Two facets of stress and indirect effects on child diet through emotion-driven eating
Introduction
The prevalence of childhood obesity has prompted widespread investigation into factors influencing healthy eating behavior in children (Barlow and Dietz, 1998, Ebbeling et al., 2002, Story et al., 2009). Childhood obesity has been associated with earlier puberty in girls, metabolic syndrome, and adult obesity, which may increase risk of cancer in adulthood (Biro & Wien, 2010). Recent research has begun to suggest that stress may increase consumption of high-calorie/low-nutrient foods (HCLN) high in fat, salt, and sugar, at least for certain types of stress (e.g., socio-emotional) (Michels et al., 2012, Tryon et al., 2013a, Tryon et al., 2013b). Chronic stress may alter the brain's activation patterns in response to high-calorie foods, increasing activity in areas associated with reward and decreasing activation in pre-frontal areas associated with emotional control (Tryon, Carter, et al., 2013). If stress prompts increased consumption of unhealthy foods, healthier options may be crowded out of the diet. In this case, children experiencing high stress may consume fewer fruits and vegetables and have greater intake of high-fat, sugary foods.
Socio-economic disadvantage and stressful experiences could increase child negative affect through many paths including changes in the family environment, and disruptions could prompt emotional eating as a coping technique, contributing to obesity (Hemmingsson, 2014, Pervanidou and Chrousos, 2011). Indeed, some evidence indicates that 4th grade children who experience a greater number of negative events report eating fewer fruits and vegetables, even controlling for emotional eating behavior (Michels et al., 2012). Using cortisol as an indicator of stress, hypercortisolism is associated with more frequent consumption of sweet and fatty snack foods but not fruits and vegetables (Michels et al., 2013). Finally, although Hispanic and African-American populations may be at higher risk for obesity in the US (Lutfiyya, Garcia, Dankwa, Young, & Lipsky, 2008), limited studies have investigated these effects within minority populations (Nguyen-Michel, Unger, & Spruijt-Metz, 2007).
Emotion-driven eating is the tendency to consume food as a means to cope with moods or stress rather than physical hunger (Nguyen-Rodriguez et al., 2008, Rollins et al., 2011, Spruijt-Metz, 1999) and may be an important underlying process connecting stress to dietary intake. Among children, emotion-driven eating has been associated with stressful life events (Hou et al., 2013, Michels et al., 2012) and intake of sweet and salty energy-dense foods (Nguyen-Michel et al., 2007, Rollins et al., 2011). Emotion-driven eating has been associated with higher snack food intake with television and video-gaming in children (Pentz et al., 2011, Snoek et al., 2006). Emotional eating has been found to occur at higher rates for girls (Hou et al., 2013) yet is associated with more frequent fruit and vegetable consumption (Nguyen-Michel et al., 2007) and high-calorie/low nutrient food intake in boys (Rollins et al., 2011). Stress may increase emotional eating in adolescents (Kubiak et al., 2008, Pentz et al., 2011). One study tested a cross-sectional mediational model in pre-adolescents for three types of stressors: problems, life events, and daily hassles (Michels et al., 2012). They found that problems were associated with higher sweet and fatty food consumption, yet events were associated with higher fruit and vegetable intakes. Although emotional eating was associated with both types of stressors, none of the relationships were mediated by emotional eating (Michels et al., 2012). Thus, the type of stress may impact how diet is affected. Yet study findings are inconclusive, with some studies finding no relationships between stress, emotional eating, and healthy eating habits (Austin et al., 2009, Markus et al., 2012). While previous research has shown a correlation between stress and unhealthy food intake, effects of stress on emotion-driven eating and healthy food intake remain unclear.
One potential reason for contradictory findings is that researchers often conceptualize and measure stress as a uni-dimensional construct (Austin et al., 2009, Nguyen-Rodriguez et al., 2008). The Perceived Stress Scale was originally designed as a uni-dimensional measure using Cronbach's alpha as a measure of internal consistency reliability in a college student sample (Cohen, Kamarck, & Mermelstein, 1983). However, more recent validation studies have used exploratory and confirmatory factor analysis and find that stress falls predominantly into two factors: (a) perceived self-efficacy and (b) perceived helplessness (Andreou et al., 2011, Lee, 2012). High perceived self-efficacy indicates confidence in one's ability to manage stressors, whereas high perceived helplessness reflects negative affectivity and feeling unable to cope or exert control. In a recent review of studies examining psychometric properties of the Perceived Stress Scale, Lee (2012) found that most studies indicated this two-factor structure for the 10- and 14-item versions. Thus, these separate factors seem to reflect two distinct constructs—confidence in managing stressors and negative affective responses. Accordingly, a person could theoretically score high on both dimensions. These two facets of stress could relate differently to dietary intakes of healthy and unhealthy foods. For example, the ability to manage stressors could decrease the tendency to engage in overconsumption of highly palatable “comfort” foods even in the face of stress, allowing children to maintain healthier dietary consumption patterns. Conversely, negative affective reactivity could lead to emotion-driven eating that prompts consumption of foods high in fat, salt and sugar. Some studies suggest a mediating mechanism of the brain's reward system becoming sensitized to high-calorie, palatable foods (Tryon et al., 2013a, Wagner et al., 2012).
This cross-sectional study investigated whether two facets of stress had direct and indirect effects on self-reported intake of HCLN and fruits/vegetables, mediated by emotion-driven eating. Hypotheses were: (a) perceived helplessness would be associated with higher consumption of HCLN foods and lower fruit/vegetable intake; (b) perceived self-efficacy would be associated with higher fruit/vegetable consumption and lower HCLN intake; and (c) these relationships would be mediated by emotion-driven eating.
Section snippets
Methods
Participants were from the baseline wave of a controlled, school-based obesity intervention study called Pathways to Health (Riggs, Sakuma, & Pentz, 2007). The program was designed to improve executive function skills, dietary intake, and physical activity levels (Riggs et al., 2007). Participants were 4th grade students from across 28 Southern California elementary schools. Schools were randomized to the intervention or control condition and had an average of 35 participating classrooms (range =
Results
Table 1 shows demographic characteristics by gender. Boys and girls were similar in age, ethnicity, free/reduced lunch status and intervention group. However, more boys (31%) than girls (18%) were obese (p < 0.001). A higher percentage of Hispanic students was obese (35%) compared to non-Hispanic students (20%), χ2 = 24.85, p < .001. Table 2 shows correlations, means, and standard deviations for observed study variables. Variables for hypothesized factors tended to have significant intercorrelations
Discussion
These results suggest that adolescents who feel confident about their ability to handle stress eat more fruits and vegetables, yet those who feel helpless to manage stressors engage in more emotion-driven eating and report more frequent consumption of high-calorie/low-nutrient foods. Although many researchers use a summary score from the Perceived Stress Scale to examine effects on eating behavior (e.x., Austin et al., 2009, Barrington et al., 2012, Chen et al., 2012) combining the two facets
Role of funding sources
Funding for this study was provided by the National Institutes of Health Cancer Control and Epidemiology Research Training Grant 5T32 CA 009492; National Cancer Institute #R01 HD052107 (Pentz, PI). NIH had no role in the study design, collection, analysis or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication.
Contributors
Eleanor B. Tate, Donna Spruijt-Metz, and Mary Ann Pentz designed the study. Eleanor B. Tate wrote the first draft. Trevor A. Pickering completed the statistical analysis. All authors contributed to and have approved the final manuscript.
Conflict of interest
The authors declare no conflicts of interest.
Acknowledgments
National Institutes of Health Cancer Control and Epidemiology Research Training Grant 5T32 CA 009492 and National Cancer Institute R01 HD052107 (Pentz, PI) are gratefully acknowledged.
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