A new study led by researchers at The Miriam Hospital’s Weight Control & Diabetes Research Center finds that dieters who have the tendency to eat in response to external factors, such as at festive celebrations, have fewer problems with their weight loss than those who eat in response to internal factors such as emotions. The study also found that emotional eating was associated with weight regain in successful losers.

The study is published in the October 2007 issue of Obesity.

“We found that the more people report eating in response to thoughts and feelings, such as, ‘when I feel lonely, I console myself by eating,’ the less weight they lost in a behavioral weight loss program. In addition, amongst successful weight losers, those who report emotional eating are more likely to regain,” says lead author Heather Niemeier, Ph.D.

This is important, the authors note, because one of greatest challenges facing the field of obesity treatment remains the problem of weight regain following weight loss.

“Participants in behavioral weight loss programs lose an average of 10 percent of their body weight and these losses are associated with significant health benefits. Unfortunately, the majority of participants return to their baseline weight within three to five years,” Niemeier says.

In this study, researchers analyzed individual’s responses to a questionnaire widely used in obesity research called the Eating Inventory. The Eating Inventory is a clinical tool that is designed to assess three aspects of eating behavior in individuals – cognitive restraint, hunger, and disinhibition.

Specifically, Niemeier and her team focused on the disinhibition component of the Eating Inventory because although past studies have suggested that disinhibition as a whole is an accurate predictor of weight loss, the scale itself includes multiple factors that could independently forecast outcomes.

“The disinhibition scale evaluates impulsive eating in response to emotional, cognitive, or social cues. Our goal was to examine and isolate the factors that make up the disinhibition scale, and then determine if these factors have a specific relationship to weight loss and regain,” says Niemeier.

Participants in the study included two groups of individuals. The first group consisted of 286 overweight men and women who were currently participating in a behavioral weight loss program. The second group included 3,345 members of the National Weight Control Registry (NWCR), an ongoing study of adults who have lost at least 30 pounds and kept it off for at least one year.

“By examining these two very different sample groups, we were able to assess the effect of disinhibition on individuals attempting to lose weight, as well as on those who are trying to maintain weight loss,” the authors note.

Upon examination, the researchers found that the components within the disinhibition scale could be grouped into two distinct factors – external and internal disinhibition.

External disinhibition describes experiences that are external to the individual such as, “When I am with someone who is overeating, I usually overeat, too” and “I usually eat too much at social occasions, like parties and picnics”. Internal disinhibition refers to eating in response to thoughts and feelings that are internal to the individual and includes emotional eating such as, “When I feel lonely, I console myself by eating” and “While on a diet, if I eat a food that is not allowed, I often splurge and eat other high calorie foods”.

Results showed that in both groups of participants, internal disinhibition was a significant predictor of weight over time. For participants in the weight loss program, the higher the level of internal disinhibition, the less weight an individual lost over time. The same was true for maintainers in the NWCR in that internal disinhibition predicted weight regain over the first year of registry membership.

“Interestingly, external disinhibition did not predict weight loss or regain in either sample at any time,” notes Niemeier.

In addition, the authors note that internal disinhibition predicted weight change over time above and beyond other psychological issues including depression, binge eating, and perceived stress.

“Our results suggest that we need to pay more attention to eating triggered by emotions or thoughts as they clearly play a significant role in weight loss. Current treatments provide minimal assistance with eating in response to feelings or thoughts,” says Niemeier.

She adds, “Modifying our treatments to address these triggers for unhealthy eating and help patients learn alternative strategies could improve their ability to maintain weight loss behaviors, even in the face of affective and cognitive difficulties.”

In addition to Niemeier, the research team consisted of Suzanne Phelan, Ph.D.; Joseph L. Fava, Ph.D.; and Rena R.Wing, Ph.D.; of the Weight Control and Diabetes Research Center at The Miriam Hospital and The Warren Alpert Medical School at Brown University.

This research was funded by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health.

- Lifespan