Emotional eating in patients attending a specialist obesity treatment service

Hedonic hunger, eating behavior, and food reward and preferences 1 year after initial weight loss by diet or bariatric surgery

OBJECTIVE

The objective of this study was to investigate changes in hedonic hunger, eating behavior, and food reward and preferences at 1-year (1Y) follow-up after an initial weight loss (WL) induced by a 10-week, very low-energy diet alone (controls) or in combination with bariatric surgery.

METHODS

Patients scheduled for sleeve gastrectomy or Roux-en-Y gastric bypass and controls were recruited. Body weight/composition, hedonic hunger (Power of Food Scale), eating behavior traits (Dutch Eating Behavior Questionnaire and Three-Factor Eating Questionnaire), and food reward and preferences (computerized behavioral task) were measured at baseline, 11 weeks, and 1Y follow-up.

RESULTS

Changes in anthropometric variables were comparable across groups in the initial phase (week 11), and hedonic hunger decreased overall. The bariatric-surgery groups continued to lose body weight and fat mass, whereas weight regain was seen in controls at 1Y follow-up. Decreases in emotional eating, hunger, disinhibition, and food reward and increases in dietary restraint were seen at 1Y follow-up in the bariatric-surgery groups only.

CONCLUSIONS

Continued WL with bariatric surgery is paralleled by favorable changes in eating behavior and food reward and preferences. By contrast, controls experienced weight regain at 1Y follow-up and no changes in eating behavior. These striking differences are likely to be important in the long-term WL management of individuals with severe obesity.

A paraventricular thalamus to insular cortex glutamatergic projection gates "emotional" stress-induced binge eating in females

It is well-established that stress and negative affect trigger eating disorder symptoms and that the brains of men and women respond to stress in different ways. Indeed, women suffer disproportionately from emotional or stress-related eating, as well as associated eating disorders such as binge eating disorder. Nevertheless, our understanding of the precise neural circuits driving this maladaptive eating behavior, particularly in women, remains limited. We recently established a clinically relevant model of 'emotional' stress-induced binge eating whereby only female mice display binge eating in response to an acute "emotional" stressor. Here, we combined neuroanatomic, transgenic, immunohistochemical and pathway-specific chemogenetic approaches to investigate whole brain functional architecture associated with stress-induced binge eating in females, focusing on the role of Vglut2 projections from the paraventricular thalamus (PVTVglut2+) to the medial insular cortex in this behavior. Whole brain activation mapping and hierarchical clustering of Euclidean distances revealed distinct patterns of coactivation unique to stress-induced binge eating. At a pathway-specific level, PVTVglut2+ cells projecting to the medial insular cortex were specifically activated in response to stress-induced binge eating. Subsequent chemogenetic inhibition of this pathway suppressed stress-induced binge eating. We have identified a distinct PVTVglut2+ to insular cortex projection as a key driver of "emotional" stress-induced binge eating in female mice, highlighting a novel circuit underpinning this sex-specific behavior.

Development and validation of the Pain-Induced Comfort Eating Scale in a chronic pain sample

Background

Chronic pain and higher body weight frequently co-occur. This common comorbidity is thought to be mediated by the use of comfort eating as a strategy for managing both the physical and psychological pain and discomfort associated with flare-ups of chronic pain. Valid and reliable assessment tools are needed to inform the development of effective treatments.

Aims

This study aimed to assess the psychometric properties of a new brief measure of pain-induced comfort eating in chronic pain, the Pain-Induced Comfort Eating Scale (PICES).

Methods

A sample of 166 patients with chronic pain completed an online test battery including the PICES along with measures of chronic pain and pain-related symptoms, disordered eating, and related psychological factors.

Results

Results of exploratory factor analysis revealed a single-factor model for the four-item PICES. Further, the PICES demonstrated evidence of good internal consistency as well as convergent validity with demonstrated correlations with related measures. The results of this study also revealed that comfort eating in chronic pain appears to be related to psychological distress; the PICES correlated more strongly with measures assessing mood and psychological distress compared to interference/intensity of physical pain itself. Scores on the PICES also correlated strongly with measures of uncontrolled and emotional eating.

Conclusions

Overall, our results indicate that the PICES provides a valid and useful brief measure of comfort eating in chronic pain that might be useful to inform treatments targeting the comorbid disordered eating practices that can lead to higher body weights in patients with chronic pain.

Interoceptive awareness and emotional eating in college women: the role of appetite and emotional awareness

Objective: Emotional eating is prevalent among college women. Deficits in interoceptive awareness, or the ability to perceive and identify internal sensations, are associated with emotional eating. Separately examining the specific components of interoceptive awareness, appetite and emotional awareness, in relation to emotional eating may improve prevention and treatment of emotional eating in college women.Participants: 143 women at an urban Northeastern university.Methods: This was a cross-sectional study using self-report measures of interoceptive awareness, appetite and emotional awareness, emotional eating, and depression. Simultaneous regression analyses examined the independent association of appetite and emotional awareness with emotional eating, controlling for depression.Results: Consistent with hypotheses, lower interoceptive awareness was associated with higher emotional eating. Appetite and emotional awareness, were each uniquely associated with emotional eating independent of depression, even when entered simultaneously.Conclusions: Future prevention and treatment of emotional eating in college women should target improvements in appetite and emotional awareness.

Emotional eating among adults with healthy weight, overweight and obesity: a systematic review and meta-analysis

BACKGROUND

Emotional eating (EE) is a disordered eating behaviour which may lead to overeating. It is not clear whether EE presents to an equal degree among adults, regardless of their body mass index (BMI) status. The aim of this study was to assess whether there is a difference in degree of EE between adults with healthy weight, overweight and obesity.

METHODS

MEDLINE and APA PsycINFO databases were searched from inception up to January 2022 for studies that reported EE scores from validated questionnaires. The quality of all included studies was assessed using the AXIS tool. Meta-analysis used random effects and standardised mean difference (SMD). Heterogeneity was investigated using I2 statistics and sensitivity analyses.

RESULTS

A total of 11 studies with 7207 participants were included in the meta-analysis. Degree of EE was greater in adults with a BMI above the healthy range, compared to adults with a healthy BMI (SMD 0.31, 95% CI 0.17 to 0.45; I2  = 85%). However, subgroup analysis found that degree of EE was greater only in adults with obesity (SMD 0.61, 95% CI 0.41 to 0.81; I2  = 62%), and there was no difference in degree of EE between adults with overweight and those with a healthy BMI.

CONCLUSIONS

Degree of EE is greater among adults living with obesity, compared to adults with a healthy BMI, indicating a need for behavioural support to support EE among people living with obesity seeking weight management. Future research should examine the long-term effectiveness of interventions for EE.

Behavioral and Psychological Factors Affecting Weight Loss Success

PURPOSE OF REVIEW

There is a large variability between individuals in the weight loss response to any given diet treatment, which fuels interest into personalized or precision nutrition. Although most efforts are directed toward identifying biological or metabolic factors, several behavioral and psychological factors can also be responsible for some of this interindividual variability.

RECENT FINDINGS

There are many factors that can influence the response to dietary weight loss interventions, including factors related to eating behavior (emotional eating, disinhibition, restraint, perceived stress), behaviors and societal norms related to age and sex, psychological and personal factors (motivation, self-efficacy, locus of control, self-concept), and major life events. The success of a weight loss intervention can be influenced by many psychological and behavioral constructs and not merely by physiological factors such as biology and genetics. These factors are difficult to capture accurately and are often overlooked. Future weight loss studies should consider assessing such factors to better understand the underlying reasons for the large interindividual variability to weight loss therapy.

Characterizing emotional eating: Ecological momentary assessment with person-specific modeling

Emotional eating is a topic of clinical importance, with links to weight regulation and wellness. However, issues of concept clarity and measurement can interfere with efforts to understand and intervene on emotional eating. One explanation for prior difficulties in defining emotional eating may be that this construct is not uniform across individuals. The current study critically examined emotional eating by combining ecological momentary assessment (EMA) with an idiographic analytic approach. The study examined the heterogeneity in the emotions and dysregulated eating behaviors often thought to underlie emotional eating, by establishing and comparing latent factor profiles across individuals. Ten community adults with overweight or obesity completed a 21-day EMA protocol, with 5 daily prompts to report on relevant emotions and eating behaviors. P-technique factor analysis was used to examine the data. Results suggested variability across individuals in the number of factors that emerged, the items that loaded on each factor, and the strength of loadings. Dysregulated eating was not found to covary with affective states strongly enough to produce a distinct "emotional eating" factor for any individual, nor did the correlations between factors suggest strong relationships between emotions and dysregulated eating for most participants, even in this sample with 90% of participants self-identifying as "emotional eaters." Findings are consistent with a growing body of literature questioning the validity of the "emotional eating" construct as currently defined and measured, and supports conceptualizing emotional eating as a locally heterogenous construct that varies between people. Combining EMA with an intra-individual modeling technique appears to be a promising approach for understanding emotional eating. Additional work with larger samples is needed to capture the full range in individual profiles.

A Comparison of Emotional Triggers for Eating in Men and Women with Obesity

OBJECTIVE

Emotional eating (EE) is prevalent in people seeking obesity treatment and is a contributor to poor weight loss outcomes. We aimed to delineate the emotions most associated with this type of eating, and whether they differ by sex in people undergoing obesity treatment.

METHODS

A cross-sectional study recruiting 387 adults from a hospital obesity management service. Emotional eating was measured using the Emotional Eating Scale (EES). Separate analyses included all participants, and those undergoing lifestyle interventions alone or in combination with obesity medication and/or bariatric surgery.

RESULTS

A total of 387 people (71% women) participated in the study (n = 187 receiving lifestyle modification alone; n = 200 in combination with additional treatments). Feeling 'bored' was most commonly and most strongly associated with the urge to eat, regardless of sex or treatment. Women had higher scores for total EES, for subscales of depression and anger, and individual feelings of 'blue', 'sad' and 'upset' compared to men.

CONCLUSIONS

Understanding why certain emotions differentially trigger an urge to eat in men and women, and finding strategies to break the link between boredom and eating may enable better personalisation of lifestyle interventions for people with obesity.

SHORT TERM EFFECTS OF SEMAGLUTIDE ON EMOTIONAL EATING AND OTHER ABNORMAL EATING PATTERNS AMONG SUBJECTS LIVING WITH OBESITY

OBJECTIVE

Emotional eating (EE) and other abnormal eating patterns are highly prevalent among people living with obesity (PWO). In this sense, semaglutide, by acting on areas of the brain involved in the reward system and emotion regulation, could have the potential to ameliorate these eating patterns.

METHOD

69 PWO attending an obesity clinic were evaluated baseline and after 3 months since the beginning of semaglutide. To rule out abnormal EE, the Emotional Eating Questionnaire was administered, and a structured interview was conducted.

RESULTS

69 PWO (82.6%♀, 43.7±1years, and 34.3±6kg/m 2) were included. After 3 months of semaglutide, there was a significant reduction in weight (96.1±20.9 vs 91.3±19.7kg; p<0.001) and BMI (34.3±6 vs 32.4±5.6kg/m 2; p<0.0001). The proportion of patients with EE (72.5% vs 11.5%; p<0.001), external eating (27.5% vs 10.1%; p<0.001) cravings (49.3% vs 21.7%; p<0.001) and savory cravings (53.6% vs 14.5%; p<0.001) was significantly reduced after 3 months of semaglutide. Also, the proportion of PWO with regular exercise was increased (15.9% vs 39.1%; p<0.001). However, Logistic regression analysis showed that only sweet cravings at baseline were the only factor associated, although not significant, with a poorer weight loss (p=0.05).

DISCUSSION

Semaglutide is an effective weight-loss treatment in PWO at short term. Moreover, semaglutide was highly effective in ameliorating EE and other abnormal eating patterns that exert a negative influence on weight.

Weight-loss interventions for improving emotional eating among adults with high body mass index: A systematic review with meta-analysis and meta-regression

Objectives

To evaluate the effectiveness of weight‐loss interventions on emotional eating among adults with high body mass index (BMI).

Methods

A systematic review, meta‐analysis and meta‐regression were performed on randomized controlled trials published from inception until 19 March 2021.

Results

Thirty‐one studies were included, representing 1203 participants with mean ages ranging from 21.8 to 57.3 years old and BMI 27.2–43.5 kg/m². We found small‐to‐medium interventional effects on emotional eating (n = 18; Hedges' g = 0.22; p = 0.01, I² = 61.7%), uncontrolled eating (n = 16; Hedges' g = 0.46; p < 0.001, I² = 71.6%) and cognitive restraint (n = 18; Hedges' g = 0.42; p < 0.001, I² = 75.8%). Small‐to‐medium interventional effects were only found for emotional eating (n = 8; Hedges' g = 0.45; p = 0.02, I² = 74.3%) 3‐month post‐intervention, and on BMI (n = 4; Hedges' g = 0.43; p < 0.05, I² = 33.4%) and weight (n = 6; Hedges' g = 0.36; p < 0.01, I² < 10.4%) 12‐month post‐intervention. Age, male proportion, baseline BMI, attrition rate and intervention length were not significant moderators of the heterogeneity between studies.

Conclusion

Interventions improved emotional eating and weight loss along a year‐long trajectory.

Weight‐loss interventions such as Cognitive Behaviour Therapy (CBT), diet and exercise, and mindfulness are effective in improving emotional eating, uncontrolled eating/external eating and cognitive restraint/restrained eating.

Purely mindfulness‐based interventions showed a higher interventional effect size over a combination of CBT and mindfulness, CBT and diet and/or exercise.

Small‐to‐medium interventional effect size on body mass index and weight was only observed 12‐month post‐intervention.

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.