Effects of distress, alexithymia and impulsivity on eating

A network analysis of eating disorder, PTSD, major depression, state-trait anxiety, and quality of life measures in eating disorder patients treated in residential care

BACKGROUND

The network approach in the eating disorder (ED) field has confirmed important links between EDs and posttraumatic stress disorder (PTSD) symptoms. However, studies including comorbid symptoms are scarce, which limits our understanding of potentially important connections. We hypothesised that anxiety, depression and poor quality of life (QOL) would provide a more complete picture of central, maintaining factors.

METHODS

Network analysis using R was performed in 2178 adult ED patients (91% female) admitted to residential treatment. Assessments included the ED Examination Questionnaire (EDEQ), the Eating Disorders Inventory (EDI-2), the PTSD Checklist for DSM-5 (PTSD clusters (PCL-5)), the Patient Health Questionnaire (PHQ-9), the Spielberger State-Trait Anxiety Scale (STAI), and the ED QOL Scale (EDQOL), which measure symptoms of EDs, PTSD, major depression, state-trait anxiety, and QOL, respectively.

RESULTS

EDI-2 ineffectiveness showed the highest centrality (expected influence) followed by EDI-2 interoceptive awareness, STAI state anxiety, EDEQ shape concern, EDQOL psychological subscale, and PTSD cluster D (hyperarousal) symptoms. Eating Disorder Quality of Life psychological and physical-cognitive subscales and PHQ-9 major depressive, STAI state anxiety and PCL-5 PTSD cluster E (negative alterations in mood and cognition) symptoms showed the highest bridge expected influence, suggesting their interactive role in maintaining ED-PTSD comorbidity.

CONCLUSIONS

This is the first network analysis of the interaction between ED and PTSD symptoms to include the comorbid measures of depression, anxiety, and QOL in a large clinical sample of ED patients. Our results indicate that several symptom clusters are likely to maintain ED-PTSD comorbidity and may be important targets of integrated treatment.

Unraveling the complexity and instability of negative emotional eating: A latent transition analysis

The manifestations of emotional eating are complicated, encompassing both over- and under-eating. However, little is understood about how emotional over- and under-eating constitute individuals' eating patterns and how these patterns change over time. Employing latent transition analysis, a longitudinal and person-centered approach, this study examined the patterns and stability of emotional eating. Over six months, 755 participants completed two waves of self-reported questionnaires. Results revealed four distinct latent profiles: Low Emotional Eaters (11.5-15.8%), Emotional Eating-Undereaters (31.1-40.5%), Emotional Eating-Overeaters (15.9-18.3%), and Combined-Emotional Eaters (29.7-37.2%). Approximately 50% of participants in each profile maintained their behavioral patterns over time, with transitions often shifting towards Combined-Emotional Eaters. Individuals in the profile of Emotional Eating-Overeaters exhibited the highest level of anxiety, depression, stress, and disordered eating. Gender, self-esteem level, and self-esteem instability were associated with profile membership and transition probabilities. These findings highlight the presence of distinct and relatively unstable patterns of negative emotional eating, indicating the potential distinction between trait and state emotional eating. Recognizing these inherent characteristics is crucial for future studies and intervention programs addressing negative emotional eating.

Relationships among alexithymia, psychological distress, and disordered eating behaviors in adolescents

This cross-sectional study aimed to evaluate the relations between psychological distress, alexithymia, disordered eating behaviors (DEBs), and body mass index (BMI) and to assess if psychological stress would mediate the influence of alexithymia on DEBs in adolescents. A total of 1609 high school students (58.9% females) aged 14-18 years were included in the study. Data were collected using a self-administered questionnaire. DEBs including emotional eating, cognitive restraint, and uncontrolled eating were assessed with the Three-Factor Eating Questionnaire, psychological distress was assessed with the Depression Anxiety Stress Scale and alexithymia was assessed with the Toronto Alexithymia Scale. Anthropometric measurements were performed. Psychological distress was found to be positively associated with alexithymia, emotional eating, uncontrolled eating, and cognitive restraint (p < 0.01). Both direct and indirect effects of alexithymia on emotional eating and uncontrolled eating were significant. Psychological distress partially mediated the relationship between alexithymia and uncontrolled eating (β = 0.05) and emotional eating (β = 0.04), while it fully mediated the relationship between alexithymia and cognitive restraint (β = 0.05). BMI z score was not correlated with alexithymia and psychological distress. Emotional eating (β = 0.16) and cognitive restraint (β = 0.34), but not uncontrolled eating, significantly were associated with BMI z score. This study demonstrated that alexithymia and psychological distress are positively associated with DEBs in adolescents. It also showed that psychological distress plays a mediating role between alexithymia and DEBs. Moreover, it showed that emotional eating and cognitive restraint are positively associated with the BMI z score. These results suggest that interventions aimed at improving adolescents' psychological well-being and their ability to identify and describe their emotions may reduce DEBs in adolescents, thereby preventing obesity in adolescents.

Emotional Eating in Primary Care: Considerations for Assessment and Management

LEARNING OBJECTIVES

After participating in this CME activity, the psychiatrist should be better able to:• Describe how to identify and address emotional eating in the primary care setting.

ABSTRACT

Emotional eating (i.e., eating in response to negative emotional states and stress) is a highly prevalent concern within primary care settings. It is associated with myriad health issues such as the experience of overweight or obesity, increased difficulty losing weight and sustaining weight loss, various eating disorders, diabetes, and heart disease. Given the effects of emotional eating on patient health goals regarding weight loss or management, it is imperative to incorporate interventions that address emotional underpinnings alongside traditional, behaviorally based weight-loss treatment. Ensuring that primary care providers, who represent pivotal frontline touch points for patients interested in weight-related treatment, can identify emotional eating is an important first step in supporting these patients' goals. The primary purpose of this paper is to provide background information and practical guidance for addressing emotional eating in the primary care setting. We summarize theorized biological and psychological mechanisms that underlie emotional eating, and review traditional (i.e., psychological) interventions, with special consideration for adapting available treatments for use in primary care contexts.

Emotional Eating Prevalence and Correlates in Adolescents in the United States

Background: Adolescent obesity rates continue to rise. A better understanding of who engages in emotional eating, a maladaptive eating style, is needed. Despite emotional eating being a frequent research target, the prevalence of emotional eating in US adolescents is currently unknown. Methods: Nationally representative adolescents (n = 1622, m = 14.48 years, 63.8% non-Hispanic White, 50.6% female) reported eating behaviors in the National Cancer Institute's Family Life, Activity, Sun, Health, and Eating (FLASHE) study. Frequencies and one-way ANOVAs were conducted to examine the rates of emotional eating across demographic and weight status groups. Correlations between emotional eating and dietary intake were examined. Results: In total, 30% of adolescents engaged in emotional eating. Older adolescents (35% of 17-year-olds), females (39%), non-Hispanic White individuals (32%), and adolescents with obesity (44%) had significantly higher rates of emotional eating. Controlling for weight status, greater adolescent emotional eating was correlated with more frequent intake of energy-dense/nutrient-poor foods (β = 0.10, p < 0.001), junk food (β = 0.12, p < 0.001), and convenience foods (β = 0.13, p < 0.001). Conclusions: This study fills a critical gap by providing insight into how common adolescent emotional eating is and highlighting demographic factors that are associated with higher rates. Nearly a third of adolescents in the United States reported eating due to anxiety or sadness, with rates higher in older adolescents, girls, non-Hispanic White adolescents, and adolescents with obesity. Emotional eating was associated with consuming less healthy foods, which conveys immediate and long-term health risks. Practitioners can intervene with emotional eating to reduce obesity and comorbid health risks.

Longitudinal associations between psychosomatic and emotional status and selected food portion sizes in European children and adolescents: IDEFICS/I.Family study

This study aims to investigate the influence of psychosomatic and emotional status on food portion sizes (PSs) consumption from high energy-dense food groups in European children and adolescents. We hypothesized that psychosomatic and emotional status would have a significant association with the PS selection of energy-dense food. The study included 7355 children aged between 2 and 9.9 years at baseline (T0) (48.8% females); 3869 after 2 years (T1) (48.2% females), and 2971 (51.8% females) after 6 years of follow-up (T3). Psychosomatic and emotional status were measured using emotional well-being during the last week score (KINDL) and Strengths and Difficulties Questionnaire. PS was calculated from daily food intake recorded in 24-hour dietary recalls. The associations between emotional status indicators and PS from selected energy-dense food groups were assessed by multilevel linear regression models. In the cross-sectional analysis, we observed that higher KINDL scores were linked to lower PS consumption from sweet bakery products and savory snacks in both genders. Moreover, we found that adolescent females with high emotional and peer problem scores tended to consume larger PS of carbohydrate-rich and sugar-fatty food items (P < .017). Longitudinally, higher peer problem scores were associated with increased PS from bread and rolls, margarine and lipids, and dairy products in all genders and age groups (P< .017). In adolescents, psychosomatic and emotional status could be a trigger for consuming large PS from carbohydrate-rich and sugar-fatty energy-dense foods. Thus, nutritional interventions should consider emotional status to decrease unhealthy dietary habits in children and adolescents.

The Absence of Attentional Bias to Low-Calorie Food Stimuli in Restrictive Dieters: Differences in the Allocation of Attentional Resources to High-Calorie Foods

Restrictive dieters are those who expect to achieve body shape and weight control through dieting. However, they often have difficulty suppressing the desire to consume food when confronted with it. It has been shown that when high- and low-calorie foods are presented together, the attention of restrictive eaters is preferentially directed to high-calorie foods. However, whether attentional bias occurs when low-calorie foods are present alone and whether the allocation of attentional resources is consistent with that for high-calorie foods has yet to be explored. The present study focused on the effects of high-/low-calorie foods on attentional bias in restrictive dieters. Seventy-eight participants were recruited to participate in the experiment via the Dutch Eating Behavior Questionnaire (DEBQ) scale, which is administered in a rapid serial visual presentation (RSVP) task. The results revealed that failed restrictive dieters had the lowest percentage of correct answers at the lag2 level, indicating attentional bias. Failed restrictive dieters allocated more attentional resources to high-calorie foods than to low-calorie foods. Restrictive dieters showed no attentional bias when low-calorie foods were presented alone. The results suggest that low-calorie foods do not elicit an attentional bias in restrictive dieters and that the allocation of attentional resources is not consistent when compared to that for high-calorie foods.

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.

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.

Applying psycho-behavioural phenotyping in obesity characterization

Individual differences in obesity, beyond being explained by metabolic and medical complications, are understood by alterations in eating behaviour which underlie psychological processes. From this psychological perspective, studies have identified several potential characteristic features at the psycho-behavioural level that could additionally explain the maintenance of chronic excess weight or the unsuccessful results of current treatments. To date, despite the growing evidence, the heterogeneity of the psychological evidence associated with obesity has made it challenging to generate consensus on whether these psycho-behavioural phenotypes can be a complement to improve outcomes of existing interventions. For this reason, this narrative review is an overview focused on summarizing studies describing the psycho-behavioural phenotypes associated with obesity. Based on the literature, three psychological constructs have emerged: reward dependence, cognitive control, and mood and emotion. We discuss the clinical implications of stratifying and identifying these psycho-behavioural profiles as potential target for interventions which may ensure a better response to treatment in individuals with obesity. Our conclusions pointed out a considerable overlap between these psycho-behavioural phenotypes suggesting bidirectional interactions between them. These findings endorse the complexity of the psycho-behavioural features associated with obesity and reinforce the need to consider them in order to improve treatment outcomes.

The Relationship between Social Media Use and Body Image in Lebanese University Students

Well-being is not only defined as being physically healthy; multiple factors can affect a person's well-being. Social media is strongly correlated with the body dissatisfaction of an individual. High exposure to lean and toned body shapes has created new standards and "idealized" body types. The aim of this article was to assess the relationship between social media and body image among university students in Lebanon. Data were obtained from 292 university students (median age: 22 years), selected from different Lebanese regions by using convenience sampling. Demographic data, social media addiction, body satisfaction, levels of physical activity, eating behaviors, and ultimate well-being were expressed as median and interquartile range. People who relied more on social media were younger than those who did not. Individuals addicted to social media had higher odds of having moderate and marked body image concerns. A significant association was found between social media addiction and emotional overeating, food responsiveness, and feeling hunger. These findings stress the need for rising regional and national awareness among social media users, especially the younger ones, and the implementation of intervention and prevention techniques to help prevent body image dissatisfaction, disordered eating patterns, and the alteration of overall well-being.

Network analysis of eating disorder and depression symptoms among university students in the late stage of COVID-19 pandemic in China

Background

Eating disorders (EDs) and depression are common in university students, especially during the COVID-19 pandemic. The aim of this study was to elucidate characteristics of EDs and depression symptoms networks among Chinese university students in the later stage of the COVID-19 pandemic in China.

Methods

A total of 929 university students completed the SCOFF questionnaire measuring EDs and Patient Health Questionnaire with 9 items (PHQ-9) measuring depression in Guangzhou, China. The network model was applied to identify central symptoms, bridge symptoms, and important connections between SCOFF and PHQ-9 using R studio. The subgroup analyses of both genders in medical and non-medical students were further explored.

Results

In the networks of the whole sample, central symptoms included "Loss of control over eating" (EDs) and "Appetite changes" (depression). The bridge connections were between "Loss of control over eating" (EDs) and "Appetite changes" (depression), between "Deliberate vomiting" (EDs) and "Thoughts of death" (depression). "Appetite changes" (depression) and "Feeling of worthlessness" (depression) were central symptoms in both subgroups of medical and non-medical students. "Fatigue" (depression) was the central symptom in the female and medical students group. The edge between "Loss of control over eating" (EDs) and "Appetite changes" (depression) acted as a bridge in all subgroups.

Conclusion

Social network approaches offered promising ways of further understanding the association between EDs and depression among university students during the pandemic of COVID-19 in China. Investigations targeting central and bridge symptoms would help to develop effective treatments for both EDs and depression for this population.

A study of intentional inhibition of food stimuli among female restricted eaters

Restrictive eating is the propensity to restrict food consumption to control body weight. Most previous studies have focused on reactive inhibition induced by external cessation signals. Individuals usually engage in intentional inhibition, an internal form of inhibitory control that arises spontaneously in the absence of an explicit external inhibitory signal. However, there has been no clear research on intentional inhibition in restricted eaters. Therefore, the Go/No-Go/Choose experimental paradigm was used in this study to investigate the performance of intentional inhibition among restrained and unrestrained eaters under general stimuli, food stimuli, and food context conditions. The findings showed that only when food stimuli were present did the intentional inhibition of restricted and non-restricted eaters differ. In contrast to non-restricted eaters, restricted eaters significantly inhibit high-calorie foods in favor of low-calorie ones. There was no difference in intentional inhibition responses between the two groups in the non-food-related or food-context conditions, indicating that the intentional inhibition process was specific to restricted/non-restricted eaters.

A Systematic Review on the Association between Obesity and Mood Disorders and the Role of Gut Microbiota

Obesity is a complex health condition that increases the susceptibility to developing cardiovascular diseases, diabetes, and numerous other metabolic health issues. The effect of obesity is not just limited to the conditions mentioned above; it is also seen to have a profound impact on the patient’s mental state, leading to the onset of various mental disorders, particularly mood disorders. Therefore, it is necessary to understand the mechanism underlying the crosstalk between obesity and mental disorders. The gut microbiota is vital in regulating and maintaining host physiology, including metabolism and neuronal circuits. Because of this newly developed understanding of gut microbiota role, here we evaluated the published diverse information to summarize the achievement in the field. In this review, we gave an overview of the association between obesity, mental disorders, and the role of gut microbiota there. Further new guidelines and experimental tools are necessary to understand the microbial contribution to regulate a balanced healthy life.

Depression mediates the relationship between alexithymia and obesity in the Northern Finland Birth Cohort 1966 (NFBC1966)

BACKGROUND

The fact that a complex relationship exists between alexithymia and body mass index (BMI) is well established, but the underlying mechanisms remain poorly understood. Here, we explore the relationship between alexithymia and depressive symptoms in relation to adiposity measures, including the direct and indirect effect of alexithymia and depressive symptoms on obesity over a 15-year time-period, in the Northern Finland Birth Cohort 1966 (NFBC1966).

METHODS

The study included individuals from the Northern Finland Birth Cohort 1966 (NFBC1966) who had available data for adiposity measures (body mass index and waist-to-hip ratio), alexithymia (measured by the 20-Item Toronto Alexithymia Scale: TAS-20), depressive symptoms (measured by the 13-item depression subscale of Hopkins Symptom Checklist: HSCL-13) at age of 31 years (n = 4773) and 46 years (n = 4431). Pearson's (r) correlation, and multiple linear regression were used to investigate the relationships between alexithymia, depressive symptoms, and adiposity measures. The potential mediating role of depressive symptoms was examined via Hayes' procedure (PROCESS).

RESULTS

Positive correlations were confirmed between adiposity measures (BMI and WHR) and the TAS-20 score (and its subscale), but not between obesity and HSCL-13 score. The strongest correlation was between the DIF (difficulty identifying feelings) subscale of the TAS-20 and HSCL-13 at both time points (31 y: r₍₃₀₁₃₎ = 0.41, p < 0.01, 46 y: r₍₃₀₁₃₎ = 0.43, p < 0.01). Depressive symptoms completely (z = 2.55 (±0.00003), p = 0.01) and partly (z = 2.16 (±0.0001), p = 0.03) mediated the alexithymia-obesity relationship over the 15-year time-period.

LIMITATIONS

Other psychological and environmental factors such as interoception, dietary intake and physical activities may also play a role as a potential mediating factor in alexithymia-obesity relationship.

CONCLUSIONS

Our findings provide additional insights of theoretical framework of depressive symptoms mediation effect in the relationship between alexithymia and obesity. Alexithymia and depression should, therefore, be considered in the design of future clinical obesity research.

Associations of parental feeding practices with children's eating behaviors and food preferences: a Chinese cross-sectional study

BACKGROUND

Childhood inadequate eating behaviors contribute to the epidemic of obesity. Previous research suggests that parental feeding practices are partially associated with development of eating behaviors among children, but the results are inconsistent. The present study was to investigate whether parental feeding practices were associated with eating behaviors and food preferences among Chinese children.

METHODS

A cross-sectional study was conducted to collect data from 242 children (ages 7-12) in six-primary schools in Shanghai, China. A series of questionnaires including parental feeding practices and children's eating behaviors have been validated, and were completed by one of parent who has responded for child's daily diet and living. In addition, researchers instructed children to complete the questionnaire of food preference. After adjustment for children's age, sex and BMI status, as well as parental education and family income, the linear regression analysis was used to evaluate relationships of parental feeding practices with children's eating behaviors and food preferences.

RESULTS

Parents with boys had higher level of control overeating practice than those with girls. Mothers who responded to child's daily diet and living and completed feeding practices questionnaire used a greater level of emotional feeding practices than fathers. Boys had higher levels of food responsiveness, emotional overeating, enjoyment of food and desire to drink than girls. Boys had different preferences for meat, processed meat products, fast foods, dairy foods, eggs, and snacks and starchy staples & beans from girls. In addition, scores of instrumental feeding practice and preference for meat significantly differed among children with different weight status. Furthermore, parental emotional feeding practice was positively associated with children's emotional undereating (β 0.54, 95% CI 0.16 to 0.92). There were also positive associations of parental encouragement to eat with children's preference for the processed meat (β 0.43, 95% CI 0.08 to 0.77). Moreover, instrumental feeding practice was negatively associated with children's fish liking (β -0.47, 95% CI -0.94 to -0.01).

CONCLUSION

The current findings support associations of emotional feeding practice with some children's emotional undereating, as well as parental encouragement to eat and instrumental feeding practice related to preference for processed meat and fish, respectively. Further studies should continue to ascertain these associations using longitudinal designs, and to evaluate efficacy of parental feeding practices impacting developments of healthy eating behaviors and preferences for healthy foods among children by interventional studies.

Latent classes of eating disorders and addictions by sex: Implication of alexithymia and stressful life events in youths

Introduction

Eating disorders (EDs) and behavioural addictions show common psychological vulnerability factors such as alexithymia and stressful life events (SLE). This study aims, firstly, to explore the prevalence and latent profiles of participants based on their risk of suffering EDs, gambling disorder (GD), alcohol and/or drug abuse, and compulsive buying (CB) by sex. Secondly, it aimed to test whether alexithymia and having experienced SLE are associated with group membership.

Methods

The sample was predominantly drawn from university students and social networks. It was composed of 352 young adults between 18 and 35 years old, of whom 77.8% were women and 22.2% men.

Results

The results showed that the most prevalent disorders of the sample were alcohol, EDs, CB, drugs and GD, respectively. Moreover, latent class analyses were conducted based on the risk of suffering EDs or addictions by sex. Three main profiles were found: 'Men with addictions', 'Healthy women' and 'Women with EDs'. Finally, differences in SLE and alexithymia levels were tested by latent classes. "Men with addictions" and "Women with EDs" had higher scores on alexithymia and SLE than the group of "Healthy women". However, the group of "Women with EDs" (class 3) reported significantly higher levels of SLE and alexithymia than the other two groups.

Discussion and conclusion

In conclusion, we discuss the possibility that some vulnerability factors operate generally and transdiagnostically in EDs and addictive disorders. The identification of clinical phenotypes could complement and deepen prediction, prevention and treatment research in clinical settings. The need to take sex and gender differences into account is reinforced.

A systematic review of the relationship between alexithymia and emotional eating in adults

Elucidating psychological characteristics associated with emotional eating may further inform interventions for this behaviour related to eating psychopathology. The present systematic review aimed to examine the relationship between alexithymia and self-reported emotional eating in adults, and provide a narrative synthesis of the existing literature. Using the PRISMA method for systematic reviews, six databases (MEDLINE, PsycInfo, PsycArticles, PubMed, SCOPUS, and Web of Science) were searched for peer-reviewed, quantitative research published between January 1994 and 20^th July 2021, when the searches were conducted. Eligible articles investigated the association between alexithymia, as measured by the Toronto Alexithymia Scale (Bagby, Parker, & Taylor, 1994), and emotional eating, as measured by any validated self-report instrument. Nine cross-sectional articles were reviewed, and risk of bias was assessed using the Appraisal Tool for Cross-Sectional Studies (Downes, Brennan, Williams, & Dean, 2016). A narrative synthesis of articles suggests positive associations between alexithymia and self-reported emotional eating. Five measures of emotional eating were used across articles, with limited but consistent evidence for the relationship between alexithymia and emotional eating as measured by the Dutch Eating Behaviour Questionnaire (Van strien et al., 1986). Further research is required to add evidence to the nature of the relationship between alexithymia and emotional eating, and to explore mechanisms that might underpin any relationships. Understanding the association between alexithymia and emotional eating may support strategies and interventions for those seeking help for emotional eating and related eating behaviours.

Associations among alexithymia, disordered eating, and depressive symptoms in treatment-seeking adolescent military dependents at risk for adult binge-eating disorder and obesity

PURPOSE

Evidence suggests that difficulties identifying and describing one's feelings, core components of alexithymia, are associated with attitudinal and behavioral symptoms of disordered eating; depressive symptoms also may underlie these associations. Specifically, research indicates that alexithymia is positively related to depressive symptoms, which in turn may promote both disordered-eating attitudes and certain disinhibited-eating behaviors (e.g., emotional eating). Findings also suggest that military-dependent youth with high weight may exhibit elevated depressive symptoms and disordered eating. As such, understanding associations among alexithymia, depressive symptoms, and disordered eating is particularly relevant for this vulnerable population.

METHODS

We examined 149 adolescent military dependents (14.4 ± 1.6y; 55.0% female; 20.0% non-Hispanic Black; BMIz: 1.9 ± 0.4) at high risk for binge-eating disorder and obesity in adulthood. Participants completed questionnaires assessing two components of alexithymia (difficulty identifying feelings [DIF] and difficulty describing feelings [DDF]), depressive symptoms, emotional eating, and trait anxiety; disordered-eating attitudes were assessed via semi-structured interview.

RESULTS

A series of regression-based models examined indirect relationships of DIF and DDF with disordered-eating attitudes and emotional eating through depressive symptoms. Bootstrapped 95% confidence intervals revealed a significant indirect path from each of the alexithymia components to disordered-eating attitudes via depressive symptoms; indirect paths to emotional eating were non-significant.

CONCLUSION

Results support the salience of depressive symptoms in the relationship between alexithymia and disordered-eating attitudes. Future research should utilize prospective designs and explore direct and indirect associations of alexithymia with other disordered-eating behaviors.

LEVEL OF EVIDENCE

Level III, evidence obtained from a well-designed cohort study.

Is emotional eating associated with behavioral traits and Mediterranean diet in children? A cross-sectional study

Background

Stress and negative emotions may impact on appetite, inducing some individuals to eat less and others to eat more. This behavior has been implicated in the onset of bodyweight problems and eating disorders in childhood. The aim of our study is to evaluate factors potentially associated with emotional eating in children.

Methods

The present cross-sectional study derives from a survey conducted in 2021 on 8–9 years old children attending 11 primary schools. A questionnaire was administered that contained multiple-choice items relating to the children and their mothers, and touching on all the factors thought to be associated with emotional eating as behavioral traits or adherence to Mediterranean diet. A multivariable logistic regression was performed to test the association.

Results

Emotional undereating was positively associated with emotional symptoms (OR 1.72; 95% CI 1.11–2.67); emotional overeating was positively associated with both emotional symptoms (OR 2.01; 95% CI 1.29–3.13) and hyperactivity (OR 2.80; 95% CI 1.59–4.92), and inversely associated with peer problems (OR 0.50; 95% CI 0.25–0.99). Emotional undereating was also positively associated with the number of siblings (OR 1.50; 95% CI 1.03–2.18), and inversely associated with a good adherence to the Mediterranean diet (OR 0.25; 95% CI 0.08–0.84).

Conclusions

The study found children’s emotional eating associated with both dietary patterns and behavioral traits (in particular emotional symptoms, hyperactivity and peer problems). It could be useful to improve parents’ awareness so that they can anticipate and pay more attention to this issue. Adherence to the Mediterranean diet should also be reinforced, by means of health promotion interventions at school, for example.

Factorial Model of Obese Adolescents: The Role of Body Image Concerns and Selective Depersonalization-A Pilot Study

BACKGROUND

The relationship binding body weight to psychological well-being is unclear. The present study aims at identifying the contribution, and specificity, of some dimensions (i.e., eating-related symptoms, body image disorders, eating habits, personality traits, and emotional difficulties) characterizing the psychological profile of obese adolescents (749 participants, 325 females; 58.3% normal-weight, 29.9% overweight, and 11.7% obese; mean age = 16.05, SD = 0.82).

METHODS

By introducing the scores obtained by standardized self-report tools into a generalized linear model, a factorial reduction design was used to detect the best fitting discriminant functions and the principal components explaining the higher proportion of the variance.

RESULTS

We found two discriminant functions correctly classifying 87.1% of normal-weight, 57.2% of overweight, and 68.2% of obese adolescents. Furthermore, two independent factors, explaining 69.68% of the total variance, emerged.

CONCLUSIONS

The first factor, "Body Image Concerns", included the drive for thinness, body dissatisfaction, and interpersonal distrust. The second factor, "Selective Depersonalization", included a trend toward depersonalization and dissatisfaction with the torso. The neurophysiological implications of our findings will be discussed.

Emotion regulation difficulties as common and unique predictors of impulsive behaviors in university students

Objectives: Researchers examined associations between specific forms of emotion dysregulation and numerous behavioral manifestations of impulsivity (i.e., problematic alcohol use, drug use, risky sexual activity, binge eating, non-suicidal self-injury). Participants: Participants were 238 undergraduate students (69% female). Method: Emotion dysregulation was assessed using the Difficulties in Emotion Regulation Scale (DERS). Path models examined each DERS subscale on its own, and all DERS subscales together, as predictors of all impulsive behaviors. Results: Lack of emotional clarity predicted the largest number of impulsive behaviors, both on its own and after controlling for other forms of emotion dysregulation. Non-acceptance of emotions and difficulties achieving goals when upset also related to several impulsive behaviors. Conclusions: Certain emotion regulation difficulties, particularly poor emotional clarity, may represent specific mechanisms that lead to maladaptive impulsive behaviors. Findings provide useful information for incorporating specific emotion regulation skills in harm prevention programs and treatments for university students.

Gender Differences in the Relationships between Perceived Stress, Eating Behaviors, Sleep, Dietary Risk, and Body Mass Index

BACKGROUND

Obesity is a growing epidemic among university students, and the high levels of stress reported by this population could contribute to this issue. Singular relationships between perceived stress; engagement in restrained, uncontrolled, and emotional eating; sleep; dietary risk; and body mass index (BMI) have been reported in the current body of literature; however, these constructs interact with each other, and the complex relationships among them are infrequently examined. Therefore, the aim of the present study was to explore the complex relationships between these constructs using mediation and moderation analyses stratified by gender.

METHODS

A cross-sectional study, enrolling university students from the United States (U.S.), the Netherlands, South Korea, Malaysia, Ireland, Ghana, and China, was conducted between October 2020 and January 2021 during the COVID-19 pandemic. Perceived stress; maladaptive eating behaviors including restrained, uncontrolled, and emotional eating; sleep duration and quality; dietary risk; and BMI were assessed using validated questionnaires, which were distributed through an online platform.

RESULTS

A total of 1392 students completed the online survey (379 male, 973 female, and 40 who self-identified as "other"). Uncontrolled and emotional eating mediated the relationship between perceived stress and dietary risk for both males and females; higher sleep quality weakened this relationship among female students but not males. Emotional eating mediated the relationship between perceived stress and BMI for both males and females, but higher sleep quality weakened this relationship only among females.

CONCLUSIONS

Our findings suggest that students in higher education are likely to benefit from interventions to reduce uncontrolled and emotional eating. Programs that improve sleep quality, especially during highly stressful periods, may be helpful.

Food Consciousness Intervention Improves Interoceptive Sensitivity and Expression of Exteroception in Women

The perception of the body’s internal state (interoception) and the perception and processing of environmental sensory stimuli (exteroception) act together to modulate adaptive behaviour, including eating behaviour, and are related to bodyweight control. This study evaluated the impact of the Food and Nutrition Education Program with Sensory and Cognitive Exercises on interoceptive sensitivity and on the expression of exteroceptive perception in women who experienced difficulty in controlling their body weight. Thirty-seven women were randomized into two groups and evaluated at two moments: before and after the intervention or before and after a 3- to 4-week waiting period. A heartbeat tracking task was used for interoception evaluation. Participants were asked to write a text describing three foods after tasting them for exteroception evaluation. After the intervention, the participants showed an increase in interoceptive sensitivity, and an increase in the expression of exteroceptive stimuli perception through a semantic assessment of their writing related to the tasting experience. In addition, the results point to a possible connection between the mechanisms governing interoception and exteroception. This work brings important contributions to the search for strategies capable of promoting the perception and integration of physiological and environmental stimuli in food consumption.

Facial Emotion Recognition in Obesity and in Fibromyalgia: A Systematic Review

Facial emotion recognition (FER) is extensively investigated in psychological sciences in healthy individuals and clinical conditions. In this paper, we analyzed those studies in which FER was assessed in the case of obesity or fibromyalgia, in relation to the levels of alexithymia. Crucially, these two conditions frequently co-occur; however, no study has explored FER considering both fibromyalgia and obesity. Studies were identified using the electronic search engine of PubMed. The last research was run on 23 July 2021. Two independent lists were generated for the two clinical conditions. Six records were reviewed about obesity, while three records about fibromyalgia. The evidence relative to FER in obesity was not conclusive, whereas the evidence about an altered FER in fibromyalgia seemed more straightforward. Moreover, the role of alexithymia on FER in these clinical conditions was not extensively investigated. In our discussion, we highlighted those factors that should be carefully addressed in investigating FER in these clinical conditions. Moreover, we underlined methodological criticisms that should be overcome in future research.

Obese Subjects without Eating Disorders Experience Binge Episodes Also Independently of Emotional Eating and Personality Traits among University Students of Southern Italy

It is widely acknowledged that obesity is a growing public clinical issue involving both physical and psychological well-being. Nevertheless, the relationship between psychological features and weight gain is still unclear. Although emotional eating (EE) and personality traits are considered significant predictors of eating disorders, their role in obesity without eating disorders (OB-wed) is far from proven. The present study aimed at investigating the cumulative effect of EE and personality traits on overeating behavior in a sample of 266 university students (169 female; mean age = 21.85, SD = 2.39) stratified based on their body mass index (BMI; normal weight, overweight, obese). They were enrolled during free screening days promoted by the Human Dietetic and Sport Service of a Southern Italian university. The results show a psychological pattern of increasing overeating behavior and lower Self-Directedness combined with higher Sadness and Anger. However, OB-wed subjects overate regardless of this emotional/personological configuration.

Changes in lifestyle, diet, and body weight during the first COVID 19 'lockdown' in a student sample

Changes in lifestyle and body weight were examined retrospectively in students at a German university during the first COVID-19 lockdown period (March 12- May 3, 2020) using an online survey. Data from a total of 827 participants was used. Almost half of the students reported perceived body weight changes with about 27% gaining weight and around 22% losing weight. Regression analyses showed that consumption changes in the following food categories: fruits, sweets and cakes, bread and bakery products, pasta, savoury snacks, and meats and sausages were predictive of weight changes. Additionally, changes in the frequency of cooking with fresh ingredients, physical activity, exercise, smoking, and alcohol consumption as well as pre-lockdown BMI were all predictive of weight changes. Given the continuous global pandemic, increased and innovative public health efforts to support this population group are needed.

Parent-Infant Attachment Insecurity and Emotional Eating in Adolescence: Mediation through Emotion Suppression and Alexithymia

Emotional eating (EE), the propensity to eat in response to emotions, is thought to have its origins in the early parent–infant relationship. This study tested the hypothesis that infant attachment insecurity results in EE in adolescence through the increased use of the emotion regulation strategy suppression of emotions and subsequent alexithymia. At the age of 15 months, parent–infant attachment security (n = 129) was observed with two abbreviated attachment measures: the shortened strange situation procedure (SSSP), and the shortened attachment Q-set (S-AQS). At the age of 12 years, children completed self-report questionnaires to assess the suppression of emotions, alexithymia, and EE. At the age of 16 years, EE was measured again. The mediation models indicated that lower parent–infant attachment security predicted increased use of suppression of emotions, which was related to increased alexithymia, and in turn more EE at the age of 12 years. These results were similar and significant for both attachment measures, and also (marginal) significant with EE at the age of 16 years as an outcome. Lastly, when parental caregiving quality was included, the models with the SSSP as predictor remained significant, but the models with the S-AQS became insignificant. These results indicated that to a certain extent, infant attachment security could predict adolescent EE above and beyond parental caregiving quality.

The effect of online restaurant menus on consumers' purchase intentions during the COVID-19 pandemic

As COVID-19 escalated globally in 2020, mandated suspension of dine-in services was instilled to control virus transmission. Restaurants lost billions of dollars, millions experienced severe employment changes, and numerous small restaurants closed. For those remaining in business, converting to online food ordering was essential. Unique to the food ordering setting, this study extended the Stimulus-Organism-Response model to predict the purchase intentions of participants in an online food ordering context. Using structural equation modeling, this study discovered the indirect effects of the menu's visual appeal and informativeness, and the perception of COVID-19 risks on consumer purchase intentions. This causal relationship was significantly mediated by consumers' desire for food and their perceived convenience of online food ordering. Through providing theoretical and managerial implications for how to identify appropriate products, utilize content marketing effectively, and attract new customers, this study could assist restaurants in adapting to remaining competitive, even post COVID-19.

Rumination, mood, and maladaptive eating behaviors in overweight and healthy populations

PURPOSE

The literature suggests that rumination (i.e., repetitive thinking about 1 or more negative concerns that is perceived as difficult to control) is linked to impaired emotional regulation and increases negative affect. Not only individuals suffering from overweight or obesity, but also healthy individuals might use emotional eating as a coping strategy to deal with negative affect caused by rumination. The aim of the present study was to determine the link between rumination and maladaptive eating strategies in participants with normal weight and overweight/obesity using trait and ecological momentary measures.

METHOD

In Study 1, 88 individuals from overweight/obese (N = 33) and control group (N = 50) filled in a series of questionnaires assessing trait rumination, and eating behaviors. In Study 2 momentary affect, rumination and eating behavior of 26 participants were assessed using ecological momentary assessment (EMA) methodology.

RESULTS

In Study 1, the moderated mediation model revealed that emotional eating mediates the link between rumination and uncontrolled eating or snacking, but only in healthy participants and not in the participants with overweight. The results of Study 2 suggest that when both momentary rumination and sad mood are entered into the model predicting momentary daily emotional eating, only rumination remains a significant predictor of emotional eating. This relationship is not modified by the fact that the participants are from healthy controls or the overweight/obese group.

DISCUSSION

Study 1 provided evidence on the differential role of emotional eating in participants with normal weight and with overweight. Study 2 provided initial insights into the role of momentary mood and momentary repetitive thinking in the use of emotional eating in participants' everyday lives. The differences in group effect in trait and EMA measures indicated also the importance of considering the consciousness of using rumination and emotional eating, while studying those processes in individuals with overweight.

LEVEL OF EVIDENCE

Level III, case-control analytic study.

The Effect of Social Isolation during COVID-19 Pandemic on Nutrition and Exercise Behaviors of Nursing Students

This study aims to examine the effect of social isolation during COVID-19 pandemic on nutrition and exercise behaviors of nursing students. This descriptive study was conducted with nursing students of a university in eastern Turkey. The sample of the study consisted of 1,011 nursing students. The data were collected via e-mail using the Questionnaire of Descriptive Characteristics and the Nutrition Exercise Behavior Scale. Nutrition and exercise behaviors were affected by lockdown. During lockdown due to the COVID-19 pandemic, nearly half of students (46.9%) gained weight, and the majority (56.7%) did not exercise regularly. A statistically significant difference was found between the students' psychological/addictive eating behavior and unhealthy nutrition-exercise behavior subscales mean scores according to change in body weight, most intense emotion, status of currently doing regular exercise (p < .001), gender, frequency of eating and status of doing regular exercise before COVID-19 pandemic (p < .05). It is recommended to prepare informative guidelines and educate individuals about dietary habits, meal schedules, regular exercise, and healthy nutrition.

Application of three different coaching strategies through a virtual coach for people with emotional eating: a vignette study

BACKGROUND

Around 13% of the world's population suffers from obesity. More than 40% of people with obesity display emotional eating behaviour (eating in response to negative emotions or distress). It is an alternate to more effective coping strategies for negative emotions. Our study explored the opportunities for helping adults with emotional overeating using a virtual coach, aiming to identify preferences for tailored coaching strategies applicable in a personal virtual coach environment. Three different coaching strategies were tested: a validating, a focus-on-change, and a dialectical one - the latter being a synthesis of the first two strategies.

METHODS

A qualitative study used vignettes reflecting the two most relevant situations for people with emotional eating: 1. experiencing negative emotions, with ensuing food cravings; and 2. after losing control to emotional eating, with ensuing feelings of low self-esteem. Applied design: 2 situations × 3 coaching strategies.

PARTICIPANTS

71 adult women (Mage 44.4/years, range 19-70, SD = 12.86) with high scores on the DEBQ-emotional eating scale (Memo 3.65, range 1.69-4.92, SD = .69) with mean BMI 30.1 (range 18-46, SD = 6.53). They were recruited via dieticians' practices, were randomly assigned to the conditions and asked how they would face and react to the presented coaching strategies. Data were transcribed and a thematic analysis was conducted.

RESULTS

Qualitative results showed that participants valued both the validating coaching strategy and the focus-on-change strategy, but indicated that a combination of validation and focus-on-change provides both mental support and practical advice. Data showed that participants differed in their level of awareness of the role that emotions play in their overeating and the need for emotion-regulation skills.

CONCLUSION

The design of the virtual coach should be based on dialectical coaching strategies as preferred by participants with emotional eating behaviour. It should be tailored to the different stages of awareness of their emotions and individual emotion-regulation skills.

Emotional eating during COVID-19 in the United Kingdom: Exploring the roles of alexithymia and emotion dysregulation

Emotional eating, generally defined as (over)-eating in response to negative emotions, has been associated with poor physical and psychological outcomes. During a time of heightened negative affect, it is important to understand the impact of the COVID-19 pandemic and associated lockdown measures on eating behaviours, and further elucidate the ways in which emotional eating is related to emotion dysregulation and impaired abilities to identify emotions (i.e. alexithymia). The aims of this study were to explore perceived changes in eating behaviours in relation to self-reported negative affect during the pandemic and to examine direct and indirect effects of alexithymia on emotional eating. An online questionnaire measured these constructs in the general population of the United Kingdom (n = 136). Findings demonstrated that those who reported changes to their eating behaviours during the pandemic also reported greater levels of depression during the same time frame. Mediation analyses revealed that difficulties identifying and describing feelings both predicted emotional eating indirectly via emotion dysregulation. Findings contribute to the understanding of the mechanisms underpinning the relationship between alexithymia and emotional eating and describe changes to eating behaviours during COVID-19. We discuss how these findings should be applied, and recommendations for future research.

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One quarter of participants reported eating more than usual during COVID-19.

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One third of participants reported eating less healthfully than usual.

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Difficulty identifying feelings influences emotional eating via emotion dysregulation.

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Difficulty describing feelings influences emotional eating via emotion dysregulation.

Negative mood regulation expectancies moderate the effect of childhood maltreatment on compulsive buying

OBJECTIVE

Two studies investigated childhood maltreatment, alexithymia-the inability to identify one's mood-and negative mood regulation expectancies (NMRE)-confidence that one can alleviate one's negative moods-as predictors of compulsive buying (CB).

METHOD

Participants were recruited from internet CB forums and undergraduate psychology classes. Online, they completed questionnaires and a behavioral task that assessed impulsive spending.

RESULTS

In Study 1 (N = 646), analyses indicated that NMRE, alexithymia, and childhood maltreatment were significant independent predictors of CB. For Study 2, a subset of participants from the Study 1 pool (N = 295) who met the criterion for clinical levels of CB were selected, based on their self-report. Analyses revealed that NMRE buffered the effect of maltreatment: among participants with high NMRE-higher levels of maltreatment were associated with minimal increases in CB and impulsive spending behavior.

CONCLUSION

Being confident that one can control one's unpleasant moods was a protective factor from the maladaptive consequences of childhood maltreatment. Increasing NMRE early in psychotherapy for CB may result in clients' using more adaptive coping strategies.

The Cross-Cultural Adaptation and the Reliability Test for the Chinese-Version Dietary Behavior and Psychological Series Scales in Maintenance Hemodialysis Patients

PURPOSE

To translate three novel measures of psychological mechanisms associated with dietary behavior, including the Dietary Goal-Desire Incongruence scale (DG-DI), the Motivation for Dietary Self-control scale (MDSC), the Satisfaction with Dietary Behavior scale (SWDB), to cross-culturally adapt the measures into Chinese and verify their reliability and validity in maintenance hemodialysis patients.

METHOD

After the forward translation and the back-translation, the perspective of a panel of experts and cognitive interviews with maintenance hemodialysis patients were used to ensure cultural relevance of the three scales. Subsequently, 420 maintenance hemodialysis patients from three hemodialysis centers in Zhengzhou were recruited for the item analysis and the internal consistency, content validity, construct validity and reliability tests.

RESULTS

The moderate associations between items and domains (r>0.50) and the significant differences between the high and low groups were measured by an independent sample t test (P<0.001). The Cronbach's α coefficient of the DG-DI reached 0.884. The Cronbach's α of the MDSC was 0.831, with Cronbach's α values (0.865,0.800 and 0.797 for "Internal", "External" and "Amotivation", respectively). In addition, the Cronbach's alpha of the SWDB was 0. 914. The scale-level content validity index (S-CVI) reached 0.96, 0.98 and 1.00 for the DG-DI, the MDSC and the SWDB, respectively. The exploratory factor analysis verified the scale structures of five factors, and the cumulative variance contribution rate of the respective factor was 65.507%. The confirmatory factor analysis was conducted to test the original structure of the scale.

CONCLUSION

The DG-DI, the MDSC and the SWDB showed satisfactory psychometric characteristics. They could effectively assess the eating behavior of hemodialysis patients. Subsequent studies should recruit other different population samples in China to verify the applicability of the scale.

Deter the emotions: Alexithymia, impulsivity and their relationship to binge drinking

Introduction

The relevance of both emotion processing and impulsivity to alcohol use and misuse is increasingly recognised, yet there is a scarcity of studies addressing their reciprocal interaction. The present study aimed to examine the role that difficulties in emotion processing and trait impulsivity play in explaining binge drinking pattern of alcohol use in student population. We looked at binge drinking, as it is a risk factor to later alcohol abuse and is a common alcohol drinking habit among students. Alexithymia (from Greek as "deter/repel emotions"), a difficulty in identifying and describing feelings in self and others is increasingly recognised as a feature of alcohol misuse.

Methods

One-hundred and seventy-four student alcohol drinkers were assessed for their drinking habits (Alcohol Use Questionnaire), as well as for alexithymia (Toronto Alexithymia Scale) and impulsivity trait (Barratt Impulsiveness Scale); facial emotional expression judgements were also tested.

Results

A direct relationships between, both, alexithymia and impulsivity, and binge drinking was found. When combined, trait impulsivity partially mediated the relationship between alexithymia and binge drinking. Facial emotional expression judgements also showed a relationship with binge drinking.

Conclusions

These findings highlight the importance of both emotion processing and impulsivity in understanding binge drinking and indicate potential routes for prevention and intervention techniques, especially towards those who may be at risk of later alcohol abuse.

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.

Interoceptive reliance as a major determinant of emotional eating in adult obesity

This study examined the association between emotional eating, emotion dysregulations, and interoceptive sensibility in 116 patients with obesity by distinguishing an “awareness” and a “reliance” component of interoceptive sensibility. Deficits in interoceptive awareness were only associated with more emotional eating in obesity through less interoceptive reliance and more emotion dysregulations. The results suggest that good interoceptive awareness can increase the risk of emotional eating if not supported by good interoceptive reliance. Interoceptive reliance, like the ability to trust, positively consider, and positively use inner sensations, should be a privileged target of psychotherapeutic interventions in obesity.

Obesity risk in Hispanic children: Bidirectional associations between child eating behavior and child weight status over time

Individual differences in eating behaviors have been associated with obesity among young children. Food responsiveness tends to be positively associated with childhood obesity, satiety responsiveness tends to show a negative association, and the results for emotional overeating are mixed. Previous studies in this area, however, have generally employed cross-sectional designs. The purpose of the present study was to examine, in a sample of Hispanic children from families with low-income levels, the degree to which individual differences in child eating behaviors in the preschool years predicted changes in child weight into the early elementary school years. Parent/child dyads (n = 113) were seen on three separate occasions starting when the children were 4-years-old and ending when they were 8-years-old. Separate cross-lag panel analyses were conducted for food responsiveness, satiety responsiveness, and emotional overeating in examining the relationships between child eating behavior and child weight status over time. Consistent with previous cross-sectional studies, at all three time points, food responsiveness was positively associated with concurrent child weight status and satiety responsiveness showed a negative relationship. No concurrent relationship with child weight status was found for emotional overeating until the third time point when children were eight-years-old. Only two cross-lag associations between child eating behavior and child weight status were significant: emotional overeating and child weight status showed a bidirectional relationship between the second and third time points. Future longitudinal studies should examine these relationships in other populations.

Emotion regulation difficulties and impaired working memory interact to predict boredom emotional eating

Emotional eating (EE), or eating in response to emotions, is related to depression, binge eating, and weight gain. Emotion regulation difficulties are a risk factor for EE. Working memory deficits may also be a risk factor for EE, as working memory is an important cognitive factor in emotion regulation. The current study is a secondary analysis that examined whether working memory moderated the relationship between emotion regulation and emotional eating. A college student sample completed measures of EE in response to depression, boredom, and anxiety/anger (Emotional Eating Scale), emotion regulation (Difficulties in Emotion Regulation Scale) and a working memory task (AOSPAN). Moderated regression analyses were conducted. Conditional moderation was observed, such that greater emotion regulation difficulties were associated with boredom EE, when working memory was one standard deviation (SD) below average. Moderation analyses were not significant when examining associations between working memory, emotion regulation difficulties, and depression and anxiety EE. Findings suggest that the correlates of boredom EE may be different than depression and anxiety/anger EE. Although the current study was cross-sectional, it is possible that individuals with poorer working memory and emotion regulation difficulties, especially in tandem, may be at increased risk for boredom EE.

Difficulties in emotion regulation and deficits in interoceptive awareness in moderate and severe obesity

PURPOSE

Difficulties in emotion regulation and deficits in interoceptive awareness may be responsible for overeating and weight gain in obesity by increasing the risks of problematic eating behaviors. This study aimed to: (1) examine emotion regulation difficulties and interoceptive deficits in obesity; (2) compare the emotion regulation and interoceptive abilities of moderately and severely obese patients.

METHODS

Participants were recruited through the university, diabetology centers and bariatric surgery departments. A total of 165 participants were categorized in three groups, matched by age and gender, according to their Body Mass Index (BMI). The severely obese (SO), moderately obese (MO) and normal weight (NW) groups were constituted of 55 participants each. Self-report questionnaires were used to assess emotion regulation difficulties (CERQ-DERS) and interoceptive awareness (MAIA-FFMQ).

RESULTS

Overall, obese participants reported more emotion regulation difficulties and less interoceptive awareness than NW participants did. They also reported a lack of planning strategies and emotional awareness, as well as less ability to observe, notice and trust body sensations. No differences in emotion regulation and interoceptive abilities were found between MO and SO participants.

CONCLUSIONS

Emotion regulation and interoceptive awareness should be targeted in the psychotherapeutic care of obese people, regardless of their BMI.

LEVEL OF EVIDENCE

Level III, case-control analytic study.

Food Addiction Is Associated with Irrational Beliefs via Trait Anxiety and Emotional Eating

Irrational beliefs (IB) are believed, in cognitive behavioral therapies, to be a prime cause of psychopathologies including anxiety, depression, problem eating, and alcohol misuse. "Food addiction" (FA), which has been modeled on diagnostic criteria for substance use disorder, and emotional eating (EE) have both been implicated in the rise in overweight and obesity. Both FA and EE are associated with anxiety. Thus, in the present study, the hypothesis that IB is associated with FA and with EE was tested. Furthermore, possible mediation of these relationships by trait anxiety and depression (and EE for IB and FA) was examined. The responses of 239 adult participants to questionnaires measuring FA, IB, EE, depression, trait anxiety, and anthropometrics were recorded. The results revealed that IB was significantly positively correlated with FA and EE (and depression and trait anxiety). Furthermore, only EE mediated the effect of IB on FA and this was not moderated by BMI. Finally, trait anxiety (but not depression) mediated the effect of IB on EE. Exploratory analysis revealed a significant serial mediation such that IB predicted higher FA via elevated trait anxiety and emotional eating in that order. The results of this study suggest that IB may be a source of the anxiety that is associated with EE and FA and suggest that clinicians may find IB a target for treatment of those persons who report experiences of EE and FA. IB may play a role in food misuse that leads to elevated BMI.

The association between alexithymia and eating behavior in children and adolescents

OBJECTIVE

Alexithymia, or the difficulty identifying or describing one's own emotions, may be a risk factor for dysregulated eating and excess weight gain. However, the relationships between alexithymia and eating behaviors in community samples of non-clinical youth have not been well-characterized. We hypothesized that alexithymia would be positively associated with disordered and disinhibited eating in a community-based sample of boys and girls without an eating disorder.

METHOD

Two hundred children (8-17 years old) across the weight spectrum completed an interview to assess loss of control (LOC) eating and eating-related psychopathology, a laboratory test meal designed to induce disinhibited eating, and questionnaires to assess alexithymia, eating in the absence of hunger, and emotional eating. Linear and logistic regressions were conducted to examine the relationship between alexithymia and eating variables, with age, sex, race, and fat mass as covariates. Test meal analyses also adjusted for lean mass. Given the overlap between alexithymia and depression, all models were repeated with depressive symptoms as an additional covariate.

RESULTS

Alexithymia was associated with an increased likelihood of reporting LOC eating (p < .05). Moreover, alexithymia was positively associated with disordered eating attitudes, emotional eating, and eating in the absence of hunger (ps < .05). Greater alexithymia was associated with more carbohydrate and less fat intake at the test meal (ps < .05). After adjusting for depressive symptoms, alexithymia remained associated with eating in the absence of hunger and carbohydrate and fat intake (ps < .05).

DISCUSSION

In healthy children, alexithymia is associated with some facets of eating behavior and food intake. If supported prospectively, these preliminary findings suggest alexithymia may be a modifiable risk factor to reduce disordered eating and excess weight gain in youth.

Parenting quality in infancy and emotional eating in adolescence: Mediation through emotion suppression and alexithymia

This study assessed the association between parenting quality at age 15 and 28 months and emotional eating (EE) at age 12 and 16 years through serial mediation by suppression of emotions and alexithymia at 12 years. The sample included 129 children and their parents. Lower parental quality in infancy was related to more suppression of emotions, which in turn was related to more difficulty identifying emotions, and in turn to higher EE in adolescence. This serial mediation model was significant for EE at 12 years, and for EE at 16 years. If future studies reveal converging findings, this knowledge points to the need for programs preventing the development of EE in adolescence through increasing the quality of parenting in infancy.