RISK FACTORS OF EMOTIONAL EATING IN UNDERGRADUATES by ALAN Y HO Submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy Dissertation Adviser: Dr. Anastasia Dimitropoulos Department of Psychological Sciences CASE WESTERN RESERVE UNIVERSITY August, 2014 CASE WESTERN RESERVE UNIVERSITY SCHOOL OF GRADUATE STUDIES We hereby approve the thesis/dissertation of Alan Y Ho Candidate for the Doctor of Philosophy degree *. Committee Chair Anastasia Dimitropolous Committee Member Heath Demaree Committee Member Elizabeth Short Committee Member Eileen Anderson-Fye Date of Defense May 12, 2014 *We also certify that written approval has been obtained for any proprietary material contained therein. 1 Table of Contents List of Tables ……………………………………………………………………… 2 List of Figures …………………………………………………………………….. 3 Abstract …………………………………………………………………………… 4 Introduction ……………………………………………………………………….. 6 Methods …………………………………………………………………………… 38 Results …………………………………………………………………………….. 43 Discussion ………………………………………………………………………… 49 Tables ……………………………………………………………………………... 66 Appendices …………………………………………………………………………. 77 References ………………………………………………………………………… 85 2 List of Tables Table 1 – Sample Descriptives ...………………………………………………..... 66 Table 2 - Medications Taken in Past 30 Days from Participants in Study ………. 67 Table 3 – The COPE Subscales as used in the Current Study …………………….. 67 Table 4 – Normality ………………………………………………………………. 68 Table 5 – Non-Normal Variables Log Transformation …………………………. 68 Table 6 – Gender Independent T-tests …………………………………………….. 69 Table 7 – Coping Styles and Parental Bonding …………………………………… 70 Table 8 – Coping Styles and Adjustment to College ……………………………… 70 Table 9 – Parental Bonding and Emotional Eating Correlation …………………… 71 Table 10 – Coping and Emotional Eating Correlation M + F ……………………… 72 Table 11 – Coping and Emotional Eating Correlation, Male ……………………… 72 Table 12 – Coping and Emotional Eating Correlation, Female …………………… 73 Table 13 – Asian vs. White Independent T-Test …………………………………… 74 Table 14 – Regression Coefficients ………………………………………………… 75 Table 15 – Multiple Linear Regression Model Summary …………………………. 75 3 List of Figures Figure 1 – Hypothesized Model ……………………………………………………. 36 Figure 2 – Male (M), Female (F), and Male + Female (T) correlation results of hypothesized model …………………………………………………………………. 76 4 Risk Factors of Emotional Eating among Undergraduates Abstract By ALAN Y HO While food quenches one’s hunger, it also assuages feelings. When food is eaten to satisfy one’s feelings instead of satisfying hunger, it results in emotional eating which is associated with negative consequences such as increased risk for heart disease, symptoms of anxiety and depression, and increased risk of obesity. This study examined the risk factors of emotional eating in hopes of giving clinicians a better understanding on how to prevent or lesson emotional eating. There are a myriad of risk factors to emotional eating. Studying emotional eating is complex because it is influenced by many factors such as food preferences, genetics, culture, psychology, and the social and physical environment. Thus, there are many more risk factors than what is being studied here. However, this study attempts to add to the existing psychology literature in emotional eating. Using survey assessments, this study examined whether parental bonding was associated with emotional eating in non-clinical college students who lived among their peers instead of their family. Furthermore, this study investigated whether one’s level of adjustment to college was associated with emotional eating. In addition, an attempt to replicate previous associations between coping style, one’s transition to college, and parental bonding was performed using measures that allowed for more detailed analysis and in order to use these variables as predictors in a multiple regression. Results indicated that perceived parental bonding and level of adjustment to college had 5 no meaningful association with emotional eating. However, gender and race differences in emotional eating were identified. Additionally, gender, race, avoidance coping and socially-supported coping predicted 27% of the variance seen in emotional eating suggesting that in order to curb emotional eating, therapy should concentrate on learning effective coping styles. In addition, this study may also help clinicians and dieticians alike better understand the risks that lead to emotional eating. 6 Introduction Emotional states and situations can have a monumental effect on eating behavior that goes beyond our physiological need for food. Geliebter and Aversa (2003) define emotional eating as food intake that is triggered by strong emotions, both negative and positive, rather than to our internal hunger cues. The hot fudge sundae that you choose to eat after a depressing day or for a celebration is not necessarily due to hunger or your need to fulfill your daily recommended nutrient intake, but because it soothes you or makes you feel happier. Across cultures, food is used for celebrations such as weddings, birthdays, or after a sporting win and thus, it is likely that positive affect and food intake are related through associative learning (Patel & Schlundt, 2001). Likewise, the stress of final exams may lead someone to indulge in a pint of Ben & Jerry’s ice cream. Eating a small amount of sweet foods has been shown to improve negative mood states immediately, albeit temporarily (Macht & Mueller, 2007). Eating in response to an emotional state is convenient because food surrounds us and is an intricate part of our celebrations from holidays to personal milestones, our social life, business meetings, and even our mourning. This is something not observed in other animals and why researchers believe eating is more than just replenishing our energy (McGrew & Feistner, 1992). However, eating in response to emotions and not internal hunger cues, is associated with negative consequences. Emotional eating has been associated with psychopathology including symptoms of anxiety and depression (Goossens, Braet, Van Vlierberghe, & Mels, 2009; Heaven, Mulligan, Merrilees, Woods, & Fairooz, 2001), negative self-concept and feelings of physical incompetence (Braet & Van Strien, 1997), 7 difficulties in interpersonal relationships and sexuality (Van Strien, Schippers, & Cox, 1995), overeating (Wardle et al., 1992), and bulimic behaviors (Waller & Osman, 1998). In addition, emotional eating has been linked with elevated consumption of high-calorie and high fat foods (Oliver, Wardle, & Gibson, 2000; Wallis & Hetherington, 2004), increased risk of obesity (Sung, Lee, Song, Lee, & Lee, 2010), and poor weight loss outcomes (Elfhag & Rossner, 2005). Overconsumption of high-calorie and high fat foods and being overweight or obese is associated with pathological changes in the body which increases the risk for many chronic diseases such as heart disease, type 2 diabetes, and stroke (Lean, Hans, & Seidell, 1998). Even if emotional eating is not associated with obesity, poor dietary behaviors such as eating food that are high in saturated fat have been linked to poor cardiovascular health (Hermansen, 2000). The body runs on fuel in the form of nutrients from food and if the fuel put into the body is not healthy, the body cannot function at peak performance (Nantz, Rowe, Nieves, & Percival, 2006). For the body to function to the best of its ability, essential nutrients such as vitamins, proteins, and minerals are necessary (Lane, Magno, Lane, Chan, Hoyt, & Greenfield, 2008). Healthy food contains vitamins the body requires to function optimally such as Vitamins A, B, C, and D (Lane et al., 2008). Foods such as spinach and carrots contain a healthy amount of vitamin A, which contributes to healthy skin and hair and healthy vision (Chapman, 2012). Fruits such as oranges and grapefruit contain vitamin C, which increases one’s immune system and aids in iron absorption (Nantz et al., 2006). Foods such as chicken, beef, pork, and fish contain protein and vitamin B which are important for optimal brain performance and lean muscle mass (Feng, 2012). Calcium, a mineral, aids in bone strength and is found in 8 foods such as milk and cheese (Lutz et al., 2012). These essential nutrients are found sparingly, if at all, in unhealthy foods even though sweet desserts or salty chips may satisfy one’s hunger. Food intake characterized by high levels of saturated fat and processed sugar is negatively associated with high density lipoprotein (HDL) cholesterol and positively associated with levels of total cholesterol, blood sugar levels, and increased systolic blood pressure (van Dam, Grievinik, Ocke, & Feskens, 2003). HDL reduces plaque in the arteries and is considered “good” lipoproteins (van Dam et al., 2003). While there are certain risk factors for sub-optimal health that cannot be altered such as heredity and increasing age, eating behavior and obesity is a risk factor that can be changed (Brown & Roberts, 2012). Thus, a look into the risk factors of emotional eating, which is linked to an increase in the likelihood of poor dietary behaviors, is important as it is a behavior that can be modified. Self-Regulation Researchers have suggested that emotional eating is a learned response (Bruch, 1973; Galloway, Farrow, & Martz., 2010); this response is believed to have emerged in adolescence in association with depressive feelings and inadequate parenting (Ouwen, Van Strien, & van Leeuwe, 2009; Snoek, Engels, & Janssens, 2007; Van Strien, Snoek, van der Zwaluw, & Engels, 2010). In a recent study, Galloway and researchers (2010) investigated how feeding practices used in childhood relate to eating behaviors and weight status in early adulthood. College students’ and their parents’ retrospective reports on child feeding practices when the students were in middle school were examined. Parents have significant control over the intake and selection of foods their