Eating Behaviors 14 (2013) 525–528
Contents lists available at ScienceDirect
Eating Behaviors
The relationship between emotional eating and weight problem perception is not a function of body mass index or depression☆ Ashley A. Wiedemann ⁎, Karen K. Saules Eastern Michigan University, Psychology Department, Ypsilanti, MI, United States
a r t i c l e
i n f o
Article history: Received 18 January 2013 Received in revised form 31 May 2013 Accepted 15 July 2013 Available online 21 July 2013 Keywords: Emotional eating Weight status Body mass index
a b s t r a c t Weight problem perception (WPP) refers to the belief that one is overweight. Previous research suggests that WPP, even in the absence of actual overweight status, is associated with disordered eating, binge eating, and body image dissatisfaction. However, the relationship between emotional eating, BMI, and WPP has not yet been explored. This investigation recruited a total of 409 college students who completed a web-based survey. An additional 76 participants were recruited to complete an identical survey with the addition of a depression measure to evaluate the contribution of this potentially important covariate. As hypothesized, WPP was associated with emotional eating, while actual BMI was not. In the second sample, WPP remained significantly associated with emotional eating, even after depression was included as a covariate. Results suggest that nonoverweight young adults who express the belief that they are overweight may be at risk for emotional eating, which, over the long term, could indeed adversely impact BMI. Cognitive approaches to address disordered eating may benefit from addressing WPP. © 2013 Elsevier Ltd. All rights reserved.
1. Introduction Weight problem perception (WPP) refers to the belief that one is overweight (Saules et al., 2009). In the literature, this construct has also been referred to as “perceived weight status” (Bardone-Cone, Abramson, Vohs, Heatherton, & Joiner, 2006), “body image perception” (Nicoli & Junior, 2011), “perception of overweight” (Fonseca & Gaspar de Matos, 2005), “self-perception of body weight” (Siqueira, Appolinário, & Sichieri, 2005), “self-reported weight status” (Strauss, 1999), “body weight perception” (ter Bogt et al., 2006), “fat body-weight self schema” (Stein & Corte, 2003) and perhaps other variants. This discrepant terminology across studies has led to a lack of integration of findings, which have been remarkably consistent, but perhaps relatively unknown. Stein and Corte (2003) suggest that having an inflexible “fat bodyweight self schema” may confer vulnerability to disordered eating behaviors, and the literature largely supports this notion. Specifically, research suggests that WPP is associated with dieting (Strauss, 1999), binge eating (Nicoli & Junior, 2011; Saules et al., 2009), bulimia (Bardone-Cone et al., 2006), psychological distress (Atlantis & Ball, 2008) and, in adolescents, internalizing and externalizing problem behavior (ter Bogt et al., 2006). In general, the literature suggests that ☆ Preparation of this manuscript was supported by the Eastern Michigan University Department of Psychology and the EMU Graduate School. Data presented in this manuscript were included in a preliminary report presented at the Annual Meeting of Association for Behavioral and Cognitive Therapies (ABCT, November, 2011). ⁎ Corresponding author at: EMU Psychology Clinic, 611 W. Cross Street, Ypsilanti, MI 48197, United States. Tel./fax: + 1 734 487 4989. E-mail address: [email protected] (A.A. Wiedemann). 1471-0153/$ – see front matter © 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.eatbeh.2013.07.003
WPP is associated with disordered eating behavior beyond that which can be predicted by BMI and other known correlates of disordered eating (Saules et al., 2009). Emotional eating is common among those with Binge Eating Disorder (BED), but it appears to be unrelated to BMI (Masheb & Grilo, 2006). The association between emotional eating and BED may be mediated by attentional and motor impulsivity (leading to loss of control over eating), given that emotional eating is associated with these types of impulsivity (Ebneter, Latner, Rosewall, & Chisholm, 2012). Relative to other forms of disordered eating, emotional eating has been less studied and its association with WPP has not yet been documented. Based on the extant WPP literature, however, which supports strong and consistent relationships with other forms of disordered eating, we hypothesized that emotional eating would be associated with WPP but not BMI. It was also hypothesized that this relationship would remain significant after controlling for depression. 2. Method 2.1. Participants Participants were undergraduate students recruited from psychology classes at a Midwestern university between Fall 2011 and Summer 2012. 2.2. Procedures A member of the research team solicited e-mail addresses from students after providing a brief overview of the study. Immediately after
526
A.A. Wiedemann, K.K. Saules / Eating Behaviors 14 (2013) 525–528
the e-mail addresses were obtained, students received an e-mail with a link to the web-based study. Participants voluntarily completed a webbased survey created using SurveyMonkey (www.surveymonkey.com). Participants may have received extra course credit for participating in psychological research, but this was not under the control of the investigators. 2.3. Measures During Wave 1 (Fall, 2011 and Winter, 2012) the web-based survey included the following measures: Multidimensional Body Self-Relations Questionnaire (MBSRQ-AS, Cash, 2000), Emotional Eating Scale (EES; Arnow, Kenardy, & Agras, 1995), and a demographics questionnaire. During Wave 2 (Spring–Summer 2012), the same measures were included, along with a measure to assess depression (PHQ-9; Spitzer, Kroenke, & Williams, 1999). 2.3.1. Multidimensional Body Self-Relations Questionnaire (MBSRQ-AS, Cash, 2000) The MBSRQ-AS is a 34-item self-report subscale of the original 69-item measure assessing attitudinal body image (Cash, 2000). More specifically, this subscale is composed of cognitive, affective, and behavioral aspects of body image. The MBSRQ-AS has strong psychometric properties demonstrating high internal consistency (α = .73 to .89 among the subscales). For the purpose of this investigation, the SelfClassified Weight subscale was used, which assesses how one perceives and labels one's weight from very underweight to very overweight. 2.3.2. Emotional Eating Scale (EES; Arnow et al., 1995) The EES (Arnow et al., 1995) is a 25-item measure designed to assess how certain emotions may lead to the urge to eat. Participants rate various emotions (e.g., angry, helpless) on a 5 point-likert scale (0 = no desire to eat, 4 = an overwhelming urge to eat, with “a small desire to eat,” and “a moderate desire to eat,” and “a strong desire to eat” at intermediate points). Scores on the EES range from 0 to 100, with higher scores reflecting a greater urge to eat in response to a negative emotional state. There are no reverse-scored items. Three subscales comprise the EES: anger/frustration (11 items), anxiety (9 items), and depressed mood (5 items). Arnow et al. (1995) examined the psychometric properties among obese females and the EES demonstrated good discriminant validity and construct validity. It also demonstrated high internal consistency among a non-eating disordered population (α = .93) (Waller and Osman, 1998).
2.3.3. Patient Health Questionnaire (PHQ) Depression Screening (PHQ-9; Spitzer et al., 1999) The PHQ-9 is a brief self-report measure based upon nine diagnostic criteria designed to assess DSM-IV symptoms of depression. The nine items for the PHQ-9 directly correspond to DSM-IV criteria for major depressive disorder over the past two weeks. Scores are calculated ranging from 0, indicating “not at all” to a 3, indicating “nearly everyday.” Scores range from 0 to 27 with higher scores reflecting greater symptom severity, with cut-points of 5, 10, 15 and 20 which correspond to mild, moderate, moderately severe and severe depression, respectively. A validation study which examined 6,000 primary care and obstetricgynecology patients reported excellent internal consistency (α = .86–.89) and test-retest reliability (.84) over 48 h (Kroenke, Spitzer & Williams, 2001). 2.3.4. Body mass index (BMI) BMI was calculated based on the participant's self-reported height and weight. 3. Data Analysis Participants were categorized as overweight or not based on selfreported height and weight. Self-perception of weight status was based on a one-item question from the self-classification scale on the MBSRQ: “I think I am: Very underweight, somewhat underweight, normal weight, somewhat overweight, very overweight (WPP: I think I'm overweight vs. I think I'm not overweight). A 2 (Weight status: Overweight, Not-overweight) X 2 (WPP: I think I'm overweight, I think I'm not overweight”) ANOVA was conducted to explore differences on the three subscales of the EES. 4. Results 4.1. Participants During Wave 1, 409 participants were sampled. Participants had a mean age of 22.34 (SD = 6.68) and the majority were female (81.1%) and Caucasian (65%). The average BMI was 26.15 (SD = 6.61), which is slightly overweight. The average EES total score for the Wave 1 sample was 24.39 (SD = 17.43). During Wave 2, 76 participants were sampled. Participants had a mean age of 23.75 (SD = 5.92) and the majority were female (69.8%) and Caucasian (68%). The average BMI was 25.95 (SD = 5.55), which is slightly overweight. The average PHQ-9 score was 15.67 (SD = 6.40),
Fig. 1. Relationship of Weight Problem Perception and Emotional Eating: EES Subscales of Anger/Frustration, Anxiety, and Depression are all significantly elevated among women who believe they are overweight, regardless of actual overweight statusa. All p's b .05. aN = 409; Overweight, Thinks Overweight (n = 163), Overweight, Thinks Not-overweight (n = 34), Not-Overweight, Thinks Overweight (n = 58), Not-Overweight, Thinks Not-Overweight (n = 154). Note. Data are from Wave 1 only.
527
15.88 4.27 4.78 7.5 2.62
35.14 11.14 12.86 11.14 19.14
± ± ± ± ±
17.97 4.22 8.97 .49 5.75
25.27 7.90 8.08 8.55 14.71
± ± ± ± ±
15.45 4.15 5.35 7.17 5.43
which corresponds to a “moderately severe” level of depression and the average EES total was 26.03 (SD = 17.51). As hypothesized, WPP was associated with emotional eating, while actual overweight classification was not. Post-hoc analyses revealed significant differences in emotional eating between those who defined themselves as overweight and not-overweight on the EES subscales of anger/frustration F (1, 405) 5.084, p = .025, partial η2 = .012, anxiety F (1, 405) 7.990, p = .005, partial η2 = .019, and depression F (1, 405) 11.205, 11.205, partial η2 = .027 (See Fig. 1). Given that Wave 1 data included limited information on mental health factors, Wave 2 assessed depression. To ensure that the relationship between WPP and emotional eating was not solely a function of depression, a 2 (overweight status) X 2 (WPP) ANCOVA was conducted, this time with depression entered as a covariate. As expected, WPP remained significantly associated with emotional eating (F (1, 75) 5.59, p b .05, partial η2 = .073), while actual overweight status and depression were not significant (See Table 1).
13.00 4.33 4.11 4.56 11.89
± ± ± ± ±
5. Discussion
21.57 ± 19.92 5.88 ± 4.34 7.27 ± 6.53 8.43 ± 7.82 n/a
30.83 9.26 9.48 12.09 17.52
± ± ± ± ±
19.01 4.26 6.81 9.63 7.88
The findings from this investigation suggest that WPP is associated with emotional eating, independent of overweight status and depression. Specifically, defining oneself as overweight is associated with a greater likelihood of emotional eating in response to anger/frustration, anxiety, and depression. These findings further highlight the importance of assessing WPP, as it may have clinical implications of the treatment of many forms of disordered eating, now including emotional eating. Simply assessing whether or not patients believe they are overweight may provide more predictive power than actual weight status when seeking to identify those most at risk for disordered eating behavior. The results of this investigation are supported by the findings of Saules et al. (2009), who found that defining oneself as overweight was associated with binge eating above and beyond gender, BMI, and depression. There were however some limitations to this investigation. The majority of both study samples were female and Caucasian; future research should examine emotional eating and WPP among a larger and more diverse population. Furthermore, data were obtained through self-report, and there is evidence that individuals tend to underreport their weight. Cash, Counts, Hangen, and Huffine (1989) found that although self-reported weight and actual weight were highly correlated, in two separate samples, 30.6% and 17.9% inaccurately defined their weight by more than 5 lb, with those in the greater weight categories more likely to underreport their weight. However, those who were not overweight but perceived themselves as overweight (WPP) scored highest on EES scores of anxiety and depression. Therefore, while overweight participants may have been more likely to underreport weight, it is the non-overweight WPP group who scored highest on emotional eating. Future research should explore whether treatments for disordered eating may be enhanced by cognitive strategies that target weight problem perception and emotional eating. The clinical significance of addressing each of these variables in isolation or combination remains an empirical question. Nonetheless, the present results and extant literature supports the importance of addressing weight problem perception as an easy to assess variable that may a harbinger of multifaceted forms of disordered eating.
a
Values are expressed as M ± SD.
27.90 ± 15.29 7.83 ± 4.45 9.86 ± 6.23 10.21 ± 7.60 n/a 20.32 ± 19.89 5.65 ± 4.54 6.59 ± 7.16 8.09 ± 9.05 n/a 26.64 ± 19.95 7.3 ± 4.55 8.52 ± 6.60 10.83 ± 8.64 n/a EES Total Score EES Depression EES Anxiety EES Anger/Frustration PHQ-9 Score
Wave 2
Not-Overweight, Thinks Overweight (n = 58) Overweight, Thinks Not-overweight (n = 34) Overweight, Thinks Overweight (n = 163)
Wave 1
Table 1 Measures of Emotional Eating Scores from Wave 1 and 2, and PHQ-9 scores from Wave 2.
Not-Overweight, Thinks Not-Overweight (n = 154)
Overweight, Thinks Overweight (n = 23)
Overweight, Thinks Not-Overweight (n = 9)
Not-Overweight, Thinks Overweight (n = 7)
Not-Overweight, Thinks Not-Overweight (n = 38)
A.A. Wiedemann, K.K. Saules / Eating Behaviors 14 (2013) 525–528
Role of funding sources The first author was supported by the Eastern Michigan University Graduate School. Contributors Wiedemann and Saules contributed equally to the study design, data analysis, and manuscript preparation. Both authors contributed to and have approved the final manuscript.
Conflict of interest The authors have no conflicts of interest to disclose.
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References Arnow, B., Kenardy, J., & Agras, W. S. (1995). The emotional eating scale: The development of a measure to assess coping with negative affect by eating. International Journal of Eating Disorders, 17, 79–90. Atlantis, E., & Ball, K. (2008). Association between weight perception and psychological distress. International Journal of Obesity, 32(4), 715–721. Bardone-Cone, A.M., Abramson, L. Y., Vohs, K. D., Heatherton, T. F., & Joiner, T. E., Jr. (2006). Predicting bulimic symptoms: An interactive model of self-efficacy, perfectionism, and perceived weight status. Behaviour Research and Therapy, 44(1), 27–42. Cash, T. F. (2000). The Multidimensional Body-Self Relations Questionnaire. Retrieved November 8, 2007, from http://www.body-images.com. Cash, T. F., Counts, B., Hangen, J., & Huffine, C. E. (1989). How much do you weigh? Determinants of validity of self-reported body weight. Perceptual and Motor Skills, 69, 248–250. Ebneter, D., Latner, J., Rosewall, J., & Chisholm, A. (2012). Impulsivity in restrained eaters: emotional and external eating are associated with attentional and motor impulsivity. Eating and Weight Disorders, 17(1), e62–e65. Fonseca, H., & Gaspar de Matos, M. (2005). Perception of overweight and obesity among Portuguese adolescents: An overview of associated factors. European Journal of Public Health, 15(3), 323–328. Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606–613. Masheb, R. M., & Grilo, C. M. (2006). Emotional overeating and its associations with eating disorder psychopathology among overweight patients with binge eating disorder. International Journal of Eating Disorders, 39(2), 141–146.
Nicoli, M. G., & Junior, R. D. (2011). Binge Eating Disorder and body image perception among university students. Eating Behaviors, 12(4), 284–288. Saules, K. K., Collings, A. S., Hoodin, F., Angelella, N. E., Alschuler, K., Ivezaj, V., et al. (2009). The contributions of weight problem perception, BMI, gender, mood, and smoking status to binge eating among college students. Eating Behaviors, 10(1), 1–9. Siqueira, K. S., Appolinário, J. C., & Sichieri, R. (2005). Relationship between binge-eating episodes and self-perception of body weight in a nonclinical sample of five Brazilian cities. Revista Brasileira de Psiquiatria, 27(4), 290–294. Spitzer, R. L., Kroenke, K., & Williams, J. B. W. (1999). Validation and utility of a self report version of PRIME-MD: The PHQ Primary Care Study. JAMA: The Journal of the American Medical Association, 282, 1737–1744. Stein, K. F., & Corte, C. (2003). Reconceptualizing causative factors and intervention strategies in the eating disorders: A shift from body image to self-concept impairments. Archives of Psychiatric Nursing, 17(2), 57–66. Strauss, R. S. (1999). Self-reported weight status and dieting in a cross-sectional sample of young adolescents: National Health and Nutrition Examination Survey III. Archives of Pediatric Adolescent Medicine, 153(7), 741–747. ter Bogt, T. F., van Dorsselaer, S. A., Monshouwer, K., Verdurmen, J. E., Engels, R. C., & Vollebergh, W. A. (2006). Body mass index and body weight perception as risk factors for internalizing and externalizing problem behavior among adolescents. Journal of Adolescent Health, 39(1), 27–34. Waller, G., & Osman, S. (1998). Emotional eating and eating psychopathology among non-eating-disordered women. The International Journal of Eating Disorders, 23(4), 419–424.
Contents lists available at ScienceDirect
Eating Behaviors
The relationship between emotional eating and weight problem perception is not a function of body mass index or depression☆ Ashley A. Wiedemann ⁎, Karen K. Saules Eastern Michigan University, Psychology Department, Ypsilanti, MI, United States
a r t i c l e
i n f o
Article history: Received 18 January 2013 Received in revised form 31 May 2013 Accepted 15 July 2013 Available online 21 July 2013 Keywords: Emotional eating Weight status Body mass index
a b s t r a c t Weight problem perception (WPP) refers to the belief that one is overweight. Previous research suggests that WPP, even in the absence of actual overweight status, is associated with disordered eating, binge eating, and body image dissatisfaction. However, the relationship between emotional eating, BMI, and WPP has not yet been explored. This investigation recruited a total of 409 college students who completed a web-based survey. An additional 76 participants were recruited to complete an identical survey with the addition of a depression measure to evaluate the contribution of this potentially important covariate. As hypothesized, WPP was associated with emotional eating, while actual BMI was not. In the second sample, WPP remained significantly associated with emotional eating, even after depression was included as a covariate. Results suggest that nonoverweight young adults who express the belief that they are overweight may be at risk for emotional eating, which, over the long term, could indeed adversely impact BMI. Cognitive approaches to address disordered eating may benefit from addressing WPP. © 2013 Elsevier Ltd. All rights reserved.
1. Introduction Weight problem perception (WPP) refers to the belief that one is overweight (Saules et al., 2009). In the literature, this construct has also been referred to as “perceived weight status” (Bardone-Cone, Abramson, Vohs, Heatherton, & Joiner, 2006), “body image perception” (Nicoli & Junior, 2011), “perception of overweight” (Fonseca & Gaspar de Matos, 2005), “self-perception of body weight” (Siqueira, Appolinário, & Sichieri, 2005), “self-reported weight status” (Strauss, 1999), “body weight perception” (ter Bogt et al., 2006), “fat body-weight self schema” (Stein & Corte, 2003) and perhaps other variants. This discrepant terminology across studies has led to a lack of integration of findings, which have been remarkably consistent, but perhaps relatively unknown. Stein and Corte (2003) suggest that having an inflexible “fat bodyweight self schema” may confer vulnerability to disordered eating behaviors, and the literature largely supports this notion. Specifically, research suggests that WPP is associated with dieting (Strauss, 1999), binge eating (Nicoli & Junior, 2011; Saules et al., 2009), bulimia (Bardone-Cone et al., 2006), psychological distress (Atlantis & Ball, 2008) and, in adolescents, internalizing and externalizing problem behavior (ter Bogt et al., 2006). In general, the literature suggests that ☆ Preparation of this manuscript was supported by the Eastern Michigan University Department of Psychology and the EMU Graduate School. Data presented in this manuscript were included in a preliminary report presented at the Annual Meeting of Association for Behavioral and Cognitive Therapies (ABCT, November, 2011). ⁎ Corresponding author at: EMU Psychology Clinic, 611 W. Cross Street, Ypsilanti, MI 48197, United States. Tel./fax: + 1 734 487 4989. E-mail address: [email protected] (A.A. Wiedemann). 1471-0153/$ – see front matter © 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.eatbeh.2013.07.003
WPP is associated with disordered eating behavior beyond that which can be predicted by BMI and other known correlates of disordered eating (Saules et al., 2009). Emotional eating is common among those with Binge Eating Disorder (BED), but it appears to be unrelated to BMI (Masheb & Grilo, 2006). The association between emotional eating and BED may be mediated by attentional and motor impulsivity (leading to loss of control over eating), given that emotional eating is associated with these types of impulsivity (Ebneter, Latner, Rosewall, & Chisholm, 2012). Relative to other forms of disordered eating, emotional eating has been less studied and its association with WPP has not yet been documented. Based on the extant WPP literature, however, which supports strong and consistent relationships with other forms of disordered eating, we hypothesized that emotional eating would be associated with WPP but not BMI. It was also hypothesized that this relationship would remain significant after controlling for depression. 2. Method 2.1. Participants Participants were undergraduate students recruited from psychology classes at a Midwestern university between Fall 2011 and Summer 2012. 2.2. Procedures A member of the research team solicited e-mail addresses from students after providing a brief overview of the study. Immediately after
526
A.A. Wiedemann, K.K. Saules / Eating Behaviors 14 (2013) 525–528
the e-mail addresses were obtained, students received an e-mail with a link to the web-based study. Participants voluntarily completed a webbased survey created using SurveyMonkey (www.surveymonkey.com). Participants may have received extra course credit for participating in psychological research, but this was not under the control of the investigators. 2.3. Measures During Wave 1 (Fall, 2011 and Winter, 2012) the web-based survey included the following measures: Multidimensional Body Self-Relations Questionnaire (MBSRQ-AS, Cash, 2000), Emotional Eating Scale (EES; Arnow, Kenardy, & Agras, 1995), and a demographics questionnaire. During Wave 2 (Spring–Summer 2012), the same measures were included, along with a measure to assess depression (PHQ-9; Spitzer, Kroenke, & Williams, 1999). 2.3.1. Multidimensional Body Self-Relations Questionnaire (MBSRQ-AS, Cash, 2000) The MBSRQ-AS is a 34-item self-report subscale of the original 69-item measure assessing attitudinal body image (Cash, 2000). More specifically, this subscale is composed of cognitive, affective, and behavioral aspects of body image. The MBSRQ-AS has strong psychometric properties demonstrating high internal consistency (α = .73 to .89 among the subscales). For the purpose of this investigation, the SelfClassified Weight subscale was used, which assesses how one perceives and labels one's weight from very underweight to very overweight. 2.3.2. Emotional Eating Scale (EES; Arnow et al., 1995) The EES (Arnow et al., 1995) is a 25-item measure designed to assess how certain emotions may lead to the urge to eat. Participants rate various emotions (e.g., angry, helpless) on a 5 point-likert scale (0 = no desire to eat, 4 = an overwhelming urge to eat, with “a small desire to eat,” and “a moderate desire to eat,” and “a strong desire to eat” at intermediate points). Scores on the EES range from 0 to 100, with higher scores reflecting a greater urge to eat in response to a negative emotional state. There are no reverse-scored items. Three subscales comprise the EES: anger/frustration (11 items), anxiety (9 items), and depressed mood (5 items). Arnow et al. (1995) examined the psychometric properties among obese females and the EES demonstrated good discriminant validity and construct validity. It also demonstrated high internal consistency among a non-eating disordered population (α = .93) (Waller and Osman, 1998).
2.3.3. Patient Health Questionnaire (PHQ) Depression Screening (PHQ-9; Spitzer et al., 1999) The PHQ-9 is a brief self-report measure based upon nine diagnostic criteria designed to assess DSM-IV symptoms of depression. The nine items for the PHQ-9 directly correspond to DSM-IV criteria for major depressive disorder over the past two weeks. Scores are calculated ranging from 0, indicating “not at all” to a 3, indicating “nearly everyday.” Scores range from 0 to 27 with higher scores reflecting greater symptom severity, with cut-points of 5, 10, 15 and 20 which correspond to mild, moderate, moderately severe and severe depression, respectively. A validation study which examined 6,000 primary care and obstetricgynecology patients reported excellent internal consistency (α = .86–.89) and test-retest reliability (.84) over 48 h (Kroenke, Spitzer & Williams, 2001). 2.3.4. Body mass index (BMI) BMI was calculated based on the participant's self-reported height and weight. 3. Data Analysis Participants were categorized as overweight or not based on selfreported height and weight. Self-perception of weight status was based on a one-item question from the self-classification scale on the MBSRQ: “I think I am: Very underweight, somewhat underweight, normal weight, somewhat overweight, very overweight (WPP: I think I'm overweight vs. I think I'm not overweight). A 2 (Weight status: Overweight, Not-overweight) X 2 (WPP: I think I'm overweight, I think I'm not overweight”) ANOVA was conducted to explore differences on the three subscales of the EES. 4. Results 4.1. Participants During Wave 1, 409 participants were sampled. Participants had a mean age of 22.34 (SD = 6.68) and the majority were female (81.1%) and Caucasian (65%). The average BMI was 26.15 (SD = 6.61), which is slightly overweight. The average EES total score for the Wave 1 sample was 24.39 (SD = 17.43). During Wave 2, 76 participants were sampled. Participants had a mean age of 23.75 (SD = 5.92) and the majority were female (69.8%) and Caucasian (68%). The average BMI was 25.95 (SD = 5.55), which is slightly overweight. The average PHQ-9 score was 15.67 (SD = 6.40),
Fig. 1. Relationship of Weight Problem Perception and Emotional Eating: EES Subscales of Anger/Frustration, Anxiety, and Depression are all significantly elevated among women who believe they are overweight, regardless of actual overweight statusa. All p's b .05. aN = 409; Overweight, Thinks Overweight (n = 163), Overweight, Thinks Not-overweight (n = 34), Not-Overweight, Thinks Overweight (n = 58), Not-Overweight, Thinks Not-Overweight (n = 154). Note. Data are from Wave 1 only.
527
15.88 4.27 4.78 7.5 2.62
35.14 11.14 12.86 11.14 19.14
± ± ± ± ±
17.97 4.22 8.97 .49 5.75
25.27 7.90 8.08 8.55 14.71
± ± ± ± ±
15.45 4.15 5.35 7.17 5.43
which corresponds to a “moderately severe” level of depression and the average EES total was 26.03 (SD = 17.51). As hypothesized, WPP was associated with emotional eating, while actual overweight classification was not. Post-hoc analyses revealed significant differences in emotional eating between those who defined themselves as overweight and not-overweight on the EES subscales of anger/frustration F (1, 405) 5.084, p = .025, partial η2 = .012, anxiety F (1, 405) 7.990, p = .005, partial η2 = .019, and depression F (1, 405) 11.205, 11.205, partial η2 = .027 (See Fig. 1). Given that Wave 1 data included limited information on mental health factors, Wave 2 assessed depression. To ensure that the relationship between WPP and emotional eating was not solely a function of depression, a 2 (overweight status) X 2 (WPP) ANCOVA was conducted, this time with depression entered as a covariate. As expected, WPP remained significantly associated with emotional eating (F (1, 75) 5.59, p b .05, partial η2 = .073), while actual overweight status and depression were not significant (See Table 1).
13.00 4.33 4.11 4.56 11.89
± ± ± ± ±
5. Discussion
21.57 ± 19.92 5.88 ± 4.34 7.27 ± 6.53 8.43 ± 7.82 n/a
30.83 9.26 9.48 12.09 17.52
± ± ± ± ±
19.01 4.26 6.81 9.63 7.88
The findings from this investigation suggest that WPP is associated with emotional eating, independent of overweight status and depression. Specifically, defining oneself as overweight is associated with a greater likelihood of emotional eating in response to anger/frustration, anxiety, and depression. These findings further highlight the importance of assessing WPP, as it may have clinical implications of the treatment of many forms of disordered eating, now including emotional eating. Simply assessing whether or not patients believe they are overweight may provide more predictive power than actual weight status when seeking to identify those most at risk for disordered eating behavior. The results of this investigation are supported by the findings of Saules et al. (2009), who found that defining oneself as overweight was associated with binge eating above and beyond gender, BMI, and depression. There were however some limitations to this investigation. The majority of both study samples were female and Caucasian; future research should examine emotional eating and WPP among a larger and more diverse population. Furthermore, data were obtained through self-report, and there is evidence that individuals tend to underreport their weight. Cash, Counts, Hangen, and Huffine (1989) found that although self-reported weight and actual weight were highly correlated, in two separate samples, 30.6% and 17.9% inaccurately defined their weight by more than 5 lb, with those in the greater weight categories more likely to underreport their weight. However, those who were not overweight but perceived themselves as overweight (WPP) scored highest on EES scores of anxiety and depression. Therefore, while overweight participants may have been more likely to underreport weight, it is the non-overweight WPP group who scored highest on emotional eating. Future research should explore whether treatments for disordered eating may be enhanced by cognitive strategies that target weight problem perception and emotional eating. The clinical significance of addressing each of these variables in isolation or combination remains an empirical question. Nonetheless, the present results and extant literature supports the importance of addressing weight problem perception as an easy to assess variable that may a harbinger of multifaceted forms of disordered eating.
a
Values are expressed as M ± SD.
27.90 ± 15.29 7.83 ± 4.45 9.86 ± 6.23 10.21 ± 7.60 n/a 20.32 ± 19.89 5.65 ± 4.54 6.59 ± 7.16 8.09 ± 9.05 n/a 26.64 ± 19.95 7.3 ± 4.55 8.52 ± 6.60 10.83 ± 8.64 n/a EES Total Score EES Depression EES Anxiety EES Anger/Frustration PHQ-9 Score
Wave 2
Not-Overweight, Thinks Overweight (n = 58) Overweight, Thinks Not-overweight (n = 34) Overweight, Thinks Overweight (n = 163)
Wave 1
Table 1 Measures of Emotional Eating Scores from Wave 1 and 2, and PHQ-9 scores from Wave 2.
Not-Overweight, Thinks Not-Overweight (n = 154)
Overweight, Thinks Overweight (n = 23)
Overweight, Thinks Not-Overweight (n = 9)
Not-Overweight, Thinks Overweight (n = 7)
Not-Overweight, Thinks Not-Overweight (n = 38)
A.A. Wiedemann, K.K. Saules / Eating Behaviors 14 (2013) 525–528
Role of funding sources The first author was supported by the Eastern Michigan University Graduate School. Contributors Wiedemann and Saules contributed equally to the study design, data analysis, and manuscript preparation. Both authors contributed to and have approved the final manuscript.
Conflict of interest The authors have no conflicts of interest to disclose.
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A.A. Wiedemann, K.K. Saules / Eating Behaviors 14 (2013) 525–528
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