Causes of Emotional Eating and Matched Treatment of Obesity

Structure of family health and its association with obesity-related eating behavior and depressive symptoms: Insights from network analysis

The health of families is inextricably linked to the health of individuals and communities, providing the foundation for their development. Family health is a multifaceted concept and has been suggested to impact individuals' obesity-related eating behavior and the alleviation of depressive symptoms. However, existing studies have not comprehensively examined the structure of family health and its' potential associations with obesity-related eating behavior and depressive symptoms. The present study employed network analysis to ascertain the most pivotal characteristics within the interdisciplinary and holistic concept of family health. In addition, this study investigated the moderating effect of family health on the association between obesity-related eating behavior and depressive symptoms, and identified the characteristics of family health that were the most strongly linked to the association. A total of 9091 adults participated in this nationally representative study between 10 July and September 15, 2021. The participants completed self-report assessments of family health, obesity-related eating behavior, and depressive symptoms. The results of network analysis indicated that helping each other in seeking health care services when needed (such as making physician's appointments) had the highest node expected influence (1.154) within the network. The results of moderation analysis showed that family health significantly buffered the association between obesity-related eating behavior and depressive symptoms (B = -0.06, 95 % CI = -0.077, -0.042). Further investigation demonstrated that not trusting doctors and other health professionals in the family presented the strongest negative correlation (-0.125) with obesity-related eating behavior, and not having adequate housing in the family showed the strongest negative correlation (-0.069) with depressive symptoms. These findings provide further insight into the critical aspects of family health and its significant correlations with obesity-related eating behavior and depressive symptoms.

Pilot study to reduce chewing and eating rates using haptic feedback from the OCOsense glasses

Obesity is a global concern and chewing manipulation has shown promising results for weight management. This preliminary pilot study explored the use of the OCOsense glasses to deliver personalised haptic feedback to encourage slower chewing. It was hypothesised that feedback would reduce chewing rate. A repeated-measures experimental design was used. At T1, participants consumed pasta to collect baseline chewing rates. At T2 (one week later), participants ate pasta but received haptic feedback when chewing exceeded 80 % of their T1 rate. Additional measures included eating rate, food intake, hunger, fullness, feasibility, and acceptability. Twenty-two participants (BMI 18.5-29.9) were recruited. Chewing rate data were collected using the OCOsense glasses. Eating rate was calculated as grams/min by weighing food pre/post-meal, and hunger/fullness levels were self-reported. T-tests compared T1 and T2 data, while feasibility and acceptability were evaluated descriptively. Results showed significant reductions in chewing rate (t(21) = 7.3, p < 0.001) and eating rate (T(N = 22) = 11, p < 0.001) at T2. Despite higher hunger levels at T2 (t(21) = -3.095, p = 0.005), food intake remained unchanged (t(21) = 0.093, p = 0.927). The system ran smoothly and was deemed acceptable. In conclusion, this preliminary study suggests that haptic feedback may reduce chewing rate, highlighting potential for modifying eating behaviour. However, methodological limitations-such as lack of randomisation and control for confounders-warrant cautious interpretation. Future research should explore effects in individuals with obesity. The OCOsense glasses represent a promising tool for addressing eating habits and obesity through innovative technology.

Negative affect and emotional eating: Daily dynamics and their links to difficulties in emotional regulation

Emotional eating is considered a maladaptive coping strategy for negative affect. This study aimed to examine the daily relationship between negative affect and emotional eating, and further explore the role of emotion regulation in this process. Daily diary data was collected among 108 college students (Meanage = 19.8 ± 1.51, 83.3 % women) to assess the dynamic relationships between negative affect and emotional eating over 14 days. Difficulties in emotion regulation was assessed at pre- and post-test. Results of dynamic structural equation modeling revealed that emotional eating predicted next day's negative affect (β = .06, 95 % Credible Interval [.01, .15]), but not vice versa. Moreover, four subscales of difficulties in emotion regulation at baseline-nonacceptance of emotional responses, difficulties in engaging in goal-directed behavior, impulse control difficulties, and limited access to emotion regulation strategies-significantly predicted the association between negative affect and emotional eating. This association, in turn, was associated with five subscales of difficulties in emotion regulation at posttest, including nonacceptance of emotional responses, difficulties in engaging in goal-directed behavior, impulse control difficulties, limited access to emotion regulation strategies, and lack of emotional clarity. Our findings suggest that emotional eating can reinforce negative affect the following day, especially in individuals with difficulties in emotion regulation. Further, when emotional eating and negative affect are strongly linked, this may be associated with the reinforcement of difficulties in emotion regulation. Whether negative affect can trigger emotional eating could not be determined by our study, and should be investigated with more intensive study designs.

Development and preliminary validation of the comprehensive emotional eating scale (CEES)

In emotional eating (EE), affective states influence desire to eat and/or eating behavior. Most research on EE focuses on over-/under-eating in response to negative emotions, the former of which is related to higher weight and binge-spectrum eating disorder (ED) symptoms while the latter has been implicated in low weight and restrictive-only ED. Individuals endorsing both forms of negative EE are more impaired than those reporting unidirectional negative EE. Less is known about the influence of positive emotions on eating, in part due to a lack of self-report measures of positive over- and under-eating as separate constructs. The current study presents the development, including item reduction and initial factorial validity (primary aims) and convergent validity (secondary aims) of the Comprehensive Emotional Eating Scale (CEES), a four-factor measure of positive and negative over- and under-eating. The initial 134-item pool for the CEES was based on a review of extant emotional eating scales and emotion words from the Positive and Negative Affect Schedule. The item pool was reduced and four factors identified using exploratory graphical analysis. The structure of the final set of 40 items was evaluated using confirmatory factor analysis. Convergent validity of the negative over- and under-eating scales was established using measures of body image-focused eating disorder and ARFID symptoms, and exploratory data on the correlates of positive over- and under eating were reported. The CEES showed preliminary evidence of factorial and convergent validity in a US-based convenience sample. It allows for classification on all four quadrants of emotional eating.

Virtual body image exercises for people with obesity - results on eating behavior and body perception of the ViTraS pilot study

BACKGROUND

A negative body image can have an impact on developing and maintaining obesity. Using virtual reality (VR) to conduct cognitive behavioral therapy (CBT) is an innovative approach to treat people with obesity. This multicenter non-randomized pilot study examined the feasibility and the effect on eating behavior and body perception of a newly developed VR system to conduct body image exercises.

METHODS

Participants with a body mass index (BMI) ≥ 30.0 kg/m2 without severe mental diseases attended three study visits in an interval of one to four weeks to receive virtual (VR intervention) or traditional (non-VR intervention) body image exercises. Data on anthropometrics, eating behavior (Dutch Eating Behavior Questionnaire, DEBQ), body perception (Body Shape Questionnaire, BSQ; Multidimensional Assessment of Interoceptive Awareness, MAIA), and satisfaction (standardized interview and questionnaire) were collected.

RESULTS

In total, 66 participants (VR intervention: 31, non-VR intervention: 35) were included. The majority was female (52/66, 78.8 %), the mean age was 45.0 ± 12.8 years, and the mean BMI was 36.8 ± 4.3 kg/m2. Both intervention groups showed non-significant body weight reduction (VR intervention: 1.7 ± 3.3 %, non-VR intervention: 0.9 ± 3.0 %) and showed no statistically significant difference between the groups (p = 0.35). Scores of DEBQ, BSQ, and MAIA showed over time no statistically significant changes neither between the two groups nor within the groups (all p ≥ 0.05). The overall satisfaction of the VR group with the two virtual body image exercises was high (4.1 ± 0.8 on a 5-point Likert scale).

CONCLUSIONS

The intervention with the developed VR system was feasible and the virtual and traditional body image exercises resulted in statistically non-significant weight loss. It seems that single focus on body image is not successful in improving eating behavior and body perception in people with obesity. Long-term human intervention studies with larger sample sizes are necessary to examine the efficacy of integrating this kind of VR system into standard obesity therapy.

TRIAL REGISTRATION

This study was registered in the German Clinical Trials Register (Registration number: DRKS00027906, Date of registration: 8th February 2022).

[Validation of the Garaulet Emotional Intake Questionnaire in students of the Universidad Nacional de Colombia]

Introduction

Introduction: the emotional state influences the selection of foods that an individual consumes. In Colombia, no tool allows to detect the people most susceptible to develop emotional intake. Objective: to validate the Emotional Intake Questionnaire-Garaulet in a student population of the National University of Colombia. Methods: a cross-sectional descriptive observational study was conducted with a convenience sample of students in all the University's campuses in two stages employing the Spanish and the Colombian questionnaires through e-mail. Two questions were included in the survey, to assess the emotions of sadness and anxiety; a linearity relationship was established with the cut-off scores to maintain proportionality and preserve the dimensions of the study phenomenon. Results: in phase 1, 1177 subjects participated, and in phase 2, 831 subjects participated. Of these, 63.6 % and 52.8 % were emotional and very emotional eaters in the Colombian and Spanish versions, respectively. Taking the total amount of people, 22.3 % were emotional and very emotional eaters with body mass index > 25 kg/m². In addition, 4.7 % had an eating disorder and 14.2 % had a psychiatric disorder. Finally, sensitivity, specificity, and positive and negative predictive values were 99.0 %, 49.3 %, 89.9 % and 91.2 %, respectively. Conclusions: the Colombian version of the Emotional Eating Questionnaire demonstrates acceptable validity and reliability compared to the Spanish version. A high prevalence of emotional eaters was observed in the university population, which could be detected early through the use of this questionnaire. Suffering from this disorder is a risk factor for developing obesity and other metabolic diseases in the future.

Reduction of High Emotional Eating via Increased Physical Activity: Assessing a Path Informed by Multiple Behavioral Theories Within Community-Based Obesity Interventions

Emotional eating (EE; eating in response to negative emotions) is a considerable problem in adults with obesity. Recent meta-analyses of behavioral treatments for those with elevated body mass index (BMI) have demonstrated inconsistent, but generally minimal, effects for dealing with EE. This might largely be due to inappropriate sampling, cross-sectional research designs, and a lack of understanding of theory-driven psychosocial mechanisms of EE change. This study aimed to inform mental health, medical, and health behavior-change professionals on methods to address EE within obesity treatments. Within the present field-based research, women with high EE participated in 6-month community-based obesity treatments emphasizing either weight-management education + attention on EE (n = 34), self-regulatory skills-no attention on EE (n = 43), or self-regulatory skills + attention on EE (n = 42). Each condition incorporated physical activity for its mood-change potentials. Significant improvements in physical activity, mood, eating-related self-regulation and self-efficacy, EE, and weight were found in all groups, with greater advances occurring in the self-regulation vs. educationally focused conditions. Incorporating aggregated data, significant theory- and previous research-derived paths from changes in physical activity → mood → self-regulation → self-efficacy → EE change over 6 months, and over 12 months, were identified. Reductions in EE over 6 and 12 months predicted weight loss over 6, 12, and 24 months. Findings supported tenets of social cognitive theory, self-regulation theory, the mood-behavior model, and self-efficacy theory, and informed future behavioral obesity treatments on evidence-driven methods to better-address EE within scalable settings.

Individual participant data meta-analysis of eating behaviour traits as effect modifiers in acceptance and commitment therapy-based weight management interventions

BACKGROUND

Obesity care may benefit from precision approaches, matching patients to treatment types based on their individual characteristics, including eating behaviour traits (EBTs) like emotional eating, uncontrolled eating, external eating, internal disinhibition and restraint. Initial evidence suggests that Acceptance and Commitment Therapy (ACT)-based interventions might address dysregulated EBTs more effectively than standard behavioural treatments. However, it is unclear if ACT is more effective for certain EBT levels.

METHODS AND ANALYSIS

This pre-registered (CRD42022359691) one-stage Individual Participant Data (IPD) meta-analysis explored the moderating effects of baseline EBTs on weight outcomes in trials of ACT-based interventions for adults with a BMI ≥ 25 kg/m2. Unlike traditional meta-analyses, IPD meta-analyses re-analyse existing data to answer novel research questions. We identified 16 eligible trials through a systematic search of eight databases until June 20, 2022. We obtained, checked, and harmonised data from 15 trials (N = 2535). We used mixed regression models to investigate both continuous and categorical interaction effects.

RESULTS

We found no evidence of interactions between ACT vs. control and baseline EBTs as continuous variables on percentage weight change. However, we found evidence to suggest an added difference in weight change of -4.47% (95%CI -1.15, -7.73) from baseline to 12-months after intervention end in participants with medium levels of internal disinhibition compared to those with high levels. Sensitivity analyses similarly indicated a greater intervention benefit for participants with medium, rather than high, emotional eating levels (in trials that reduced experiential avoidance and in trials using the three-factor eating questionnaire) and internal disinhibition (in analyses of participants with at least 60% attendance). Given the exploratory nature of analyses, results should be interpreted with caution.

CONCLUSION

Findings suggest potential non-linear interaction effects of ACT with internal disinhibition but require replication in confirmatory trials. These results may help guide further research on precision approaches based on EBTs.

Middle childhood weight stigmatization and appetite self-regulation as predictors of adolescent weight - A prospective mediation analysis

Children's weight is a common reason for stigmatization. The aim of this study was to examine the effect of weight stigmatization (WS) during middle childhood on adolescent weight and the role of appetite self-regulation (ASR) as a potential mediator. Across three measurement time points, the study utilized a community sample of N = 1612 participants (51.9% female), aged 7-11 (T1), 9-13 (T2), and 16-21 (T3). WS was assessed via child-reports, different ASR facets (food responsiveness, emotional overeating, satiety responsiveness, external eating) via parent-reports, and height and weight were measured to calculate the standardized body mass index (BMI-SDS). Structural equation modeling was used to analyze the proposed prospective mediation. A total of 11.2% of the children reported WS experiences, with significant differences between the weight groups. ASR fully mediated the prospective association between WS and BMI-SDS. Higher WS predicted higher food responsiveness, higher emotional overeating, and, among older children, lower satiety responsiveness. Additionally, higher food responsiveness predicted higher adolescent BMI-SDS, indicating a specific indirect effect. The total indirect and specific indirect effects for food responsiveness remained significant when controlling for the established influences of parental BMI and body dissatisfaction. Our results highlight a prospective effect of WS on ASR and propose ASR as a mediator for the association between WS and weight. WS and ASR might therefore be important factors for the prevention of overweight and obesity in children and adolescents.

An investigation of the effects of COVID-19 fear on the nutrition habits and emotional appetites of healthcare professionals

BackgroundThe COVID-19 pandemic led to significant changes in daily routines and lifestyles, potentially affecting eating behavior and psychological well-being.ObjectivesThis study aims to determine the level of fear caused by the COVID-19 pandemic in healthcare professionals and to investigate the effect of fear of coronavirus on individuals' eating habits.Methods108 male and 388 female healthcare professionals working in any healthcare facility in Turkey during the COVID-19 pandemic filled out an online survey that included socio-demographic characteristics, nutrition and food purchasing habits, Fear of COVID-19 Scale, and Emotional Appetite Questionnaire (EAQ).ResultsWe found that fear of COVID-19 is higher in female healthcare professionals than in males. Higher COVID-19 fear predicted a greater risk of positive emotional appetite (OR:2.2; 95%CI:1.4-3.2). In addition, the Fear of COVID-19 Scale total score positively correlated with negative EAQ scores in females (p < 0.05). Fear of COVID-19 Scale scores of healthcare professionals who reported that they experienced a decrease in appetite levels and meal frequency during the COVID-19 pandemic were higher than those who declared that their appetite level and meal frequency did not change (p < 0.05). Finally, we found that the odds of positive emotional eating were 2.3 times higher in overweight and obese people compared to underweight and normal weight people.ConclusionsThese findings highlight the significant impact of COVID-19-related fear on the emotional eating behaviors and overall dietary habits of healthcare professionals, emphasizing the need for targeted interventions to address psychological and nutritional challenges in this vulnerable population during and after pandemics.

Broader Validation of New Zealand Eating Behavior Questionnaire as Clinical Assessment Tool to Identify Actionable Eating Behavior Traits

Background/Objectives: The New Zealand Eating Behavior Questionnaire (NZ-EBQ) is a validated questionnaire that comprises three distinct scales that measure satiation at mealtimes, satiety in the post-eating period, and emotional eating behavior. This study evaluated the model validity of the NZ-EBQ across two additional samples of demographically diverse participants using confirmatory factor analysis. Methods: We compared the classification of the eating behavior (EB) type with that of the initial cohort used to develop the three-factor model. Two cohorts of 81 and 214 participants provided complete data sets for analysis. Cohort 1 was characterized by the use of more weight management medications, and participants in Cohort 2 were significantly heavier. Confirmatory factor analysis was performed using combined data from both cohorts to maximize the sample size. Results: Except for one item, all items demonstrated a factor loading consistent with the established three-factor model. After removing one item from the emotional eating scale, the model fit statistics did not change significantly. Participants were assigned to one of the three EB types based on their highest median score, and most could be classified into one of the three EB types, with only a few who could not be classified (Cohort 1:12.3%; Cohort 2:13.0%). The test-retest reliability performed in a subset of participants was comparable to that of the initial validation cohort. A significant positive correlation was found between BMI and the individual EB scores. Conclusions: The NZ-EBQ may serve as a screening tool for identifying actionable EB traits that help select targeted interventions based on EB, supporting precision medicine-based approaches.

Associations between intuitive eating, overall diet quality, and physical health indicators: Results of the PREDISE study

Intuitive eating is a positive approach to eating involving high responsiveness to hunger and satiety cues. Although the association between intuitive eating and many psychological health indicators is well-documented, its associations with overall diet quality and physical health indicators are less explored. This study aimed to assess whether intuitive eating is associated with adherence to Canada's Food Guide recommendations and with physical health indicators. In the context of the PREDISE study, 1088 French-speaking Canadian adults from the Province of Québec completed a web-based survey including the Intuitive Eating Scale-2. Three web-based 24-h dietary recalls were completed and used to calculate the Canadian Healthy Eating Index (C-HEI) score, an indicator of adherence to Canada's Food Guide. Participants visited the research center to assess physical health indicators (body mass index, waist circumference, blood pressure, cholesterol, and blood glucose). Multiple linear regression analyses were performed to assess how intuitive eating is associated with diet quality and physical health indicators. The total intuitive eating score was not associated with C-HEI (B = 1.47, 95% CI: -0.10, 3.04). However, the "Body-Food Choice Congruence" subscale was positively associated with C-HEI (B = 5.60, 95% CI: 4.44, 6.76), while the "Unconditional Permission to Eat" subscale was negatively associated with C-HEI (B = -4.04, 95% CI: -5.28, -2.80). The total intuitive eating score was negatively associated with BMI in men (B = -4.83, 95% CI: -5.75, -3.91, p < 0.0001) and women (B = -5.01, 95% CI: -6.00, -4.02, p < 0.0001), with waist circumference in men (B = -3.60, 95% CI: -5.33, -1.87) and women (B = -2.20, 95% CI: -3.71, -0.70), and with HDL cholesterol only in women (B = -0.10, 95% CI: -0.17, -0.02). The associations of intuitive eating with diet quality are inconsistent, and only a few associations with physical health indicators were observed.

Understanding the Interaction Between Family Dynamics and Childhood Obesity in the Middle Eastern Population: A Qualitative Study

OBJECTIVE(S)

We aim to understand the interaction between family dynamics and lifestyle behaviors of school-age children with overweight or obesity in Oman. The outcomes would clarify the mediating familial determinants that contribute to childhood obesity in the Middle East population.

DESIGN

A qualitative phenomenological approach.

SAMPLE

Mothers of school-age children with overweight or obesity.

MEASUREMENTS

Semi-structured interviews were conducted following an interview guide, and thematic analysis was used to identify key themes and subthemes.

RESULTS

The study identified three main themes based on data collected from 12 participants. The first theme, "Children's Lifestyle Behaviors," highlighted the need to address unhealthy food consumption, low physical activity, and inconsistent sleeping habits. The second theme, "Parenting Lifestyle behaviors," underscored the importance of regaining control over children's eating behaviors, fostering shared interest in outdoor activities, and establishing a consistent sleep routine. Lastly, the third theme, "Determinants of Parenting Lifestyle Behaviors," identified factors such as parental stress, the high cost of healthy options, cultural influence on healthy eating, limited outdoor activity options, and the availability of unhealthy snacks in schools.

CONCLUSION

Our study underscores the need for family-centered obesity programs that address several determinants of parenting lifestyle behaviors, including psychological, financial, social, and environmental challenges.

Emotional Eating and Its Relationship with Symptoms of Anxiety, Depression, and Stress During the COVID-19 Pandemic: A Multicenter Study in College Students

Emotional eating refers to overeating triggered by negative emotions, and it is common among those with mental health challenges. Academics are vulnerable to changes in eating habits and mental well-being, especially after the pandemic began. This study aimed to analyze the relationship between emotional eating and the signs and symptoms of mental disorders in undergraduates aged 18 and older. They completed a virtual questionnaire assessing emotional eating using the Three-Factor Eating Questionnaire, and mental health by a reduced version of the Depression Anxiety and Stress Scale. In this cross-sectional, multicenter survey, 8650 students (65.7% female, average age 22) participated, with a median body mass index of 23.3 kg/m2, and 23.8% were enrolled in health-related courses. The median emotional eating score was 44.4 (22.2-66.7), and a large proportion had symptoms of depression (73.2%), stress (68.1%), and anxiety (66.1%). Symptoms of anxiety (CI = 1.291-1.714), depression (CI = 1.469-1.983), and stress (CI = 1.483-2.006) were independently associated with higher emotional eating scores (≥66.7) in multiple regression analyses. Based on the significant associations found, the importance of integrating mental health support and intervention strategies, such as psychological counseling and nutritional guidance, to mitigate emotional eating among university students is highlighted, along with the need for future studies to explore the causal relationships.

The relationship between negative psychological state and quality of life among cardiovascular disease patients in China: the masking effect of abnormal dietary behavior

Background

It is well known that abnormal dietary behavior increases the risk for cardiovascular disease especially if the person is depressed and/or anxious. The purpose of this study was to construct a moderated mediation model to explore the roles of abnormal dietary behavior and family health in the mechanism through which depression/anxiety influences Quality of life (QoL) in patients with cardiovascular disease.

Methods

A field survey was conducted in China and ultimately included 730 patients with cardiovascular disease aged 20-60 years. Data were collected using the Europe Quality of five-dimensional five-level questionnaire, Short-Form of the Eating Behavior Scale, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and the Chinese version of the short-form of the Family Health Scale. All data were analyzed using SPSS Statistics 23.0.

Results

(1) Depression was negatively associated with QoL (r = -0.386/-0.230, p < 0.001), and was positively correlated with abnormal dietary behavior (r = 0.377, p < 0.001). Anxiety was negatively associated with QoL (r = -0.383/-0.231, p < 0.001), and was positively correlated with abnormal dietary behavior (r = 0.333, p < 0.001). Abnormal dietary behavior was negatively correlated with QoL (r = -0.077/-0.119, p = 0.039/0.001). (2) In the mediation model, abnormal dietary behavior only had a masking effect on the relationship between depression and QoL, with a mediating effect size of 7.18%. The mediating effect of abnormal dietary behavior between anxiety and QoL was not significant. (3) The mediating effect size of abnormal dietary behavior between depression/anxiety and QoL increased to 14.77% and 13.57% in unhealthy families. The above masking mediation effect was not significant in healthy families.

Conclusions

Abnormal dietary behavior positively mediated the relationship between depression and QoL and attenuated the negative effect of depression on QoL in patients with cardiovascular disease. The masking mediating effect of abnormal dietary behavior between depression/anxiety and QoL was stronger for patients in unhealthy families.

The development of emotional overeating: a longitudinal twin study from toddlerhood to early adolescence

BACKGROUND

Previous research has estimated the genetic and environmental contribution to individual differences in emotional overeating in toddlerhood and early childhood. However, little is known how this behaviour tracks into adolescence. Here, we aimed to replicated previous work and examine the aetiology of stability and change in emotional overeating across time.

METHODS

Data were from the UK Gemini Twin Study, which includes 2402 twin pairs born in 2007. Parents reported on children's emotional overeating at 16 months (n = 3784), 5 years (n = 2064), and 12 years (n = 964), using the Emotional Overeating Scale of the Child Eating Behaviour Questionnaire (CEBQ) at 5 and 12 years, and the CEBQ-T (toddler version) at 16 months. A Cholesky Decomposition twin model was used to quantify the additive genetic, shared, and nonshared environmental influences on emotional overeating at each time point, partitioned into aetiological effects unique to each age and those carried across time.

RESULTS

Additive genetic effects were minimal at 16 months and 5 years (9% and 7% respectively) but increased to 34% by 12 years. Shared environmental effects explained the majority of variance in emotional overeating at all three time points, but significantly less at 12 years (41%) than earlier (> 81%). The longitudinal phenotypic associations (r = 0.23-0.43) were explained by the shared environment.

CONCLUSION

The shared environment plays a major role in the development of emotional overeating in early life. Most aetiological influences on emotional overeating were unique to each age, indicating the need for family-based interventions targeted to each developmental stage.

Home office is associated with weight gain during the COVID-19 pandemic: Brazilian population-based studies

The COVID-19 pandemic caused changes in life, affecting habits and behaviors, and one of its consequences is an increase in weight. We aimed to evaluate the association between remote work and weight gain during the COVID-19 pandemic in two cities in southern Brazil. A population-based cross-sectional study carried out in the southern region of Brazil. Data were collected face-to-face, in households selected by census sampling. The outcome was weight gain, and the exposure was remote working. To verify this association, Poisson Regression was used to calculate the crude and adjusted prevalence ratio and its 95% confidence intervals, using 5% significance level. In total, 2,152 individuals were interviewed. The prevalence of weight gain during the pandemic was 38.4% (95%CI 36.1-40.7), being significantly higher in those who worked remotely (47.0% vs 37.7, p=0.02). Those individuals who worked remotely were 23% more likely to gain weight during the pandemic compared to those who did not work remotely (PR: 1.23; 95%CI 1.02-1.49). Health and education services may be encouraged to implement educational actions at the collective level, aimed at enlightening the population and preventing weight gain in periods of confinement.

The role of interoception in lifestyle factors: A systematic review

BACKGROUND

Interoception, the perception of the internal state of the body, offers an underrepresented and intriguing potential avenue for altering lifestyle-related behaviors. Interoception is intrinsically related to maintaining homeostasis and the flexible allostatic regulation of complex demands. Internal bodily states may also be influenced by lifestyle factors and related problems. This systematic review aimed to provide insight into the current state of evidence about the role of interoception in lifestyle factors.

METHODS

Studies from three databases (PubMed, Embase, and Web of Science) were screened for eligibility based on two inclusion criteria: 1) at least one measure of interoception (e.g., interoceptive accuracy, attention, or awareness), and 2) at least one measure of a lifestyle factor (i.e., alcohol consumption, cognitive leisure and relaxation activities, eating behavior, exercise, sleep, or smoking). Risk of bias was assessed using an adjusted quality score checklist, consisting of five items related to study design, population size, exposure measurement, outcome measurement, and adjustment for confounders.

RESULTS

The review included 73 studies. Out of the included studies, 51 measured interoceptive accuracy and 36 measured interoceptive attention. Six studies quantified interoceptive awareness. In terms of lifestyle factors, 26 studies on cognitive leisure and relaxation activities, 19 studies on eating behavior, 12 studies focused on alcohol consumption, 10 studies on exercise, five studies on smoking, and four studies on sleep were identified. Findings show positive relations between interoceptive domains and cognitive leisure and relaxation activities, eating behavior, and exercise. Conversely, the consumption of alcohol is negatively related to interoceptive domains. Studies in the smoking and sleep lifestyle factors were sparse and of varying methodological quality.

DISCUSSION

The findings of this review show that interoceptive domains are associated with various lifestyle factors, but the quality of the evidence is limited. Future longitudinal studies with more objective measures of interoception are needed in order to better understand the interrelations between interoception and lifestyle factors.

Dietary Habits, Obesity, and Bariatric Surgery: A Review of Impact and Interventions

Eating behavior encompasses the psychological, physiological, and environmental factors influencing food intake. Dysregulation in eating behavior, such as emotional eating, binge eating, or loss of satiety signals, contributes to excessive caloric intake and weight gain. These behaviors are often linked to hormonal imbalances, stress, or genetic predisposition. Obesity is a chronic, multifactorial disease characterized by excessive body fat accumulation, with a body mass index (BMI) ≥ 30 kg/m2 often used for diagnosis. It is associated with significant morbidity, including type 2 diabetes, cardiovascular disease, and obstructive sleep apnea. Pathophysiological mechanisms underlying obesity include insulin resistance, leptin dysregulation, and altered gut microbiota, which perpetuate metabolic derangements. Lifestyle interventions remain first-line treatment, but sustained weight loss is challenging for many patients. Bariatric surgery is a therapeutic option for individuals with severe obesity (BMI ≥ 40 kg/m2 or ≥35 kg/m2 with comorbidities) who have failed conservative management. Procedures such as Roux-en-Y gastric bypass and sleeve gastrectomy alter gastrointestinal anatomy, promoting weight loss through restriction, malabsorption, and hormonal modulation (e.g., increased GLP-1 secretion). Bariatric surgery improves obesity-related comorbidities and enhances quality of life. However, it requires lifelong medical follow-up to address potential nutritional deficiencies and ensure sustainable outcomes.

Multidimensional Assessment of Orthorexia Nervosa: A Case-Control Study Comparing Eating Behavior, Adherence to the Mediterranean Diet, Body Mass Index, Psychological Symptoms, and Autonomic Arousal

Background: The research on orthorexia nervosa (ON) has thoroughly outlined the connection between it and various mental disorders, including obsessive-compulsive disorders and eating disorders, in addition to stress. However, research has not considered psychophysical stress and other measures of psychophysical health, such as adherence to the Mediterranean diet. Methods: This cross-sectional and case-control research involved 63 students from the University of Parma, aged between 18 and 49 years. The ORTO-15 questionnaire was utilized to categorize the entire sample into two groups: one without orthorexia (score > 35) and another with orthorexia (score < 35). All subjects were assessed with the Psychophysiological Stress Profile (PSP) and completed the Eating Disorder Inventory-3 (EDI-3) and the Symptom Checklist-90-Revised (SCL-90-R). In addition, they were interviewed using the PREDIMED questionnaire to assess adherence to the Mediterranean Diet, and their body mass index (BMI) was calculated. Results: Subjects with orthorexia represented 38.10% of the total sample and reported a higher BMI than controls, although the PREDIMED score did not show a difference in adherence to the Mediterranean diet. The EDI-3 highlighted emotional dysregulation and hypercontrol in students with orthorexia, and a dissociation between subjective and objective measures of stress emerged. Particularly, the psychophysiological parameters of skin conductance, heart rate, and heart rate variability showed greater reactivity to stressful stimuli, but no difference was noted in psychological symptoms. Conclusions: These findings confirmed the presence of alterations in eating behavior in people with orthorexia as well as a higher BMI. It was hypothesized that hypercontrol might favor the perception of psychological well-being at a subjective level, although inadequate management of stress emerged at an objective psychophysiological level. Further studies are needed to highlight the causality between ON, hypercontrol, diet, and psychophysical stress, given that students with orthorexia present a dysregulation of emotions associated with greater autonomic arousal.

Psychological attributes and eating behaviors in 5- to 12-year-old children during periods of stress

OBJECTIVE

The objective of this study was to investigate the association between psychological attributes and obesogenic behaviors in children during the period of COVID-19 pandemic-induced stress.

METHODS

This observational study collected data from caregivers of 5- to 12-year-old children from three diverse groups assessing sociodemographic, economic, and perceived stress, along with the Strengths and Difficulties Questionnaire (SDQ) and the Family Eating and Activity Habits Questionnaire, revised (FEAHQ-R), in October 2020 and June 2021. The outcome measures were SDQ and FEAHQ-R scores. The SDQ subscales were compared with US child norms. Linear mixed models were used to examine the association between the SDQ subscales and FEAHQ-R domains, adjusting for socioeconomic covariates.

RESULTS

A total of 361 families (496 children) completed the SDQ and FEAHQ-R. The SDQ subscale scores were higher than those of age/gender norms (p = 0.006-<0.001). Eating style (p < 0.001) and food stimulus exposure scores (p = 0.005-0.01) were associated with the SDQ subscales, but not satiety response. Perceived stress was a significant covariate (p < 0.01). The baseline obesity status of the children was not statistically significant.

CONCLUSIONS

Psychological stress is associated with higher hedonic behavior in children. Food stimulus exposure and leisure access can be targeted for intervention during periods of prolonged stress.

Bicultural identity integration, depressive symptoms, and emotional eating among Asian and Latino undergraduate students in the U.S

College students increasingly identify as bicultural. Bicultural identity integration (BII), the extent to which an individual can effectively manage their various cultural identities, has been associated with mental health, including depressive symptoms. However, few studies have examined the association between BII and eating behaviors among racial/ethnic minority students, even though these students are at high risk for disordered eating behaviors. The primary goals of the present study were to examine the association between BII and emotional eating, and whether depressive symptoms represent an indirect pathway in the association. Asian and Latino undergraduate college students in the U.S. (N = 497; age range: 18-46 years, M = 20.81) completed online standardized questionnaires assessing demographics, BII, depressive symptoms, and emotional eating. Higher scores on BII harmony, not blendedness, were associated with fewer depressive symptoms (r = - 0.16, p < .001) and less emotional eating (r = - 0.13, p < .001). Moreover, depressive symptoms were the indirect pathway between BII harmony and emotional eating (b = - 0.15, p = .003, 95%CI boot [- 0.25, - 0.05]), but not between BII blendedness and emotional eating (b = - 0.04, p = .42, 95%CI boot [- 0.15, 0.06]). The results can help inform counseling services about the need to address cultural harmony to promote healthy eating behaviors, mental health, and well-being among bicultural undergraduate students.

What internet- and mobile-based interventions are currently available for adults with overweight or obesity experiencing symptoms of depression? A systematic review

Given the high prevalence of overweight and obesity and high comorbidity of depressive symptoms, there is a need for low-threshold, accessible care approaches for people with overweight/obesity aimed at improving mental health. Internet and mobile-based interventions (IMI) represent an innovative complementary treatment option. This review systematically searches for IMI aimed at improving mental health in people with overweight/obesity. We conducted a systematic literature search according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria in the databases MEDLINE, Cochrane Library, PsycINFO, Web of Science and Google Scholar. Randomized controlled trials (RCTs) of IMI for adults with overweight/obesity and comorbid depressive symptoms aiming at improving mental health were screened and extracted. Study quality was assessed with RoB 2 (revised Cochrane Risk of Bias tool in RCTs). After excluding duplicates, n = 790 results were included in title and abstract screening. After full-text-screening of n = 26 studies, n = 3 RCT studies were included. All interventions aimed to reduce both weight and depressive symptoms. In two RCTs, a significant reduction in both depressive symptoms and weight was achieved. One RCT indicated a significant reduction in depressive symptoms, but not in weight. Two intervention had a duration of 6 months and were guided by health carers, the third takes 3 months and can be used without professional guidance. There is evidence that IMI are effective in improving mental health for people with overweight/obesity and comorbid depressive symptoms. However, currently there are few interventions aiming at reducing depressive symptoms, all targeting English-speaking people. As IMI for depressive symptoms can be easily integrated in the somatic therapy of obesity as additional option and has high public health potential, target group-adapted and low-threshold accessible interventions in different languages should be developed and implemented for improving mental health in people with overweight/obesity. Prospero registration number: CRD42023361771.

Metabolomics in Depression: What We Learn from Preclinical and Clinical Evidences

Depression is one of the predominant common mental illnesses that affects millions of people of all ages worldwide. Random mood changes, loss of interest in routine activities, and prevalent unpleasant senses often characterize this common depreciated mental illness. Subjects with depressive disorders have a likelihood of developing cardiovascular complications, diabesity, and stroke. The exact genesis and pathogenesis of this disease are still questionable. A significant proportion of subjects with clinical depression display inadequate response to antidepressant therapies. Hence, clinicians often face challenges in predicting the treatment response. Emerging reports have indicated the association of depression with metabolic alterations. Metabolomics is one of the promising approaches that can offer fresh perspectives into the diagnosis, treatment, and prognosis of depression at the metabolic level. Despite numerous studies exploring metabolite profiles post-pharmacological interventions, a quantitative understanding of consistently altered metabolites is not yet established. The article gives a brief discussion on different biomarkers in depression and the degree to which biomarkers can improve treatment outcomes. In this review article, we have systemically reviewed the role of metabolomics in depression along with current challenges and future perspectives.

Investigating the Impact of Ashwagandha and Meditation on Stress Induced Obesogenic Eating Behaviours

Obesity has been identified as a rapidly rising pandemic within the developed world, potentially increasing the risks of type 2 diabetes and cardiovascular disease. Various studies have identified a positive association between stress, elevated cortisol levels and obesity. Mechanisms of the stress response lead to hyperpalatable food preference and increased appetite through the activation of the HPA axis, elevated cortisol and the resulting interactions with the dopaminergic system, neuropeptide Y, ghrelin, leptin and insulin. The methodology of this review involved a Systematic Search of the Literature with a Critical Appraisal of papers considering ashwagandha, mediation and mindfulness in relation to mechanisms of the stress response. It incorporated 12 searches yielding 330 hits. A total of 51 studies met the inclusion criteria and were critically appraised with ARRIVE, SIGN50 and Strobe checklists. Data from the 51 studies was extracted, coded into key themes and summarized in a narrative analysis. Thematic analysis identified 4 key themes related to ashwagandha and 2 key themes related to meditation. Results provide an overview of evidence assessing the efficacy of ashwagandha and meditation in relation to weight loss interventions by supporting the stress response and the pathways highlighted. Results of Clinical studies indicate that ashwagandha supports weight loss through reduced stress, cortisol and food cravings. Pre-clinical studies also suggest that ashwagandha possesses the capacity to regulate food intake by improving leptin and insulin sensitivity and reducing addictive behaviors through dopamine regulation. Clinical studies on meditation indicate it may enhance a weight loss protocol by reducing the stress response, cortisol release and blood glucose and improving eating behaviors.

Stress-induced eating and drinking and their associations with weight among women and men during 30-year follow-up

BACKGROUND

Stress is associated with obesity through several mechanisms, including coping methods used in stressful situations. However, long-term prospective studies investigating stress-induced eating and drinking in parallel and their relationships with weight are scarce.

PURPOSE

We examined the prevalence of stress-induced eating and drinking and their associations with body mass index (BMI) among women and men during a 30-year follow-up, as well as BMI trajectories from early adulthood to middle age.

METHODS

Participants of a Finnish cohort study were followed by questionnaires at the ages of 22 (N = 1656), 32 (N = 1471), 42 (N = 1334), and 52 (N = 1160). Their coping methods were evaluated by asking how common it was for them to act in certain ways when they encountered stressful situations. We used linear regression analysis to examine the associations between coping methods and BMI, and latent growth models to analyze the BMI trajectories.

RESULTS

The prevalence of stress-induced eating was higher among women than men throughout the follow-up, whereas stress-induced drinking was more common among men at 22 and 32 years of age. Stress-induced eating was associated with higher BMI at all ages among women, and from the age of 32 among men. Eating as a persistent coping method over the life course was associated with a higher and faster growth rate of BMI trajectories. Stress-induced drinking was associated with higher BMI in middle age, and with a faster growth of BMI among men.

CONCLUSIONS

Effective, appropriate stress management may be one essential factor in preventing weight gain in the adult population.

Working Memory and Inhibition as Mediators in the Relationship Between Adverse Childhood Experiences and Emotional Eating

Objective: Previous studies have focused on the dual relationship among adverse childhood experiences (ACEs), cognitive abilities, and emotional eating. The current study aims to test the mediating role of executive functioning (working memory and inhibition) between ACEs and emotional eating. Methods: A total of 1105 community-based participants, aged 18-45 (Mean = 26.28, SD = 7.09), were included in the study. Among the participants, 698 (63.16%) were female, and 407 (36.84%) were male. Participants completed the Childhood Trauma Questionnaire; the Adult Executive Functioning Inventory; the Dutch Eating Behaviour Scale; the Life Events Checklist; and the Depression, Anxiety, Stress Scale Short Form. Multiple mediation analyses were employed using MPlus 8.3. Results: Multiple mediation analysis results showed that working memory and inhibition mediate the relationship between ACEs and emotional eating. Furthermore, working memory and inhibition were positively correlated with emotional eating. Discussion: Our findings indicate that difficulties in working memory and inhibition may increase the risk of emotional eating. Early intervention targeting executive functions may prevent emotional eating. Public Significance: Our findings highlight the relationship among ACEs, executive functioning, and emotional eating. Intervening in executive function may have clinical benefits for individuals with ACEs.

Emotional Eating Prevalence and Correlates in Adolescents in the United States

Background: Adolescent obesity rates continue to rise. A better understanding of who engages in emotional eating, a maladaptive eating style, is needed. Despite emotional eating being a frequent research target, the prevalence of emotional eating in US adolescents is currently unknown. Methods: Nationally representative adolescents (n = 1622, m = 14.48 years, 63.8% non-Hispanic White, 50.6% female) reported eating behaviors in the National Cancer Institute's Family Life, Activity, Sun, Health, and Eating (FLASHE) study. Frequencies and one-way ANOVAs were conducted to examine the rates of emotional eating across demographic and weight status groups. Correlations between emotional eating and dietary intake were examined. Results: In total, 30% of adolescents engaged in emotional eating. Older adolescents (35% of 17-year-olds), females (39%), non-Hispanic White individuals (32%), and adolescents with obesity (44%) had significantly higher rates of emotional eating. Controlling for weight status, greater adolescent emotional eating was correlated with more frequent intake of energy-dense/nutrient-poor foods (β = 0.10, p < 0.001), junk food (β = 0.12, p < 0.001), and convenience foods (β = 0.13, p < 0.001). Conclusions: This study fills a critical gap by providing insight into how common adolescent emotional eating is and highlighting demographic factors that are associated with higher rates. Nearly a third of adolescents in the United States reported eating due to anxiety or sadness, with rates higher in older adolescents, girls, non-Hispanic White adolescents, and adolescents with obesity. Emotional eating was associated with consuming less healthy foods, which conveys immediate and long-term health risks. Practitioners can intervene with emotional eating to reduce obesity and comorbid health risks.

Psychological Mediators of the Association between Obesity and Symptoms of Depression, Anxiety, and Stress

INTRODUCTION

There is still paucity of knowledge about which factors can mediate the link between obesity and mental health problems. This study aimed to investigate psychological mediators of the association between different weight profiles (healthy, overweight, and obesity) and symptoms of depression, anxiety, and stress.

METHODS

A sample of 407 adults (≥18 years old) with different weight profiles recruited from general population was assessed for symptoms of depression, anxiety, and stress, and dimensions of emotion regulation and body investment/body image. Robust regression and robust mediation analyses were employed to investigate predictors and mediators of mental health outcomes in relation to different weight profiles.

RESULTS

Body investment difficulties in relation to body image and body care, and emotion regulation difficulties related to a tendency towards negative secondary responses to negative emotions, and/or denial of distress, significantly mediated the association between obesity and symptoms of depression. The association between obesity and symptoms of anxiety and stress was significantly mediated by body investment difficulties related to body image concerns.

CONCLUSIONS

The current study brings evidence on specific dimensions of emotion regulation and body image that play a key role for the co-occurrence of mental health problems in individuals with obesity.

INTRODUCTION

There is still paucity of knowledge about which factors can mediate the link between obesity and mental health problems. This study aimed to investigate psychological mediators of the association between different weight profiles (healthy, overweight, and obesity) and symptoms of depression, anxiety, and stress.

METHODS

A sample of 407 adults (≥18 years old) with different weight profiles recruited from general population was assessed for symptoms of depression, anxiety, and stress, and dimensions of emotion regulation and body investment/body image. Robust regression and robust mediation analyses were employed to investigate predictors and mediators of mental health outcomes in relation to different weight profiles.

RESULTS

Body investment difficulties in relation to body image and body care, and emotion regulation difficulties related to a tendency towards negative secondary responses to negative emotions, and/or denial of distress, significantly mediated the association between obesity and symptoms of depression. The association between obesity and symptoms of anxiety and stress was significantly mediated by body investment difficulties related to body image concerns.

CONCLUSIONS

The current study brings evidence on specific dimensions of emotion regulation and body image that play a key role for the co-occurrence of mental health problems in individuals with obesity.

Nondietary psychological app program leads to sustained weight loss due to trained physiological satiety perception

Obese people are mostly unable to maintain successful weight loss after the end of a dietary change. One reason is that conventional weight reduction concepts neglect physiological hunger and satiety perception, leading to a relapse to previous eating habits on the long run. We examined the long-term efficacy of a psychological smartphone weight loss program, which avoids any dietary instructions and aims at relearning of satiety perception. Parameters of body weight alterations and psychological features, for example, satiety perception, food cravings, and emotional eating, were explored in a nonrandomized experimental study comprising 75 obese participants. Measurements occurred at baseline, two times during program application, as well as at 6- and 12-month follow-up. Participants displayed significant weight loss during the entire study period (p = .029) and showed an improved body composition at the 6-month follow-up (p = .018). These effects were associated with increased satiety perception, as well as reduced food cravings, and emotional eating habits. Notably, all improvements in measured parameters significantly sustained between the end of the program and the 12-month follow-up (p < .005 for all). Psychological relearning of satiety perception may outclass dietary approaches in terms of long-term efficiency.

Relationship between emotional eating and nutritional intake in adult women with overweight and obesity: a cross-sectional study

BACKGROUND

Emotional eating (EE) is particularly prevalent in overweight or obese women, who may turn to food as a way to cope with stress, sadness, or anxiety. Limited research has been conducted on the association between EE and nutritional intake. Therefore, present study was designed to explore this association in adult women with overweight and obesity.

METHODS

In this cross-sectional study, the relationship between EE and nutritional intake in 303 overweight and obese women (aged 18-50 years) was examined. The researchers used the validated semi-quantitative Food Frequency Questionnaire (FFQ) to assess participants' nutritional intake and the Dutch Eating Behavior Questionnaire (DEBQ) to evaluate their eating behavior. To determine the association between EE and nutritional intake, we employed the multiple linear regression analysis.

RESULTS

The frequency of high intensity EE was 64.4% among the study participants and the mean total score of EE subscale of DBEQ was 2.32 ± 0.81. The total score of EE was positively associated with the energy intake (β = 0.396, P = 0.007), even after adjusting for age and BMI. In addition, a significant inverse association was found between the score of EE and the daily intake of calcium (β= -0.219, P = 0.026), riboflavin (β= -0.166, P = 0.043), and vitamin B12 (β= -0.271, P = 0.035), independent from energy and age. Also the results showed a significant positive association between the score of EE and the frequency of daily intake of cracker, muffin, cake, cream cake, pastry, candy, ice cream, pickles, melon, hydrogenated vegetable oil, peanut, salted and roasted seeds, and corn-cheese puff snack.

CONCLUSION

This study found that overweight or obese women with higher intensity of EE might have a higher intake of energy and a lower intake of dietary calcium, riboflavin and vitamin B12. Integrating a balanced diet with psychotherapy is suggested to help individuals with EE reducing the urge to eat in response to emotions.

The Associations between Depression and Sugar Consumption Are Mediated by Emotional Eating and Craving Control in Multi-Ethnic Young Adults

BACKGROUND/OBJECTIVES

Individuals with mental health conditions such as depression are vulnerable to poor dietary habits, potentially due to the maladaptive eating behaviors often used to regulate negative emotion. However, the specific dietary components most associated with depression, as well as the mediating roles of emotion regulation and other eating behaviors, remains ambiguous in young adults.

METHODS

For this cross-sectional evaluation, a total of 151 (86 F, 65 M; BMI: 22.0 ± 5.1 kg/m2; age: 21.4 ± 2.5 y) multi-ethnic participants (50 White, 36 Black, 60 Asian, and 5 White Hispanic) completed a digital 24-h dietary recall and self-reported measures of depressive symptoms, emotional regulation, and eating behaviors. LASSO regression was used to identify the dietary variables most associated with each subscale and to remove extraneous dietary variables, and multiple regression and mediation analyses were conducted for the remaining variables.

RESULTS

Out of >100 dietary factors included, only added sugar in the combined sample (p = 0.043), and relative sugar in females (p = 0.045), were retained and positively associated with depressive symptoms. However, the relationships between depression and added and relative sugar intake were mediated by craving control and emotional eating, respectively. Individuals with higher added sugar intake (p = 0.012-0.037), and females with higher relative sugar intake (p = 0.029-0.033), had significantly higher odds of risk for major depression disorder and the use of mental health medications.

CONCLUSIONS

Added and relative sugar intake are significantly associated with depressive symptoms in young adults, but these relationships may be mediated by facets of emotional dysregulation, such as emotional eating and craving control.

Eating behaviour characteristics and dietary intake among Japanese junior high school students: A cross-sectional study

BACKGROUND

Psychological characteristics of eating behaviour may be related to dietary habits.

AIM

We investigated the association between eating behaviour characteristics and nutrition and food intake adequacy in Japanese adolescents.

METHODS

This cross-sectional survey was conducted among 136 junior high school students (boys: 90, girls: 46) at a junior high school in Tokyo, Japan. Eating behaviour was categorised into three types (emotional, external, and restrained) using scores on the Japanese version of the Dutch Eating Behaviour Questionnaire. Dietary intake was assessed using a validated, brief self-administered diet history questionnaire. Inadequate nutrient intake was determined by counting the number of nutrients not meeting the dietary reference intake (DRI) for the Japanese population. The statistical analyses included Wilcoxon signed-rank tests, Spearman's rank correlation coefficient, and multiple regression analysis using JMP ver.14 (SAS Institute Inc., Cary, NC, USA). All reported p values are two-tailed, and p < 0.05 was regarded as statistically significant.

RESULTS

Multiple regression analysis showed that restrained eating score was inversely associated with the number of nutrients not meeting the DRI (β =  - 0.28; p = 0.0027) and with total weight of snack intake (β =  - 0.30; p = 0.0010). Neither emotional nor external eating was significantly associated with the number of nutrients not meeting the DRI and with total weight of snack intake.

CONCLUSIONS

These results suggest that adolescents with low restrained eating scores may have less self-control over their eating behaviour and may therefore have inadequate dietary intake.

The Impact of Negative Emotional Dysregulation on the Outcome of Bariatric Surgery in Patients with Severe Obesity: An Observational One-Year Follow-Up Study

Background: Psychiatric symptoms are highly prevalent in patients with severe obesity, often representing pivotal factors in the development and progression of this condition. This study examines the association between negative emotional dysregulation (NED) and weight loss following bariatric surgery. Methods: Ninety-nine patients were consecutively enrolled at the Obesity Center of the Pisa University Hospital between March 2019 and February 2021, during a routine psychiatric evaluation before bariatric surgery. Psychopathological dimensions were assessed using the Mini-International Neuropsychiatric Interview (MINI), the Reactivity, Intensity, Polarity, and Stability questionnaire in its 40-item version (RIPoSt-40), the Wender-Reimherr Adult Attention Deficit Disorder Scale (WRAADDS) and the Barratt Impulsiveness Scale (BIS-11). Based on a RIPoSt-40 cut-off score of 70, subjects were divided into two groups: with (NED+) and without (NED-) NED. Results: NED+ subjects had a higher rate of psychiatric comorbidities and eating disorders than NED- patients. Of the total sample, 76 underwent bariatric surgery, and 65 of them were re-evaluated one-year after surgery. Among them, 10 of 28 NED+ subjects (37.5%) had inadequate weight loss one year after surgery compared to 5 of 37 NED- subjects (13.5%) (p = 0.035, OR 3.55, 95%, C.I. 1.05-12.03). Conclusions: Our results suggest a significant association between NED and inadequate weight loss at one-year post surgery.

Negative emotional eating patterns in general Chinese adults: A replication and expansion study examining group differences in eating disorder symptomatology, psychosocial impairment, and emotion regulation difficulties

Previous research identified four patterns of negative emotional eating in American and Chinese university students and proposed future directions (e.g., exploring potential differences in emotion regulation across patterns and replicating the patterns in a general, non-student population). Furthermore, prior research has not explored group differences in muscularity-oriented eating disorder symptomatology or psychosocial impairment. Therefore, the present study addressed these gaps in a sample of general Chinese adults, further testing group differences in typical and muscularity-oriented eating disorder symptomatology, psychosocial impairment, and emotion regulation difficulties across patterns of negative emotional eating. A total of 600 Chinese adults were recruited. Latent class analysis (LCA) was used. Results replicated the four patterns of negative emotional eating in previous research, including non-emotional eating (non-EE), emotional over- and under-eating (EOE-EUE), emotional over-eating (EOE), and emotional under-eating (EUE). Significant class differences were identified in eating disorder symptomatology, psychosocial impairment, and emotion regulation difficulties. Specifically, individuals with EOE and EOE-EUE patterns exhibited higher eating disorder symptomatology, higher psychosocial impairment, and more emotion regulation difficulties than those with non-EE and EUE patterns. Therefore, these two classes (i.e., EOE and EOE-EUE), especially the poorly researched EOE-EUE group, should be further examined to elucidate research and clinical applications. Furthermore, findings underscore the role of emotion regulation difficulties in further describing the differences across these negative emotional eating patterns, which can be considered in future interventions for reducing negative emotional eating.

Traces of social culture in the lived experiences of emotional eating among Iranian obese women

INTRODUCTION

Emotional eating is a situation with harmful consequences for the physical, mental and social health of humans. In this regard, the present study aimed to explain the role of social culture in the lived experiences of emotional eating in Iranian obese women.

METHODS

This was a qualitative study conducted using the phenomenological approach. Purposive heterogeneous sampling method was used to select 17 women with body mass index of 30 and above who had emotional eating experience. Data were collected through semi-structured and face-to-face interviews. A guideline designed by the research team, whose content validity was confirmed by the expert panel, was used to conduct the interviews. Data were analyzed based on Diekelmann 7-step approach, and trustworthiness was evaluated by Lincoln and Guba criteria.

RESULTS

The main topic of the findings was social culture and emotional eating, which was explained by three themes: "influence of social culture", "language culture of eating" and "the culture of eating together". Influence of social culture had three sub-themes: "a legal and popular entertainment", "hospitality culture: encouraging guests to overeat", and "coping with the social stigma of thinness and obesity". The language culture of eating had two sub-themes of "association of common infinitives" and "the symbol of swallowing anger ". Also, "culture of eating together" included 2 sub-topics with the titles "pleasant symbol of belonging and love" and "the symbol of family cohesion".

CONCLUSION

This study found that social culture through language, norms, and customs can initiate and/or reinforce emotional eating. The results of this study can be used in the design of interventions to improve emotional eating behavior in women by emphasizing the characteristics of Iranian social culture.

The effect of middle and high school students' emotional eating behavior on obesity

AIM

This study was conducted to determine the effect of middle and high school students' emotional eating behavior on obesity.

METHOD

A descriptive, correlational, and cross-sectional study design was used. The sample consisted of 267 students studying in 5th, 6th, 7th, 8th, 9th, 10th, 11th, and 12th grades. Data were collected using a Child Information Form and the Emotional Eating Scale. The researchers measured the students' height and weight and calculated their body mass indices (BMI), and BMI percentiles were evaluated according to age and gender. Percentage calculations, mean scores, Spearman correlation analysis, Pearson's correlation analysis, and multiple regression analysis were used in the analysis of the data.

RESULTS

Of the students participating in the study, 54.7% were girl and 45.3% were boy. It was determined that 28.4% of the students were overweight and obese. As a result of multiple regression analysis, it was determined that students' emotional eating behavior explained 25% of obesity (p < 0.001). It was found that anxiety-anger- frustration, one of the subscales of the emotional eating scale, was the only variable that significantly predicted students' obesity status (β = 0.387). Emotional eating significantly predicted the obesity status of boy and girl students (p < 0.001).

CONCLUSION

In this study, it was concluded that students' emotional eating behavior affected obesity.

IMPLICATIONS FOR PRACTICE

In line with these results, it is recommended that studies on other variables that may predict the effect of students' emotional eating behavior on obesity should be conducted and that nurses should contact schools to conduct emotional eating behavior screenings and provide emotional eating education for students who exhibit emotional eating behavior.

A Qualitative Model of Weight Cycling

Weight cycling is a likely consequence of striving to lose weight after internalizing body image ideals, making upward social comparisons, and experiencing weight stigma. Despite weight cycling's potential physical and psychological consequences, the interplay of weight cycling, social pressures, and experienced and internalized stigma have not been qualitatively explored. Thus, through in-depth interviews of 36 weight-cycling adults, this study sought to understand how people negotiate weight cycling. Interviews informed the development of a qualitative model of weight cycling, which was derived from a theory-neutral inductive analysis. The model's stages included entering the cycle, undergoing the cycle, and challenging the cycle. Participants were triggered to enter the cycle due to weight stigma caused by social pressures. Within the cycle, interviewees internalized weight stigma and engaged in disordered weight management behaviors. Some participants challenged the cycle by becoming more self-aware and mitigating their toxic dieting behaviors. However, it was very difficult, if not impossible, for many to fully exit weight cycling and the restraints of previous weight management thinking and patterns. Our investigation underscores the seriousness of weight cycling and suggests ways to combat weight cycling on both macro and individual levels. It may also be useful to consider weight cycling as disordered eating in hopes of shifting society's dangerous focus on rapid weight loss.

Understanding the experiences of ketogenic metabolic therapy for people living with varying levels of depressive symptoms: a thematic analysis

Background

Evidence suggests that a ketogenic diet (KD) may help to alleviate psychiatric symptoms, including depression and anxiety. Positive changes have been reported such as improvements in cognition, concentration, and sleep, a reduction in hunger, and an increase in well-being, energy, confidence, and resilience. This research aims to understand the impact of a non-calorie-restricted KD on depression and aspects of psychological well-being in those with varying degrees of depressive symptoms. Though there are a few studies directly exploring the experiences of those following a KD, this will be the first study to explore the narrative from a mental health and psychological well-being viewpoint.

Method

A sample of nine participants who had followed a non-calorie restricted KD intervention of 50 g of carbohydrates or less per day for at least 12 weeks were recruited. Participants were split into 'healthy adults' group who had no to low depressive symptoms and 'depressive symptoms' group who had mild to moderate depressive symptoms. A reflexive thematic analysis was considered suitable for this study.

Findings

Five core themes and 24 subthemes were created. These were, (1) Poor health prior to program; (2) Hunger and cravings-the food and mood connection; (3) Psychological well-being improvements; (4) It becomes a lifestyle; and (5) Implementation difficulties. Participants experienced mental health improvements such as increased self-esteem, confidence, motivation, and achievement. Some experienced more control in life and a greater sense of reward. Those with depressive symptoms who initially reported low self-worth and hopelessness later reported increased self-esteem and renewed meaning and purpose in life. The findings from this study reflect the previous reports that the diet implementation can be difficult initially, but soon becomes easy to follow and turns into a lifestyle.

Conclusion

In the literature, there are very few qualitative studies that explore the accounts and lived experiences of those following a KD. From the participants' accounts in this study, it appears that the benefits and positive outcomes of this diet outweigh any negative side-effects experienced. This is encouraging for those who are looking for adjunctive therapies to address and improve their depressive symptoms and overall mental health.

Orthorectic behavior among students and motivation for physical activity, dietary habits, and restrictive eating

Introduction

Orthorexia lacks official recognition as an eating disorder; however, orthorexic behaviors, associated with a stringent selection of food, may serve as a predisposing factor to the development of eating disorders. It is characterized by an obsessive preoccupation with healthy eating and strict dietary standards, often prevalent in high-risk groups such as athletes and individuals concerned with their physical appearance. The objective of this study was to evaluate the incidence of orthorexia among students exhibiting varying lifestyles (including dietary habits and levels of physical activity, along with their respective motivational factors). The research involved 600 participants equally distributed between health-related (HRF) and non-health-related (NRF) academic categories, with the majority of participants in the HRF category being women.

Methods

Assessments included BMI calculations, dietary evaluation based on Polish standards, categorization of physical activity levels, the EMI-2 questionnaire on motivation to exercise, the DOS test for orthorexia propensity, and the TFEQ-13 questionnaire for eating behavior.

Results and discussion

Results showed that primary motivators for physical activity included disease prevention, health maintenance, strength/endurance, and physical appearance. Orthorexia tendencies were prevalent, particularly in the HRF group, linked to lower BMI, better diet quality, higher physical activity levels, and a higher prevalence of restrictive eating. In conclusion, students in health-related fields, driven by a strong health consciousness, are at risk of orthorexia. This emphasizes the need for balanced health education and support.

Conclusion

Orthorexic tendencies are associated with distorted perceptions of food portions and calories, underscoring the importance of awareness and intervention.

Weight loss impacts risky decisions in obesity

BACKGROUND & AIMS

Risky decision making is shaped by individual psychological and metabolic state. Individuals with obesity show not only altered risk behavior, but also metabolic and psychological abnormalities. The aim of the present study was to investigate whether a substantial weight loss in individuals with severe obesity will 1) normalize their metabolic and psychological state and 2) will change their pattern of decision guidance.

METHODS

We assessed the effect of glycated hemoglobin (HbA1c) and mood on risk behavior in individuals with obesity (n = 62, 41 women; BMI, 46.5 ± 4.8 kg/m2; age, 44.9 ± 14.7 years) before and after 10-weeks weight loss intervention.

RESULTS

Results showed that this intervention reduced participants' risk behavior, which was significantly predicted by their changes in BMI. Before intervention, mood, but not HbA1c significantly predicted decisions. After the weight loss, mood no longer, but HbA1c significantly predicted decisions.

CONCLUSION

Our findings shed light on the psychological and metabolic mechanisms underlying altered risky decision making in severe obesity and can inform the development of strategies in the context of weight loss interventions.

Behavioral and Psychosocial Mediators of the Effects of Increased Self-Regulation on Short- and Long-Term Weight Loss in Women Within Community-Based Obesity Treatments

The aim of this study was to evaluate behavioral mediators of relationships between increased self-regulation of eating and weight loss so that findings on psychosocial correlates of treatment-associated weight change could be extended. Participants were women enrolled in 6-month community-based obesity treatments using primarily self-regulatory (SR-treatment, n = 52) or education-focused (Didactic training, n = 54) methods. Changes from baseline in self-regulation of eating, self-efficacy for controlled eating, emotional eating propensity, exercise, and the diet were first calculated. There were significant overall improvements in each psychosocial and behavioral measure, and weight. Except for emotional eating change from baseline-Month 12, improvements were each significantly greater in the SR-treatment group. Mediation of the relationships of change in self-regulation with 6-, 12-, and 24-month weight changes, by changes in self-efficacy and emotional eating, were significant, R2s = .19-.26, ps < .001. Only changes in emotional eating over 6 and 12 months were significant mediators. Mediations of the same self-regulation-weight change relationships by changes in exercise and the diet were also significant, R2s = .19-.28, ps < .001, and only changes in exercise over 12 and 24 months were significant mediators. Although group membership did not moderate effects on weight, substitution of sweets for the (composite) diet demonstrated it to be a significant mediator over 6 and 12 months. In women with obesity, self-regulation improvement was associated with short- and longer-term weight loss through changes in emotional eating, exercise, and sweets consumption. Thus, behavioral treatments will benefit from targeting those variables.

The effects of time-restricted eating and Ramadan fasting on gut microbiota composition: a systematic review of human and animal studies

CONTEXT

It is well known that the microbiome undergoes cyclical diurnal rhythms. It has thus been hypothesized that meal timing may affect gut microbial composition, function, and host health.

OBJECTIVE

This review aims to examine the effects of time-restricted eating (TRE) and Ramadan fasting (RF) on the composition of the gut microbiota in animal and human studies. The associations between composition of microbiota and host metabolic parameters are also examined.

DATA SOURCES

A search was performed on the PubMed, Cochrane, Scopus, and Web of Science databases up to December 31, 2022. The search strategy was performed using the Medical Subject Heading (MeSH) terms "intermittent fasting" and "gastrointestinal microbiome" and the key words "Ramadan fasting" and "microbes."

DATA EXTRACTION

Seven human studies (4 TRE and 3 RF) and 9 animal studies (7 TRE, 2 RF-like) were retrieved.

DATA ANALYSIS

TRE and RF in human studies lead to an increase in gut microbial community alpha-diversity. In animal studies (both TRE and RF-like), fasting is not associated with improved alpha-diversity, but enhancement of microbial fluctuation is observed, compared with high-fat diet ad libitum groups. Within Firmicutes and Bacteroidetes phyla, no specific direction of changes resulting from fasting are observed in both animals and human. After TRE or RF, a greater abundance of the Faecalibacterium genus is observed in human studies; changes in Lactobacillus abundance are found in animal studies; and increases in Akkermansia are seen both in humans and in animals fed a feed-pellet diet. Only 2 human studies show a beneficial correlation between microbiota changes and host metabolic (HDL cholesterol) or anthropometric parameters (body mass index).

CONCLUSIONS

These findings support the importance of both regimens in improving the gut microbiota composition. However, based on results of animal studies, it can be suggested that diet remains the essential factor in forming the microbiota's environment.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42021278918.

The melanocortin-4 receptor pathway and the emergence of precision medicine in obesity management

Over the past few decades, there has been a global surge in the prevalence of obesity, rendering it a globally recognized epidemic. Contrary to simply being a medical condition, obesity is an intricate disease with a multifactorial aetiology. Understanding the precise cause of obesity remains a challenge; nevertheless, there seems to be a complex interplay among biological, psychosocial and behavioural factors. Studies on the genetic factors of obesity have revealed several pathways in the brain that play a crucial role in food intake regulation. The best characterized pathway, thus far, is the leptin-melanocortin pathway, from which disruptions are responsible for the majority of monogenic obesity disorders. The effectiveness of conservative lifestyle interventions in addressing monogenic obesity has been limited. Therefore, it is crucial to complement the management strategy with pharmacological and surgical options. Emphasis has been placed on developing drugs aimed at replacing the absent signals, with the goal of restoring the pathway. In both monogenic and polygenic forms of obesity, outcomes differ across various interventions, likely due to the multifaceted nature of the disease. This underscores the need to explore alternative therapeutic strategies that can mitigate this heterogeneity. Precision medicine can be regarded as a powerful tool that can address this concern, as it values the understanding of the underlying abnormality triggering the disease and provides a tailored treatment accordingly. This would assist in optimizing outcomes of the current therapeutic approaches and even aid in the development of novel treatments capable of more effectively managing the global obesity epidemic.

Obesity: current state of the problem, multidisciplinary approach. (based on the consensus of the World Gastroenterological Organization “Obesity 2023” and the European guideline on obesity care in patients with gastrointestinal and liver diseases, 2022)

Obesity is the largest pandemic in the world, and its prevalence continues to increase. The purpose of the presented publication is to raise awareness of doctors about modern methods of diagnosing obesity and approaches to therapy, using an interdisciplinary team approach similar to that used in other chronic diseases, such as diabetes, heart disease and cancer. The article presents data from the World Gastroenterological Organization (2023) and the European Guidelines for the Treatment of Obesity in patients with diseases of the gastrointestinal tract and liver (2022). According to modern approaches, obesity should be considered as a chronic recurrent progressive disease, the treatment of which requires a comprehensive interdisciplinary approach involving psychologists and psychiatrists, nutritionists/nutritionists, therapists, endoscopists and surgeons, including lifestyle changes, a well-defined diet and exercise regimen, drug therapy, endoscopic or surgical methods of treatment. Conclusions. In order to stop the growing wave of obesity and its many complications and costs, doctors, insurance companies and health authorities should make systematic efforts to raise public awareness of both the adverse health risks associated with obesity and the potential reduction of risks through a comprehensive approach to therapy.

Determination of the width of the presacral space on magnetic resonance imaging among adults in south-western Nigeria

BACKGROUND

The presacral space is a clinically relevant potential space and contents may give rise to a variety of benign and malignant conditions, hence the need for detailed knowledge of its dimensions.

PURPOSE

To determine the width of the presacral space and existing variations among adults in south-western Nigeria using a magnetic resonance imaging (MRI) technique.

MATERIAL AND METHODS

A total of 369 consenting adults were included in the study. Measurements of the presacral space were then made electronically by consensus of two radiologists. Values derived were recorded and subjected to analyses of variance.

RESULTS

The mean normal widths of the presacral space in men and women were 11.7 mm and 11.1 mm at the S1 level, 11.7 mm and 10.35 mm at the S2 level, and 12.3 mm and 9.7 mm at the S3 level, respectively. Measurements of the presacral space width were significantly larger in the male population. Variations in the dimensions due to age greater than 40 years, male sex, and increasing body mass index (BMI) were also noted.

CONCLUSION

This study provides baseline dimensions under more physiological conditions and gives more accurate information about the true width of the space in Nigerian adults. Variations due to age, sex, and BMI may also be considered while interpreting abnormal values.

Interoceptive abilities impairment correlates with emotional eating and taste abnormalities in children with overweight and obesity

Weight problems in children are associated with emotional eating, which has been linked to interoceptive abilities. Previous research also shows altered olfactory and gustatory perception in children with obesity and overweight. Therefore, we aimed to investigate the connection of alterations in olfactory and gustatory perception to interoceptive abilities and emotional eating among children with obesity and overweight. 23 children with overweight and obesity and age-matched controls with normal weight (12-16 years old) underwent olfactory and gustatory testing. Interoceptive abilities were assessed, focusing on interoceptive accuracy and interoceptive sensibility. Children with overweight and obesity showed significantly higher accuracy for detection of sweet taste, but descriptively lower accuracy for all other taste qualities compared to normal weight children. We found no changes in olfactory abilities in children with overweight and obesity. Emotional eating scores were elevated for children with overweight and obesity, and interoceptive accuracy scores were significantly lower. In both groups, interoceptive accuracy was inversely correlated with emotional eating. Our results support prior findings of altered gustatory abilities in children with overweight and obesity. The observed link between impaired interoceptive processes and heightened emotional eating in this group implies that interventions for overweight in children could benefit from targeting interoceptive abilities. This study provides meaningful grounds for further investigations into the roles of taste, emotional eating, and interoceptive abilities for overweight in children and adolescents.

Effects of Shared Decision Making Model-Based Guided Self-Help Program on Emotional Eating and Uncontrolled Eating Behavior in Individuals with a Severe Mental Disorder: A Randomized Controlled Trial

PURPOSE

The study was aimed at determining the effectiveness of the Shared Decision Making Model-based Guided Self-Help Program (SDM-GSH) on emotional eating behavior and uncontrolled eating behavior in individuals with a severe mental disorder.

METHOD

This randomized controlled experimental study was conducted in the Community Mental Health Center of a university hospital between September 2020 and November 2022. The sample of the study consisted of 64 participants. Of them, 33 were in the Experimental Group and 31 were in the control group. To collect the study data, the Patient Information Form, Emotional Eater Questionnaire, and Three-Factor Eating Questionnaire were administered. The participants in the Experimental Group took part in the SDM-GSH. The study data were collected from the participants in the Experimental and Control Groups before, right after and 6 months after the intervention.

RESULTS

The comparison of the BMI values of the participants with a severe mental disorder who took part in the SDM-GSH demonstrated that their pre-intervention BMI values significantly decreased at the measurements preformed right after and 6 months after the intervention (p < 0.05). The mean emotional eating (λ = 0.189, η2 = 0.811) and uncontrolled eating (λ = 0.218, η2 = 0.782) scores obtained by the participants in the Experimental Group before the intervention significantly decreased at the measurements preformed right after and 6 months after the intervention (p < 0.05).

CONCLUSION

Based on the results of our study, it is concluded that the SDM-GSH positively affected the BMI values, emotional eating behaviors and uncontrolled eating behaviors of the participants with a severe mental disorder.

Psychological approaches to obesity in young adults: state of the art

Background

Obesity has become a significant health concern among young adults aged 18-35 years. Addressing this issue is crucial, and exploring psychological treatments and perspectives specifically for this population is essential.

Methods

This literature review examines psychological treatments for obesity in young adults over the past decade. It focuses on interventions and discussions particularly relevant to this age group.

Discussion

Research on obesity often overlooks young adults, with most interventions primarily focusing on weight loss and neglecting emotional aspects. Cognitive-behavioral approaches are commonly used for self-regulation and motivation, but psychodynamic perspectives remain underutilized. While group-based methods lack a detailed analysis of benefits, hybrid approaches demonstrate higher engagement compared to technology-only interventions. There is a notable gap in tailoring obesity interventions to meet the unique needs of young adults during this transitional life phase. It's imperative to shift the focus from merely weight loss to a broader consideration of psychological, emotional, and unconscious factors. Integrating group modalities with psychodynamic approaches might offer additional benefits.

Conclusion

This review highlights the need for further research into the psychological well-being of young adults with obesity. A more comprehensive approach is required to address their distinct needs and psychological factors.

Soreness Reminds Me of Grief: Patients With Chronic Pain Show Less Differentiated Representations of Emotional Feelings and Bodily States

People experience similarities between emotional feelings and bodily states on a daily basis, but both the magnitude and pervasiveness of this experiential similarity vary across individuals. Inspired by previous findings that chronic pain (CP) is characterized by strengthened pain-affect coupling and reduced interoceptive accuracy, we conducted 2 cross-sectional studies to examine whether patients with CP would exhibit less differentiated perception and mental representation of emotional feelings and bodily states. In study 1 (N = 500), patients with CP and healthy controls (HCs) completed a self-report questionnaire that asked explicitly about the perceived similarity between 5 basic emotion categories and a series of bodily states. In study 2 (N = 73), a specially designed false memory test was administered to examine whether patients with CP would have reduced differentiation of concepts of negative emotion and somatic distress. We found that patients with CP perceived greater and more pervasive similarities between emotional feelings and bodily states, as indicated by higher questionnaire scores and denser, less specialized bipartite emotion-body networks, both associated with lower subjective interoceptive accuracy. Furthermore, patients with CP formed false memories of negative emotion words (eg, grief) more readily than HCs after memorizing somatic distress words (eg, soreness), as if they represented negative emotion and somatic distress as a single, enmeshed semantic category. Our findings extend previous literature by demonstrating reduced discrimination between emotional and bodily experiences in CP that is not restricted to pain-related emotional and sensory experiences and may be related to a fundamentally less differentiated interoception. PERSPECTIVES: This study shows that patients with chronic pain have a profoundly less differentiated perception and implicit conceptualization of emotional feelings and bodily states, which appears to be associated with altered interoception. These findings may provide new perspectives on why they often experience a stronger pain-affect coupling.