An Open Trial Examining Dialectical Behavior Therapy Skills and Behavioral Weight Loss for Adults With Emotional Eating and Overweight/Obesity

Emotion dysregulation and obesity: A conceptual review of the literature

Problematic eating behaviours are prevalent in individuals living with obesity and have been linked to weight gain over time. Furthermore, there is evidence that heightened negative emotionality is common in a subset of individuals living with obesity and that negative emotions often precede problematic eating behaviours. Consequently, several theories have highlighted emotion dysregulation as a potential explanatory mechanism of this relationship. However, to date, no comprehensive review has compiled the specific ways in which individuals living with obesity exhibit emotion dysregulation. The present review utilizes Gratz and Roemer's (2004) multidimensional conceptualization of emotion regulation and dysregulation as a framework to summarize the extant literature on emotion dysregulation in obesity. Specifically, this review examines research related to: (1) awareness and clarity of emotions; (2) acceptance of, and willingness to experience, emotion; (3) the ability to remain goal directed and inhibit impulsive behaviour when distressed; and (4) access to emotion regulation strategies. Overall, findings from the present review demonstrate that individuals living with obesity exhibit deficits in emotion clarity, and experience difficulty inhibiting impulsive behaviour and remaining goal directed when experiencing emotion. Strengths and limitations of the literature are reviewed, and future research directions and clinical implications are discussed in light of these findings.

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.

Negative emotional eating patterns in general Chinese adults: A replication and expansion study examining group differences in eating disorder symptomatology, psychosocial impairment, and emotion regulation difficulties

Previous research identified four patterns of negative emotional eating in American and Chinese university students and proposed future directions (e.g., exploring potential differences in emotion regulation across patterns and replicating the patterns in a general, non-student population). Furthermore, prior research has not explored group differences in muscularity-oriented eating disorder symptomatology or psychosocial impairment. Therefore, the present study addressed these gaps in a sample of general Chinese adults, further testing group differences in typical and muscularity-oriented eating disorder symptomatology, psychosocial impairment, and emotion regulation difficulties across patterns of negative emotional eating. A total of 600 Chinese adults were recruited. Latent class analysis (LCA) was used. Results replicated the four patterns of negative emotional eating in previous research, including non-emotional eating (non-EE), emotional over- and under-eating (EOE-EUE), emotional over-eating (EOE), and emotional under-eating (EUE). Significant class differences were identified in eating disorder symptomatology, psychosocial impairment, and emotion regulation difficulties. Specifically, individuals with EOE and EOE-EUE patterns exhibited higher eating disorder symptomatology, higher psychosocial impairment, and more emotion regulation difficulties than those with non-EE and EUE patterns. Therefore, these two classes (i.e., EOE and EOE-EUE), especially the poorly researched EOE-EUE group, should be further examined to elucidate research and clinical applications. Furthermore, findings underscore the role of emotion regulation difficulties in further describing the differences across these negative emotional eating patterns, which can be considered in future interventions for reducing negative emotional eating.

Preferences for coaching strategies in a personalized virtual coach for emotional eaters: an explorative study

Objectives

Emotional eating is recognized as a potential contributor to weight gain. Emotional eaters often hide their problems because of feelings of shame about their behavior, making it challenging to provide them with the necessary support. The introduction of a virtual coach might offer a potential solution in assisting them. To find out whether emotional eaters are receptive to online personalized coaching, we presented emotional eaters with two essential proto-typical problem situations for emotional eaters: "experiencing cravings" and "after giving in to cravings," and asked them whether they preferred one of the three coaching strategies presented: Validating, Focus-on-Change and Dialectical.

Methods

An experimental vignette study (2 × 3 design) was carried out. The vignettes featured two distinct personas, each representing one of the two common problem scenarios experienced by emotional eaters, along with three distinct coaching strategies for each scenario. To identify potential predictors for recognition of problem situations, questionnaires on emotional eating (DEBQ), personality traits (Big-5), well-being (PANAS), and BMI were administrated.

Results

A total of 62% of the respondents identified themselves with "after giving in to cravings" and 47% with "experiencing cravings." BMI, emotional eating and emotional stability appeared to be predictors in recognizing both the problem situations. In "experiencing cravings," the participating women preferred Dialectical and the Validation coaching strategies. In the "after giving in to cravings" condition, they revealed a preference for the Dialectical and the Focus-on-Change coaching strategies.

Conclusion

Using vignettes allowed a less threatening way of bringing up sensitive topics for emotional eaters. The personas representing the problem situations were reasonably well recognized. To further enhance this recognition, it is important for the design and content of the personas to be even more closely related to the typical problem scenarios of emotional eaters, rather than focusing on physical characteristics or social backgrounds. This way, users may be less distracted by these factors. With the knowledge gained about the predictors that may influence recognition of the problem situations, design for coaching can be more customized. The participants represented individuals with high emotional eating levels, enhancing external validity.

Cognitive Behavioural Therapies for Weight-Loss in Adults: A Scoping Review Protocol

Obesity and being overweight are very important public health issues due to their increasing prevalence worldwide. Third-wave cognitive behavioural therapies (3wCBT) have emerged in the last few years to promote weight loss. However, the scientific evidence identifying the most commonly used 3wCBT in weight-loss interventions in adults is still needed. The objective of this scoping review will be to identify the most widely researched 3wCBT used to facilitate weight loss in an adult population who are overweight and obese, according to the published scientific literature. The search will be carried out independently by two authors in PubMed (MEDLINE), Scopus, EMBASE, Web of Science, and PsycINFO, using search equations that contain keywords related to our search question: (1) population: adult and elderly population, (2) intervention: terms related to 3wCBT, and (3) results: weight loss or weight management. The data extraction will be performed following the indications of the Cochrane manual, and the results will be presented in three tables. The 3wCBTs have shown promising results for weight loss, but it is not yet known which of them is the most widely used to achieve weight loss in the adult population. Thus, the results of this scoping review could guide professionals in the psychological treatment of obesity and being overweight.

Stability and longitudinal association between Body Mass Index and maladaptive eating behaviors in older adults: Results from the NutriAct Family Study (NFS)

PURPOSE

Due to the increasing prevalence of overweight and obesity with age and associated health risks, older adults are an important target group to promote healthy weight. Evidence indicates that maladaptive eating behaviors are associated with higher BMI. However, older adults are often neglected in this research field. This prospective study aims to clarify the temporal relationship between BMI and maladaptive eating behaviors among older adults.

METHODS

In total, 964 participants of the NutriAct Family Study (Mage = 63.34 years) completed web-based questionnaires two times (M = 3.33 years apart). BMI was assessed via self-reported height and weight, and maladaptive eating behaviors with the Dutch Eating Behavior Questionnaire (DEBQ). The stability and longitudinal associations were analyzed using cross-lagged models.

RESULTS

Cross-sectional analysis showed positive correlations between BMI and emotional (r = 0.218), external (r = 0.101), as well as restrictive eating (r = 0.160). All maladaptive eating behaviors (β > 0.684) and BMI (β > 0.922) were longitudinally stable. No significant bidirectional relationships were found between BMI and maladaptive eating behaviors over time, except for BMI predicting restrictive eating (β = 0.133).

CONCLUSION

The observed cross-sectional, but not longitudinal associations between BMI and maladaptive eating behaviors underline the need for prospective study designs to deepen the understanding of the role of maladaptive eating behaviors in weight management among the general population. Maladaptive eating behaviors among older adults may have already consolidated and play a smaller role in explaining weight course, compared to early life like childhood.

Mindfulness facets differentially relate to self-reported negative and positive emotional eating types in treatment-seeking adults with overweight/obesity

BACKGROUND

Mindfulness is a meaningful therapeutic target in the treatment of emotional eating in adults with overweight/obesity. Descriptive research mapping relations between mindfulness facets and emotional eating types in treatment-seeking adults with overweight/obesity is needed.

METHODS

Cross-sectional relations between mindfulness facets (i.e., acting with awareness, describe, non-judgment, non-reactive, and observe; Five Facet Mindfulness Questionnaire-Short Form) and emotional eating types (i.e., self-reported negative and positive emotional eating; Emotional Eating Scale-Revised, Emotional Appetite Questionnaire) were examined in a treatment-seeking sample of adults with overweight/obesity (N = 63).

RESULTS

Significant bivariate correlations revealed negative relations between mindfulness facets and emotional eating types. Multiple regressions revealed that higher describe (β = - 0.42, p = 0.004) mindfulness was associated with lower self-reported emotional eating-anger/anxiety; higher non-reactive (β = - 0.31, p = 0.01) and non-judgment (β = - 0.28, p = 0.02) mindfulness were associated with lower self-reported emotional eating-depression; and higher non-judgment (β = 0.26, p = 0.04) mindfulness was associated with higher self-reported emotional eating-positive.

CONCLUSIONS

Describe, non-judgment, and non-reactive mindfulness were uniquely and significantly associated with eating in response to negative and positive emotions. Results suggest the potential need for intervention programs to be sensitive to the multidimensional nature of mindfulness in the treatment of distinct types of emotional eating in adults with overweight/obesity.

LEVEL OF EVIDENCE

V, cross-sectional descriptive study.

Eating when depressed, anxious, bored, or happy: An examination in treatment-seeking adults with overweight/obesity

Emotions that differ in valence are uniquely associated with eating. In our previous study with an online sample of adults with overweight/obesity, eating in response to depression was the type of emotional eating most closely associated with negative psychosocial correlates (Braden et al., 2018). The current study extended this research by examining associations between emotional eating types (eating in response to depression, anxiety, boredom, happiness) and psychological correlates among treatment-seeking adults. The present study was a secondary analysis of adults (N = 63; 96.8% female) with overweight/obesity and self-identified emotional eating who completed a baseline assessment for a behavioral weight loss intervention. Emotional eating in response to depression (EE-depression), anxiety/anger (EE-anxiety/anger), and boredom (EE-boredom) were assessed with the revised Emotional Eating Scale (EES-R), and positive emotional eating (EE-positive) was assessed with the positive emotions subscale of the Emotional Appetite Questionnaire (EMAQ). The Eating Disorder Examination Questionnaire (EDE-Q), Binge Eating Scale (BES), Difficulties in Emotion Regulation Scale (DERS), and Patient Health Questionnaire-9 (PHQ-9; depressive symptoms) were also administered. Frequencies showed the most endorsed emotional eating type was EE-depression (44.4%; n = 28). Four multiple regression analyses examined associations between emotional eating (EE-depression, EE-anxiety/anger, EE-boredom, and EE-positive) and dependent variables (EDE-Q, BES, DERS, and PHQ-9). Results showed that depression was the emotional eating type most closely related to disordered eating, binge eating, and depressive symptoms. Eating in response to anxiety was closely related to emotion regulation difficulties. Positive emotional eating was related to less depressive symptoms. Exploratory analyses showed that lower levels of positive emotional eating were related to higher depressive symptoms among adults with greater emotion regulation difficulties. Researchers and clinicians may consider tailoring weight loss treatment based on unique emotions that trigger eating.

Effects of the healthy lifestyle community program (cohort 1) on stress-eating and weight change after 8 weeks: a controlled study

Stress-eating (eating more or more unhealthily in order to accommodate to stress), contributes to the development and maintenance of obesity. The effect of comprehensive weight loss interventions on changes in stress-eating as well as the contributing role of stress-eating on weight reduction has not been examined. The impact of the 8-week intensive phase of the Healthy Lifestyle Community Programme (HLCP, cohort 1) on emotional, external and restrained eating, as expressions of stress-eating was evaluated in a non-randomized controlled trial. Intervention: 14 seminars (twice per week, including practical units), complemented by stress-regulation and cooking workshops and coaching sessions empowering participants to change their behaviour towards a healthy plant-based diet (ad libitum), stress regulation, regular exercise and to focus on social support. Participants were recruited from the general population. In the intervention group, 91 participants (IG; age: 56 ± 10, 77% female) and in the control group, 52 (CG; age: 62 ± 14, 57% female) were enrolled. At baseline, participants of the IG reported higher levels of stress (9.7 ± 5.4 points [P] vs. 7.6 ± 6.2; p < 0.011), and of emotional eating (27.9 ± 9.4 vs. 20.0 ± 7.1; p < 0.001) and external eating (29.1 ± 4.9 vs. 25.5 ± 5.6; p < 0.001) than participants of the CG. Within 8 weeks, in the IG, scores of emotional eating (- 3.5 ± 5.4 P) and external eating significantly decreased (= - 2.0 ± 3.8 P), while restrained eating increased (2.7 ± 5.0 P; p for all < 0.001). Weight change was negatively correlated with change of external eating (R² = 0.045; CC = - 0.285; p = 0.014), indicating that a greater weight change was associated with a smaller change of external eating. This is the first study to prospectively investigate the role of stress-eating on the weight reduction effect of comprehensive lifestyle interventions. Our data confirm that overweight is associated with EE and external eating and suggest that the HLCP is capable to reduce both, weight and stress-eating.Trial registration: German Clinical Trials Register (DRKS; reference: DRKS00018821; September 18th 2019; retrospectively registered).

Dietary changes in an acceptance-based weight loss pilot intervention study

OBJECTIVE

To evaluate pre-post changes in dietary intake and the possible role of emotional eating (EE) as a mediator of dietary changes in a novel behavioral weight loss intervention (Live FREE).

DESIGN

Secondary analysis of an open label pilot study.

PARTICIPANTS

Thirty-nine adults with overweight/obesity and EE.

INTERVENTION

Live FREE is a 16-week group-based program in which participants learn emotional regulation skills from Dialectical Behavior Therapy followed by traditional behavioral weight loss techniques.

MAIN OUTCOME MEASURE

Dietary intake and EE were measured at baseline and post-treatment with the Automated Self-Administered 24-Hour Dietary Assessment Tool and the depression subscale of the revised Emotional Eating Scale.

ANALYSIS

Paired sample t-tests and mediation for repeated measures designs.

RESULTS

Consumption of calories (t(33) = 5.31, p < .001), saturated fat (t(33) = 5.25, p < .001), and added sugar (t(33) = 4.44, p < .001) decreased from pre-post-treatment. EE change mediated the effect of the intervention on change in saturated fat intake pre-post-treatment, B = 6.16, BootSE = 2.47, 95 % CI (1.53 to 11.37), but did not mediate change in caloric or added sugar intake.

CONCLUSIONS AND IMPLICATIONS

Participants reported improvement in caloric, saturated fat, and added sugar intake. Improvement in EE may be closely related to decreasing saturated fat consumption. (200).

Relationships between retrospective parental feeding practices and Chinese university students' current appetitive traits, weight status, and satisfaction with food-related life

Accumulating evidence suggests that parental feeding practices during childhood are related to adults' eating behaviors and weight status, but research exploring these relationships is largely conducted in Western contexts. However, China, a country that holds the largest world population, has distinct patterns of eating habits and food culture from Western countries. Therefore, the present study aimed to examine relationships between retrospective parental feeding practices (e.g., concern, monitoring, pressure to eat, and restriction) and current body mass index (BMI) and satisfaction with food-related life in a sample of 476 Chinese university students (195 men; Mage = 19.78 years, SD = 1.23). We also examined whether appetitive traits mediated these associations. Retrospective parental feeding practices were significantly related with participants' current BMI (concern: r = 0.26, p < .001; pressure to eat: r = -0.15, p < .001) and satisfaction with food-related life (concern: r = 0.15, p < .001; monitoring: r = 0.12, p = .009; pressure to eat: r = 0.13, p = .006; restriction: r = 0.16, p < .001). Relationships were partially mediated by young adults' current appetitive traits (e.g., enjoyment of food, emotional overeating, satiety responsiveness, slowness in eating). These findings suggest that retrospective parental feeding practices are important correlates of young adults' current weight status and satisfaction with food-related life, and that appetitive traits partially explain these relationships in the Chinese context.