Emotional Undereating Research Articles

Negative emotional eating patterns in Chinese adolescents: A replication and longitudinal extension with latent profile and transition analyses

This study, which is a longitudinal extension of previous cross-sectional studies in Chinese and American college students and general adults (Dixit et al., 2023; He et al., 2020; Xu et al., 2024), used latent profile and latent transition analyses to investigate negative emotional eating patterns and the stability of these patterns in 1462 Chinese adolescents (41% boys, aged 11−17 years) at baseline and 18 months later. We also explored baseline demographic predictors of negative emotional eating patterns and the associations between these patterns and outcome variables measured 18 months later. Negative emotional eating was measured with the Adult Eating Behavior Questionnaire (emotional undereating and emotional overeating subscales). Latent profile analysis (LPA) replicated the four patterns of negative emotional eating in each wave of assessment: low emotional eating (Low-EE), emotional overeating (EOE), emotional undereating (EUE), and emotional over- and under-eating (EOE-EUE). Latent transition analysis (LTA) showed that the EE patterns had transition probabilities of <55% remaining in the same class across 18 months. Furthermore, relative to adolescents in the stable Low-EE group, adolescents in all other stable or unstable emotional eating groups in LTA were linked to higher eating disorder psychopathology and psychological distress measured 18 months later. Thus, emotional eating, regardless of type (i.e., EOE, EUE, and EOE-EUE) and stability (i.e., stable or unstable), may be a viable research and treatment target in improving adolescents’ eating behaviors and mental health.

Variations of Eating Behaviors Among Vietnamese Preschool Children and Their Association With Children's Anthropometric Z-Scores: Results From Analyses of the Children's Eating Behavior Questionnaire in 10 000 Children.

Eating behaviors, which are shaped during childhood, are one of the important factors influencing children's growth. This study aimed to investigate the variations in eating behaviors among Vietnamese preschool children aged 3 to 6 years using the Children Eating Behavior Questionnaire (CEBQ) and their association with anthropometric Z-scores. A cross-sectional study was conducted on 10 172 children from 36 to 72 months old, recruited from three different socioeconomic regions of Hanoi. Differentiation of eating behaviors between two sexes was observed across all age groups, but most obvious at 36 to 48 months of age. The subscales of emotional overeating (EOE), enjoyment of food (EF), and desire to drink (DD) were higher in 60- to 72-month age groups and vice versa for slowness in eating (SE) and emotional undereating (EUE) subscales. Analyses using the general linear model showed that CEBQ subscales were associated with anthropometric Z-scores in both girls and boys.

Negative emotional eating patterns in general Chinese adults: A replication and expansion study examining group differences in eating disorder symptomatology, psychosocial impairment, and emotion regulation difficulties

Previous research identified four patterns of negative emotional eating in American and Chinese university students and proposed future directions (e.g., exploring potential differences in emotion regulation across patterns and replicating the patterns in a general, non-student population). Furthermore, prior research has not explored group differences in muscularity-oriented eating disorder symptomatology or psychosocial impairment. Therefore, the present study addressed these gaps in a sample of general Chinese adults, further testing group differences in typical and muscularity-oriented eating disorder symptomatology, psychosocial impairment, and emotion regulation difficulties across patterns of negative emotional eating. A total of 600 Chinese adults were recruited. Latent class analysis (LCA) was used. Results replicated the four patterns of negative emotional eating in previous research, including non-emotional eating (non-EE), emotional over- and under-eating (EOE-EUE), emotional over-eating (EOE), and emotional under-eating (EUE). Significant class differences were identified in eating disorder symptomatology, psychosocial impairment, and emotion regulation difficulties. Specifically, individuals with EOE and EOE-EUE patterns exhibited higher eating disorder symptomatology, higher psychosocial impairment, and more emotion regulation difficulties than those with non-EE and EUE patterns. Therefore, these two classes (i.e., EOE and EOE-EUE), especially the poorly researched EOE-EUE group, should be further examined to elucidate research and clinical applications. Furthermore, findings underscore the role of emotion regulation difficulties in further describing the differences across these negative emotional eating patterns, which can be considered in future interventions for reducing negative emotional eating.

Effect of early feeding practices and eating behaviors on body composition in primary school children

BackgroundUnderstanding children’s feeding practices and eating behaviors is important to determine etiology of childhood obesity. This study aimed to explore the relationship between early feeding practices, eating behavior and body composition among primary school children.MethodsThe data were collected from 403 primary school children. They were administered structured questionnaire, including sociodemographic characteristics, early feeding practices and Child’s Eating Behavior Questionnaire. Anthropometric and blood pressure (BP) measurements were performed.ResultsChildren with obesity and overweight showed higher food approach subscales and lower food avoidance subscales compared to a healthy and underweight child. Children who were exclusively or predominantly breast fed during the first 6 months had the lowest scores for the food approach subscales, food responsiveness (FR) and emotional overeating (EOE) and had the highest scores for the food avoidance subscales, satiety responsiveness (SR) and emotional under eating (EUE). Children who were introduced solid food after 6 months showed lower scores for FR, enjoyment of food and EOE but scored highest for SR, slowness in eating (SE) and EUE. All anthropometric measurements were positively correlated with all food approach subscales and negatively with SE, SR and food fussiness. All food approach subscales were positively correlated with BP percentiles. All food avoidance subscales were negatively correlated with both BP percentiles, except for EUE, which was negatively correlated with diastolic BP percentile only. Age, SR, SE and FR were predictors for child body mass index.ConclusionEarly feeding practices and eating behavior are considered as prevention approaches for obesity.

Intergenerational transmission of appetite: Associations between mother-child dyads in a Mexican population.

The Child Eating Behaviour Questionnaire (CEBQ) and the Adult Eating Behaviour Questionnaire (AEBQ) measure ‘food approach’ [Food responsiveness (FR); Emotional overeating (EOE); Enjoyment of food (EF); Desire to Drink] and ‘food avoidant’ [Satiety responsiveness (SR); Emotional undereating (EUE); Food fussiness (FF); Slowness in eating (SE)] appetitive traits (ATs) in children and adults, respectively. ‘Food approach’ traits predispose to overweight while ‘food avoidance’ traits provide protection, but little is known about the relationships between parents’ and their offspring’s ATs. The aim was to examine the associations between maternal and child appetitive traits, using the AEBQ-Esp and CEBQ-Mex adapted for use in Mexican populations. Sociodemographic data, weights and heights of mothers and their children (aged 3–13 years), who were recruited from a teaching hospital in Guadalajara, Mexico, were measured. Mothers completed both the AEBQ-Esp and the CEBQ-Mex. The CEBQ-Mex was developed, and its reliability was tested using Cronbach’s alpha and Omega, and Confirmatory Factor Analysis (CFA) was used to assess its validity. Pearson’s correlation coefficients were used to assess associations between mothers’ and children’s Ats. The sample included 842 mother-child dyads (mother’s mean age = 34.8±SD6.9 years, BMI 29.7±6.1 kg/m2; children’s mean age = 8.5 ±SD2.5 years, BMIz 1.5±1.6). Internal reliability was moderate to high [Cronbach alpha = .68-.86; Omega = .71-.87] for the CEBQ-Mex and validity was confirmed for an 8-factor model through CFA [RMSEA = 0.065; CFI = 0.840, NFI = 0.805; IFI = 0.842; and χ2(df = 532) = 2939.51, p < 0.001]. All but one of the children’s appetitive traits showed small to moderate, significant correlations with their mother’s counterpart [FR (r = .22; p<001); EOE (r = .30; p < .001); EF (r = .15; < .001); SR (r = .16; p < .001); EUE (r = .34; p < .001) and FF (r = .14; p < .001). Only SE was not significantly associated with maternal SE (r = .01; p>.05). ATs tend to run in families, signalling the intergenerational transmission of eating behaviours. These may be useful targets for family-wide interventions to support the development and maintenance of healthy eating behaviours in childhood.

Validation of the Adult Eating Behaviour Questionnaire adapted for the French-speaking Canadian population.

The Adult Eating Behaviour Questionnaire (AEBQ) is a newly developed questionnaire adapted from the widely used Child Eating Behaviour Questionnaire. This questionnaire assesses four food approach scales, namely hunger, food responsiveness, emotional overeating (EOE) and enjoyment of food, and four food avoidance scales, namely satiety responsiveness (SR), emotional undereating (EUE), food fussiness and slowness in eating (SE). This study aimed to validate a French version of the AEBQ in controlled conditions among French-speaking adults from Quebec, Canada. The AEBQ was pre-tested through structured interviews with 30 individuals. Participants of the validation study (n = 197, aged 19-65years) had their height and weight measured and completed the AEBQ, Three-Factor Eating Questionnaire (TFEQ) and Intuitive Eating Scale-2 to assess factorial structure, internal consistency and construct validity. Test-retest reliability over 2 weeks was assessed among 144 participants. Confirmatory factor analysis indicated an excellent model fit (NNFI = 0.98, CFI = 0.98, RMSEA = 0.03, χ2/df = 1.17) and provided support for the use of the original 8-factor questionnaire. Internal consistency was adequate for most scales (Cronbach's alpha = 0.66-0.94) and moderate to excellent test-retest reliability was observed for all scales (ICC = 0.70-90). Women showed higher levels of EOE and SR, and individuals with overweight and obesity showed higher levels of EOE and lower levels of EUE and SE. Construct validity was also supported by expected correlations with disinhibition and susceptibility to hunger from the TFEQ and intuitive eating. This study indicates that the French AEBQ is a valid and reliable tool to measure eating behaviours in the adult population of Quebec. Level III: Evidence obtained from well-designed cohort or case-control analytic studies. The data are cross-sectional, but all measurement were undertaken in controlled laboratory conditions and the study provided new information.

Gender effect on eating habits of Nigerian school children.

It is important to investigate children's eating habits based on different eating behaviors such as satiety responsiveness (SR), slowness in eating (SE), food fussiness (FF), food responsiveness (FR), enjoyment of food (EF), desire to drink (DD), emotional under-eating (EUE), and emotional over-eating (EOE). The main objective of this research was to investigate whether gender affects the eating habits of Nigerian school children.A cross-sectional survey was conducted between March and June 2019. A total of 120 parents of school children participated in the study. The Child Eating Behavior Questionnaire (CEBQ) was used to collect data. The CEBQ is composed of 35 items and eight subscales.Based on the analysis of parents’ reports, DD was higher in boys than girls, t (118) = 7.086, P < .001; EOE was higher in boys than girls, t (118) = 5.184, P < .001; EF was higher in boys than girls, t (118) = 2.183, P < .001; FF was higher in boys than girls, t (118) = 9.441, P < .001; and SR was higher in boys than girls, t (118) = 7.323, P < .001. However, EUE was lower in boys than girls, t (118) = −4.339, P < .001; FR was lower in boys than girls, t(118) = −3.112, P < .001; SE was lower in boys than girls, t(118) = −3.832, P < .001; thus, gender had a significant influence on eating habits of the school children.Gender significantly affects the eating habits of Nigerian school children. Thus, gender is an important factor to be considered when aiming to improve the eating habits of Nigerian school children.

Association of Appetitive Traits of Schoolchildren with Obesity and Those of Their Mothers

Abstract Objectives To measure appetitive traits (AT) in mother-child dyads with obesity and identify the association between the ATs of the mothers and Body Mass Index (BMI) and the ATs of the child and BMI z-scores (BMIz). Methods In a cross-sectional study children with obesity accompanied by their biological mothers participated at the Hospital. The weight and height of the dyads were measured and mother's completed sociodemographic data and the Spanish versions of the Adult Eating Behaviour Questionnaire (AEBQ-Esp), and the Children Eating Behaviour Questionnaire (CEBQ-Mex). These questionnaires measure stable responses to food known as ATs using 8 subscales (traits). Four food approach traits: Food Responsiveness (FR), Emotional Over-eating (EOE), Enjoyment of Food (EF), and Desire to Drink (DD) (DD in children only); and 4 food avoidance traits: Satiety Responsiveness (SR), Emotional Under-eating (EUE), Food Fussiness (FF) and Slowness in eating (SE). Pearson´s correlations to analyze the associations between the AEBQ-Esp ATs and BMI of the mothers and the CEBQ-Mex ATs and BMIz of the children. Results Data from 308 dyads were collected. The age of the mothers was 36.1 ± 6.9 years, 39% had secondary school level education, 72% were housewives; BMI was 31.8 ± 6.3 kg/m2 and 59% were diagnosed with obesity. The age of the schoolchildren was 9.3 ± 1.8 years, 59.7% boys, and the BMIz were 2.6 ± 1.0 SD. There was a significant positive correlation between EOE and BMI (r = 0.12, P &amp;lt; 0.05). In children, positive significant correlations were found between BMIz and FR (r = 0.23, P &amp;lt; 0.01), EOE (r = 0.29, P &amp;lt; 0.01), EF (r = 0.20, P &amp;lt; 0.01) and DD (r = 0.16, P &amp;lt; 0.05), and negative with SE (r = −0.17, P &amp;lt; 0.01). Conclusions Positive association were observed between food approach ATs and BMIs of the mothers and BMIz of the children; negative associations were found with food avoidance traits and BMIs of the mothers and BMIz of the children, as expected. Funding Sources Universidad de Guadalajara and Consejo Nacional de Ciencia y Tecnología de México.

Relationships among Child Eating Behaviors and Household Food Insecurity in Youth with Obesity.

Background: Food insecurity may trigger eating behaviors that contribute to pediatric obesity. The aim of this study is to identify eating behaviors among a pediatric population with obesity and household food insecurity. Methods: A cross-sectional study analyzed Child Eating Behavior Questionnaire (CEBQ) and household food insecurity screener responses, and BMI measurements from pediatric participants with obesity (BMI ≥95th percentile) from a weight management clinic between 2013 and 2017. Multivariate linear regression was performed to evaluate associations between CEBQ eating domains [Food Responsiveness, Emotional Overeating, Enjoyment of Food, Desire to Drink (DD), Satiety Responsiveness, Slowness in Eating, Emotional Undereating (EUE), and Food Fussiness] and household food insecurity, adjusting for age, sex, race/ethnicity, SNAP participation, and BMI percentile. A sub-group analysis was performed on participants from food insecure (FI) households to evaluate the associations between SNAP participation and eating domains. Results: Eight hundred twenty-two participants were included in the final analysis. Participants from FI households had significantly higher BMI percentiles even after adjustment for age, sex, race/ethnicity, and SNAP status (p = 0.000). Household food insecurity was associated with increased DD beverages (p = 0.000). Among participants from FI households, SNAP participation was significantly positively associated with the EUE (p = 0.009). Conclusions: Youth from FI households have higher BMIs even among a population with obesity. DD is positively associated with household food insecurity and may contribute to obesity in this population. Results suggest that providers treating pediatric patients with obesity should consider regularly screening for household food insecurity and associated eating behaviors as part of their medical management of obesity.

Emotional eating is learned not inherited in children, regardless of obesity risk.

SummaryBackgroundEmotional over‐eating (EOE) and emotional under‐eating (EUE) are common behaviours that develop in early childhood and are hypothesised to play a role in weight status. Data from a British twin cohort demonstrated that environmental, rather than genetic, factors shape individual differences in both behaviours in early childhood.ObjectiveThe aim of this current study was to replicate this finding in a subsample (n = 398) of 4‐year‐old twins selected for high or low risk of obesity from another population‐based cohort of British twins (the Twins Early Development Study).MethodsParental ratings of child EOE and EUE were analysed using genetic model fitting.ResultsGenetic influence was not significant, while shared environmental factors explained 71% (52–79%) of the variance in EOE and 77% (62–85%) in EUE. The two behaviours correlated positively (r = 0.53, 95% CI: 0.44, 0.61), and about two‐thirds of the shared environmental factors influencing EOE and EUE were the same (r C = 0.67, 95% CI: 0.51, 0.85).ConclusionsEmotional eating in childhood is shaped by the home family environment; parents are therefore promising intervention targets.

Emotional over- and under-eating in early childhood are learned not inherited

Emotional overeating (EOE) has been associated with increased obesity risk, while emotional undereating (EUE) may be protective. Interestingly, EOE and EUE tend to correlate positively, but it is unclear whether they reflect different aspects of the same underlying trait, or are distinct behaviours with different aetiologies. Data were from 2054 five-year-old children from the Gemini twin birth cohort, including parental ratings of child EOE and EUE using the Child Eating Behaviour Questionnaire. Genetic and environmental influences on variation and covariation in EUE and EOE were established using a bivariate Twin Model. Variation in both behaviours was largely explained by aspects of the environment completely shared by twin pairs (EOE: C = 90%, 95% CI: 89%-92%; EUE: C = 91%, 95% CI: 90%-92%). Genetic influence was low (EOE: A = 7%, 95% CI: 6%-9%; EUE: A = 7%, 95% CI: 6%-9%). EOE and EUE correlated positively (r = 0.43, p < 0.001), and this association was explained by common shared environmental influences (BivC = 45%, 95% CI: 40%-50%). Many of the shared environmental influences underlying EUE and EOE were the same (rC = 0.50, 95% CI: 0.44, 0.55). Childhood EOE and EUE are etiologically distinct. The tendency to eat more or less in response to emotion is learned rather than inherited.

Appetitive traits and relationships with BMI in adults: Development of the Adult Eating Behaviour Questionnaire

The Child Eating Behaviour Questionnaire (CEBQ) is a validated parent-report measure of appetitive traits associated with weight in childhood. There is currently no matched measure for use in adults. The aim of this study was to adapt the CEBQ into a self-report Adult Eating Behaviour Questionnaire (AEBQ) to explore whether the associations between appetitive traits and BMI observed in children are present in adults. Two adult samples were recruited one year apart from an online survey panel in 2013 (n = 708) and 2014 (n = 954). Both samples completed the AEBQ and self-reported their weight and height. Principal component analysis (PCA) was used to derive 35 items for the AEBQ in Sample 1 and confirmatory factor analysis (CFA) was used to replicate the factor structure in Sample 2. Reliability of the AEBQ was assessed using Cronbach’s α and a two week test-retest in a sub-sample of 93 participants. Correlations between appetitive traits measured by the AEBQ and BMI were calculated. PCA and CFA results showed the AEBQ to be a reliable questionnaire (Cronbach’s α > 0.70) measuring 8 appetitive traits similar to the CEBQ [Hunger (H), Food Responsiveness (FR), Emotional Over-Eating (EOE), Enjoyment of Food (EF), Satiety Responsiveness (SR), Emotional Under-eating (EUE), Food Fussiness (FF) and Slowness in Eating (SE)]. Associations with BMI showed FR, EF (p < 0.05) and EOE (p < 0.01) were positively associated and SR, EUE and SE (p < 0.01) were negatively associated. Overall, the AEBQ appears to be a reliable measure of appetitive traits in adults which translates well from the validated child measure. Adults with a higher BMI had higher scores for ‘food approach’ traits (FR, EOE and EF) and lower scores for ‘food avoidance’ traits (SR, EUE and SE).

Children's eating behavior: comparison between normal and overweight children from a school in Pelotas, Rio Grande do Sul, Brazil

ObjectiveTo evaluate differences in children's eating behavior in relation to their nutritional status, gender and age. MethodsMale and female children aged six to ten years were included. They were recruited from a private school in the city of Pelotas, Rio Grande do Sul, southern Brazil, in 2012. Children´s Eating Behaviour Questionnaire (CEBQ) subscales were used to assess eating behaviors: Food Responsiveness (FR), Enjoyment of Food (EF), Desire to Drink (DD), Emotional Overeating (EOE), Emotional Undereating (EUE), Satiety Responsiveness (SR), Food Fussiness (FF) and Slowness in Eating (SE). Age-adjusted body mass index (BMI) z-scores were calculated according to the WHO recommendations to assess nutritional status. ResultsThe study sample comprised 335 children aged 87.9±10.4 months and 49.3% had normal weight (n=163), 26% were overweight (n=86), 15% were obese (n=50) and 9.7% were severely obese (n=32). Children with excess weight showed higher scores at the CEBQ subscales associated with “food approach” (FR, EF, DD, EOE, p<0.001) and lower scores on two “food avoidance” subscales (SR and SE, p<0.001 and p=0.003, respectively) compared to normal weight children. Differences in the eating behavior related to gender and age were not found. Conclusions“Food approach” subscales were positively associated to excess weight in children, but no associations with gender and age were found.

Comportamento alimentar infantil: comparação entre crianças sem e com excesso de peso em uma escola do município de Pelotas, RS

ObjectiveTo evaluate differences in children's eating behavior as a function of their nutritional status, sex and age. MethodsMale and female children aged six to ten years were included. They were recruited from a private school in the city of Pelotas, southern Brazil, in 2012. Children's Eating Behaviour Questionnaire (CEBQ) subscales were used to assess eating behaviours: Food Responsiveness (FR), Enjoyment of Food (EF), Desire to Drink (DD), Emotional Overeating (EOE), Emotional Undereating (EUE), Satiety Responsiveness (SR), Fussiness (FF) and Slowness in Eating (SE). Age‐adjusted body mass index (BMI) z‐scores were calculated according to the WHO recommendations to assess nutritional status. ResultsThe study sample comprised 335 children aged 87.9±10.4 months and 49.3% were normal weight (n=163), 26% overweight (n=86), 15% obese (n=50) and 9.7% severely obese (n=32). Children with excessive weight showed higher scores on the CEBQ subscales associated with “food approach” (FR, EF, DD, EOE, p<0.001) and lower scores on two “food avoidance” subscales (SR and SE, p<0.001 and p=0.003, respectively) compared to normal weight children. Conclusions“Food approach” subscales were positively associated to excessive weight in children. Significant age and gender differences in eating behaviours were not found.

한국어판 아동식습관 설문지를 사용한 식욕부진 소아의 식욕 개선 평가

Background Children's Eating Behaviour Questionnaire (CEBQ) is a parents-targeted questionnaire to measure eating behavior of children, developed in United Kingdom and verified validity and reliability in several countries. Validity of Korean version of CEBQ (K-CEBQ) was verified in 2009. Objectives The study was conducted to assess the appetite improvement after herbal treatment in children who have anorexia. Methods The parents of the 26 children(anorexia 11, non-anorexia 15; <TEX>$79.54{\pm}38.17$</TEX> months) who visited one university hospital was surveyed using K-CEBQ from April 2010 to April 2011. It was re-surveyed at intervals of 3 months. Differences between the anorexia group and the non-anorexia group were analyzed by Mann-Whitney U test, and comparisons of pre-treatment and post-treatment in anorexia group and non-anorexia group were verified by Wilcoxon signed-rank test. Results Depends on the presence of anorexia in child, Slowness in eating/Satiety responsiveness (SE/SR), Enjoyment of food (EF), Emotional undereating (EUE) and total scores were significantly different (<TEX>$p$</TEX><0.05). Also, there were significant difference in SE/SR and total scores before and after the herbal treatment in anorexia group (p<0.05), and all scores tended to increase a few. However there were no significant difference before and after the herbal treatment in non-anorexia group, and the scores except for Desire to drink (DD) and Emotional overeating (EOE) were decreased. Conclusions Herbal treatment in children who have anorexia has improved their appetite in terms of eating sensitivity.