Preferences for coaching strategies in a personalized virtual coach for emotional eaters: an explorative study.

Objectives: Emotional eating is recognized as a potential contributor to weight gain. Emotional eaters often hide their problems because of feelings of shame about their behavior, making it challenging to provide them with the necessary support. The introduction of a virtual coach might offer a potential solution in assisting them. To find out whether emotional eaters are receptive to online personalized coaching, we presented emotional eaters with two essential proto-typical problem situations for emotional eaters: "experiencing cravings" and "after giving in to cravings," and asked them whether they preferred one of the three coaching strategies presented: Validating, Focus-on-Change and Dialectical. Methods: An experimental vignette study (2 × 3 design) was carried out. The vignettes featured two distinct personas, each representing one of the two common problem scenarios experienced by emotional eaters, along with three distinct coaching strategies for each scenario. To identify potential predictors for recognition of problem situations, questionnaires on emotional eating (DEBQ), personality traits (Big-5), well-being (PANAS), and BMI were administrated. Results: A total of 62% of the respondents identified themselves with "after giving in to cravings" and 47% with "experiencing cravings." BMI, emotional eating and emotional stability appeared to be predictors in recognizing both the problem situations. In "experiencing cravings," the participating women preferred Dialectical and the Validation coaching strategies. In the "after giving in to cravings" condition, they revealed a preference for the Dialectical and the Focus-on-Change coaching strategies. Conclusion: Using vignettes allowed a less threatening way of bringing up sensitive topics for emotional eaters. The personas representing the problem situations were reasonably well recognized. To further enhance this recognition, it is important for the design and content of the personas to be even more closely related to the typical problem scenarios of emotional eaters, rather than focusing on physical characteristics or social backgrounds. This way, users may be less distracted by these factors. With the knowledge gained about the predictors that may influence recognition of the problem situations, design for coaching can be more customized. The participants represented individuals with high emotional eating levels, enhancing external validity.

Dialectical behavior therapy compared to cognitive behavior therapy in binge-eating disorder: An effectiveness study with 6-month follow-up.

OBJECTIVE: To evaluate whether the results of a quasi-randomized study, comparing dialectical behavior therapy for binge-eating disorder (DBT-BED) and an intensive, outpatient cognitive behavior therapy (CBT+) in individuals with BED, would be replicated in a nonrandomized study with patients who more closely resemble everyday clinical practice. METHOD: Patients with (subthreshold) BED (N = 175) started one of two group treatments: DBT-BED (n = 42) or CBT+ (n = 133), at a community eating disorder service. Measures of eating disorder pathology, emotion regulation, and general psychopathology were examined at end of treatment (EOT) and at 6-month follow-up using generalized linear models with multiple imputation. RESULTS: Both treatments lead to substantial decreases on primary and secondary measures. Statistically significant, medium-size differences between groups were limited to global eating disorder psychopathology (d = -.62; 95% CI = .231, .949) at EOT and depressive symptoms at follow-up (d = -.45; 95% CI = .149, 6.965), favoring CBT+. Dropout of treatment included 15.0% from CBT+ and 19.0% from DBT-BED (difference nonsignificant). DISCUSSION: Decreases in global eating disorder psychopathology were achieved faster with CBT+. Overall, improvements in DBT-BED were comparable to those observed in CBT+. Findings of the original trial, favoring CBT+ on the number of OBE episodes, emotional dysregulation and self-esteem at EOT, and on eating disorder psychopathology and self-esteem at follow-up, were not replicated. With similar rates of treatment dropout and about half of the therapy time used in CBT+, DBT-BED can be considered a relevant treatment for BED in everyday clinical practice. PUBLIC SIGNIFICANCE: In this effectiveness study, dialectical behavior therapy (DBT) resulted in clinically relevant improvements in individuals with binge eating disorder. Changes were broadly comparable to those of cognitive behavior therapy (CBT), the current treatment of choice. Although CBT resulted in decreases in eating disorder psychopathology faster, there was a trend toward relapse in CBT at 6-month follow-up. Therefore, the less costly DBT-program can be considered a relevant treatment in clinical practice.

Parent-Infant Attachment Insecurity and Emotional Eating in Adolescence: Mediation through Emotion Suppression and Alexithymia.

Emotional eating (EE), the propensity to eat in response to emotions, is thought to have its origins in the early parent-infant relationship. This study tested the hypothesis that infant attachment insecurity results in EE in adolescence through the increased use of the emotion regulation strategy suppression of emotions and subsequent alexithymia. At the age of 15 months, parent-infant attachment security (n = 129) was observed with two abbreviated attachment measures: the shortened strange situation procedure (SSSP), and the shortened attachment Q-set (S-AQS). At the age of 12 years, children completed self-report questionnaires to assess the suppression of emotions, alexithymia, and EE. At the age of 16 years, EE was measured again. The mediation models indicated that lower parent-infant attachment security predicted increased use of suppression of emotions, which was related to increased alexithymia, and in turn more EE at the age of 12 years. These results were similar and significant for both attachment measures, and also (marginal) significant with EE at the age of 16 years as an outcome. Lastly, when parental caregiving quality was included, the models with the SSSP as predictor remained significant, but the models with the S-AQS became insignificant. These results indicated that to a certain extent, infant attachment security could predict adolescent EE above and beyond parental caregiving quality.

Application of three different coaching strategies through a virtual coach for people with emotional eating: a vignette study.

BACKGROUND: Around 13% of the world's population suffers from obesity. More than 40% of people with obesity display emotional eating behaviour (eating in response to negative emotions or distress). It is an alternate to more effective coping strategies for negative emotions. Our study explored the opportunities for helping adults with emotional overeating using a virtual coach, aiming to identify preferences for tailored coaching strategies applicable in a personal virtual coach environment. Three different coaching strategies were tested: a validating, a focus-on-change, and a dialectical one - the latter being a synthesis of the first two strategies. METHODS: A qualitative study used vignettes reflecting the two most relevant situations for people with emotional eating: 1. experiencing negative emotions, with ensuing food cravings; and 2. after losing control to emotional eating, with ensuing feelings of low self-esteem. Applied design: 2 situations × 3 coaching strategies. PARTICIPANTS: 71 adult women (Mage 44.4/years, range 19-70, SD = 12.86) with high scores on the DEBQ-emotional eating scale (Memo 3.65, range 1.69-4.92, SD = .69) with mean BMI 30.1 (range 18-46, SD = 6.53). They were recruited via dieticians' practices, were randomly assigned to the conditions and asked how they would face and react to the presented coaching strategies. Data were transcribed and a thematic analysis was conducted. RESULTS: Qualitative results showed that participants valued both the validating coaching strategy and the focus-on-change strategy, but indicated that a combination of validation and focus-on-change provides both mental support and practical advice. Data showed that participants differed in their level of awareness of the role that emotions play in their overeating and the need for emotion-regulation skills. CONCLUSION: The design of the virtual coach should be based on dialectical coaching strategies as preferred by participants with emotional eating behaviour. It should be tailored to the different stages of awareness of their emotions and individual emotion-regulation skills.

Dialectical behavior therapy adapted for binge eating compared to cognitive behavior therapy in obese adults with binge eating disorder: a controlled study.

BACKGROUND: Current guidelines recommend cognitive behavior therapy (CBT) as the treatment of choice for binge eating disorder (BED). Although CBT is quite effective, a substantial number of patients do not reach abstinence from binge eating. To tackle this problem, various theoretical conceptualizations and treatment models have been proposed. Dialectical behavior therapy (DBT), focusing on emotion regulation, is one such model. Preliminary evidence comparing DBT adapted for BED (DBT-BED) to CBT is promising but the available data do not favor one treatment over the other. The aim of this study is to evaluate outcome of DBT-BED, compared to a more intensive eating disorders-focused form of cognitive behavior therapy (CBT+), in individuals with BED who are overweight and engage in emotional eating. METHODS: Seventy-four obese patients with BED who reported above average levels of emotional eating were quasi-randomly allocated to one of two manualized 20-session group treatments: DBT-BED (n = 41) or CBT+ (n = 33). Intention-to-treat outcome was examined at post-treatment and at 6-month follow-up using general or generalized linear models with multiple imputation. RESULTS: Overall, greater improvements were observed in CBT+. Differences in number of objective binge eating episodes at end of treatment, and eating disorder psychopathology (EDE-Q Global score) and self-esteem (EDI-3 Low Self-Esteem) at follow-up reached statistical significance with medium effect sizes (Cohen's d between .46 and .59). Of the patients in the DBT group, 69.9% reached clinically significant change at end of the treatment vs 65.0% at follow-up. Although higher, this was not significantly different from the patients in the CBT+ group (52.9% vs 45.8%). CONCLUSIONS: The results of this study show that CBT+ produces better outcomes than the less intensive DBT-BED on several measures. Yet, regardless of the dose-difference, the data suggest that DBT-BED and CBT+ lead to comparable levels of clinically meaningful change in global eating disorder psychopathology. Future recommendations include the need for dose-matched comparisons in a sufficiently powered randomized controlled trial, and the need to determine mediators and moderators of treatment outcome. TRIAL REGISTRATION: Nederlands Trial Register: NL3982 (NTR4154). Date of registration: 2013 August 28, retrospectively registered.

Mediation of emotional and external eating between dieting and food intake or BMI gain in women.

OBJECTIVE: Dieting to control body weight is often associated with weight gain, particularly so in women; however, the underlying mechanisms are unclear. In a series of studies on women, we examined whether the relationship between dieting and weight gain can be explained by (serial) mediation of emotional eating (EE) and/or subsequent external eating (EX). METHODS: In a pilot study (116 women), we first assessed this (serial) mediation between dieting or dietary restraint and actual food consumption in the laboratory. In Study 1, a four-year follow up on patients with newly diagnosed type 2 diabetes (51 women), we assessed this (serial) mediation between dietary restraint and change in BMI and intake of energy (Kcal; Food Frequency Questionnaire). In Study 2, a three-year follow up study in a representative Dutch sample (287 women), we assessed this (serial) mediation between dieting and change in BMI. RESULTS: There was consistent support for (serial) mediation: In the pilot study, frequency of dieting and dietary restraint were both indirectly associated with grams of crackers eaten through EE and EX. In study 1, dietary restraint had a significant (95% CI) indirect association with subsequent change in measured BMI and a marginally (90% CI) significant indirect association with intake of energy through EE and EX. In study 2, EE marginally (90% CI) acted as a mediator between frequency of dieting and subsequent self-reported change in BMI. In the subsample of overweight women (n = 146) frequency of dieting was indirectly associated with subsequent self-reported change in BMI through EE and EX. CONCLUSION: The possibility that female dieters may gain weight through EE and/or subsequent EX should be taken into account when treating women with overweight or obesity.

Is comfort food actually comforting for emotional eaters? A (moderated) mediation analysis.

An important but unreplicated earlier finding on comfort eating was that the association between food intake and immediate mood improvement appeared to be mediated by the palatability of the food, and that this effect was more pronounced for high than for low emotional eaters [26]. This has not yet been formally tested using mediation and moderated mediation analysis. We conducted these analyses using data from two experiments on non-obese female students (n = 29 and n = 74). Mood and eating satisfaction in Study 1, and mood, tastiness and emotional eating in Study 2 were all self-reported. In Study 1, using a sad mood induction procedure, emotional eaters ate more food, and when mood was assessed immediately after food intake, 'eating satisfaction' acted as mediator between food intake and mood improvement (decrease in sadness or increase in happiness). In Study 2, where we measured the difference in actual food intake after a control or a stress task (modified Trier Social Stress Test), and assessed mood during the food intake after stress, we found significant moderated mediation. As expected, there was a significant positive mediation effect of tastiness between food intake and mood improvement in the high emotional eaters, but also a significant negative mediation effect of tastiness between food intake and mood improvement in the low emotional eaters. This suggests that tastiness promotes 'comfort' from food in female emotional eaters, but conflicts in non-emotional eaters with a tendency to eat less when stressed. In conclusion, palatable food may indeed provide comfort specifically for high emotional eaters during eating.

Parenting quality in infancy and emotional eating in adolescence: Mediation through emotion suppression and alexithymia.

This study assessed the association between parenting quality at age 15 and 28 months and emotional eating (EE) at age 12 and 16 years through serial mediation by suppression of emotions and alexithymia at 12 years. The sample included 129 children and their parents. Lower parental quality in infancy was related to more suppression of emotions, which in turn was related to more difficulty identifying emotions, and in turn to higher EE in adolescence. This serial mediation model was significant for EE at 12 years, and for EE at 16 years. If future studies reveal converging findings, this knowledge points to the need for programs preventing the development of EE in adolescence through increasing the quality of parenting in infancy.

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

BACKGROUND: Emotional eating (i.e. eating in response to negative emotions) has been suggested to be one mechanism linking depression and subsequent development of obesity. However, studies have rarely examined this mediation effect in a prospective setting and its dependence on other factors linked to stress and its management. We used a population-based prospective cohort of adults and aimed to examine 1) whether emotional eating mediated the associations between depression and 7-year change in body mass index (BMI) and waist circumference (WC), and 2) whether gender, age, night sleep duration or physical activity moderated these associations. METHODS: Participants were Finnish 25- to 74-year-olds who attended the DILGOM study at baseline in 2007 and follow-up in 2014. At baseline (n = 5024), height, weight and WC were measured in a health examination. At follow-up (n = 3735), height, weight and WC were based on measured or self-reported information. Depression (Center for Epidemiological Studies - Depression Scale), emotional eating (Three-Factor Eating Questionnaire-R18), physical activity and night sleep duration were self-reported. Age- and gender-adjusted structural equation models with full information maximum likelihood estimator were used in the analyses. RESULTS: Depression and emotional eating were positively associated and they both predicted higher 7-year increase in BMI (R2 = 0.048) and WC (R2 = 0.045). The effects of depression on change in BMI and WC were mediated by emotional eating. Night sleep duration moderated the associations of emotional eating, while age moderated the associations of depression. More specifically, emotional eating predicted higher BMI (P = 0.007 for the interaction) and WC (P = 0.026, respectively) gain in shorter sleepers (7 h or less), but not in longer sleepers (9 h or more). Depression predicted higher BMI (P < 0.001 for the interaction) and WC (P = 0.065, respectively) increase in younger participants, but not in older participants. CONCLUSIONS: Our findings offer support for the hypothesis that emotional eating is one behavioural mechanism between depression and development of obesity and abdominal obesity. Moreover, adults with a combination of shorter night sleep duration and higher emotional eating may be particularly vulnerable to weight gain. Future research should examine the clinical significance of our observations by tailoring weight management programs according to these characteristics.

Duration of breastfeeding is associated with emotional eating through its effect on alexithymia in boys, but not girls.

Emotional eating (EE), or eating in response to negative emotions, was earlier shown to be associated with difficulty in identifying emotions (alexithymia). To improve our understanding of possible causes of alexithymia and EE, we assessed possible associations with duration of breastfeeding in infancy. The aim of the present study was to examine in a prospective, longitudinal study whether duration of breastfeeding is associated with EE in adolescence, through its effect on alexithymia difficulty identifying emotions, and whether this mediation effect is contingent on gender. Our hypothesis was that longer duration of breastfeeding would be associated with lower EE in adolescence through its effect on lower alexithymia difficulty identifying feelings in boys but not in girls (Moderated mediation). The sample included 129 children and their families (67 boys and 62 girls). Duration of breastfeeding was reported by the mother when the infant was 15 months old. Alexithymia difficulty identifying feelings (Toronto Alexithymia Scale) and EE (Dutch Eating Behavior Questionnaire) were reported by the child at 12 years of age. EE was also reported by the child at 16 years of age. Moderated mediation was significant for EE at 12 years, and borderline significant for EE at 16 years. As hypothesized, for boys but not for girls, longer duration of breastfeeding was related to less difficulties in identifying feelings, resulting in lower degrees of EE in adolescence. It is concluded that breastfeeding in infancy may protect boys against EE through its positive association with better ability to identify feelings.

Depression and eating styles are independently associated with dietary intake.

Depression and eating styles are two important, interrelated factors associated with dietary intake. However, it remains unclear whether depression and eating styles are independently associated with dietary intake, and whether associations between depression and dietary intake are mediated by eating styles. Therefore, the aim of the current study was to investigate the associations of, and interplay between depression and eating styles in relation to different aspects of dietary intake. Cross-sectional data from 1442 participants (healthy controls (22.7%), remitted (61.0%) and current patients (16.3%)) from the Netherlands Study of Depression and Anxiety were used. Linear regression analyses were used to determine associations of depressive disorders (DSM-IV based psychiatric interview), self-reported depressive symptoms (Inventory of Depressive Symptomatology), emotional, external and restrained eating (Dutch Eating Behavior Questionnaire) with 4 measures of dietary intake (total energy intake (kcal/d), Mediterranean diet score (MDS), intake of sweets foods (g/d), and snack/fast-food (g/d)) measured with a 238-item food frequency questionnaire. Statistical mediation analyses were used to study whether associations between depression and dietary intake were mediated by eating styles. Current depression diagnosis and severity were associated with lower MDS and higher intake of sweet foods and snack/fast-food. Emotional and external eating were associated with higher intakes of snack/fast-food; external eating was also associated with higher total energy intake. Restrained eating was associated with lower total energy and intake of sweet foods, and higher MDS. Associations between current depression or severity and intake of snack/fast-food were mediated by external eating. In general, depression and eating styles contributed independently to poorer diet quality and higher intake of sweet and snack/fast-food. The association between depression and higher intake of snack/fast-food was mediated by external eating.

Causes of Emotional Eating and Matched Treatment of Obesity.

PURPOSE OF THE REVIEW: Eating in response to negative emotions (EE) may be an explanatory factor of the weight regain of many dieters. This narrative review presents evidence on possible causes of EE and the association of EE with depression and obesity and discusses implications of these findings for the treatment of obesity. RECENT FINDINGS: Possible causes of EE are high dietary restraint, poor interoceptive awareness, alexithymia, emotion dysregulation and a reversed hypothalamic pituitary adrenal (HPA) stress axis. EE may be the outcome of inadequate parenting or depressive feelings in interaction with genetic susceptibility. There is also robust evidence that EE is a mediator between depression and obesity. The association of EE with depression and poor emotion regulation skills suggests that the treatment of obese people with high EE should not focus on calorie-restricted diets but on emotion regulation skills. The DEBQ (Dutch Eating Behavior Questionnaire) enables such a matched treatment of obesity.

The Mindful Eating Behavior Scale: Development and Psychometric Properties in a Sample of Dutch Adults Aged 55 Years and Older.

BACKGROUND: Earlier scales on mindful eating do not measure mindful eating independent from emotional or external eating, or mindful eating in common situations. OBJECTIVE: The objective was to develop a new instrument to measure the attention element of mindful eating, the Mindful Eating Behavior Scale (MEBS), and to compute the internal structure, reliabilities, and convergent validity of this scale. DESIGN: A cross-sectional ancillary study within the Longitudinal Aging Study Amsterdam was conducted between fall 2014 and spring 2015. PARTICIPANTS/SETTING: Participants were 1,227 Dutch adults aged 55 years and older from the Longitudinal Aging Study Amsterdam. MAIN OUTCOME MEASURE: A selection of 20 items from existing instruments was used to design an initial version of the MEBS. STATISTICAL ANALYSES PERFORMED: The internal structure of the MEBS was evaluated using an exploratory structural equation modeling approach on half of the sample and confirmatory factor analysis on the whole sample to develop the final version of the scale. The measurement invariance of the scores was tested with respect to sex, age, and body mass index. Reliabilities of subscales were determined with Cronbach's α. To test convergent validity, the scores of the new scale were correlated with theoretically relevant variables. RESULTS: Two items were deleted because of low item loadings and one item because of high correlated uniqueness. The final confirmatory factor analysis model with 17 items and four domains (Focused Eating, Hunger and Satiety Cues, Eating with Awareness, and Eating without Distraction) showed good fit (comparative fit index=0.97, Tucker-Lewis index=0.96, and root mean square error of approximation=0.04). Measurement invariance was found for sex, age, and body mass index. Cronbach's α values were medium to high (.70 to .89). Most correlations were in the expected directions, which indicated good preliminary convergent validity. CONCLUSIONS: The MEBS was successfully developed consisting of 17 items and four domains. Because of low interfactor correlations, a total score combining the four domains should not be computed. The MEBS showed good internal consistency and preliminary convergent validity in a sample of Dutch adults aged 55 years and older.

Eating styles in major depressive disorder: Results from a large-scale study.

Depressed persons have been found to present disturbances in eating styles, but it is unclear whether eating styles are different in subgroups of depressed patients. We studied the association between depressive disorder, severity, course and specific depressive symptom profiles and unhealthy eating styles. Cross-sectional and course data from 1060 remitted depressed patients, 309 currently depressed patients and 381 healthy controls from the Netherlands Study of Depression and Anxiety were used. Depressive disorders (DSM-IV based psychiatric interview) and self-reported depressive symptoms (Inventory of Depressive Symptomatology) were related to emotional, external and restrained eating (Dutch Eating Behavior Questionnaire) using analyses of covariance and linear regression. Remitted and current depressive disorders were significantly associated with higher emotional eating (Cohen's d = 0.40 and 0.60 respectively, p < 0.001) and higher external eating (Cohen's d = 0.20, p = 0.001 and Cohen's d = 0.32, p < 0.001 respectively). Little differences in eating styles between depression course groups were observed. Associations followed a dose-response association, with more emotional and external eating when depression was more severe (both p-values <0.001). Longer symptom duration was also associated to more emotional and external eating (p < 0.001 and p = 0.001 respectively). When examining individual depressive symptoms, neuro-vegetative depressive symptoms contributed relatively more to emotional and external eating, while mood and anxious symptoms contributed relatively less to emotional and external eating. No depression associations were found with restrained eating. Intervention programs for depression should examine whether treating disordered eating specifically in those with neuro-vegetative, atypical depressive symptoms may help prevent or minimize adverse health consequences.

A systematic review and secondary data analysis of the interactions between the serotonin transporter 5-HTTLPR polymorphism and environmental and psychological factors in eating disorders.

OBJECTIVES: To summarize and synthesize the growing gene x environment (GxE) research investigating the promoter region of the serotonin transporter gene (5-HTTLPR) in the eating disorders (ED) field, and overcome the common limitation of low sample size, by undertaking a systematic review followed by a secondary data meta-analysis of studies identified by the review. METHOD: A systematic review of articles using PsycINFO, PubMed, and EMBASE was undertaken to identify studies investigating the interaction between 5-HTTLPR and an environmental or psychological factor, with an ED-related outcome variable. Seven studies were identified by the systematic review, with complete data sets of five community (n = 1750, 64.5% female) and two clinical (n = 426, 100% female) samples combined to perform four secondary-data analyses: 5-HTTLPR x Traumatic Life Events to predict ED status (n = 909), 5-HTTLPR x Sexual and Physical Abuse to predict bulimic symptoms (n = 1097), 5-HTTLPR x Depression to predict bulimic symptoms (n = 1256), and 5-HTTLPR x Impulsiveness to predict disordered eating (n = 1149). RESULTS: Under a multiplicative model, the low function (s) allele of 5-HTTLPR interacted with traumatic life events and experiencing both sexual and physical abuse (but not only one) to predict increased likelihood of an ED and bulimic symptoms, respectively. However, under an additive model there was also an interaction between sexual and physical abuse considered independently and 5-HTTLPR, and no interaction with traumatic life events. No other GxE interactions were significant. CONCLUSION: Early promising results should be followed-up with continued cross-institutional collaboration in order to achieve the large sample sizes necessary for genetic research.

The mediation effect of emotional eating between depression and body mass index in the two European countries Denmark and Spain.

In two European countries with a different prevalence of depression, namely Denmark (high) and Spain (low), we assessed whether the mediation effect of emotional eating between depression and Body Mass Index (BMI) as found in earlier studies can be replicated and whether this mediation effect is contingent on 1) change in appetite and 2) gender. Mediation and moderated mediation was assessed with Hayes' PROCESS macro in SPSS. Emotional eating (DEBQ: Dutch Eating Behavior Questionnaire), depressive symptoms (CES-D: Center for Epidemiologic Studies Depression Scale), change in appetite, weight and height were self-reported. In both countries, emotional eating acted as a mediator between depression and BMI (Denmark: B = 0.03 (SE = 0.01), 95% CI, [0.03, 0.05]; Spain: B = 0.03 (SE = 0.01), 95% CI, [0.02, 0.04]). In Denmark this mediation effect was stronger for participants with increased appetite and for females than for participants with decreases/no change in appetite and for males (more appetite: B = 0.08, (SE = 0.03), [0.03, 0.15]; decreased appetite/no change in appetite: B = 0.03 (SE = 0.01), [0.02, 0.04]); females: B = 0.05 (SE = 0.01), [0.03, 0.07]; males: B = 0.01 (SE = 0.01), [0.004, 0.04]. This supports depression with atypical features as an underlying mechanism in the mediation effect of emotional eating. In Spain there was no support for depression with atypical features as underlying mechanism because the mediation effect was neither moderated by change in appetite nor by gender. Instead, post-hoc analyses suggested 'stress of unemployment' as possible explanatory factor of the mediation effect, with stronger mediation effects for unemployed than for employed people (unemployed: B = 0.05 (SE = 0.01), [0.03, 0.07]; employed B = 0.02 (SE = 0.01), [0.01, 0.04]). The mediating effect of emotional eating between depressive symptoms and body mass index in both countries suggests that obesity interventions should take emotional eating into account.

Internal Structure and Measurement Invariance of the Dutch Eating Behavior Questionnaire (DEBQ) in a (Nearly) Representative Dutch Community Sample.

The Dutch Eating Behavior Questionnaire is a widely used instrument for assessment of emotional, external and restrained eating. The aim of the present study is to (i) analyse its internal structure using exploratory structural equation modelling; (ii) to assess its measurement invariance with respect to sex, BMI, age and level of education; and (iii) to evaluate the relations of the factors with these variables. Except that women were slightly over-represented, the sample (n = 2173) closely followed the sociodemographic characteristics of the overall Dutch population. The three theoretical factors that emerged from the analysis were in close correspondence with the three scales for emotional, external and restrained eating. Only two items (item 3 - 'desire to eat when nothing to do…' and item 21 - 'resist delicious food...') presented problematic loadings. The questionnaire showed satisfactory measurement invariance, and expected patterns of mean differences and relations were found. All in all, the results highlight the adequate psychometric properties of the Dutch Eating Behavior Questionnaire. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.

Emotional eating as a mediator between depression and weight gain.

Depression is often associated with weight gain but underlying mechanisms are unclear. This study assessed whether three psychological eating styles (emotional eating, external eating and restrained eating) act as mediators between depression and weight gain. We used structural equation modelling to test the hypothesized mediation models in a sample of 298 fathers and 294 mothers by assessing self-reported eating styles (Dutch Eating Behavior Questionnaire), depressive feelings (Depressive Mood List) and body mass index (BMI) at baseline and BMI after five years. In the model with emotional eating we also assessed the moderation effect of 5-HTTLPR genotype in a sub-sample of 520 Caucasians. All analyses were performed separately for the two sexes. Although the overall effect of depression on weight gain was statistically non-significant in both sexes, there was a causal chain between depression, emotional eating and weight gain in the mothers. Depressive symptoms were related to higher emotional eating and emotional eating predicted greater increases in BMI independently of depression. Moreover, the indirect effect (via emotional eating) of depression on BMI change was significant (Beta = 0.18, P = 0.026). This mediation effect was found to be independent of 5-HTTLPR genotype. No such mediation effect was found for the fathers. Further, external eating and restrained eating did not act as mediators between depression and weight gain in either sex. The finding that emotional eating acted as mediator between depression and weight gain in the mothers suggests that obesity interventions should take emotional eating into account.

Is desire to eat in response to positive emotions an 'obese' eating style: Is Kummerspeck for some people a misnomer?

Is desire to eat in response to positive emotions an 'obese' eating style: a style more prevalent in people with obesity? In other words: Is Kummerspeck (German: sorrow-fat) for some people a misnomer? This question was addressed in three studies on women. Study 1 (n = 188) tested the moderator effect of subjective well-being on the association of BMI with the scale on desire to eat in response to negative emotions (DEBQ-E). Study 2 tested in women (n = 832) whether items on desire to eat in response to positive emotions loaded on the same factor as those in response to negative emotions and body mass. Study 3 assessed in the total sample (n = 203) and an overweight subsample (n = 40) a) whether self-reported desire to eat in response to positive emotions predicted actual food intake and b) whether this also held true over and above self-reported desire to eat in response to negative emotions. Study 1 showed only for women with low positive affect a significant positive association of BMI with DEBQ-E. In Study 2, only items on desire to eat in response to negative emotions loaded on the same factor as BMI. Study 3: In the total sample, the significant effect on food intake of the scale on desire to eat in response to positive emotions disappeared when a scale on desire to eat in response to negative emotions was added to the model. In the overweight-subsample there was only an effect on food intake for desire to eat in response to negative emotions. It is concluded that only desire to eat in response to negative emotions is an 'obese' eating style, suggesting that Kummerspeck is not a misnomer.