GPs are being called upon to help patients who are emotionally eating

Primary care physicians are well positioned to address emotional eating because of their long-standing relationships with patients, note Jana DeSimone Wozniak, Ph.D., and Hsiang Huang, MD, MPH, of Harvard Medical School and Cambridge Health Alliance in Cambridge, Massachusetts.

According to their article published in Harvard Review of PsychiatryEmotional eating has been linked to numerous health problems, including being overweight or obese, difficulty losing weight and maintaining weight loss, diabetes, and heart disease.

“Emotional eating is characterized by increased motivation for food consumption in response to stress and/or emotional and mood states,” Dr. Wozniak and Dr. Huang explain. “Individuals who eat in response to negative emotional states and stimuli report a tendency to consume so-called ‘palatable foods’ (i.e., foods high in sugar, fat, and calories).”

Some nonobese individuals report eating in response to negative emotions or stress, the authors say, but emotional eating is more often associated with increased body fat, waist circumference, and body mass index. Moreover, emotional eating has been linked to reduced success with traditional, behavioral weight loss treatments (e.g., reducing portion size, calorie and fat intake, and/or the amount of carbohydrates consumed).

GPs are well positioned to recognise emotional eating

Emotional eating often overlaps with depression, anxiety, and eating disorders, Dr. Wozniak and Dr. Huang note. They recommend using the Patient Health Questionnaire–9 (PHQ-9) and the Generalized Anxiety Disorder–7 (GAD-7) to screen for disordered eating behaviors in the context of negative emotional states or psychosocial stressors. For example, if a patient presents with weight-related concerns and reports “poor appetite or overeating” on the PHQ-9, the provider can further investigate the nature of the eating disorder and emotion regulation patterns.

Primary care professionals may wish to pursue further research using screening tools that assess for eating disorders and life stressors. Examples that are appropriate for primary care include the Screen for Disordered Eating, the Perceived Stress Scale–10, and the Eating Disorder Examination Questionnaire.

Dr. Wozniak and Dr. Huang caution that people who meet the criteria for binge eating disorder (BED) may also eat emotionally. However, not everyone who eats emotionally meets the diagnostic criteria for BED (episodes of compulsive eating that recur an average of once a week for at least three months).

Clinical Considerations for Primary Care Providers in Addressing Emotional Eating

Psychological interventions, particularly cognitive behavioral therapy and mindfulness-based interventions, are the standard first-line approaches for treating emotional eating, the authors say. However, acceptance and commitment therapy and dialectical behavior therapy also reduce emotional eating in adults with overweight or obesity, and research suggests that the improvements are sustained.

The U.S. Food and Drug Administration has not approved any medications for the treatment of emotional eating. However, psychopharmacological treatment may be necessary for underlying mental health conditions, with special attention to comorbidities.

Dr. Wozniak and Dr. Huang acknowledge that psychological interventions specifically designed to address emotional eating may not be readily available to all primary care populations.

They explain: “Encouraging patients to track their moods and eating habits to become more aware of the triggers of emotional eating, engaging in mindfulness exercises via the internet or phone applications, and helping patients identify alternative, adaptive emotion regulation strategies can all help to increase awareness of the internal and external factors that contribute to and maintain emotional eating and encourage nonjudgmental, adaptive coping.”