emotional eating
Abstract
In a nationwide sample of 10,087 Dutch adolescents aged 11-16 (M = 13.0, Sd = 0.8) on average 25% of the respondents watched more than 3 hours TV per day.
Lowest levels of television viewing (TVV) were found in Dutch adolescents as compared to other ethnic groups, and in groups with higher compared to lower educational levels. Snacking was negatively associated with physical activity and positively associated with TVV. For both boys and girls, the posi-tive association between TVV and snacking was stronger in adolescents who scored high on external and (only for boys) emotional eating, while restrained eating attenuated this association.
Families on the balance 186
Introduction
Ample research examined the association between children’s television view-ing (TVV) and weight. Cross-sectional studies, a few intervention studies, and recent longitudinal studies (Hancox et al., 2004) have shown a positive relationship be-tween hours of TVV and weight (increase) during childhood and adolescence (Coon
& Tucker, 2002). Two primary mechanisms by which TVV contributes to obesity have been suggested: Reduced physical activity and increased energy intake (Epstein et al., 2002).
Inverse associations between TVV and physical activity have been found (Crespo et al., 2001), albeit in some studies this association was weak or non-significant (Coon
& Tucker, 2002). There is also evidence that at least part of the relationship between TVV and overweight is due to food intake. TVV is associated with higher intake of energy and fat, and is assumed to promote snacking (Halford et al., 2004) and con-sumption of nutritionally poorer diets.
Two major hypotheses about the mechanism by which TVV exactly promotes food intake are often mentioned. First, TV is believed to provide food cues (e.g., food advertisements) that may alter the viewer’s food preferences and intake. Second, weight-related messages on TV like thin idealizations and stigmatization of over-weight people as well as showing incorrect, contradictory messages of slim actors who eat unhealthily without gaining any weight could cause negative emotions and overeating in persons who are preoccupied with weight. Such theories how-ever assume that people react similarly to food cues and to negative emotions, and do not explain for individual differences in eating behaviour. The objective of the present study is to provide a framework for explaining individual differences in the magnitude of the association between TVV and food intake. We discuss three major psychological theories on the relationship between eating behaviour and overweight:
External, restrained, and emotional eating, and subsequently test their moderating effects on the association between TVV and snacking.
The first theory, focussing on external eating, states that certain people are more sensible to external food cues than others, and that they eat in response to those stimuli, regardless of their internal state of hunger and satiety (Schachter & Rodin, 1974). TVV can provide food cues in the form of food advertisements. The association between advertisement and food intake has been studied extensively. Watching TV commercials was found to be associated with children’s preferences for the adver-tised foods (Borzekowski & Robinson, 2001), and persuading parents to buy those foods (Brody et al., 1981). It seems, however, unreasonable to assume that everyone is affected by this exposure to advertisements in the same way. External eaters are more sensitive to external cues and more likely to respond to those food advertise-ments by eating. Inter-personal differences in sensitivity for TV food cues have been studied by Halford et al. (2004). In their study, obese subjects recognized more food advertisements than lean subjects, and this was associated with higher food intake following exposure to these food advertisements. No significant interaction of advertisement recognition with external eating was found, but this might be due to the small sample (Halford et al., 2004). In our study, the positive association between
CH11 Eating behaviour, TVV, and snacking in adolescents 187 TVV and food intake was hypothesized to be stronger in subjects who scored higher
on external eating.
According to the restraint theory, dieting can lead to overeating. People who diet, suppress their feelings of hunger cognitively and eat less. However, when cognitions are undermined (disinhibition) restrained eaters are more likely to overeat than non-dieting individuals; this is called counter-regulation (Herman & Polivy, 1980). Several disinhibitors have been studied, such as food preloads, alcohol, and also weight related media messages. Weight related media messages are linked with negative feelings like body dissatisfaction and low self-esteem (Groesz et al., 2002). Restrained participants ate more than unrestrained subjects in response to a video-tape or magazine advertisements containing stereotypical images of thin attractive females (Mills, 2002; Seddon & Berry, 1996) or after viewing diet-oriented TV advertise-ments. Moreover, Schotte and colleagues showed that watching a frightening movie was associated with negative affect, which triggered overeating among restrained participants (Cools et al., 1992; Schotte et al., 1990). TVV may be a disinhibitor for restrained eating and thus the combination of high-restrained eating and high TVV was hypothesized to be associated with higher snack intake.
According to the psychosomatic theory “emotional eaters” do not eat in response to internal signals, feelings of hunger and satiety, but in response to their emotions.
In case of emotional arousal or stress, emotional eaters respond with excessive eating instead of the normal reaction, loss of appetite (Bruch, 1973). In adult stud-ies, TVV has also been associated with negative emotions, like loneliness, feelings of failure and guilt, and depression (Dittmar, 1994). These negative emotions have been related to overeating in highly emotional eaters (Ganley, 1989; Slochower, 1983).
To the best of our knowledge there are no studies linking emotional eating to TVV.
Assuming that TVV is associated with negative emotions (Dittmar, 1994), high TVV might especially be associated with overeating in subjects that eat in response to those negative emotions (i.e., high emotional eaters).
This study describes the association of physical activity and snacking with TVV in a large (n = 10,087) nationwide sample of Dutch adolescents. Individual differences in the association between TVV and snacking are studied by introducing external, restrained, and emotional eating behaviours as moderator variables for this associa-tion. Additionally demographic and ethnic differences in TVV are reported.
Methods
A nationwide sample of 10.087 Dutch undergraduates aged 11-16 (M = 13.0, Sd = 0.8) were recruited through their schools, the total response of participating schools was 91.9%. Details of the selection procedure are described elsewhere (Otten, Engels, & van den Eijnden, 2005).
The number of sweet and/or savoury snacks respondents usually ate per day measured Snacking. This item was derived from a larger food intake questionnaire and had been used in an adolescent sample before. Television viewing on a regular
Families on the balance 188
school day (including video and dVd) was rated on an 8-points scale from 0 (almost never) to 7 (more than 4 hours per day). Self-reported TVV has been used in most non-experimental studies on TVV, and weekday TVV has been found to be a valid indicator of total TVV time in adolescents (Hancox et al., 2004). Eating behaviour was measured with the deBQ (Dutch Eating Behaviour Questionnaire) and includes ex-ternal, restrained, and emotional eating which have a high internal consistency, high validity for food consumption, and high convergent and discriminative validity (van Strien, 2002). Cronbach’s alphas in this study were .84 and higher. The Godin-Shep-hard questionnaire was used to assess Physical activity. Respondents were asked to report the durance of habitual physical activity at three levels of intensity: Light (e.g., walking), moderate (e.g., badminton) and strenuous (e.g., basketball). Total physi-cal activity was physi-calculated by a combination of these sub scores, using the following formula: (9 x strenuous) + (6 x moderate) + (3 x light). The scale has been validated for adolescents (Godin & Shephard, 1985).
For analyses, scores on eating behaviour were divided in high and low by means of a median split, TVV was divided in low and high (≤ or >3 hours TVV/ day), high TVV roughly corresponded with the upper quartile for both boys and girls. This classifica-tion was done because intense TV viewers were expected to be particularly at risk of overweight and problematic eating behaviours. Heavy TVV has been found to be associated with a statistically higher risk of obesity (Crespo et al., 2001), low physical activity, smoking, and depression in young adults (Sidney et al., 1996).
Results
Table 1 shows TVV per group of subjects, differences were found between age, educational level and ethnic groups but not for gender (Table 1). TVV was negatively associated with physical activity (r = -.06 for boys, and r = -.10 for girls, p’s < .001) and positively associated with snacking (r = .25 for boys, and r = .21 for girls, p’s < .001).
Adolescents who scored high on external eating ate more snacks than those who scored low on external eating (t(4810) = -15.95 for boys, and t(5042) = -19.54 for girls, p’s < .001). Adolescents who scored high on restrained eating ate fewer snacks than those who scored low on restraint eating (t(4799) = 9.94 for boys, and t(5039) = 9.58 for girls, p’s < .001). Adolescents who scored high on emotional eating ate more snacks than those who scored low on emotional eating (t(4798) = -7.16 for boys, and t(5035) = -11.59 for girls, p’s < .001) (see Table 2).
Significant main effects on snacking were found for the three eating behaviours, as well as significant TVV × eating behaviour interactions on snacking for TVV × ex-ternal eating (p < .01 for boys and p = .01 for girls), TVV × restrained eating (p = .03 for boys and .02 for girls), and TVV × emotional eating (p = .01 for boys).
CH11 Eating behaviour, TVV, and snacking in adolescents 189 Table 1: Television viewing per group of subjects
1 lower-level education (LWOO, VmBO; preparatory college for vocational training) and higher level education (HaVO, VWO; preparatory school for college or university).
2 Ethnicity was determined by the native country of the parents.
% n Television viewing (%) Statistics
< 1hour 1-3 hours
>3 hours Gender
Boys 49 4712 22 54 24 χ2 (2, n=9658) =
1.16, p = .56
Girls 51 4946 22 53 25
Age
11-12 29 2760 26 55 19 χ2 (6, n=9652) =
131.82, p < .001
13 47 4506 21 55 24
14 22 2092 18 51 31
15 3 294 19 43 38
Educational level1
Lower level education 54 5224 20 48 32 χ2 (2, n=9600) = 347.81, p < .001 Higher level education 46 4376 24 60 16
Ethnicity2
Dutch 81 7710 23 55 22 χ2 (8, n=9493) =
123.89, p < .001
Surinam/Antillean 4 372 12 46 42
Moroccan 1 107 17 48 35
Turkish 3 326 15 49 36
Other 10 978 20 51 29
Families on the balance 190
Table 2: Average number of snacks per day per group of subjects sorted by score on eating behaviour and hours TV watched per day (mean (SD))
Boys Girls
Score on eating behaviour
Television viewing * Television viewing *
<= 3 hours >3 hours <= 3 hours >3 hours n = 3516 n = 1116 n = 3675 n = 1223 External Eating *
Below median 1.98 (1.10) 2.42 (1.35) 1.75 (0.93) 2.09 (1.18) Above median 2.47 (1.30) 3.16 (1.47) 2.29 (1.16) 2.81 (1.33) Restraint Eating *
Below median 2.36 (1.27) 3.06 (1.50) 2.12 (1.13) 2.71 (1.36) Above median 2.03 (1.14) 2.55 (1.37) 1.83 (0.98) 2.24 (1.22) Emotional Eating *
Below median 2.09 (1.18) 2.58 (1.44) 1.83 (0.98) 2.23 (1.26) Above median 2.31 (1.25) 3.03 (1.46) 2.16 (1.13) 2.68 (1.32)
Total 2.20 (1.22) 2.83 (1.47) 1.99 (1.08) 2.47 (1.31)
* Groups differ significantly in snack consumption (p < .001) (One-way Anova)
Discussion
This study provides tentative evidence that external, restrained and emotional eating might play a role in the association between TVV and snacking. Conform our hypothesis high external and emotional eaters had stronger associations between TVV and snacking. Interestingly, the interaction between TVV, emotional eating and snacking was only significant for boys, these gender differences need further inves-tigation. Possibly, in certain people both heavy TVV and emotional eating might be the consequences of inadequacy of to deal with negative emotions (Dittmar, 1994), mechanism that might differ between men and women. Opposite to our prediction, restrained eating attenuated the association between TVV and snacking. Perhaps,
CH11 Eating behaviour, TVV, and snacking in adolescents 191 TVV and accompanied thin idealizing messages do not always lead to negative
emo-tions and disinhibition but have also shown inspiring effects in restrained eaters (Mills et al., 2002). Such mechanisms should preferably be studied in real life settings and over longer time periods.
Snacking was measured with a questionnaire instead of dietary food intake measurements, and does therefore not allow for conclusions about nutrient intake.
We can also not rule out the possible effect of socially desirable answers on dieting and snacking. A strength of this study is that it covers a large sample and substantial proportions of ethnic minorities and lower education level groups. Although the data are cross-sectional and no causal inferences from the results can be drawn, they indicate that studying eating behaviour in other designs, where snacking during TVV is measured can provide more insight in the mechanisms that underlie the associa-tion between TVV and food intake in adolescents.
Families on the balance 192
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