Is emotional eating associated with behavioral traits and Mediterranean diet in children? A cross-sectional study | BMC Public Health

This study examined the associations between emotional eating and behavioral traits in a sample of 8- to 9-year-old Italian primary school children. It found that EUE was positively associated with emotional symptoms and EOE was positively associated with emotional symptoms and hyperactivity and inversely associated with peer problems. EUE also showed a positive association with a social environment variable (number of siblings) and an inverse association with good adherence to MD.

To the best of our knowledge, the present study is the first to find a negative association between EUE and childhood MD adherence. In particular, good adherence to MD was associated with a lower risk of EUE, while there was no such association for EOE. A previous study by Jalo et al. found a direct link between emotional overeating and an unhealthy diet in a large international sample of 9- to 11-year-old children [9]. Other studies conducted on adults and 12- to 15-year-olds showed that emotional eating is linked to eating sweet and high-fat foods [20,21,22]. On the other hand, there are also reports of no association between emotional eating and the consumption of snacks, sweet foods, or fatty foods in children aged 5 to 12 years [23, 24]. Models based on psychodynamic and developmental perspectives generally suggest that eating disorders and their various symptoms could be viewed as an impaired cognitive ability to process and regulate emotions [25]. The challenge for caregivers is to create structure and boundaries without restricting the children’s eating autonomy to the point that they no longer regulate their eating habits themselves and instead see external factors as eating cues [26]. Feeding styles capture the overall emotional climate of meals and are measured along two dimensions: responsiveness (represented by warmth, acceptance, and involvement during feeding) and entitlement (represented by parental control and monitoring of feeding). Using these two dimensions, eating behavior is often classified in one of four ways, as authoritarian, authoritarian, indulgent, or uninvolved [27]. Previous studies found that indulgent eating styles are associated with children who are less able to self-regulate their eating and emphasized the importance of setting boundaries when eating [27, 28]. From this perspective, good adherence to MD may be part of a generally positive family attitude towards nutrition. Children with a healthy diet may redirect their negative emotions to other coping strategies, thereby avoiding the risk of EUE.

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The present study also found evidence that behavioral traits are involved in both EUE and EOE, with the Emotional Symptoms subscale of the SDQ being associated with both emotional eating behaviors. The subscale includes questions about the children’s frequency of headaches, abdominal pain or nausea, worries, fears, unhappy feelings, and how they feel in new situations [13]. Food in general (and tasty food in particular) can improve our mood [29]and food can reduce the intensity of negative emotions [30]. Children whose parents offer food as an emotional regulation strategy may be prone to overeating and may learn to associate food with pleasure, leading to a greater dependence on food as a means of managing emotions rather than on eating to meet their nutritional needs [31]. However, psychological theories to explain emotional malnutrition are virtually nonexistent, and EUE has been attributed to biological mechanisms [30]. In fact, the most natural response to emotional stress is hunger suppression due to decreased gut activity when emotionally aroused [32]sympathetic activation and glucocorticoid release [33]. These former psychological and latter biological mechanisms may partially unravel our findings.

In addition, we found a relationship between EOE and two other SDQ subscales, hyperactivity and peer problems. The hyperactivity subscale of the SDQ [13] defines hyperactivity as a tendency to be restless, overactive, constantly fidgeting or squirming, easily distracted, and having poor concentration/attention spans; The construct of peer problems concerns a child’s tendency to play alone and to get along better with adults than with other children [34]. These behavioral characteristics are considered a stress factor [24]. The link between stress (including peer issues and hyperactivity) and EOE is well established, as it is defined as overeating in response to emotional arousal [24]. Food can be used as a stress management tool by reducing stress levels and increasing feelings of reward [35, 36].

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More generally, a study examining the association between the core symptoms of Attention Deficit Hyperactivity Disorder (ADHD) and eating disorders found that the inattentive symptoms of ADHD were associated with a decreased awareness of internal signals of hunger/satiety, and that deficit was Eating positively associated with a disorder, particularly binge eating/disinhibited eating [37]. Our data partially confirmed the existing literature: indeed, EOE is positively associated with hyperactivity, while peer problems are negatively associated with EOE in our results, in contrast to the previous literature. Given our conflicting data, other studies will be needed to confirm and elucidate this finding.

Finally, we found an association between the number of siblings and EUE: for each additional sibling, the likelihood of a child exhibiting EUE behavior increased by 50%. In examining emotional eating in adolescents, De Leeuw et al. found that siblings who are close and show affection and empathy tend to be more similar in their emotional eating behaviors [38]. Further research that also examines sibling characteristics is needed to clarify why the number of siblings might influence children’s emotional eating behaviors – and more generally how the family environment might influence these behaviors.

Consistent with other studies, we found no association between BMI and emotional eating [9, 23, 39], although some newspapers have supported this union. Consistent with our results, Jalo et al. emphasized their somewhat controversial finding that emotional eating is related to the health of people’s diet, but not to their BMI. It should be noted that dietary patterns are assessed in terms of diet quality rather than energy intake, while the latter may be more closely related to BMI [9]. When Jalo et al. Discussing their findings, they pointed out that most of the literature reporting positive associations between emotional eating and BMI (obesity) accounted for parent-reported emotional eating, while studies examining child-reported emotional eating mainly did the reverse found associations [9]. These discrepancies may indicate the limitations of using self-reported data, which may be influenced by social desirability. The use of self-reported measurement of diet and BMI is also a shortcoming of our study. There are also other limitations that need to be considered when it comes to interpreting the results of the present research. First, the design of this study did not allow us to establish causality for the significant associations examined. It would be worthwhile to search for such possible causal relationships and mechanisms with suitable study designs. Our data on emotional eating and other variables were collected using questionnaires. This method is not objective and may suffer from social desirability bias, although we can assume that our use of anonymous questionnaires curbed this potential source of bias. Nonetheless, mothers can be sensitive to their children’s behavior, so our results may be biased because they exaggerated or downplayed their children’s eating habits. It is also possible that they did not answer the questions correctly because they do not know how their children behave outside the home (e.g. at school). Another shortcoming might be the relatively low participation rates, which might indicate selection bias if the sample that participated in the study is disproportionate to the subgroups of exposure and outcome variables in the source population. The low participation rates and consequent small sample size also affect the accuracy of the study’s estimates.

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Still, given the lack of literature, the study has the power to address a relevant issue and provide an overall picture of the risk factors of emotional eating in children, also considering the particular time of the pandemic that impacted children’s mental well-being [40].

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