Perceptions of emotional eating behavior. A qualitative study of ...

Appetite 60 (2013) 187–192

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Research report

Perceptions of emotional eating behavior. A qualitative study of college students Jessica Bennett a, Geoffrey Greene a, Donna Schwartz-Barcott b,⇑ a b

Department of Nutrition and Food Sciences, University of Rhode Island, Ranger Hall, Kingston, RI 02881, United States College of Nursing, University of Rhode Island, White Hall, Kingston, RI 02881, United States

a r t i c l e

i n f o

Article history: Received 9 January 2012 Received in revised form 29 August 2012 Accepted 20 September 2012 Available online 6 October 2012 Keywords: Qualitative research Emotional eating Emotions Dietary behaviors College population

a b s t r a c t Approximately one-third of college students are overweight or obese and the average student gains 5 kg during college. Previous research has identified a relationship between emotional eating and weight gain in young adults, but outside the realm of eating disorders, few studies qualitatively capture why individuals cope with emotions by eating. Exploratory qualitative research was conducted, including 3-day food journals and indepth interviews, with proportionate quota sampling of eight male and eight female undergraduate students to gain an understanding of students’ perceptions of their emotional eating behaviors. Participants were purposively selected based on their emotional eating scores on the Weight Related Eating Questionnaire from a larger survey assessing student eating behaviors. Participants’ (n = 16) mean age was 19.6 ± 1.0 years and all self-reported their race to be white. Mean Body Mass Index (BMI) for females and males was 24.1 ± 1.2 kg/m2 and 24.8 ± 1.7 kg/m2, respectively. Findings from the qualitative analyses indicated gender differences and similarities. Females identified stress as the primary trigger for emotional eating, frequently followed by guilt. Males were primarily triggered by unpleasant feelings such as boredom or anxiety turning to food as a distraction; however, males were less likely to experience guilt after an emotional eating episode than females. During emotional eating episodes, both genders chose what they defined as unhealthful foods. These findings indicate a multidisciplinary intervention focusing on emotion and stress management in addition to dietary behavior change should be developed to reduce the potential for weight gain associated with emotional eating in the college-aged population. Ó 2012 Elsevier Ltd. All rights reserved.

Introduction One out of every three Americans are obese and two out of every three Americans are overweight (Flegal, Carroll, Ogden, & Curtin, 2010). Data from the National Health and Nutrition Examination Survey 2009–2010 indicated that 18.3% of adolescents (12– 19 years of age) were obese and 32.6% in 20–39 year olds (Ogden, Carroll, Kit, & Flegal, 2012). The increase in the prevalence of obesity appears to be caused by a gradual, but sustained annual increase in weight. Investigators from the Coronary Artery Risk Development in Young Adults (CARDIA) study found young adults aged 18–30 years at baseline gained an average of 0.69–1.19 kg/ year over 10 years. In men and African–American women, total weight gain during the early to midtwenties was larger than during the thirties (Lewis et al., 2000). In 2009, 20% of college students were considered overweight and 11% obese (American College Health Association, 2009); Zagorsky and Smith found that college students gain an average of 5 kg (Zagorsky & Smith, 2011). Over ⇑ Corresponding author. E-mail addresses: [email protected] (J. Bennett), [email protected] (G. Greene), [email protected] (D. Schwartz-Barcott). 0195-6663/$ - see front matter Ó 2012 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.appet.2012.09.023

time, this weight gain can lead to overweight and obesity. Obese individuals are at greater risk for chronic conditions such as arthritis, cancer, diabetes, heart disease, high cholesterol and hypertension (Malnick & Knobler, 2006). Emotional eating has been defined as eating in response to emotional cues, often as a coping response to negative emotions (Kandiah, Yake, Jones, & Meyer, 2006; Konttinen, Mannisto, Lahteenkorva, Silventoinen, & Haukkala, 2010; Laitinen, Ek, & Sovio, 2002; Macht & Simons, 2000) and is associated with weight gain (Blair, Lewis, & Booth, 1990; Geliebter & Aversa, 2003). However, most of this research has focused on individuals with eating disorders (Fox, 2009; McNamara, Chur-Hansen, & Hay, 2008; Skarderud, 2007). Few studies used qualitative research methods to explore the phenomena in individuals without eating pathology (Fox, 2009; Macht, Meininger, & Roth, 2005). Due to the variability in emotions and eating behaviors, different emotions may increase or decrease eating. More research is needed to explore why emotions can increase food intake in certain eaters for instance, but decrease food intake in other groups (Macht, 2008). This exploratory research was conducted to understand the perceptions of emotional eating behaviors in college-aged individuals in general and whether any differences exist between male and

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Table 1 Content and theoretical background of interview protocol. Questions

Activities

Theories and conceptual approaches

What are you favorite foods? Why? Do you have any stories associated with these foods? Is there any particular way you express these emotions? Do you ever feel happy? Sad? Angry? Fear? Love? Surprise?

Probe individual to mention feelings with these stories, which allows for transition into topic of emotions List emotions and frequency

Do these emotions affect your eating behavior?

Describe and provide instances where this occurs

Do positive emotions affect your eating behaviors differently than negative emotions? In qualifying for this study, you scored high on an emotional eating instrument, what do you think this means?

Contrast positive and negative emotions and varying degrees of impact each emotion exhibits Discuss whether participant considers himself/ herself to be an emotional eater

Stress/emotions affect food choices (Kandiah et al., 2006; Konttinen et al., 2010) Emotional patterns (Macht & Simons, 2000) Emotionally instrumental eating (Macht & Simons, 2000) Model of emotional eating (Macht, 2008)

female students, as a basis of future intervention development aimed at modifying emotional eating and decreasing weight gain in susceptible individuals. Methods The University of Rhode Island Institutional Review Board reviewed and approved this study. Participants gave informed, written consent before interviews. Sampling Undergraduates (ages 18–24) from The University of Rhode Island were recruited during the fall 2010 and spring 2011 semesters in introductory classes via an online survey conducted to assess cognitive influences on eating behaviors including items assessing emotional eating (socio-demographic data and anthropometrics were also collected). In the survey, emotional eating was assessed using the WREQ (Schembre, Greene, & Melanson, 2009). The WREQ contains an emotional eating construct assessed by five items using an anchored Likert response scale ranging from one (low) to five (high). The emotional eating construct was defined as eating in response to negative emotions, e.g., ‘‘I tend to eat when I am disappointed or feel let down.’’ Individuals who indicated willingness to participate in future nutrition research were eligible for the current study. Proportional quota sampling was used to randomly select eight males and eight females with a WREQ emotional eating score greater than the mean plus one standard deviation for his/her gender. Individuals scoring at or above this criterion (males P12; females P16) were classified as emotional eaters. Determination of sample size was based upon previous qualitative studies investigating emotions and eating behavior where samples of 10–13 subjects provided categories suggested by data (Fox, 2009; McNamara et al., 2008; Skarderud, 2007). Potential participants were excluded for: an emotional eating construct less than the criterion; previous diagnosis with an eating disorder by a professional; BMI less than 21 or greater than 30; nutrition majors; pregnancy; lactation; smoking or taking medications affecting appetite. These exclusion criteria preserved internal validity of participants as emotional eaters within the realm of the non-clinical ‘‘normal eating’’ population as defined in this study. Sixteen undergraduate students selected due to high emotional eating scores on the Weight Related Eating Questionnaire (Schembre et al., 2009) emotional eating subscale kept a 3-day food log prior to indepth interviews on their emotional eating behaviors. Table 1 includes the interview guide and theoretical background of questions. The guide was developed to answer the following research questions:

Weight related eating questionnaire emotional eating Subscale (Schembre et al., 2009)

(1) What range of emotions do young adults perceive themselves experiencing in their daily lives? a. Are there any differences between male and female young adults? (2) Do young adults perceive any of these emotions as influencing their eating patterns? a. Are there any differences between male and female young adults? (3) What kind of relationship might exist between emotions and eating patterns? a. Are there similarities and differences between how males and female eating patterns are influenced by emotions? (4) Do young adults feel that the WREQ instrument correctly identified them as emotional eaters? a. Are there any differences between how male and female young adults identify themselves as emotional eaters?

Data collection Prospective participants received email notification inviting them to participate in the current study. Over 45 emails were sent to recruit potential participants. If they agreed to participate, students documented their meals in conjunction with their mood using a food journal for 3 days prior to the interview. Participants brought their journals to their interview. All interviews were conducted by the author on a one-on-one basis in a private setting in a nutrition laboratory on the university campus. While the participant was reading and signing the consent form, the interviewer reviewed the journal to understand the participant’s eating behaviors and patterns. When asked about the food journal, all participants stated they completed the journal to the best of their ability. From this brief review, additional openended questions for the interview, specific for each participant, were written down for inclusion in the interview in addition to semi-structured questions. The intent of the food journal exercise was to raise participant awareness of eating behavior in relationship to their emotions. With the goal of achieving substantive direct responses during the interview, it was believed additional reflective time prior to the interview through the food journal exercise would be beneficial for the participant. Each interview lasted approximately 30 min, was tape-recorded and subsequently transcribed. Within a week of each interview transcription, a one-page summary of the discussion was prepared and the participant returned a second time for a summary review. All participants approved the content summary and provided no additional changes/comments. Participants were compensated seven dollars after the interview and eight dollars after the summary review.


Prior to the first interview, two pilot interviews were conducted with two women who were non-clinical emotional eaters during September 2010 to check the feasibility of the food journal and the usefulness of the questions in obtaining targeted, thoughtful responses. Data analysis The analysis included several steps, beginning with the transcriptions to an indepth analysis of data from each participant in relation to the research questions and finally cross participant comparative analysis. First, each interview was read several times to check for the accuracy and completeness of the transcription and to gain familiarity with the text. Second, each participant’s log and interview were reread to identify the range of emotions experienced by the participant during the 3-day log and in daily life in general (research question one). Third, the participant’s interview was reread to examine to what extent, if any, the participant saw these emotions as influencing their eating patterns, and if so how (research questions two and three). Steps two and three were then repeated to compare and contrast the range of emotions experienced, the students’ perceptions of a link between their emotions and their eating behaviors and the nature of that link. Step four was to ask whether students identified themselves as emotional eaters in order to further validate the WREQ. These steps were completed by highlighting quotes and grouping them into possible themes. These themes (e.g. eating when stressed) were identified across all participants and then analyzed by gender, allowing the development of beginning hypotheses. Results Participants Eight males and eight females were interviewed. The mean age of the 16 participants was 19.6 ± 1.0 years. Four first year students, seven second year students, three third year students and two fourth year students were interviewed. All participants selfreported their race to be White. The average BMI for females was 24.1 ± 1.2 kg/m2 with a range of 22.7 kg/m2 to 25.7 kg/m2. Three females had BMIs greater than 25. The mean BMI for males was 24.8 ± 1.7 kg/m2 with a range of 22.8 kg/m2 to 27.7 kg/m2. Four males had BMIs greater than 25 kg/m2. The mean emotional eating subscale score was 15.5 ± 2.1 for males (range of 13–20) and 19.8 ± 2.5 for females (range of 17–25). The mean score for nonparticipants was 8.3 ± 4.3 for males and 10.6 ± 5.4 for females. The qualitative findings are presented below, first in relation to the range of emotions experienced and the negative emotions associated with eating. This is followed by a discussion of participant eating patterns during and after periods of emotional eating and how these had developed over time, especially since becoming a college student. Lastly, the level of concern participants expressed about their emotional eating patterns and any efforts they had tried to reduce these are discussed. Quotations are used to illustrate the findings. All the initials cited are pseudonyms. Perceived emotions in daily life When told they had been identified as emotional eaters, all eight females and six males agreed that this identification was correct. The remaining two males disagreed, but they scored lower on the emotional eating subscale (both scored 15) compared to other males. Only one male (score of 13) scored lower than the two males who did not identify themselves as emotional eaters.

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In the food journals, a small number of emotions were listed within each individual participant’s journal and across the entire sample. These included stressed, happy, and bored. Females perceived themselves as experiencing two main emotions in their daily lives, stress and happiness: ‘‘Stressed out a lot. I feel like I’m stressed out a lot and tired because I spend four days on campus . . . I’m here all day.’’ (BW) ‘‘I would say I’m a very happy person most of the time, besides when I get stressed, but that’s mostly during school.’’ (NE) Males perceived themselves as experiencing stress, happiness, depression and anxiety: ‘‘Stress. Moving away from home and not having your parents on your back all the time, you think it would be easier. For me, it’s the opposite. They’re on my back more now that I’m here . . . it makes me stressed more.’’ (FJ) ‘‘I normally suffer from anxiety a lot . . . I’m always feeling anxious because I don’t have much time.’’ (GS) Negative emotions and eating behavior The participants focused primarily on the negative emotions as influencing their eating behavior. Females commented that stress most frequently affected their eating. ‘‘When I get stressed, I tend to eat more because I’m the type of person that likes to eat when I’m stressed.’’ (NE) ‘‘When I’m upset I know that I eat more. If I’m mad about something, I’ll just turn to chocolate.’’ (RM) More specifically, they described levels of stress. For example, one participant described how a moderate amount of stress led to increased eating. ‘‘I just got out of work and it was Saturday night. I was stressed and my roommate got me upset . . . I ate chocolate chip cookies, ice cream, and then later on in the night I ate cookie dough ice cream and [more] cookies and [candy] bars.’’ (PB) Another participant described how difficult levels of stress affected her eating. ‘‘If I’m sad, I’ll want to eat . . . a lot, but then in other situations I don’t want to eat. It really depends on what it is and what level of stress.’’ (AP) Although less frequent, males also commented on how stress and relationships may reduce eating. ‘‘When I’m stressed, I probably won’t eat anything during the day. I get hungry at 12 a.m. . . . and then realize I’m starving so I order something.’’ (FJ) ‘‘If I break up with someone I’m not going to eat a whole tub of ice cream. If anything when I get really depressed, I stop eating.’’ (MM) The role of family relationships affecting food intake was also discussed by one female: ‘‘When I’m angry, I don’t really like to eat. My mom was offering me food and I just kept saying no. When I’m angry, I think I kind of just deny food.’’ (CK) Periods of emotional eating Females discussed the concept of using food as a distraction mechanism during periods of emotional arousal. During these periods, they eat without abandon in opposition to their normal eating patterns where consciousness of intake is observed.

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‘‘I don’t really think about what I’m consuming at all. Whereas most of the other times during the day [I do] . . . I really worry about what I am eating.’’ (CK) Using food as a distraction from schoolwork was also discussed. ‘‘In the library, I was bored so I had a chocolate bar because I was just sitting there studying and thought I don’t want to be doing this right now so I’m going to eat a chocolate bar.’’ (EM) Males discussed emotional eating as a distraction to escape unpleasant feelings. ‘‘One of the bad things I do is have candy in my room like chocolates. When I’m feeling unhappy sometimes I’ll go into the candy thinking this will make me feel good.’’ (DL) Post-emotional eating

‘‘Throughout my high school I’ve always had good breakfasts and meals throughout the day, but then in college I transferred here, I’ve noticed I’ll have more snacks just because I’m in a dorm. My mom isn’t cooking something.’’ (CB) The remaining participants believed they always ate emotionally or couldn’t remember when the behavior started. Concerns about and efforts at reducing emotional eating In response to the question of whether their emotional eating bothered them, only one female (quoted below) and two males expressed concern: ‘‘Yeah, it really is something I’m trying to work on. I’m trying to resist it, but sometimes I just can’t. So it is something I’m trying to work on because I don’t think it’s healthy to overeat like that.’’ (CK)

To determine if emotional eating maintained or improved mood, participants were asked how they felt after eating emotionally. Some females commented on the overwhelming feeling of guilt afterwards:

The remaining 13 participants were not bothered by their emotional eating. One male in particular cited the summer as a time when eating returned to normal because exams would be finished and school out of session:

‘‘I tend to get more stressed out because I feel bad after eating. After I eat a lot of food I do get stressed out more, but I still just have those cravings.’’ (CK) ‘‘We’ll say why did we even eat that? We didn’t need that. No one wants to eat bad food, we just do anyway.’’ (JN)

‘‘I feel once everything is done in two weeks and done, it will return to normal during the summer.’’ (FJ)

Males described post-emotional eating effects from the standpoint of overconsumption of portion sizes with less feelings of guilt. ‘‘I realized I just ate ice cream and I wasn’t hungry anymore and was like whoa, that’s a lot.’’ (HN) ‘‘I’m like ok, that’s enough of those cookies, I’m going to chill out now.’’ (CB) ‘‘It’s a sense of stress at the end of that day, when I think about what I’ve eaten all day.’’ (GS) One male stated that feelings of sadness often encourage temporary relief and then post-guilt. After having eating a calzone at 1 a.m., participant claimed he was: ‘‘Tired, hungry, I was anxious. I think I had an exam the next day. I was up and couldn’t sleep. I was nervous. Then afterwards, you feel relieved a little bit in a weird way. I don’t know how to describe it. It’s not fulfilling, but you eat it and you don’t feel good about yourself, you feel guilty.’’ (GS) Development of emotional eating Participants were asked when they first noticed their emotional eating and how it developed over time since becoming college students. Seven females and five males cited that emotional eating developed in high school and then intensified in college or developed in college. Females cited both stress and increased access to food as enablers to emotional eating: ‘‘Mostly in the past three years. Junior, senior [high school] and going into college because it was the most stressful times probably. So I noticed that I started eating more. I feel like when I was younger . . . I wasn’t so worried about what I was eating. I didn’t stress it as much.’’ (CK) ‘‘Since college I think because I have the access to food more.’’ (NE) Males were more likely to mention parents and the role they played in maintaining healthy eating behaviors: ‘‘My parents made food before and I could just tell them to make it, but now I have to make it.’’ (TC)

Interestingly, all participants reported that only negative emotions adversely affected their eating and when happy they ate normally. The majority of solutions cited by males and females to reduce emotional eating included non-food activities such as watching television, reading, talking with friends, exercise and use of the computer. If a participant consumed a healthful food to satisfy the urge to eat emotionally, the post-eating guilt was not as intense. When asked what other methods would help cope with emotional eating, participants cited general coping strategies such as eliminating boredom and reducing stress. They were unable to provide examples of how to manage these emotions as they were more focused on immediate and temporary relief from the emotion provided by eating unhealthful food. Discussion The present study explored emotional eating and compared how male and female college students perceived their emotions and eating behaviors influenced by these emotions. An unstructured interview guide was used to better understand the driving factors behind emotional eating and potentially validate the WREQ emotional eating construct. The college environment may be particularly obesogenic in terms of availability of all-you-can eat cafeterias, easy access to foods high in solid fats and added sugars with limited access to nutrient dense foods, evening snacking, and school/social demands that reduce perceived time available for physical activity (Byrd-Bredbenner et al., 2012; Greaney, Less, White, et al., 2009; Nelson & Story, 2009; Vella-Zarb & Elgar, 2009). Greene and colleagues found that college students scoring high on an emotional eating assessment had higher BMIs than students with lower emotional eating scores. Therefore, understanding the meaning of emotional eating may be particularly important in preventing weight gain during college that may lead to adult obesity (Greene et al., 2011). Range of emotions perceived by young adults Both females and males frequently cited happiness and stress as the two most commonly experienced emotions. As college students, it is logical that the main source of stress cited by the


participants was school-related (Greaney et al., 2009). In particular, studying for exams, completing schoolwork and time management were all cited as sources of stress. These results confirm previous research about the transition to college (Rosen, Compas, & Tacy, 1993). Furthermore, a majority of participants were either first or second year students, which could create challenges in identity and role formation (Arnett, 2000). Stress has been described as an intrapersonal barrier to maintaining a healthy weight in college students (Greaney et al., 2009); results of this study confirm this barrier for emotional eaters. Seven participants had BMIs greater than 25 and were classified as overweight. Given that individuals between 18 and 29 as well as emotional eaters are at risk for weight gain (Blair et al., 1990; Lewis et al., 2000; Mokdad et al., 1999), these emotional eaters are at risk for future weight gain and becoming obese. Emotions as influencing eating patterns Stress affected both female and male eating behavior, but in an opposite manner. Females increased their consumption when stressed about school while males were more apt to decrease consumption. For one female, she was cognizant of how she automatically turned to chocolate for comfort. This may suggest, as past studies have, that a decrease in healthful foods and an increase in unhealthful foods (i.e. chocolate) during times of emotional eating from stress (Kandiah et al., 2006; Laitinen et al., 2002). Under more severe cases of stress females discussed the distaste for food more so than males. The suppression of appetite from intense emotions has been studied and confirmed previously (Herman & Polivy, 1984; Macht, 2008). The loss of a loved one or sickness of a close friend or family member decreased appetite and subsequent intake. Relationships between emotions and eating patterns To investigate whether emotional eating improved mood, participants responded to the question of how they felt after eating. The sense of guilt amongst males and females was present. For females, eating with other females alleviated a negative mood, but then resulted in feelings of guilt afterwards. Only three participants were bothered by emotional eating and wanted to change their behavior. Solutions cited to reduce emotional eating mostly concerned traditional techniques such as distracting himself or herself by watching TV or going on the computer. These alternative activities can be viewed as non-food related attempts to cope with the emotional issue on hand, but do not solve the underlying source of the emotion: stress management. Participants were consciously aware of healthful food options as they frequently defined a healthy diet as balanced across food groups consisting of fruits and vegetables. However, participants selected less healthful foods during emotional eating. Therefore, it could be hypothesized that a traditional, balanced, caloric deficit weight management program could be counterproductive in emotional eaters. In this study, emotional eating trumped healthy eating, resulting in participants consuming food they labeled as ‘‘bad’’ and likely to produce weight gain. Participants frequently mentioned the pressure to eat from friends. In social settings participants stated their hunger was minimal, yet they consumed food to avoid being hassled by friends. Dieters have been observed to consume more in response to social pressures than nondieters (Herman & Polivy, 1984). Participants in the current study were aware they were eating for social reasons, but made a conscious decision to avoid listening to their physiological satiety signs. Since, the majority of the participants who cited eating as a result of social pressures were first or second year students, the need to form new friendships at the beginning of college

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may be greater than those of third or fourth year students. The effects of social pressures may decrease over time. Limitations There are several limitations to this study. Given that participants were between 18 and 24 years old and white from a single northeastern university, this study is not generalizable across different age groups, ethnicities, socio-economic statuses and geographic regions. The food journal meal documentation also interfered with the generalizability of the study as asking the same questions of a population through spontaneous interviews without prior meditation could have resulted in different responses. The instrument used to assess emotional eating, the WREQ, evaluates negative emotional affect. If positive emotions were included as part of the instrument, results could have been different than those obtained. It is interesting, however that participants felt they could eat normally when happy. Use of the online survey as the only method of recruitment created several limitations. Male participants in the survey scored an average WREQ emotional eating construct of 8.1 ± 4.1 out of a possible score of 25 indicating a relatively low level of emotional eating and only those individuals who agreed to participate in other research studies could be contacted. Recruitment was conducted in classes that predominantly enroll first and second year students. Therefore, the sample may have been more diverse if classes with high enrollment of upper class students were used for recruitment. Conclusion The transition to college is a stressful period for both males and females. Participants were educated about nutritious foods, but emotional eating resulted in the consumption of unhealthful foods with high caloric densities. How emotions are managed during these formative years is critical for developing sustainable healthful eating behaviors. Coping with stress through eating was identified as a significant barrier towards healthy eating across genders. At the same time, boredom was also cited as an emotional eating enabler. This could be the result of undeveloped time management skills. As one progresses from young adulthood to adulthood, greater responsibilities and thus more stress could be expected to occur. Therefore, a multidisciplinary intervention focusing on time and stress management skills for college students should be developed for those susceptible to emotional eating. References American College Health Association (2009). American College Health Association – National College Health Assessment Spring 2008 reference group data report. Journal of American College Health, 57, 469–479. Arnett, J. J. (2000). Emerging adulthood, a theory of development from the late teens through the twenties. American Psychologist, 55, 469–480. Blair, A. J., Lewis, V. J., & Booth, D. A. (1990). Does emotional eating interfere with success in attempts at weight control? Appetite, 15(2), 151–157. Byrd-Bredbenner, C., Johnson, M., Quick, V. M., Walsh, J., Greene, G. W., Hoerr, S., Colby, S., Kattelmann, K. K., Phillips, B. W., Kidd, T., & Horacek, T. M. (2012). Sweet and salty. An assessment of the snacks and beverages sold in vending machines on US post-secondary institution campuses. Appetite, 58(3), 1143–1151. Flegal, K. M., Carroll, M. D., Ogden, C. L., & Curtin, L. R. (2010). Prevalence and trends in obesity among US adults, 1999–2008. The Journal of the American Medical Association, 303(3), 235–241. Fox, J. R. (2009). A qualitative exploration of the perception of emotions in anorexia nervosa. A basic emotion and developmental perspective. Clinical Psychology and Psychotherapy, 16, 276–302. Geliebter, A., & Aversa, A. (2003). Emotional eating in overweight, normal weight, and underweight individuals. Eating Behaviors, 3(4), 341–347. Greaney, M. L., Less, F. D., White, A. A., et al. (2009). College students’ barriers and enablers for healthful weight management. A qualitative study. Journal Nutrition Education Behavior, 41, 281–286.

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