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Transdiagnostic views on eating disorders and obesity and new approaches for treatment

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Eat your heart out: how emotions shape eating disorders

New research shows how conditions such as bulimia and anorexia are affected differently by mood, inviting more personalised treatment.

Health

Eating disorders such as anorexia, bulimia and binge eating affect millions of Europeans, yet their causes remain unclear. “There is strong debate about whether they are all the same, or separate entities, and what the risk factors are,” explains Jens Blechert, project coordinator of the EU-funded NewEat project. “There is also a debate about what drives binge eating on the one hand, and restriction, extreme fasting and anorexia on the other hand,” he adds. “We believe that emotional eating is a central dimension that characterises different eating disorders.” Emotional eating is the term for when emotions, rather than hunger, are the main cause for overeating. In about a third of the general population, food cravings and appetite are strongly enhanced in the presence of negative emotions. This alone is not pathological, says Blechert, but if strong enough can lead to binge eating and uncontrolled overeating. The central question for Blechert and his team at the University of Salzburg was why some people turn to binge eating and overeating, while others start to restrict their diets. “If we find they have specific characteristics, we would know why they are different,” remarks Blechert. “And if the degree of emotional overeating is different than in healthy individuals, we might identify a factor involved in having that eating disorder.”

Happy meals

To answer this, Blechert and his colleagues developed a questionnaire that was completed for more than 200 patients at clinics for eating disorders. In addition, a number of patients were brought into the laboratory where they were primed to focus on negative emotions before their behavioural responses to food were measured. Differentiating emotions into four key states – happiness, anger, sadness and anxiety – Blechert and his colleagues were able to see how these differently affected emotional eating in different patient groups. “We found that each disorder has a very characteristic pattern of emotional eating,” he says. For example, happiness tended to increase appetite in anorexic patients and decrease it in bulimic patients, while healthy controls were largely unchanged. Meanwhile, the opposite effect was seen for sad emotional states, with healthy patients also tending to eat more. Emotional eating was most pronounced in patients with bulimia and binge eating disorder, groups which are known to have the most severe binge eating episodes. “Researchers thought anorexia was all about rules, and emotions did not play a role, because they are so cognitive and controlling in their eating,” notes Blechert. “That’s not the case, you can see they eat less when in a negative emotional state, suggesting that fasting helps them in dealing with these emotions.” On the flip side, positive emotions seem to help them eat more, and thus act in a ‘self-healing’ manner.

Smartphone app

Blechert says this shows the need for a change in strategy for dealing with eating disorders: “Most clinics are treating all eating disorders alike, at least in group therapy, our results clearly show that a disorder-specific approach is needed here.” His team is continuing to publish data from the studies. They also plan to develop a smartphone app that can help translate these results into tools for eating disorder patients to manage their binge eating. The app will monitor the user’s emotional state through a daily questionnaire, and if problematic moods are detected, offer advice on avoiding unhealthy eating. “We’re currently evaluating it with a small group, but it is too early to say what additional benefit can be generated,” concludes Blechert.

Keywords

NewEat, eating disorder, mood, emotional eating, emotion, anorexia, bulimia, binge, app

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