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.

The role of emotion in eating behavior and decisions

The present paper aims to provide the latest perspectives and future directions on the association between emotions and eating behavior. We discussed individual differences in the impact of negative emotions on eating, emotional eating as disinhibited eating decisions with heightened reward values of and sensitivity to palatable foods in response to negative emotions and social isolation, in addition to emotional eating as maladaptive coping strategies under negative emotion and stress, hedonic (pleasure-oriented) eating decisions mediated by the brain reward system, and self-controlled (health-oriented) eating decisions mediated by the brain control system. Perspectives on future directions were addressed, including the development of early eating phenotypes in infancy, shared neural mechanisms mediated by the ventromedial prefrontal cortex and the dorsolateral prefrontal cortex in emotion and eating decision regulation, possible roles of interoception incorporating hunger and satiety signals, gut microbiome, the insula and the orbitofrontal cortex, and emotional processing capacities in hedonic eating and weight gain.

Emotional Eating in College Students: Associations with Coping and Healthy Eating Motivators and Barriers

BACKGROUND

Emotional eating, or eating in response to stress and other negative affective states, bears negative consequences including excessive weight gain and heightened risk of binge eating disorder. Responding to stress with emotional eating is not universal, and it is important to elucidate under what circumstances and by what mechanisms stress is associated with emotional eating. This is particularly important to understand among college students, who are at risk of experiencing heightened stress and negative changes to dietary habits.

METHOD

The present study investigated the relationships among perceived stress, emotional eating, coping, and barriers to and motivators of healthy eating both concurrently and 1 year later in a sample of young adult college students (n = 232).

RESULTS

At baseline, emotional eating was significantly associated with perceived stress (r = 0.36, p < .001), barriers to (r = 0.31, p < .001) and motivators of (r =  - 0.14, p < .05) healthy eating, and avoidance coping (r = 0.37, p < .001), but not approach coping. Furthermore, avoidance coping mediated (indirect effect b = 0.36, 95% CI = 0.13, 0.61) and moderated (b =  - 0.07, p = 0.04) the relationship between perceived stress and emotional eating. Contrary to study hypotheses, baseline stress levels were not associated with emotional eating 1 year later.

CONCLUSION

College students who utilize avoidance coping strategies may be particularly susceptible to the effects of stress on emotional eating. Healthy eating interventions targeting college students might address stress coping strategies in addition to reduction of barriers to healthy eating.

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.

The clinicians' view of food-related obstacles for treating eating disorders: A qualitative study

Background

Good health requires healthy eating. However, individuals with eating disorders, such as anorexia nervosa, require treatment to modify their dietary behaviours and prevent health complications. There is no consensus on the best treatment practices and treatment outcomes are usually poor. While normalising eating behaviour is a cornerstone in treatment, few studies have focused on eating and food-related obstacles to treatment.

Objective

The aim of the study was to investigate clinicians' perceived food-related obstacles to treatment of eating disorders (EDs).

Design

Qualitative focus group discussions were conducted with clinicians involved in eating disorder treatment to get an understanding of their perceptions and beliefs regarding food and eating among eating disorder patients. Thematic analysis was used to find common patterns in the collected material.

Results

From the thematic analysis the following five themes were identified: (1) ideas about healthy and unhealthy food, (2) calculating with calories, (3) taste, texture, and temperature as an excuse, (4) the problems with hidden ingredients and (5) the challenges of extra food.

Discussion

All identified themes showed not only connections to each other but also some overlap. All themes were associated with a requirement of control, where food may be perceived as a threat, with the effects of food consumption resulting in a perceived net loss, rather than a gain. This mindset can greatly influence decision making.

Conclusions

The results of this study are based on experience and practical knowledge that could improve future ED treatments by enhancing our understanding the challenges certain foods pose for patients. The results may also help to improve dietary plans by including and explaining challenges for patients at different stages of treatment. Future studies could further investigate the causes and best treatment practices for people suffering from EDs and other eating disturbances.

Effects of the guided self-help based on shared decision making on eating behaviors in an individual with bipolar disorder

BACKGROUND

Eating behavior in individuals with chronic mental disorders is affected by several factors such as stress, drugs, and the environment. Eating problems can lead to over-nutrition and obesity. Therefore, the Shared Decision Making Model-based Guided Self-Help Program aimed at solving the eating problems of individuals with bipolar disorder living in the community should be tested with preliminary studies. Thus, it would be appropriate to create a useful, accessible, and applicable program for these individuals to overcome their eating problems.

CASE PRESENTATION

In this case study, the effects of the Guided Self-Help Program based on the Shared Decision Making Model (GSHP-SDM) on the eating behaviors of an individual who was diagnosed with bipolar disorder and displayed binge eating and emotional eating behaviors were investigated. In the study, it was determined that implementation of the eight-session GSHP-SDM, during which the participant was interviewed once a week, improved her emotional and uncontrolled eating behaviors.

CONCLUSIONS

This study is the first case study in which the GSHP was implemented to change the eating behavior of an individual with a chronic mental disorder. We observed that the GSHP regulated her eating behavior. We also observed that SDM therapeutic intervention enabled her to decide that she could regulate her eating behaviors.

Emotional eating experiences of individuals with severe mental disorders: A qualitative study

PURPOSE

The aim of this study is to understand the emotional eating experiences of individuals with severe mental disorders.

DESIGN AND METHODS

The study used a descriptive qualitative design. Data were collected from 19 individuals who displayed emotional eating behavior and a severe mental disorder.

FINDINGS

The main themes of this study are "Triggers," "Emotional Eating Process," and "Feelings after Emotional Eating." Participants stated that negative emotions and certain initiating factors were the triggers of their emotional eating; they also experienced feelings of regret and guilt after emotional eating.

PRACTICE IMPLICATIONS

It was concluded that programs for regulating the eating behaviors of individuals with severe mental disorders should be organized and that psychosocial interventions to prevent emotional eating among these individuals should be integrated into the programs' contents.

Correlation between Eating Behavior and Use of Social Media with Energy-Dense Food Intake Based on Gender among Students in Semarang, Indonesia

BACKGROUND: Eating behavior and the use of social media are believed to affect the intake of energy-dense foods. This study aimed to determine the relationship between eating behavior and use of social media with energy-dense food intake in students by gender. METHODS: This study used a cross-sectional method. The subjects were 123 peoples from one of university in Semarang, Indonesia aged 18-24 years, taken using the consecutive sampling method. Energy-dense food intake was taken using the Semi-Quantitative Food Frequency Questionnaire, eating behavior was using the Dutch Eating Behavior Questionnaire and social media use was using the Scale of Effects of Social Media on Eating Behavior and self-identity questionnaire. Data were analyzed using Pearson's test, Spearman's rank test, and multiple linear regression. RESULTS: The intake of energy-dense foods was higher in men than women. This study showed that there was a relationship between emotional eating (p = 0.001; r = 0.408), external eating (p = 0.008; r = 0.338), and eating behavior due to social media (p = 0.001; r = 0.415) and energy-dense food intake. in women, and duration of social media use (p = 0.003; r = 0.377) with energy-dense food intake in men. Gender and eating behavior due to social media had an effect of 24.9% on energy-dense food intake. CONCLUSION: In women, emotional eating, external eating, and eating behavior due to social media were related to the intake of energy-dense foods. In men, the duration of social media use was related to the intake of energy-dense foods. Gender and eating behavior due to social media were the most influential variables on energy-dense food intake.

Effects of Game Situation-Dependent Emotions on Sport Spectators' Food Craving

This study sought to challenge prevalent accounts of emotional eating by exploring the effects of situation-dependent emotions on consumers’ food craving. Four specific game situations in the context of spectator sports, each corresponding to the four types of emotional coping (outcome-desire conflict, avoidance, fulfillment, and pursuit), were identified as follows: decisive victories, decisive losses, close victories, and close losses. By employing laboratory-based virtual reality spectatorship, Study 1 tested the causal effects of happiness (fulfillment), anger (conflict), sadness (conflict), fear (avoidance), and hope (pursuit) on food craving. Study 2 further designed fans’ previous association between emotions and eating as a moderating mechanism in the context of online sport viewership. The results of the two experiments supported the three theoretical principles of eating behavior, including the “food as fuel” principle of anger, the hedonic eating principle of happiness, and the self-regulation principle of hope. However, the results rejected the escape awareness principle of sadness and fear. The study concludes with a discussion of context-dependent emotional positioning and intervention strategies for marketers and policy makers.

The effect of mood on food versus non-food interference among females who are high and low on emotional eating

BACKGROUND

Emotional eating refers to overeating triggered by emotional experiences and may cause significant psychological distress and health problems. Thus, it is important to better understand its underlying mechanisms. The study examined if the ability to ignore task-irrelevant information, namely, interference control, is modulated by mood and exposure to food stimuli among females who are high and low on emotional eating.

METHOD

The study's sample included 80 women who were high (N = 40) or low (N = 40) on an emotional eating scale. Participants were divided to a negative or neutral mood induction group. Following the mood induction, they completed a food-flanker task that allowed assessing attentional interference caused by food and non-food stimuli separately.

RESULTS

The low emotional eating group had significantly greater food compared to non-food interference, suggesting difficulty at ignoring food stimuli while attending a neutral target. In the high emotional eating group, there was no difference between food and non-food interference. However, higher levels of emotional eating predicted lower levels of food interference.

CONCLUSION

The pattern of results suggests a food-avoidance attentional tendency among those with higher levels of emotional eating. The mood manipulation did not influence food-related interference in either group. The lack of an effect of mood on food-related interference questions the impact of negative emotions on basic attentional processes among individuals with emotional eating.

Finally, the chance to eat healthily: Longitudinal study about food consumption during and after the first COVID-19 lockdown in Italy

With the COVID-19 outbreak, structural constraints and social psychological factors changed the dietary habits of many people. This two-wave longitudinal study performed in Italy aimed to explore people’s perceptions of changes in healthy and unhealthy food consumption before and during the first lockdown and the possible persistence of such changes after its official end, as a function of the number of people cohabiting, negative emotion activation, and individual eating styles. A total of 728 Italian adults completed self-reported food consumption measures and related psychological variables at both time points. In the lockdown period, participants reported an increase in healthy food consumption and involvement in cooking and a decrease in the consumption of junk food. This general pattern was stronger for both young and restrained eaters. The intensity of negative emotions and the number of cohabitants were not associated with the examined behaviour. In the post-lockdown period, the new consumption pattern acquired during the confinement was partially discontinued: participants cut down their healthy food consumption as well as their involvement in food preparation, but they continued to reduce their junk food intake. These results suggest that people’s food consumption patterns can easily improve when the situation is favourable (e.g., more time and opportunities for cooking healthy meals) and offer an interesting theoretical contribution to understanding the factors useful in promoting healthy eating, in the event of a future outbreak.

Food Choices and Their Impact on Health and Environment

Food choices are complex and highly variable, even over short periods, as they are influenced by numerous psychological, social, and cultural factors, in addition to biological and economic ones. Consumer choices are increasingly complex because of the growing quantity and variety of available food products, which also affects individuals’ environments. This paper is part of a larger study on health-related food choices, and it discusses how food choices affect the environment. To achieve the research goal, classes of respondents that are homogeneous in their food choices were identified. The authors used an algorithm to build classification trees and found that health status is determined by respondents’ age and food consumption habits. The paper demonstrates that understanding individual nutritional choices is a prerequisite for changing consumption habits and shaping healthy behavior, which is in line with the principle of sustainable development through sustainable consumption. The findings are relevant to public health researchers and practitioners who wish to understand the relationship between nutritional practices and health in line with sustainable development.

Emotional eating among Lebanese adults: scale validation, prevalence and correlates

OBJECTIVES

The present study aimed at developing an Arabic version of the Emotional Eating Scale (EES) and examining its reliability and validity among a sample of the Lebanese population. The secondary objective was to evaluate the correlation between emotional eating and body dissatisfaction along with depression and/or self-esteem among a representative sample of the Lebanese population.

METHODS

This cross-sectional study was conducted between January and May 2018. The sample was drawn proportionately from all Lebanese Mohafazat.

RESULTS

All items could be extracted from the list, except items 17 and 19. The EES items converged over a solution of four factors that had an Eigenvalue over 1, explaining a total of 67.06% of the variance (KMO = 0.939; Bartlett's test of sphericity p < 0.001; α_Cronbach = 0.952). A higher body dissatisfaction was significantly associated with higher emotional eating (β = 0.31) and lower self-esteem (β =  - 0.054); however, no significant association was found with depression. Self-esteem and depression were not found to be significantly associated with emotional eating. When introducing depression and self-esteem as mediator factors for body dissatisfaction and emotional eating, body dissatisfaction did not remain significantly associated with emotional eating.

CONCLUSION

In this study, the Emotional Eating Scale was validated in Arabic among the Lebanese adult population, making this scale usable in further Lebanese research. Moreover, our results showed that body dissatisfaction was positively correlated with emotional eating and self-esteem, but not with depression. A positive association between body dissatisfaction and emotional eating was also demonstrated. This research offers new perspectives for the evaluation of emotional eating among the Lebanese adult population.

LEVEL OF EVIDENCE

Level V Cross-sectional descriptive study.

Relationships among perceived stress, emotional eating, and dietary intake in college students: Eating self-regulation as a mediator

This study aimed to examine the relationships among perceived stress, eating self-regulation, emotional eating, and dietary intake among undergraduate college students. This cross-sectional study was conducted with 523 students recruited from Amazon Mechanical Turk. All participants completed an online survey that assessed perceived stress, eating self-regulation, emotional eating, dietary intake, and demographics. The study sample was 47% female, 30% Hispanic, 8% Black, and 33% Asian. The overweight and obesity rate was 33%. Nearly 83% reported having moderate to high levels of stress, and over 80% had low to medium levels of eating self-regulation skills. On average, students consumed fruits and vegetables 2.42 times per day and sweets and soft drinks about once every other day. Perceived stress was positively correlated with emotional eating (β = 0.12, p = .005), and negatively correlated with eating self-regulation (β = -0.40, p < .001). Eating self-regulation partially mediated the relationship between perceived stress and emotional eating (β = 0.11, p < .001). Emotional eating was positively related to intake of sweets and soft drinks. Eating self-regulation was negatively related to sweet intake (β = -0.19, p < .001). Eating self-regulation and emotional eating fully mediated the relationship between perceived stress and sweet intake (β = 0.09, p < .001). Although warranting further investigation, this study's results emphasize the significant protective role of eating self-regulation for controlling college students' intake of sweets and soft drinks, and the negative effects of perceived stress and emotional eating on their dietary intake. Future interventions could consider strategies focusing on stress management and eating self-regulation to improve dietary intake among this young population.

Mood-induced changes in the cortical processing of food images in bulimia nervosa

BACKGROUND

Negative mood often triggers binge eating in bulimia nervosa (BN). We investigated motivational salience as a possible underlying mechanism using event-related potentials (ERPs) as indicators of motivated attention allocation (P300) and sustained processing (LPP).

METHODS

We collected ERPs (P300: 350-400 ms; LPP: 600-1000 ms) from 21 women with full-syndrome or partially remitted BN and 21 healthy women (HC), matched for age and body mass index. Idiosyncratic negative and neutral situations were used to induce corresponding mood states (counterbalanced), before participants viewed images of high- and low-calorie foods and neutral objects, and provided ratings for pleasantness and desire to eat.

RESULTS

P300 was larger for foods than objects; LPP was largest for high-calorie foods, followed by low-calorie foods, then objects. The BN group showed an increased desire to eat high-calorie foods under negative mood and stronger mood induction effects on ERPs than the HC group, with generally reduced P300 and a small increase in LPP for high-calorie foods. Effects were limited to circumscribed electrode positions. Exploratory analyses showed clearer effects when comparing high vs. low emotional eaters.

CONCLUSION

We argue that negative mood decreased the availability of cognitive resources (decreased P300) in BN, thereby facilitating disinhibition and food cravings (increased desire-to-eat ratings). Increased sustained processing might be linked to emotional eating tendencies rather than BN pathology per se, and reflect approach motivation, conflict, or regulatory processes. Negative mood appears to induce complex changes in food image processing, whose understanding may contribute to the development of tailored interventions in the future.

An examination of emotional eating behavior in individuals with a severe mental disorder

Emotional eating behavior is commonly accompanied by negative emotions in individuals with a severe mental disorder in community. This descriptive study has aimed to identify emotional eating behavior and the factors acting on emotional eating behavior and to investigate the relationship of uncontrolled eating and cognitive restriction scores with emotional eating behavior in individuals with a severe mental disorder followed up in community mental health centers (CMHC). The study included 130 patients with a severe mental disorder. The Emotional Eater Questionnaire (EEQ) and the Three-Factor Eating Questionnaire (TFEQ-R21) were used for data collection. The chi-square significance test and correlation analyses were used for determining the correlation of emotional eating behavior scores across independent variables. The prevalence of emotional eating behavior was 49.22% among individuals with a severe mental disorder. The mean EEQ score of the individuals was 11.74 ± 7.42. Emotional eating behavior was observed in 56.7% of individuals at ages from 35 to 49 years, in 62.5% of women, in 58.6% of individuals with a history of dieting, and in 61.2% of individuals with night eating behavior. This study has shown that emotional eating behavior can occur in individuals with a severe mental disorder independent of the diagnosis, use of antipsychotic medications, body mass index (BMI), physical exercise, and eating behavior. It was observed that emotional eating behavior was correlated with being middle-aged, being female, and night eating behavior.

Do emotions predict eating? The role of previous experiences in emotional eating in the lab and in daily life

Emotional eating is defined as an increase in eating following negative emotion. Self-reported emotional eating has been associated with physical health concerns. However, experimental and daily diary studies indicate that induced or naturally experienced negative emotions do not reliably lead to increased eating behavior in people without eating disorders, not even among self-professed emotional eaters. Emotional eating may depend on associations people have made between specific emotions and eating. We describe a set of studies with the overarching goal of determining whether accounting for the variation in people's associations between eating and different discrete emotions is the key to observing emotional eating. In both Study 1 (N = 118) and 2 (N = 111), we asked people to report on their tendency to eat following sadness and anxiety and determined how much they ate when induced to feel sad or anxious in the lab (Study 1) or experiencing these emotions in daily life (Study 2). We found no support for our hypotheses in either study; self-professed sad- or anxious-eaters did not eat more when induced to experience these emotions in the lab, or when experiencing these emotions in daily life. Thus, accounting for the variation in people's associations between eating and two discrete emotions, sadness and anxiety, is not the key to observing sad or anxious eating behavior in the lab or in daily life. Preregistration, materials, data, and code: https://osf.io/kcqej/ (Study 1) and https://osf.io/3euvg/ (Study 2).

Emotional eating and obesity in adults: the role of depression, sleep and genes

Stress and other negative emotions, such as depression and anxiety, can lead to both decreased and increased food intake. The term 'emotional eating' has been widely used to refer to the latter response: a tendency to eat in response to negative emotions with the chosen foods being primarily energy-dense and palatable ones. Emotional eating can be caused by various mechanisms, such as using eating to cope with negative emotions or confusing internal states of hunger and satiety with physiological changes related to emotions. An increasing number of prospective studies have shown that emotional eating predicts subsequent weight gain in adults. This review discusses particularly three lines of research on emotional eating and obesity in adults. First, studies implying that emotional eating may be one behavioural mechanism linking depression and development of obesity. Secondly, studies highlighting the relevance of night sleep duration by showing that adults with a combination of shorter sleep and higher emotional eating may be especially vulnerable to weight gain. Thirdly, an emerging literature suggesting that genes may influence body weight partly through emotional eating and other eating behaviour dimensions. The review concludes by discussing what kind of implications these three avenues of research offer for obesity prevention and treatment interventions.

Effects of social exclusion and maternal rejection on Children's high-caloric food consumption

Research has shown that the quality of interpersonal relationships plays an important role in influencing childhood obesity-risk behavior. However, studies conducted so far have focused mostly on self-report data. But they rarely control for the effect of experimentally-induced social rejection or perceived maternal rejection. The aim of this study was to investigate the effects of the quality of the maternal relationships as well as experimentally-induced social rejection on children's motivation to consume high-caloric food. Eighty children (8-12 years of age) and their mothers participated in an experimental study. Participants were randomly assigned to a social inclusion (acceptance) or exclusion (rejection) condition in a computer-based ball-toss game (Cyberball). After completing the Cyberball game, children were presented with high-caloric food and were evaluated on the amount of the food they consumed. Participants also completed a self-report questionnaire assessing their perceptions of their mothers' acceptance-rejection. Further, mothers' Body Mass Index (BMI) was measured, and a semi-structured interview was conducted to assess the tendency of mothers to regulate their child's stress with food. Results showed that the consumption of high-caloric food was directly influenced by the children's perceptions of maternal acceptance-rejection, and by the experience of brief, experimentally-induced social exclusion (rejection). Additionally, children's consumption of high-caloric food was related to their mothers' use of food to help regulate children's distress, and by the children's own BMI. The results document the importance of affective-relational experiences in the development of childhood obesity. The results also highlight the apparent fact that regardless of individual and family characteristics, the experience of even short-term social rejection can activate obesity-risk behaviors which deplete children's self-regulatory mechanisms, thereby resulting in more consumption of high-caloric food.