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Research Article

The effect of emotion regulation on emotional eating among undergraduate students in China: The chain mediating role of impulsivity and depressive symptoms

Contributed equally to this work with: Huimin Yang, Xinyi Zhou

Roles Conceptualization, Data curation, Formal analysis, Writing – original draft, Writing – review & editing

Affiliation School of Nursing, Peking University, Beijing, China

Roles Conceptualization, Writing – original draft, Writing – review & editing

Roles Project administration, Visualization

Roles Conceptualization, Supervision, Validation

* E-mail: [email protected]

Affiliation Department of Community Nursing, School of Nursing, Peking University, Beijing, China

• Huimin Yang, 
• Xinyi Zhou, 
• Longjiao Xie, 

• Published: June 15, 2023
• https://doi.org/10.1371/journal.pone.0280701
• Reader Comments

This study aimed to examine the relationship between difficulties in emotion regulation and emotional eating and the role of impulsivity and depressive symptoms in mediating this chain. Four hundred ninety-four undergraduate students participated in the study. A self-designed questionnaire was used in the survey from February 6 to 13, 2022, to finish our purpose, including the Emotional Eating Scale (EES-R), Depression Scale (CES-D), Short Version of the Impulsivity Behavior Scale (UPPS-P) and Difficulties in Emotion Regulation Scale (DERS). The results showed that 1) difficulties in emotion regulation, impulsivity, depressive symptoms, and emotional eating were correlated; 2) impulsivity and depressive symptoms separately mediated the relationship between difficulties in emotion regulation and emotional eating; 3) impulsivity and depressive symptoms played a chain mediating role between difficulties in emotion regulation and emotional eating. The current study provided a better understanding of the psychologically related pathway of emotional eating. The results would be helpful for prevention and intervention of emotional eating among undergraduate students.

Citation: Yang H, Zhou X, Xie L, Sun J (2023) The effect of emotion regulation on emotional eating among undergraduate students in China: The chain mediating role of impulsivity and depressive symptoms. PLoS ONE 18(6): e0280701. https://doi.org/10.1371/journal.pone.0280701

Editor: Lilybeth Fontanesi, G. D’Annunzio University of Chieti-Pescara, ITALY

Received: January 5, 2023; Accepted: May 30, 2023; Published: June 15, 2023

Copyright: © 2023 Yang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the paper and its Supporting Information files.

Funding: This research has been supported by Students Innovation Project [grant numbers: BJMU-HL-202017D, URL: https://nursing.bjmu.edu.cn ], Peking University. HMY, XYZ, LJX, and JS received the funding. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

Introduction

Eating disorders are characterized by persistent disordered eating behaviors that interfere with daily social and psychological functioning [ 1 ]. The global incidence of eating disorders in 2019 was 41.9 million worldwide and caused 6.6 million disability-adjusted life years (DALYs) in that year [ 2 ]. Patients with eating disorders described their binge eating behaviors as a result of negative emotions [ 3 ]. Emotional eating (EE) is combating negative emotions by engaging in binge eating behaviors [ 4 , 5 ]. The number of people who have EE has continually increased over the past years [ 6 ]. EE affects people of all ages, and approximately 20% of people regularly adopt emotional eating behaviors [ 7 ]. The researcher found that adults aged 21 to 39 are much more likely to have EE [ 7 ]. Ashley’s study noted that approximately 10% to 60% of adolescents are emotional eaters [ 8 ].

Evidence from a follow-up study showed that EE impels people to overeat and causes weight gain [ 9 ]. Notably, EE was particularly related to the preference for sweet and high-fat foods, which can lead to excessive intake of high energy-density foods and promote the occurrence of obesity [ 10 ]. Researchers have also paid attention to the relationship between EE and weight loss [ 11 ] and found that EE hinders weight loss [ 12 ], and a higher level of EE is related to less weight loss over the same period [ 13 , 14 ]. As an abnormal eating behavior, EE is the trigger for gastrointestinal disorders and was found to be a factor causing pharyngeal reflux and acid reflux [ 6 ].

Emotion regulation is defined as the ability to cope with negative emotions adaptively [ 15 ]. Difficulties in emotion regulation were found among obese adolescents with emotional eating [ 16 ], which was proven to be one factor in overeating [ 17 , 18 ]. Poor emotion regulation was related to impulsivity [ 19 ] and depression [ 20 ], both of which were shown to have a positive connection with emotional eating [ 21 , 22 ].

Impulsivity is recognized as rapid and unplanned reactions to stimulation without thinking about the negative consequences of these reactions [ 23 ]. It is a multidimensional construct that involves attentional, behavioral, and cognitive components [ 24 ] and has been reported frequently for years [ 25 , 26 ]. Data from a large national sample of the United States population showed that nearly 20% of the participants have impulsivity, especially among younger individuals [ 27 ]. Forty percent of children and 58.3% of adults had higher clinically elevated impulsivity, as indicated by the data in 2011 [ 28 ].

Depression is an unusually low and unpleasant mood-altering negative emotional state that harms personal life and society [ 29 ]. The World Health Organization reports that the global prevalence of depression is as high as 12.8% [ 30 ]. College students have more negative emotions due to their high academic pressure, uncertain employment prospects, and other problems [ 31 ]. The study elucidated that the prevalence of depressive symptoms among college students is increasing [ 32 ]. Approximately 23.8% of first-year university students have depressive symptoms [ 33 ], and more than 30% of university students have depression [ 34 ].

Emotion regulation and emotional eating

Difficulties in emotion regulation lead to unhealthy eating behaviors [ 35 , 36 ], especially binge eating [ 37 ]. The escape model explains that individuals who have d ifficulties in emotion regulation may erode the usual inhibitions around food and make people willing to escape the negative emotions by breaking their dietary rules and restricting their focus to eating itself [ 38 , 39 ]. Emotion regulation and eating disorders had positive relations, as proven by multiple correlation analysis in Italian university students [ 40 ]. Gianini investigated 326 obese and binge-eating adults and found that difficulties in emotion regulation can predict emotional eating [ 37 ]. A study among 552 undergraduate students demonstrated that difficulties in emotion regulation contribute greatly to emotional eating [ 36 ].

The mediating role of impulsivity

Impulsivity is one of the mental dimensions taking part in emotion regulation [ 41 ], which is generally regarded as a consequence of impaired executive functioning. Emotion regulation was negatively associated with impulsivity [ 19 ]. Prior work proved that emotion dysregulation was related to impulsive behaviors (r = 0.31, p<0.1) [ 42 ]. Multivariable analysis indicated that eating disorders are positively associated with impulsivity in obese people [ 43 ]. Emotion-based impulsivity may manifest in the form of binge eating [ 44 ]. Although individuals realized the adverse effect of this action, the behaviors had become compulsive to escape negative emotions [ 45 ]. A sample containing 121 obese participants with binge eating behaviors was proven to have high impulsivity, with an average score of 31.11 assessed by the UPPS-P Impulsive Behavior Scale [ 43 ].

The mediating role of depressive symptoms

Depression was taken as a result of inappropriate emotion regulation [ 46 ]. A study conducted among university students indicated that individuals with depression had more difficulties in emotion regulation [ 47 ]. The results from random effects analyses indicated that difficulties in emotion regulation were connected with depressive symptoms [ 48 ]. Researchers used an emotion-provoking film to increase the negative emotion of participants and showed that difficulties in emotion regulation were related to higher levels of depression symptoms [ 49 ]. Braden experimented with adults with overweight or obesity and indicated that eating as a response to depression was most closely related to emotion regulation difficulties [ 50 ]. A study conducted in a random sample of 10,000 people in Finland revealed that emotional eating is associated with an increase in depression [ 51 ].

The chain mediating role of emotion regulation and emotional eating

Increased impulsivity and negative mood may be amplified by difficulties in emotion regulation among overweight people, which was found in Leehr’s experiment using electroencephalography and eye tracking [ 52 ]. A study among adolescents aged 13–21 years implied that difficulties with impulse control can result in emotional eating when they have a negative mood [ 53 ]. A large cohort of studies conducted on adults revealed that impulsivity, as a distinct personality factor, gives rise to one set of depressive illnesses in adults [ 23 ]. A study indicated that patients with major depressive disorder had higher scores on the factors that indicated impulsive reactivity [ 54 ]. Previous research on adolescents has suggested that impulsivity is related to rumination, self-blaming, and catastrophes [ 55 ]. Impulsivity also leads adolescents to encounter adverse situations, which, in turn, result in depression [ 56 ]. Above all, difficulties in emotion regulation issues in emotional eating are also related to impulsivity and negative mood. Meanwhile, depression is a typical negative mood.

Although previous studies have proven the relationship between emotion regulation and emotional eating, no study to date has explored this relationship in undergraduate students. For our first goal, we focused on the status of emotional eating among undergraduate students. Next, we aimed to explore the mechanism of emotional eating and test whether impulsivity and depressive symptoms can mediate the relationship between emotion regulation and emotional eating, which has been neglected by existing studies. Our study would contribute to exploring the psychological factors related to emotional eating and finding effective prevention and interventions by mechanism analysis.

We have the following hypothesis:

• H1: Difficulties in emotion regulation are positively correlated with emotional eating among Chinese undergraduate students.
• H2: Impulsivity plays a mediating role in difficulties in emotion regulation and emotional eating among Chinese undergraduate students.
• H3: Depressive symptoms play a mediating role in difficulties in emotion regulation and emotional eating among Chinese undergraduate students.
• H4: Impulsivity and depressive symptoms play a chain mediating role in difficulties in emotion regulation and emotional eating among Chinese undergraduate students.

Materials and methods

Data source.

According to the principle of multivariate statistical analysis, the estimated sample size was 5 times the number of observation indexes [ 57 ]. Given that there is a potential 10 percent missing samples, 467 samples were planned to be included. The sample was recruited on social networks, and convenience sampling was used in this study. We made an OR code for the questionnaire by the Wenjuanxing app and distributed it via the WeChat app. The participants scanned the OR code by their smartphones online from February 6 to 13, 2022. Verbal informed consent was obtained from all participants. The participants were undergraduate students during the investigation procedure. The inclusion criteria were ①undergraduate students aged from 18 to 26; ② participation in this research was entirely voluntary; ③ no mental health problems. The exclusion criteria were ① completion of the questionnaire in less than 100 seconds; ② age younger than 18 years or older than 26 years.

Research Ethics Committee written approval was obtained from the IRB of Peking University (No. IRB00001052-21150). Verbal informed consent was obtained from all participants. Before conducting the online survey, the participants were informed that involvement was completely voluntary and anonymous. In addition, we introduced the purpose of the study again in the guidelines of each questionnaire and emphasized the confidentiality of the survey.

Emotional eating.

Zhu Hong (2012) revised the Chinese version of the Emotional Eating Scale (EES-R), adding an emotional dimension to the original scale [ 58 ]. There are 23 items divided into four dimensions: depression, anxiety, anger and positivity. Responses ranged from 1 to 5, with 1 representing a total lack of these emotions and 5 indicating a high degree of emotion. The higher the score, the higher the desire to eat in a certain mood. The Cronbach’s alpha coefficient in this study was 0.935.

Emotion regulation.

Gratz developed the difficulties in Emotion Regulation Scale (DERS) and his team in 2004 [ 59 ]. The scale is a total of 36 items, which can be divided into six dimensions: difficulty in emotional awareness, difficulty in emotional understanding, difficulty in impulse control, difficulty in goal orientation, difficulty in accepting emotional responses, and difficulty in effectively using regulatory strategies. Each item’s responses range from 1 (never) to 4 (always). Item 11 is scored in reverse. The higher the score is, the more serious the emotion regulation difficulty and the lower the emotion regulation ability. In this study, Cronbach’s alpha coefficient was 0.934.

Impulsivity.

The short version of the UPPS-P Impulsive Behavior Scale (UPPS-P) is a 20-point evaluation of five different impulsive personality traits that demonstrate conceptual validity [ 60 ]. Responses to questions ranged from 1 (strongly agree) to 4 (strongly disagree), with higher scores indicating stronger negative urgency. In this study, Cronbach’s alpha coefficient was 0.834.

Depressive symptoms.

The Center for Epidemiological Survey, Depression Scale (CES-D) was developed by Radloff, National Institute of Psychiatry in 1977 [ 61 ]. The scale has a total of 20 items, each of which measures one symptom. According to the frequency of symptoms occurring in the last week, each item response ranged from 0 (none or very few) to 3 (disagree strongly), and 4, 8, 12 and 16 were scored in reverse. A score less than or equal to 15 indicates no depressive symptoms, 16–19 is likely to have depressive symptoms, and 20 indicates depression symptoms. The Cronbach’s alpha coefficient was 0.884.

Data analysis

All statistical analyses were performed with SPSS 25.0. At the outset of the data analysis, descriptive statistics were used to describe the profile of the sample. The Pearson product-moment correlation coefficient (r) was used in the correlation analysis. The range from -1 to 1 and the values of 0.1, 0.3, and 0.5 represent “small”, “medium”, and “high” correlations, respectively [ 62 ]. In the hierarchical regression analysis, the contribution of all these components to emotional eating was examined by including emotion regulation, impulsivity and depression in the final model. Model 6 of the SPSS process plug-in was used to test the chain mediation model. For the significance test of the regression coefficient, the bootstrapping method with 5,000 repeated samples was selected to obtain a robust [ 63 ].

Sociodemographic characteristics and descriptive analysis

A total of 506 questionnaires were collected across 25 Chinese provinces (N = 264 in Beijing, N = 80 in Guangdong, N = 19 in Shandong and N = 131 in other provinces). The final sample size was 494, with an effective valid response rate of 97.7%.

The sample of this study was undergraduate students whose average age was 20.1 ± 1.9 years old. The descriptive statistics are shown in Table 1 . The majority of the participants were female (62.8%), while 184 males were included. There were 340 junior-grade students in our study, accounting for 68.8%, and the rest of the participants were senior students (N = 154, 31.2%).

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https://doi.org/10.1371/journal.pone.0280701.t001

Pearson correlation analysis

There was a significantly correlated relationship among difficulties in emotion regulation, impulsivity, depressive symptoms, and emotional eating. As shown in Table 2 , Pearson correlation analyses revealed that there was a medium positive correlation between emotional eating and depressive symptoms (r = 0.363, p<0.01), difficulties in emotion regulation (r = 0.260, p<0.01) and impulsivity (r = 0.382, p<0.01). Impulsivity was found to be moderately positively correlated with depressive symptoms (r = 0.422, p<0.01) and difficulties in emotion regulation (r = 0.473, p<0.01). The correlation between depressive symptoms and difficulties in emotion regulation was high (r = 0.656, p<0.01). The results showed that there were significant positive correlations between difficulties in emotion regulation, impulsivity and depressive symptoms, supporting hypothesis 1. In addition, age was significantly correlated with depressive symptoms, difficulties in emotion regulation and emotional eating, while BMI was insignificantly correlated with these variables.

https://doi.org/10.1371/journal.pone.0280701.t002

Hierarchical regression analysis

As shown in Table 3 , there were 4 models in the hierarchical regression analysis. Impulsivity may mediate difficulties in emotion regulation and emotional eating. To verify Hypothesis 1, at the first stage (Model 1), difficulties in emotion regulation were added to the model as an independent variable and significantly predicted emotional eating (β = 0.221, p < 0.001). In the second stage (Model 2), impulsivity was included in the model as a dependent variable, and difficulties in emotion regulation significantly predicted impulsivity (β = 0.445, p < 0.001). In the third stage (Model 3), difficulties in emotion regulation (β = 0.572, p < 0.001) and impulsivity (β = 0.127, p < 0.05) significantly and positively predicted depressive symptoms. In the fourth stage (Model 4), the addition of impulsivity and depressive symptoms to the model as independent variables led to a distinct change in the beta value of difficulties in emotion regulation, and difficulties in emotion regulation no longer made a significant contribution to emotional eating.

https://doi.org/10.1371/journal.pone.0280701.t003

Mediation analysis

The PROCESS macro of SPSS was suitable for the analysis of the effects of mediation and for chain mediation models with multiple mediating variables [ 64 ]. Therefore, we used Model 6 in the PROCESS macro of SPSS to analyze the chain mediation effect of impulsivity and depressive symptoms between difficulties in emotion regulation and emotional eating. Taking emotion regulation difficulties as the independent variable, emotional eating as the dependent variable, and impulsivity and depressive symptoms as the mediating variables, the chain mediation effect test yielded the results shown in Fig 1 and Table 4 . Our study examined the gender, age, grade and income mediating effects as control variables. The results show that difficulties in emotion regulation have a significant indirect effect on emotional eating through impulsivity (β = 0.1172, 95% CI = [0.07,0.17]); that is, impulsivity has a significant mediating effect on the relationship between emotional regulation difficulties and emotional eating, which supported Hypothesis 2. Thus, difficulties in emotion regulation have significant indirect effects on emotional eating through depressive symptoms (β = 0.1316, 95% CI = [0.07, 0.20]); that is, depressive symptoms have a significant mediating effect on the relationship between difficulties in emotion regulation and emotional eating, which supported Hypothesis 3. Finally, the indirect effect of difficulties in emotion regulation on emotional eating through impulsivity and depressive symptoms was significant (β = 0.0130, 95% CI = [0.00, 0.03]). In other words, impulsivity can affect depressive symptoms. At the same time, the chain mediation path from difficulties in emotion regulation to impulsivity, then to depressive symptoms, and finally to emotional eating is significant, supporting Hypothesis 4. The total effect of difficulties in emotion regulation on emotional eating was significant (β = 0.2053, 95% CI = [0.13, 0.28]), while the total indirect effect of difficulties in emotion regulation on emotional eating was significant (β = 0.2608, 95% CI = [0.17, 0.34]). The results indicate that impulsivity and depressive symptoms play a continuous mediating role in the relationship between difficulties in emotion regulation and emotional eating.

Note: ***p<0.001. Values on paths are path coefficients (standardized βs).

https://doi.org/10.1371/journal.pone.0280701.g001

https://doi.org/10.1371/journal.pone.0280701.t004

Although emotional eating has been studied for years, few studies have examined emotional eating among undergraduate students and the specific mechanism between difficulties in emotion regulation and emotional eating. In this study, we discussed the mediating role of impulsivity and depressive symptoms in the relationship between difficulties in emotion regulation and emotional eating among undergraduate students. Stressed the significance of regulating emotions and the importance of impulsivity and depressive symptoms in preventing and intervening in emotional eating.

The status of emotional eating

In our study, the average score of emotional eating among undergraduate students was 61, higher than the score of 52 in Shi’s study [ 65 ]. The mean BMI of the sample was 21.64, which was consistent with the study conducted in 2021, which showed that nearly 80% of undergraduate students had BMI ranging from 18 to 24 [ 66 ]. Our results showed that senior students were more likely to engage in emotional eating. It can be explained that senior students usually face more employment and academic pressure as they are near graduation [ 67 ]. The current data indicated that males have a higher level of emotional eating than females, which is contrary to some previous studies [ 6 , 68 ]. It can be explained that women are more concerned with weight control and body shape maintenance [ 69 ]. Average monthly income is also a factor that influences emotional eating in our study, and lower income indicates a higher level of emotional eating, which is consistent with a previous report [ 70 ]. Hemmingsson’s theory emphasized that low income may cause negative mood, which finally induces eating energy-dense foods to alleviate negative emotions and stress [ 71 ]. Burdick proved that lower income is associated with greater impulsivity [ 72 ]. People with higher impulsivity are deeply influenced by negative emotions, which appear to be the cause of emotional eating [ 73 ].

Difficulties in emotion regulation are positively correlated with emotional eating

Based on our study, difficulties in emotion regulation had a positive predictive effect on emotional eating, which verifies H1. People who have difficulties in emotion regulation are more likely to experience negative emotions [ 74 ]. A review reported that people with depression use fewer emotion regulation strategies [ 75 ]. People with difficulties in emotion regulation cannot understand the feelings they have, and this lack of emotional clarity makes of the eating disorder [ 37 ]. Difficulties in emotion regulation lead to an inability to deal with tasks [ 50 ] and to use effective regulatory strategies [ 59 ], subsequently increasing the probability of eating as an attempt to escape from adverse emotional states [ 50 ]. Under negative circumstances, people choose eating as a strategy because they can feel happy in this way [ 76 ]; moreover, eating more calories in the first 5 minutes can make them more positive [ 77 ]. Dopamine is a probable explanation; eating increases dopamine release by glutamatergic projection to the ventral tegmental area mediates and N-methyl-D-aspartic acid receptor (NMDA) receptor, which then causes the feeling of pleasure to people [ 78 , 79 ]. Above all, difficulties in emotion regulation result in various physical and mental changes, which lead to emotional eating.

The relationship between difficulties in emotion regulation and emotional eating is mediated by impulsivity

The current study found that impulsivity played a mediating role between difficulties in emotion regulation and emotional eating, which verifies H2. Valente (2017) suggested that emotional eating is an iceberg on top of a three-step ladder and that the hidden base of the iceberg is represented by both emotional dysregulation and the level of impulsivity [ 80 ]. Difficulties in emotion regulation, especially impulse control, may decrease dopamine D 2 (DAD 2 ) receptor availability in the striatum and result in lower DA-argic activity, which signifies a tendency toward impulsivity [ 81 ]. Bratec (2017) found that difficulties in emotion regulation reduce the influence of the prefrontal cortex on ventral striatal aPE signals after then changing the normal status of the striatum [ 82 ]. Individuals who cannot activate striatal circuits appropriately may have impaired self-regulatory control, which contributes to impulsive behaviors [ 83 ]. Overeating behavior has been confirmed to have an association with impulsivity [ 84 ]. Impulsivity may contribute to overeating in situations of uncontrolled emotion [ 85 ]. Thus, difficulties in emotion regulation can induce emotional eating through impulsivity, which indicates that enhancing the ability of emotion regulation and reducing impulsivity can improve the status of emotional eating.

The relationship between difficulties in emotion regulation and emotional eating is mediated by depressive symptoms

The current study found that depressive symptoms played a mediating role between difficulties in emotion regulation and emotional eating, consistent with previous studies [ 86 ], which verifies H3. Martin et al proved that difficulties in emotion regulation may be a predictor of depression in general adults [ 87 ]. Difficulties in emotion regulation lead to added negative moods and might result in depressive symptoms after some time [ 88 , 89 ]. Longitudinal research has found that eating can be a way to temporarily numb uncomfortable emotions, such as depression. Individuals who are experiencing depression may use food as entertainment [ 90 ]. Eating triggered by depression was closely associated with emotion regulation difficulties [ 50 ]. It is possible that when experiencing negative emotions (e.g., depression), individuals increase their eating behavior as a strategy for regulation. The 5-hydroxytryptamine transporter (5-HTTLPR) has been proven to be associated with depression [ 91 ]. Additionally, a study proved that adolescents with depressive symptoms showed a greater increase in emotional eating if they carried the 5-HTTLPR genotype [ 92 ]. Thus, methods to boost mood and reduce depressive symptoms can help improve emotional eating.

Impulsivity and depressive symptoms are chain mediators in the relationship between difficulties in emotion regulation and emotional eating

Our results showed the chain mediation of difficulties in emotion regulation on emotional eating through impulsivity and depressive symptoms, which verifies H4. The results of our research are consistent with a previous study, which proved that impulsivity can predict the onset of depression as a distinct personality factor in adults by a logistic regression model [ 56 ]. Individuals who have difficulties in emotion regulation are at significant risk of using inappropriate strategies to cope with life events [ 93 ]. Past research found that the higher emotion dysregulation group scored significantly higher on impulsivity [ 94 ]. Low levels of 5-hydroxytryptamine (5-HT) and 5-hydroxyindole acetic acid (5-HIAA) were found in people classified as impulsive [ 95 – 97 ], and levels of 5-HT and 5-HIAA have a positive relationship with the severity of depression and could be good markers for evaluating depression [ 98 ]. Our results suggested that difficulties in emotion regulation may have a tendency toward impulsivity and depression. By effectively acting as mediators through impulsivity and depressive symptoms, people might have emotional eating when they have difficulties in emotion regulation [ 99 ]. The current study is the first to document a sequential process in which difficulties in emotion regulation affect impulsivity, which in turn predicts depression and thus overeating.

Through our study, it can be seen that the state of emotional eating among Chinese university students is grim. The status of emotional eating seems to be associated with difficulties in emotion regulation. It is time to explore the relationship because emotional eating can increase the risk of obesity and other diseases. The relationship between difficulties in emotion regulation and emotional eating is mediated by impulsivity and depression symptoms, respectively. In addition, impulsivity and depressive symptoms are chain mediators in the relationship between the two.

Strengths and limitations

Our study contributes to understanding the latest situation of emotional eating among undergraduate students. This is the first study to build a chain mediation model that explores the relevant factors and mechanisms of emotional eating.

One limitation of the study is that the results cannot be generalized to the overall population because undergraduate students differ in social pressure and the environment from others. The sample was underrepresented to demonstrate the overall situation of college students in China because the sample size is limited and sample sources cannot cover all regions of China. Emotional eating, difficulties in emotion regulation, impulsivity and depressive symptoms were measured by self-report, and the results are not as accurate as laboratory studies or observational measures in daily routine. We cannot make sure that each participant understands the question well and if they wrote a wrong answer that was different from reality. The participants may have false memories or lie to us.

A laboratory study or observational measure is needed to assess emotional eating, difficulties in emotion regulation, impulsivity and depressive symptoms to further explore this research question. Future studies should investigate different results of emotional eating after intervening in the two mediation variables in the current study to explore the impact of emotional eating.

Supporting information

https://doi.org/10.1371/journal.pone.0280701.s001

Acknowledgments

We wish to thank all the college students who participated in our questionnaire investigation.

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• Ambre Godet   ORCID: orcid.org/0000-0002-0276-4392 1 ,
• Alexandra Fortier   ORCID: orcid.org/0000-0003-2232-0163 1 ,
• Elise Bannier   ORCID: orcid.org/0000-0002-8942-7486 2 , 3 ,
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Emotional eating is commonly defined as the tendency to (over)eat in response to emotion. Insofar as it involves the (over)consumption of high-calorie palatable foods, emotional eating is a maladaptive behavior that can lead to eating disorders, and ultimately to metabolic disorders and obesity. Emotional eating is associated with eating disorder subtypes and with abnormalities in emotion processing at a behavioral level. However, not enough is known about the neural pathways involved in both emotion processing and food intake. In this review, we provide an overview of recent neuroimaging studies, highlighting the brain correlates between emotions and eating behavior that may be involved in emotional eating. Interaction between neural and neuro-endocrine pathways (HPA axis) may be involved. In addition to behavioral interventions, there is a need for a holistic approach encompassing both neural and physiological levels to prevent emotional eating. Based on recent imaging, this review indicates that more attention should be paid to prefrontal areas, the insular and orbitofrontal cortices, and reward pathways, in addition to regions that play a major role in both the cognitive control of emotions and eating behavior. Identifying these brain regions could allow for neuromodulation interventions, including neurofeedback training, which deserves further investigation.

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Abbreviations.

Anterior cingulate cortex

Binge eating disorder

Basolateral amygdala

Body mass index

Blood-oxygen-level-dependent

Corticotrophin-releasing hormone

Dutch Eating Behavior Questionnaire

Dorsolateral prefrontal cortex

Dorsomedial prefrontal cortex

Eating disorder

Electroencephalography

Enteric nervous system

Functional magnetic resonance imaging

Hypothalamic-pituitary-adrenal

Inferior frontal gyrus

Late positive potential

Nucleus accumbens

Norepinephrine

Neurofeedback

Orbitofrontal cortex

Posterior cingulate cortex

Positron emission tomography

Prefrontal cortex

Resting-state functional connectivity

Supplementary motor area

Transcranial direct-current stimulation

Three-Factor Eating Questionnaire

Ventrolateral prefrontal cortex

Ventromedial prefrontal cortex

Ventral tegmental area

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The present research was funded by the University of Rennes 1, Fondation de l’Avenir, the Benjamin Delessert Institute, and INRAE. A. Godet received a PhD grant from the University of Rennes 1. Univ Rennes

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Nicolas Coquery and David Val-Laillet contributed equally to this paper.

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Ambre Godet, Alexandra Fortier, Nicolas Coquery & David Val-Laillet

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Godet, A., Fortier, A., Bannier, E. et al. Interactions between emotions and eating behaviors: Main issues, neuroimaging contributions, and innovative preventive or corrective strategies. Rev Endocr Metab Disord 23 , 807–831 (2022). https://doi.org/10.1007/s11154-021-09700-x

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Depression, emotional eating and long-term weight changes: a population-based prospective study

• Hanna Konttinen   ORCID: orcid.org/0000-0002-6001-4418 1 , 2 ,
• Tatjana van Strien 3 , 4 ,
• Satu Männistö 5 ,
• Pekka Jousilahti 5 &
• Ari Haukkala 2  

International Journal of Behavioral Nutrition and Physical Activity volume  16 , Article number:  28 ( 2019 ) Cite this article

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Emotional eating (i.e. eating in response to negative emotions) has been suggested to be one mechanism linking depression and subsequent development of obesity. However, studies have rarely examined this mediation effect in a prospective setting and its dependence on other factors linked to stress and its management. We used a population-based prospective cohort of adults and aimed to examine 1) whether emotional eating mediated the associations between depression and 7-year change in body mass index (BMI) and waist circumference (WC), and 2) whether gender, age, night sleep duration or physical activity moderated these associations.

Participants were Finnish 25- to 74-year-olds who attended the DILGOM study at baseline in 2007 and follow-up in 2014. At baseline ( n  = 5024), height, weight and WC were measured in a health examination. At follow-up ( n  = 3735), height, weight and WC were based on measured or self-reported information. Depression (Center for Epidemiological Studies - Depression Scale), emotional eating (Three-Factor Eating Questionnaire-R18), physical activity and night sleep duration were self-reported. Age- and gender-adjusted structural equation models with full information maximum likelihood estimator were used in the analyses.

Depression and emotional eating were positively associated and they both predicted higher 7-year increase in BMI ( R 2  = 0.048) and WC ( R 2  = 0.045). The effects of depression on change in BMI and WC were mediated by emotional eating. Night sleep duration moderated the associations of emotional eating, while age moderated the associations of depression. More specifically, emotional eating predicted higher BMI ( P  = 0.007 for the interaction) and WC ( P  = 0.026, respectively) gain in shorter sleepers (7 h or less), but not in longer sleepers (9 h or more). Depression predicted higher BMI ( P  < 0.001 for the interaction) and WC ( P  = 0.065, respectively) increase in younger participants, but not in older participants.

Conclusions

Our findings offer support for the hypothesis that emotional eating is one behavioural mechanism between depression and development of obesity and abdominal obesity. Moreover, adults with a combination of shorter night sleep duration and higher emotional eating may be particularly vulnerable to weight gain. Future research should examine the clinical significance of our observations by tailoring weight management programs according to these characteristics.

It has been estimated that worldwide over 300 million people suffer from depression and over 650 million are affected by obesity [ 1 , 2 ]. The consequences of these conditions in terms of lost health, functioning and quality of life are huge – depression and obesity are both related to an elevated risk of developing several chronic diseases and depression is a major contributor to suicide deaths [ 1 , 2 ]. There is thus a critical need to develop interventions that are effective in reducing the occurrence of both conditions. Numerous studies have demonstrated that depression and obesity often occur together and are bi-directionally associated over time [ 3 , 4 ]. In an exploration of possible underlying mechanisms linking depression and obesity, a population-based cross-sectional study showed the link to be mediated by emotional eating [ 5 , 6 ]. Emotional eating refers to a tendency to eat in response to negative emotions (e.g. depression, anxiety, stress) with the chosen foods being primarily energy-dense and palatable ones [ 6 , 7 , 8 ]. It can be caused by various mechanisms, such as using eating to cope with negative emotions or confusing internal states of hunger and satiety with physiological changes associated with emotions [ 9 ]. Using the 7-year follow-up data of the same population-based sample, the present study assessed whether emotional eating also acts as a mediator between depression and subsequent weight gain, and whether such a mediation effect is dependent on other factors, including gender, night sleep duration and physical activity. A more detailed knowledge of these factors may point out novel targets for improved obesity and depression interventions to decrease the global burden of disease and increase individual well-being.

Depression (depression-melancholia) is typically characterized by loss of appetite and subsequent weight loss, but there exists also a depression subtype that is characterized by the a-typical vegetative symptom of increased appetite and weight gain [ 10 , 11 , 12 ]. Emotional eating has been considered a marker of this a-typical depression subtype, because it shares with this depression subtype the a-typical feature of increased appetite in response to distress [ 13 , 14 ]. The depression – obesity link may therefore be mediated by emotional eating, for which there was indeed support in various cross-sectional studies for both genders [ 5 , 6 , 15 , 16 ] and for women [ 17 ]. To date, studies have rarely examined the links between depression, emotional eating and weight gain in a prospective setting. As an exception, a 5-year study in Dutch parents [ 18 ] and an 18-year study in mid-life US adults [ 19 ] demonstrated that emotional eating acted as a mediator between depression and BMI gain or obesity development particularly in women. With the evidence from the above studies regarding gender being partly mixed, it remains inconclusive whether the mediation effect of emotional eating varies across women and men. Gender was therefore one of the moderators tested in the present prospective study.

The mediation effect of emotional eating between depression and weight gain may also depend on physical activity and sleep duration, though to our best knowledge their moderating effects in this context have not been directly tested before. Both factors have been linked to stress and its management, with exercise being a treatment for depression and anxiety disorders [ 20 , 21 , 22 ] and short sleep duration being associated with psychological stress [ 23 , 24 ]. Higher physical activity has also been associated with lower emotional eating [ 25 , 26 ]. Accordingly, it has been proposed that increasing physical activity could be a viable strategy to reduce excessive intake of high-fat and -sugar foods under negative emotional states [ 27 ] and extending sleep duration could have comparable effects [ 28 ]. Exercise could thus attenuate the effects of depression and emotional eating on weight gain via improvements in emotion regulation. In contrast, short sleep duration might strengthen their effects on weight gain – i.e. reduced sleep can be seen as a stressor itself and a marker of perceived stress [ 29 , 30 ] and evidence is emerging that it interferes with emotion regulation [ 31 ]. In support of this, findings from a laboratory study of 64 women suggested that short sleep duration (less than 7 h per night) may act as a stressor and lead to elevated snack intake in those prone to emotional eating [ 32 ].

A few observational studies have also found that sleep duration and physical activity moderated the emotional eating – weight gain association. Van Strien and Koenders [ 29 ] studied a sample of Dutch employees and observed that women with a combination of short sleep duration and high emotional eating experienced the greatest increases in body mass index (BMI) over 2 years. A similar pattern of findings was reported by Chaput et al. [ 33 ] in a sample of French Canadian adults with 6-year follow-up and information on disinhibited eating behaviour (i.e. tendency to overeat in response to food or emotional cues). Moreover, emotional eating was less strongly associated with BMI and its gain in participants with high physical activity than in those with low physical activity in the Dutch employee sample [ 34 ] and in a Swiss population survey [ 26 ]. However, it is important to explore whether these findings can be replicated and extended using an independent sample of adults with long-term follow-up as well as information on symptoms of depression and change in abdominal obesity.

In the present study, we used a large population-based 7-year prospective cohort of adults to increase our knowledge on the interplay between depression, emotional eating and weight changes in the context of gender, night sleep duration and physical activity patterns. Because of the large age range (between 25 and 74 years at baseline) in this sample, we were also interested in the possible moderating effects of age. More specifically, our aims were to examine 1) whether emotional eating mediated the associations between symptoms of depression and 7-year change in BMI and waist circumference (WC), and 2) whether gender, age, night sleep duration or physical activity moderated these associations.

Participants and procedure

Participants were 25- to 74-year-old Finnish men and women who attended the baseline ( n  = 5024) and follow-up ( n  = 3735) phases of the DIetary, Lifestyle and Genetic determinants of Obesity and Metabolic syndrome (DILGOM) study (for a participant flow chart, see [ 35 ]). The baseline phase was conducted in 2007 as a part of the FINRISK 2007 study in which a random sample of 10,000 people, stratified by 10-year age groups and gender, was drawn from the Finnish population register in five large study areas [ 36 ]. All participants who attended the FINRISK 2007 study ( n  = 6258, response rate = 63%) in January–March were invited to the DILGOM 2007 study ( n  = 5024, response rate = 80%) conducted in April–June. The baseline phase contained a health examination (including measurements on height, weight and WC) at a study center and several self-administered questionnaires completed either during the visit or at home. All baseline participants alive at the end of the year 2013 received an invitation to the follow-up phase conducted in April–June 2014 ( n  = 3735, response rate = 82%). The data collection was carried out in two groups: 1) participants who lived in the areas of Turku and Loimaa and in the cities of Helsinki and Vantaa were invited to a similar health examination to the one at baseline ( n  = 1312); 2) participants who lived in the other three study areas (North Karelia, North Savo, Oulu) received a mail-back questionnaire and self-reported their current weight and height ( n  = 2423). They also measured their WC themselves, with a measurement tape that was sent to them together with detailed measurement instructions. Participants who did not attend the follow-up phase were more often men (χ 2  = 7.22, df = 1, P  = 0.007) and tended to be younger (F(1, 5022) = 13.83, P  < 0.001, η 2  = 0.003) and have higher BMI and WC (F(1, 5015) = 26.56, P  < 0.001, η 2  = 0.005 and F(1, 4992) = 30.88, P  < 0.001, η 2  = 0.006, respectively) at baseline than follow-up participants, but these mean differences were small in size. There were no statistically significant differences between these two groups of participants in terms of baseline education (F(1, 4983) = 3.68, P  = 0.055, η 2  = 0.001), depression (F(1, 4727) = 3.70, P = 0.055, η 2  = 0.001) or emotional eating (F(1, 4853) = 0.60, P  = 0.438, η 2  = 0.000).

The research protocols of the DILGOM baseline and follow-up studies were designed and conducted in accordance with the guidelines of the Declaration of Helsinki and have been approved by the Ethics Committee of Helsinki and Uusimaa Hospital District (decision numbers 229/E0/2006 and 332/13/03/00/2013, respectively). In addition, written informed consent was obtained from all participants.

Outcome variables

Trained research nurses measured participant’s height, weight and WC by using standardized international protocols [ 37 ] at baseline and follow-up. Weight was measured to the nearest 0.1 kg, height to the nearest 0.1 cm and WC to the nearest 0.5 cm. All measurements were made in a standing position in light clothing and without shoes. WC was measured at a level midway between the lower rib margin and iliac crest. At baseline, weight and height measurements were available for 5017 (99.9%) participants to calculate BMI (kg/m 2 ), while WC measurement was available for 4994 (99.4%) participants. At follow-up, BMI and WC were based on measured ( n  = 1310 and 1305, respectively) or self-reported ( n  = 2352 and 2288, respectively) information. In a recent validation study conducted in a subset of DILGOM participants, the mean differences between self-reported and nurse-measured height, weight and WC were small and the intra-class correlations were 0.95 or greater in both genders [ 38 ]. Respondents with measured and self-reported anthropometric data at follow-up were therefore included in this study.

Predictor variables

The 20-item Center for Epidemiological Studies - Depression (CES-D) Scale [ 39 ] was used to measure depressive symptoms at baseline. The scale is designed to measure depressive symptomatology in the general population, and it has been found to be adequately related to clinical ratings of depression [ 40 ]. For each item, respondents indicate how often they have felt in the described way during the past week using a four-point scale (from 0 “rarely or none of the time” to 3 “almost all of the time”). A meta-analysis of 28 studies examining the structure of the CES-D scale concluded that the proposed four-factor structure (negative affect, somatic and retarded activity, lack of positive affect, interpersonal difficulties) best described the scale [ 41 ]. In line with this and our previous cross-sectional study [ 5 ], we modelled depression as a latent factor with four indicators where each indicator was the mean of the items belonging to the respective original factor. It is noteworthy that the CES-D scale contains one item on loss of appetite (“I did not feel like eating; my appetite was poor”), while there is no corresponding item on increased appetite. We decided to exclude the loss of appetite item from the present analyses, because it represents an unbalanced measurement of appetite change with potentially biasing the measurement towards depression subtype characterized by decreased appetite and weight loss. Thus, somatic and retarded activity indicator variable was calculated based on 6 items instead of 7 items.

• Emotional eating

Emotional eating at baseline was assessed by using the emotional eating scale of the 18-item Three-Factor Eating Questionnaire (TFEQ-R18) [ 42 ]. Karlsson et al. [ 42 ] developed the TFEQ-R18 on the basis of a factor analysis of the original 51-item TFEQ in the Swedish Obese Subjects study and it has been found to be valid in the general population [ 43 , 44 ]. The scale contains three items that are all rated on a four-point scale (from 1″ does not describe me at all″ to 4″ describes me exactly″): 1) When I feel anxious, I find myself eating, 2) When I feel blue I often overeat, and 3) When I feel lonely, I console myself by eating. In line with our previous cross-sectional study [ 5 ], emotional eating was modelled as a latent factor with the three items as indicators.

Moderators and covariates

Night sleep duration and physical activity.

Night sleep duration at baseline was assessed with the following question “How many hours per night do you usually sleep?”. The item was treated as a continuous variable in the analyses. Physical activity at baseline was measured with the International Physical Activity Questionnaire - Short Form (IPAQ-SF) [ 45 ]. It asks respondents to report their physical activity during the past 7 days across a comprehensive set of domains (leisure time, work, transport, domestic work and gardening) and three intensity levels (vigorous activities, moderate activities and walking). The data were scored according to the IPAQ manual and a combined total physical activity score (minutes per week) was used on a continuous scale in the main analyses. We repeated the analyses with vigorous physical activity score (minutes per week), but it should be noted that 41.6% of participants had not engaged in any vigorous activities during the past week.

Age and gender

Baseline age was treated as a continuous variable (years) and gender as a dichotomous variable (1 = men, 2 = women) in the analyses.

Statistical methods

We used structural equation modelling (SEM) to test the hypothesized mediation models between depression, emotional eating and 7-year change in adiposity indicators. Depression and emotional eating were modelled as latent factors because ignoring measurement error in predictors can lead to biased regression coefficients and latent variables allow taking measurement error into account [ 46 ]. The analyses were conducted in three steps. Firstly, confirmatory factor analysis with two latent factors (depression and emotional eating) was used to test whether the four depression indicators and the three emotional eating indicators loaded on separate factors. Secondly, the hypothesized mediation models with baseline age and gender as covariates were estimated separately for change in BMI and WC – change modelled by regressing the measurement at follow-up on the baseline measurement. The absence of an interaction between exposure (i.e. depression latent factor) and mediator (i.e. emotional eating latent factor) in both models allowed us to apply the SEM approach to mediation analysis (β = 0.12, SE = 0.07, P  = 0.080 and β = 0.04, SE = 0.07, P  = 0.585 for the interaction in the model for BMI and WC, respectively) [ 46 , 47 ]. The results were reported as the total, direct and indirect effects (i.e. regression coefficients and bias-corrected bootstrap 95% confidence intervals) of depression and emotional eating. The reported indirect effect reflects how much of the association between depression and change in adiposity indicator is explained by emotional eating [ 48 ]. The total effect represents the relationship between depression and change in adiposity indicator before adjustment for emotional eating. Thirdly, the moderator effects of gender, age, night sleep duration and physical activity were examined in a separate set of models by adding a moderator (in the case of sleep duration and physical activity) and interaction terms (moderator × emotional eating, moderator × depression) as predictors, and testing the significance of these interactions (Mplus code was obtained from Stride et al. [ 49 ] – model 59 with X and M as latent variables).

Full Information Maximum Likelihood (FIML) was used as an estimator, which allows estimation with missing data [ 50 , 51 ]. It does not impute missing values, but estimates parameters directly using all the observed data. Model fit was evaluated by utilizing Chi-Square statistic, Standardized Root Mean Square Residual (SRMR), Tucker-Lewis Index (TLI), Comparative Fit Index (CFI), and Root Mean Square Error of Approximation (RMSEA). As proposed by Hu and Bentler [ 52 ], TLI and CFI values ≥0.95, SRMR values ≤0.08, and RMSEA values ≤0.06 were defined to indicate an adequate fit for the data. Descriptive statistics were derived from IBM SPSS Statistics for Windows, Version 24.0 (IBM Corp., Armonk, NY), while all other analyses were performed with Mplus Version 8 (Muthén & Muthén, Los Angeles, CA).

Descriptive characteristics of the DILGOM participants at baseline in 2007 and follow-up in 2014 are displayed in Table  1 . Participants’ WC mostly increased during the 7-year study period with a mean increase of 2.3 ± 6.4 cm in men and 2.1 ± 7.5 cm in women, while their BMI remained rather stable (mean change of 0.0 ± 2.0 kg/m 2 in men and 0.2 ± 2.3 kg/m 2 in women). Using the definition of weight maintenance suggested by Stevens et al. [ 53 ], a quarter of participants (26% of men and 25% of women) could be defined as weight losers (lost ≥3% of their initial weight) and one-third of them (33% of men and 39% of women) could be defined as weight gainers (gained ≥3% of their initial weight). Change in BMI (F(2, 3657) = 99.88, P  < 0.001, η 2  = 0.052) and WC (F(2, 3571) = 59.70, P  < 0.001, η 2  = 0.032) varied across age groups with 25–39-year-olds (0.6 ± 2.4 kg/m 2 for BMI and 3.6 ± 7.6 cm for WC) and 40–59-year-olds (0.4 ± 1.9 kg/m 2 and 2.9 ± 6.4 cm, respectively) showing greater mean increases than 60–74-year-olds (− 0.5 ± 2.1 kg/m 2 and 0.5 ± 7.1 cm, respectively). Average night sleep duration was 7.3 h with 18.5% of participants sleeping less than 7 h per night. The respective percentages for 7 h, 8 h, and 9 h or more were 38.2, 34.9, and 8.4%. On average, participants spent 12.4 h (median 9.0 h) per week in physical activity of vigorous or moderate intensity or walking. For vigorous physical activity, the mean and median values were 2.8 h and 1.0 h per week. Pearson’s correlations between the main study variables can be found from Additional file  1 .

Results from the confirmatory factor analysis supported the two-factor structure of the depression and emotional eating indicators. The two-factor model had an adequate fit with the data (Chi-Square = 48.4, df = 13, p  < 0.001; CFI = 1.00; TLI = 1.00; RMSEA = 0.02; SRMR = 0.01) and each indicator loaded significantly ( P  < 0.001) on its respective latent factor with standardized factor loadings varying from 0.79 to 0.90 for emotional eating and from 0.45 to 0.91 for depression.

Figures  1 and 2 show that the mediation models between depression, emotional eating and 7-year change in BMI or WC fitted the data adequately. Depression and emotional eating were positively associated with each other and they both predicted higher 7-year increase in BMI and WC. The effects of depression on change in BMI (std. β = 0.025, P  = 0.001 for the indirect effect) and WC (std. β = 0.028, P  < 0.001 for the indirect effect) were mediated by emotional eating. These mediation models explained 4.8 and 4.5% of variance in BMI and WC change, respectively. Sensitivity analyses including only those participants ( n  = 1305–1310) with measured anthropometric data from both study phases produced comparable estimates with the exception that the effects of depression and emotional eating on WC change were not statistically significant at P  < 0.05 level (see Additional files  2 and 3 ).

Results from the mediation model between depression, emotional eating and 7-year change in BMI ( n  = 4986). Depression and emotional eating were modelled as latent factors. Change in BMI was modelled by regressing the measurement at follow-up on the baseline measurement. The model was also adjusted for age and gender (not shown in Figure). Unstandardized and standardized regression coefficients (with 95% bias-corrected bootstrap confidence intervals) are represented on the arrows. Note. Total effect = c + ab. Indirect effect = ab. Indirect effect of depression on 7-year change in BMI: β = 0.068; 95% CI = 0.026, 0.105; P  = 0.001 and std. β = 0.025; 95% CI = 0.009, 0.038; P  = 0.001

Results from the mediation model between depression, emotional eating and 7-year change in WC ( n  = 4985). Depression and emotional eating were modelled as latent factors. Change in WC was modelled by regressing the measurement at follow-up on the baseline measurement. The model was also adjusted for age and gender (not shown in Figure). Unstandardized and standardized regression coefficients (with 95% bias-corrected bootstrap confidence intervals) are represented on the arrows. Note. Total effect = c + ab. Indirect effect = ab. Indirect effect of depression on 7-year change in WC: β = 0.077; 95% CI = 0.041, 0.118; P  < 0.001 and std. β = 0.028; 95% CI = 0.016, 0.043; P  < 0.001

Gender did not moderate the associations of depression ( P  = 0.205–0.214 for the interaction terms) or emotional eating ( P  = 0.260–0.284 for the interaction terms) with change in BMI or WC (Table  2 ). However, while depression and emotional eating predicted higher BMI and WC gain in women, the estimates were non-significant in men. Emotional eating also mediated the effects of depression on change in BMI (β = 0.041, P  = 0.190 in men and β = 0.085, P  = 0.001 in women) and WC (β = 0.051, P  = 0.110 in men and β = 0.093, P  = 0.001 in women) only in women. The associations of depression with change in BMI ( P  < 0.001 for the interaction) and WC ( P  = 0.065 for the interaction) tended to vary according to age (Table 2 ). To interpret these interactions, we calculated simple slope tests at different values of the age moderator [ 49 ]: depression predicted higher BMI and WC gain at age 35 years and at age 50 years, but not at age 65 years.

Night sleep duration moderated the relationships of emotional eating with change in BMI ( P  = 0.007 for the interaction) and WC ( P  = 0.026 for the interaction) (Table  3 ). We again calculated simple slope tests at different values of the moderator to interpret these interactions: emotional eating predicted higher BMI and WC gain particularly at 6 h of sleep and at 7 h of sleep, while no such associations were observed at 9 h of sleep. Moreover, emotional eating mediated the effects of depression on change in BMI (e.g. β = 0.078, P  = 0.049 for 6 h and β = − 0.002, P  = 0.905 for 9 h) and WC (e.g. β = 0.075, P  = 0.052 for 6 h and β = 0.009, P  = 0.672 for 9 h) only in participants with shorter sleep duration. Total physical activity did not moderate the relationships of depression or emotional eating with change in BMI or WC (Table 3 ).

Finally, the association between depression and emotional eating did not vary according to gender ( P  = 0.970–0.981 for the interactions terms), age ( P  = 0.766–0.782, respectively), night sleep duration ( P  = 0.120–0.131, respectively) or physical activity ( P  = 0.072–0.075, respectively) in any of the tested models.

To our best knowledge, this is the first study to examine the mediation effect of emotional eating between depression and long-term weight changes in the context of gender, age, night sleep duration and physical activity patterns. There are two main findings: Firstly, we found that eating in response to negative emotions mediated the positive associations between depression and increase in BMI and WC over 7 years – a finding providing support for the hypothesis that emotional eating is one behavioural mechanism between depression and subsequent development of obesity and abdominal obesity. Secondly, we observed that night sleep duration moderated the associations of emotional eating: individuals with higher emotional eating and shorter sleep duration were particularly vulnerable to BMI and WC gain.

Our results regarding the mediation effect of emotional eating are consistent with two prospective studies conducted in Dutch parents [ 18 ] and mid-life US adults [ 19 ] with self-reported anthropometrics (BMI and a composite of BMI and WC, respectively) and confirm our cross-sectional results in the baseline data of the DILGOM study [ 5 ]. The present prospective research extends observations from the Dutch and US samples by having also measured information on obesity (BMI) and abdominal obesity (WC) indicators, analyzing them as separate outcomes and testing several moderators (i.e. gender, age, sleep and physical activity) simultaneously. In the Dutch and US samples, emotional eating acted as a mediator between depression and risk of developing obesity only in women. Although gender did not have statistically significant moderator effects in our study, we found a consistent trend resembling this gender difference: the direct and indirect effects of depression and emotional eating on BMI and WC gain were more pronounced in women than in men (and significant only in women). The stronger effects in women are likely to be linked to their higher susceptibility to engage in emotional eating [ 5 , 16 , 26 ] and experience symptoms of depression [ 54 ]. Sex differences in physiological stress response could also bear relevance. The typical physiological response is hyper-activation of the hypothalamic-pituitary-adrenal axis and decreased appetite, while adult women often show lower hypothalamic-pituitary-adrenal axis and autonomic stress responses than men of same age [ 55 ]. Evidence has further suggested a role for blunted rather than enhanced cortisol response to stress in increased food intake of high emotional eaters [ 56 ], binge eaters [ 57 ] or chronically highly stressed [ 58 ].

In accordance with two earlier studies examining the interplay between emotional eating and sleep duration in the development of obesity, we found that the positive associations of emotional eating with BMI and WC gain were stronger in the short sleepers (e.g. 6 h per night) than in the long sleepers (e.g. 9 h per night). Emotional eating consequently mediated the link between depression and weight gain primarily in those sleeping fewer hours per night. The fact that a similar moderation effect has now been detected in three independent samples of French Canadian adults [ 33 ], Dutch employees [ 29 ] and Finnish adults builds confidence on the robustness of this observation. Evidence is also emerging that sleep restriction enhances brain neuronal activation in response to unhealthy food stimuli compared with non-restricted sleep [ 59 ] – suggesting that short sleep duration is a type of stressor that is especially likely to induce increased food intake in emotional eaters. It is though noteworthy that short sleepers are a heterogeneous group involving at least three types of individuals: those for whom short sleep schedule represents their natural way of functioning, those who reduce their sleep time to meet other demands of daily life, and those who have sleeping difficulties [ 60 ]. Thus, short sleep is likely to be a source of stress or a marker of perceived stress only for the latter two types of people. Yet, as a whole, our findings highlight that individuals with a combination of shorter night sleep duration and higher degree of emotional eating may require tailored approaches in weight management programs.

In contrast to our expectations, we did not find evidence that the level of total physical activity would moderate the relationships between depression, emotional eating and change in BMI and WC. However, consistent with previous observations [ 25 , 26 ] individuals with higher levels of vigorous and total physical activity scored slightly lower on emotional eating. Regarding the lack of the moderator effect, it is possible that engaging in activities of vigorous intensity is particularly relevant: some observational studies (though not all) have reported stronger associations between vigorous physical activity and decreased likelihood of depression as compared to the associations involving moderate activities [ 61 ]. In the study of the Dutch employees, particularly strenuous physical activity (running, working out) moderated the association of emotional eating with BMI change [ 34 ]. We repeated the moderator analyses with dichotomous (42% non-vigorous vs. 58% vigorous) and continuous vigorous physical activity scores, but again did not detect statistically significant interactions ( P  = 0.194–0.971 for the interactions involving emotional eating and P  = 0.106–0.771 for the interactions involving depression). However, this could be at least partly explained by present participants’ relatively low levels of vigorous activities.

Because of the large age range (between 25 and 74 years at baseline) in our study, we additionally examined whether the associations varied across age groups. The results suggested that symptoms of depression predicted BMI and WC gain especially in younger participants. Age-related changes in body composition and weight offer one potential explanation for this observation. For instance, aging is known to lead to decreases in muscle mass [ 62 ]. In the present sample, WC increased more in 25–34-year-olds than in 65–74-year-olds and BMI even slightly decreased in 65–74-year-olds over 7 years. It is therefore possible that such age-related patterns have obscured the effects in older adults.

Individuals may engage in emotional eating to cope with stress and other negative emotions, but in the long-term it is often a maladaptive emotion regulation strategy. Besides that emotional eating may lead to less healthy food intake patterns and subsequent weight gain, it is unlikely to result on long-term improvements in mood – i.e. intake of palatable food has shown to improve experimentally induced negative mood state immediately, but the effect tends to be short-term and is easily followed by other negative emotions (e.g. feelings of guilt) especially in dieters [ 63 , 64 ]. Individuals with a high susceptibility to emotional eating might therefore benefit from interventions that teach emotion regulation skills as is done in dialectical behaviour therapy [ 65 ] or that incorporate mindfulness training [ 66 ]. The present findings also imply that future randomized controlled trials could test whether extending sleep is a viable strategy to prevent weight gain and promote healthier food intake in emotional eaters. Interestingly, a recent pilot study in habitually short sleepers (with no information on emotional eating) demonstrated that sleep extension was feasible and led to decreased intake of free sugars [ 28 ].

A particular strength of the present study is that it was based on a large population-based sample with 7-year follow-up on both BMI and WC. The wealth of both measured and self-reported health-related information and the prospective design allowed us to provide novel insights on depression and emotional eating as risk factors for (abdominal) obesity. However, certain limitations need to be taken into account while interpreting the results. Firstly, although the sample was initially randomly derived from the Finnish population register, there were non-participants as in all observational studies. We detected small differences between participants and non-participants at follow-up in terms of baseline age, gender, BMI and WC. Despite that we used FIML to handle missing data, which has shown to produce less biased estimates than conventional techniques, such as listwise deletion [ 50 , 51 ], our observations could still generalize less well to younger men and individuals with higher initial weight. Secondly, although measured anthropometric data were available for all participants at baseline, two-thirds of the participants self-reported their height, weight and WC at follow-up with measured data available for one-third [ 38 ]. Nonetheless, sensitivity analyses excluding those with self-reported anthropometrics at follow-up supported our findings by producing fairly comparable point estimates. Thirdly, the widely used CES-D scale and TFEQ-R18 have also some restrictions: the former does not yield information on clinical depression, while the latter contains only three items to measure emotional eating. Fourthly, night sleep duration and physical activity tested as moderators in this study could alternatively be hypothesized to mediate the depression – obesity link. For that reason, we conducted a final set of mediation models testing these hypotheses, but there was no consistent evidence for the mediation effect of physical activity ( P  = 0.529 for indirect effect on BMI and P  = 0.684 for indirect effect on WC) or sleep duration ( P  = 0.056 and P  = 0.682, respectively) in line with a recent 4-year prospective cohort study [ 67 ]. Finally, it should be noted that the tested mediation models including depression, emotional eating, gender and age as predictors explained only around 5% of variance in change in BMI and WC, which highlights the well-recognized fact that long-term weight changes are influenced by myriad of factors.

The present findings highlight the interplay between depression, emotional eating and short night sleep duration in influencing subsequent development of obesity and abdominal obesity. Future research should test the clinical significance of our observations by tailoring weight management programs according to these characteristics.

Abbreviations

Body mass index

Center for Epidemiological Studies – Depression

Comparative Fit Index

Confidence interval

DIetary, Lifestyle and Genetic determinants of Obesity and Metabolic syndrome

Full Information Maximum Likelihood

International Physical Activity Questionnaire - Short Form

• Physical activity

Root Mean Square Error of Approximation

Standard deviation

Standard error

Standardized Root Mean Square Residual

Three-Factor Eating Questionnaire-R18

Tucker-Lewis Index

United States

Waist circumference

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This work was supported by the Academy of Finland (grants 265796, 309157 to HK, grants 136895, 263836 to SM, grant 118065 to PJ, and grants 118139, 275033 to AH), Emil Aaltonen Foundation (grant to HK), Yrjö Jahnsson Foundation (grant to HK), and Juho Vainio Foundation (grant to PJ). Funding of TvS was provided by the European Union FP7 MoodFood Project ‘Multi-country collaborative project on the role of Diet, Food-related behaviour, and Obesity in the prevention of Depression’ (grant agreement no. 613598). The funding sources had no involvement in study design, data collection, analysis or interpretation, writing the article, or in the decision to submit the article for publication.

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HK, SM, PJ and AH were involved in the data collection. HK, TvS, SM, PJ and AH contributed substantively to the study conceptualization and design. HK analyzed the data and wrote the first version of the manuscript. TvS, SM, PJ and AH commented and critically revised the manuscript. HK had primary responsibility for the final content of the manuscript. All authors read and approved the final manuscript.

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Additional file 1:.

Pearson’s correlation coefficients between the main study variables. (DOCX 14 kb)

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Results from sensitivity analysis including only those participants ( n  = 1310) whose height and weight were measured at baseline and follow-up: the mediation model between depression, emotional eating and 7-year change in BMI. (DOCX 36 kb)

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Results from sensitivity analysis including only those participants ( n  = 1305) whose WC was measured at baseline and follow-up: the mediation model between depression, emotional eating and 7-year change in WC. (DOCX 37 kb)

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Konttinen, H., van Strien, T., Männistö, S. et al. Depression, emotional eating and long-term weight changes: a population-based prospective study. Int J Behav Nutr Phys Act 16 , 28 (2019). https://doi.org/10.1186/s12966-019-0791-8

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By Laura Holsen

Stress and negative emotional states exert powerful effects on critical aspects of human behavior, including sleep, reproduction, and feeding. However, these effects are not always uniform; substantial individual differences exist which determine whether cumulative, long-term impacts of stress and emotion ultimately influence vulnerability to disease states. We previously found that individuals with trait-level chronic stress exhibit varying levels of appetite and food-related brain reward processing in a controlled, non-stressful state. Based on this prior work, we wondered whether individuals with opposing behavioral traits related to emotional eating might react dissimilarly in terms of their physiological and brain response to a potent external stressor.

To answer this question, we recruited 28 healthy adults from the community to participate in a study protocol involving exposure to stress and measurement of blood (to assess cortisol, a hypothalamic-pituitary-adrenal axis hormone) and brain activation using functional magnetic resonance imaging (fMRI), a non-invasive method for assessing brain function. Approximately half of these subjects were categorized as emotional eaters: individuals who tend eat more when they experience strong (usually negative) emotions. The other half of the subjects were classified as non-emotional eaters. Participants completed two study visits. During one visit, they underwent a laboratory stress task designed to induce psychosocial stress (stress with a psychological and social component) and a robust cortisol response. During the other visit, they experienced a non-stressful control version of this task. At both visits, they had blood and anxiety ratings measured before and after the stress/control task, then completed an fMRI task during which they responded to reward or neutral cues: reward cues indicated they had a chance to win a snack point during that trial, while neutral cues indicated they would not have a chance to win a snack point during that trial (snack points could be used to “purchase” actual food after the scanning section). Based on the speed of their response to those cues, they obtained feedback indicating success or failure of food reward receipt. We then compared the emotional vs. non-emotional eaters on their cortisol levels and brain activation, particularly in three regions involved in reward processing: the nucleus accumbens (NAcc), the caudate, and the putamen.

Schematic of study protocol (top) involving the acute psychosocial stressor and fMRI food reward task, and overview of results (bottom) showing reduced nucleus accumbens activation during anticipation of food reward in Emotional Eaters.

Our analyses showed three primary results. First, we saw differences in ratings of emotion and in cortisol. Emotional eaters exhibited significantly elevated levels of anxiety and increased cortisol in response to the stress task, but not the control task, while anxiety and cortisol in non-emotional eaters did not differ between tasks. Second, we observed differences in brain activation. Relative to non-emotional eaters, emotional eaters displayed reduced brain activation in the NAcc, caudate, and putamen while responding to food reward (vs. neutral) cues during the stress visit, while groups did not differ in brain activation during the control visit. Third, we found relationships between mood and brain reward activation, such that those who showed the greatest increases in anxiety exhibited the lowest levels of brain activation in the NAcc and caudate. We did not find any group differences in brain activation during the receipt component of the food reward task.

Before this study, there were no data using this approach combining a rigorous stress task vs. a control task, measurement of cortisol, and an fMRI task of food reward allowing for parsing of anticipation and receipt in emotional and non-emotional eaters. With our data, we have new insight into the mechanisms which might drive individuals to eat more during stress: a more robust HPA axis response, more anxiety, and lower activation in reward regions while anticipating food. The hypoactivation in NAcc, caudate, and putamen might trigger behaviors to compensate, such as emotional eating in an attempt to normalize reward circuitry functioning, although future studies are needed to explicitly test these trajectories temporally. Together, these aberrant responses might serve as a mechanism for maintenance of maladaptive eating behaviors during states of low mood and high stress in emotional eaters. Moreover, they point to potential wellness targets such as stress reduction to mediate unhealthy eating patterns in otherwise healthy individuals. Ongoing work in the lab will extend these findings to individuals with mental health conditions associated with disordered eating, towards discovery of novel targets for neuromodulation and pharmacologic treatment.

This work was supported the National Institute of Diabetes and Digestive and Kidney Diseases (R01DK104772; LMH, PI).

Laura Holsen is an Associate Professor of Psychiatry at Brigham and Women’s Hospital.

Learn more in the original research article: Stress-induced alterations in HPA-axis reactivity and mesolimbic reward activation in individuals with emotional eating. Chang RS, Cerit H, Hye T, Durham EL, Aizley H, Boukezzi S, Haimovici F, Goldstein JM, Dillon DG, Pizzagalli DA, Holsen LM.  Appetite. 2022 Jan 1;168:105707.

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Article contents

Homeostatic and non-homeostatic influences on eating behaviour, emotional eating: definition, scope and significance for science and practice, theories of emotional eating, the scope of the present review and the role of the type of emotions, different types of emotions and individual differences, evidence from psychometric research, summary and suggestions for future research: psychometric studies, experimental studies on emotional eating, experimental research supporting the validity of emotional eating, experimental research questioning the validity of emotional eating, summary and suggestions for future research: experimental studies, conducting naturalistic research with regard to emotional eating, evidence from naturalistic research, summary and suggestions for future research: naturalistic studies, general discussion/future directions, clinical implications, emotional eating in healthy individuals and patients with an eating disorder: evidence from psychometric, experimental and naturalistic studies.

Published online by Cambridge University Press:  13 May 2020

Emotional eating has traditionally been defined as (over)eating in response to negative emotions. Such overeating can impact general health because of excess energy intake and mental health, due to the risks of developing binge eating. Yet, there is still significant controversy on the validity of the emotional eating concept and several theories compete in explaining its mechanisms. The present paper examines the emotional eating construct by reviewing and integrating recent evidence from psychometric, experimental and naturalistic research. Several psychometric questionnaires are available and some suggest that emotions differ fundamentally in how they affect eating (i.e. overeating, undereating). However, the general validity of such questionnaires in predicting actual food intake in experimental studies is questioned and other eating styles such as restrained eating seem to be better predictors of increased food intake under negative emotions. Also, naturalistic studies, involving the repeated assessment of momentary emotions and eating behaviour in daily life, are split between studies supporting and studies contradicting emotional eating in healthy individuals. Individuals with clinical forms of overeating (i.e. binge eating) consistently show positive relationships between negative emotions and eating in daily life. We will conclude with a summary of the controversies around the emotional eating construct and provide recommendations for future research and treatment development.

Fulfilling basic human needs such as breathing, sleeping or eating ensures survival. Regarding the latter, in its simplest form, food intake is initiated in states of hunger and energy deficit and terminated upon satiation, thus representing a homeostatic balance of energy intake and expenditure. However, human subjects regularly consume more food than needed and such overeating can lead to negative physiological and psychological health outcomes ( Reference Guh, Zhang and Bansback 1 , Reference Tuthill, Slawik and O'rahilly 2 ) . In extreme forms, such overeating is referred to as binge eating, defined as the consumption of an unusual large amount of food in a short time alongside the loss of control (DSM-5 ( 3 ) ). Frequent and regular binge eating episodes are a defining criterion for eating disorders such as bulimia nervosa, binge eating disorder, but also the binge–purge subtype of anorexia nervosa.

The prominence of non-homeostatic influences on food intake might be related to the high availability and affordability of palatable and high-energetic foods in nowadays' prosperous societies. A range of factors influence deviations from homeostatic eating, such as social norms, availability of foods, cultural traditions, eating styles/food cravings/food addiction and eating habits ( Reference Renner, Sproesser and Strohbach 4 ) . The present review will focus on the role of emotions for initiating or modulating eating, as negative emotions have been shown to be one of the most important non-homeostatic reasons for overconsumption ( Reference Cleobury and Tapper 5 , Reference Verhoeven, Adriaanse and de Vet 6 ) .

Ice cream after a breakup, potato chips while watching television after a stressful day, chocolates while preparing for an exam; additional food intake in response to sadness and worry (i.e. emotions) is well reflected in folk psychology. In German, the term ‘Kummerspeck’ (‘grief bacon’) relates to the consequences of these phenomena, namely an increase in weight and body fat. Scientifically, emotional eating can be defined as eating in response to negative emotions. This seemingly simple concept has kept research across several disciplines busy in the past four decades. Emotional eating theories have been discussed in social psychology ( Reference Stroebe, Van Koningsbruggen and Papies 7 ) , clinical psychology and psychotherapy (patients with an eating disorder ( Reference Vögele, Lutz, Gibson, Stewart Agras and Robinson 8 ) ), nutrition sciences (emotional eating and dieting ( Reference Appelhans 9 ) ), health psychology, public health (snacking and physical health ( Reference O'Connor, Jones and Conner 10 ) ) and metabolic sciences ( Reference Berthoud 11 ) , among others. Interest in emotional eating is further fuelled because of its clinical significance in binge eating: patients with eating disorders regularly attribute their binge eating episodes to negative affect ( Reference Alpers and Tuschen-Caffier 12 ) and correspondingly, negative affect resembles the most widely reported antecedent of binge eating episodes ( Reference Wolfe, Baker and Smith 13 ) . Due to this high clinical significance, emotional eating research has developed several rivalling families of theories to explain such phenomena.

The most widespread emotional eating theories differ in their focus and emphasis on (a) interoception, (b) cognitive processes and (c) learning processes. In the following section, we will briefly introduce one prominent exemplar of each of these theory families.

Psychosomatic theory, exemplifying an interoception-based theory was introduced by Hilde Bruch in 1955 ( Reference Bruch 14 ) to explain psychological factors causal to obesity. Accordingly, individuals with obesity overeat in response to negative emotions because of a lack of interoceptive awareness (e.g. an internal sensation of hunger). Thus, individuals with obesity might confuse physiological arousal related to the emotions with hunger and therefore respond with eating instead of engaging in more functional emotion regulatory strategies. The psychosomatic theory is largely disconfirmed as an account of obesity, while interoception continues to be a fruitful concept in eating behaviour and dieting in particular ( Reference Tylka and Wilcox 15 ) .

Illustrating one of the more cognitive theories, and in opposition to psychosomatic theory, restraint theory was developed ( Reference Herman, Polivy and Stunkard 16 ) . The theory states that some individuals who want to lose weight are prone to develop rigid dieting rules (e.g. ‘never eat chocolate’). As a result, even minor violations of such rules can lead to cognitive abandonment of the rule and to overeating (‘what the heck’ effect). Importantly, in the present context, emotions might interfere with the cognitive control needed to uphold such strict diet rules. Restraint eating theory remains central to current emotional eating theorising, as it is pivotal in weight loss dieting.

Regarding learning-based emotional eating theories, the affect regulation model ( Reference Booth 17 ) proposes that the rewarding aspects of palatable food intake counter the negative emotions and make such behaviour more likely in the future through the principles of operant conditioning (negative reinforcement). Repeated pairing of negative emotions and eating can further lead to classical conditioning which results in increased motivation to eat in the presence of negative emotions ( Reference Macht, Simons, Nyklícek, Vingerhoets and Zeelenberg 18 ) .

Several physiological theories have been articulated, owing to the observation that many physiological effects of stress and negative emotions affect key hormones such as cortisol, insulin or glucose but are beyond the scope of this review. Similarly, several nutritional components have been linked with the precursors of neurotransmitters, potentially explaining the mood-alleviating and stress-reducing effects of food intake and the reader is referred to respective review papers ( Reference Bose, Oliván and Laferrère 19 , Reference Gibson 20 ) .

Irrespective of the underlying theory, the empirical evidence for emotional eating is surprisingly mixed. Hence, we will review the literature from psychometric, experimental and naturalistic studies, focusing on the effect of negative emotions on food intake (see Fig. 1 ) with particular emphasis on methodological factors that might give rise to this heterogeneity of empirical evidence. We will exclude studies that study the effect of eating or food components on subsequent mood or emotions (instead of the effect of emotions on subsequent eating) as these tap into a different set of theories and are likely less helpful for explaining binge eating and non-homeostatic overeating. We will further exclude studies that explicitly focused on the effect of stress on subsequent eating, due to the unclear relationship of this literature with emotional eating. In addition, we will give particular emphasis to the type and valence of the emotions in question, as this might be an important moderator of how eating is affected (increased or decreased food intake).

Fig. 1. Main effect model of emotional eating.

The idea that specific discrete emotions might differ in their effect on subsequent eating has led to intense research efforts. Macht ( Reference Macht 21 ) , for example, proposed that negative emotions can both increase or decrease food intake depending on their intensity: high arousal negative emotions such as fear or anger might decrease intake, owing to the physiological influence on metabolism, whereas medium-level negative emotions might increase intake. Relatedly, research started to acknowledge the role of positive emotions for increased food intake ( Reference Cardi, Leppanen and Treasure 22 – Reference Bongers, Jansen and Houben 24 ) , but the mechanisms involved might be different and will therefore not be covered here in detail.

So far we have conceptualised the relationship between negative emotions and eating as a general and fundamental phenomenon (i.e. main effect model), but there are actually marked individual differences (i.e. moderation model). As can be seen in Fig. 2 , several trait and state factors moderate the emotional eating relationship, indicative of inter- and intra-individual differences. To illustrate, previous research reported that trait eating styles such as restrained eating, i.e. a tendency to restrict food intake in order to maintain or lose weight, and emotional eating, i.e. an individual's habitual tendency to eat in response to negative emotions, as well as pathological forms reflected by eating disorders (e.g. bulimia nervosa, binge eating disorder) are likely to show different patterns of emotional eating compared to those scoring low on these eating styles and those without an eating disorder diagnosis. To tap into such inter-individual differences, several psychometric questionnaires have been developed which we will review in the next section. Other factors to consider are contextual or state factors. Easier food availability might make emotional eating more likely, e.g. Zenk et al . ( Reference Zenk, Horoi and McDonald 25 ) found that the positive relationship between more daily hassles and more snack-food intake was stronger when foods were easily available. Furthermore, social context might influence emotional eating as the social context might alter emotional experiences and determine whether someone overeats or not ( Reference Herman 26 , Reference Higgs and Thomas 27 ) . Similarly, other consummatory behaviour might play a role, in that smoking or excessive alcohol consumption (i.e. unhealthy habits) might be used instead of eating behaviour. To illustrate, we found that in times of high perceived stress, non-smokers report increased food intake whereas smokers decrease their food intake, potentially because they rather rely on smoking instead of eating as a way to cope with the stress ( Reference Meule, Reichenberger and Blechert 28 ) . Also, emotion regulation might play a role and might affect the emotion–eating link both as trait or state level (thus not displayed in Fig. 2 ) in that making use of adaptive emotion regulation strategies such as reappraisal or acceptance might dampen the effect of emotions on eating behaviour. To illustrate, Svaldi et al . ( Reference Svaldi, Werle and Naumann 29 ) demonstrated that in daily life, the impact of emotions on eating behaviour depends on various emotion regulation strategies.

Fig. 2. Moderation model of emotional eating.

A range of questionnaires have been developed to measure emotional eating as a trait, personality-like disposition. Questionnaires differ on the types of emotions assessed and the wording of actual eating, desire to eat and eating increase v. decrease. One of the most frequently used measures is the Dutch eating behaviour questionnaire ( Reference Van Strien, Frijters and Bergers 30 ) measuring the effect of emotions and emotion-related states (including, e.g. boredom) on desire to eat. The three factors eating questionnaire uses emotional eating items on the ‘disinhibition’ subscale ( Reference Stunkard and Messick 31 ) . Other scales are the emotional eating scale ( Reference Arnow, Kenardy and Agras 32 ) , the emotional overeating questionnaire ( Reference Masheb and Grilo 33 ) , the emotional appetite questionnaire ( Reference Geliebter and Aversa 34 ) or the positive–negative emotional eating scale ( Reference Sultson, Kukk and Akkermann 35 ) . The properties of these scales have been reviewed before, e.g. in Bongers and Jansen ( Reference Bongers and Jansen 36 ) . One of the newer questionnaires is the Salzburg emotional eating scale ( Reference Meule, Reichenberger and Blechert 37 ) , developed in our workgroup and we will thus briefly review its measurement concept and initial validation data.

The Salzburg emotional eating scale expands the concept of negative emotional eating in mapping the effects of different basic negative and positive emotions on both over- and undereating to more fully represent the relationship between emotions and eating. It includes subscales for happiness, sadness, anger and anxiety and assesses their effects on increased or decreased food intake. Results revealed that participants reported increased eating when experiencing sadness, unchanged eating when being happy and decreased eating when experiencing anger or anxiety ( Reference Meule, Reichenberger and Blechert 37 ) . This is generally in line with the model by Macht ( Reference Macht 21 ) that postulated differences between the basic emotions. Moreover, we found that patients with bulimia nervosa reported increased food intake in response to all three negative emotional subscales, whereas patients with anorexia nervosa reported increased food intake in response to happiness, and decreased food intake to the negative emotional subscales ( Reference Meule, Richard and Schnepper 38 ) , validating the clinical usefulness of the scale and documenting the role of psychopathology as a moderator of the interaction between emotion and eating.

Yet, several researchers have questioned the validity of emotional eating questionnaires in their prediction of actual food intake, both in the laboratory and in daily life ( Reference Bongers and Jansen 36 , Reference Adriaanse, de Ridder and Evers 39 ) . Evers et al . ( Reference Evers, de Ridder and Adriaanse 40 ) coined the term ‘triple recall bias’ to describe the sources of error in self-reported emotional eating: in order to validly complete such questionnaires, first, a negative emotional state has to be accurately recalled, secondly the respective eating behaviour and thirdly the connection between both. Lastly, respondents ideally aggregate over several such instances to determine a response that is representative to the gross of such situations. Clearly, multiple sources of error are likely to bias the questionnaire scores and might lead to inconsistent effects when actual food intake is assessed as a function of such questionnaire scores. To illustrate, Bongers and Jansen ( Reference Bongers and Jansen 36 ) reviewed studies on differences between high and low trait emotional eaters in the laboratory (i.e. food intake in response to a negative compared to a neutral mood condition) and in daily life settings (i.e. food intake in response to daily negative emotions). They found that higher emotional eating questionnaire scores did not consistently predict more eating in the laboratory and daily life. Bongers and Jansen ( Reference Bongers and Jansen 36 ) offered several alternative accounts about why some individuals experience their emotions and eating as related. First, self-reported emotional eating might more adequately be interpreted as a more general concept of low self-control and concerns about (over-)eating. Secondly, emotional eating might rather be a retrospective attribution of overeating to negative affect ( Reference Adriaanse, Prinsen and de Witt Huberts 41 ) , i.e. emotion not being causal for the increased eating but retrospectively ‘constructed’ as a possible reason, or even an excuse for overeating. Thirdly, emotional eaters, when under stress, might overestimate their food intake, despite normal actual intake ( Reference Royal and Kurtz 42 ) . Thus, individuals with normal consumption misidentify themselves as emotional eaters. Fourthly, self-reported high emotional eaters might be characterised by a generalised learned cue-reactivity in which a variety of cues such as negative and positive emotional states but also the sight and smell of food, the environment one is in or time of day can elicit eating behaviour ( Reference Bongers, de Graaff and Jansen 43 ) .

To summarise, measures for assessing emotional eating vary with regard to the emotions included in the questionnaire (e.g. negative v. positive, generic v. specific) and the resultant eating behaviour (e.g. tendency to eat v. actual food intake), potentially contributing to inconsistent results. In addition, self-reported emotional eating suffers from biases (e.g. recall bias) similar to other subjective assessments ( Reference Gorin, Stone, Baum, Revenson and Singer 44 ) . Future research might thus profit from comparing various self-report scales (as done in e.g. ( Reference Braden, Emley and Watford 45 ) ) and explicitly testing their ecological validity (as done in e.g. ( Reference Mason, Pacanowski and Lavender 46 ) ) in addition to doing experimental research under controlled conditions to minimise such biases and enable causal conclusions.

Laboratory-based studies provide high control over potentially confounding contextual factors and allow for an objective measure of food intake. Causal effects of emotional state are investigated by using induction of emotions in the laboratory and by assessing subsequent food intake. Mood/emotion induction methods vary from more standardised methods such as exposure to movie excerpts, music or vignettes to more idiosyncratic approaches in which participants recount and imagine recent individual emotional experiences or are exposed to stressful evaluated speech tasks such as in the Trier social stress test (see ( Reference Allen, Kennedy and Dockray 47 ) for more details). Various approaches have been followed also for assessing food intake. The gold standard method is the so-called bogus ‘taste’ test, where participants are asked to give taste ratings of various foods while actual food intake is unobtrusively measured ( Reference Robinson, Haynes and Hardman 48 ) . Various factors in the design of a food intake measure need to be considered such as the range and taste quality of offered foods. For example, actual food intake can be assessed in total energy or grams of certain foods offering sweet (e.g. cookies, ice cream, etc.), savoury (e.g. crisps, pretzels, etc.) or both types of foods. In the following, we will review a few exemplar experimental studies to illustrate the laboratory approach to emotional eating.

Providing support for emotional eating in a laboratory setting, Van Strien et al . ( Reference Van Strien, Herman and Anschutz 49 ) exposed participants to a negative (via a sad movie in study 1 and a stress task in study 2) and a neutral (via a neutral movie in study 1 and a control task in study 2) mood condition and assessed their subsequent food intake. Trait emotional eating moderated the emotional eating relationship in that high emotional eaters consumed more food on a taste test following the sad movie and the stress task compared to the neutral conditions, whereas low emotional eaters showed the opposite pattern. In contrast to the standardised stressors/induction methods in Van Strien et al . ( Reference Van Strien, Herman and Anschutz 49 ) , in our study, we opted for an idiosyncratic approach to approximate participants' actual real-life stressors ( Reference Blechert, Goltsche and Herbert 50 ) . To do so, an idiosyncratic interview first explored a recent situation that triggered emotions such as sadness or frustration ( Reference Hilbert, Vögele and Tuschen-Caffier 51 ) . In the task, participants were then presented with sentences describing this situation, intending to trigger the respective memories and emotions. Interleaved with the sentences, food and object pictures were presented. This setup allowed for the assessment of ratings of momentary desire to eat for each food image instead of actual food intake, alongside recordings of electroencephalography, and other psychophysiological markers of emotion-related food cue reactivity. The key finding was that trait emotional eating moderated the emotional eating relationship in that high emotional eaters increased whereas low emotional eaters decreased their food craving ratings in the negative compared to the neutral mood condition. This was paralleled by a specific pattern of neural activity that indicated that also more implicit response levels were engaged by the task. Note that we opted against a taste test as a dependent variable and measured desire to eat and psychophysiological responses to food cues instead. These responses are sometimes termed ‘food cue reactivity’, and might be less sensitive to the social desirability effects that impact actual food intake in the laboratory.

Contradicting these results, Braden et al . ( Reference Braden, Emley and Watford 45 ) conducted two laboratory-based studies. Study 1 used a mood induction via a sad clip from a drama series and a neutral clip from a nature documentary. Study 2 used a mood induction by a guided imagery exercise to identify and re-experience a recent memory associated with a negative emotion or a neutral route typically taken and assessed food intake in a bogus taste test. The authors revealed that in both studies self-reported emotional eating did not relate to emotional eating in the laboratory. Similarly, Evers et al . ( Reference Evers, de Ridder and Adriaanse 40 ) conducted four studies using different mood induction methods, namely vignettes (study 1), film excerpts (study 2), recall (study 3) and providing false feedback (study 4), to induce negative or neutral/positive emotions. They found no increase in food intake in a bogus taste test after the induction of negative emotions compared to the control conditions in self-described emotional eaters regardless of induction method. Such inconsistencies call for systematic reviews that could try to identify boundary conditions within which current theories make valid predictions (e.g. emotional eating only in certain contexts such as being at home or being alone, or only in certain individuals such as patients with an eating disorder). In addition, the meta-analytic investigation could look at quantitative evidence aggregated across studies while also considering the variation of the studies in moderator analyses.

Cardi et al . ( Reference Cardi, Leppanen and Treasure 22 ) conducted a meta-analysis on emotional eating in the laboratory which included thirty-three studies with a total of 2491 participants ranging from healthy controls to patients diagnosed with an eating disorder and participants with obesity. They found that overall participants consumed more food under the negative compared to the neutral mood condition (i.e. the main effect). In addition, participant group, mood induction (method as well as the type of mood) and offered food types influenced the strength of the relationship: more food consumption in the negative mood condition was found for participants with pathological eating behaviour (binge eating disorder, subthreshold binge eating disorder and restrained eaters) compared to mentally healthy participants with obesity and healthy controls without obesity. Similarly, Evers et al . ( Reference Evers, Dingemans and Junghans 23 ) reported on a meta-analysis including fifty-six studies (twenty-seven of those included in the aforementioned meta-analysis) with a total of 3670 participants ranging from healthy controls to individuals with pathological eating behaviour (i.e. emotional eaters, patients with an eating disorder or participants with obesity). In contrast to Cardi et al . ( Reference Cardi, Leppanen and Treasure 22 ) , Evers et al . ( Reference Evers, Dingemans and Junghans 23 ) found no significant overall effect of negative emotion condition on food intake. Again, mood induction method significantly influenced the results in that participants in the social feedback method consumed less food than participants confronted with aversive social materials (movie clips, vignettes, sad stories). The level of restrained eating was again a significant moderator. Restrained eaters consumed a larger amount of food in the negative compared to the neutral mood condition. However, unexpectedly, trait emotional eating did not exhibit a significant moderation effect nor did eating- or weight-related pathology moderate the emotion–food intake relationship as found by Cardi et al . ( Reference Cardi, Leppanen and Treasure 22 ) . Evers et al . ( Reference Evers, Dingemans and Junghans 23 ) explained the discrepancy to Cardi et al . ( Reference Cardi, Leppanen and Treasure 22 ) by (a) additional, new studies, and (b) broader search terms which resulted in a higher number of included studies and (c) by only including studies with a reliable mood induction.

To summarise, findings from experimental settings are markedly inconsistent, but, in line with the individual differences approach outlined earlier, the investigated sample seems to play an important role (e.g. restrained eaters, patients). The two available meta-analyses agree on the influence of the emotion type/mood induction method, consistent with the idea elaborated earlier that specific emotions differ in their effect on eating. More recently, research has shifted towards more naturalistic assessment methods to circumvent the limitations of laboratory food intake assessment which might be problematic as individuals might alter their eating behaviour because of the heightened self-awareness ( Reference Robinson, Hardman and Halford 52 ) . Furthermore, the highly standardised setting limits possible types of emotions and possible food choices which may not be matched to individual preferences.

To remedy these limitations, research has turned to the assessment of emotional eating in naturalistic, daily life settings using ecological momentary assessment (EMA). EMA is the assessment of daily experiences, behaviour, physiological and psychological status as individuals engage in their natural environment ( Reference Shiffman, Stone and Hufford 53 ) . As an advantage, recall biases can be minimised, whereas ecological validity and generalisability can be maximised. Additionally, apart from between-person relationships, EMA studies allow for assessing within-person relationships. This method of assessment seems especially important with regard to eating behaviours as it helps to sample highly dynamic states such as affect and to determine relationships with other dynamic variables such as eating ( Reference Smyth, Wonderlich and Crosby 54 , Reference Engel, Crosby and Thomas 55 ) . EMA studies afford various sampling schemes: signal-contingent sampling involves prompting participants at specific time points whereas in event-contingent sampling participants self-initiate a survey upon the occurrence of specific behaviour (e.g. eating) or situations (e.g. stress). The frequency of daily assessment on signal-contingent sampling balances participant load with the rate at which the phenomena of interest change (mood, eating or hunger). The naturalistic context allows EMA assessment schemes to measure eating behaviour more broadly (see also ( Reference Schembre, Liao and O'Connor 56 ) ): information can be obtained on desire to eat ratings ( Reference Reichenberger, Richard and Smyth 57 ) , snacking ( Reference Zenk, Horoi and McDonald 25 ) , specific food item intake ( Reference Richard, Meule and Reichenberger 58 ) , energy density of meals ( Reference Kikuchi, Yoshiuchi and Inada 59 – Reference Burd, Mitchell and Crosby 61 ) but also loss of control over eating ( Reference Goldschmidt, Engel and Wonderlich 62 ) or clinical binge eating episodes ( Reference Smith, Mason and Schaefer 63 ) .

Healthy individuals

Haedt-Matt et al . ( Reference Haedt-Matt, Keel and Racine 64 ) asked 239 female twins from a community-based sample about their affect and emotional eating urges once daily for 45 consecutive days and showed that higher negative affect was concurrently associated with higher emotional eating urges, providing support for emotional eating in naturalistic EMA settings. Other studies in mostly healthy individuals showed that negative affect related to greater binge eating ( Reference Mason, Heron and Braitman 65 , Reference Keating, Mills and Rawana 66 ) , more consumption of comfort food ( Reference Rodgers, Fuller-Tyszkiewicz and Holmes 67 ) and more consumption of meat/protein ( Reference Ashurst, van Woerden and Dunton 68 ) . While these studies support the main effect model where emotions are linked with eating regardless of another person-level moderator, we recently found support for an individual difference (i.e. moderation) model: our EMA study in fifty-nine participants involved five daily signals for 10 days on current negative emotional state and eating behaviour ( Reference Reichenberger, Kuppens and Liedlgruber 69 ) . We aimed at the hedonic component of eating, thus we asked participants to report on the extent to which they ate their last meals out of taste (as opposed to hunger). Results revealed that trait emotional eating moderated the emotional eating relationship in daily life in that low emotional eaters decreased their taste-eating with increasing negative emotions, whereas high emotional eaters increased their taste-eating with increasing negative emotions.

Contradicting these findings, Adriaanse et al . ( Reference Adriaanse, de Ridder and Evers 39 ) conducted two studies asking 151 and 184 participants once daily for 7 days to report the amount of their healthy and unhealthy snacks. Whereas trait emotional eating status did not explain unhealthy snacking, self-reported habitual snacking and dietary restraint did explain unhealthy snacking. Various other studies showed that negative affect did not relate to subsequent unhealthy eating ( Reference Schultchen, Reichenberger and Mittl 70 ) , snack intake ( Reference Zenk, Horoi and McDonald 25 ) or subclinical pathological eating behaviour such as eating large amounts of food ( Reference Heron, Scott and Sliwinski 71 ) , or even related to decreased subsequent energy consumption ( Reference Wouters, Jacobs and Duif 72 ) in healthy individuals.

Individuals with an eating disorder

Reviewing thirty-six previous naturalistic studies in a total of 968 individuals with an eating disorder, Haedt-Matt and Keel ( Reference Haedt-Matt and Keel 73 ) showed that negative affect precedes binge eating, although post-binge negative affect was even increased. In more detail, negative affect was greater prior to binge eating compared to general levels of negative affect or prior to other regular eating episodes. Diagnosis (bulimia nervosa v. binge eating disorder) accounted for a significant amount of variability in that the relationships were smaller in individuals with bulimia nervosa compared to those with binge eating disorder. Moreover, assessment parameters such as the sampling scheme (signal- or event-based sampling), length and frequency of EMA assessment as well as provisions of binge eating definitions influenced the magnitude of the relationship between affect and binge eating. The majority of EMA studies in patients with an eating disorder demonstrated a positive relationship between negative emotions and binge eating episodes, including also subcomponents such as over- or loss of control eating ( Reference Svaldi, Werle and Naumann 29 , Reference Goldschmidt, Engel and Wonderlich 62 , Reference Ambwani, Roche and Minnick 74 – Reference Stevenson, Dvorak and Wonderlich 80 ) . EMA research also investigated the types of negative emotions that precede binge eating: Becker et al . ( Reference Becker, Jostmann and Holland 81 ) showed that emotions high on negative valence, arousal and avoidance-relation precede a binge eating episode. In contrast, Berg et al . ( Reference Berg, Crosby and Cao 82 , Reference Berg, Crosby and Cao 83 ) emphasised the role of distinct emotions such as fear, hostility, sadness, but especially guilt in preceding binge eating episodes.

To summarise, in healthy individuals, large variability arises, potentially driven by the various assessment strategies for measuring eating behaviour in naturalistic studies. Additionally, lack of standardisation and methodological gold standards in naturalistic studies hinder consensus. Also in children and adolescents, the influence of negative emotions on eating behaviour and dietary intake in daily life remains inconclusive and revealed mixed results (for review see ( Reference Mason, Do and Wang 84 ) ). However, a systematic review of the evidence regarding emotional eating in healthy adults in daily life remains a worthwhile future direction. In contrast to findings in healthy individuals, results in individuals with an eating disorder seem quite consistent.

Given the complex relationship between emotion and eating behaviour variables as well as their moderators, new statistical avenues (e.g. machine learning approach) are needed that do not assume the linearity of tested variables. Also, as emotions might impact eating with some delay (e.g. next meal or within the whole day), statistical methods with variable time lags might be needed. In the same vein, contextual and situational factors (e.g. eating alone v. in company, food availability) might influence daily emotional eating because of their broader variability in naturalistic settings. Furthermore, subjective and objective data not always correspond so that the integration of objective methods that more accurately characterise participant's emotions and eating behaviour in daily life might be a fruitful future direction (e.g. ( Reference Smith, Mason and Juarascio 85 ) ). To illustrate, there are attempts to sense emotional states from heart rate variability readouts ( Reference Wilhelm and Grossman 86 ) or voice audio recordings ( Reference Koolagudi and Rao 87 ) . Similarly, objective food intake can be assisted by obtaining the pictures of the food eaten, food lists ( Reference Lieffers and Hanning 88 ) or barcode scanning ( Reference Illner, Freisling and Boeing 89 ) , or can be approached by electromyography of swallowing or chewing behaviour ( Reference Blechert, Liedlgruber and Lender 90 ) or bite counters ( Reference Dong, Hoover and Scisco 91 , Reference Thomaz, Essa and Abowd 92 ) .

To conclude, several controversies characterise the literature reviewed earlier. Open questions relate to the type and intensity of emotions that are assumed to cause changes in eating behaviour (see Fig. 3 ). A general negative affect model would assume that all negative emotions employ similar mechanisms in driving the need for relief and hedonic improvement. A specific emotion model, by contrast would have to distinguish several specific emotion–eating relationships, one for each specific emotion. In addition, it would be worthwhile to consider the inclusion of positive emotions (e.g. see ( Reference Bongers, Jansen and Houben 24 , Reference Evers, Adriaanse and de Ridder 93 ) ) into a broader definition of emotional eating. Another open question is a clearer separation of emotions and stress in their impact on eating behaviour (see ( Reference Meule, Reichenberger and Blechert 94 ) for a reasoning on that aspect). Similarly, one has to be aware that eating behaviour can be measured via food craving (i.e. a desire to eat) v. actual food and energy intake likely resulting in different results.

Fig. 3. Current controversies and future directions.

A bundle of potential trait and state moderators have been outlined earlier resulting in a complex emotional eating relationship. Consolidation on a theoretical and practical ground might be helpful to further specify the emotional eating construct and aid in testing different theories or mechanisms (outlined earlier) against each other (e.g. for clarifying the role of trait emotional eating v. trait restrained eating and related affect regulation theory v. restraint theory).

Fruitful future directions show that the combination of various study types might be especially helpful. To illustrate, Smith et al . ( Reference Smith, Mason and Crosby 95 ) examined laboratory-assessed impulsivity in combination with daily life relationships of negative affect and binge eating and revealed that greater delay discounting strengthened the relationship between negative affect and binge eating. Similarly, Wonderlich et al . ( Reference Wonderlich, Breithaupt and Thompson 96 ) showed that neural responses to food cues moderate the relationship between negative affect and binge eating in daily life. By combining psychometric, experimental and naturalistic settings, the respective design strengths (experimental research, internal validity; naturalistic setting, external validity) can be combined.

Based on the literature reviewed earlier, interventions using cognitive-behaviour therapy, especially emotion regulation interventions might be fruitful in reducing negative affect, which might in turn reduce the likelihood of overconsumption or bingeing. Recently, research started to use the induction of positive emotions as the method to decrease the likelihood of binge eating and promising results have been obtained. To illustrate, Cardi et al . ( Reference Cardi, Leppanen and Leslie 97 ) induced positive emotions in individuals with bulimia nervosa and binge eating disorder and found that these individuals exhibited less negative emotions and consumed less food in a subsequent taste test compared to a neutral condition (similar results obtained by Sproesser et al . ( Reference Sproesser, Schupp and Renner 98 ) in stress eating).

Progress in basic research is currently not paralleled by a corresponding progress in intervention development. Thus, while established guidelines for treating emotional eating in eating and weight disorders exist, hardly any innovative non-face-to-face interventions exist. Only recently have researchers proposed to use online interventions or smartphone-based interventions in daily life, lowering the threshold for treatment engagement. To illustrate, the so-called just-in-time adaptive interventions ( Reference Juarascio, Parker and Lagacey 99 ) use subjectively and objectively derived data from several state variables (e.g. current emotions, social context) to detect an optimal time point for sending brief therapeutic text messages, potentially adapted to the participant (e.g. with or without eating disorder). Hence, future research on the construct of emotional eating might pave the way towards personalised treatments for eating and weight disorders.

Financial Support

J. B., R. S., A.-K. A. and J. R. were supported by the European Research Council (ERC) under the European Union's Horizon 2020 research and innovation programme (ERC-StG-2014 639445 NewEat).

Conflict of Interest

The authors had joint responsibility for all aspects of preparation of this paper.

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• Volume 79, Issue 3
• Julia Reichenberger (a1) , Rebekka Schnepper (a1) , Ann-Kathrin Arend (a1) and Jens Blechert (a1)
• DOI: https://doi.org/10.1017/S0029665120007004

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Emotional eating: eating when emotional or emotional about eating?

Affiliation.

• 1 Utrecht University, Clinical and Health Psychology, Utrecht, The Netherlands. [email protected]
• PMID: 20204980
• DOI: 10.1080/08870440903207627

This article examines the extent to which self-reported emotional eating is a predictor of unhealthy snack consumption or, alternatively, an expression of beliefs about the relation between emotions and eating derived from concerns about eating behaviour. Three studies were conducted. Study 1 (N = 151) and Study 2 (N = 184) investigated the predictive validity of emotional eating compared to habit strength in snack consumption, employing 7-day snack diaries. Both studies demonstrated that snack consumption was not predicted by emotional eating but depended on the habit of unhealthy snacking and on restraint eating. As emotional eating was not a significant predictor of snack intake, Study 3 addressed the alternative hypothesis of emotional eating being an expression of concerns about eating behaviour. Results from this cross-sectional survey (N = 134) showed that emotional eating was significantly associated with several concerns. Together, these studies show that snack intake is better predicted by habit strength and restraint eating than by emotional eating. Additionally, the results suggest that in normal-weight women the concept of emotional eating may not capture the tendency to eat under emotional conditions, but rather reflects beliefs about the relation between emotions and eating.

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Relationship between perceived stress and emotional eating. A cross sectional study

Tannia valeria carpio-arias.

a Grupo de Investigación en Alimentación y Nutrición Humana (GIANH), Escuela Superior Politécnica de Chimborazo, Riobamba, 060101, Ecuador

Angélica María Solís Manzano

b Grupo de investigación en Nutrición, Dietética, Biotecnología y Análisis de Alimentos (GINDBA), Universidad Estatal de Milagro, 091050, Ecuador

Verónica Sandoval

Andrés fernando vinueza-veloz.

c Medico General El Guzo, Penipe-Chimborazo, 060503, Ecuador

Andrés Rodríguez Betancourt

d Antropólogo Forense, Calles Río Upano y Río Marañón, Riobamba-Chimborazo, 060101, Ecuador

e Liverpool John Moores University, Ecuador

Sarita Lucila Betancourt Ortíz

f Centro Politécnico de Investigación de alimentos para el desarrollo CEPIAD, Carrera de Nutrición y Dietética, Escuela Superior Politécnica de Chimborazo, Riobamba, 060101, Ecuador

María Fernanda Vinueza-Veloz

g Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Ecuador

Associated Data

Background and aims.

Stress-related to self-isolation during the COVID-19 pandemic has shown a strong correlation with issues in the diet and health of the population. In this study, we aimed to relate the perceived stress of a group of Ecuadorian adults with emotional eating.

Cross-sectional design study. We applied validated questionnaires of perceived stress and emotional eating to adults of both sexes who virtually completed a form between the months of January and March 2021. The analyzes were carried out using Chi2 statistical tests, Student's t-tests and a multiple linear regression model., the analyzes were performed using the statistical software R.

The sample was composed of 2333 participants, the median age was 25 years (interquartile range 21–37 years). Females reported more perceived stress than males (77.91% vs. 22.09%). Nearly 64% of participants who displayed perceived stress were emotional eaters. A statistically significant association was found between the emotional eating score and perceived stress (p < 0.001), the effect was an elevation of 0.44 points in the emotional eating score for each stress point perceived. For each unit increase in BMI the emotional eating score increased 0.26 units (p < 0.001) and for each unit increase in age the emotional eating score decreased by 0.27 units (p = 0.03).

Conclusions

It is concluded that stress is associated to emotional eating. Dietary intake that responds to emotions and not to physiological hunger may have long-term problems related to unhealthy diet. It is recommended to consider stress and emotional eating in the nutritional care process of people.

1. Introduction

SARS-CoV-2, the novel coronavirus responsible for COVID-19, was identified in China at the end of 2019. Due to its high transmissibility and infectivity, on the 11th of March 2020, the World Health Organization (WHO) declared COVID-19 a pandemic [ 1 ]. After this declaration, a large part of the nations around the world implemented measures of social isolation as a measure to stop the spread of SARS-CoV-2 [ 2 ]. Social distancing and home isolation can produce changes in eating behaviors, food intake, and physical activity patterns, thus influencing body weight and overall health and wellbeing [ 3 ].

Ecuador culminated its first year of the pandemic with around 60,000 excess deaths and 340 deaths per 100,000 inhabitants, positioning it as the second South American country most affected by the pandemic only behind Peru, which registered 560 deaths per 100,000 inhabitants [ 4 , 5 ]. The full morgues and the oversaturation of the health system was soon a cause for concern in all the inhabitants [ [6] , [7] , [8] ].

As with any global catastrophe, one area of impact that requires special attention is mental health. Several studies have concluded the deleterious effects on the mental health of citizens subjected to the stress of the pandemic, but also social distancing [ 9 , 10 ]. During quarantine, people have been found to experience twice the rate of mild to severe mental health disorders compared to rates reported prior to quarantine [ 11 ]. In addition, a considerable increase in anxiety rates has been reported in countries such as China [ 12 ]. However, according to the authors, this information was not enough to conclude that the presence of psychological symptoms is a product of confinement, and that it is necessary to evaluate the general population to reach such conclusions [ 13 ].

In this sense, a recent meta-analysis concluded that stress can lead to the interruption of normal eating behaviors, although the strength of this association is unknown. This same study concluded that stress increases the consumption of unhealthy foods [ 14 ]. Thus, lack of sleep, decreased physical activity, and eating in response to stress are behaviors related to weight gain during quarantine [ 15 ]. Therefore, eating habits driven by emotions and stress, which resemble addictive behaviors, are considered a risk factor for overweight and obesity [ 16 ]. In this context, the terms “emotional eating” (EE) (or “comfort eating”) have been used to reflect the tendency to eat in response to emotions rather than feelings of hunger or satiety [ 17 ].

Obesity is considered a biological determinant of EE. In a recent study conducted in the USA During COVID-19 (n = 123), respondents who reported weight gains of 2.3–4.5 kg (22% of the sample) also suffered emotional eating behaviors [ 18 ]. In a study made up of a sample of Mexican youth, depressive symptoms were associated with higher levels of EE, and higher emotional eating predicted a higher body weight [ 19 ].

For healthcare personnel, it is very important to study the relationship between stress and emotional eating [ 18 ] since the consequences of excess weight are related to a deterioration of the immune system, which in turn is produced for chronic diseases, inflammation, endothelial dysfunction and mitochondrial dysfunction. The vulnerability to infections and inflammation in the adipose tissue generates metabolic alterations that can cause comorbidities such as dyslipidemia, hypertension, cardiovascular diseases, and diabetes. These comorbidities increase the risk of SARS-CoV-2 infection, as well as its severity and mortality [ 20 ].

The purpose of this cross-sectional study is to provide information on the relationship between perceived stress and emotional eating in a sample of Ecuadorian adults. The results gathered in this study will serve as the basis for further research.

2. Materials and methods

2.1. study design and setting.

The present study uses an observational, cross-sectional approach. Data was collected through an online survey questionnaire consisting of multiple-choice questions. Data collection took place between January 2021 and February 2021. During this time confinement was mandatory in Ecuador.

2.2. Participants and sampling

The sample consisted of 752 male and 1581 female adults (over 18 years old), totaling 2333 individuals. Participants were recruited through social networks such as Facebook, Instagram, Twitter, and WhatsApp, and by official email from the universities participating in the study. Non-probability convenience sampling was used for recruitment. The survey questionnaire was voluntary [ 21 ] and it was requested that it be answered by adults of both sexes over 18 years of age. 2870 surveys were complete (3.000 survey were sent, survey responsum rate: 95.6%), of which 2333 were selected after excluding surveys that contained information inconsistencies and those that were completed by minors.

2.3. Survey questionnaire

An online survey questionnaire designed to be completed by the participants was designed by four health and nutrition experts from two Ecuadorian universities (Escuela Superior Politécnica de Chimborazo and Universidad Estatal de Milagro). A pilot test was conducted where the survey was taken by 30 Ecuadorian adults (15 males and 15 females) aged 18–64 years old. The survey questionnaire was then reviewed and revised by the same four experts. After changes were implemented, the survey was loaded onto Google Forms and shared through different social networks. The survey consisted of four sections: Section 1 , which included an introduction, objectives and an informed consent form; Section 2 , which contained questions regarding socio-demographic information; Section 3 , which included questions regarding health habits; and Section 4 , which contained questions that aimed to assess emotional eating and perceived stress.

The socio-demographic variables considered for this study were sex (male, female), marital status: single (including divorced and widowed participants) and accompanied (including individuals who were married or had a cohabiting partner), education level (primary, secondary, higher), and ethnicity (white, mestizo, black, indigenous). The body mass index (BMI) was described through measures of central tendency.

2.4. Variables

2.4.1. dependent variable.

Emotional eating (EE) was considered as the main dependent variable. EE was assessed in the third section of the online survey using a validated questionnaire developed by Garaulet [ 22 ]. The EE questionnaire included 10 questions with four possible answers: 1) Never, 2) Sometimes, 3) Frequently, and 4) Always. The answers were assigned a score of 0, 1, 2, and 3 respectively, therefore, participants could obtain a total score between 0 and 30, which corresponded to the sum of the scores of the 10 questions. A lower score was considered representative of a healthier behavior, and vice versa. For descriptive purposes and in line with the author's methodology; EE was categorized into 4 different groups based on total score: 1) 0–5 as non-emotional eater 2) 6–10 as low emotional eater, 3) 11–20 as emotional eater, and 4) 21–30 as very emotional eater). For the statistical analysis, EE was operationalized as a continuous variable [ 22 ].

2.4.2. Independent variable

Perceived stress (PS) was considered as the main independent variable. Perceived stress was estimated using the Perceived Stress Scale (PSS), which assesses the degree at which a specific situation is seen as stressful by an individual [ 23 ]. The PSS consists of 14 items, with possible answers ranging from 0 (never) to 4 (very often). Individuals who undergo this assessment instrument can get a score ranging from 0 to 56, the higher the overall score, the higher the level of perceived stress [ 24 ]. For descriptive purposes, the variable PS was classified into two categories: stress and no stress. The median of PSS was used as the cut point to identify two groups: one without perceived stress (<median), and one with perceived stress (> or = median). For the statistical analysis, PS was operationalized as a continuous variable.

2.5. Statistical analyses

A descriptive analysis was performed based on the independent variable and the general characteristics of the study group. The statistical significance (p < 0.05) of the proportional difference in the univariate analysis was established using the chi2 tests for the categorical variables and the Mann Whitney U test for the continuous variables.

In order to assess the relationship between the dependent and independent variable, a multiple linear regression model was developed, including the emotional eating score as the dependent variable and the perceived stress score as the independent variable. To better understand the association between emotional eating and perceived stress we implemented a logistic regression model, using emotional eating and perceived stress as categorical variables. In order to include in the logistic model an outcome with two levels we grouped together individuals who were non or low emotional eaters and those who were emotional or very emotional eaters. Both models were adjusted for age (years), sex (male and female), marital status (single and accompanied), BMI (kg/m2) and ethnicity (white, black, mestizo and indigenous).All analyzes were performed using R version 4.0.1 and related packages [ 24 ].

2.6. Ethics approval and related considerations

The present study was carried out following the Declaration of Helsinki for working with humans and in accordance with the “Singapore Declaration on Research Integrity”. It was approved by the Ethics Committee in Human Research of the University of Cuenca, with an approval code 2019-232EO-I. All participants accepted and completed an informed consent form included at the beginning of the survey. Participants' responses were anonymous and confidential in accordance with Google's privacy policy, which can be found in English at https://policies.google.com/privacy?hl=en [ 25 ]. Participants were not allowed to provide their names or contact information. In addition, participants were able to stop participating in the study and leave the questionnaire at any stage before the submission process, their responses were not saved. Responses were saved only by clicking the “submit” button provided.

2333 volunteers participated in the study, the population consisted for the most part of female participants (n = 1581, 67.8%), single (n = 1585, 67.9%), of mestizo ethnicity (n = 2173, 93.1%) and with more than 12 years of formal education (n = 1859, 79.7%). The median age was 25 years (interquartile range = 21–37) and the median BMI was 25.50 kg/m2 (interquartile range = 22.06–27.59). Female participants reported higher perceived stress (77.91%) than males (22.09%). Accompanied participants (74.09%) reported higher perceived stress in comparison with single, widowed, and divorced participants (25.91%). Finally, the mean age (23 years) of subjects who displayed perceived stress was lower than that of the subjects who did not show perceived stress (28 years). These differences were statistically significant (test: chi2, p < 0.001). Education level (test: chi2, p < 0.17), ethnicity (test: chi2, p < 0.051) and Body Mass Index did not show statistically significant differences ( Table 1 ).

Table 1

Socio-demographic characteristics of the study population according to perceived stress.

Legend: n = absolute frequency; % = relative frequency; IQR = interquartile range; p = p-value for significance level. Source: prepared by the authors, 2021.

Approximately half of the participants presented stress (50.71%) while 49.29% did not present stress (test: chi2, p < 0.001). The population was mostly classified as non-emotional eater (36.6%) or low emotional eater (31.8%) (test: chi2, p < 0.001). When it comes to perceived stress, the majority of non-stressed participants were non-emotional eaters and low emotional eaters, whereas the majority of stressed participants were emotional or highly emotional eaters (test: chi2, p < 0.001). See Table 1 .

In the multiple linear regression model, a statistically significant association was found between the emotional eating score and perceived stress (F = 417, gl = 1, p < 0.001), the effect was an elevation of 0.44 points in the score of emotional eating for each perceived stress point. See Fig. 1 . Analysis of outcome and exposure as categorical showed similar results. In this case, emotional eating was also significantly associated with perceived stress (Chi2 = 172.60, df = 1, p  < 0.001). The odds of being emotional eater among stressed individuals was 3.75 (95%CI, 3.09:4.58) times the odds of being emotional eater among non-stressed individuals.

Association between perceived stress and emotional eating in the study population. Multiple linear regression model between the emotional eating scale and the perceived stress score.

The variables BMI (F = 112, gl = 1, p < 0.001) and age (F = 4.48, gl = 1, p = 0.03) were statistically significantly associated with the emotional eating score. For each unit increase in BMI the emotional eating score increased 0.26 units and for each unit increase in age the emotional eating score decreased by 0.27 units (See Supplementary graphs 1 and 2 ). The variables marital status (F = 1.2, gl = 1, p = 0.27), ethnicity (F = 1.1, gl = 1, p = 0.34), sex (F = 1.9, gl = 1, p = 0.16), and education (F = 2, gl = 1, p = 0.13) did not show a statistically significant relationship with the emotional eating score.

4. Discussion

The COVID-19 pandemic has brought significant changes in the lives of the world's population. The repercussions of self-isolation are being reflected with greater force every day on people's mental health [ 26 ]. In this research article the relationship between perceived stress and emotionality when eating was studied. It was found that subjects who displayed perceived stress were more influenced by their emotions when eating, which over a period of time can present a problem in people's dietary intake and therefore their nutritional status [ 27 ].

4.1. Perceived stress and emotional eaters

According to De Pasquale et al., the fear of infection during the COVID-19 pandemic has been a significant cause of stress for the population. Food represents a compensating experience, distracting from feelings of uncertainty, fear and despair, causing alterations in eating habits and behaviors [ 28 ].

Stress has been associated with eating habits, in some cases decreasing dietary intake, but in most of the population increasing caloric intake [ 29 ]. A study by Konttinen et al. offers support for the hypothesis that emotional eating is a behavioral mechanism between depression and development of obesity and abdominal obesity. Moreover, adults with higher emotional eating may be particularly vulnerable to weight gain [ 30 ]. This situation represents a serious problem due to its association with overweight and obesity, arterial hypertension, and other cardio-metabolic diseases [ 31 ] since excessive dietary intake usually happens due to the consumption of foods rich in fat, sugar or salt, and the deficient consumption of foods rich in fiber vitamins and minerals [ 32 ].

In this study it was found that subjects who display perceived stress have a higher risk of being emotional eaters, which is consistent with previous studies that show that stress and emotional situations such as depression can also condition an individual's dietary intake [ 30 , 32 ].

According to Van Strien (2018), previous studies have described that emotional eating can be caused by several mechanisms, such as eating to cope with negative emotions like stress and depression, or confused internal states of hunger and satiety with physiological changes associated with emotions [ 33 ].

The immediate effect of consuming palatable foods from emotional eating can bring a certain satisfaction to the individual [ 22 ]. However, it is often a maladaptive emotional regulation strategy as it is unlikely to result in long-term improvements in mood. The consequences of this, as stated above, are an excessive dietary intake of poorly nutritious foods, and the subsequent appearance of negative emotions (e.g. feelings of guilt) [ 33 ].

Therefore, it is urgent to implement programs that help people manage their perceived stress and, in particular, programs associated with resilience to the stress of confinement or the conditions associated with the COVID-19 pandemic. It is important to teach people to address their emotions and stress problems; in order to prevent perceived stress from being responsible for unhealthy diets.

It is known that in stressful situations, a greater amount of cortisol is released through the hypothalamic–pituitary–adrenal axis [ 34 ]. Continued exposure to stressors and the accompanying hormonal imbalances trigger an increase in appetite [ 35 ]. The relationship between stress, cortisol, and high food intake has visceral adiposity and insulin resistance as predisposing factors for a metabolic disruption with significant consequences for human health [ 35 ].

In this study it was observed that female individuals presented higher percentages of perceived stress than males, which is in accordance with previous studies, where it is mentioned that women are risk groups for presenting greater problems of anxiety, depression [ 36 ], and emotional eating [ 34 ]. It is also known that women tend to be more likely to have a need to incorporate compensatory substances to emotional states, such as sweet foods and foods rich in fat. In the short term, these substances could allow a greater release of neurotransmitters such as serotonin and dopamine at the level of the reward system, specifically on the NAc Nucleus Accumbens -NAc, however in the long term they could generate a compulsive and uncontrolled consumption of palatable foods [ 37 ].

5. Study strengths and limitations

The main weakness of this study, due to the properties of this method, was the non-probability sampling that was carried out. Nonetheless, it was possible to achieve a high response rate from the participants, which allowed us to obtain practical conclusions. In addition, it should be noted that the variables analyzed were self-reported by the participants, however, in order to minimize bias, validated virtual questionnaires were used.

6. Conclusion

Perceived stress is associated with people's eating behaviors. A dietary intake that responds to emotions and not to physiological hunger can have long-term repercussions. The impact on the health status and body weight of the participants in this study. Further research should be carried out on the association between stress and emotional eating in order to issue more precise recommendations to the general population and to prevent health and nutritional problems.

Authors’ contributions

TVCA conceived of the idea at the basis of the article, collected and interpreted the data, designed the study, was responsible for submitting the project to the Ethics Committee, prepared and revised the manuscript; AMS, VS interpreted the data and revised the manuscript; MFVV processed the data; ARB prepared and revised the manuscript; SLBO interpreted the data, prepared and revised the manuscript. All authors approved the final manuscript.

Formatting of funding sources

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Declaration of competing interest

All authors declare that they have no conflict of interests.

Acknowledgment

The authors are grateful for people's participation in this study. The research team appreciates the support of the Research Institute - ESPOCH.

Appendix A Supplementary data to this article can be found online at https://doi.org/10.1016/j.clnesp.2022.03.030 .

Appendix A. Supplementary data

The following are the supplementary data to this article:

• Research article
• Open access
• Published: 14 September 2018

Emotional eating and weight regulation: a qualitative study of compensatory behaviors and concerns

• Mallory Frayn   ORCID: orcid.org/0000-0001-8583-6816 1 ,
• Simone Livshits 1 &
• Bärbel Knäuper 1  

Journal of Eating Disorders volume  6 , Article number:  23 ( 2018 ) Cite this article

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Emotional eating, or overeating in response to negative emotions, is a behavior endorsed by both normal weight and people with overweight/obesity. For some individuals, emotional eating contributes to weight gain and difficulties losing weight. However, there are also many who engage in emotional eating who maintain a normal weight. Little is known about the mechanisms by which these individuals are able to regulate their weight.

The present study seeks to gain insight into the behaviors of individuals of normal weight who engage in emotional eating through a series of one-on-one, 1-h long, qualitative interviews. Interviews were semi-structured and guided by questions pertaining to participants’ compensatory behaviors used to regulate weight and concerns regarding their emotional eating. All interviews were transcribed and then objected to a thematic analysis of their content.

The results of this analysis showed that participants endorsed using physical activity, controlling their eating behaviors, and engaging in alternative stress reduction and coping strategies to mitigate the effects of their emotional eating. They reported concern over the effects of emotional eating on their weight, body image, and health and saw this behavior as an unhealthy coping mechanism that was difficult to control.

Conclusions

These results suggest that programs promoting exercise, mindful eating, emotion regulation, and positive body image could have a positive effect on emotional eaters who struggle to maintain a healthy weight.

Plain English summary

Emotional eating is the act of eating in response to negative emotions and is commonly endorsed by individuals who have overweight/obesity, as well as those who are of normal weight. However, little is known about what allows individuals of normal weight to maintain their weight in spite of their emotional eating. The present study examined emotional eating in those of normal weight through a series of one-on-one interviews. The interviews asked questions about ways in which participants regulated their weight, as well as concerns held by participants about their emotional eating. Participants endorsed using exercise and regulating their eating behaviors in order to regulate their weight. They noted concern over their health and potential weight gain long-term. These findings have implications assisting emotional eaters who have overweight/obesity in helping them to regulate their weight and improve their health through exercise, mindful eating, and other stress reduction strategies.

Emotional eating is defined as the “tendency to overeat in response to negative emotions such as anxiety or irritability” ([ 1 ], p. 106). This behavior is of interest because emotional eating has been consistently associated with weight concerns such as overweight and obesity [ 2 , 3 , 4 ]. Additionally, individuals with overweight have been found to exhibit less effective coping skills in response to negative emotions, leading them to emotionally eat more frequently [ 5 ]. Difficulties with weight loss have also been associated with emotional eating (e.g., [ 6 , 7 ]). Difficulties with weight loss that have been associated with emotional eating are increased binge eating, reduced self-monitoring, and lower quality social support [ 8 , 9 , 10 , 11 , 12 , 13 ].

Despite these findings, many individuals maintain a normal weight even though they engage in emotional eating [ 14 ]. Minimal focus has been dedicated to this group, and what differentiates these individuals from emotional eaters who become overweight or obese, as will be elaborated below. The present study seeks to illuminate the factors that allow emotional eaters of normal weight to maintain their weight through conducting in-depth one-on-one interviews. For reasons elaborated below, we chose to pursue the following two areas to increase understanding of the relationship between emotional eating and weight in individuals of normal weight: (1) compensatory behaviors used to regulate their weight, and (2) concerns regarding their emotional eating.

Compensatory behaviors for weight regulation

The present study seeks to elucidate how some emotional eaters manage to maintain a normal weight despite consuming excess calories during emotional eating episodes. In order to do so, we aimed to identify behaviors that offset the excess calories (i.e. compensatory behaviors) that individuals of normal weight who engage in emotional eating use. Such compensatory behaviors may explain the lack of weight gain in these emotional eaters (e.g., [ 15 , 16 , 17 , 18 ]).

Many compensatory behaviors exist but specifically exercise and compensatory eating behaviors have been associated with emotional eating. Previous studies have shown that exercise contributes to weight maintenance in emotional eaters [ 1 , 2 ], however the quantitative design of such studies has not allowed for an in-depth examination of what motivates these individuals to exercise and whether exercise is used as a direct compensation for overeating. Compensatory eating behaviors may also be related to emotional eating and weight maintenance. For example, the ability to monitor internal hunger and satiety cues has also been implicated in regulating eating behaviors and reducing food consumption [ 14 , 19 , 20 ]. However, specific ways in which emotional eaters of normal weight may rely on these cues to regulate their eating and weight is not known.

Exercise as a compensatory behavior

Engaging in regular physical activity has been shown to protect against weight gain [ 21 ] as well as reduce depression and other forms of negative affect [ 22 ] that can lead to emotional eating. Subsequent longitudinal studies have shown the importance of physical activity for emotional eaters; physical activity has been found to moderate the relationship between emotional eating and weight gain over time [ 4 ]. Dohle et al. [ 2 ] similarly found that emotional eaters who exercised more frequently had lower BMIs over a 1-year period than those who exercised less frequently. Physical activity may help compensate for overeating and thus help to prevent weight gain typically observed in emotional eaters.

Compensatory eating behaviors and emotional eating

Emotional eating has been associated with reduced awareness of internal hunger and satiety cues, in part because stress alters one’s ability to be aware of these internal cues [ 19 , 20 ]. also found that individuals who experienced binge-eating episodes engaged in emotional eating because they were unable to suppress their food consumption. However, individuals of normal weight who engage in emotional eating have been found to consume less food in response to negative emotions than individuals with overweight or obesity [ 14 ]. Thus, it may be that individuals of normal weight are more aware of their internal hunger and satiety cues even under stress.

Other compensatory eating behaviors are associated with eating disorders and disordered eating behavior. For example, fasting is a correlate of body dissatisfaction, internalization of thin ideals, and restrained eating [ 23 ]. Purging is also associated with eating disorders including bulimia and binge eating disorder [ 24 ]. The present study seeks to examine whether or not such behaviors are present in emotional eaters of normal weight.

Concerns regarding emotional eating

Emotional eating has been related to concerns including increased external motivation for eating healthily and heightened monitoring of one’s food consumption, outside of emotional eating episodes [ 25 ]. Similarly, worries about weight prior to a physical activity intervention have been shown to predict emotional eating and continued concern about weight but not post-intervention BMI [ 26 ]. Thus, weight concerns may help to protect against actual weight gain. The present study aims to identify what concerns individuals of normal weight who engage in emotional eating may have with regards to their eating behaviors and explore how such concerns may motivate weight regulation.

Concerns regarding body image

Negative body image has been associated with emotional eating [ 27 ]. Additionally, being discontent with one’s body is related to wanting to lose weight [ 28 ]. Conversely, individuals who are less concerned about their body image and eating habits may be less likely to engage in emotional eating [ 29 ]. Individuals with greater flexibility in their body image are also less likely to binge eat, which is associated with emotional eating [ 30 ]. However, previous research on the relationship between body image, weight, and emotional eating has predominantly studied individuals with overweight or obesity or individuals with diagnosed eating disorders. The present study will explore the extent to which individuals of normal weight who engage in emotional eating experience body image concerns and examine the relationship between these concerns, emotional eating, and weight.

Through qualitative interviews examining the compensatory behaviors and concerns associated with emotional eating in individuals of normal weight, the present study aims to elucidate the mechanisms through which individuals of normal weight who engage in emotional eating maintain their weight.

Participants

Participants for the study were undergraduate students recruited from a larger survey study ( N  = 200) exploring the relationship between emotional eating and several psychological constructs. Both studies were approved by the university’s research ethics board. Of those who completed the survey, a total of 58 participants were deemed eligible to participate in the present study based on the following three inclusion criteria: (1) scoring 3.25 or higher on the emotional eating subscale of the Dutch Eating Behavior Questionnaire (DEBQ; [ 31 ]), which represents the 80th percentile based on a normative Dutch sample [ 32 ], (2) endorsing a BMI within the normal weight range based on self-reported height and weight, and (3) reporting that they had maintained their weight within 5 pounds over the past 1 to 2 years. Weight maintenance was a criterion to ensure that participants were not formerly of higher weight, and thus did not differ in compensatory behaviors and concerns based on previous weight status.

Recruitment for the present study was conducted sequentially, as the larger survey study from which participants were selected was ongoing. For every 50 participants who completed the larger survey study, eligible participants were identified based on the criteria outlined above. Two participants were then randomly selected using a random number generator ( randomizer.org ) and sent an email invite to participate in the interview. If a participant failed to respond, a new one was randomly selected and contacted from the same cohort of eligible individuals. Throughout this process and until data saturation was achieved, a total of five individuals refused to participate (3 did not respond to the initial email, 1 stated that they were too busy to participate, and 1 failed to attend their interview appointment with no reason provided). This initial email was the only direct contact participants had with the researcher prior to the study.

Data saturation

There is a lack of consensus between researchers regarding the number of interviews required in qualitative research to reach data saturation [ 33 ]. Rather it has been suggested to treat data saturation as a moving target that is achieved once no new codings and themes are identified from additional interviews [ 34 ]. To facilitate this approach in the present study, participants were recruited two at a time and preliminary codings and themes were generated after the first couple of interviews and then refined as subsequent interviews were conducted. Recruitment was terminated when new themes ceased to emerge in interviews. This point of data saturation was achieved after eight interviews in the present study as per consensus amongst the three researchers (all authors). This number of interviews was in line with findings by Guest, Bunce, and Johnson [ 34 ] who conducted an experimental study and found that data saturation may occur within as few as six interviews. As emphasized by Burmeister and Aitken [ 35 ], the focus of the present study was on data richness and depth, rather than solely data quantity.

The DEBQ is a self-report questionnaire with 33 items on three different subscales: restrained eating, emotional eating, and external eating. For the purpose of this study, only the 13-item emotional eating subscale was used. Participants were asked to rate the frequency with which they experienced the desire to eat in response to a variety of emotions on a 5-point Likert-type rating scale from never (1) to very often (5). The DEBQ has been found to have high factorial validity as well as high internal consistency [ 31 ].

Individual in-depth interviews were conducted with each participant to learn about various aspects of their emotional eating. Each interview lasted between 45 to 60 min and was conducted in a closed office on the university campus. Participants were compensated $20 for their time at the end of the interview. The interviews were semi-structured, following a set of questions examining three aspects of emotional eating: (1) history of emotional eating, (2) compensatory behaviors used to maintain weight, and (3) concerns regarding emotional eating. For the purpose of this study and its focus on emotional eating and weight regulation, only data from the latter two sections of the interview were included. The interviews were conducted by the first author, a female senior PhD student in clinical psychology who had received training in interviewing and assessment as part of her clinical training. A female undergraduate research assistant (second author) observed some of the interviews for learning and training purposes.

Prior to commencing each interview, the researcher introduced herself and provided participants with a brief overview of the purpose of the study, namely that the researchers were interested in examining the relationship between emotional eating and weight. Participants were informed that they would be asked several questions pertaining to this topic and that they were free to answer as they wished, both regarding content and level of disclosure. They were also informed that the interview would be audio recorded for transcription purposes. All participants consented to this prior to study commencement.

The section on compensatory behaviors explored strategies that participants utilize to regulate their weight. They were asked how they thought they maintained a normal weight despite their eating behaviors, as well as what behaviors they actively engaged in to maintain their weight. Questions were also asked to better understand what their episodes of emotional eating looked like, delving specifically into the factors that caused them to stop eating.

The final section asked questions about participants’ concerns regarding emotional eating. This part of the interview explored the feelings individuals had when engaging in emotional eating, as well as the possible negative effects they thought emotional eating might have on their life, both in terms of weight and other health problems. Questions were also asked to ascertain individuals’ interest in reducing or eliminating their emotional eating, versus how they felt about continuing to engage in this behavior.

Data analysis

Braun and Clarke’s [ 36 ] procedure for thematic analysis in psychological research was used to analyze the data. A data-driven approach was used for the analysis with themes derived from the data itself instead of being identified in advance. All interviews were first transcribed and then coded into basic elements. Codings were then organized into preliminary themes, based on the sections of the interviews pertaining to compensatory behaviors and and concerns with emotional eating. Preliminary themes were reviewed and edited, prior to defining and naming a finalized list of themes that encompassed the entirety of the data set. Codings and themes were reviewed by two researchers (first and second author) throughout the analytic process to ensure consensus.

Demographics

A total of 8 participants were interviewed, 7 of which were female. 88% of the sample identified as Caucasian. The mean age of participants was 19.00 years and the mean BMI was 22.09. Participants scored an average of 3.78 on the DEBQ emotional eating subscale.

Themes pertaining to compensatory behaviors

Four themes were identified regarding compensatory behaviors used by individuals to compensate for their emotional eating: (1) physical activity as a compensatory behavior, (2) the use of alternative stress reduction and coping strategies, (3) compensatory eating behaviors, and (4) the impact of metabolism.

T1: Physical activity as a compensatory behavior

The vast majority of participants endorsed the use of physical activity to compensate for their emotional eating and regulate their weight. The type and duration of physical activity varied between participants, with some participants engaging in unstructured, moderate exercise (e.g., long walks) and others reporting structured, high intensity exercise (e.g., cardio exercises such as running or interval training). Some participants noted that they engaged in physical activity regardless of the severity and frequency of emotional eating episodes while others described engaging in more physical activity after episodes of emotional eating. Multiple participants reported using exercise for stress relief to avoid emotional eating.

I know that like as long as I get a workout in before noon every day, the rest of my day is going to be great. It’s going to be fine, and whatever stress I have, I’m not going to go to an extreme. (8).

Some participants also connected their use of physical activity to helping alleviate mental health concerns, both in the presence and absence of their emotional eating.

Even when I’m not overeating, exercise just makes me feel like a lot better, physically, but also emotionally and mentally. (4).

T2: The use of alternative stress reduction and coping strategies

Participants cited the use of specific stress reduction techniques and other coping strategies as replacements for the mood enhancing effects of emotional eating. Such techniques included tools derived from Cognitive Behavioral Therapy (CBT), like thought records for cognitive restructuring, that participants described learning during therapy for mental health concerns such as anxiety. Participants who had experienced mental health concerns noted that managing these concerns helped them to reduce emotional eating.

Part of the CBT techniques that my counsellor taught me was to pinpoint exactly what triggered my bad mood, and work from there to see whether or not it’s rational for me to be upset over it, or if I’m blowing things out of proportion. (1).

Social support was also mentioned as a coping strategy. Some participants said that engaging socially with others compensated for negative emotions, such as loneliness, that led to emotional eating. Multiple participants discussed talking to friends about things that were bothering them while others reported using their parents as a support system.

It feels like I don’t have to just turn to food to feel better, I can turn to friends instead. (7).

T3: Compensatory eating behaviors

Participants described eating behaviors they engaged in after emotionally eating to compensate for their overconsumption. A common theme was the reduction of food intake after emotional eating. Some participants fasted in the days after emotional eating episodes while others simply ate less food in the subsequent days.

If I do have a big weekend of eating, like a big emotional eating session, I will be more careful in what I’m eating for the following days. (6).

Many participants also endorsed the desire to engage in healthy eating habits, regardless of their emotional eating, viewing it as a lifestyle choice. However, many also cited healthy eating as motivation to avoid emotional eating. For example, participants described that by starting their day in a healthy way, they were more likely to continue eating healthy (and thus avoid emotional eating) throughout the remainder of the day.

Some participants took their perception of “healthy” eating to an extreme, engaging in cleanses after prolonged emotional eating. Most, however, simply monitored what they consumed and elected to make healthy, balanced dietary choices. Several participants also endorsed vegetarian or vegan lifestyles, which required them to consume healthier foods.

A big thing that has helped me in changing my diet has been becoming a vegetarian, and now becoming a vegan. I kind of create even more restrictions to my day. (5).

Several participants mentioned that they avoided overeating during emotional eating episodes. In other words, despite consuming unhealthy foods when emotional, many described still trying to stop once they noted that they were full.

I don’t tend to overeat that much because I don’t want to gain weight. I don’t want to be overweight, so I’ll overeat to like 5% past my capacity. I won’t get to a point where I want to vomit, it’ll just be a point where I’m full. (3).

Some participants noted mindful eating habits; they described intuitively paying attention to their hunger and satiety cues to guide their eating. This body awareness was attributed to a few factors. One participant credited chronic pain with helping her to be aware of what her body needed, while others endorsed feeling in tune with their bodies as helping them maintain a normal weight.

I’ve become a little bit better with recognizing what it is my body needs {as a result of chronic pain}, and this awareness helps with my eating. (4).

Avoiding unhealthy trigger foods was another strategy frequently used by participants. Participants endorsed not buying certain foods that they knew they would be likely to consume in response to emotions. Some participants avoided grocery shopping while hungry as to not make unhealthy choices, or even hid food from themselves to avoid consuming it while emotional.

Peanut butter, Nutella, those are my two big ones. So those just don’t come into my apartment, and if they do they’re in little individual packages, because it’s really hard to eat those without noticing. (6).

Notably, most people did not endorse purposefully purging to compensate for overeating. One participant noted that while they did not actively attempt to purge, they would often eat so much during emotional eating episodes that they would inadvertently vomit.

I’m often physically sick like 75% of the time {when I engage in emotional eating}. (6).

Finally, participants put forward the idea that avoiding emotional eating behaviors led to feelings of competence and autonomy. In other words, avoiding emotional eating appeared to increase participants’ self-efficacy that they could continue to disengage from this behavior and engage in healthier behaviors instead. Some participants thus made active attempts to improve their emotional eating habits and become healthier, as well as to attain a more balanced lifestyle.

I’ll start, and like, today’s going to be different, today I’ll have a healthy breakfast, and then once you do and you feel really good about it and you’re like “hey, this is nice to maintain”, and then yeah, I feel like it’s also just like a meal prep kind of thing of like “oh, I’ll make this and then I’ll have it for lunch today, and lunch tomorrow, and then I’ll take this snack to my class”. (5).

T4: The impact of metabolism

Several participants believed that they were able to maintain their weight because of a fast metabolism. These participants, more often than not, reported that they did not eat particularly healthily and also did not exercise. However, they did acknowledge that they would not always be able to rely on their metabolism to maintain their weight.

I honestly could not tell you {how I maintain my weight}. I find it a miracle that I’m not morbidly obese. I think it’s probably some sort of genetic thing because my weight doesn’t fluctuate. (4).

Themes regarding concerns about emotional eating

There were six overarching themes regarding participants’ concerns about their emotional eating: (1) concerns about weight, (2) concerns about health, (3) emotional eating as an ineffective coping mechanism, (4) emotional eating as difficult to abate, (5) avoiding immediate negative physical and psychological effects of emotional eating, and (6) negative social evaluation.

T1: Concerns about weight

The majority of participants endorsed concerns about eventual weight gain. While some participants viewed emotional eating as a barrier to attaining their ideal body weight, others believed that over time, emotional eating would cause them to become overweight. Some participants put forward the idea that their worry about weight gain would protect them from actually gaining weight. Similarly, some participants noted that they were diligent about compensatory behaviors such as exercise because they were concerned about weight gain.

I still do have a lot of anxiety over weight gain, so when I do have a large emotional eating session, I think about that a lot and stress over it, which is one of the reasons why exercise is such a compulsion afterwards. (8).

Although many participants were more concerned about long term weight gain, some participants endorsed that their emotional eating could trigger them to worry about immediate weight gain.

Total regret. Yeah, as soon as I start eating it, I’ll be like “Ah this was a mistake”. I know it’s not happening, but I feel myself physically gaining weight. (3).

Additionally, a few participants described a relationship between avoiding emotional eating and body image concerns. The negative body image that they believed would come with weight gain was cited as motivation to avoid emotional eating.

I’ll always have that fear of putting that weight back on, so that also keeps me from doing it a lot. I was just so unhappy at the weight that I was, I wasn’t comfortable in my body, I didn’t feel pretty, I hated my body. I’m terrified of ever feeling like that again. (6).

T2: Concerns about health

Participants reported concerns about their health, regardless of weight. Multiple individuals noted that they were actively trying to reduce their emotional eating because of anticipated health concerns. Some described worry about experiencing similar health concerns to their parents, such as developing chronic diseases like diabetes. Participants mostly predicted long-term concerns about their health but were not noticeably concerned about the implications of emotional eating on their health in the short-term. Multiple participants also noted that they were concerned about health problems associated with weight cycling that could occur as a result of emotional eating. Regardless of weight gain, however, individuals noted concern about the potential effects of their emotional eating on their overall health.

Even though you’re not putting on weight, it still can affect your cholesterol, your, you know, everything else. There could be health consequences, so there’s that that you need to be mindful about also. (4).

T3: Emotional eating as an ineffective coping mechanism

Some participants viewed emotional eating as an unhealthy way to cope with their problems. These participants believed that emotional eating carried mental repercussions such as negative body image and ineffective coping. A few participants put forth the idea that emotional eating covered up a deeper issue that needed to be dealt with. Some of the participants who endorsed emotional eating as an unhealthy way to cope with stress reported that they were actively working on using alternatives to coping mechanisms.

I think it’s kind of a cover-up to a deeper issue that you’re not dealing with. You have an issue and instead of learning to deal with it, you’re covering it up. While that might work for the time, you can’t live your whole life avoiding your problems. At some point, something’s going to catch up to you. (5).

Multiple participants cited concern that their emotional eating would lead to other, more problematic behaviors. They believed that engaging in emotional eating reduced their willpower and could make it easier to use other substances for comfort and emotion regulation. In other words, they cited concerns about “addiction transfer” from food to other addictive substances.

I think it’d just become more and more easy to turn to any substance that would make you feel better. If it’s not food, it’s cigarettes, it’s drugs, it’s drinking. I think eventually, you just start looking for something to make you feel better, and then that stops working, so you look for something better than that, and something better than that. It can definitely be a spiral. (6).

T4: Emotional eating as difficult to abate

Participants were varied in their motivation to cease emotional eating. Many participants believed that their emotional eating would be virtually impossible to get rid of. While some described that they were actively trying to reduce emotional eating, others were more ambivalent about changing their emotional eating. Multiple participants tended to normalize their emotional eating, justifying that because they were normal weight, they needed not be concerned about it. Some had previously tried to eliminate their emotional eating and because of failed past attempts they were now content with the reality that their emotional eating could not be eliminated.

I mean, it’s always good to dream that it will go away, but knowing myself I’ll know that I’ll be able to reduce it, but it will never go away. It will always be this part of me and it’s just going to come back. (7).

Many participants described concerns pertaining to emotional eating and control. Control was described on a continuum from feeling in control of their emotional eating at times, to worrying about “losing control” over emotional eating. For many of the participants who described concerns with control, emotional eating was considered an addiction. Also, some participants felt ashamed of their emotional eating and regarded it as an indicator of low self-control.

T5: Avoiding immediate negative physical and psychological effects of emotional eating

Most participants described that both the physical and psychological effects that occurred as a result of emotional eating were unpleasant. Some participants noted that they disliked the bloated and lethargic feelings that resulted from overeating. Participants also endorsed that avoiding aversive physical consequences related to emotional eating motivated them to avoid engaging in this behavior. Some participants said that they avoided emotional eating because they knew that their bodies felt better when they consumed healthier foods.

Throughout the years with exercising more and everything, I feel like I have become a little better at recognizing what’s healthy and what’s not. As I’ve started eating healthier, my body just doesn’t react as well to junk food. (4).

Participants also cited the desire to avoid aversive psychological consequences of emotional eating, such as feelings of guilt and shame. Many participants described that guilt helped them to self-regulate. For example, for some participants guilt arose from fear of gaining weight, thus motivating them to avoid emotional eating. Overall, participants described that negative psychological feelings such as guilt helped motivate them to not engage in emotional eating.

I don’t do well with guilt generally, and I generally tend to build up a lot of guilt that’s unnecessary. So if I feel guilt after emotional eating, it really hits me hard, and I feel like it’s motivation that I don’t want to feel bad about this again. (5).

Conversely, other participants endorsed that they did not experience negative feelings such as guilt after emotionally eating. They reported feeling that emotional eating was normal, had no noticeable effects on their body, and that the act of eating palatable food was overall pleasant.

It’s anticipation {of eating}, it’s enjoying it at the time. I don’t know if I would necessarily feel super guilty after, maybe because it’s become kind of status quo and I accept a little bit that it’s out of my control. (2).

T6: Negative social evaluation

Several participants saw their eating habits as abnormal compared to that of their peers and cited this as a motivation to change their behavior. Hearing other people’s negative comments about their eating, especially those of family members helped some participants reduce their emotional eating. Others described that seeing their roommates and friends eating healthier foods motivated them to do the same and thus not engage in emotional eating behaviors.

I feel like there’s more of an expectation living with roommates. When I see them going through a healthy day, it’s like, “well I’m not even hungry, so why, when like they’re not constantly eating, why do I?” Then I don’t do it as much, because you see healthy behavior and you’re like, “well, that seems more logical, I’m going to do that.” (5).

Others endorsed the concern that their behavior would be off-putting to others if they were aware of it.

It was always the feeling of getting caught, and just being embarrassed that somebody saw me in that state, so, not that I think there’s a real consequence, but more I just fear that judgment again. (6).

The present study aimed to provide insight into the ways in which individuals of normal weight who engage in emotional eating are able to maintain their weight, approaching this goal through qualitative interviews. These interviews focused broadly on two domains: (1) compensatory behaviors used by these individuals to maintain their weight, and (2) concerns held by individuals of normal weight regarding their emotional eating.

• Compensatory behaviors

Physical activity was a compensatory behavior frequently endorsed by participants. Because physical activity has been found to protect against weight gain, this relationship may explain why participants were able to maintain their weight while emotionally eating [ 2 , 4 , 21 ]. Additionally, participation in physical activity may play a role in reducing the severity of mental health concerns and disordered eating that were associated with emotional eating in the present study. Herring, O’Connor, and Dishman [ 37 ] conducted a systematic review finding that exercise improved symptoms of anxiety. Because emotional eating has been linked to mental health concerns such as anxiety and depression [ 38 ], these findings provide empirical support that physical exercise may have alleviated some of these concerns and thus lessened the severity of emotional eating for some participants.

Several participants mentioned their metabolism as a key factor in their weight regulation, attributing their ability to maintain a normal weight to their genetics and ability to metabolize foods quickly. Interestingly, these participants were less likely to endorse actively using compensatory mechanisms to try to maintain their weight. Future research could examine whether such individuals are more likely to gain weight in the future given that metabolic processes slow during aging [ 39 ].

Despite regularly engaging in emotional eating, some participants also endorsed the use of alternative stress reduction and coping strategies to try and reduce the frequency of their emotional eating. It is likely that the development of such strategies assisted their weight regulation as these participants had alternative options to cope with negative emotions that did not involve food. This finding points to the importance of teaching emotion regulation to emotional eaters to promote both physical and mental health.

Additionally, several participants cited compensatory eating behaviors; these individuals endorsed some ability to suppress their food intake in attempts to avoid overeating. Thus some individuals of normal weight who engage in emotional eating may be able to maintain their weight because they minimize consumption of large food portions during emotional eating episodes. This regulation of intake may result from attending to their internal hunger and satiety cues, as was cited by participants in the present study, and is consistent with the findings of Tan and Chow [ 20 ]. Thus listening to internal cues to moderate food intake may help facilitate weight maintenance in emotional eaters of normal weight.

Participants frequently endorsed concerns about their weight, specifically citing worry about weight gain. Consistent with previous research, these individuals endorsed high worry regarding weight gain, despite emotional eating not influencing their actual weight [ 26 ]. While body image concerns have been related to a desire to lose weight [ 28 ], participants in the present study cited motivation to maintain their current weight to avoid negative body image in the future. Participants also described concerns pertaining to their future health. This finding is consistent with studies that have found that emotional eating may lead to concerns such as heightened monitoring of eating habits and greater external motivation to pursue healthy eating and lifestyle habits [ 25 ].

Furthermore, participants tended to view their emotional eating as an ineffective coping mechanism and also cited concerns that their behaviors could lead to negative social evaluation. It is possible that some individuals in the present study experienced stigmatization due to their emotional eating. Experiencing stigma has been associated with having eating disorders such as binge eating disorder [ 40 ], which is related to emotional eating. Further research is needed to explore the presence of stigma towards emotional eaters and the possible effects this may have on these individuals.

Finally, participants endorsed the idea that emotional eating was difficult to abate, despite attempts to engage in alternative forms of emotion coping. They also noted that they disliked and thus attempted to avoid the short-term negative physical and psychological effects of emotional eating, such as guilt and shame, as much as possible. This is consistent with the findings of Bennett, Greene, and Schwartz-Barcott [ 41 ] who found that guilt was associated with emotional eating, especially in females. Despite maintaining their weight, perceived weight concerns held by individuals of normal weight who engage in emotional eating may lead them to use food to cope, similar to those with overweight and obesity.

Findings from the present study highlight ways in which emotional eaters of normal weight maintain their weight. Comparing the present findings with the literature on emotional eating in individuals with overweight/obesity can provide insight on ways to target emotional eating in individuals of various weight statuses. For example, some emotional eaters in the present study were found to consume what they described as small amounts of food in response to negative emotions. Past studies have found that individuals with overweight and obesity consume greater amounts of food during negative mood-inducted emotional eating episodes than individuals of normal weight [ 14 , 42 ]. In the present study, efforts to regulate food consumption was related back to both awareness of hunger and satiety cues, as well as attempts to use alternative coping strategies to address negative emotions. Thus emotional eaters of all sizes may benefit from learning strategies for regulating food intake, such as mindful eating techniques e.g., [ 43 ]. These techniques may help them to better attend to their internal hunger and satiety cues to guide them in when and how much to eat. Programs that involve emotion regulation strategies would also be useful, such as those that teach emotional eaters how to utilize healthier coping mechanisms like social support and self-care when they are experiencing negative emotions. Therapeutic approaches such as Acceptance and Commitment Therapy (ACT; [ 44 ]) and Dialectical Behavior Therapy (DBT; [ 45 , 46 ]) may be applied to help promote distress tolerance in emotional eaters.

Also, these results suggest that promoting exercise may be useful for emotional eaters, both in terms of weight regulation and stress reduction. As discussed, past studies have found a protective effect of exercise on weight gain in emotional eaters [ 2 , 4 ]. However, it is also necessary to consider the way in which exercise is viewed by the individual before recommending it to target emotional eating. In the present study, several participants used exercise to compensate for their emotional eating in an almost compulsive manner, exercising excessively to burn off perceived excess calories. This type of exercise has been implicated in disordered eating behaviors [ 47 ]. To avoid this, disordered eating should be screened for and exercise should be tailored to the individual, including both psychoeducational and nutritional information [ 48 ].

Finally, because negative body image has been associated with emotional eating, both by individuals of normal weight in the present study and by those with overweight and obesity in past research [ 27 ], programs that target body image improvement could also improve the overall health and well-being of emotional eaters.

Limitations and future directions

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Frayn, M., Livshits, S. & Knäuper, B. Emotional eating and weight regulation: a qualitative study of compensatory behaviors and concerns. J Eat Disord 6 , 23 (2018). https://doi.org/10.1186/s40337-018-0210-6

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Emotions and food consumption: emotional eating behavior in a european population.

1. Introduction

2. materials and methods, 2.1. participants, 2.2. questionnaire, 2.3. statistical methods, 3.1. demographic characteristics of the study groups, 3.2. lifestyle habits and health motivation eating behavior, 3.3. emotional conditions of food consumption, 3.4. consuming food as a way of coping with stress and depression, 3.5. finding emotional consolation in food consumption, 3.6. improving physical and psychological conditions through food consumption, 4. discussion, limitations, 5. conclusions, supplementary materials, author contributions, data availability statement, acknowledgments, conflicts of interest.

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Ljubičić, M.; Matek Sarić, M.; Klarin, I.; Rumbak, I.; Colić Barić, I.; Ranilović, J.; Dželalija, B.; Sarić, A.; Nakić, D.; Djekic, I.; et al. Emotions and Food Consumption: Emotional Eating Behavior in a European Population. Foods 2023 , 12 , 872. https://doi.org/10.3390/foods12040872

Ljubičić M, Matek Sarić M, Klarin I, Rumbak I, Colić Barić I, Ranilović J, Dželalija B, Sarić A, Nakić D, Djekic I, et al. Emotions and Food Consumption: Emotional Eating Behavior in a European Population. Foods . 2023; 12(4):872. https://doi.org/10.3390/foods12040872

Ljubičić, Marija, Marijana Matek Sarić, Ivo Klarin, Ivana Rumbak, Irena Colić Barić, Jasmina Ranilović, Boris Dželalija, Ana Sarić, Dario Nakić, Ilija Djekic, and et al. 2023. "Emotions and Food Consumption: Emotional Eating Behavior in a European Population" Foods 12, no. 4: 872. https://doi.org/10.3390/foods12040872

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