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The emotional eating scale: The development of a measure to assess coping with negative affect by eating
Abstract
The development of the Emotional Eating Scale (EES) is described. The factor solution replicated the scale's construction, revealing Anger/Frustration, Anxiety, and Depression subscales. All three subscales correlated highly with measures of binge eating, providing evidence of construct validity. None of the EES subscales correlated significantly with general measures of psychopathology. With few exceptions, changes in EES subscales correlated with treatment-related changes in binge eating. In support of the measure's discriminant efficiency, when compared with obese binge eaters, subscale scores of a sample of anxiety-disordered patients were significantly lower. Lack of correlation between a measure of cognitive restraint and EES subscales suggests that emotional eating may precipitate binge episodes among the obese independent of the level of restraint. The 25-item scale is presented in an Appendix (Arnow, B., Kenardy, J., & Agras, W.S.: International Journal of Eating Disorders, 17, 00-00, 1995). © 1995 by John Wiley & Sons, Inc.
... Additional inclusion criteria were: (a) no known contraindication for safe treatment participation, (b) no participation in another weight-management program/weight-related counseling (including self-directed) within 12 months of study start, (c) no change in a psychotropic medication or dosage within 6 months of study start, and (d) no current/soonplanned pregnancy. Additionally, and consistent with previous research concerned with EE intervention (Goldbacher et al., 2016), participants were required to have a score on the Emotional Eating Scale (Arnow et al., 1995; detailed in the Measures subsection below) in the highest tertile (33%) for adult women (regardless of BMI or any other factor that might impact propensity for high EE). Thus, the original number of volunteers who were required to have obesity as an inclusion criterion in the present research was reduced from 160 to 127 (i.e., 21% reduction, rather than 33%). ...
... Internal consistency within the present sample was α = 0.75. EE was the degree an urge to eat is provoked by negative emotions as measured by the Emotional Eating Scale (Arnow et al., 1995). Fifteen items were related to the proposed dimensions of EE, which were anxiety, depression, and anger/frustration (item examples, "nervous," "sad," "irritated," respectively). ...
... Previous research on women with obesity reported internal consistencies ranging from α = 0.72-0.79, with test-retest reliability over 3 weeks at 0.79 (Arnow et al., 1995). Convergent and discriminant validity was previously supported through Emotional Eating Scale score correspondences with scales of binge eating (Ricca et al., 2009), but no significant association with scales of general psychopathology (Arnow et al., 1995). ...
Emotional eating (EE; eating in response to negative emotions) is a considerable problem in adults with obesity. Recent meta-analyses of behavioral treatments for those with elevated body mass index (BMI) have demonstrated inconsistent, but generally minimal, effects for dealing with EE. This might largely be due to inappropriate sampling, cross-sectional research designs, and a lack of understanding of theory-driven psychosocial mechanisms of EE change. This study aimed to inform mental health, medical, and health behavior-change professionals on methods to address EE within obesity treatments. Within the present field-based research, women with high EE participated in 6-month community-based obesity treatments emphasizing either weight-management education + attention on EE (n = 34), self-regulatory skills-no attention on EE (n = 43), or self-regulatory skills + attention on EE (n = 42). Each condition incorporated physical activity for its mood-change potentials. Significant improvements in physical activity, mood, eating-related self-regulation and self-efficacy, EE, and weight were found in all groups, with greater advances occurring in the self-regulation vs. educationally focused conditions. Incorporating aggregated data, significant theory- and previous research-derived paths from changes in physical activity → mood → self-regulation → self-efficacy → EE change over 6 months, and over 12 months, were identified. Reductions in EE over 6 and 12 months predicted weight loss over 6, 12, and 24 months. Findings supported tenets of social cognitive theory, self-regulation theory, the mood-behavior model, and self-efficacy theory, and informed future behavioral obesity treatments on evidence-driven methods to better-address EE within scalable settings.
... Patients were administered the Emotional Eating Scale (EES) to assess the tendency to overfeed in response to emotional states [39]. The survey consists of a 25-item scale measuring overeating in the presence of negative emotional states related to anger, anxiety, and depression. ...
... Participants rate the extent to which certain feelings lead to the urge to eat using a 5-point Likert scale ranging from "no desire to eat" to "an overwhelming urge to eat". According to Arnow's article [39], participants were classified as high in EES if their score was ≥25, as an EES scale score greater than or equal to 25 indicates that "reliance on food to manage emotions is probably affecting the patient's quality of life". The EES showed good reliability and validity, and coefficient alphas for the validation study of 0.89 and 0.85 for the anger and anxiety subscales, respectively [39]. ...
... According to Arnow's article [39], participants were classified as high in EES if their score was ≥25, as an EES scale score greater than or equal to 25 indicates that "reliance on food to manage emotions is probably affecting the patient's quality of life". The EES showed good reliability and validity, and coefficient alphas for the validation study of 0.89 and 0.85 for the anger and anxiety subscales, respectively [39]. ...
Background/Objectives: Obesity is a major public health challenge of the 21st century, with prevalence rates steadily rising globally. Disordered eating behaviors, particularly emotional eating (EE), complicate the clinical management of obesity and hinder long-term outcomes, such as maintaining weight loss after bariatric surgery. Studies reveal that EE affects 65–75% of overweight or obese adults, and such behavior may stem from a disrupted brain reward system linked to emotional dysregulation and impulsivity. Impulsivity in obesity involves deficient cognitive inhibitory control, creating an imbalance between impulsive and reflective systems. While problematic eating behaviors and obesity are well studied, the role of affective temperaments—innate traits influencing mood, energy, and responses to stimuli—remains underexplored. This study aims to examine the interplay between emotional eating, impulsivity, and affective temperaments in obese patients preparing for bariatric surgery. Methods: A total sample of 304 obese outpatients was consecutively enrolled at the Psychiatry Clinic of the Department of Clinical and Experimental Medicine of the University of Pisa during the presurgical mental health evaluation routinely performed before the bariatric intervention. Sociodemographic and clinical data were collected by psychiatrists during a single consultation. Assessments also included the following psychometric tests: the Structured Clinical Interview (SCID-5), the Emotional Eating Scale (EES), the Barratt Impulsivity Scale-Version 11 (BIS-11), and the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego-Auto-questionnaire (TEMPS-A). Results: A significant correlation was observed between the EES total score and the BIS total score (p = 0.003), as well as with the sub-dimensions of attentional impulsivity (p < 0.001) and motor impulsivity (p = 0.024). In addition, a significant correlation has been found between the total score of EES and the cyclothymic (p < 0.001), depressive (p < 0.001), irritable (p = 0.013), and anxious (0.020) temperaments. When comparing obese patients with EE and without EE (No-EE), higher rates of both current (p = 0.007) and lifetime (p = 0.024) psychiatric comorbidities were observed in the EE group, namely for anxiety disorders (p = 0.008) and eating disorders (p = 0.014). Conclusions: Our study highlights a significant association between EE in obese patients with the cyclothymic, irritable, anxious, and depressive temperaments, and impulsivity dimension. Thus, problematic eating behaviors and temperamental traits may have a bidirectional psychopathological influence in obese patients and need to be carefully evaluated in subjects seeking bariatric surgery.
... In the original FEED study, item 8 (jittery/"ansioso") is part of the anger factor, and item 10 (uneasy/"inquieto") is part of the depression factor, but in the present study, both items loaded on the anxiety factor. Arnow and colleagues [28], when developing one of the first measures of emotional eating, found that jittery and uneasiness loaded on the anxiety factor, corroborating our findings. In line, anxiety disorder endorses a range of signs and symptoms that may include uneasiness [27]. ...
... In the original FEED study, item 12 (jealous/"enciumado") is part of the anxiety factor, and item 18 (confused/"confuso") is part of the depression factor, but both items in the present study carried the anger factor. The findings of Arnow et al. [28] support some of our results, as jealousy loaded on the anger factor and confusion loaded on both the anger and anxiety factors. An experimental study [29] showed that, in the context of romantic couples, having meals with someone provoked more jealousy than face-to-face interactions, which could generate feelings of discomfort, such as anger. ...
... Also, we used as a source the English version available in the article that developed each measure, as suggested by the original authors; however, PNEES was originally produced in an Estonian context and FEED in an Italian context. Although this may have influenced the content, the items of both measures were derived from other measures [28] already consolidated in English with the same/similar content. ...
Objective
This study aimed to cross-culturally adapt the Positive-Negative Emotional Eating Scale and the Florence Emotional Eating Drive into the Portuguese language and investigate their dimensionality (i.e., validity) for a sample of Brazilian individuals.
Methods
The cross-cultural adaptation process entailed translation, synthesis, expert committee review, pretesting, back-translation, and submission to the original authors. From the translations, synthesized versions of the measures emerged, which were evaluated by a committee of experts. Subsequently, the preliminary version was pre-tested with the target audience. A larger group of individuals completed the final Portuguese version of the instruments online, and the data were subjected to exploratory factor analysis to ascertain their dimensionality.
Results
Thirty-six individuals (female: 76.5%, mean age: 26.3±9.6 years) participated in the pretest, reporting ease in comprehending the content of both Positive-Negative Emotional Eating Scale and Florence Emotional Eating Drive. The back-translations closely resembled the originals, as confirmed by the authors of the instruments. Data from 721 individuals (female: 61.2%, mean age: 32.2±10.6 years) who completed the measures were analyzed. A two-factor model for Positive-Negative Emotional Eating Scale demonstrated a good fit, consistent with the original proposal. For Florence Emotional Eating Drive, a three-factor model akin to the original proposal emerged, with six items loading on different factors.
Conclusion
The Positive-Negative Emotional Eating Scale and Florence Emotional Eating Drive were successfully adapted to Portuguese, with Brazilian participants indicating good understanding. The dimensionality of the measures remained consistent with the original proposals. These findings offer valuable insights for future screening protocols to foster appropriate eating behaviors.
Keywords
Eating; Emotions; Factor analysis; Feeding behavior; Measures; Translating
... El Ducht Eating Behavior Questionnaire (DEBQ, por sus siglas en inglés; van Strien et al., 1986) fue el primer autoreporte que incluyó la medición de la IE como uno patrón alimentario asociado a la obesidad, este instrumento fue diseñado para población adulta. Sin embargo, la Emotional Eating Scale (EES-A, por sus siglas en inglés; Arnow et al., 1995) fue la primera escala en medir únicamente la IE, considerando tres dimensiones: Enojo/Frustración, Ansiedad y Depresión; también en adultos. En el DEBQ como en la EES-A, la IE es evaluada a partir de preguntar por modificaciones en el apetito a razón de experiencias emocionales displacenteras o ambiguas. ...
... La descripción general de los autoreportes analizados se muestra en la Tabla 1. Se analizaron los siguientes instrumentos: EES-A (Arnow et al., 1995), el Emotional Appetite Questionnaire -EMAQ, por sus siglas en inglés- (Geliebter y Aversa, 2003), el Emotional Overeating Questionnaire -EOQ, por sus siglas en inglés- (Masheb & Grilo, 2006) Tres de los instrumentos son de origen estadounidense y el resto pertenece a diferentes países. El número de reactivos que integran los autoreportes oscilan entre 6 y 36 reactivos (M = 19.5 y Md = 20) con una escala de respuesta tipo Likert, siendo de cinco opciones de respuesta la más empleada. ...
... Siete de los nueve autoreportes son multidimensionales: la EES-A (Arnow et al., 1995), el EMAQ (Geliebter & Aversa, 2003) El EMAQ (Geliebter & Aversa, 2003) incluye dos dimensiones de estados emocionales (una positiva y otra negativa) así como una de situaciones "positivas" y otra de situaciones "negativas". En el caso del CCE (Garaulet et al., 2012) sus dimensiones están más enfocadas en la IE en episodios de atracón (Desinhibición, Tipo de Comida y Culpa). ...
El interés por la ingesta emocional (IE) ha ido en aumento, así como el número de autoreportes que permiten evaluarla. El objetivo de la presente investigación fue realizar una revisión sistemática de la calidad psicométrica de los autoreportes de IE en población adulta (PROSPERO ID: CRD42022374665). La búsqueda se realizó en PubMed, Web of Science, Scopus, Springer link, Taylor & Francis, Science Direct e identificación manual considerando los lineamientos PRISMA. La calidad metodológica y de las propiedades de medida fueron evaluadas a partir de los estándares y criterios COSMIN. Fueron analizados nueve autoreportes que denotaron discrepancias conceptuales y que en su mayoría se trataron de escalas multidimensionales. Las principales evidencias de validez reportadas fueron la estructural (a través de análisis factorial exploratorio o análisis de componentes principales) y de constructo, en menor medida, algunos artículos realizaron procedimientos cualitativos como parte de la validez de contenido. En tanto a la confiabilidad, el procedimiento más empleado fue el análisis de consistencia interna (α = .77-.94) y en menor medida la estabilidad temporal. La Positive-Negative Emotional Eating Scale y la Salzburg Emotional Eating Scale obtuvieron mejores calificaciones respecto a
... A related, but distinct construct to disordered eating is emotional eating. Emotional eating is defined as eating in response to negative (e.g., depression, stress, frustration) and positive (e.g., celebration, happiness) emotions in the absence of physiological hunger (Arnow et al., 1995). While both disordered and emotional eating are considered maladaptive, emotional eating focuses on specific emotional triggers associated with an eating response, while disordered eating ranges from sub-clinical to full-threshold attitudes, cognitions, and behaviors that relate to broad eating, shape, weight, and restriction concerns. ...
... Perceived discrimination, which ranges from subtle day-to-day experiences to significant life events, is related to deleterious eating disorder symptoms in minoritized populations (Kwan et al., 2018). For example, perceived discrimination contributes to eating for reasons other than hunger among African American Women (Johnson et al., 2002), which can be conceptualized closely to emotional eating (i.e., eating in response to negative emotions) (Arnow et al., 1995). Likewise, in a sample of 104 college-aged Black Women, higher race and gender-related stress (Jackson et al., 2005) was positively associated with Body Mass Index (BMI) among students who engaged in emotional eating. ...
... Emotional Eating. The Emotional Eating Scale-Revised (EES-R, Koball et al., 2012) was reconstructed from the original Emotional Eating Scale (EES, Arnow et al., 1995) to include a separate boredom factor. The EES-R is a Likert scale measurement that assesses emotional eating in three subscales: Depression, Boredom, and Anxiety/ Anger. ...
Direct relationships between perceived discrimination and eating pathology in ethnic minorities are well-documented. However, theoretical work examining unique risk and resilience factors that strengthen or weaken the relation between these constructs in ethnic minorities is lacking. The current study aims to address this gap by incorporating stress-process and tripartite frameworks to examine social and personal resources as they relate to perceived discrimination and eating pathology. In a sample of Black, Asian, and Latine women ( N = 296, M age = 30.82), social support did not mediate the relationship between perceived discrimination and eating pathology. A significant interaction effect was observed for thin-ideal internalization strengthening the relation between perceived discrimination and negative emotional eating. Thin-ideal internalization moderated the relation between perceived discrimination and negative emotional eating in Latine Women, and disordered eating in Black Women. Overall, findings suggest ethnic minority Women have both personal and social resources that may influence the strength of effect on the relation between perceived discrimination on eating pathology.
... Research has found that emotional eating shares similar theoretical grounds and often precedes binge eating (Arnow et al., 1995;Barnhart et al., 2024). However, compared to binge-eating, emotional eating occurs in less clinical, more diffuse states (Barnhart et al., 2024). ...
... Emotional Eating Scale (EES; Arnow et al., 1995; Portuguese version by Duarte & Pinto-Gouveia, 2015): a 25-item self-report measurement that assesses the desire and urge to eat in response to different emotions, comprising three subscales: Depression, Anxiety and Anger/Frustration. The items are rated on a 5-point scale, between 0 (No desire to eat) and 4 (An overwhelming urge to eat). ...
... With regards to emotional and stress eating, restrained eaters should eat more than usually when emotional or stressed because the affective experience can lead them to abandon their strict dieting roles and disinhibit the usually suppressed eating impulse (Herman & Mack, 1975). Several trait questionnaires have been developed to measure interindividual differences in emotional and stress eating, including the emotional eating subscale of the Dutch Eating Behavior Questionnaire (DEBQ; van Strien et al., 1986), the Emotional Eating Scale (EES; Arnow et al., 1995), and the Three-Factor Eating Questionnaire (TFEQ; Karlsson et al., 2000) that all ask for individuals' perceived tendency to experience increased desire to eat when emotionally aroused. The Salzburg Emotional Eating Scale (SEES; Meule et al., 2018) and Salzburg Stress Eating Scale (SSES; Meule et al., 2018b) built on that work and aimed to overcome some shortcomings identified in earlier scales: (1) the SEES and SSES measure the effects of stress and emotions on eating behavior (rather than a desire to eat as e.g. in the DEBQ), (2) the SEES and SSES include the possibility that some people might eat less than usual when emotionally aroused/stressed, and (3) the SEES provides subscales for different specific emotions including positive ones, rather than assessing effects of global negative emotions, thereby diversifying the concept of emotional eating. ...
... While boredom has not played the most prominent role in emotional eating research, our findings are in line with some earlier studies that found boredom to predict future eating (Cleobury & Tapper, 2014;Havermans et al., 2015;Koball et al., 2012;Moynihan et al., 2015) and that individuals reporting more boredom also report more cravings . A revised version of the Emotional Eating Scale (Arnow et al., 1995) contains a subscale for boredom (Koball et al., 2012) but we did not administer this questionnaire. One item in the SEES and two items in the DEBQ cover boredom but those are then averaged with other items to form the sadness or emotional eating subscale, respectively, possibly lowering their unique predictive value. ...
... The Emotional Eating Scale (EES) (Arnow et al., 1995) assessed the intensity of participants' urges to eat in response to negative affective states (e.g., "Worried," "Blue," "Frustrated," "Guilty," "Upset"). The EES comprises 25 items that are rated on a Likert-type scale from 0 = no desire to eat to 4 = an overwhelming urge to eat and summed to create a total score. ...
... The EES comprises 25 items that are rated on a Likert-type scale from 0 = no desire to eat to 4 = an overwhelming urge to eat and summed to create a total score. The measure has demonstrated good-to-excellent internal consistency among perinatal samples (Fowles et al., 2011;Thompson & Bardone-Cone, 2022) and convergent validity with other measures of disinhibited eating, including binge eating (Arnow et al., 1995). Additionally, research supports the use of self-report measures of emotional eating as they share significant variance and agreement with objective laboratory measures (Schnepper et al., 2023). ...
... To establish valid psychometric properties within the MEQ scale, Framson et al. (2009) identified seven potential constructs or domains from previously validated scales within research contexts from eating behaviors and mindfulness (see Appendix 1 for the scale and scoring, respectively). Eating behavior scales included the Three-Factor Eating Questionnaire by Stunkard and Messick (1985), the Dutch Eating Behaviour Questionnaire by Van Strien et al. (1986), and the Emotional Eating Scale by Arnow et al. (1995). These scales covered four of the seven domains: disinhibition or deliberately eating against social principles, external cues by society such as advertising, emotional responses to food and eating, and cognitive restraint that could be differentiated from mindful eating. ...
... Emotional and external eating are defined as eating without the presence of hunger, in response to emotional triggers (e.g., most commonly sadness or anxiety in emotional eating) and eating in response to external food cues (i.e., sight, smell, or taste in external eating) [23,24]. Previous research has found relatively consistent associations between emotional and external eating and negative diet-related outcomes. ...
Background: Fruit and vegetable (FV) intake is critical for optimizing pregnancy outcomes. Several socio-demographic factors are associated with FV intake, but less is known about behavioral and mental health correlates. Furthermore, existing knowledge is largely based on self-reported FV intake. The current cross-sectional study examined depressive symptoms and income as moderators of the association between eating behaviors and skin carotenoids (FV status biomarker) in pregnancy. Methods: Participants living in an urban area of the south-astern part of the U.S. (N = 299) and who were in their third trimester of pregnancy were recruited for lab visits between 2019 and 2022 and completed the Dutch Eating Behavior Questionnaire and the Center for Epidemiological Studies Depression Scale. FV status was assessed using a pressure-mediated reflection spectroscopy to determine skin carotenoids. Hypotheses were tested via multiple regression. Results: There was an interaction between dietary restraint and depressive symptomatology such that greater restraint predicted higher skin carotenoids at low levels of depressive but not high levels. There was an interaction between restrained eating and family income in predicting skin carotenoids that was significant at high- but not low-income level. External and emotional eating did not predict skin carotenoids. Conclusions: Restrained eating might positively influence skin carotenoids during pregnancy. However, those who suffer from higher levels of depressive symptoms and/or live in lower-income households face additional barriers that might impede FV status. Further research is warranted to advance our understanding of the interplay between mental health, restrained eating and income on FV status in pregnancy.
... Based on the bulimia scale (BS) in the Japanese version of EDI-91, five items with high factor loading were selected to evaluate overeating. Moreover, to measure depressive moods, the "Depressive Eating Scale" in the "Emotional Eating Scale" [17] was revised to the "Depressive Mood Scale" (DMS; e.g., "I have depressed feelings, " "I feel uneasy, " "I feel sad"). For CICBS, BS, and DMS, they evaluated three periods, including the first state of declared emergency, in Japan. ...
Although the pandemic was adequately managed in Japan, mental health problems, such as school refusal and obesity, continue to increase among adolescents and adults in Japan. This study focuses on how health locus of control (HLOC) prior to the COVID-19 pandemic and dietary style may have impacted COVID-19 infection control and their role in the continuation of psychological burden and exhaustion. Specifically, it looks at how pre-pandemic healthcare and parenting styles influenced the burden of COVID-19 infection control through diet and were associated with depressed mood and overeating tendencies in parents of adolescents and young adults. In December 2022, this study was focused on pre-pandemic dietary habits, health management, and parent–child communication and a web survey was conducted among 908 parents with children in junior to senior high school living in metropolitan areas with a population of more than 1 million to determine their depressive mood and tendency to overeat. The results revealed that mothers had a higher burden of COVID-19 infection control than fathers in all three periods, although the fathers’ burden of infection control was more strongly associated with their depressive mood and tendency to overeat from 2020 to 2022. With regard to the HLOC, internal attribution type was negatively associated with infection control fatigue in both fathers and mothers. The attribution style “family” was associated with increased family bonding during the pandemic, whereas both fathers and mothers were more sensitive to food safety, increasing the burden of infection control.
... Emotional Eating Scale (EES) [25]. The EES is a 25-item scale designed to assess the tendency of individuals to eat in response to negative emotional stimuli-e.g., "sad", "guilty", "bored"-with three subscales of anger/frustration, anxiety, and depression. ...
Objectives: This study aimed to develop a gender-specific model to understand the causal relationship between body image dissatisfaction, emotional eating, and suicide risk among bariatric surgery patients. A secondary objective was to evaluate gender differences in the associations between these variables. It was hypothesized that, independent of objective weight loss, body dissatisfaction and emotional eating would lead to increased suicide risk. Methods: A total of 109 participants completed self-report measures of suicidal ideation, body image dissatisfaction, and emotional eating before and after bariatric surgery. Results: Cross-lagged analysis indicated that pre-surgery suicide ideation significantly predicts body dissatisfaction primarily among men, independent of the extent of weight loss. High levels of pre-surgery suicide risk correlated with post-surgery body image dissatisfaction in men. The autoregressive effect of suicide ideation was stronger than that of body dissatisfaction for both genders; however, the latter was stronger among women, indicating that past dissatisfaction levels significantly influenced future dissatisfaction. Conclusions: The complex interplay between gender, body dissatisfaction, emotional eating, and suicide risk warrants further research.
... The Emotional Eating Scale (EES), developed by Arnow et al. (1995), examines the relationship between negative emotions and food intake. It consists of 25 distinct emotions. ...
The purpose of the present study was to examine the efficacy of online Dialectical Behavior Therapy for Binge Eating Disorder (DBT-BED) in reducing eating psychopathology and investigate the factors that influence the severity and frequency of binge eating. Seventy-three individuals seeking treatment for BED participated in 20 two-hour group sessions. Participants completed the Emotional Eating Scale (EES), Binge Eating Scale (BES), and Eating Disorder Examination Questionnaire (EDE-Q) before and after the treatment and at three- and six-month follow-ups. Results from 58 participants were analyzed. The study results indicated a significant decrease in objective binge eating (OBE) days, as well as in all EES, BES, and EDE-Q subscales (except the Restraint subscale), and global EDE-Q score at the end of treatment and follow-ups. Moreover, the Body Mass Index (BMI) reduced at the end of treatment and during the follow-up period. Except for the Restraint subscale, more OBE days were linked with higher EES, BES, and EDE-Q scores. Overall, the study suggests that online DBT-BED is an effective approach to treating Binge Eating Disorder (BED) for individuals who cannot receive in-person therapy. Further research is necessary to compare the efficacy of online DBT-BED with other interventions.
... The measurement tools used in this study were the Emotional Eating Scale (EES) and a selfrecording of emotional eating behavior in daily life. The Emotional Eating Scale (EES), designed by Arnow, Kenardy, and Agras (1995), measures the desire to eat in response to negative emotions. EES is a self-report inventory with 25 items and consists of three subscales: feelings of anger/frustration, anxiety, and depression. ...
Emerging adulthood is a transitional period from adolescence to adulthood characterized by instability in roles and relationships as individuals navigate the demands of higher education, employment, intimate relationships, and self-identity formation. This transition often triggers various negative emotions, such as anxiety, distress, and self-doubt, particularly in women, making them more susceptible to engaging in emotional eating as a means of seeking temporary comfort or distraction. Emotional eating is a mechanism for temporary emotional relief, but feelings of regret or guilt often follow it. Emotion regulation skills are crucial when experiencing negative emotions. This study aims to demonstrate the effectiveness of Dialectical Behavior Therapy (DBT), an intervention designed to enhance emotion regulation skills, in reducing the occurrence of emotional eating among emerging adult women. The study employed a single case experiment design with two 21-year-old female participants experiencing emotional eating. The Emotional Eating Scale (EES) and emotional eating self-recording were used as measurement tools. Each participant received DBT over 7 sessions, each lasting 60-90 minutes. The results indicated that DBT reduced the frequency of emotional eating in both participants, with the effect persisting up to 14 days post-intervention. These findings suggest that DBT is an effective intervention for reducing emotional eating in emerging adult women.
... Emotional eating is commonly defined as the tendency to eat in response to negative emotional states or stress (Arnow, Kenardy, & Agras, 1995;van Strien et al., 2007). This behavior has been studied in a wide range of contexts and demographics, particularly in relation to body weight and weight management (Dakanalis et al., 2023;Frayn, Livshits, & Knäuper, 2018;Limbers & Summers, 2021;Smith, Ang, Giles, & Traviss-Turner, 2023;Vasileiou & Abbott, 2023), psychological distress, and specifically as a mediator of the effects of depression and anxiety on weight gain (Dakanalis et al., 2023;Konttinen, van Strien, Mannisto, Jousilahti, & Haukkala, 2019;van Strien, Konttinen, Homberg, Engels, & Winkens, 2016;. ...
This study aims to examine in depth the relationship between emotional eating and mindful eating in the light of the opinions of professionals from different disciplines (dieticians, psychological counselors and psychologists). In the study, the reasons for the emergence of emotional eating, the factors that sustain it and the potential effects of mindful eating on this situation were examined through one-on-one interviews with participants from these three different professional groups. Seventeen open-ended questions were asked to the participants within the scope of emotional eating, awareness and mindful eating. The study, which adopts the phenomenological design from qualitative research methods, contributes to the development of a more comprehensive understanding of this subject by revealing the psychological, social and biological factors underlying emotional eating. The research results show that emotional eating is closely related to individuals' emotional states, thought patterns and environmental factors and that mindful eating is an effective strategy in coping with emotional eating.
Questionnaire measures of negative emotional eating (NEE) have been associated with elevated body mass index (BMI). Relatively fewer studies have examined positive emotional eating (PEE) and they report that PEE is associated with lower BMI or is not associated with BMI. To examine whether NEE and PEE are linked to BMI, we conducted a systematic review and meta-analysis of studies that used the Emotional Appetite Questionnaire (EMAQ) and the Salzburg Emotional Eating Scale (SEES), which assess change in eating associated with positive and negative emotions, and measured BMI in adults with a range of BMIs. A search of databases (CINAHL Medline, and PsycINFO), citations (Google Scholar) and dissertations (Proquest), and a preprint registry (Open Science Framework, OSF) was conducted independently by three screeners. Forty-three cross-sectional studies were eligible for inclusion. Correlations between BMI and NEE scales and PEE scales were extracted. Age and sex were examined as potential moderators. We found statistically significant (ps < .001) and small mean effect sizes with random-effects models. Higher EMAQ NEE (d = .152 [.11, .19], N = 18,576) and SEES NEE scales (sadness, d = .209 [.168, .250]; angry, d = .096 [.047, .144]; anxiety, d = .169 [.124, .211], N = 4141) were associated with higher BMI. The EMAQ PEE (d = −.073 [-.106, −.041], N = 18,806) and the SEES happy (d = −.157 [-.100, −.114], N = 4141) scales were associated with lower BMI. There was significant heterogeneity in effect sizes for PEE and NEE; however, there was no statistically significant moderation by age or sex. There was also no evidence for publication bias except for SEES sadness. This analysis is limited to cross-sectional questionnaire-based studies. NEE may be associated more strongly than PEE with emotional regulation difficulties and overeating of energy-dense foods which may be why it is associated with higher BMI.
link: https://kwnsfk27.r.eu-west-1.awstrack.me/L0/https:%2F%2Fauthors.elsevier.com%2Fa%2F1kpVCiVKTozFl/1/01020195c74b245c-907ddd78-96ce-413e-84c9-e66d62323994-000000/ApvFxzUY3G20NDT1kgStHrxWV8Q=418
In the present study, a Japanese version of the Short Boredom Proneness Scale (SBPS) was developed, and its reliability and validity were examined. In addition, the effects of boredom proneness on eating behaviors, such as emotional eating and intuitive eating, were examined. In study 1,208 men and women completed the questionnaire. Confirmatory factor analysis revealed that the Japanese version of the SBPS had a one-factor structure similar to the original version, and the reliability and validity of the Japanese version of the SBPS were demonstrated. In study 2,782 men and women completed the questionnaire. A hierarchical multiple regression analysis indicated that the more easily bored one was, the more likely one was to engage in emotional eating. Regarding the moderating effect of emotion regulation strategies, the function of emotion regulation differed depending on sex and the characteristic factors of boredom. The results of this study suggest that by accounting for the characteristic factors of boredom, effective interventions for eating behavior may be enabled by accounting for the characteristic factors of boredom.
Background and Aim: Emotional eating (EE) is the uncontrollable desire to eat in response to negative emotions such as anxiety, irritation, or depression. The 2019 coronavirus (COVID-19) pandemic and strict quarantine raised the likelihood of mental symptoms and, as a consequence, EE. The main objective of this study was to assess the extent of EE and mental health among Lebanese university students and to identify the main correlates of EE.
Methods: A cross-sectional study was undertaken between March and April 2021. Overall, 356 Lebanese university students aged between 18 and 25 years completed an online questionnaire that assesses EE and mental state, as well as health and eating habits.
Results: The total mean EE score was 33.82 (±8.52). The main predictors of EE among university students were a higher grade point average (GPA) (p=0.010), higher body mass index (BMI) (p<0.001), consuming more fats (p=0.013), and eating more sweets and cookies (p=0.010). In addition, depression, anxiety, and stress were highly prevalent among Lebanese university students during the pandemic (43.8%, 51.7%, and 91.6%, respectively).
Conclusion: This study provides evidence of the negative impact of the COVID-19 outbreak on emotional well-being and eating behaviors among Lebanese university students. Targeted nutrition education programs that address the cultural and economic realities of Lebanese students, as well as psychological counseling offered by the universities, would be of interest to improve the diet quality and emotional well-being of the students.
Introduction: Autism and ADHD shape behaviours related to food, exercise, and body image, potentially influencing obesity treatment outcomes, as seen in eating disorder research. Resultantly, autistic and ADHD patients with obesity may have distinct experiences and differences compared to non-autistic and non-ADHD patients. This review maps existing literature on autism and ADHD in adults with obesity. Methods: Following PRISMA guidelines, six databases (Embase, MEDLINE, PsycINFO, Web of Science, CENTRAL, and Scopus) were searched for studies on autism and/or ADHD (diagnosed, probable, or traits) in adults with obesity. Screening and data extraction were conducted twice independently for each record. Results: Thirty-one studies were included, with 1,027,773 participants. Two case reports described successful use of weight loss drugs in autistic people with obesity. Eight prevalence studies suggested ADHD is overrepresented in obesity, regardless of binge eating status. Nineteen studies examined clinical profiles: ADHD patients had lower socioeconomic status, poorer health-related quality of life, increased impulsivity, cognitive inflexibility, and neuroticism, alongside lower agreeableness, conscientiousness, self-directedness, and cooperativeness. ADHD patients also exhibited higher psychopathology, problematic alcohol use, and disordered eating. Eight studies assessed treatment responses, noting poorer outcomes from behavioural programs and obesity pharmacotherapy, but similar post-surgical weight outcomes, despite increased complications. Two studies considered ADHD-specific treatment adaptions, one reporting a successful trial of ADHD medication for weight loss and the other reporting on switching to transdermal ADHD medications after bariatric surgery. Conclusions: This review underscores the need for more research on autism and obesity. For ADHD, findings suggest frequent co-occurrence with obesity, but lived experiences and tailored interventions remain underexplored.
Background
A sense of loss of control over eating, such that eating occurs despite the intent not to, is common in people with obesity and eating disorders such as binge eating disorder and bulimia nervosa. Currently, options for management of loss of control eating are limited. We recently determined that the pro-drug N-acetylcysteine (NAC) reduces compulsive-like eating in a rat model of diet-induced obesity. We will now conduct a single site, open-label pilot study to examine the feasibility of a randomized controlled trial (RCT) of NAC for loss of control eating in humans.
Methods
Thirty-six adult volunteers with loss of control eating will be enrolled. All participants will receive NAC at a dose of 1200 mg orally twice daily for 12 weeks. Eating behaviors and triggers will be assessed before and after the NAC treatment period using questionnaires (Eating Loss of Control Scale, Palatable Eating Motives Scale: Coping Subscale, Food Craving Inventory, Reward-Based Eating Scale, Perceived Stress Scale, and Emotional Eating Scale) and ecological momentary assessment (EMA). The primary outcomes of this feasibility study are recruitment rate, participant retention rate at week 12, and medication adherence. The secondary outcome is change in Eating Loss of Control Scale score from baseline to week 12. Exploratory data will be collected on the change in eating behaviors from baseline to week 12. Although EMA can provide real-time data on eating behaviors compared with retrospective questionnaires, it relies on repeated daily measurement for long periods which can affect participant’s adherence to study protocol. Therefore, this feasibility study will assess the performance of EMA versus retrospective questionnaires and will determine which approach suits the purposes of the research.
Discussion
The results of this study will inform the feasibility of a RCT of NAC for loss of control eating using EMA.
Trial registration
This study was prospectively registered with the Australian and New Zealand Clinical Trials Registry in June 2022 (ACTRN12622000902796).
Objective
The objective of this study was to identify pretreatment predictors of weight loss in a 12‐month behavioral obesity treatment that restricted either fat or carbohydrates.
Methods
Participants were 436 adults with overweight or obesity from the Diet Intervention Examining The Factors Interacting with Treatment Success (DIETFITS) trial. Signal detection analysis was used to identify which combinations of 51 pretreatment demographic, clinical, behavioral, and psychosocial variables, along with diet type (healthy low‐fat vs. healthy low‐carbohydrate), formed subgroups that varied in proportion of those achieving at least 5% weight loss at 12 months.
Results
Overall, 51% of participants achieved at least 5% weight loss at 12 months, with eight subgroups identified through signal detection. Diet type was not a key factor. Among racial and ethnic minority participants, the best predictors of weight loss were lower levels of emotional eating, less friend discouragement, and presence of metabolic syndrome. Among non‐Hispanic White participants, the best predictors were high confidence in participating fully in the intervention, more family encouragement, and lower outcome expectations.
Conclusions
We found that psychosocial and clinical factors, along with race and ethnicity, successfully differentiated subgroups that varied in their 12‐month weight loss. Given the heterogeneity in response to behavioral obesity treatment, these results can help generate hypotheses to move intervention science toward a precision medicine approach by matching individuals to their most suitable obesity treatments.
The Behavioral Susceptibility Theory posits that food approach/avoidance traits are key genetic contributors to obesity and disordered eating. The genetic tendency to approach/avoid food may manifest with emotional eating (i.e., over or under-eating in response to emotional cues). Research indicates that emotional eating (EE) affects long-term success after bariatric surgery, but findings focus mainly on the tendency to overeat in response to negative emotions. The current study examined the role of both emotional over- and under-eating within a pre-bariatric sample, and their association with psychosocial outcomes. Using Latent Class Analysis, responses from 446 participants (74.3% female; 71.5% White, 12.1% African American, 10.3% Hispanic, 4.1% multiracial, 1.1% Other/Unreported; MAge = 42.38, MBMI = 49.15 kg/m2) on the emotional eating subscales of the Adult Eating Behavior Questionnaire were analyzed to identify EE patterns. Participants also responded to measures of emotional distress, quality of life, and disordered eating (e.g., night eating, binge eating, and avoidant/restrictive food intake disorder). A four-class solution emerged: (a) emotional over- and undereating (EOE-EUE; 14.4%), (b) emotional overeating (EOE; 25.3%), (c) emotional undereating (EUE; 26.0%), and (d) non-emotional eating (non-EE; 34.3%). Consistent with previous research, the EOE-EUE class exhibited high levels of psychosocial impairment, and emotional eating classes exhibited higher levels of disordered eating compared to the non-emotional eating class. These findings provide a more nuanced understanding of EE within a pre-bariatric population by identifying patterns of both over- and under-eating within individuals and differentially identifying risk factors associated with such patterns. Limitations include the lack of a non-surgery-seeking comparison group, the potential for response biases, and the reliance on cross-sectional data.
Rationale
Obesity is an increasing medical issue not responding well to behavioural treatments beyond their initial weeks/months.
Aims and Objectives
Before suggesting surgical or pharmacological interventions, medical professionals might consider referrals to cost‐effective, community‐based behavioural treatments if stronger theoretical/empirical bases were demonstrated. Thus, evaluation of such is warranted.
Method
Women with obesity were randomly assigned to 6‐month treatments emphasizing either behavioural theory‐based methods focused on exercise‐associated psychological changes generalizing to dietary changes ( n = 101), or typical instruction in weight‐control methods ( n = 53). Theory‐driven psychosocial, behavioural and weight changes were assessed over 12 months.
Results
Improvements in all measured variables were significantly greater in the behavioural theory group. In the evaluation of hypothesized theory‐based relationships–which have overarching bases in social cognitive theory–(1) self‐efficacy theory was supported by self‐regulation‐associated increases in self‐efficacy predicting later positive changes in exercise and the diet; (2) coaction theory was reinforced by the identified transfer of changes in self‐regulation of exercise to self‐regulation of eating; (3) the mood‐behaviour model was sustained by improved mood predicting exercise and dietary improvements through (mediated by) self‐regulation changes; (4) self‐regulation theory was bolstered through early improvements in self‐regulation supporting its longer‐term increase, especially under conditions of self‐regulatory skills practice and (5) operant conditioning theory was supported through results indicating a reinforcing effect from exercise‐associated mood improvement to reduced emotional eating. Across the theories, relationships among tested variables were generally stronger in the behavioural theory group. Improvements in exercise and dietary behaviours were significant independent predictors of reduced weight.
Conclusion
Findings support the addressed behavioural theories within a community‐based obesity treatment model that emphasized exercise for its psychosocial impacts on dietary behaviours and sustained weight loss. Based on the present empirical supports, medical professionals should consider referral to such approaches before (or in combination with) surgical or pharmacological methods.
Introduction
The present study aims to investigate the relationship between social-media pressure, the tendency to internalize standards of beauty and attractiveness associated with thin bodies, which subsequently leads to distortion of body shape perceptions, and restrictive and emotional eating behavior disorders.
Methods
A survey-based research design was employed, utilizing an online questionnaire to collect data. The study sample consisted of 614 students, selected from the most prestigious universities in Bucharest. The questionnaire incorporated validated scales measuring Socio-Media Pressure for a Thin Body Image (SMPTB), Body Appreciation (BA), Body Shape Perception (BSP), Restrained Eating Behavior (REB), and Emotional Eating Behavior (EEB).
Results
The results confirmed the hypotheses of the research, meaning food restrictions are a way to diminish the level of dissatisfaction with body shape, to reduce the difference between the ideal body shape and the real one. Food restrictions are perceived as natural behaviors, appropriate to support the standards of beauty and attractiveness specific to this historical stage. Emotional eating disorders emerge as a way to compensate for the discomfort generated by low body esteem.
Discussion
The results underscore the pervasive influence of social media in shaping eating behaviors and body image perceptions. Food restrictions, framed as natural responses to societal pressures, highlight the need for interventions addressing the normalization of harmful beauty standards. Emotional eating behaviors reveal the psychological toll of body dissatisfaction, emphasizing the importance of strategies to foster positive body image and mental well-being. These findings provide a foundation for developing educational campaigns and therapeutic approaches targeting the psychological impact of social media on eating behaviors.
The 2019 coronavirus (COVID-19) pandemic and strict quarantine increased the likelihood of mental symptoms and abnormal eating behaviours. This study aimed to assess the magnitude of emotional eating (EE) among nurses working in Lebanese hospitals and its association with mental health. A cross-sectional study was conducted among nurses aged between 18 and 50 years working in Lebanese hospitals during the COVID-19 outbreak and the economic crisis. A total of 303 nurses consented to participate. The mean EE score was 28.56 (±8.11). The results of this study revealed that 53.8% of the nurses reported depression, 58.1% suffered from anxiety and 95.1% experienced either moderate or severe stress. The study concluded that females (β = 8.112, P = 0.004), non-smokers (β = –4.732, P = 0.01) and depressed nurses (β = 0.596, P = 0.046) had a higher tendency towards EE. Additionally, it was found that EE was associated with weight gain (β = 6.048, P = 0.03) and increased consumption of fried foods (β = 5.223, P = 0.001). Females experienced more stress (β = 2.244, P = 0.003) and anxiety (β = 1.526, P = 0.021) than their male counterparts. With regard to mental health, depression was associated with weight gain (β = 2.402, P = 0.003) and with lower consumption of healthy foods such as nuts (β = –1.706, P = 0.009) and dishes prepared with sofrito sauce (β = –1.378, P = 0.012). These results can help the health authorities to design preparedness plans to ensure proper mental and physical well-being of nurses during any unforeseen emergencies.
Objective
The present study aimed to examine: (a) whether distinct momentary emotion dysregulation dimensions differentially mediated momentary associations between affect and disordered eating behaviours (DEBs) in the natural environment; (b) whether these associations differed based on affect, emotion dysregulation, and DEB type.
Method
150 women with eating disorder pathology ( M age = 20.95, SD = 4.14) completed 4 surveys targeting affect, emotion dysregulation, and DEBs each day for a 10‐day ecological momentary assessment period. Multilevel structural equation models examined whether four momentary emotion dysregulation dimensions (difficulties with emotional and behavioural modulation, lack of emotional acceptance, awareness, and clarity) mediated momentary associations between negative and positive affect (PA), and loss of control eating, overeating, and dietary restriction.
Results
Momentary difficulties with emotional and behavioural modulation mediated momentary associations between negative affect (NA) and women's loss of control eating and overeating. These findings did not extend to PA, the other emotion dysregulation dimensions, or dietary restriction.
Conclusions
Collectively, these results support emotional and behavioural modulation deficits in the natural environment as potential transdiagnostic maintenance mechanisms of overeating and loss of control eating. These findings also support the potential benefits of targeting NA and this type of emotion dysregulation in existing and novel real‐time eating disorders interventions.
Background
Hypoactive Sexual Desire Disorder (HSDD) is a frequent sex-related problem in women; however, a specific tool to characterize HSDD subtypes based on sexual inhibitory and excitatory factors is still lacking.
Aim
(1) To find a cutoff value in Sexual Inhibition Scale (SIS)/Sexual Excitation Scale (SES) scores predicting a diagnosis of HSDD in women consulting for sexual symptoms, (2) to explore the sexual inhibitory and excitatory profiles in women referred to a clinic for female sexual dysfunction by stratifying the sample according to the newfound cutoffs, and (3) to identify biopsychosocial factors significantly associated with the 2 profiles.
Methods
An overall 133 women consulting for sexual symptoms were retrospectively evaluated for clinical, biochemical, and psychosexologic data collected at the first visit. A subgroup of 55 women treated with transdermal testosterone was retrospectively analyzed at baseline and the 6-month visit.
Outcomes
Patients underwent physical and laboratory examinations and completed the SIS/SES, Female Sexual Function Index, Female Sexual Distress Scale–Revised, Emotional Eating Scale, and Middlesex Hospital Questionnaire.
Results
Specific cutoffs for SIS1 (≥32.5; indicating threat of performance failure) and SES (≤46.5) predicted HSDD diagnosis with an accuracy of 66.4% (P = .002) and 68.7% (P < .0001), respectively. Patients with impaired SIS1 scores showed higher distress and psychopathologic symptoms, while those with impaired SES scores demonstrated lower desire and arousal and a negative association with some metabolic and hormonal parameters. SES score also showed a significant predictive value on testosterone treatment efficacy for HSDD.
Clinical Translation
A better characterization of HSDD would enable individualized treatment based on the main underlying etiologies.
Strengths and Limitations
Limitations of the study include the small sample size and cross-sectional retrospective design, with the choice of treatment for HSDD limited to transdermal testosterone. Strengths comprise the thorough and multifactorial evaluation of every aspect potentially affecting inhibitory and excitatory components of sexual desire.
Conclusion
Validated cutoffs of SIS/SES scores could allow deep characterization of women diagnosed with HSDD, thus ensuring better tailoring of therapy and prediction of the probability of response to specific treatments.
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.
Objective
Binge eating disorder (BED), although relatively recently recognized as a distinct clinical syndrome, is the most common eating disorder. BED can occur as a separate phenomenon or in combination with other mental disorders, adding to the overall burden of the illness. Due to the relatively short history of recognizing BED as a distinct disorder, this review aimed to summarize the current knowledge on the co-occurrence of BED with other psychiatric disorders.
Method
This review adhered to the PRISMA guidelines. Multiple databases, such as MEDLINE, MEDLINE Complete, and Academic Search Ultimate, were used to identify relevant studies. Of the 3766 articles initially identified, 63 articles published within the last 13 years were included in this review. This systematic review has been registered through INPLASY (INPLASY202370075).
Results
The most frequently observed comorbidities associated with BED were mood disorders, anxiety disorders and substance use disorders. They were also related to more severe BED presentations. Other psychiatric conditions frequently associated with BED include reaction to severe stress and adjustment disorders, impulse control disorder, ADHD, personality disorders, behavioral disorders, disorders of bodily distress or bodily experience, and psychotic disorders. Additionally, BED was linked to suicidality and sleep disorders.
Discussion
The findings highlight the interconnected nature of BED with various psychiatric conditions and related factors, shedding light on the complexity and broader impact of BED on mental health and the need for appropriate screening and appropriately targeted clinical interventions.
Eating disorders are chronic abnormalities in eating or eating-related activities, causing severe impairments in psychosocial functioning and physical health. The global prevalence of eating disorders has increased, with women accounting for a greater proportion. Emotional dysregulation and emotional processing deficiencies contribute to ED psychopathology. Binge eating disorder (BED) is associated with co-morbid mental health conditions. This study examines the incidence of emotional eating disorders among working women professionals in Kolkata, revealing the prevalence of emotional eating, stress, nutritional problems, and eating disorders. This research highlights the prevalence of eating disorders and perceived stress among women working professionals, which can be addressed through awareness and management strategies.
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.
Introduction
Depressive and anxious symptoms and maladaptive eating behaviors fluctuate with stressful events for patients seeking bariatric surgery. These associations are less clear for patients postoperatively. Using the COVID-19 pandemic as a frame, we examined associations between changes in depressive and anxious symptoms and maladaptive eating behaviors between up to four years postoperatively.
Methods
Participants (N = 703) who underwent surgery between 2018 and 2021 completed web-based questionnaires between 2021 and 2022. Demographic and surgical data were obtained from electronic health records. Participants reported whether depressive and anxious symptoms increased or were stable/decreased during the COVID-19 pandemic, and completed eating behavior measures.
Results
Many participants reported increased depressive (27.5%) and anxious (33.7%) symptoms during the COVID-19 pandemic. Compared to those who reported stable or decreased symptoms, these participants were as follows: (1) more likely to endorse presence of binge, loss-of-control, graze, and night eating; (2) reported higher emotional eating in response to anger and frustration, depression, and anxiety; and (3) reported higher driven and compulsive eating behaviors. Frequency of binge, loss-of-control, graze, and night eating episodes did not differ between groups (e.g., increased vs. stable/decreased anxious symptoms) among participants who endorsed any episodes.
Conclusion
A large portion of the sample reported increased depressive and anxious symptoms during the COVID-19 pandemic, and these increases were associated with maladaptive eating behaviors. Depressive and anxious symptoms and eating behaviors should be assessed postoperatively as significant stressors may be associated with increased distress and maladaptive eating behaviors that can affect postoperative outcomes. Postoperative interventions may be useful at simultaneously targeting these concerns.
Graphical Abstract
The aim of this study was to evaluate behavioral mediators of relationships between increased self-regulation of eating and weight loss so that findings on psychosocial correlates of treatment-associated weight change could be extended. Participants were women enrolled in 6-month community-based obesity treatments using primarily self-regulatory (SR-treatment, n = 52) or education-focused (Didactic training, n = 54) methods. Changes from baseline in self-regulation of eating, self-efficacy for controlled eating, emotional eating propensity, exercise, and the diet were first calculated. There were significant overall improvements in each psychosocial and behavioral measure, and weight. Except for emotional eating change from baseline–Month 12, improvements were each significantly greater in the SR-treatment group. Mediation of the relationships of change in self-regulation with 6-, 12-, and 24-month weight changes, by changes in self-efficacy and emotional eating, were significant, R ² s = .19–.26, ps < .001. Only changes in emotional eating over 6 and 12 months were significant mediators. Mediations of the same self-regulation-weight change relationships by changes in exercise and the diet were also significant, R ² s = .19–.28, ps < .001, and only changes in exercise over 12 and 24 months were significant mediators. Although group membership did not moderate effects on weight, substitution of sweets for the (composite) diet demonstrated it to be a significant mediator over 6 and 12 months. In women with obesity, self-regulation improvement was associated with short- and longer-term weight loss through changes in emotional eating, exercise, and sweets consumption. Thus, behavioral treatments will benefit from targeting those variables.
Behavioral obesity treatments are typically unable to facilitate meaningful weight loss beyond the short term. Implications of malleable psychosocial factors are unclear, which limits behavioral intervention contents. The current aim was to inform obesity treatments to improve their foci on psychosocial factors leading to resilient behavioral changes and maintained weight loss.
Based on pre-planned analyses, women participating in a community-based obesity treatment emphasizing self-regulation and exercise, and who lost at least 3% of their initial weight (N = 89), were measured on eating-related self-efficacy, negative mood, emotional eating, body satisfaction, and self-regulating eating at baseline, Month 3, and Month 6; and on weight change over 12 months.
From baseline to Month 6, there was a significant overall improvement in each psychosocial variable. In separate multiple regression equations, scores at (1) Month 6, (2) change from baseline to Month 6, and (3) change from Month 3 to Month 6 were entered as predictors of maintained weight loss from Month 6 to Month 12. Using a backward elimination process, only negative mood was retained in the final Month 6 model, and significantly predicted maintained weight loss (R2adjusted = .03, p = .050). Changes in self-efficacy, mood, emotional eating, and self-regulation were retained in the final baseline to Month 6 model, and significantly predicted weight loss maintained over 12 months (R2adjusted = .30, p < .001).
Findings add to research on obesity treatment development by suggesting an enhanced focus on facilitating changes in self-efficacy, mood, emotional eating, and self-regulation may enhance maintenance of lost weight (or increase weight loss).
Objective
This study aimed to investigate the mediating effects of caregiver responses to a child’s negative emotions on the associations between infant temperament and emotional overeating in preschool children.
Method
A sample of 358 children and their caregivers enrolled in the STRONG Kids 2 (SK2) birth cohort study (N = 468) provided data for this analysis. Caregivers completed questionnaires assessing child temperament at 3 months, caregiver response to negative emotions at 18 months, and child emotional overeating at 36 months. Structural Equation Modeling was conducted using the lavaan package in RStudio to test hypothesized models examining whether the relations between early temperament and subsequent emotional eating were mediated by caregiver responses to a child’s emotions.
Results
Findings revealed that infant temperamental orienting/regulation predicted the later development of emotional overeating through supportive caregiver responses to a child’s negative emotions. Lower levels of orienting/regulation were associated with greater emotional overeating, explained by less supportive caregiver responses to the child’s emotions. Moreover, infant surgency had a positive direct influence on emotional overeating at 36 months. Both supportive and non-supportive caregiver responses to a child’s negative emotions had significant direct influences on emotional overeating.
Conclusion
The results highlight the importance of caregiver response to a child’s negative emotions as a mediator between infant temperament and emotional overeating in preschool children. Intervention strategies can be implemented to support caregivers in adopting supportive responses to their child’s negative emotions to promote healthy eating behaviors from early childhood. Future studies are needed to explore these pathways of influences throughout child development.
In this study we examined the effects of anxiety and food deprivation on the amount of food consumed ad lib by dieters and nondieters. Eighty female college students served as subjects in an ostensible market research study in which an anxiety manipulation was embedded. Reassignment of the subjects to anxiety condition on the basis of self-reported anxiety produced a significant (p < .02) three-way interaction among level of anxiety, food deprivation, and dieting status. The results suggest that (a) for nondieters, anxiety suppresses hunger but has no effect when subjects are not initially hungry, and (b) for dieters, anxiety increases eating only when the subject is initially hungry. These results are interpreted in terms of Herman and Polivy's (1984) boundary model of eating.
During the past decade much research on eating disorders has been devoted to instrument development. Herman and Polivy's 10-item Restraint Scale has been the most widely used instrument, but it has both conceptual and psychometric limitations (Ruderman, 1986). To improve the measurement of restraint, and to combine it with the concept of latent obesity, Stunkard and Messick (1982, 1985) used itemselection and factor-analytic techniques to develop their Eating Inventory (EI). The current paper reports a factor analysis of this instrument on a large sample (N = 442) of relatively unselected, adult women (age 25–40). The results confirm the EI's Dietary Restraint and Perceived Hunger factors. However, the Disinhibition factor split to form two new factors: Weight Lability and Emotional Eating. The Emotional Eating factor may be particularly important because of the growing body of evidence that emotions–perhaps even more than cognitions–affect the eating of obese individuals. The Weight Lability factor was able to differentiate between two obese subgroups, suggesting that it may be useful in research on obesity.
Do emotions influence the eating patterns of obese individuals? This paper reviews 30 years of clinical and experimental research in order to answer this question. The result is a picture of considerable complexity in which emotions appear to influence eating by obese subjects, but only if individual variability and several qualities of emotional eating are considered. That is, unlike Kaplan and Kaplan's (1957) simplistic anxiety-reduction model, current research indicates that individual differences in food choice and in type of emotion precipitating eating need to be considered. In addition, secrecy surrounding the eating and an episodic quality related to overall level of stress need to be taken into consideration. When these parameters are included, it appears that in certain emotional situations obese people eat more than normal-weight individuals. Such eating appears to have an affect-reducing effect, especially for negative emotions such as anger, loneliness, boredom, and depression. Problems with current research including methodological shortcomings are discussed.
Nineteen obese females applying for treatment for binge eating were administered a semistructured interview assessing the presence or absence of food restrictions, thoughts, feelings and physical sensations associated with binges, typical precipitants to binges, and factors identified as useful in avoiding binge eating. Both negative mood and abstinence violations emerged as important precipitants. The results also suggested that these precipitants constitute separate, independent pathways to binge eating. Implications of these findings with respect to restraint theory are discussed.
This article proposes that binge eating is motivated by a desire to escape from self-awareness. Binge eaters suffer from high standards and expectations, especially an acute sensitivity to the difficult (perceived) demands of others. When they fall short of these standards, they develop an aversive pattern of high self-awareness, characterized by unflattering views of self and concern over how they are perceived by others. These aversive self-perceptions are accompanied by emotional distress, which often includes anxiety and depression. To escape from this unpleasant state, binge eaters attempt the cognitive response of narrowing attention to the immediate stimulus environment and avoiding broadly meaningful thought. This narrowing of attention disengages normal inhibitions against eating and fosters an uncritical acceptance of irrational beliefs and thoughts. The escape model is capable of integrating much of the available evidence about binge eating.
This study tested the initial effects of cognitive-behavioral therapy for binge eating in Ss who do not purge. Forty-four female binge eaters were randomized to either cognitive-behavioral treatment (CB) or a waiting-list (WL) control. Treatment was administered in small groups that met for 10 weekly sessions. At posttreatment a significant difference was found, with 79% of CB Ss reporting abstinence from binge eating and a 94% decrease in binge eating compared with a nonsignificant reduction (9%) in binge eating and zero abstinence rate in WL Ss. Following the posttest assessment, WL Ss were treated and evidenced an 85% reduction in binge episodes and a 73% abstinence rate. Binge eating significantly increased at 10-week follow-up for initially treated Ss; however, the frequency remained significantly improved compared with baseline levels.
The present study compared obese female binge eaters and nonbinge eaters of comparable age and weight on mood, diet behavior, and responses to a standard versus modified behavioral weight-control program. The modified behavioral program emphasized meal regularity, intake of complex carbohydrates, and activity as an alternate to overeating. Binge eaters reported significantly more depressive symptomatology, psychological distress, and maladaptive diet behavior than nonbinge eaters at pretreatment and at all subsequent assessments. Furthermore, binge eaters were more likely to drop out of treatment. No differences in weight loss at posttreatment occurred between binge eaters and nonbinge eaters, but binge eaters regained significantly more weight than nonbinge eaters at 6-month follow-up. Differences in weight loss between the groups were not significant at the 1-year follow-up, and no significant differences between the standard and modified treatment conditions were observed. Marked differences between binge eaters and nonbinge eaters in affect and cognitions appeared to persist despite behavioral treatment.
We first establish the association between binge eating and dieting and present sequence data indicating that dieting usually precedes binging, chronologically. We propose that dieting causes binging by promoting the adoption of a cognitively regulated eating style, which is necessary if the physiological defense of body weight is to be overcome. The defense of body weight entails various metabolic adjustments that assist energy conservation, but the behavioral reaction of binge eating is best understood in cognitive, not physiological, terms. By supplanting physiological regulatory controls with cognitive controls, dieting makes the dieter vulnerable to disinhibition and consequent overeating. Implications for therapy are discussed, as are the societal consequences of regarding dieting as a "solution" to the problem of binging.
Indicates that there are striking behavioral parallels between obese individuals and hungry individuals, suggesting that many obese individuals are actually in a chronic state of energy deficit and are genuinely hungry, perhaps because they attempt to hold their weight below its biologically dictated "set point." This conclusion is consistent with the remarkable similarities between the behavior of obese human beings and the behavior of animals that become obese after lesions of the ventromedial hypothalamus. Consideration of these parallels suggests a reexamination of traditional views of hunger and the ventromedial hypothalamus syndrome. (106 ref.)
Compared 19 female and 3 male overweight Ss who had maintained a weight loss for a 1-yr period by means of questionnaires, interviews, and tests with 30 females and 4 males who had regained the weight they had lost and 28 female and 11 male normal controls. The regainers indicated eating in response to a variety of states of emotional arousal. The maintainers reported that eating was more specific to loneliness and boredom; results from the control group showed that food consumption was primarily in response to hunger. The regainers rated the concept of eating in a more positive and active direction than did the maintainer group. The regainers' greater difficulty in maintaining a weight loss may be related to a large number of emotional states that are discriminative stimuli for food intake. (30 ref.)
A group of 20 overweight persons (predominantly women) who had successfully maintained a weight loss over a 1-yr period were compared with 28 Ss who had failed to maintain a weight loss and 20 normal weight controls. Results indicate that all groups tended to eat balanced meals, but the regainers ate high-caloric snacks in a greater variety of situations unrelated to internal cues of hunger. Differences were also found in the type of change in affective state that occurred after eating and in the frequency that the various groups spent out of the home during the daytime and evening. Implications of these findings for behavior therapy approaches with overweight persons are discussed.
Examined similarities between experimental findings with obese human Ss and lesioned hyperphagic rats. In comparison to normals, obese Ss (a) eat more of a good- and less of a bad-tasting food; (b) eat fewer meals/day, eat more/meal, and eat more rapidly; (c) react more emotionally; (d) eat more when food is easy to procure and less when it is difficult; (e) do not regulate food consumption when preloaded with solids, but do when preloaded with liquids; and (f) are less active. N. Mrosovosky's theory that the ventromedial hypothalamus is functionally quiescent in obese Ss is discussed. The function of the hypothalamus is examined. It is hypothesized that obese Ss are stimulus-bound. Experiments reveal that obese Ss (a) do better on recall tests, (b) respond faster with fewer errors on complex RT tasks, (c) are more distractible, and (d) work harder for food when food cues are prominent. Reexamining the activity levels of Ss, it was found that beyond a given stimulus intensity, Ss are more reactive than normals. Difficulties with the comparison and formulation are noted. (38 ref.)
Examined the effects of manipulated fear and food deprivation on the amounts eaten by 43 obese and 48 normal Ss. Normals eat more when they are calm than when frightened and eat more when they are food deprived than when they are sated. The manipulations have no effects on the amounts eaten by obese Ss who eat roughly the same amounts in all experimental conditions. (18 ref.)
The development of the Dutch Eating Behaviour Questionnaire (DEBQ) with scales for restrained, emotional, and external eating is described. Factor analyses have shown that all items on restrained and external eating each have high loadings on one factor, but items on emotional eating have two dimensions, one dealing with eating in response to diffuse emotions, and the other with eating in response to clearly labelled emotions. The pattern of corrected item-total correlation coefficients and of the factors was very similar for various subsamples, which indicates a high degree of stability of dimensions on the eating behavior scales. The norms and Cronbach's alpha coefficients of the scales and also the Pearson's correlation coefficients to assess interrelationships between scales indicate that the scales have a high internal consistency and factorial validity. However, their external validity has yet to be investigated.
The specific psychopathology of anorexia nervosa and bulimia nervosa is complex in form. Although for many purposes self-report questionnaires are a satisfactory measure of this psychopathology, for detailed psychopathological studies and for investigations into the effects of treatment, more sensitive and flexible assessment measures are required. For this reason a semi-structured interview was developed. This interview, the Eating Disorder Examination, is designed to assess the full range of the specific psychopathology of eating disorders, including these patients' extreme concerns about their shape and weight.
several phases of binge eating can be identified, each of which can be analyzed in terms of determining influences, including psychological influences / divide the binge episode into five phases / examine the impact of psychological mechanisms at each of these stages / evaluate the various models that have been proposed to explain binge eating in terms of how they recognize and explain the operation of these psychological mechanisms at each phase
addictions model / conditioning model / affective disorders/regulation model / escape model / dieting model / biopsychosocial models (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Assessment of binge eating and purging in bulimia nervosa necessarily relies upon self-report. The reliability and validity of self-report is discussed, with special reference to other substance abuse disorders. The Time Line follow back technique is recommended as a means of obtaining more precise, accurate, and clinically useful self-reports of binge eating and purging. The necessity for multidimensional assessment of treatment effects is underscored, with suggestions of the form this might take.
Self-report and interview data from 81 obese patients show that binge eating, defined by Diagnostic and Statistical Manual of Mental Disorders (DSM-III) criteria for bulimia, was significantly more prevalent as the degree of obesity increased. Findings support the DSM-III criteria, and a relation between binging and excessive dieting associated with being overweight is suggested. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Discusses the prevalence and characteristics of binge eating among the obese and its effects on treatment outcome. Two questions are addressed: Do obese binge eaters (OBEs) resemble normal-weight bulimic patients and how do OBEs differ from obese individuals who do not have a binge eating problem? The present authors report that binge behaviors of obese Ss and normal-weight bulimics appear to be similar in the types and quantity of food consumed and the duration of episodes; however, OBEs report a lower frequency of binges, and purge behavior is less prevalent. Consistent differences in diet attitudes and behavior and self-reported psychiatric symptomatology are observed when OBEs are compared to obese non-binge eaters. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Reports studies to examine the hypothesis that obese persons are more responsive to external cues and less to internal physiological cues associated with hunger, than nonobese persons. Various experiments were carried out in which preliminary eating, fear, circumstances of eating, and manipulating time were related to amounts eaten by normal and obese Ss under controlled conditions. In addition, other studies on effects of taste, fasting, choice of eating place, and time-zone changes on eating patterns of obese and nonobese Ss are reviewed. Results consistently support the finding that the obese are "relatively insensitive to variations in the physiological correlates of food deprivation but highly sensitive to environmental, food-related cues . . . ." These findings help to explain why many weight control programs for the obese are temporary in their effectiveness. (18 ref.) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
In the present study, the Eating Disorder Examination (EDE), a clinical interview designed to characterize the psychopathohgy specific to eating disorders, was administered to 17 obese women seeking treatment for binge eating problems. Subjects also completed questionnaires to assess binge severity, depression, and weight history. Obese binge eaters obtained EDE subscale scores that did not differ from those reported for normal weight bulimia nervosa patients on the Overeating, Shape Concern, Weight Concern, and Eating Concern Sub-scales of the EDE; however, bulimia nervosa patients had higher scores on the EDE Restraint Subscale. Questionnaire data indicated that obese binge eaters had considerable depressive symptomatology and that early onset obesity, frequent weight losses, and family histories of obesity were common. These findings suggest that obese binge eaters and bulimia nervosa patients have similar levels of eating disorders psychopathohgy, but that future research directly comparing overweight and normal weight patients is needed.
The present study investigated seven antecedents to the binge-purge cycle proposed by Orleans and Barnett (1984), including restraint, stress, mood, thoughts of food, fatigue, hunger, and dichotomous cognitions. For 1 week, 19 bulimics, 15 binge eaters, and 20 normal control subjects recorded detailed information about these antecedent conditions and the types and quantities of food consumed for each eating episode. Results indicated that prior to their binge episodes, bulimics reported significantly greater stress, preoccupation with food, and negative mood than binge eaters reported prior to their binges and normal controls reported prior to all of their eating episodes. Both bulimics and binge eaters reported greater dichotomous cognitions prior to binge episodes than normal controls experienced prior to all of their eating episodes. Comparisons of the antecedents to eating episodes which bulimics and binge eaters regarded as nonbinge episodes with all eating episodes of the control group indicated that although bulimics and binge eaters experienced significantly greater negative moods than normal controls prior to their nonbinge episodes, only bulimics experienced significantly greater dichotomous cognitions prior to these eating episodes. Theoretical and clinical implications of these findings are discussed.
In this study a comparison was made between the amounts eaten by restrained and unrestrained eaters following an anxiety-induction procedure. Subjects' level of perceived hunger was assessed and the interactive effects on eating of anxiety and perceived hunger were examined. Results revealed a significant three-way interaction. Unrestrained subjects did not alter their eating in response to either anxiety or hunger. When relaxed, restrained subjects ate more when hungry than when not hungry. However, in restrained subjects, anxiety appeared to counteract the disinheriting effect of hunger, so that anxious hungry subjects ate less than relaxed hungry subjects and the same amount as relaxed subjects who were not hungry. © 1993 by John Wiley & Sons, Inc.
This report deals with certain theoretical and clinical aspects of the problem of overeating and obesity. It considers the advantages, especially in psychiatric research, if obesity were found to represent, not one disease, but the end stage of a variety of different conditions with differing etiologies. Experimentally-induced obesity in animals serves as a model of such a contingency since it can be produced by different methods, which result in different types of obesity. Some of the most striking differences have been found in the field of behavior, a recent study having demonstrated characteristic differences between the feeding patterns of obese and non-obese mice, and even between the feeding patterns of mice afflicted with different forms of obesity.
The eating behavior of obese human subjects is considered from this point of view, and three distinctive eating patterns are described. The first of these patterns is that of the night-eating syndrome, characterized by morning anorexia, evening hyperphagia, and insomnia. The second pattern is that of the eating binge, in which large amounts of food are consumed in an orgiastic manner at irregular intervals. The third pattern is that of eating-without-satiation which has been observed in persons suffering from damage to the central nervous system.
The aim of this study was to compare the effects of weight loss treatment, cognitive-behavioral treatment, and desipramine on binge eating and weight in a three group additive design involving 108 overweight participants with binge eating disorder. Subjects were allocated at random to either 9-months weight-loss-only treatment; 3-months of cognitive-behavioral treatment followed by weight loss treatment for 6-months; or the combination treatment with desipramine added for the last 6-months. After 3-months of treatment, those receiving cognitive-behavioral therapy had reduced binge eating significantly more than participants receiving weight loss therapy only, and the weight loss only group had lost significantly more weight than those in the cognitive-behavioral groups. The addition of medication did not lead to greater reductions in the frequency of binge eating. Hence, there was no evidence that either cognitive-behavioral therapy or desipramine added to the effectiveness of weight loss therapy. However, those receiving medication lost significantly more weight than the comparable group without medication at follow-up. Abstinence from binge eating was associated with significantly greater weight losses. Overall, however, the achieved weight losses were small and the abstinence rates low. Moreover, there were no differences between the three groups either at the end of treatment or at follow-up. Suggestions for further research aimed at improving the therapeutic results for this difficult clinical problem are discussed.
The development of the Dutch Eating Behaviour Questionnaire (DEBQ) with scales for restrained, emotional, and external eating is described. Factor analyses have shown that all items on restrained and external eating each have high loadings on one factor, but items on emotional eating have two dimensions, one dealing with eating in reponse to diffuse emotions, and the other with eating in response to clearly labelled emotions. The pattern of corrected item-total correlation coefficients and of the factors was very similar for various subsamples, which indicates a high degree of stability of dimensions on the eating behavior scales. The norms and Cronbach's alpha coefficients of the scales and also the Pearson's correlation coefficients to assess interrelationships between scales indicate that the scales have a high internal consistency and factorial validity. However, their external validity has yet to be investigated.
Hypothesized that individual differences in eating behavior based on the distinction between obese and normal Ss could be demonstrated within a population of normal Ss classified as to the extent of restraint chronically exercised with respect to eating. Ss were 42 female college students. Restrained Ss resembled the obese behaviorally, and unrestrained Ss resembled normals. This demonstration was effected in the context of a test of the psychosomatic hypothesis of obesity. Results indicate that although some individuals may eat more when anxious, there is little empirical support for the notion that eating serves to reduce anxiety. An explanation for this apparent inconsistency is offered. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Nisbett's (1972) model of obesity implies that individual differences in relative deprivation (relative to set-point weight) within obese and normal weight groups should produce corresponding within-group differences in eating behavior. Normal weight subjects were separated into hypothetically deprived (high restraint) and non-deprived (low restraint) groups. The expectation that high restraint subjects' intake would vary directly with preload size while low restraint subjects would eat in inverse proportion to preload size, was confirmed. It was concluded that relative deprivation rather than obesity per se may be the cirtical determinant of individual differences in eating behavior. Consideration was given to the concept of "restraint" as an important behavioral mechanism affecting the expression of physiologically-based hungar.
We tested the effects of 3 mood inductions (neutral, positive, and negative) on food intake in 91 women of varying degrees of dietary restraint. Mood induction was accomplished by exposure to 1 of 3 film segments: a travelogue (neutral affect), a comedy film (positive affect), and a horror film (negative affect). In subjects exposed to the neutral film, food intake decreased with increasing levels of dietary restraint. Among subjects who viewed either the comedy film or the horror film, however, food intake increased with increasing restraint. Although the horror film appeared to be more disinhibiting than the comedy film, this effect may have resulted from a difference in the intensity of the emotions induced rather than from their valence. These results suggest that emotional arousal, regardless of valence, may trigger overeating among restrained eaters.
Twenty-three women with nonpurging bulimia underwent a 12-week, double-blind, placebo-controlled trial of desipramine hydrochloride. Repeated standardized rating scales, mood assessments, and self-reports of dietary habits were used to measure changes in binge frequency and cognitive processes associated with food intake. The women who received desipramine reduced their frequency of binge eating by 63%, but women receiving placebo increased their frequency of binge eating by 16%. Twelve weeks after initiating treatment, 60% of the treatment group but only 15% of the placebo group abstained from binge eating. The women who received desipramine showed significantly more dietary restraint and reported significantly less hunger, suggesting that desipramine acts to suppress appetite. These preliminary findings suggest that the therapeutic effects of desipramine established in the treatment of purging bulimia nervosa extend to patients with nonpurging bulimia.
The present study was conducted to determine the prevalence and severity of binge eating among 432 women seeking behavioral treatment for obesity and to assess the relationship between binge eating and dietary restraint. Subjects completed standardized self-report questionnaires which assessed the severity of binge eating and habitual dietary restraint. Binge eating was extremely prevalent, with 46% of subjects reporting serious problems. Serious binge eating was more common in younger and heavier subjects. Further, binge eating severity was significantly related to overall dietary restraint. The current findings indicate that the treatments of binge eating may need to be considered in planning behavioral programs for the obese.
This report describes the construction of a questionnaire to measure three dimensions of human eating behavior. The first step was a collation of items from two existing questionnaires that measure the related concepts of 'restrained eating' and 'latent obesity', to which were added items newly written to elucidate these concepts. This version was administered to several populations selected to include persons who exhibited the spectrum from extreme dietary restraint to extreme lack of restraint. The resulting responses were factor analyzed and the resulting factor structure was used to revise the questionnaire. This process was then repeated: administration of the revised questionnaire to groups representing extremes of dietary restraint, factor analysis of the results and questionnaire revision. Three stable factors emerged: (1) 'cognitive restraint of eating', (2) 'disinhibition' and (3) 'hunger'. The new 51-item questionnaire measuring these factors is presented.
of 82 patients with primary anorexia nervosa and a pilot study of 16 patients with massive obesity. The anorexia nervosa patients-G male and 76 female-have all been seen at length by myself, and the majority have been treated as in-patients. Many of them have been referred to in previous reports [l-5]. In particular the view has been expressed that many patients with anorexia nervosa come from an obese or otherwise nutritionally disordered population so far as family and personal constitutional factors are concerned. Not all patients with anorexia nervosa develop this illness in their teens. The majority of the remainder in the present series have been women who developed the illness in their twenties, often having first become more obese during their teens. The majority of the massively obese patients, one male and 15 female, were admitted routinely and successively under a general physician and later seen by me, initially as a collaborative exercise. Only two of these patients were referred directly to me by their general practitioners, one patient because of her high amphetamine intake, the other because his general practitioner wanted psychiatric treatment for the patient’s complaint of being overweight. Five of these patients have subsequently been treated as in-patients in a psychiatric unit, each for about 6-8 consecutive months during which time they have all lost between 8-10 st. in weight. Another two of these patients provided a history of anorexia nervosa during their teens. The discovery of such relationships, between marked underweight and gross overweight, has led to the present study: in particular, to the examination of such psychosomatic factors as sexual behaviour and level of activity in the two groups, also to the consideration of such concepts and descriptive features as ‘denial’, ‘compulsion’ and ‘addiction’, seemingly applicable to and shared by both groups. Firstly I want to restate my view [2, 61 that primary anorexia nervosa is almost invariably a state of weight phobia, hingeing on and pivoting round puberty. This central phobia, no longer only of excess weight as part of a feeding disorder, but of normal (functioning) adolescent weight, is usually evident and fearfully admitted to by the patient. There are some few patients who vigorously deny such a fear. They only come to reveal it in a treatment situation in which they are being pressed to gain weight up to a ‘normal’ amount. I do not therefore take the view that the psychopathological disorder in anorexia nervosa is any longer primarily a feeding disorder akin [7] to the feeding disorders of childhood in which food more often seems to represent and stand for the (absent) mother and for her (absent) love. The intervening factor separating off these feeding disorders and anorexia nervosa, and giving a
A survey was carried out of binge-eating behavior in a group of 44 patients who had completed group behavioral treatment for obesity. Obese binge eaters, defined by DSM-III criteria for bulimia, lost significantly less weight immediatedly posttreatment and at 6-month follow-up than non-binge eaters.
Laboratory studies indicate that obese individuals are more emotionally reactive and more likely to overeat when distressed than are those of normal weight. These studies were conducted under highly artificial conditions, however, and their generality outside of the laboratory remains largely untested. The present study compared the emotional reactivity and emotional eating of normal and overweight female college students in the natural environment. Subjects self-monitored their food intake and mood just prior to each instance of eating for 12 consecutive days. The results indicated that obese subjects were more emotionally reactive and more likely to engage in emotional eating than normals, but these findings applied only to snacks, not to meals. Correlational analyses indicated that emotional distress associated with snacks and emotional eating associated with both snacks and meals were related to subjects' percentage overweight. The two groups did not differ on any measure of positive emotions of consumption following positive emotions, nor were these two variables related to percentage overweight. The theoretical and clinical implications of these findings are briefly discussed.
Binge eating is a complex behavioral problem that often contributes to obesity and complicates standard behavioral weight reduction treatment. This paper reviews previous investigations of binge eating in overweight populations and presents new data from 280 participants in an intensive weight reduction program. These data corroborate clinical impressions that binge eating is frequently accompanied by interpersonal, self-esteem, and stress management deficits. Related preliminary findings aid in a functional analysis of binge behavior patterns and provide empirical support for diagnostic criteria suggested for bulimia in the Diagnostic and Statistical Manual III (DSM-III). Guidelines for a functional analysis of binge eating are presented and suggestions for a comprehensive behavioral and dietary approach to binge eating are outlined. Programmed bingeing is given special attention as one useful therapeutic strategy.
SYNOPSIS
Thirty-two patients who complained of episodes of ravenous overeating which they felt unable to control (bulimia) were asked to describe their behaviour and symptoms. There was considerable variation both between and within individuals, but a number of factors were defined which appeared to be common to all with the complaint. It is difficult to set up strict criteria for the recognition of bulimia, and those that have recently been proposed are criticized in the light of our present findings.
The purpose of this study was to conduct an assessment of binge eating severity among obese persons. Two questionnaires were developed. A 16-item Binge Eating Scale was constructed describing both behavioral manifestations (e.g., eating large amounts of food) and feeling/cognitions surrounding a binge episode (e.g., guilt, fear of being unable to stop eating). An 11-item Cognitive Factors Scale was developed measure two cognitive phenomena thought to be related to binge eating: the tendency to set unrealistic standards for a diet (e.g., eliminating "favorite foods") and low efficacy expectations for sustaining a diet. The results showed that the Binge Eating Scale successfully discriminated among persons judged by trained interviewers to have either no, moderate or severe binge eating problems. Significant correlation between the scales were obtained such that severe bingers tended to set up diets which were unrealistically strict while reporting low efficacy expectations to sustain a diet. The discussion highlighted the differences among obese persons on binge eating severity and emphasized the role of cognitions in the relapse of self control of eating.
Your Emotional Investment in Eating: A Test was administered to 26 subjects 20 or more pounds overweight, and to 36 subjects within 20 pounds of “desirable” weight. The test as a whole differentiated the groups as did 11 of 30 individual items. The overweight persons showed greater emotional reactivity, were more self-dissatisfied, more private or solitary in their eating habits, and more immoderate in eating than controls if bored or depressed.
Obese patients entering a weight control program were classified as binge eaters if they reported uncontrolled consumption of what others would regard as an unusually large amount of food at least once a week for the previous month. Binge eaters differed significantly from nonbingers across a broad range of eating and weight-related characteristics assessed using a self-report version of the Eating Disorder Examination. Attitudinal differences were marked. The results provided no support for the view that obese binge eaters have a pattern of general "addictiveness" to psychoactive substances or other activities.
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