre, post, and follow-up measurements. Of the 115 10- to-14-year old adolescents with obesity (52.2% girls), 65 were allocated to the ER training. Physicians measured their height and weight objectively (4 times). Participants also filled out questionnaires on ER competencies (ER abilities and ER strategies), emotional eating and well-being (3 times). Significant pre-post interactions were found for "emotional awareness," "problem solving," and "evoking a positive mood." Moreover, the positive effects of the ER training on emotion regulation strategies were maintained at follow-up. Concerning well-being, no significant pre-post interaction effects were found but a significant interaction effect was found when comparing pre with follow-up. Analyses show a significant main effect of time on weight loss, but this was not qualified by a Time × Condition interaction effect. The current RCT study shows limited but promising effects of adding an ER training to the MOT. Further research should investigate whether the positive short-term effects will be maintained.

Investigation of the relationship between university students' attentional impulsivity levels and psychological and physiological stress responses

Introduction

The purpose of this study is to investigate the relationship between attentional impulsivity levels and physiological and psychological stress responses of university students.

Methods

300 university students participated in the study. Four different data collection tools were used in the study: a personal information form, the Physiological Stress Response Inventory, and the Attentional Impulsivity Part of Barratt Impulsiveness Scale.

Results

We showed that attentional impulsivity of the participants is significantly related to both physiological stress responses (R2 = 0.04, F[1;267] = 11.45, p < 0.05) and psychological stress responses (R2 = 0.04, F[1;270] = 10.40, p < 0.05). At the same time, there is a significant negative association between physiological stress responses and psychological stress responses (r = -0.68).

Conclusions

The attentional impulsivity is an important variable for explaining changes in both physiological and psychological stress responses. Physiological and psychological stress responses should be considered as separate kinds of stress responses in stress response measurements.

Goal pursuit increases more after dietary success than after dietary failure: examining conflicting theories of self-regulation using ecological momentary assessment

BACKGROUND

Maintaining a healthy body weight and reaching long-term dietary goals requires ongoing self-monitoring and behavioral adjustments. How individuals respond to successes and failures is described in models of self-regulation: while cybernetic models propose that failures lead to increased self-regulatory efforts and successes permit a reduction of such efforts, motivational models (e.g., social-cognitive theory) make opposite predictions. Here, we tested these conflicting models in an ecological momentary assessment (EMA) context and explored whether effort adjustments are related to inter-individual differences in perceived self-regulatory success in dieting (i.e., weight management).

METHODS

Using linear mixed effects models, we tested in 174 diet-interested individuals whether current day dietary success or failure (e.g., on Monday) was followed by self-regulatory effort adjustment for the next day (e.g., on Tuesday) across 14 days. Success vs. failure was operationalized with two EMA items: first, whether food intake was higher vs. lower than usual and second, whether food intake was perceived as more vs. less goal-congruent than usual. Trait-level perceived self-regulatory success in dieting was measured on a questionnaire.

RESULTS

Intended self-regulatory effort increased more strongly after days with dietary success (i.e., eating less than usual / rating intake as goal-congruent) than after days with dietary failure (i.e., eating more than usual / rating intake as goal-incongruent), especially in those individuals with lower scores on perceived self-regulatory success in dieting.

CONCLUSIONS

Findings support mechanisms proposed by social-cognitive theory, especially in unsuccessful dieters. Thus, future dietary interventions could focus on preventing the decrease in self-regulatory effort after instances of dietary failures and thereby mitigate the potential risk that a single dietary failure initiates a downward spiral into unhealthy eating.

Excess after stress-A three-study validation of the salzburg stress drinking scale as a new tool to measure the stress-drinking relationship

Stress frequently influences a person's propensity to drink alcohol. Inter-individual differences in such stress-related drinking can be assessed through psychometric scales; however, available questionnaires conflate stress- with emotion-related reasons to drink and ignore evidence of decreased alcohol consumption in response to stress. Therefore, we developed a genuine stress-drinking scale (Salzburg Stress Drinking Scale; SSDS), adapted from the Salzburg Stress Eating Scale, and assessed its psychometric properties. In study 1 (n = 639), the SSDS was found to have a one-factor structure, excellent internal consistency, and acceptable test-retest reliability. SSDS scores were significantly correlated with other measures assessing emotional drinking, but uncorrelated with general alcohol pathology and other health-relevant consummatory behaviors such as stress-related eating or nicotine consumption. In addition, no significant sex differences arose. In study 2 (n = 42) patients with an alcohol use disorder or addiction scored significantly higher on the SSDS compared to healthy controls. In an Ecological Momentary Assessment study 3 (n = 67), the SSDS showed partial ecological validity through significant relationships with daily alcohol consumption, but not daily stress-drinking relationships. In sum, the SSDS represents a psychometrically sound tool for the measurement of stress-related drinking and complements a battery of stress-related changes in health-relevant behaviors.

Social support and overeating in young women: The role of altering functional network connectivity patterns and negative emotions

Research suggests that social support has a protective effect on emotional health and emotionally induced overeating. Women are especially more sensitive to benefits from social support when facing eating problems. Although it has been demonstrated that social support can affect the neural processes of emotion regulation and reward perception, it is unclear how social support alters synergistic patterns in large-scale brain networks associated with negative emotions and overeating. We used a large sample of young women aged 17-22 years (N = 360) to examine how social support influences the synchrony of five intrinsic networks (executive control network [ECN], default mode network, salience network [SN], basal ganglia network, and precuneus network [PN]) and how these networks influence negative affect and overeating. Additionally, we explored these analyses in another sample of males (N = 136). After statistically controlling for differences in age and head movement, we observed significant associations of higher levels of social support with increased intra- and inter-network functional synchrony, particularly for ECN-centered network connectivity. Subsequent chain-mediated analyses showed that social support predicted overeating through the ECN-SN and ECN-PN network connectivity and negative emotions. However, these results were not found in men. These findings suggest that social support influences the synergistic patterns within and between intrinsic networks related to inhibitory control, emotion salience, self-referential thinking, and reward sensitivity. Furthermore, they reveal that social support and its neural markers may play a key role in young women's emotional health and eating behavior.

Mindful eating and eating behaviours in Greece: exploring the validity and reliability of two mindful eating scales and other eating behaviours for Greek-speaking populations

BACKGROUND

Mindful eating has seen an increase in clinical and non-clinical practices of changing health outcomes. Meanwhile, the restriction of not having validated scales in other languages proposes a barrier to exploring the impact of mindful eating cross-culturally, and specific to the present project, across Greek-speaking populations, limiting the potential of exploring the association with Mediterranean dieting.

METHODS

In the present research, volunteers (n = 706) completed online the Mindful Eating Behaviour Scale and the Mindful Eating Scale. A forward-backwards translation, leading to face validity, and was assessed for internal consistency (Cronbach's Alpha) and followed up by an assessment of the factorial structure of the scales. Divergent and convergent validity was explored using motivations to eat palatable foods, grazing, craving, Dusseldorf orthorexia, Salzburg emotional eating, and the Salzburg stress eating scales.

RESULTS

Results indicated that both scales displayed good internal consistency, and the assessment of the factorial structure of the scales was equally good and semi-consistent with the English versions, with parallel analyses and item loadings proposing problems that have been shown in critical review literature. Associations of mindful eating scales to other eating behaviours were replicated to previously established findings with English-speaking populations.

CONCLUSIONS

Findings that deviated from the expected outcomes are central to the discussion on the measurement of mindful eating, and further direction highlights the way forward for researchers and clinicians.

LEVEL V

Descriptive studies.

Stress-induced brain responses are associated with BMI in women

Overweight and obesity are associated with altered stress reactivity and increased inflammation. However, it is not known whether stress-induced changes in brain function scale with BMI and if such associations are driven by peripheral cytokines. Here, we investigate multimodal stress responses in a large transdiagnostic sample using predictive modeling based on spatio-temporal profiles of stress-induced changes in activation and functional connectivity. BMI is associated with increased brain responses as well as greater negative affect after stress and individual response profiles are associated with BMI in females (pperm < 0.001), but not males. Although stress-induced changes reflecting BMI are associated with baseline cortisol, there is no robust association with peripheral cytokines. To conclude, alterations in body weight and energy metabolism might scale acute brain responses to stress more strongly in females compared to males, echoing observational studies. Our findings highlight sex-dependent associations of stress with differences in endocrine markers, largely independent of peripheral inflammation.

Testing the effectiveness of a mobile approach avoidance intervention and measuring approach biases in an ecological momentary assessment context: study protocol for a randomised-controlled trial

INTRODUCTION

Unhealthy eating behaviour is a major contributor to obesity and related diseases and is associated with a behavioural bias to approach rather than avoid desired foods, as measured with reaction time tasks. Approach-avoidance interventions (AAIs) have been proposed as a way to modify food evaluations and help people to eat in accordance with their dietary goals. Mobile implementations of AAI might be easily accessible, low threshold interventions, but their effectiveness has not been established yet.

METHODS AND ANALYSIS

Participants who aim to change their eating behaviour are randomised to intervention or control groups. They complete six sessions of a smartphone-based AAI, in which they push (ie, avoid) or pull (ie, approach) personalised food images. Intervention group participants always avoid foods that they personally want to eat less often and approach foods that they personally want to eat more often. In the control group, images are paired equally often with both response directions. To evaluate contextual and dynamic intervention effects, ecological momentary assessment (EMA) is measured throughout, with questions about food intake, hunger, stress, emotions, eating intentions, food craving and impulsivity twice a day. Additional EMA preintervention and postintervention measures are administered before and after the intervention phase (4 days each) with a 1-day follow-up EMA 4 weeks after the intervention. Multilevel models will examine the temporal covariance between approach bias and self-reported variables as well as short-term and long-term intervention effects on approach bias, food intake and craving.

ETHICS AND DISSEMINATION

The study was approved by the Ethics Committee of the University of Salzburg. Results will be published in peer-reviewed scientific journals and presented at scientific conferences.

TRIAL REGISTRATION NUMBER

German Clinical Trials Register DRKS, registration number DRKS00030780.

Real-time Assessment of the Bidirectional Relationship Between Affective States and Glucose: Protocol for a 14-Day Observational Study

BACKGROUND

Glucose variability increases cardiometabolic disease risk. While many factors can influence glucose levels, postprandial glucose response is the primary driver of glucose variability. Furthermore, affect may directly and indirectly impact glucose variability through its effect on eating behavior. Continuous glucose monitors (CGMs) facilitate the real-time evaluation of blood glucose, and ecological momentary assessment (EMA) can be used to assess affect in real time. Together, data collected from these sources provide the opportunity to further understand the role of affect in glucose levels.

OBJECTIVE

This paper presents the protocol for a study that aims to (1) evaluate the feasibility and acceptability of using CGMs along with EMA in nondiabetic populations and (2) examine the bidirectional relationship between affect and glucose in nondiabetic adults with overweight or obesity using a CGM and EMA.

METHODS

Eligibility criteria for the study include participants (1) aged 18 to 65 years old, (2) with a BMI of ≥25 kg/m², (3) who are able to read and write in English, and (4) who own a smartphone. Individuals will be excluded if they (1) have type 1 or 2 diabetes or have any other condition that requires glucose monitoring, (2) are pregnant, (3) use any medications that have the potential to alter blood glucose levels or interfere with the glucose sensing process, or (4) have a diagnosed gastrointestinal condition or eating disorder. In a 14-day observational study, participants will wear a FreeStyle Libre Pro CGM sensor (Abbott) and will receive mobile phone-based EMA prompts 6 times per day (randomly within six 2-hour windows between 8 AM and 8 PM) to assess positive and negative affect. Participants will also wear a Fitbit Inspire 2 (Fitbit) to continuously monitor physical activity and sleep, which will be included as covariates in the analysis. Multilevel linear regression models will be used to evaluate the acute relationship between glucose level and affect.

RESULTS

Recruitment started in October 2022 and is expected to be completed in March 2023. We will aim to recruit 100 participants. As of December 12, 2022, a total of 39 participants have been enrolled.

CONCLUSIONS

The results of this study will further elucidate the role of affect in glucose variability. By identifying affective states that may lead to glucose excursions, our findings could inform just-in-time behavioral interventions by indicating opportunities for intervention delivery.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/45104.

Glucocorticoids, stress and eating: The mediating role of appetite-regulating hormones

Disrupted hormonal appetite signaling plays a crucial role in obesity as it may lead to uncontrolled reward-related eating. Such disturbances can be induced not only by weight gain itself but also by glucocorticoid overexposure, for example, due to chronic stress, disease, or medication use. However, the exact pathways are just starting to be understood. Here, we present a conceptual framework of how glucocorticoid excess may impair hormonal appetite signaling and, consequently, eating control in the context of obesity. The evidence we present suggests that counteracting glucocorticoid excess can lead to improvements in appetite signaling and may therefore pose a crucial target for obesity prevention and treatment. In turn, targeting hormonal appetite signals may not only improve weight management and eating behavior but may also decrease detrimental effects of glucocorticoid excess on cardio-metabolic outcomes and mood. We conclude that gaining a better understanding of the relationship between glucocorticoid excess and circulating appetite signals will contribute greatly to improvements in personalized obesity prevention and treatment.

Individual differences in the dietary response to stress in ecological momentary assessment: Does the individual-difference model need expansion?

According to the individual-difference model, individuals differ in the way stress changes their eating behaviour. Research shows that some increase, some decrease, and others show no change in food intake. Despite numerous efforts to identify moderating variables that explain these individual (i.e., between-person) differences, evidence remains inconclusive. The present study aims at deepening the understanding of the stress and eating relationship by applying ecological momentary assessment to study (1) the influence of stress on whether and how much individuals eat and (2) the moderating role of gender, age, BMI, trait stress-eating, and eating styles. The APPetite-mobile-app was used for 3 days to capture actual food intake (event-contingent) and perceived stress (signal-contingent). Data of 154 healthy adults suggest that stress is not associated with whether but how much individuals eat. Only gender moderated the relationship between stress and the amount of food intake. Individual differences were small indicating that an individual's dietary response to stress might not be as stable as yet assumed. Moreover, a study suggests that time-varying factors (e.g., food availability) moderate the stress and eating relationship. Hence, intraindividual (i.e., within-person) variability may be relevant. Therefore, we propose an expansion of the individual-difference model, which accounts for time-varying factors.

Psychometric Properties of the Emotional Eater Questionnaire in University Students

Emotional Eating (EE) patterns have been shown to play a relevant role in the development of overweight and obesity. The aim of this study was to analyze the factor structure and psychometric properties of the Emotional Eater Questionnaire (EEQ) in university students from Huelva. The EEQ was administered to 1282 students (age 22.00 (±5.10), BMI 23.59 (±6.74)), belonging to the University of Huelva. An exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were carried out. The internal structure of the questionnaire, internal consistency, test-retest reliability, and convergent validity were analyzed. Principal component analysis of the questionnaire showed two dimensions, explaining 56% of the variance. Internal consistency showed a Cronbach's alpha of 0.859 globally, and of 0.841-0.855 if the items were removed. The corrected item-total correlation yielded values of 0.444-0.687. The test-retest stability was ICC = 0.924 (p < 0.001). The data showed significant correlations between EEQ and the rest of the variables, and a Spearman's Coefficient ranging from -0.367 to 0.400. The fit indexes were good for the confirmatory factor analysis. The results obtained with this structure found an adequate reliability and validity of the questionnaire in comparison with previous studies.

Indoor nature integration for stress recovery and healthy eating: A picture experiment with plants versus green color

AIM

Urbanized environments may stimulate unhealthy food choices and stress. Several theories explain that exposure to green nature can counter these stress effects. Since we spend most time indoors, integrating nature in the interior could be a promising health promotion tool. Hence, we tested whether the beneficial effect of nature for stress recovery is also present in indoor settings via the use of plants or green colors, and whether it is applicable on eating behavior as a new outcome.

METHODS

The 92 participants (18-30y, 16% men) were divided into four groups. Each viewed a 6-min slideshow with room pictures containing either green plants, green objects, greyscale plants or greyscale objects to allow distinction between color- and plant-effects. Group differences were tested for the perceived restorativeness scale, psychological recovery and eating behavior. To allow psychological recovery testing, participants were exposed to a stressor before the picture slideshow via the Trier Social Stress Test. The change of self-reports (stress, positive and negative affect) and psychophysiology (heart rate and vagal-induced heart rate variability RMSSD) post-slideshow versus pre-slideshow was checked. Eating behavior outcomes included change in hunger, craving, and food choice (for fruits, vegetables and snacks).

RESULTS

From the four picture sets, the green plants pictures were reported as most mentally restorative and appeared most beneficial for post-stressor recovery of positive affect, but not for negative affect or stress recovery. The green plants group also had higher preference for vegetables and lower preference or craving for (unhealthy) snacks. Those significant group differences were mainly due to the presence of plants and only occasionally due to the green color.

CONCLUSION

Indoor green plant pictures were associated with higher mental restorativeness and healthier food choices. Integrating plants in the interior seems to be a relevant health promotion approach, while applying green colors seems less relevant.

Cross-cultural adaptation and psychometric assessment of the Portuguese language version of the Eating and Appraisal due to Emotions and Stress (EADES) Questionnaire in Brazilian adults

PURPOSES

To develop a Brazilian Portuguese version of the Eating and Appraisal due to Emotions and Stress (EADES) Questionnaire and estimate the psychometric properties of the EADES factorial model for young Brazilian adults and also to assess the association between EADES factors and age, body mass index (BMI), and economic level.

METHODS

The cross-cultural adaptation was performed using a standardized protocol. The psychometric properties were assessed separately for each sex. A structural model for each sex was developed to investigate the influence of age, economic level, and BMI on the EADES factors.

RESULTS

A total of 1240 participants completed the study [65.8% female, mean age 23.91 (SD = 5.03) years]. The EADES original factorial model did not present good psychometric properties. Then, a factorial model proposed for a Mexican sample was tested and a different model was fitted for each sex. The results showed that younger women have lower self-efficacy and self-confidence and poorer assessment of resources and coping skills. Women with a higher economic level have lower self-efficacy. Higher BMI was associated with lower self-efficacy and self-confidence in both sexes. Younger men have lower self-efficacy and poorer assessment of resources and coping skills.

CONCLUSIONS

The Brazilian Portuguese version of the EADES provided valid and reliable data after refinement, and a different model was fitted for each sex. Sex, age, BMI, and economic level were significantly associated with the EADES factors.

LEVEL OF EVIDENCE

Level V, descriptive cross-sectional study.

A Mobile App for Stress Management in Middle-Aged Men and Women (Calm): Feasibility Randomized Controlled Trial

BACKGROUND

Middle-aged adults (40-65 years) report higher stress levels than most other age groups. There is a need to determine the feasibility of using a meditation app to reduce stress and improve stress-related outcomes in middle-aged adults with a focus on men, as previous meditation app-based studies have reported a low proportion of or even no male participants.

OBJECTIVE

This study aims to (1) determine the feasibility (ie, acceptability and demand with a focus on men) of a consumer-based meditation app (Calm), to reduce stress among middle-aged adults reporting elevated stress levels, and (2) explore the preliminary effects of Calm on perceived stress, psychological outcomes (anxiety, depressive symptoms, mindfulness, and general coping), health behaviors (physical activity and eating habits), and COVID-19 perceptions.

METHODS

This feasibility randomized controlled trial evaluated an app-based meditation intervention in middle-aged adults (N=83) with elevated stress levels (ie, Perceived Stress Scale score ≥15) and limited or no previous experience with meditation. Participants were randomized to the intervention group (Calm app) or a control (educational podcasts; POD) group. Participants completed self-report assessments at baseline and postintervention (week 4). Feasibility was measured as acceptability and demand using Bowen framework. Feasibility and COVID-19 perceptions data were examined using descriptive statistics, and preliminary effects were evaluated using repeated measures analysis of variance.

RESULTS

Participants were satisfied with Calm (27/28, 96%) and found it appropriate or useful (26/28, 93%). Most reported they would likely continue using the Calm app (18/28, 64%). More Calm users reported satisfaction, appropriateness or usefulness, and intent to continue app use than POD users. Calm users (n=33) completed a mean of 20 (SD 31.1) minutes of meditation on the days they meditated and 103 (SD 109.1) minutes of meditation per week. The average adherence rate to the prescribed meditation was 71% among Calm app users, compared to 62% among POD users. Recruitment rate of men was 35% (29/83). Of those randomized to Calm, 55% (15/29) were men, and retention among them was higher (14/15, 93%) than that among women (12/20, 60%). No significant within or between group differences were observed.

CONCLUSIONS

A 4-week, app-based mindfulness meditation intervention (Calm) may be feasible for middle-aged adults and a useful stress-management tool. Calm users expressed satisfaction with the app and felt it was appropriate and useful. Significant improvements in perceived stress and psychological outcomes or stress-related health behaviors were not observed. Even though men spent less time in meditation than women did and completed fewer weekly sessions, they were more likely to adhere to the prescription. Further research is needed for improving stress and stress-related outcomes among middle-aged adults with emphasis on the effects of mindfulness meditation apps for men.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04272138; https://clinicaltrials.gov/ct2/show/NCT04272138.

Clustering individuals' temporal patterns of affective states, hunger, and food craving by latent class vector-autoregression

Background

Eating plays an important role in mental and physical health and is influenced by affective (e.g., emotions, stress) and appetitive (i.e., food craving, hunger) states, among others. Yet, substantial temporal variability and marked individual differences in these relationships have been reported. Exploratory data analytical approaches that account for variability between and within individuals might benefit respective theory development and subsequent confirmatory studies.

Methods

Across 2 weeks, 115 individuals (83% female) reported on momentary affective states, hunger, and food craving six times a day. Based on these ecological momentary assessment (EMA) data we investigated whether latent class vector-autoregression (LCVAR) can identify different clusters of participants based on similarities in their temporal associations between these states.

Results

LCVAR allocated participants into three distinct clusters. Within clusters, we found both positive and negative associations between affective states and hunger/food craving, which further varied temporally across lags. Associations between hunger/food craving and subsequent affective states were more pronounced than vice versa. Clusters differed on eating-related traits such as stress-eating and food craving as well as on EMA completion rates.

Discussion

LCVAR provides novel opportunities to analyse time-series data in affective science and eating behaviour research and uncovers that traditional models of affect-eating relationships might be overly simplistic. Temporal associations differ between subgroups of individuals with specific links to eating-related traits. Moreover, even within subgroups, differences in associations across time and specific affective states can be observed. To account for this high degree of variability, future research and theories should consider individual differences in direction and time lag of associations between affective states and eating behaviour, daytime and specific affective states. In addition to that, methodological implications for EMA research are discussed.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-022-01293-1.

Stress-induced hyperphagia: empirical characterization of stress-overeaters

Background

Stressful situations can have an impact on an individual’s eating behavior. People vulnerable to the influence of stress tend to change the quantity and quality of their food intake. Variables such as sex and body mass index (BMI) seem to be related to this stress-eating behavior, but it is rather unclear what factors account to the parameters associated with stress-eating behavior. The aim of this survey was to identify further characteristics of adults in Germany related to stress-overeating, focusing on stress perception, coping, eating motives and comfort foods as well as personality types.

Methods

This online survey was performed throughout Germany and comprised a 38-item pre-tested questionnaire. Stress-induced overeating was classified based on the Salzburg Stress Eating Scale (SSES). Moreover, validated questionnaires were used to identify additional characteristics of stress eaters. Participants were recruited using a convenience sampling approach, and data were collected between January and April 2021.

Results

The overall sample consisted of 1222 participants (female 80.8%, aged 31.5±12.8). 42.1% of participants were identified as stress-overeaters. Among the remaining group, 78.9% stated to eat less, 21.1% to eat equally when stressed. Female participants had a higher mean SSES score compared to male participants. The BMI was positively correlated to SSES, r(1220)=0.28, p>0.005. ‘Agreeableness’ (BigFive) was found to be a negative predictor of stress-overeating. The most pronounced difference in eating motives (The Eating Motivation Survey, TEMS) was found for ‘Affect Regulation’ and ‘Weight Control’.

Conclusions

The results indicate that stress-overeating affects a large proportion of the surveyed population. BMI, personality and eating motives additionally characterize stress-overeaters and may contribute to develop new approaches to address unhealthy stress-related eating patterns.

Dynamic associations between anxiety, stress, physical activity, and eating regulation over the course of a behavioral weight loss intervention

Negative emotional experiences are associated with dysregulated eating behaviors that impede weight management. While weight loss interventions promote physical activity and self-regulation of eating, no studies have examined how physical activity may directly influence eating by attenuating associations between negative emotions and eating.

OBJECTIVE

The current study examined how momentary negative emotions (stress and anxiety), moderate-to-vigorous intensity physical activity (MVPA), and their interactions predict eating dysregulation (i.e., intensity of eating temptations, inability to resist eating tempting foods, overeating), as well as how these associations change during a weight loss intervention.

METHODS

Women with overweight/obesity (N = 55) completed 14-day ecological momentary assessment (EMA) protocols with objective measurement of physical activity (i.e., bout-related MVPA time) before and after a three-month internet-based weight loss program.

RESULTS

Three-way interactions emerged predicting overeating and eating tempting foods. When women experienced higher than usual levels of momentary anxiety or stress at end-of-treatment, they were less likely to subsequently overeat or eat tempting foods when they had recently engaged in more MVPA (relative to their usual level). No significant associations were found for ratings of temptation intensity.

CONCLUSIONS

Findings suggest MVPA may exert direct effects on eating regulation. Specifically, MVPA appears to increasingly buffer the effect of negative emotional states on dysregulated eating behavior over the course of a weight loss intervention. Future work is needed to develop ways of communicating to patients how activity can have both indirect and direct effects on body weight, and examine whether such knowledge improves outcomes.

Is there stress eating in children and adolescents? A first validation of the Dutch version of the Salzburg Stress Eating Scale

The recently developed Salzburg Stress Eating Scale (SSES) is the first to specifically address the relationship of stress experiences and coping failure on the one hand and increases or decreases in food intake on the other hand. The SSES demonstrated good psychometric properties in English and German speaking adult samples. However, it has not been applied to younger age groups, which may differ in their expression and reporting of stress related eating behavior. Therefore, the current study evaluated the psychometric properties and correlates of the SSES in a Dutch speaking community sample of adolescents (study 1; N = 244, 9-18 years, adjusted BMI range = 71-189%, M = 103%) and in an inpatient sample of adolescents with obesity (study 2; N = 100, 9-16 years, adjusted BMI range = 151-310%, M = 194.5%). Factor analysis confirmed the original one factor structure in both studies. Internal consistency was 0.85 in study 1 and 0.90 in study 2 (Cronbach's alpha). In both the obesity and community sample, SSES scores were positively correlated with other eating-related measures (e.g., emotional eating, external eating), and uncorrelated with non-eating-related wellbeing measures (e.g., perceived stress, depressive symptoms). Unexpectedly, however, no association with adjusted BMI was found in the community sample, obesity sample, or combined sample. The scores of the obesity sample were also compared to the community sample in an age and sex-matched subsample of study 1. Against our hypothesis, the obesity sample did not report higher SSES scores than the community sample. The good internal consistency and the evidence for convergent and discriminant validity indicate that the Dutch version of the SSES seems useful in examining this clinically important eating behavior in adolescents. However, validity with regard to stress eating and BMI remains to be further explored.

Momentary affective response to bouts of moderate-to-vigorous physical activity predicts changes in physical activity and sedentary behavior during behavioral weight loss

BACKGROUND

Affective responses are posited to be key predictors of the uptake and maintenance of health behaviors. However, few studies have examined how individuals' affective response to physical activity, as well as the degree to which their affect response changes, may predict changes in physical activity and sedentary time during behavioral weight loss treatment.

PURPOSE

The current study examined how baseline momentary affective response (i.e., stress and anxiety) to moderate-to-vigorous physical activity (MVPA) and the degree of pre--post intervention change in this response predicted change in daily sedentary, light, and MVPA time during a three-month internet-based weight loss program.

METHODS

Women with overweight/obesity (final N=37) completed 14-day ecological momentary assessment (EMA) protocols with objective measurement of physical activity (i.e., bout-related MVPA time) before and after the intervention.

RESULTS

Women who had more reinforcing responses to MVPA (i.e., greater reductions in anxiety and stress response following MVPA bouts) at baseline had greater increases in overall MVPA at the end of the intervention. Those who had greater anxiety reductions after MVPA bouts at baseline also evidenced less sedentary time at the end of the intervention. Changes in affective responses across the intervention were not related to changes in physical activity levels.

CONCLUSIONS

Findings suggest initial levels of affective reinforcement from MVPA bouts predict future change in MVPA and sedentary time during behavioral weight loss. Future work is needed to examine the utility of more precisely targeting affective responses to physical activity to optimize intervention approaches.

Two of a Kind? Mapping the Psychopathological Space between Obesity with and without Binge Eating Disorder

(1) Background: Obesity (OB) is a frequent co-morbidity in Binge Eating Disorder (BED), suggesting that both conditions share phenotypical features along a spectrum of eating-related behaviors. However, the evidence is inconsistent. This study aimed to comprehensively compare OB-BED patients against OB individuals without BED and healthy, normal-weight controls in general psychopathological features, eating-related phenotypes, and early life experiences. (2) Methods: OB-BED patients (n = 37), OB individuals (n = 50), and controls (n = 44) completed a battery of standardized questionnaires. Responses were analyzed using univariate comparisons and dimensionality reduction techniques (linear discriminant analysis, LDA). (3) Results: OB-BED patients showed the highest scores across assessments (e.g., depression, emotional and stress eating, food cravings, food addiction). OB-BED patients did not differ from OB individuals in terms of childhood traumatization or attachment styles. The LDA revealed a two-dimensional solution that distinguished controls from OB and OB-BED in terms of increasing problematic eating behaviors and attitudes, depression, and childhood adversities, as well as OB-BED from OB groups in terms of emotional eating tendencies and self-regulation impairments. (4) Conclusions: Findings support the idea of a shared spectrum of eating-related disorders but also highlight important distinctions relevant to identifying and treating BED in obese patients.

Humor and Hunger Affect the Response Toward Food Cues

The omnipresence of food cues in everyday life has been linked to troubled eating behavior and rising rates of obesity. While extended research has been conducted on the effects of negative emotions and stress on food consumption, very little is known about how positive emotions affect eating and particularly attention toward food cues. In the present study, we investigated whether humor impacts attentional bias toward food and whether it will affect preferences for healthy and unhealthy food items, depending on the hunger state. To do so, a group of randomly assigned participants watched funny video clips (humor group, N = 46) or neutral ones (control group, N = 49). Afterwards, they performed a modified Posner cueing task with low or high caloric food images serving as cues. We found a significant group × hunger interaction. Compared to the control group, the humor group responded more slowly to food cues when hungry, whereas the opposite was true when participants were satiated. Additionally, our results suggest that hunger possibly directs attention away from healthy food cues and toward unhealthy ones. No group differences were found with respect to food preferences and engagement and disengagement of attention. We discuss the potential of humor in counteracting aversive consequences of hunger on attention allocation toward food. We propose an underlying mechanism involving a combined reduction in cortisol levels and a decrease in activation of the reward system. However, given the novelty of the findings, further research is warranted, both to replicate the results as well as to investigate the suggested underlying processes.

[Cross-cultural adaptation and psychometric investigation of the Salzburg Stress Eating Scale (SSES) in a sample of Brazilian adults]

The study's objectives were to adapt the Salzburg Stress Eating Scale (SSES) to Brazilian Portuguese, estimate its psychometric properties in a sample of young adults, and verify (separately for each sex) the relationship between age and BMI and dietary intake during stress. Adaptation of the SSES to Portuguese was performed according to the consolidated protocol. The psychometric properties were estimated for each sex based on factor and convergent validities and reliability. Invariance was tested in independent subsamples for each sex. The relationship between age and bod mass index (BMI) and dietary intake during stress was investigated for each sex using structural equation modeling. Prevalence of individuals in categories that represented maintenance, reduction, or increases in dietary intake in the face of stress was calculated. Participation in the study included 1,030 individuals (61.8% women) with a mean age of 25.5 (SD = 5.3) years. The original model of the SSES presented good fit for the female sample, but for the male sample one item was excluded and a residual correlation was inserted. These models were invariant in independent subsamples. High BMI influenced dietary intake in the face of stress. Men maintained their habitual diet, while women increased their dietary intake during stress. The Portuguese version of the SSES will be useful for investigating dietary intake during stress in Brazil. Different models of SESS were adjusted for each sex. BMI was a significant variable for assessing dietary intake in the face of stress.

Characterising binge eating over the course of a feasibility trial among individuals with binge eating disorder and bulimia nervosa

Binge eating disorder and bulimia nervosa are eating disorders that are characterized by recurrent binge eating episodes. The highly contextualized nature of binge eating makes naturalistic research a particularly suitable means of understanding the context within which binge eating occurs. The present study aimed to characterise binge eating days with regards to the frequency and probability of negative affect, food craving, meal skipping, and dietary restriction. In addition, it aimed to examine whether a combined intervention that targets the experience of 'loss of control' over eating can decrease these potential maintenance factors that often precede binge eating episodes. Seventy-eight participants with bulimia nervosa (N = 40) or binge eating disorder (n = 38), who were randomly allocated to a food-specific or general intervention combining inhibitory control training and implementation intentions, completed mood and food diaries over four weeks. Results suggest that negative affect and food craving were elevated on binge eating days, but that dietary restraint and meal skipping did not characterise binge eating days. Moreover, meal skipping, binge eating, restriction, and compensation decreased throughout the intervention period, while negative affect and food craving did not. This suggests that some interventions may successfully reduce binge eating frequency without necessarily decreasing negative affect or food craving, thus pointing to the different routes to targeting binge eating and providing implications for future interventions.

A Brief Motivational Intervention Differentially Reduces Sugar-sweetened Beverage (SSB) Consumption

Background

Environmental and behavioral interventions hold promise to reduce sugar-sweetened beverage (SSBs) consumption.

Purpose

To test, among frequent SSB consumers, whether motivations to consume SSBs moderated the effects of (a) a workplace SSB sales ban (environmental intervention) alone, and (b) a “brief motivational intervention” (BI) in addition to the sales ban, on changes in SSB consumption.

Methods

We assessed whether (1) baseline motivations to consume SSBs (craving, psychological stress, or taste enjoyment) impacted changes in daily SSB consumption at 6-month follow-up among frequent (>12oz of SSBs/day) SSB consumers (N = 214); (2) participants randomized to the BI (n = 109) versus to the sales ban only (n = 105) reported greater reductions in SSB consumption at follow-up; and (3) motivations to consume SSBs moderated any changes in SSB consumption.

Results

In response to the sales ban alone, individuals with stronger SSB cravings (+1 SD) at baseline showed significantly smaller reductions in daily SSB consumption at 6-month follow-up relative to individuals with weaker (−1 SD) SSB cravings (2.5 oz vs. 22.5 oz), p < .01. Receiving the BI significantly increased reductions for those with stronger SSB cravings: Among individuals with stronger cravings, those who received the BI evidenced significantly greater reductions in daily SSB consumption [M(SE) = −19.2 (2.74) oz] than those who did not [M(SE) = −2.5 (2.3) oz, p < .001], a difference of 16.72 oz.

Conclusions

Frequent SSB consumers with stronger SSB cravings report minimal reductions in daily SSB consumption with a sales ban only, but report greater reductions if they also receive a motivational intervention. Future multilevel interventions for institutions should consider both environmental and individualized multi-level interventions.

Clinical Trial information

NCT02585336.

Green nature effect on stress response and stress eating in the lab: Color versus environmental content

INTRODUCTION

It is still unclear which green nature aspects can counteract psychosocial stress: the green color or rather the environmental content (=nature). Since stress is often stimulating excess/unhealthy food intake, we hypothesize that green nature also buffers stress-induced eating. This study analyzed the effects of green/nature pictures on restorativeness, stress reactivity/response and stress eating in the lab.

METHODS

Before (5min) and after (8min) the Trier Social Stress Test, 81 participants (82% women, 19-30y) saw one of the four slideshows with nature or urban environments in green or black-white shades. Group differences were tested on Perceived Restorativeness Scale, five repeated measures of heart rate variability (HRV), salivary cortisol and mood, food wanting and snack buffet consumption.

RESULTS

The four groups did not differ in background and baseline values. Reported restorative power was higher in the nature pictures than urban pictures with an even better attentional/happiness restoration capacity for green versus black-white nature, while green urban pictures might induce more stress feelings than black-white urban pictures. The stress time patterns confirmed successful stress induction. Most consistent during stress induction was a higher happiness recovery in the green nature group. Nature overall was somewhat beneficial compared to urban pictures by lower HRV and negative emotions reactivity, although this might be due to unfavorable effects of green urban pictures. In food intake or wanting, no differences existed.

CONCLUSION

Nature pictures were estimated higher in restorative power and green nature pictures had a positive effect on happiness recovery. Thus for prevention, the environmental content (=nature) as such seems important while just a green color seemed not enough. Future research should examine the effect of green nature in realistic indoor settings and consider influence on fruit/vegetable intake instead of solely snacks.

Networks of stress, affect and eating behaviour: anticipated stress coping predicts goal-congruent eating in young adults

BACKGROUND

Many people aim to eat healthily. Yet, affluent food environments encourage consumption of energy dense and nutrient-poor foods, making it difficult to accomplish individual goals such as maintaining a healthy diet and weight. Moreover, goal-congruent eating might be influenced by affects, stress and intense food cravings and might also impinge on these in turn. Directionality and interrelations of these variables are currently unclear, which impedes targeted intervention. Psychological network models offer an exploratory approach that might be helpful to identify unique associations between numerous variables as well as their directionality when based on longitudinal time-series data.

METHODS

Across 14 days, 84 diet-interested participants (age range: 18-38 years, 85.7% female, mostly recruited via universities) reported their momentary states as well as retrospective eating episodes four times a day. We used multilevel vector autoregressive network models based on ecological momentary assessment data of momentary affects, perceived stress and stress coping, hunger, food craving as well as goal-congruent eating behaviour.

RESULTS

Neither of the momentary measures of stress (experience of stress or stress coping), momentary affects or craving uniquely predicted goal-congruent eating. Yet, temporal effects indicated that higher anticipated stress coping predicted subsequent goal-congruent eating. Thus, the more confident participants were in their coping with upcoming challenges, the more they ate in line with their goals.

CONCLUSION

Most eating behaviour interventions focus on hunger and craving alongside negative and positive affect, thereby overlooking additional important variables like stress coping. Furthermore, self-regulation of eating behaviours seems to be represented by how much someone perceives a particular eating episode as matching their individual eating goal. To conclude, stress coping might be a potential novel intervention target for eating related Just-In-Time Adaptive Interventions in the context of intensive longitudinal assessment.

Factor Structure and Psychometric Properties of Emotional Eater Questionnaire (EEQ) in Spanish Colleges

Emotional eating (EE) patterns have been shown to play a relevant role in the development of overweight problems. However, there is a gap in research aimed at validating questionnaires to assess EE in specific populations. The aim of the study was to analyze factor structure and psychometric properties of Emotional Eater Questionnaire (EEQ) in Spanish universities. EEQ, state-anxiety subscale of STAI and a questionnaire about health habits were filled out by 295 students. Exploratory Factor Analysis (EFA) by using Unweight Least Squares (ULS) method was carried out. To determine factor numbers we used eigenvalues, parallel analysis, and goodness of fit statistics. Cronbach’s alpha and Spearman correlations were used to analyze reliability, convergent, and concurrent validity. The parallel analysis and goodness of fit statistics showed that unifactorial structure of seven items was the most appropriate what accounted for 57% of the variance. Internal consistency was good (α = 0.753), as well as convergent validity (r = 0.317; p < 0.001). Concurrent validity was significant for three of the five criteria (r = −0.224; p < 0.001 and r = −0.259; p < 0.001). The results suggest some differences in the structure of the psychometric assessment of EE in sub-clinical population in comparison with previous studies carried on with an overweight population, what could be relevant to obesity prevention.

Emotional overeating questionnaire: a validation study in Italian adults with obesity, overweight or normal weight

PURPOSE

This study aimed at testing the validity and reliability of the Emotional Overeating Questionnaire (EOQ) in a sample of Italian adults with obesity, overweight or normal weight.

MATERIALS AND METHODS

Participants were 314 Italian adults (72.6% females, aged 18-76 years) with obesity (27.4%), overweight (21.3%), or normal weight (51.3%), who completed the EOQ and measures of binge eating, mental well-being, and mindful eating. Retesting was performed 4 weeks later in a randomly selected subsample of 60 participants. Factor structure of the EOQ was estimated by confirmatory factor analysis (CFA). Reliability was tested with McDonald's ω and ordinal α coefficients for internal consistency and Cohen's weighted Kappa coefficient (K_w) for test-retest reliability.

RESULTS

Based on CFA, the five negative emotional items formed one factor (EOQ-5) with good reliability (ω = 0.89; ordinal α = 0.88; K_w= 0.71), while the item referring to happiness was dropped. EOQ-5 scores were associated with higher binge eating, lower mental well-being, and lower mindful eating. A cut-off point of two identified individuals at risk for binge eating disorders with 75% sensitivity and 67% specificity. Negative emotional overeating was more frequent in women with obesity than women with normal weight and men with obesity.

CONCLUSIONS

EOQ-5 is a valid and reliable tool for measuring the frequency of emotional overeating at the Italian community-level.

LEVEL OF EVIDENCE

Level V, cross-sectional, descriptive study.

Does stress eat away at you or make you eat? EMA measures of stress predict day to day food craving and perceived food intake as a function of trait stress-eating

Eating behaviour can be driven by non-homeostatic factors like stress. Both increased and decreased food intake in response to stress has been documented, but it has remained difficult to identify a trait that predicts who shows either pattern. Thus, we collected naturalistic data from Ecological Momentary Assessment in combination with the trait-level Salzburg Stress Eating Scale (SSES). In study 1, 97 individuals completed the SSES and 6 daily reports about stress, food craving and perceived food intake across 8 days, whereas in study 2, 83 diet-interested participants completed the same measures at 4 daily prompts across 14 days. Consistent across both studies, multilevel modelling revealed that participants with high SSES-scores showed relatively more positive intra-day stress-craving relationships than those with low SSES-scores. On the day level, stress also predicted perceived food intake as a function of SSES-scores. Controlling for negative affect did not alter results. Results support an individual difference model of stress-eating where decrease vs increase of eating depends on SSES-scores. In affected individuals stress influences simultaneous food craving but might exhibit cumulative or delayed effects on food intake. Furthermore, the SSES provides a valid instrument for identifying at risk individuals and for tailoring interventions.

Emotional eating in healthy individuals and patients with an eating disorder: evidence from psychometric, experimental and naturalistic studies

Emotional eating has traditionally been defined as (over)eating in response to negative emotions. Such overeating can impact general health because of excess energy intake and mental health, due to the risks of developing binge eating. Yet, there is still significant controversy on the validity of the emotional eating concept and several theories compete in explaining its mechanisms. The present paper examines the emotional eating construct by reviewing and integrating recent evidence from psychometric, experimental and naturalistic research. Several psychometric questionnaires are available and some suggest that emotions differ fundamentally in how they affect eating (i.e. overeating, undereating). However, the general validity of such questionnaires in predicting actual food intake in experimental studies is questioned and other eating styles such as restrained eating seem to be better predictors of increased food intake under negative emotions. Also, naturalistic studies, involving the repeated assessment of momentary emotions and eating behaviour in daily life, are split between studies supporting and studies contradicting emotional eating in healthy individuals. Individuals with clinical forms of overeating (i.e. binge eating) consistently show positive relationships between negative emotions and eating in daily life. We will conclude with a summary of the controversies around the emotional eating construct and provide recommendations for future research and treatment development.

Emotion regulation training in the treatment of obesity in young adolescents: protocol for a randomized controlled trial

BACKGROUND

The prevalence rates of childhood obesity are increasing. The current multidisciplinary treatments for (childhood) obesity are effective but only moderately and in the short term. A possible explanation for the onset and maintenance of childhood obesity is that it reflects a maladaptive mechanism for regulating high levels of stress and emotions. Therefore, the current RCT study aims to test the effectiveness of adding an emotion regulation training to care as usual (multidisciplinary obesity treatment) in young inpatients (10-14) involved in an obesity treatment program compared to care as usual alone. The research model for this RCT study states that when high levels of stress are regulated in a maladaptive way, this can contribute to the development of obesity.

METHODS

The current study will recruit 140 youngsters (10-14 years) who are involved in an inpatient multidisciplinary obesity treatment (MOT) program. After giving consent to participate in the study, youngsters will be randomly assigned, during consecutive waves, to one of two conditions: care as usual (receiving MOT) or intervention (receiving MOT in addition to emotion regulation training). The training itself consists of 12 weekly sessions, followed by a booster session after 3 and 5 months. The participants will be tested pretraining, post-training, and at 6 months' follow-up. We hypothesize that, compared to the control condition, youngsters in the intervention condition will (1) use more adaptive emotion regulation strategies and (2) report less emotional eating, both primary outcome measures. Moreover, on the level of secondary outcome measures, we hypothesize that youngsters in the intervention condition, compared with the control condition, will (3) report better sleep quality, (4) undergo improved weight loss and weight loss maintenance, and (5) experience better long-term (6-months) psychological well-being.

DISCUSSION

This study will add to both the scientific and clinical literature on the role of emotion regulation in the development and maintenance of different psychopathologies, as emotion regulation is a transdiagnostic factor.

TRIAL REGISTRATION

The RCT study protocol is registered at ISRCTN Registry, with study ID "ISRCTN 83822934." Registered on 13 December 2017.

Four main barriers to weight loss maintenance? A quantitative analysis of difficulties experienced by obese patients after successful weight reduction

BACKGROUND

Weight maintenance remains to be a challenge for patients in a reduced obese state and it has been recommended to provide them more individualized support. For this purpose it is crucial to understand the barriers patients are experiencing after weight loss. Many have been identified by qualitative studies. We evaluated if a quantitative assessment of patient perspective during weight maintenance can help identify major barriers that refer to actual regain.

METHODS

Follow-up data were analyzed from patients attempting weight maintenances after successful completion of a nonsurgical weight loss and lifestyle intervention for morbid obesity. The data were acquired at mandatory follow-up assessments and included rating of 26 probable difficulties. A principal component analysis was carried out to explore whether these difficulties could be grouped into meaningful factors. Associations with socio-demographics, follow-up time, and weight changes were evaluated.

RESULTS

Data from 88 out of 102 patients were available (baseline BMI 49.5 ± 7.4 kg/m²; 12-month weight loss 24.3 ± 9.6%; follow-up time 1.48 ± 0.6 years). Four solid factors, composed of 21 items and explaining 56% of the variance were extracted and interpreted as 'Hedonic Hunger', 'Mental Distress', 'Binge Eating', and 'Demoralization'. Weight regain (12.4 ± 12%) was correlated with each factor, most closely with 'Mental Distress' (r = 0.38). When controlling for age and follow-up time, 'Binge Eating' was the most important predictor (adj. R² = 0.297).

CONCLUSIONS

A quantitative assessment of patient perspective during the first years after weight loss can help identify valid barriers to weight loss maintenance.

Do stress eating or compulsive eating influence metabolic health in a mindfulness-based weight loss intervention?

OBJECTIVE

We aimed to understand the associations of compulsive eating (CE) and stress eating (SE) with metabolic health among adults with obesity and whether mindfulness-based weight loss training may buffer these associations.

METHOD

We used data from a trial in which we randomized 194 participants with obesity to a diet-exercise weight loss intervention with either mindful eating training plus mindfulness-based eating awareness and stress management training (n = 100) or active control components (n = 94). We measured CE, SE, weight, and fasting blood glucose (FBG) at baseline, and 6, 12 months, and 18 months. We tested CE and SE as both moderators and mediators of intervention effects on changes in metabolic health.

RESULTS

Participants higher (+ 1 SD) in CE at baseline randomized to the mindfulness (vs. control) intervention had greater improvements in FBG at 18 months (p = .05). Twelve-month reductions in CE mediated the effect of the intervention on changes in FBG and weight at 12 and 18 months postbaseline (p ≤ .05). Furthermore, those higher (+ 1 SD) in SE at baseline were nearly 2 BMI points higher than those lower (-1 SD) in SE (p < .01). Decreases in SE (B = 3.42; p < .001; 95% CI [2.55, 4.30]) and CE (B = 0.45; p < .001; 95% CI [0.36, 0.54]) in all participants at 6 months were associated with greater weight loss at 18 months.

CONCLUSIONS

Those with greater compulsive eating may reduce risk for metabolic decline by participating in a mindfulness-based weight loss program. Future obesity interventions should consider tailoring treatment toward trait-level characteristics, such as compulsive eating. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Emotion regulation and emotional eating in anorexia nervosa and bulimia nervosa

Individuals with anorexia nervosa (AN) and bulimia nervosa (BN) show emotion regulation deficits. While individuals with BN use binge eating to regulate negative affect, individuals with restricting-type AN may use self-starvation for this purpose. The current study examined the emotion regulatory function of over- and undereating in response to different emotional states in women with restrictive AN (n = 54), BN (n = 47), and women without eating disorders (n = 68). Participants completed self-report measures assessing the use of emotion regulation strategies and emotional eating. Both patient groups reported using more dysfunctional and less functional emotion regulation strategies than controls. The BN group reported eating more than usual in response to negative emotions but less than usual in response to positive emotions. In contrast, the AN group reported eating more than usual in response to positive emotions and less than usual in response to negative emotions. More dysfunctional emotion regulation related to eating less in response to negative emotions in the AN group. Less functional emotion regulation related to eating less when being happy in the BN group. The current study highlights the need to differentiate between different eating outcomes and different emotional states when examining emotion effects on food intake.

Smoking, Stress Eating, and Body Weight: The Moderating Role of Perceived Stress

BACKGROUND

Some individuals respond to stress with increased food intake while others reduce their food intake. Smokers often report using smoking to cope with stress and have a lower body weight than nonsmokers on average. Thus, smokers may tend to eat less when stressed, which may partly explain their lower body weight as compared to nonsmokers. In turn, nonsmokers may tend to eat more when stressed, which may partly explain their higher body weight as compared to smokers.

OBJECTIVE

To examine the interplay between smoking and stress-related eating.

METHODS

N = 314 (78% female, 14% smokers) participants reported whether they were current smokers, their body height and weight and completed the Salzburg Stress Eating Scale and the Perceived Stress Scale.

RESULTS

Smokers did not differ from nonsmokers in body mass index (BMI), stress eating and perceived stress. When perceived stress was high, however, nonsmokers reported eating more and smokers reported eating less than usual. Moreover, in individuals with high perceived stress, being a smoker was indirectly related to lower BMI through eating less when stressed and being a nonsmoker was indirectly related to higher BMI through eating more when stressed.

CONCLUSION

Smokers most likely use smoking instead of eating to cope with stress and, therefore, food intake and body weight decrease in stressed smokers. After smoking cessation, these individuals may be more susceptible to weight gain when-similar to nonsmokers-eating instead of smoking is used to cope with stress.

Development and Preliminary Validation of the Salzburg Emotional Eating Scale

Existing self-report questionnaires for the assessment of emotional eating do not differentiate between specific types of emotions and between increased or decreased food intake in response to these emotions. Therefore, we developed a new measure of emotional eating-the Salzburg Emotional Eating Scale (SEES)-for which higher scores indicate eating more than usual in response to emotions and lower scores indicate eating less than usual in response to emotions. In study 1, a pool of items describing 40 emotional states was used. Factor analysis yielded four factors, which represented both positive (happiness subscale) and negative emotions (sadness, anger, and anxiety subscales). Subsequently, the scale was reduced to 20 items (5 items for each subscale) and its four-factor structure was replicated in studies 2 and 3. In all three studies, internal consistencies of each subscale were α > 0.70 and mean subscale scores significantly differed from each other such that individuals reported the strongest tendency to eat more than usual when being sad and the strongest tendency to eat less than usual when being anxious (sadness > happiness > anger > anxiety). Higher scores on the happiness subscale related to lower scores on the negative emotions subscales, lower body mass index (BMI), and lower eating pathology. In contrast, higher scores on the negative emotions subscales related to lower scores on the happiness subscale, higher BMI, and higher eating pathology. The SEES represents a useful measure for the investigation of emotional eating by increasing both specificity (differentiation between specific emotional states) and breadth (differentiation between increase and decrease of food intake) in the assessment of the emotion-eating relationship.