food and emotion
TRANSCRIPT
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Food and emotion
Laura Canetti a, Eytan Bachar b, Elliot M. Berry a,*
a Department of Human Nutrition and Metabolism, Hebrew University / Hadassah Medical School, Jerusalem 91120, Israelb Department of Psychiatry, Hadassah University Hospital, Jerusalem 91120, Israel
Received 10 December 2001; accepted 4 March 2002
Abstract
The relationship between eating and emotion has always interested researchers of human behavior. This relationship
varies according to the particular characteristics of the individual and according to the specific emotional state. We
consider findings on the reciprocal interactions between, on the one hand, emotions and food intake, and, on the other,
the psychological and emotional consequences of losing weight and dieting. Theories on the relationship between
emotions and eating behaviors have their origin in the literature on obesity. The psychosomatic theory of obesity
proposes that eating may reduce anxiety, and that the obese overeat in order to reduce discomfort. The internal/external
theory of obesity hypothesizes that overweight people do not recognize physiological cues of hunger or satiety because
of faulty learning. It thus predicts that normal weight people will alter (either increase or decrease) their eating whenstressed, while obese people will eat regardless of their physiological state. The restraint hypothesis postulates that
people who chronically restrict their food intake overeat in the presence of disinhibitors such as the perception of
having overeaten, alcohol or stress. These theories are examined in the light of present research and their implications
on eating disorders are presented.
# 2002 Elsevier Science B.V. All rights reserved.
Keywords: Eating behavior; Eating disorders; Emotion; Obesity
In their eating behavior, human beings are very
much affected by their emotions: food choices,
quantity and frequency of meals are all dependenton many variables not necessarily related to their
physiological needs. The increasing prevalence of
eating disorders and obesity in Western societies
has raised many questions about the role that
emotions play in the etiology of these problems.
That these changes have occurred in a relatively
short time frame suggests that environmental and
psychological, rather than metabolic or genetic,
causes are responsible.Although eating behavior has been studied in
animals from a biological viewpoint, we will focus
on human studies as the purpose of this article is to
present eating behavior from a psychological
viewpoint. It is widely accepted that the eating
behavior in humans, changes according to changes
in their emotional arousal (anxiety, anger, joy,
depression, sadness and other emotions). How-
ever, it is not possible to make a general statement
about these relationships since the relation be-* Corresponding author. Fax: '/972-2-643-1105
E-mail address: [email protected] (E.M. Berry).
Behavioural Processes 60 (2002) 157/164
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tween eating and emotion differs according to the
particular characteristics of the individual and
according to the specific emotional state. This
paper will look first at the influence of emotionson eating behavior, then the influence of emotion
on dieting and finally will discuss different theories
dealing with the relationship between eating beha-
vior and emotions and their implications for eating
disorders.
1. The influence of emotions on eating behavior
Emotions differ in their antecedent conditions,
physiological correlates, frequency of occurrenceand duration (Scherer et al., 1986). The associa-
tions between a particular emotion and eating
behavior should be stronger if this emotion occurs
more frequently in eating contexts than other
emotions (Macht and Simons, 2000). Early re-
search paid little attention to the differential
effects of different emotions. More recently a
number of studies have compared various emo-
tions, but research on their differential role
characteristics is still sparse. Mehrabian (1980)
inv
estigated the relationship between differentemotions and amount of food intake. He found
that higher food consumption was reported during
boredom, depression and fatigue and lower food
intake was reported during fear, tension and pain.
Lyman (1982) showed a greater tendency to
consume healthy foods during positive emotions
and a greater tendency to consume junk food
during negative emotions. Patel and Schlundt
(2001) found that meals eaten in positive and
negative moods were significantly larger than
meals eaten in a neutral mood and that positive
mood has a stronger impact than negative moodson food intake. Macht (1999) studied the differ-
ential impact of anger, fear, sadness and joy.
Subjects reported experiencing higher levels of
hunger during anger and joy than during fear
and sadness. They also reported that during anger
there was an increase of impulsive eating (fast,
irregular and careless eating directed at any food
type available), and that during joy there was an
increase of hedonic eating (the tendency to eat
because of the pleasant taste of the food or
because the consumed food is thought to be
healthy). Thus, Machts study showed stronger
influences of anger and joy on eating than of
sadness and fear. This author suggests that angerand joy have a greater influence because these
emotions are in general, more frequently experi-
enced than sadness and fear.
2. The influence of weight loss and dieting on
emotion
The classic work by Keys et al. (1950) showed
that weight loss, even in normal weight men, may
lead to physiologic and psychological moodchanges, some of which were quite similar to those
found in anorectic subjects. The famous experi-
ment, which was carried out on conscientious
objectors, showed that problems, which are con-
sidered to be characteristic of females with eating
disorders, might also occur in males after con-
siderable weight loss (mean 26%). The men
complained of apathy, depression, irritability and
moodiness; they also became preoccupied with
food in thoughts and conversation. They collected
recipes, became angry at food wastage and wouldtoy with their meals, sometimes taking up to 2 h to
complete them. Thus, weight loss per se (whether
in the obese or those of normal weight) may be the
common trigger, which in certain predisposed
individuals precipitates an abnormal response to
food and body weight.
Significant weight loss may also be accompanied
by persistent physical and behavioral symptoms.
These include mood changes and depression, cold
intolerance, hair loss, and carotenemia and idea-
tion similar to that found in patients with anorexia
nervosa, accompanied by issues of control, regi-mentation, compulsive exercising, and preoccupa-
tion with food and body image, even though the
subjects may still be obese. Ironically an obese
subject who goes from (say) 130/100 kg may have
behavioral and physiological changes similar to
those in an anorexic one at 30 kg weight (Berry,
1999).
Male patients who developed eating disorders
after gastroplasty or bilio-pancreatic by-pass sur-
gery, afford another example of the relationship
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between dieting and mood changes. Bonne et al.
(1996) described two morbidly obese young men
who, following gastric surgery and weight losses of
over 80 kg, became anorexic with intakes of lessthan 500 kcal/d and required psychiatric hospita-
lization. At the other extreme are weight-restored
anorexic patients who still have problems of size
over-estimation with different sensory mod-
alities*/visual, tactile and oral (Berry et al.,
1995). Over 30 years ago Glucksman and Hirsch
(1969) showed, using a distorting lens, that dieting
may lead to a change in body image. Both weight
loss and maintenance were associated with over-
estimation of neutral and personal shapes.
The National Weight Control Registry(NWCR) in the USA has sought to characterize
successful dieters who have maintained an average
weight loss of 13 kg for at least 5 years. While
these subjects in some studies showed no different
eating disorder pathology from normal obese
subjects (Klem et al., 1997), other work from the
same group noted among 784 subjects that 14%
had worse thoughts about food and 20% about
weight, than before their dieting (Klem et al.,
1998). However, it remains a moot point whether
it is possible to extrapolate from these ratherunique successful subjects (c5% of dieters) to the
majority of unsuccessful yo-yo dieters.
3. Theories relating emotions and eating behaviors
The assumption that affect and eating are
related has its origins in the literature on obesity.
Thus, earlier theories explained overeating in
obese individuals, while more recent theories aim
at explaining eating behavior in a normal weight
population. The following section looks at bothtypes of theory.
3.1. Psychosomatic theories of obesity
3.1.1. The Kaplan and Kaplan psychosomatic
theory of obesity
Kaplan and Kaplan (1957) proposed that obese
people overeat when anxious and eating reduces
this anxiety. The mechanism by which eating
reduces anxiety is not completely understood but
may involve differential effects of protein and
carbohydrate intakes affecting the synthesis of
brain neurotransmitters, in particular serotonin.
Learning factors are also probably involved, e.g.an earlier association of pleasurable, non-anxious
situations with feeding. However, these authors
felt that the anxiety-reducing effects of eating
cannot be solely explained on the basis of learned
habits. They hypothesized that there is some
degree of physiological incompatibility between
the act of eating and intense fear or anxiety and
that while eating, these emotions are temporarily
diminished. Obese individuals are unable to dis-
tinguish between hunger and anxiety because they
learnt to eat in response to anxiety as well as inresponse to hunger. Thus, eating in order to reduce
anxiety may lead to compulsive overeating and
obesity.
3.1.2. Bruchs theory
Bruch (1973) connected overeating to faulty
hunger awareness. This theory proposes that the
experience of hunger is not innate but learning is
necessary for its organization into recognizable
patterns. In the case of obese people something
had gone wrong in the experiential and interper-sonal process surrounding the satisfaction of
nutritional and other bodily needs. Incorrect and
confusing early experiences had interfered with
their ability to recognize hunger and satiation.
These early experiences had also interfered with
the ability to differentiate hunger (the urge to eat),
from other signals of discomfort that have nothing
to do with food deprivation like emotional tension
states aroused by a great variety of conflicts and
problems. Such individuals do not recognize when
they are hungry or satiated, nor do they differ-
entiate need for food from other uncomfortablesensations and feelings. They require signals com-
ing from outside to know when to eat and how
much; since their own inner awareness has not
been programmed correctly (Bruch, 1973). Thus,
according to this theory, a person will overeat in
response to emotional tension and uncomforta-
ble sensations and feelings. Both Kaplan and
Kaplan and Bruchs theories reach the same
prediction: that obese individuals will overeat in
response to uncomfortable emotional states.
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When summarizing her lifetime work in the
field, Bruch (1985) who is considered a leading
figure in the psychoanalytic thinking about anor-
exia and bulimia, pointed to self psychology as thetheory which conceptualizes best her approach.
Self psychology views food (its consumption in
bulimia and its avoidance in anorexia) as the main
stabilizing factor of dysphoric emotions and self
esteem (Bachar et al., 1999).
3.2. Schachters internal/external theory of
obesity
This theory (Schachter et al., 1968; Schachter,
1971) makes somewhat different predictions fromthe theories described above. Here the physiologi-
cal concomitants of fear and anxiety would lead
normal weight people to suppress their consump-
tion, but would not affect obese peoples con-
sumption due to their insensitivity to internal cues.
Like Bruch (1973), he hypothesized that the
recognition of a set of physiological cues, including
gastric contractions, as hunger was a learned
phenomenon and that normal weight people had
learned to label appropriately gastric contractions
as hunger, whereas ov
erweight people had not.Because gastric contractions decrease during
stress, normal weight individuals will decrease
their eating when stressed but such a decrease
would have no effect on the eating of the obese. As
a consequence of poor understanding of internal
physiological cues, obese people will rely much
more on external cues both to initiate and stop
eating.
While psychosomatic theories predict that obese
people will increase their eating when they are
stressed in order to reduce anxiety, Schachters
theory predicts that normal weight people mayeither decrease or increase their eating when
stressed, while obese people will not decrease it.
A first study performed by Schachter et al. (1968)
confirmed this prediction. They found that for
normal weight subjects, stress decreased eating
among those who were hungry and had no effect
on those who were not hungry, while overweight
subjects ate the same amount of food irrespective
of their physiological state. However, later re-
search did not replicate these previous findings
(Lowe and Fisher, 1983; Pine, 1985; Reznick and
Balch, 1977; Ruderman, 1983; Slochower et al.,
1981) and only one study (McKenna, 1972)
confirmed Schachters prediction but for palatablefood only.
The question of whether emotions do influence
eating behavior has been thoroughly studied in the
obese population. These studies findings are
closer to psychosomatic theories than to Schach-
ters theory but they also shed light on the
complexity of the eating behavior in obese people.
A review of the field (Ganley, 1989) concluded that
in massively obese subjects seeking treatment,
emotional eating appears to be very common.
Most studies reported a strong relationship be-tween eating and negative emotions or stressful life
events. The emotional eating occurs episodically
and not on a regular basis; it is done secretively, is
associated with different emotions in different
individuals and is characterized by the use of
high-calorie or high carbohydrate food (Ganley,
1989). Emotional eating has been found to be most
frequent when people are alone, when the meal is a
supper or a snack, and when the meal is eaten at
home compared to away from home (Baumeister
et al., 1994). Emotional eating is prev
alent acrossthe various social classes and the sexes. Studies
consistently report that emotional eating is most
often precipitated by negative emotions such as
anger, depression, boredom, anxiety and loneliness
and often bears an episodic relationship to stress-
ful periods of life (Ganley, 1989).
The impact of positive mood on food intake has
not been as well studied as that of negative moods.
Studies that have looked at such relationships
yield conflicting results: Schmitz (1996) and Davis
et al. (1985) did not find any correlation between
food intake and positive moods. HoweverSchlundt et al. (1988) found that positive mood
was related to overeating in social situations. A
recent study (Patel and Schlundt, 2001) showed
that food intake is larger for both positive and
negative moods compared to a neutral mood.
These authors propose that mood effects, whether
positive or negative, both involve a disinhibition of
eating control. They also suggest that positive
mood may increase food intake via an associative
learning mechanism where happiness has been
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associated with eating more food. These findings
can be also in line with Bruchs hypothesis that
obese individuals do not differentiate need for
food from emotional tension states*/in this casethe tension being a pleasant one.
All studies reviewed were performed on obese
populations and most of them found significant
differences between the obese subjects and the
normal weight control groups or significant
weight-dependent correlations in the area of emo-
tional eating. The conclusion that obese people
engage in significantly more emotional eating
compared to non-obese seems quite robust, and
provides support to the psychosomatic theories.
However, this conclusion has been criticized byAllison and Heshka (1993), who claim that per-
haps obese persons report more emotional eating
than the non-obese because they are complying
with a social role.
3.3. The restraint hypothesis
Investigators in the field observed that obese
people are almost always trying to restrain their
food intake. Thus, the question concerning eating
patterns of obese people should be rephrased tothe role of dieting in obese as well as normal
weight individuals. The restraint hypothesis was
originally developed by Herman and Mack (1975)
and further elaborated by Herman and Polivy
(1980). According to these researchers the balance
between the desire for food and the effort to resist
that desire affects eating behaviors, and restraint is
the cognitive effort to resist that desire. Restrained
eaters constantly worry about what they eat and
chronically restrict their food intake in order to
avoid becoming fat. At the other end are the
unrestrained eaters who eat freely and do notworry about their food intake or its consequences.
These authors also postulated a disinhibition
hypothesis: according to which, self control of
restrained eaters may be temporarily released by
disrupting events or disinhibitors which include
specific cognitions (the perception of having
overeaten), alcohol or strong emotional states
(such as anxiety and depression).
A review of the literature (Ruderman, 1986)
concluded that this hypothesis has been empiri-
cally confirmed. Most attention has focused on the
assumption that the perception of having over-
eaten disinhibits restrained eaters. This has been
manipulated by having subjects eat a pre-loadbefore a taste test. Overall, studies show that the
perception of having eaten a high calorie pre-load
leads to overeating in chronically restrained eaters,
who tend to think in a rigid, all-or-nothing
fashion. The influence of alcohol has also been
studied but results are not clear. The effects of
emotional states on the consumption of restrained
and unrestrained eaters have been examined. Her-
man and Polivy (1984) have hypothesized that
strong emotions make demands on restrained
eaters energies, thereby temporarily decreasingtheir motivation to diet and allowing them to
overeat. Although the restraint hypothesis predicts
that any strong emotion would disinhibit the
restrained eaters, research has focused principally
on the effects of anxiety and depression on eating
(Ruderman, 1986). In their first study Herman and
Polivy (1975) found, as expected, that unrestrained
eaters ate significantly less in the high than in the
low anxiety condition. However, restrained eaters
ate slightly, but not significantly, more in the high
than in the low anxiety condition. Poliv
y andHerman (1976) found among clinically depressed
patients, that unrestrained eaters reported a sig-
nificant weight loss and restrained eaters a sig-
nificant weight gain after the onset of depression.
Ruderman (1986) reaches the conclusion that
negative affective states generally increase the
consumption of restrained eaters, but their impact
on unrestrained eaters is unclear: negative affect
diminished consumption in the Herman and
Polivy study (1975), marginally reduced it in the
Baucom and Aiken study (1981) and did not
significantly affect it in the Ruderman study(1985). A more recent study (Schotte et al., 1990)
on negative affects induced by viewing frightening
films, replicated the finding that they trigger
overeating in restrained subjects. Again, in unrest-
rained eaters, such negative affect did not signifi-
cantly affect food intake. More recently, research
in the field also examined affects other than
anxiety and depression and reached similar results:
Cools et al. (1992) showed that exposure to a
segment from an amusing comedy film disinhib-
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ited eating in restrained eaters. Sheppard-Sawyer
et al. (2000) tested whether film-induced sadness*/
a state characterized by high negative valence, but
low arousal*/enhanced food intake in restrainedeaters. They found that exposure to sad film
segments significantly reduced food intake in
unrestrained eaters, but only increased it non-
significantly in restrained eaters. The authors
hypothesized that restrained participants may not
exhibit disinhibited eating when exposed to mood
changes that did not threaten their self-esteem.
4. Eating disorders
Although psychosomatic theories and the re-
straint hypothesis were related to observations of
eating behavior in obese people, these theories may
also explain behavior of subjects with eating
disorders. The restraint hypothesis has been theo-
retically applied (Polivy and Herman, 1985), and
empirically tested (Cooper and Bowskill, 1986;
Davis et al., 1988) in these disorders. According to
the restraint hypothesis, chronic dieters restrain
their food intake until a disinhibitor causes a
temporary break in the diet regimen with ov
er-eating. The disinhibitors might be the forced
consumption of high caloric food, the intake of
alcohol or experiencing tension states such as
anxiety and depression. Bulimic patients and
bulimic anorexics will binge eat, thus it may be
that the cause of such bingeing is restraint in the
intake of food prior to the development of the
disorder. This assumption concerning the devel-
opment of binge eating is confirmed by the
observation that in most cases, bulimia develops
several months after the onset of dieting (Boskind-
Lodahl, 1976; Boskind-Lodahl and Sirlin, 1977;Garfinkel et al., 1980; Pyle et al., 1981), and by the
fact that bulimics often have binge episodes after
negative emotional states. For example, bulimics
report more negative mood in the hour prior to a
binge episode, compared with their moods prior to
consuming a snack or meal (Davis et al., 1988). In
another study, bulimic patients were significantly
more depressed, anxious, lonely and bored in the 3
h before a binge episode, compared with baseline
ratings of the 3 h after the episode (Cooper and
Bowskill, 1986). The observation that patients
with bulimia nervosa almost always report that
tension precipitates bulimic episodes, is also in line
with the psychosomatic theories of obesity pre-dicting that overeating reduces tension states.
5. Conclusions
Emotions do influence eating behavior in hu-
man beings. Negative emotions have been thor-
oughly studied and it is well established that they
increase food consumption. Positive emotions also
increase food intake but this is less conclusive. It
seems that frequent emotions such as joy andanger have a greater impact on food intake
compared to less frequent ones. The above con-
clusions are valid for normal weight as well as
overweight people. However, the influence of
emotions on eating behavior is stronger in obese
people than in the non-obese, and it is stronger in
people on diets than in non-dieters. The conclusion
that obese people engage in significantly more
emotional eating than the non-obese has been
confirmed empirically and is in line with the
psychosomatic theories of obesity. Dieters arealso more prone to emotional eating as proposed
by the restraint theory. Binge eating in bulimic
subjects might be understood as the undesired
outcome of restrained eating.
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