Emotional Eating

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This entry is adapted from the peer-reviewed paper 10.3390/nu15051173

Emotional eating is considered as the propensity to eat in response to emotions. It is considered a critical risk factor for recurrent weight gain. Such overeating is able to affect general health due to excess energy intake and mental health.

emotional eating overweight obesity depression anxiety stress dietary patterns nutrition mental health

1. Introduction

Obesity has grown into a major public health issue worldwide. Obesity increases the risk of several diseases, including diabetes type 2, high blood pressure and cholesterol, musculoskeletal issues, and several types of cancer ^[1]. The factors that render individuals prone to overeating have been investigated comprehensively. Recent evidence suggests that there is an association between psychological factors and the etiology of obesity ^[2]. The existing literature research suggests that deficits in emotion dysregulation and a high level of negative emotions are crucial in the progression and prolongation of obesity ^[3]. Thus, there is a bidirectional correlation: obesity could not only result in physical diseases, but also occur in addition to psychological disorders and social problems, such as low self-esteem, depression, and social stigma ^[4].

Moreover, stress and emotional conditions affect the eating behavior ^[5]. Stress and negative mood are able to influence appetite inversely, prompting several people to eat more and others to eat less ^[6]^[7]. These behaviors, known as emotional overeating and emotional undereating, have been associated to the beginning of body weight complications and eating disorders ^[8]^[9]. Nevertheless, concerning a significant subgroup of people of both sexes, negative emotions, and stress render them to overeat—a kind of eating known as emotional eating ^[10]^[11]. In addition, abnormal emotional functioning means difficulty in appropriately recognizing, understanding, and coping with emotions and a long-term experience of elevated levels of harmful emotions ^[3]. Notably, elevated negative affectivity, body dissatisfaction, self-objectification, and lower self-esteem were predictive of persistent engagement in regular binge eating and inappropriate weight compensatory behaviors ^[8]^[9]. Self-objectification (thinking and monitoring the body’s outward appearance from a third-person perspective) emerged as the largest contributor of both the initiation and persistence of all behavioral symptoms ^[8]^[9].

Emotional eating is not a separate eating disorder, but an eating behavior that is influenced by behaviors, stress, emotions, and individual feelings in relation to eating. However, it must be clear that emotional eating, unlike specific eating disorders, is not related with a total failure of keeping under control the quantity and quality of food consumed ^[12]. Emotional or comfort eating, as well as stress-induced eating, leads to the predisposition to eat in response to negative emotions, with the preferred foods being mainly energy-dense, poor in nutrients and tasty ^[13]^[14]^[15]. These types of eating act as a coping mechanism to control and decrease negative emotions, such as depressed mood, anxiety, and stress ^[16]. As it concerns the prevalence of emotional eating, based on the Stress survey in America performed by the American Psychological Association, 38% of adults stated that they have been implicated in emotional eating during the past month, with 49% of them engaging in it weekly ^[17]. Furthermore, it is frequently considered as a main factor in models of eating disorders and pathological eating attitudes such as overeating and binge eating ^[9]^[18], and could lead to substantial psychological distress and health issues ^[19]. Hence, it is important to interpret its fundamental mechanisms ^[16].

Emotional eating has a positive relationship with increase in weight gain over time and difficulty of losing weight. These can be attributed to the fact that emotional eaters are more prone to greater consumption of sugary and high-fat foods, eat in response to stressors, and snack more frequently compared to non-emotional eaters ^[20]. Notably, a cross-sectional analysis of the NutriNet-Santé cohort conducted on 7378 men and 22,862 women reported that greater emotional eating was related with elevated consumption of energy-dense snacks, such as sweet and fatty foods, and these associations were predominantly stronger in women suffering from depression ^[21]. Moreover, an association between excessive alcohol consumption and emotional eating (binge eating disorder) has been reported ^[22]. These eating habits combined with increased body weight put emotional eaters at a higher risk of diabetes and heart disease ^[23]. Furthermore, emotional eaters activate the relationship of eating motive and reward, supporting evidence that food exerts a reward effect and therefore can alleviate or lessen negative mood conditions ^[13]. In addition, emotional eaters frequently feel negative emotions concerning their physical appearance right after the eating events. Practically, every person has experienced the impact of emotions on eating attitudes. On the contrary, eating behavior is also able to affect influence body image, resulting in body dissatisfaction, which implies to the body-related negative self-assessment of a person ^[17].

2. Emotional Eating and Obesity

Obesity is a serious threat to human health, and its prevalence has almost tripled since 1975. Moreover, the etiology of obesity is multifactorial and eating behavior exerts a crucial role ^[2]. Stigma and weight prejudice are associated with psychological issues and unhealthy eating behaviors (such as emotional eating). The main findings of the studies that examined the relationship between emotional eating and obesity are presented in Table 1.

Table 1. Clinical studies evaluating the association of emotional eating with obesity.

Study Type	Study Population	Methodology	Basic Results	References
Case–control analytic study	473 participants, mean age: 32.7 (SD ± 11.4) years	Coping Strategies Inventory (CSI), Dutch Eating Behavior Questionnaire (DEBQ), ΒΜΙ categories	Overweight participants score was higher in passive coping strategies, and unhealthy eating behaviors such as emotional eating and restrained eating were recorded. Coping strategies were more likely to be associated with unhealthy eating behaviors, and these were more likely to provide and retain a high BMI.	Varela et al., 2020 ^[24]
Cross-sectional study	1626 adults, mean age: 30 (SD ± 11.0) years	Emotional Eating Scale (EES), ΒΜΙ categories	Emotional eating was more common in obese individuals (43.5%) compared to normal weight (33.5%) and underweight (18.4%) individuals.	Madali et al., 2021 ^[25]
Longitudinal study	592 adults, mean age: 45.04 (SD ± 3.9) years	DEBQ, Depressive Mood List (DML) and BMI categories	Emotional eating predicted higher increases in BMI regardless of depressive symptoms only in women.	Van Strier et al., 2016 ^[26]
Cross-sectional study	600 participants, mean age: 25.4 (SD ± 5.13) years	Difficulties in Emotion Regulation Scale (DERS), the Depression Anxiety and Stress Scale (DASS-21), and the Emotional Eating subscale of the Dutch Eating Behavior Questionnaire (DEBQ-EE), BMI categories	Emotional eating was related to higher BMI.	Guerrini-Usubini et al., 2023 ^[27]
Prospective study	39.771 adults, mean age: 49.9 (SD ± 13.7) years	Revised 21-item Three-Factor Eating Questionnaire (TFEQ-R21), the CFC questionnaire (CFC-12) and the Barratt Impulsiveness Scale (BIS-11), BMI categories	Emotional eating was positively associated with BMI.	Bénard et al., 2018 ^[28]
Descriptive study	298 adults, mean age: 34.08 (SD ± 9.50) years	DERS, the Positive and Negative Affect Schedule (PANAS), the Feeling of Stress Questionnaire and TFEQ-R18, BMI categories	Emotional functioning was related to BMI in adults. Snacking exhibited an indirect impact on BMI (through emotional eating).	Czepczor-Bernat et al., 2021 ^[29]
Cross-sectional study	605 women, mean age: 29.8 (SD ± 9.6) years	Positive–Negative Emotional Eating Scale (PNEES), Eating Disorders Assessment Scale (EDAS), and DERS, BMI categories	Negative emotional eating may be a significant risk factor for disordered eating, independently of BMI.	Sultson et al., 2019 ^[30]
Prospective study	3735 participants, mean age: 52.6 (SD ± 13.5) years	Depression Scale, TFEQ-R18, physical activity and night sleep duration, BMI categories	Emotional eating was one behavioral mechanism among depressive symptoms and development of obesity and abdominal obesity.	Konttinen et al., 2019 ^[31]
Cross-sectional study	1453 adults, mean age: 20.6 (SD ± 2.5) years	Self-Efficacy in Emotion- and Stress-Related Eating of the Eating and Appraisal Due to Emotions and Stress Questionnaire (EADES), CES-D, BMI categories	Emotional eating was associated with BMI in men as well as in women.	Lazarevich et al., 2016 ^[2]
Cross-sectional study	555 participants, mean age: 22.6 (SD ± 0.4) years	TFEQ-R18, BMI, percent body fat by dual-energy X-ray absorptiometry, and central obesity	Emotional eating was associated with obesity, defined by % body fat and abdominal obesity in men and women and with obesity, defined by BMI, in women.	Pacheco et al., 2021 ^[32]
Cross-sectional study	400 adults aged 18 to 59 years	Emotional Eating Questionnaire BMI categories	Emotional eating was more common in overweight and obese participants	Calderón-Asenjo et al., 2022 ^[33]
Cross-sectional study	1126 adolescents aged 15 to 20 years	Emotional Eating Questionnaire, BMI categories	Overweight and obese adolescents had a higher prevalence of negative emotional eating behavior	Skolmowska et al., 2022 ^[34]

3. Emotional Eating and Depression

Depression is a heterogeneous syndrome that is gradually increasing in general population at an alarming rate. It raises the risk of several chronic disorders, including cardiovascular disease (CVD), diabetes mellitus and body weight gain over time. In addition, it contributes significantly to the financial burden and disability of the public ^[35]. Depression is characterized by repeated, severe, and overwhelming negative emotions and impacts ^[36].

Moreover, it is also characterized by appetite loss and subsequent weight reduction, yet there is also a subtype of depression characterized by the atypical vegetative symptomatology of an elevated appetite and increase in body weight. Emotional eating has been proposed as an indicator of atypical depression, because it shares with this depression subtype the atypical feature of enhanced appetite in response to distress ^[37]. The clinical studies that examined the association between emotional eating and depression are presented in Table 2.

Table 2. Clinical studies evaluating the association of emotional eating with depression.

Study Type	Study Population	Methodology	Basic Results	References
Longitudinal study	592 adults, mean age: 45.04 (SD ± 3.9) years	DEBQ, DML and BMI categories	Depressive symptoms were related to higher emotional eating. This mediation effect was independent of 5-HTTLPR genotype.	Van Strier et al., 2016 ^[26]
Cross-sectional study	1453 adults, mean age: 20.6 (SD ± 2.5) years	(EADES), CES-D, BMI categories	Depressive symptoms were associated with emotional eating in both sexes.	Lazarevich et al., 2016 ^[2]
Cross-sectional study	189 adults, mean age: 41.78 (SD± 13.61)	EES, The Emotional Appetite Questionnaire (EMAQ)Symptom Checklist-90-Revised (SCL-90), The Eating Disorders Examination Questionnaire (EDE-Q), DERS, short-form health survey (SF-12), BMI categories	Eating in response to depression (EE-D) was the kind of emotional eating most strongly associated with psychological well-being, eating disorder symptoms, and emotion regulation complications.	Braden et al., 2018 ^[20]
Prospective study	3735 participants, mean age: 52.6 (SD ± 13.5) years	Depression Scale, TFEQ-R18, physical activity and night sleep duration, BMI categories	Eating induced by negative emotions facilitated the positive associations with depressive symptoms.	Konttinen et al., 2019 ^[31]
Cross-sectional study	248 participants mean age: 25.5 (SD ± 3.8) years	Inventory of Depression and Anxiety Symptoms (IDAS), Five Factor Mindfulness Questionnaire (FFMQ), TFEQ-R18	Depression substantially interrelated with nonjudging of inner experience to predict emotional eating.	Hsu et al., 2021 ^[38]
Randomized controlled trial	990 overweight or obese participants, mean age: 51.7 (SD ± 13.5) years	DEBQ, 30-item Inventory of Depressive Symptomatology—Self Report (IDS-SR), semiquantitative food frequency questionnaire (FFQ)	Depression history and severity were related with more emotional and uncontrolled eating.	Paans et al., 2019 ^[39]
Cross-sectional study	120 obese participants, mean age: 43.13 (SD ± 13.56) years	DEBQ, Beck Depression Inventory Short Form (BDI-SF), Cognitive Emotion Regulation Questionnaire	Higher levels of emotion dysregulation were directly and strongly associated with higher levels of depression and anxiety in both (MO) (30 ≤ BMI < 40) and 60 with “severe obesity” (SO) (BMI > 40).	Willem et al., 2020 ^[36]
Cross-sectional study	400 adults aged 18 to 59 years	Emotional Eating Questionnaire Patient Health Questionnaire-2 (PHQ-2) scale	Depression symptoms were associated with negative emotional eating.	Calderón-Asenjo et al., 2022 ^[33]
Cross-sectional study	2055 participants, mean age 27.1 ± 9.52 years	Emotional Eating Questionnaire, Depression, Anxiety, Stress Scale (DASS-42)	Emotional eating was significantly correlated with perceived depression symptomatology.	Kaner et al., 2022 ^[40]
Cross-sectional study	506 participants, mean age: 38.59 (SD ± 11.75) years	4-part questionnaire including: Emotional Eater Questionnaire (EEQ), PSS-14	BMI was positively associated with Emotional Eater Questionnaire scores.	Barcın-Güzeldere et al., 2022 ^[41]

4. Emotional Eating and Anxiety/Stress

The concept of stress is directly related with higher probability of chronic health disorders and accelerated the rates of disease development. Over the past 25 years, the association between stress and eating behavior is well recognized worldwide, and many studies have indicated that stress is related with alterations in food consumption of adults ^[42]. Stress-stimulated eating is characterized by an enhanced consumption of energy-dense, highly tasty food for coping with stress ^[43].

However, there are various mechanisms through which such an effect could operate. Taking into consideration that stress could influence appetite by both physiological and psychological mechanisms, relaxation could exert a comparable opposite effect in both respects ^[43]. However, the dysregulation of bio-behavioral responses to food intake under stress has focused the highest research interest, taking into consideration the longer-term implications for physical disease risk ^[42]. The main findings of the studies that examined the relationship between emotional eating and stress are presented in Table 3.

Table 3. Clinical studies evaluating the association of emotional eating with anxiety/stress.

Study Type	Study Population	Method	Basic Results	References
Cross—sectional study	2333 participants, mean age: 25 years	Questionnaires of perceived stress and emotional eating	Association between the emotional eating score and perceived stress.	Carpio-Arias et al., 2022 ^[44]
Cross—sectional study	2379 young adult women, age range: 18–19 years	Perceived Stress Scale (PSS), Nutrition Patterns Form, Life Events Scale, CES-D	Engagement in comfort eating could occur for people without severe depression symptoms to buffer the impacts of unfavorable life experiences on perceived psychological stress.	Finch et al., 2015 ^[45]
Cross—sectional study	600 participants, mean age: 25.4 (SD ± 5.13) years	DERS, DASS-21, DEBQ-EE, BMI categories	Substantial associations between emotion dysregulation, psychological distress, emotional eating, and BMI.	Guerrini-Usubini et al., 2023 ^[27]
Prospective study	43 participants (female),mean age: 19.5 (SD ± 1.3) years	Laboratory test, The Trier Social Stress Test, PSS -10, BDI, TFEQ-R18, Stress intensity, Positive and Negative Affect Schedule, Drive to eat	Higher perceived life stress increased the hyperphagic effects of stress-stimulated negative affect.	Klatzkin et al., 2019 ^[46]
Cross-sectional study	868 participants, mean age: 33.53 (SF ± 11.98) years	Eating Motivation Survey, the Emotional Overeating Questionnaire, COVID-19-related stress	Emotion-related predictors were associated with higher emotional overeating.	Modrzejewska et al., 2021 ^[47]
Cross-sectional study	254 participants, mean age: 35.82 (SD ± 11.82) years	Sociodemographic and lifestyle questionnaire, Anthropometric data, Disordered Eating Behaviors Screening Questionnaire, Coronavirus Impact Scale (CIS), DASS-21, TFEQ-R21	The change enforced by the psychosocial effect of COVID-19 lockdown on disordered eating behaviors was considerably related with psychological distress.	Ramalho et al., 2022 ^[48]
Cross-sectionalstudy	24,968 participants, age range: 18–70 years	Structured questions on dietary habits, emotional eating, psychological distress symptoms, and COVID-19-related worries	Emotional eating was strongly associated with psychological distress.	Bemanian et al., 2020 ^[49]
Cross-sectional study	400 adults aged 18 to 59 years	Emotional Eating Questionnaire, Generalized Anxiety Disorder Scale (GAD-2)	Negative emotional eating was related with the presence of anxiety symptoms.	Calderón-Asenjo et al., 2022 ^[33]
Cross-sectional study	2055 participants, mean age 27.1 ± 9.52 years	Emotional Eating Questionnaire, Depression, Anxiety, Stress Scale (DASS-42)	Negative emotional eating was related with the presence of anxiety and stress symptoms.	Kaner et al., 2022 ^[40]
Cross-sectional study	450 women, mean age 30.25 ± 10.70 years	Coronavirus Anxiety Scale, Stress Coping Styles Scale and Emotional Eating Scale	Emotional eating was associated with Coronavirus anxiety, and stress coping styles.	Güner et al., 2022 ^[50]

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