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Emotional Eating and Weight in Adults: a Review

DOI:10.1007/s12144-017-9577-9
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Mallory Frayn at Drexel University
Mallory Frayn
Bärbel Knäuper at McGill University
Bärbel Knäuper
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Abstract

Emotional eating is the tendency to overeat in response to negative emotions and has shown to be associated with weight outcomes, both in respect to weight gain over time and difficulties with weight loss and weight loss maintenance. It is thus important to develop treatments to improve weight loss outcomes in emotional eaters. The purpose of this review is to explore adults’ relationship between emotional eating and weight by: (1) describing self-report measures used to assess emotional eating such as the Dutch Eating Behavior Questionnaire (DEBQ), the Three Factor Eating Questionnaire (TFEQ), and the Emotional Eating Scale (EES), (2) exploring the relationship between emotional eating and weight outcomes, namely examining weight gain in longitudinal studies and difficulties with weight loss and weight loss maintenance in intervention studies, and (3) reviewing current interventions that target emotional eating, using techniques such as mindfulness, Acceptance and Commitment Therapy (ACT), Cognitive Behavior Therapy (CBT), and Dialectical Behavior Therapy (DBT). A better understanding of adults’ emotional eating and its impact on weight is important to develop interventions that effectively target weight loss struggles unique to emotional eaters and improve weight outcomes for this population.
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Emotional Eating and Weight in Adults: a Review
Mallory Frayn
1
&Bärbel Knäuper
1
Published online: 15 March 2017
#Springer Science+Business Media New York 2017
Abstract Emotional eating is the tendency to overeat in re-
sponse to negative emotions and has shown to be associated
with weight outcomes, both in respect to weight gain over time
and difficulties with weight loss and weight loss maintenance. It
is thus important to develop treatments to improve weight loss
outcomes in emotional eaters. The purpose of this review is to
explore adults’relationship between emotional eating and
weight by: (1) describing self-report measures used to assess
emotional eating such as the Dutch Eating Behavior
Questionnaire (DEBQ), the Three Factor Eating Questionnaire
(TFEQ), and the Emotional Eating Scale (EES), (2) exploring
the relationship between emotional eating and weight outcomes,
namely examining weight gain in longitudinal studies and diffi-
culties with weight loss and weight loss maintenance in inter-
vention studies, and (3) reviewing current interventions that tar-
get emotional eating, using techniques such as mindfulness,
Acceptance and Commitment Therapy (ACT), Cognitive
Behavior Therapy (CBT), and Dialectical Behavior Therapy
(DBT). A better understanding of adults’emotional eating and
its impact on weight is important to develop interventions that
effectively target weight loss struggles unique to emotional
eaters and improve weight outcomes for this population.
Keywords Emotional eating .Wei g ht .Weight loss .Review
Introduction
Emotional eating is defined as the Btendency to overeat in
response to negative emotions, such as anxiety or irritability^
(van Strien et al. 2007, p. 106). It is a highly prevalent concern
for those who struggle with their weight; it is suggested that
60% or more of individuals who are overweight or obese are
also emotional eaters (Ganley 1989). Emotional eaters are
particularly likely to consume foods high in fat, sugar, and
calories in response to negative emotions (Elfhag and
Rossner 2005). These eating habits in combination with in-
creased body weight place emotional eaters at higher risk for
developing diabetes and heart disease (e.g., Melanson 2007;
Wang et al. 2010). This population also struggles with weight
loss; emotional eaters are half as likely as non-emotional
eaters to achieve the 10% weight loss goal of standard behav-
ioral weight loss treatment (López-Guimerà et al. 2014).
Emotional eating is important to study because of its negative
effects on weight and overall health. Thus far very few inter-
ventions have incorporated the treatment of emotional eating
into weight loss interventions.
The purpose of this paper is to review the relationship be-
tween emotional eating and body weight in adults and to ex-
plore the current treatment options used to address these con-
cerns. To our knowledge, no such review exists. Other reviews
have outlined theoretical perspectives on emotional eating
(e.g., Canetti et al. 2002), have examined the prevalence of
emotional eating in a variety of samples (e.g., Gibson 2012),
and have reviewed studies using a certain treatment approach,
namely mindfulness interventions, for emotional eating (e.g.,
Katterman et al. 2014;O’Reilly et al. 2014). However, none of
these reviews have attempted to explicate the relationship be-
tween emotional eating and weight, nor have they thoroughly
evaluated treatment options for overweight or obese emotion-
al eaters. This review seeks to fill these gaps in the existing
*Mallory Frayn
mallory.frayn@mail.mcgill.ca
Bärbel Knäuper
barbel.knauper@mcgill.ca
1
Department of Psychology, McGill University, Stewart Biology
Building, 1205 Dr. Penfield Avenue, Montreal, Quebec H3A 1B1,
Canada
Curr Psychol (2018) 37:924–933
DOI 10.1007/s12144-017-9577-9
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
... Until now, traditional behavioural weight loss interventions have demonstrated only little efficacy in reducing emotional eating [15]. This is likely because these interventions hardly give attention to the specific needs of individuals with emotional eating [16][17][18] such as using food for emotion regulation [15]. ...
... Until now, traditional behavioural weight loss interventions have demonstrated only little efficacy in reducing emotional eating [15]. This is likely because these interventions hardly give attention to the specific needs of individuals with emotional eating [16][17][18] such as using food for emotion regulation [15]. Emotion regulation is broadly defined as the extrinsic and intrinsic processes responsible for monitoring, evaluating, and modifying emotional reactions, especially their intensity and duration, to accomplish a personal goal [19]. ...
... In an attempt to spark this advancement in the treatment of individuals with emotional eating, a few recent studies have looked at the effect of a virtual coach, which tailors exercises to specific needs of individuals with emotional eating [15,30,[32][33][34]. For example, Dol et al. [35] aimed to develop a personalized coach, which tailors exercises to specific needs of individuals with Dol et al. ...
Exploring tailored virtual emotion regulation approaches for individuals with emotional eating
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... Studies in Thailand, Brazil and various European countries have shown an increase in meal deliveries to households as a possible result of having less time to prepare food (Frayn and Knäuper 2018;Grunert et al. 2021;Howarth et al. 2001). In Thailand, the frequency of weekly food orders was four to six times higher during the pandemic. ...
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... Evidence on the relationship between EE and weight problems is mixed: a study by Brogan and Hevey [19] found no correlation between a higher BMI and EE, while other studies reported a correlation between higher BMI and EE [7]. A review concluded that higher EE and higher BMI might be positively correlated and that targeting EE in interventions might facilitate weight loss [23]. However, the authors also criticize that research on the relationship between EE and weight is still at an early stage. ...
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Purpose Emotional eating (EE) refers to eating in response to (negative) emotions. Evidence for the validity of EE is mixed: some meta-analyses find EE only in eating disordered patients, others only in restrained eaters, which suggest that only certain subgroups show EE. Furthermore, EE measures from lab-based assessments, ecological momentary assessment (EMA), and psychometric measures often diverge. This paper tested whether the covariance of these three different EE methods can be modeled through a single latent variable (factorial validity), and if so, how this variable would relate to restrained eating (construct validity), Body-Mass-Index (BMI), and subclinical eating disorder symptomatology (concurrent validity). Methods 102 non-eating disordered female participants with a wide BMI range completed EE measures from three methods: psychometric questionnaires, a laboratory experiment (craving ratings of food images in induced neutral vs. negative emotion) and EMA questionnaires (within-participant correlations of momentary negative emotions and momentary food cravings across 9 days). Two measures for each method were extracted and submitted to confirmatory factor analysis. Results A one-factor model provided a good fit. The resulting EE lat factor correlated positively with subclinical eating disorder symptoms and BMI but not with restrained eating. Conclusions The one-factor solution shows that the EE construct can validly be assessed with three different methods. Individual differences in EE are supported by the data and are related to eating and weight problem symptomatology but not to restrained eating. This supports learning accounts of EE and underscores the relevance of the EE construct to physical and mental health. Level of evidence II (Evidence obtained from well-designed controlled trials without randomization).
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... Emotional eating is a common problem among people struggling with weight issues [11]. Emotional eaters are particularly prone to consuming foods high in fat, sugars, and calories in response to negative emotions [12]. ...
Psychological Inflexibility in Spanish Adults: Characteristics of Emotional Eating and the Healthy Eating Index
Preprint
Full-text available
  • Sep 2023
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... To date, aetiological studies have highlighted a number of contextual and individual factors implicated in the onset of abnormal eating patterns (Solmi et al., 2021). For instance, a review performed by Frayn and Knäuper (2017) showed how overeating in response to negative emotions is a risk factor for developing problematic weight control. Similarly, a line of research highlighted how maladaptive personality traits may relate to eating pathology (Klein et al., 2022;Van Riel et al., 2023) and identified dimensions like detachment and (low) conscientiousness as risk factors for developing eating pathology (Dufresne et al., 2020). ...
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Objective Research showed that trait emotional intelligence (trait EI), pressures from family, peers and media, and problematic perceptions of one’s body, are plausible antecedents for variation in the severity of eating disorders. This study examined the hypothesis that an association between pressures from one’s environment (peers, family, media), trait EI and eating pathology would be mediated by body uneasiness and appearance concern for one’s body. Method This online cross-sectional study enrolled a sample of 546 participants aged 18–24 years (M = 21.58; SD = 2.05), self-report questionnaires were administered to measure trait EI, environmental pressure, body uneasiness, appearance concern and eating disorder symptomatology. Results The results showed significant associations among trait EI, body uneasiness and appearance concern. Furthermore, significant links were found between environmental pressures, body uneasiness, appearance concern and eating disorders. Moreover, there was a significant association between body uneasiness and eating disorders and between appearance concern and eating disorders. Finally, indirect associations were found from trait EI to eating disorders by body uneasiness and appearance concern, and from environmental pressures to eating disorders by body uneasiness and appearance concern. Conclusions The study’s hypothesis was confirmed and suggested the importance of targeting image disturbances to improve the clinical efficacy of treatments for eating disorders. Key Points What is already known about this topic: (1) Eating disorders may be defined by the interaction of individual and environmental factors. (2) Body image disturbances are particularly significant factors influencing eating disorders. (3) Pressures from family, peers, and media are environmental factors strongly associated with eating disorders. What this topic adds: (1) Trait emotional intelligence and environmental pressures significantly influence body image issues. (2) Body image issues mediate the relationship between trait emotional intelligence and eating disorders. (3) Body image issues mediate the relationship between factors of environmental pressures and eating disorders.
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... Evidence on the relationship between EE and weight problems is mixed: A study by Brogan and Hevey (2013) found no correlation between a higher BMI and EE, while other studies reported a correlation between higher BMI and EE [7]. A review concluded that higher EE and higher BMI might be positively correlated and that targeting EE in interventions might facilitate weight loss [23]. However, the authors also criticize that research on the relationship between EE and weight is still at an early stage. ...
Emotional Eating – Elusive or Evident? Integrating Laboratory, Psychometric and Daily Life Measures
Preprint
Full-text available
  • Jun 2023
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View
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This study investigated the impact of COVID-19 information overload on emotional eating behavior in China’s post-pandemic period, while considering the mediating role of fear of COVID-19 and the protective role of self-compassion. The study was based on stimulus-organism-response framework and emotion regulation theories and it used convenience sampling to recruit 902 adult participants from 31 provinces in China, who completed the COVID-19 Information Overload Scale, Fear of COVID-19 Scale, Emotional Eating Scale, and Self-Compassion Scale. SPSS 24.0 and the Process 3.5 macro program were used to carry out descriptive statistical, correlation analyses and moderated mediating effect tests on the data. The results indicated that COVID-19 information overload is a significant predictor of emotional eating behavior, with fear of COVID-19 mediating this relationship. Furthermore, the study found that self-compassion moderates the negative effect of COVID-19 information overload on fear of COVID-19 and mitigates the effect of fear of COVID-19 on emotional eating. The findings highlight the mechanisms by which excessive and ambiguous information affects emotional eating behavior in the post-pandemic period and provide insights on how to improve individual emotional eating behavior.
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Stability and longitudinal association between Body Mass Index and maladaptive eating behaviors in older adults: Results from the NutriAct Family Study (NFS)
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Internal Structure and Measurement Invariance of the Dutch Eating Behavior Questionnaire (DEBQ) in a (Nearly) Representative Dutch Community Sample
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The Dutch Eating Behavior Questionnaire (DEBQ) is a widely used instrument for assessment of emotional, external, and restrained eating. Aim of the present study is to (1) analyze its internal structure using exploratory structural equation modeling, (2) to assess its measurement invariance with respect to sex, BMI, age, and level of education, and (3) to evaluate the relations of the factors with these variables. Except that women were slightly over-represented, the sample (n = 2,173) closely followed the socio-demographic characteristics of the overall Dutch population. The three theoretical factors that emerged from the analysis were in close correspondence with the three scales for emotional, external, and restrained eating, Only two items (Item 3 –“Desire to eat when nothing to do…”– and Item 21 –“Resist delicious food”–) presented problematic loadings. The questionnaire showed satisfactory measurement invariance and an expected patterns of mean differences and relations were found. All in all, the results highlight the adequate psychometric properties of the DEBQ.
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The emotional eating scale: The development of a measure to assess coping with negative affect by eating
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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.
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Emotion and eating in obesity: A review of the literature
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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.
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Looking at food in sad mood: Do attention biases lead emotional eaters into overeating after a negative mood induction?
Article
Background Emotional eating is associated with overeating and the development of obesity. Yet, empirical evidence for individual (trait) differences in emotional eating and cognitive mechanisms that contribute to eating during sad mood remain equivocal. Aim The aim of this study was to test if attention bias for food moderates the effect of self-reported emotional eating during sad mood (vs neutral mood on actual food intake. It was expected that emotional eating is predictive of elevated attention for food and higher food intake after an experimentally induced sad mood and that attentional maintenance on food predicts food intake during a sad versus a neutral mood. Method Participants (N = 85) were randomly assigned to one of the two experimental mood induction conditions (sad/neutral). Attentional biases for high caloric foods were measured by eye tracking during a visual probe task with pictorial food and neutral stimuli. Self-reported emotional eating was assessed with the Dutch Eating Behavior Questionnaire (DEBQ) and ad libitum food intake was tested by a disguised food offer. Results Hierarchical multivariate regression modeling showed that self-reported emotional eating did not account for changes in attention allocation for food or food intake in either condition. Yet, attention maintenance on food cues was significantly related to increased intake specifically in the neutral condition, but not in the sad mood condition. Discussion The current findings show that self-reported emotional eating (based on the DEBQ) might not validly predict who overeats when sad, at least not in a laboratory setting with healthy women. Results further suggest that attention maintenance on food relates to eating motivation when in a neutral affective state, and might therefore be a cognitive mechanism contributing to increased food intake in general, but maybe not during sad mood.
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The Dutch Eating Behavior Questionnaire (DEBQ) for assessment of restrained, emotional, and external eating behavior
Article
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.
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Emotional eating is associated with weight loss success among adults enrolled in a weight loss program
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  • Mar 2016
To examine associations between decreased emotional eating and weight loss success; and whether participation in a behavioral weight loss intervention was associated with a greater reduction in emotional eating over time compared to usual care. Secondary data analysis of a randomized controlled trial conducted at two university medical centers with 227 overweight adults with diabetes. Logistic and standard regression analyses examined associations between emotional eating change and weight loss success (i.e., weight loss of ≥7 % of body weight and decrease in BMI). After 6 months of intervention, decreased emotional eating was associated with greater odds of weight loss success (p = .05). The odds of weight loss success for subjects with decreased emotional eating at 12 months were 1.70 times higher than for subjects with increased emotional eating. No differences in change in emotional eating were found between subjects in the behavioral weight loss intervention and usual care. Strategies to reduce emotional eating may be useful to promote greater weight loss among overweight adults with diabetes.
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CBT for eating disorders: The impact of early changes in eating pathology on later changes in personality pathology, anxiety and depression
Article
  • Dec 2015
Whilst studies have consistently identified early symptom reduction as an important predictor of treatment outcome, the impact of early change on common comorbid features has not been investigated. This study of CBT for eating disorders explored patterns of early change in eating pathology and longer-term change in personality pathology, anxiety and depression. It also explored the impact of early change in eating pathology on overall change in personality pathology, anxiety and depression. Participants were 179 adults diagnosed with eating disorders who were offered a course of CBT in an out-patient community eating disorders service in the UK. Patients completed a measure of eating disorder psychopathology at the start of treatment and following the 6th session. They also completed measures of personality disorder cognitions, anxiety and depression at the start and end of treatment. There were significant changes in eating pathology over the first six sessions of treatment. Significant improvements were also seen in personality disorder pathology, anxiety and depression by the end of therapy. Effect sizes were medium to large for both completer and intention to treat analyses. Early changes in eating pathology were associated with later changes in common comorbid features, with early reduction in restraint being a key predictor. These findings demonstrate that early symptom change can be achieved in CBT for eating disorders when delivered in routine clinical practice. Such change has long-term benefits that go beyond the domain of eating pathology, enhancing change in personality pathology, anxiety and depression.
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