Emotional eating, characterized by the consumption of food in response to emotional states rather than physiological hunger, is an established behavioral factor linked to obesity^1,2. Previous research has predominantly focused on Western populations, leaving a need for studies in non-Western, culturally diverse contexts such as India^3. Emotional eating behaviors may be particularly relevant in populations undergoing lifestyle and dietary changes due to urbanization and shifts in socio-economic structures, as is observed in India^4,5. This study explores the relationship between emotional eating and BMI among Indian adults, providing insights into behavioral contributors to obesity that may be modulated by cultural influences^6.

OBJECTIVE: The primary objective is to investigate the correlation between emotional eating behavior and BMI among Indian adults, using the Emotional Eater Questionnaire (EEQ) to classify emotional eating levels and assess their relationship with obesity.

SUBJECTS: The study participants were all adults answering the test. Sample Size: 109

• z = 1.96,
• p =40.3% 15
• Desired Confidence Interval = 1-α =95%
• q= (1-p) = 59.7
• Absolute precision (d) = 7%
• n = z2 1-α [px(1-p)]/d2

Indian adults between 18-60 years of age residing in India were included in this study. While diagnosed cases of hypertension, diabetes, cancer, kidney diseases, endocrinal disorders, or heart diseases, and patients having any severe mood disorder controlled by pharmaceuticals.

design was employed, focusing on 101 adults aged 18-60 years residing in India. This approach facilitated the examination of emotional eating behavior and its correlation with BMI within a snapshot of the population.

Participants: Inclusion criteria required participants to be adults within the specified age range, without medical diagnoses of conditions like hypertension, diabetes, kidney or heart disease, or psychiatric disorders requiring medication^7. Participants were classified as obese if their BMI exceeded 23 kg/m², while a BMI below this threshold classified them as non-obese^8.

Assessment Tools: Emotional eating behavior was measured using the Emotional Eater Questionnaire (EEQ), a validated tool that evaluates eating tendencies in response to emotional cues^9. The EEQ categorizes individuals into four distinct groups based on their scores: non-emotional, low emotional, moderate emotional, and high emotional eaters.

Statistical Analysis: BMI scores were statistically compared across EEQ-defined emotional eating categories using the Spearman correlation^10. Mann-Whitney U tests assessed differences between obese and non-obese groups in EEQ scores, and one-way ANOVA tested BMI differences across the categories^11.

Ethical Approval: Obtained for IEC GMCN, approval No. 51231 dated 06/12/24.

The mean age of the 101 participants was 24.9 ± 9.6 years, with a gender distribution of 65 females and 36 males. Analysis showed that higher emotional eating scores correlated significantly with higher BMI values^12. Specifically:

• Spearman Correlation: A positive correlation was found between EEQ scores and BMI, indicating that as emotional eating scores increased, so did BMI^13.
• Mann-Whitney U Test: A significant difference in EEQ scores was observed between obese and non-obese groups, with obese individuals generally exhibiting higher scores^14.
• ANOVA Results: Analysis confirmed a statistically significant variance in BMI across the EEQ categories, with the highest BMI averages appearing in the high emotional eating group^15.

Figure.1. Score of EEQ between Obese and Non-Obese subjects

The histogram displays the distribution of emotional eating scores among obese and non-obese individuals.

• The majority of non-obese individuals have scores around 10, indicating moderate emotional eating behaviour.
• The majority of obese individuals have scores around 5 to 10, with fewer individuals scoring higher.
• There are fewer individuals in both groups with very high scores (above 20).

This histogram suggests that emotional eating is present in both obese and non-obese individuals, but the distribution patterns differ slightly, with non-obese individuals having a higher concentration around the moderate range.

Figure.2. Showing Median EEQ Score of Obese and Non-Obese subjects

The bar chart represents the results of a two-sample Mann-Whitney U test comparing the median emotional eating scores between obese and non-obese individuals. The median emotional eating score for obese individuals is higher (10) compared to non-obese individuals (8.5). indicating that, on average, obese individuals have a higher median score for emotional eating compared to non-obese individuals.

Table 1: Categorization of study participants on their Emotional eater Questionnaire Score and BMI

This table shows that:

• Non-Emotional Eaters: The majority (16 out of 26) are non-obese, with a mean BMI of 21.77 ± 3.34.
• Low Emotional Eaters: Most individuals in this category (28 out of 41) are also non-obese, with a similar mean BMI of 21.78 ± 2.83.
• Emotional Eaters: This category has a higher number of obese individuals (18 out of 28), with a mean BMI of 24.00 ± 3.85.
• Very Emotional Eaters: Almost all individuals in this category (5 out of 6) are obese, with the highest mean BMI of 27.51 ± 3.27.

This table highlights that higher emotional eating scores are associated with a higher proportion of obese individuals and a higher mean BMI.

The table presents the results of ANOVA. The groups are classified based on their scores on the Emotional Eating Questionnaire (EEQ).

1. ANOVA Test Results:

• F-value: is 4.40. This value indicates the ratio of the variance between the group means to the variance within the groups.
• P-value: is 0.006048. that is less than the commonly used significance level of 0.05, indicating that there are statistically significant differences in the mean BMI among the different groups of emotional eaters. Indicating the mean BMI increases with higher levels of emotional eating:

• Non emotional eaters and low emotional eaters have similar mean BMIs, both around 21.77.
• Emotional eaters have a higher mean BMI of approximately 23.99.
• Very emotional eaters have the highest mean BMI, around 27.51.

These findings indicate a trend where higher emotional eating scores are associated with higher mean BMI. The statistically significant p-value (0.006048) supports the conclusion that the differences in mean BMI across the groups are unlikely to be due to random chance.

2. Mann Whitney test

1. P Value:

• The p-value for the Mann-Whitney U test is 0.0435. This value indicates the probability that the observed difference in medians occurred by chance. Since the p-value is less than 0.05, it suggests that there is a statistically significant difference between the EEQ scores of obese and non-obese individuals.

2. Type of P Value:

• The p-value is two-tailed, meaning that the test considered the possibility of differences in both directions (obese having higher or lower EEQ scores than non-obese)

The results underscore the influence of emotional eating on BMI in Indian adults, consistent with findings in Western studies yet highlighting unique cultural implications^16. Emotional eating behavior may enhance the likelihood of obesity by triggering the brain’s reward pathways, which favor pleasurable food consumption over hunger-based cues^17,18. These findings emphasize the potential of addressing emotional eating as a modifiable risk factor in culturally sensitive obesity interventions, particularly in India’s shifting dietary landscape^19. A systematic review and meta-analysis by Vasileiou K, et al. examining emotional eating among adults with varying BMI statuses. Findings indicate a higher degree of emotional eating in individuals with obesity compared to those with a healthy BMI^20. A cross-sectional study exploring the relationship between emotional eating and nutritional intake in adult women with overweight and obesity. The study highlights the association between emotional eating behaviors and increased consumption of energy-dense foods^21. Research by Wanger et al linked emotional eating in response to anxiety or sadness with indicators of heart damage, such as arterial stiffness and diastolic dysfunction^22.

SUMMARY:

• Aligning Trends: Our study's findings regarding the higher prevalence of emotional eating among obese individuals align well with existing literature, reinforcing the link between emotional eating behaviours and higher BMI.
• Unique Contributions: Differences in the magnitude of the EEQ score difference, cultural context, and methodological approaches highlight the unique contributions of our study to the broader understanding of emotional eating and obesity. These variations underscore the importance of considering cultural and contextual factors when interpreting the relationship between emotional eating and obesity.

Emotional eating, as quantified through the EEQ, is a significant predictor of obesity in Indian adults. By identifying and categorizing individuals with high emotional eating scores, this study supports the need for targeted obesity prevention strategies that address behavioral aspects of eating. This approach could enhance obesity management by integrating emotional eating assessment into intervention frameworks.

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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