Does food intake mediate the association between mindful eating and change in depressive symptoms?

OBJECTIVE: To examine mediation by (i) diet quality and (ii) diet quantity in the associations of mindful eating domains with 3-year change in depressive symptoms. DESIGN: Depressive symptoms were measured with the Center for Epidemiologic Studies Depression scale at baseline and 3-year follow-up. Four mindful eating domains (Focused Eating; Eating in response to Hunger and Satiety Cues; Eating with Awareness; Eating without Distraction) were measured with the Mindful Eating Behavior Scale. Food intake was measured with a 238-item FFQ. Diet quality was defined as the Mediterranean Diet Score (MDS). Diet quantity was defined as total energy intake (kcal/d; 1 kcal = 4·184 kJ). Mediation analyses with percentile-corrected bootstrap confidence intervals were conducted to calculate indirect effects. SETTING: Longitudinal Aging Study Amsterdam. PARTICIPANTS: Adults aged 55 years or above (n 929). RESULTS: Diet quality (MDS) did not mediate associations of any of the four mindful eating domains with change in depressive symptoms. In contrast, total energy intake did mediate the associations with change in depressive symptoms for the mindful eating domains Eating with Awareness (indirect effects fully adjusted models: B = -0·014, 95 % CI -0·037, -0·002) and Eating without Distraction (B = -0·013, 95 % CI -0·033, -0·001), but not for the other two domains. Post hoc multiple mediation analyses showed similar results. CONCLUSIONS: Higher scores on two mindful eating domains were associated with a decrease in depressive symptoms through lower total energy intake. Diet quantity, but not diet quality, could be a possible underlying mechanism in the associations between mindful eating and change in depressive symptoms.

Mindful eating and change in depressive symptoms: Mediation by psychological eating styles.

Earlier cross-sectional research showed that a higher level of mindful eating is associated with less depression. This study investigated associations of attentive mindful eating with change in depressive symptoms, as well as mediation by psychological eating styles, in the Longitudinal Aging Study Amsterdam (n = 946). The mindful eating domains Focused Eating, Eating in response to Hunger and Satiety Cues, Eating with Awareness and Eating without Distraction were measured by the Mindful Eating Behavior Scale. Three-year change in depressive symptoms was measured with the Center for Epidemiologic Studies Depression Scale. Emotional, external and restrained eating were measured by the 20-item version of the Dutch Eating Behaviour Questionnaire. Higher baseline scores on Focused Eating, Eating with Awareness and Eating without Distraction were associated with a 3-year decrease in depressive symptoms. Eating in response to Hunger and Satiety Cues was not associated with a change in depressive symptoms. Multiple mediation models showed mediation by external eating for the domains Eating with Awareness, Eating without Distraction, and Eating in response to Hunger and Satiety Cues, but no mediation by emotional and restrained eating. No mediation by the eating styles was found for Focused Eating. In this study, higher scores on three mindful eating domains were associated with a decrease in depressive symptoms. Mediation analyses suggest that three domains are associated with depression through external eating.

Validation of the Dutch Eating Behavior Questionnaire (DEBQ) in a sample of Spanish women.

The Dutch Eating Behavior Questionnaire (DEBQ) was developed to measure eating styles that may contribute to or attenuate the development of overweight. It comprises three scales that measure emotional, external and restrained eating. The main goal of this study is to evaluate the internal structure of the Spanish version of the DEBQ using updated psychometric techniques in a sample of women. A sample of 647 Spanish females answered the questionnaire. Both exploratory structural equation modeling and confirmatory factor analysis were used to evaluate the factor structure of the DEBQ. Reliabilities were estimated with Cronbach's alpha. The relations between the subscales of the DEBQ and age, BMI, and scores on the Eating Attitude Test-26 (EAT) and the Restrained Scale-Revised (RS) were computed with Pearson correlations. Results showed that the internal structure was similar to the theoretical proposal, although items associated with boredom and idleness presented cross-loading problems. The reliability estimates were satisfactory. The Emotional and External Eating factors correlated with the BMI, and External Eating was negatively correlated with age. The Restraint factor of the DEBQ showed significant relationships with scales of the EAT-26 and RS. The dimensional validity of the DEBQ is reproduced in a Spanish sample, and the DEBQ seems to be an effective instrument for research in Spanish females. Minor modifications to the DEBQ are recommended.

Emotional eating and food intake after sadness and joy.

Do people with a high score on a scale for eating in response to negative emotions also show high food intake in response to positive emotions? We studied these effects in 60 female students that were preselected on the basis of extreme high or low scores on an emotional eating questionnaire. Using a between subject design we experimentally tested the difference in food intake following a mood induction designed to induce joy or sadness (the joy vs. sad mood condition). The high and low emotional eaters did not differ in their food intake, but emotional eating significantly moderated the relationship between mood condition and food intake. Whereas low emotional eaters ate similar amounts after the sad and after the joy mood condition, high emotional eaters ate significantly more after the sad mood condition than after the joy mood condition. A further finding was that a similar moderator effect for emotional eating was found for intake of sweet food but not for intake of salty food. These findings would suggest that eating in response to negative and to positive emotions refer to two different constructs.

The dual pathway model of overeating. Replication and extension with actual food consumption.

van Strien et al. [van Strien, T., Engels, R. C. M. E., van Leeuwe, J., Snoek, H. M. (2005). The Stice model of overeating: tests in clinical and non-clinical samples. Appetite, 45, 205-213] extended the negative affect pathway of Stice's dual pathway model of overeating Stice [Stice, E. (1994). Review of the evidence for a sociocultural model of bulimia nervosa and an exploration of the mechanisms of action. Clinical Psychology Review, 14(7), 633-661] successfully with the variables lack of interoceptive awareness and emotional eating. This study aimed to replicate these findings in a sample of female college students with food consumption as the measure for overeating. Structural equation modeling was used to test the original and the extended model and both models fitted. In the extended model, the relation between negative affect and consumption seemed to run only via lack of interoceptive awareness and emotional eating.

Associations of mindful eating domains with depressive symptoms and depression in three European countries.

OBJECTIVE: To examine associations of mindful eating domains with depressive symptoms and depression in three European countries. Moderation by change in appetite-with increased appetite as marker for depression with atypical features - was also tested. METHODS: Data were collected in Denmark (n = 1522), Spain (n = 1512) and the Netherlands (n = 1439). Multiple linear and logistic regression analyses segregated by country were used to test associations of four mindful eating domains (Mindful Eating Behaviour Scale; MEBS) with depressive symptoms (continuous score on the Center for Epidemiologic Studies Depression Scale; CES-D) and depression (score above the CES-D cut-off value, and/or use of antidepressants, and/or psychological treatment). Moderation by change in appetite was tested with bias-corrected bootstrap confidence intervals. RESULTS: The domains Focused Eating, Eating with Awareness and Eating without Distraction were significantly negatively associated with depressive symptoms and depression in all three countries (e.g. Focused Eating Denmark: B = - 0.71, 95% CI: - 0.87, - 0.54; OR = 0.89, 95% CI: 0.86, 0.93). The domain Hunger and Satiety Cues (only measured in the Netherlands) was significantly positively associated with depressive symptoms in the adjusted models (B = 0.09, 95% CI: 0.02, 0.16), but not with depression (OR = 1.02, 95% CI: 0.98, 1.05). These associations were found for both people with and without increased appetite. LIMITATIONS: The cross-sectional design, which makes it impossible to draw causal conclusions. CONCLUSIONS: The present study indicates that higher scores on three mindful eating domains are consistently associated with a lower level of depressive symptoms and a lower likelihood of having depression in three European countries.

Neither restrained eating nor tendency toward overeating predict food consumption after tension induction.

The present study investigates whether the so-called disinhibition effect is better accounted for by tendency toward overeating than by restraint. The rationale was that in mood-induction studies, so far, the disinhibition effect has only been found in studies that applied the Restraint Scale and hardly ever in studies that used other restraint scales. Tension was induced by the public-speaking method in half of 86 female college students before they participated in an alleged taste test. The Restraint Scale (RS), the Three-Factor Eating Questionnaire (TFEQ) and the Dutch Eating Behaviour Questionnaire (DEBQ) were used to measure restraint and tendency toward overeating. No differences were found between the tension and the control condition as to the amounts of food the participants ate. Also no proof of the disinhibition effect was obtained and, remarkably, tendency toward overeating did not predict the amount of food eaten. Possible explanations for these results are offered in the discussion.

Assessment of emotional, externally induced and restrained eating behaviour in nine to twelve-year-old obese and non-obese children.

Are there differences in eating behaviour between obese and non-obese children? Using the parent version of the Dutch Eating Behaviour Questionnaire (DEBQ-parent version), the results of the present study suggest an affirmative answer to this question. The scores for obese children were significantly higher on the scales for emotional, external and restrained eating behaviour. Relationships were found between emotional eating and negative feelings of physical competence; between external eating and negative feelings of self-worth; and between both eating styles and various aspects of problem behaviour. No relationship was found between external eating and locus of control. Higher scores on both scales were associated with greater caloric intake. These findings suggest that DEBQ can be used as a screening instrument for assessing eating styles of obese children.

The concurrent validity of a classification of dieters with low versus high susceptibility toward failure of restraint.

It has been experimentally shown that the population of high restrained eaters consists of two subpopulations, i.e., those with a low and those with a high susceptibility toward failure of restraint. Only those who combined high restraint with high scores on the disinhibition scale of the TFEQ (Three-Factor Eating Questionnaire) showed overeating after a preload. The aim of the present study was to assess the concurrent validity of a two-factorial classification using the Dutch Eating Behavior Questionnaire (DEBQ) scales for restraint, emotional and external eating, as well as the bulimia scale of the Eating Disorder Inventory (EDI) for locating dieters with low or high susceptibility toward failure. It was examined whether the resulting two-group classification is associated with self-reported behaviors and features of psychopathology, which are generally thought to differentiate both groups of dieters. The results indicated that the two-group classification was indeed associated with many of these behaviors and features of psychopathology. It was concluded that this classification has a good concurrent validity.

On the relationship between emotional and external eating behavior.

Although there is a strong relationship between emotional and external eating, separate subscales for these behaviors have been constructed in the Dutch Eating Behavior Questionnaire. This study tries to establish whether this distinction is justified. We studied relationships among self-reported ( 1) degree of emotional and external eating behavior and (2) problems with (a) emotional distress and relationships, (b) stimulus-boundness (inappropriate amounts of either too much or too little exercise, work, leisure activities, and spending money), and (c) problems with substance use (alcohol, illicit drugs, nicotine, or caffeine) in a sample of female students. No relationships were found between either type of eating behavior and problems with substance use. Furthermore, the significant relationship between emotional and external eating behavior and stimulus-boundness disappeared in the subsample who had problems with overeating. The fact that in all samples emotional eating was significantly related to problems with emotional distress and relationships (anxiety, depression, phobias, suicidal acts or ideations, intimate relations, and sexual contacts) but external eating was not, suggests that the two types of eating behaviors refer to independent constructs. Thus, the use of separate scales to measure these theoretically different aspects of overeating seems warranted.

Eating behavior, personality traits and body mass in women.

In an exploratory study in women, the relationships between scales of emotional eating, external eating, and restrained eating, and body mass index (BMI = weight/height2) were studied, as well as the interrelationships between these three eating behavior components. In addition, the relationships between the three eating behavior scales and 19 personality scales were examined. Finally, differences between obese and latent obese women with respect to eating behavior and personality were investigated. Significant relationships were found between BMI and emotional eating, and between BMI and external eating/perceived hunger, but not between BMI and Restrained Eating. Also, restrained eating was found not to be related to the other two eating behavior components. Of the three eating behavior components, emotional eating was shown to have the clearest relationships with a number of personality traits. No difference was observed between the eating behavior of latent obese and obese women, but these groups differed as to a number of personality traits. These results are discussed in terms of consequences for prevalent theories on restrained, external, and emotional eating.

Eating style, television viewing and snacking in pre-adolescent children.

INTRODUCTION: Television viewing is considered to be a risk factor for overweight in children because of its association with reduced physical activity and increased calorie intake. OBJECTIVE: The aim of the present study is to examine whether eating styles affect the relationship between television viewing (TV-viewing) and snacking. METHOD: In a sample of 962 pre-adolescents, self-reported television viewing and snacking were assessed in relation to dietary restraint, external eating and emotional eating, as measured with the child version of the Dutch Eating Behavior Questionnaire. With regression analyses we assessed the possible moderating role of emotional, external and restrained eating on the relation between TV-viewing and snacking. In all analyses we controlled for age, sex, BMI and the possible confounding effects of the other eating styles. RESULTS: Emotional eating, and not dietary restraint or external eating, moderated the relationship between TV-viewing and snacking. CONCLUSION: TV-viewing seems to be more strongly related to snacking in children with higher levels of emotional eating. TV-viewing may also be a risk factor for the development of emotional eating.

Group dialectical behavior therapy adapted for obese emotional eaters; a pilot study.

Dialectical Behavior Therapy (DBT) has been shown to effectively target binge eating disorder (BED). This study pilots the effectiveness of group DBT for obese "emotional eaters" to reduce eating psychopathology and achieve weight maintenance. Thirty-five obese male and female emotional eaters receiving 20 group psychotherapy sessions of DBT adapted for emotional eating were assessed at end-of-treatment and 6 month follow-up for reductions in eating psychopathology and weight maintenance. DBT resulted in significant reductions in emotional eating and other markers of eating psychopathology at the end-of-treatment that were maintained at follow-up. The drop-out rate was very low, with only 1 participant dropping from treatment. Thirty-three (94%) of the sample provided data at every assessment point. Of these, 80% achieved either weight reduction or weight maintenance after treatment and throughout the follow-up period. The effect size for weight reduction was small. This pilot study demonstrates group DBT targeting emotional eating in the obese to be a highly acceptable and effective intervention for reducing eating related psychopathology at both at end-of-treatment and during follow-up. The ability of DBT to limit the upward trajectory of weight gain in obese patients with high degrees of emotional eating suggests that DBT may also help limit the increase or even prevent onset of obesity related morbidity in these patients.

In defense of psychosomatic theory: a critical analysis of Allison and Heshka's critical analysis.

This article analyses Allison and Heshka's (Internal Journal of Eating Disorders, 13, 289-295, 1993.) critical analysis of studies supporting psychosomatic theory. Questionned first is, Allison and Heshka's contention that the obese overreport emotional eating as a result of effects of demand characteristics, social desirability, and interpersonal expectancies. These effects, however, indicate that a more plausible response would be an underreport of emotional eating. Also addressed is Allison and Heshka's (Eating Disorders: The Journal of Treatment and Prevention, 1, 31-38, 1993.) contention that a high correlation between a measurement instrument and a measure of social desirability invalidates that measurement instrument. Finally, in a rebuttal of Allison and Heshka's critical analysis of studies supporting psychosomatic theory, it is elaborated why emotional eating explains so little variance in weight gain and obesity.

Ice-cream consumption, tendency toward overeating, and personality.

OBJECTIVE: The exploration of the mechanisms underlying the tendency toward overeating by investigating the Dutch Eating Behavior Questionnaire (DEBQ)/Revised Eating Disorders Inventory (EDI-R) disinhibition, in sequence to the milkshake-ice cream study (van Strien, Cleven, and Schippers, in press). METHOD: In hierarchical multiple regression analyses, the relative predictive power for ice-cream consumption was assessed, that is, emotional versus external versus bulimic eating using scales of the DEBQ and the EDI-R. In nonplanned stepwise multiple regression analyses, the association was assessed between these three types of eating behaviors and non-eating-related EDI-R scales. RESULTS: Emotional eating was the most important variable for ice-cream consumption. External eating was borderline significant and bulimic eating nonsignificant when emotional and external eating had been partialled out. Emotional eating was best predicted by the EDI-R scales Asceticism, Interoceptive Awareness, and Social Insecurity. DISCUSSION: Results are consistent with psychosomatic theory, which focuses on emotional eating as the result of confusion and apprehension in recognizing and accurately responding to emotional and visceral states related to hunger and satiety.

Success and failure in the measurement of restraint: notes and data.

OBJECTIVE: The clarification of the present confusion about the confounding of success and failure in the measurement of restrained eating. METHOD: Close inspection of results regarding the Restraint Scale (RS) and the restraint scales of homogeneous measures of restrained eating, for example, the restraint scales of the Three-Factor Eating Questionnaire (TFEQ) and the Dutch Eating Behaviour Questionnaire (DEBQ). RESULTS: Various studies have led to the distinction of two different types of confounding of success and failure in the measurement of restrained eating. The first confounding is associated with the RS and the inability of its scores to differentiate between inhibition and disinhibition of restraint in one person, as a result of variance across time within one person in food intake and binging. The second type of confounding applies to the homogeneous measures of restrained eating, for example, the restraint scales of the TFEQ and DEBQ. Here the confounding is associated with the inability of their restraint scores to differentiate between dieters with low versus high susceptibility toward failure of restraint, as a result of variance across persons in food intake and binging. DISCUSSION: In contrast to the first confounding, the confounding of successful and unsuccessful dieters in subjects with high restraint scores can be easily unconfounded, by using a two-factorial classification including both scores on "pure" measures of restraint and scales for tendency toward overeating. For future research, the distinction between successful and unsuccessful dieters is an important first step in clarifying why some dieters do overeat under certain conditions.

On the relationship between dieting and "obese" and bulimic eating patterns.

OBJECTIVE: Relationships were studied between emotional, external and restrained eating behavior, and bulimia, and also between these types of eating behavior and body dissatisfaction and drive for thinness. METHOD: The sample consisted of female adolescents. Eating behavior and body evaluation were measured with scales of the Dutch Eating Behaviour Questionnaire (DEBQ) and the Eating Disorders Inventory (EDI). RESULTS: Significant and high relationships were found between emotional and external and bulimic eating behavior. The same was true for restrained eating, and body dissatisfaction and drive for thinness. However, results from factor analyses suggest that the three types of overeating do not point to one and the same construct. Further, also restrained eating was found to point at a different construct than the construct associated with body dissatisfaction and drive for thinness. Finally, no high relationships were found between restrained eating and "obese" or bulimic eating patterns. DISCUSSION. The low relationship between restrained eating and various types of overeating is in line with earlier results with the DEBQ Restraint scale and offers further support for the contention that the excessive food intake found in subjects with high scores on the Herman and Polivy's Restraint Scale (RS) may be an artefact of the RS, as a result of its bias towards the selection of a counterregulating sample.

On longitudinal versus cross-sectional studies of obesity: possible artefacts.

Within the framework of a large-scale research project on overweight, relationships between body mass index (BMI; weight/height) and two types of eating behaviour (restrained eating and emotional eating) were determined. All results obtained on one assessment date in a longitudinal study within this project were found to differ significantly from those of a cross-sectional study. The present study aimed to replicate these results on another assessment date of the same longitudinal study, and in another cross-sectional sample. The two types of studies were found to differ systematically. This difference may well be attributable to greater prevalence in the longitudinal study of the response set, acquiescence in the women of normal weight, and social desirability in the overweight women. These response biases may have resulted from sensitization of the subject to the questionnaires, and also from the intensive contact between subject and investigator due to repeated measurements. Thus in further studies use of independent response-set marker scales is recommended to improve identification and control of response sets.

Restraint, tendency toward overeating and ice cream consumption.

OBJECTIVE: The examination of the prediction of grams of ice cream eaten by preload, restraint, susceptibility toward overeating, and interaction terms. METHOD: A milkshake-ice cream study on 200 females using the Restraint Scale (RS) and the restraint and disinhibition scales from the Three-Factor Eating Questionnaire (TFEQ) and the Dutch Eating Behavior Questionnaire (DEBQ). Restraint and tendency toward disinhibition are treated as continuous variables in hierarchical step up multiple regression analyses. RESULTS: There was no disinhibition effect, as subjects did not overeat after the milkshake, neither in function of their restraint nor in function of their tendency toward overeating or any interactions between these. Tendency toward overeating was the most important variable for ice cream consumption. Restraint itself, the part that remained after tendency toward overeating had been partialed out, was not related to ice cream consumption. In terms of its association with ice cream consumption, the DEBQ disinhibition scale seems more promising than the TFEQ disinhibition scale. DISCUSSION: Restraint theory seems mainly valid for dieters with a tendency toward overeating. Tendency toward overeating may even be a better predictor than restraint, opening the possibility that overeating precedes dieting.

Validation of the eating disorders inventory in a nonclinical population using transformed and untransformed responses.

In the present study, the validity of the Eating Disorder Inventory (EDI) in a Dutch nonclinical female school population was established. The data were analyzed in two ways. In the first analyses, the factorial integrity of the questionnaire, and the internal consistencies of the subscales were not found to be very satisfactory. The data showed an impressive lack of variability. It was suggested by the authors that in a nonclinical population the variability of the EDI data is being suppressed as a result of the fact that, in concordance with the manual, the original 6-point EDI items were transformed into 4-point items. In the second analyses, this item transformation was ejected. The psychometric properties of all EDI subscales in the present study improved. Implications for the use of the untransformed EDI as a screening instrument were discussed.