Research reportEmotional eating, depressive symptoms and self-reported food consumption. A population-based study☆
Introduction
Psychological eating style is one factor that has been suggested to account for individual differences in the susceptibility to gaining weight in the current obesogenic environment of modern societies. Restrained eating, referring to the tendency to consciously restrict food intake in order to control body weight, has been investigated extensively, whereas specific overeating tendencies such as emotional eating have received less attention. The concept of emotional eating implies the tendency to eat in response to negative emotions and derives originally from psychosomatic theory (Bruch, 1973, Kaplan and Kaplan, 1957). Emotional overeating is considered to be an inappropriate response to distress (Heatherton, Herman, & Polivy, 1991). According to psychosomatic theory, it is a consequence of the inability to distinguish hunger from other aversive internal states, or of using food to reduce emotional distress, probably because of early learning experiences. It has been suggested that emotional eating increases the consumption of sweet and high-fat foods in particular (Macht, 2008).
Some experimental studies have shown that emotional eaters consume more energy-dense foods in response to negative emotions than non-emotional eaters (Oliver, Wardle, & Gibson, 2000). However, only a few studies have examined the associations between emotional eating and habitual food consumption and the results have been contradictory. Emotional eating was unrelated to total energy and macronutrient intake in the studies of Lluch, Herbeth, Mejean, and Siest (2000) and Anschutz, Van Strien, Van De Ven, and Engels (2009) whereas de Lauzon et al. (2004) and Elfhag, Tholin, and Rasmussen (2008) found that emotional eaters had a higher consumption of energy-dense sweet snacks. Two factors distinguishing these studies could partly explain the contradictory findings: the measurement level of food consumption and the measure used to assess emotional eating. The studies (Anschutz et al., 2009, Lluch et al., 2000) finding no association assessed energy and macronutrient intake while specific food groups (i.e., energy-dense snacks) were examined in the studies with positive findings (de Lauzon et al., 2004, Elfhag et al., 2008). With respect to the measure of emotional eating used, three out of four studies (including the two studies with negative findings) used the Dutch Eating Behaviour Questionnaire (Van Strien, Frijters, Bergers, & Defares, 1986), which asks for desire to eat in response to negative emotions while de Lauzon et al. (2004) used the Three-Factor Eating Questionnaire R-18 (TFEQ-R18) (Karlsson, Persson, Sjöstrom, & Sullivan, 2000) assessing perception of eating more in response to negative emotions.
The concept of emotional eating specifically suggests that emotional distress triggers emotional eating, but none of the above-mentioned studies included any measure of negative emotions or distress. Indeed, a recent study (Ouwens, van Strien, & Leeuwe, 2009) investigated the associations between emotional eating and depressive symptoms and found them to be positively related. One possible symptom of major depression is appetite change, which may take the form of increased or decreased appetite, but less severe depressive symptoms have received little research attention in relation to habitual food consumption. The few studies that have been conducted have generally found depressive symptoms to be related to a less healthy diet: two community surveys found that higher levels of affective/depressive symptoms were associated with lower likelihood to follow dietary recommendations (Sarlio-Lähteenkorva, Lahelma, & Roos, 2004) and a lower fish consumption (Tanskanen et al., 2001). In addition, among women higher psychological distress has been related to consuming fewer vegetables and less fruit (Cohen, Kristal, Neumark-Sztainaer, Rock, & Neuhouser, 2002), and higher depressive symptoms to consuming more energy-dense sweet foods and less energy-dense non-sweet and low-energy foods (Jeffery et al., 2009). Nevertheless, no previous studies have examined the possible factors that could explain the relationships of depressive symptoms with unhealthy food choices, and emotional eating could be one such factor.
Finally, psychosomatic theory (Bruch, 1973, Kaplan and Kaplan, 1957) also proposes that obese individuals are more likely to overeat when they experience negative emotions because this kind of eating pattern is seen to have a relevant role in the etiology of obesity. Obese individuals have indeed been observed to score more highly on the measures of emotional eating than normal weight individuals (de Lauzon-Guillain et al., 2006, Konttinen et al., 2009, Van Strien et al., 2009). We continue these analyses further in the present study by examining whether associations of emotional eating with food consumption differ according to body mass level.
The aim of the present study was thus to examine the associations between emotional eating, depressive symptoms and the self-reported consumption of sweet energy-dense foods, non-sweet energy-dense foods and vegetables/fruit. We chose to examine energy-dense foods as there is suggestive evidence from the previous studies that emotional eating is specifically related to the higher consumption of these foods, while vegetables and fruit were included to investigate a healthier aspect of the diet. Emotional eating was assessed as a perception of eating more in response to negative emotions (using the TFEQ-R18). A measure of restrained eating was also included in order to control for its effects, because psychological eating styles are usually interrelated (see e.g., Bryant, King, & Blundell, 2008). Moreover, we were interested in the possible interplay between emotional eating and depressive symptoms: first, does emotional eating account for the associations between depressive symptoms and energy-dense foods? Secondly, do those with high scores on both emotional eating and depressive symptom scales have the highest consumption of these foods? Finally, we analysed whether the relationships between emotional eating and food consumption were similar at all levels of BMI and waist circumference.
Section snippets
Participants
The participants took part in two phases of the National Cardiovascular Risk Factor Survey (The FINRISK Study) conducted in 2007 (Peltonen et al., 2008). The ethical committee of the National Institute for Health and Welfare and the hospital districts gave their approval of the study protocols, and all the participants gave their informed consent. A random sample of 10,000 people aged 25–74 years was drawn from the Finnish population register in five geographic areas. The sample was stratified
Results
Men consumed non-sweet energy-dense foods more frequently than women (p < 0.001) while women consumed vegetables/fruit more often (p < 0.001) (Table 1). No gender differences were found with respect to sweet energy-dense foods. Estimated total energy intake (p < 0.001) and fat contribution to energy intake (p = 0.010) were higher in men than in women. Carbohydrate contribution to energy intake was higher (p < 0.001) in women. Higher depressive symptoms were related to higher emotional eating in both
Discussion
The present study examined emotional eating and depressive symptoms simultaneously in relation to habitual food choices. As expected, higher depressive symptoms were related to higher levels of emotional eating. Furthermore, emotional eating was related to the higher consumption of sweet energy-dense foods in both genders and non-sweet energy-dense foods among men independently of restrained eating and depressive symptoms. The positive associations of depressive symptoms with sweet foods
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Support for this research was provided by the Academy of Finland (215450, Research Programme on Nutrition, Food and Health, ELVIRA).