Emotional eating and Pavlovian learning:evidence for conditioned appetitive responding to negative emotional states

Appetitive learning has been demonstrated several times using neutral cues or contexts as a predictor of food intake and it has been shown that humans easily learn cued desires for foods. It has, however, never been studied whether internal cues are also capable of appetitive conditioning. In this study, we tested whether humans can learn cued eating desires to negative moods as conditioned stimuli (CS), thereby offering a potential explanation of emotional eating (EE). Female participants were randomly presented with 10 different stimuli eliciting either negative or neutral emotional states, with one of these states paired with eating chocolate. Expectancy to eat, desire to eat, salivation, and unpleasantness of experiencing negative emotions were assessed. After conditioning, participants were brought into a negative emotional state and were asked to choose between money and chocolate. Data showed differential conditioned responding on the expectancy and desire measures, but not on salivation. Specific conditioned effects were obtained for participants with a higher BMI (body mass index) on the choice task, and for participants high on EE on the unpleasantness ratings. These findings provide the first experimental evidence for the idea that negative emotions can act as conditioned stimuli, and might suggest that classical conditioning is involved in EE

Toward Health Information Technology that Supports Overweight and Obese Women in Addressing Emotion- and Stress-Related Eating (a Mixed Methods Approach)

Extensive research shows that negative emotions and stress can prompt eating behavior that is in excess of physiological nutritional needs. Additionally, research indicates that women are more likely than men to cope with negative emotions and stress by overeating. There is a dearth of Human-Computer Interaction (HCI) research related to Health Information Technology (HIT) interventions that address overeating in context of negative emotions and stress. As a result, there is little guidance for HCI design and evaluation in this area. The study uses a convergent mixed methods design to understand how HIT can support overweight/obese women curb emotion- and stressed-related eating (ESRE), with the ultimate goal of sustained weight management. In the interview study strand, cross sectional semi-structured interviews (N = 22) explore ESRE behavior in overweight/obese women (BMI ≥ 25). The survey study strand, consisting of a questionnaire (N = 430) administered to overweight/obese women, comprises data about user characteristics, stress, ESRE, and coping, and digital access and skills. The thesis found that that overweight/obese women who engage in ESRE encountered stressors that spanned from daily hassles, persistent challenges, and life-changing losses; they also experience stressors related to serving as caretakers and social support providers. They used food as a coping response to the stress they encounter, and tend to associate food with social support. Furthermore, some have characteristics that make them particularly vulnerable to ESRE behavior. This thesis suggests that HIT should assist users before their coping eating response is triggered. Additionally, HIT should support women in becoming aware of their tendencies to associate food with social support. The thesis also found that overweight/obese women who engage in ESRE need to be supported in both the acute and chronic dimensions of their ESRE behavior. Their acute needs include instrumental support for eating awareness in- the- moment as they are making food choices that could be ESRE, as well as in the form of a just-in-time distraction intervention to prevent them from engaging in ESRE. Their chronic needs include support for holistic goals and motivation to address their ESRE, emotional support for encouragement in weight loss efforts, and informational support for appraisal to understand ESRE and change thought patterns for lasting behavior change. This thesis suggests that HIT needs to allowi for more self-experimentation and tailoring opportunities. Finally, the thesis found that stress and self-blame contribute to ESRE behavior, and that the relative influence stress and self-blame had on ESRE differs by racial groups. This thesis suggests that HIT avoid content and design choices that may incite feelings of self-blame. The thesis’ contribution is that it fills a gap in the literature by using an interpretivist approach to understand the ESRE experiences of overweight/obese women, which permits insight into previously-undescribed aspects of the experience. Additionally, the thesis relates the lived experience of ESRE to HIT design, and highlights ESRE behavior in context of socioeconomic factors. It also makes the contribution of applying the concept of self-blame to a sample of overweight/obese women who are largely not diagnosed with an eating disorder. Finally, it explores how self-blame could be taken into account in the design of HIT for weight management.PHDInformationUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttps://deepblue.lib.umich.edu/bitstream/2027.42/138457/1/andbar_1.pd

Manipulation of Negative Social Evaluative Fears on Body Dissatisfaction and Eating Behaviors: Does Fear of Social Evaluation Lead to Disordered Eating?

Social anxiety and eating disorders are highly comorbid. Researchers have suggested that there may be shared vulnerabilities that underlie the development of these disorders. Two of these proposed vulnerabilities are fear of negative evaluation and social appearance anxiety (i.e., fear of negative evaluation specifically focused on one’s appearance). Regarding disordered eating, previous self-report research has found that social appearance anxiety may be especially relevant for body dissatisfaction, whereas fear of negative evaluation may be relevant for drive for thinness. In the current study I manipulated fear of negative evaluation and social appearance anxiety using a speech task in 160 undergraduate females. Results indicated that participants in the fear of negative evaluation condition increased food consumption, whereas participants high in trait social appearance anxiety and in the social appearance anxiety condition experienced the highest amounts of state body dissatisfaction. Participants in both conditions experienced elevated state social anxiety. Additionally, I found that restraint interacted with fear of negative evaluation to produce eating. These results are discussed within an emotion regulation framework. Overall, these results support the idea that fear of negative evaluation and social appearance anxiety are shared vulnerabilities for eating and social anxiety disorders, but that the way these variables interact with the environment and with other individual differences may lead to disorder specific behaviors. Clinicians may want to consider incorporating exposures that evoke evaluation fears into treatments for individuals with disordered eating

Lived experiences of binge eating and access to care in the New Zealand health system : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Psychology (Health Psychology) at Massey University, Albany, New Zealand

This research inquiry sought to explore lived experiences of binge eating in New Zealand. Previous narrative research on eating disorders, has focused primarily on populations with Anorexia Nervosa or Bulimia Nervosa, and no New Zealand research could be found that provided narrative voices of people that self-identified as binge eaters, or had received a Binge Eating Disorder (BED) diagnosis. The purpose of this research is to provide a step towards filling the narrative gap in current literature, and to improve understandings of binge eating. A secondary focus, was to understand how participants navigated New Zealand primary care pathways. There were two parts to the study. Part one took a narrative inquiry approach, completing semi-structured interviews with eight participants who had self-identified binge eating. Allowing participants to self-identify created a space to discuss a range of experiences outside of BED diagnosis. The research took a Narrative Analysis approach, guided by a Social Constructionist epistemology, and drawing from Feminist, Foucauldian and Stigma Theories. Part two consisted of a quantitative survey sent to General Practitioners in New Zealand, and twelve complete responses were received. Key findings included the importance of protective factors, experiences of stigma, and a lack of adequate treatment pathways. Recommendations included improving education in areas of nutrition, disordered eating and mental health. Protective factors are described that could establish personal frameworks of care for binge eating in future. Stereotypes of eating disorders, alongside DSM-5 criteria (APA, 2013) were perceived as barriers to treatment. The findings suggest that diagnosis and recovery journeys for binge eating are not linear, and that recovery itself is subjective. Participants’ accounts present narratives that move away from ideas of having to reach a place of medical diagnosis and recovery for experiences to be valid. The importance of improving primary care eating disorder pathways in New Zealand is evident through the voices of interview participants and General Practitioners, with participants advocating for improving care structures in New Zealand, with focus on earlier intervention and cultural relevance. This research has provided insight into personal experiences of living with binge eating, and difficulties navigating primary care systems

THE EXPERIENCES AND PERCEPTIONS OF BEHAVIORAL FACTORS THAT CONTRIBUTE TO SUCCESSFUL WEIGHT LOSS IN MALE BARIATRIC PATIENTS

The purpose of this study was to examine the experiences and perceptions of behavioral factors that contribute to successful weight loss in male bariatric patients. By analyzing participant experiences and perceptions, this study contributes to a better understanding of which factors are most important in the postoperative phase of gastric bypass in males owing to successful weight loss. Although there is a tremendous amount of quantitative research within the bariatric population, there is a significant gap within the qualitative literature as it relates to male outcomes. As such, by conducting interviews with 10 postoperative male gastric bypass patients, this study was able to further understand how and why these participants obtained successful weight loss. Furthermore, by identifying relevant categories and thematic responses from the participants, this study may serve future researchers in designing other qualitative studies that target best practices in males for successful weight loss outcomes. The findings of this study indicate that participants found greater weight loss success by following proper eating behaviors and engaging in physical activity whereas support group attendance was not found to be an important factor in successful weight loss. This study also revealed that follow up with the bariatric nurse coordinator was greatly viewed as a positive step in adjusting to lifestyle postsurgery. As such, this supportive role by the nurse coordinator may provide further impetus for the ways in which bariatric personnel interact with patients who might not always be able to see their surgeon for follow-up

Exploring how women negotiate pregnancy in respect to food behaviours and weight status : an interpretative phenomenological study

This study is a longitudinal exploration of women’s eating behaviours and weight status during motherhood starting from pre-conception, through pregnancy and into the early postpartum period.The study aimed to explore how women negotiate pregnancy in the context of food and weight status using IPA. The rationale was to capture from the diverse voices of different women what is important to them at these different time points and collectively how this informs behaviour in the motherhood journey. The participants consisted of three different, randomly selected sample sets of women 20- 40 years. Focus groups were carried out with 10 never pregnant women, followed by serial individual interviews with five currently pregnant women, and five women who had recently given birth, interviewed at 2 different time points.The findings highlight a change in women’s priorities described in superordinate themes along the motherhood cycle. Women’s priorities changed starting in pre-conception with a strong sense of self and realisation of limited time for childbearing, to focussing on the baby at the expense of the self, during and after pregnancy.The findings strongly show that women’s eating has emotional, biological and gendered meanings during the transition to motherhood. Socialisation, social events, expectations and peer support also strongly influenced how women negotiated conflict in this continuum. There are tensions in the postpartum period between the new focus on the baby (emerging during pregnancy), which prescribes healthful eating, and the stresses of a new motherhood lifestyle which reverts women to emotional eating (present preconceptually). In negotiating these tensions, women adopt the digital discourse as part of self-support behaviours in addition to trust and desire for the support of HCPs and significant others. The findings have implications for lifestyle interventions that acknowledge these tensions, women’s priorities and their coping strategies

Consuming Your Feelings: The Mechanisms Underpinning Emotional Eating

Obesity continues to have a huge impact on society, with emotional eating considered to be one of many driving factors. Consequently, the overarching aim of this thesis is to investigate the mechanisms underpinning emotional eating, paying specific attention to the role of emotional dysregulation. Emotional dysregulation involves a combination of emotional vulnerability and an inability to regulate emotional responses which can lead to the adoption of maladaptive coping strategies, including emotional eating. However, emotional dysregulation also encompasses many of the features characteristic of alexithymia, including difficulty identifying and describing feelings. As a result, and in order to further elucidate the complex mechanisms underpinning emotional eating, alexithymia is used as a correlate of emotional dysregulation in this thesis. In addition, as alexithymia has been related to both impulsiveness and negative affect, and that emotional eating is grounded in the idea that the consumption of food follows an emotional experience, negative urgency and negative affect will also be explored as key constructs. Chapter One reviews the current literature on emotional eating, alexithymia, impulsivity and negative affect. It also sets out the aims and objectives of this thesis, putting forward a novel theoretical model to examine the influence of emotional dysregulation on emotional eating, and in turn, body mass index. Chapter Two presents the results of two studies (an exploratory analysis in a student sample and a self-replication in a more representative general population sample) examining the factors mediating the relationship between emotional dysregulation, emotional eating, and body mass index. In addition to significant associations between emotional dysregulation and emotional eating in the student sample, negative affect and negative urgency were found to mediate the relationship between alexithymia and emotional eating. However, even though significant associations between emotional dysregulation and emotional eating were confirmed in the general population sample, different pathways emerged. Specifically, negative affect was the only significant mediator between alexithymia and emotional eating. Chapters Three and Four focus on whether simulating emotional dysregulation in an experimental setting directly affects food intake. Specifically, a novel method of inducing emotional confusion as an analogue of alexithymia is developed and piloted in Chapter Three, followed by a fully powered mood manipulation study in Chapter Four to assess food intake following the induction of positive, negative and emotionally confusing mood states. Compared to a control condition, food intake did not differ significantly across experimental mood conditions. Finally, in Chapter Five, the initial theoretical model described at the end of Chapter One is extended to include interoceptive awareness and feeling fat. Here, the ability to trust bodily sensations and the experience of feeling fat was found to significantly mediate the relationship between emotional dysregulation and emotional eating. The model is also extended to include negative urgency, with increased levels of alexithymia related to a reduction in trusting bodily sensations, which in turn increases the tendency to experience sensations of feeling fat, followed by reacting rashly to alleviate the associated feelings (negative urgency), and therefore, an increased propensity to engage in emotional eating. Overall, the research presented in this thesis takes the first steps in developing an inclusive theoretical model of emotional eating. Whilst the precise nature in which emotional dysregulation influences emotional eating remains unclear, the results of this thesis nevertheless supports the role of emotional dysregulation and has important implications for the development of interventions to aid weight loss/management

An experiment analysis of the impact of advertising and food packaging on women\u27s eating behavior

Obesity is considered a national epidemic and is associated with increased eating behavior and decreased physical activity. Research has demonstrated biological underpinnings, but the dramatic increase in prevalence rates in recent decades (Flegal et al., 2002) suggests that environmental influences also contribute (Hill et al., 2008). This led researchers to speculate about the impact of our purported “Toxic Environment,” in which high-calorie, energy-dense foods are readily available for consumption and technological advances have decreased physical activity (Wadden et al., 2002). Most of the literature examining the theory of the Toxic Environment is correlational in nature, limiting causal inference. A pilot study of five participants demonstrated that exposure to purported Toxic Environment cues elicited increased food consumption compared to exposure to Thin-Ideal or Neutral cues. Therefore, the present study aimed to explore the influence of two elements of the purported Toxic Environment on women’s eating behavior – advertising and food packaging size. Eighty-two participants were randomly assigned to a 2 (toxic vs. healthy food ad) x 2 (large vs. small package-size) design. Participants, deceived about the true aims of the study, were asked to find dots in the ad stimuli and were given food according to package-size condition to consume ad lib during the session. The next day participants were contacted to provide a 24- hour dietary recall. Results demonstrated that participants exposed to healthy ads and large package size consumed more calories in session than those in other conditions. There were no differences among conditions on caloric intake in the following 24 hours. When examining the pattern of consumption, it appears that participants may have regulated their food intake during the study. Results also suggest that overweight women may be more sensitive to Toxic Environment cues, whereas restrained eaters may be more sensitive to packaging size as opposed to advertising. Binge-eaters appear to be sensitive to food cues in general, regardless of condition, compared to non-binge eaters. Results may have treatment implications for various weight-related populations. If further research supports the impact of our potentially Toxic Environment on eating behavior, implications for developing public health policies addressing the obesity epidemic may be warranted

Discourses pertaining to, and lived experiences of, 'Maternal Obesity' (Body Mass Index (BMI) ≥ 30) and Gestational Diabetes Mellitus/Type Two Diabetes Mellitus in the pregnancy and post-birth period.

This thesis reports on a qualitative exploration of the experiences of 30 women designated as ‘high risk’ due to the co-existence of ‘maternal obesity’ (BMI ≥ 30) and Gestational Diabetes Mellitus (GDM)/Type Two Diabetes Mellitus (T2DM) in pregnancy. This is examined in the context of medico-scientific/public health/ popular media discourses pertaining to ‘maternal obesity’/GDM/T2DM in pregnancy. ‘Maternal obesity’/GDM/T2DM in pregnancy are increasingly prevalent and clinically associated in manifold ways. Increasing prevalence is linked to the ‘global epidemic’ of ‘obesity’/diabetes: now commonly referred to as ‘diabesity’. Current biomedical knowledge asserts ‘maternal obesity’ and diabetes (‘maternal diabesity’) synergise in causing adverse pregnancy outcomes, have long term health implications for the offspring and contribute to an ‘intergenerational cycle’ of ‘obesity’/diabetes. This is the first qualitative study to consider pregnancy/post-birth experiences of women with co-existing ‘maternal obesity’ and GDM/T2DM in pregnancy from a sociological perspective. Participants undertook a series of auto/biographical narrative interviews. Longitudinal engagement provided nuanced psycho-social insight into women’s perceptions/experiences and the socio-cultural context of their lives. Analysis of pertinent ‘pregnancy’ Internet fora postings augmented interview data and was utilised for comparative/corroborative purposes. Participants were predominantly of low socio-economic status, congruent with epidemiological data. The concept of pregnancy ‘planning’ was not resonant and few women accessed/felt predisposed to access preconception care. Women did not identify as ‘obese’, and knowledge/perception of risks associated with the medical ‘conditions’ was low. Women perceived themselves to be stigmatised due to their weight in society and specifically within healthcare. Many participants were experiencing acute/chronic stress which appeared to have mediated risk perceptions/compromised diabetic regimen adherence. Expense of ‘healthy’ eating/diabetic diet was considered prohibitive. Women’s material circumstances/socio-cultural milieux may militate against ability to minimise risk and effect lifestyle change. Policy and practice, for the most part, fails to take this into account.ESR