EMOTIONAL EATING IN PRESCHOOLERS. Molly Meers. A Thesis

Transcription

1 EMOTIONAL EATING IN PRESCHOOLERS Molly Meers A Thesis Submitted to the Graduate College of Bowling Green State University in partial fulfillment of the requirements for the degree of MASTER OF ARTS August 2010 Committee: Dara Musher-Eizenman, Advisor Robert A. Carels William H. O Brien

2 ii ABSTRACT Dara Musher-Eizenman, Advisor The purpose of the current study was to determine whether emotional eating occurs in preschoolers using a behavioral measure. Based on Macht s (2007) five-way model of how emotions affect eating behavior, it was hypothesized that some preschoolers would increase food intake due to moderate negative emotions. This study utilized an eating in the absence of hunger research paradigm to measure the difference in caloric intake between negative and neutral mood induction conditions. The current study also examined the relationship between emotional eating and parental feeding behaviors, own eating behaviors, and the child s emotion regulation skills. Thirty 4- to 6-year-old children and the parent most involved with feeding were recruited for this study. Emotional eating was not pervasive in this sample. However, there were noteworthy individual differences associated with consuming a greater amount of calories in the negative mood condition than in the neutral mood condition. Child self-report of emotional eating was more predictive of greater caloric intake in the negative mood condition than was parent-report of the child s emotional eating. In addition, individual differences in emotion regulation skills were more predictive of greater caloric intake in the negative mood condition than parents own eating and feeding behaviors. However, when parent report of emotional eating was used as the emotional eating outcome variable rather than the behavioral measure, parental feeding for emotion regulation was most predictive of greater caloric intake in the negative mood condition.

3 iii TABLE OF CONTENTS Page INTRODUCTION Emotional Eating in Adults... 5 Emotional Eating in Children... 7 The Current Study METHOD Participants Parent Measures Demographic Information Parental Feeding Practices Child Emotional Eating Parental Eating Style Emotion Regulation Skills Child Measures Self-Report of Emotional Eating Weight and Height Caloric Intake Behavioral Measure of Emotional Eating Procedure RESULTS Preliminary Analyses Primary Analyses... 23

4 iv DISCUSSION Limitations Future Directions Clinical Applications REFERENCES APPENDIX A. COMPREHENSIVE FEEDING PRACTICES QUESTIONNAIRE APPENDIX B. PARENT REPORT OF EMOTIONAL EATING APPENDIX C. DUTCH EATING BEHAVIOR QUESTIONNAIRE APPENDIX D. EMOTION REGULATION CHECKLIST APPENDIX E. CHILD SELF-REPORT OF EMOTIONAL EATING... 51

5 v LIST OF FIGURES/TABLES Figure/Table Page 1 Macht s five-way model of how emotions induce changes in eating behavior Hunger assessment figure array Mood assessment smiley face array Means and standard deviations of key study variables Calories consumed by condition in the subsample Calories consumed by condition in the full sample... 53

6 Emotional Eating 1 INTRODUCTION Overweight is a prevalent health concern in the United States (Hedley et al., 2004; Ogden et al., 2006). Rates of overweight for children, adolescents, and adults have been steadily increasing in recent years (Hadley et al., 2006). Data from the National Health and Nutrition Survey obtained in report that 17.1% of a sample (n=3958) of children and adolescents aged 2 to 19 years old were overweight while 66.3% of a sample (n=4431) of adults over the age of 20 were overweight (Odgen et al., 2006). Overweight was determined by sex and age specific BMI criteria from the Centers for Disease Control and Prevention; and defined for children and adolescents as a BMI at or above the 95 th percentile. While some research has shown that overweight and obesity have strong genetic components (Poulsen & Vaag, 2003; Maes, Neal, & Eaves, 1997), other research has shown that overweight and obesity are related to certain behaviors (Hu, Li, Colditz, Willett, & Manson, 2003; Liebman et al., 2003). Eating behaviors in particular have received a great deal of empirical attention in their relationship to weight outcomes. One type of eating behavior that is associated with excess weight gain is eating in the absence of hunger. Eating in the absence of hunger (EAH) is the continuation of eating behavior or initiation of eating behavior without the presence of physiological hunger cues (Tanofsky-Kraff et al., 2008). EAH is thought to promote excess weight gain and has been found to predict overweight status in children (Fisher & Birch, 2002; Tanofsky-Kraff et al., 2008) and adults (Hill, Oliver, & Rogers, 1992). Three types of eating in the absence of hunger that have received considerable attention in the literature include external eating, emotional eating, and overeating as a consequence of dietary restraint (Van Strien & Oosterveld, 2008). External eating occurs in response to environmental food cues such as sight or smell (Van Strien & Oosterveld, 2008),

7 Emotional Eating 2 emotional eating occurs as a response to emotional arousal (Wallis & Hetherington, 2004), and overeating also occurs as a response to failed attempts to restrict food intake (Herman & Polivy, 1985). Emotional eating, external eating, and dietary restraint have been associated with bingeing, excessive snacking, and weight gain (van Strien & Oosterveld, 2008). The focus of the current study is emotional eating which is described in greater detail below. Emotional eating is a response to emotions that occurs when consumption of food is changed or the non-nutritive consumption of food is initiated in response to emotional stimuli. While tendency toward emotional eating is thought to be a characteristic of an individual that is stable over time, there is variability in emotional eating responses across individuals and types of emotions (Snoek, Rutger, Engels, Janssens, & van Strien, 2007). Due to this variability, a variety of models have been proposed to explain the relationship between eating behavior and emotions. The most comprehensive model that has been proposed to explain this relationship is Macht s (2007) five-way model of emotional eating (see Figure 1). In this model there are five ways in which emotions are proposed to induce changes in eating behavior. First, emotions may be aroused by food stimuli, which affects food choice. For example, infants have been found to have hedonic reactions to different foods, evidenced by differentiated facial responses to tastes (Rosenstein, D. & Oster, H., 1988). Specifically infants show approach responses to sweet foods and avoidant responses to bitter foods. Adults have also been found to demonstrate physiological responses to food cues that increase craving and body readiness for digestion after food exposure (Nederkoorn, Smulders, & Jansen, 2000). Similarly, disgust has been identified as a food-related emotion in which learned food associations come to elicit an aversive emotional response, which leads to avoiding that food (Rozin & Fallin, 1987).

8 Emotional Eating 3 Emotion Food-induced emotion? Yes Control of food choice Preference Craving Avoidance no Intense emotion? Yes Suppression Decreased food intake no Restrained eating Impairment of cognitive eating controls Increased food intake Eating habits related to emotion? Yes no Emotional eating Eating to regulate emotion Increased food intake of sweet, high-fat foods Emotion features relevant to eating? Yes Congruent modulation Change of eating congruent with emotional features no No change of eating Figure 1. Macht s five-way model of how emotions induce changes in eating behavior.

9 Emotional Eating 4 Second, Macht s model proposes that intense emotions may decrease the consumption of food. In animal studies, rats have been found to decrease food intake during high arousal while increasing food intake during low arousal (Greeno & Wing, 1994; Robbins & Fray, 1980). Biological evidence of delayed peak glucose response has been found to support the loss of appetite in response to intense psychological stress in normal weight individuals (Wing, Blair, Epstein, & McDermott, 1990). Regarding stress-induced eating as a subset of emotional eating, it has been found that some people overeat in response to stress while other people undereat (Greeno & Wing, 1994). It is possible that the perceived intensity of the stressor might account for this variability in responses. In the third and fourth steps of the model, moderately arousing emotions are associated with eating behaviors. In the third step of the model, negative or positive emotions impair the cognitive controls of restrained eaters leading to an increase in food intake. Restrained eaters are individuals who control or restrict their food intake to maintain or reduce their current weight (Wallis & Hetherington, 2004). The limited capacity hypothesis (Boon, Stroebe, Schut, & Ijntema, 2002) posits that overeating occurs in restrained eaters when their cognitive capacity is constrained. Because negative emotions decrease available cognitive capacity, overeating occurs as a result of the drain on cognitive resources (Boon, Stroebe, Schut, & Ijntema, 2002). Similarly, positive emotions have also been found to distract restrained eaters from their goal of restraint, leading to an increase in food intake (Cools, Schotte, & McNally, 1992). Wallis and Hetherington (2004) found that restrained eaters overate in response to both ego-threat and cognitive load tasks, which further supports the limited capacity hypothesis. In the fourth step of the model, emotions trigger an increase in food intake as a means of regulating emotions in emotional eaters. While restrained eaters are found to increase food intake

10 Emotional Eating 5 in an emotionally salient ego-threat condition and cognitive load condition, emotional eaters only overeat in response to the ego-threat condition (Wallis & Hetherington, 2004). The escape theory proposed by Heatherton and Baumeister (1991) posits that overeating occurs as an attempt to move attention away from an aversive emotional stimulus as a means of self-regulating one s emotions. Eating behavior occurs as a means of decreasing negative affect or is more generally an attempt to regulate one s emotions (Desmet & Schifferstein, 2008). The current study will focus on this fourth step, an increased intake of food in response to negative emotion. In the last step of Macht s five-way model, changes in eating are related to the emotion elicited during eating behavior. For example, Macht, Roth, and Ellgring (2002) found that when joy was elicited, subjects reported greater motivation to eat and found eating more pleasurable, whereas when sadness was elicited, motivation to eat was less, and eating was found to be less pleasurable. Willner and Healy (1994) also found that depressed mood induction caused a decrease in pleasure due to food consumption. This eating response to emotion occurs immediately and is thought to be observable across individuals, while emotion regulation eating (step four) occurs as a delayed reaction to emotional arousal and differs across individuals (Macht, Roth, & Ellgring, 2002). Emotional Eating in Adults While the exact pathways are still unclear, overeating in response to negative mood is thought to contribute to the etiology of obesity (Kubiak, Vögele, Siering, Schiel, & Weber, 2008; van Strien, Engels, van Leeuwe, & Snoek, 2005). For example, adults have been found to eat more sweet, high-fat foods in response to stress (van Strien, Frijters, Bergers, & Defares, 1986). Eating in response to negative affect and stress is also associated with higher levels of binge eating in obese adults and is thought to be one of the main precipitants of binge eating (Arnow,

11 Emotional Eating 6 Kenardy, & Agras, 1995). This research also suggests that binge eating occurs after negative emotional arousal independent of the presence of restrained eating behaviors, identifying emotional eating as a unique eating behavior that contributes to excessive overeating. Similarly, in a study that examined binge eating in obese females, all participants identified mood as a precipitant of binge eating behavior with negative mood being the most common trigger (Chua, Touyz, & Hill, 2004). Not only is emotional eating associated with overweight and considered a contributor to the etiology of obesity, but emotional eating has also been associated with psychological distress in adults (van Strien, Schippers, & Cox, 1995), adolescents (Wardle et al., 1992), and children (Braet & van Strien, 1997). This indicates that emotional eating is a maladaptive response to negative emotions that may occur as a symptom of a larger psychological deficit. Field studies demonstrate further support for the position that negative emotional arousal is associated with eating as a means of regulating one s emotions (Macht, Haupt, & Ellgring, 2005; Macht & Simons, 2000). Macht, Haupt, & Ellgring (2005) found that students who were stressed prior to taking an exam reported eating to distract themselves from the stress. In a review of clinical studies on emotions and eating in obese individuals, Ganley (1989) reported that subjects consistently endorsed reduction of negative emotions as a cause of emotional eating. The proposal that emotional eating is a means of regulating one s emotions is also supported by evidence that the teaching of emotion regulation skills can be successfully used to treat binge eating disorder (Telch, Agras, & Linehan, 2001; Wiser & Telch, 1999). If alternative effective means of regulating one s emotions are introduced, then overeating as a maladaptive response to negative emotions should decrease. It may be that individuals who demonstrate problematic emotional eating behaviors have deficits in emotion regulation skills.

12 Emotional Eating 7 Emotional Eating in Children Eating in the absence of hunger has been identified in children (Fisher & Birch, 2002; Moens & Braet, 2007). Once established, EAH is thought to be a stable characteristic of the child (Fisher & Birch, 2002). When EAH occurs, the self-regulating mechanisms that young children have in regard to food are lost or lessened (van Strien & Oosterveld, 2008). An understanding of the age at which EAH first occurs and the pathways by which it develops may help in our understanding of how children s natural self-regulating eating mechanisms are interrupted. The present study is concerned with the development of emotional eating in particular. Emotional eating has been identified in adolescents and children using self-report questionnaires and parental reports. In a study examining EAH in children ages 7 to 12, van Strien and Oosterveld (2008) reported that children infrequently endorsed emotional eating. However, in a study conducted by Shapiro et al. (2007), 63% of their sample of children ages 5 to 13 endorsed that they sometimes eat because they experienced negative emotions. Braet and van Strien (1997) found that overweight Belgian children between the ages of 9 and 12 endorsed emotional eating more than normal weight children. However, using a primarily Latino population of adolescents, Nyugen-Rodriguez, Chou, Unger, and Spruijt-Metz (2008) found comparable levels of emotional eating in overweight and normal weight participants. Although findings have been mixed, emotional eating as a response to stress seems to be a characteristic that is present in adolescents and children. A review of the literature on the occurrence of emotional eating suggests that there are several parental factors as well as individual differences associated with higher levels of emotional eating in children and adolescents. Parental modeling may be one pathway by which children begin eating in the absence of hunger. For example, research indicates that parents who

13 Emotional Eating 8 eat emotionally themselves have children who emotionally eat. In a study examining the relationship between parental behavior and emotional eating in adolescents, the authors found that higher levels of adolescent emotional eating were related to higher levels of parental emotional eating (Snoek, Rutger, Engels, Janssens, & van Strien, 2007). These data support a modeling effect, and also suggest that high levels of parental psychological control for younger adolescents and parental behavioral control for older adolescents were associated with higher levels of adolescent emotional eating. Parental feeding practices are another pathway by which children s self-regulating mechanisms to initiate and terminate eating based on physiological hunger cues can be interrupted (van Strien & Oosterveld, 2008). For example, restrictive feeding practices have been associated with children eating the restricted food if given the opportunity, even when not hungry (Fisher & Birch, 2000, 2002). When parental feeding practices lead to children eating when not hungry, external cues to eat can override natural physiological hunger cues. Carper, Fisher, and Birch (2000) found that perceived parental feeding pressure and restriction were associated with 5-year-old daughters eating in response to emotional and external cues rather than internal physiological cues of hunger. However, the research of Musher-Eizenman & Holub (2006) suggests that it is not restriction alone, but the context of parental restriction that leads to negative effects. Costanzo and Woody (1985) propose that parental feeding practices interfere with children s ability to self-regulate food intake when children lose opportunities to control their own intake of food. Supporting this link for emotional eating, mothers who endorsed emotionally eating themselves were found to engage in emotional feeding practices with their children (Wardle, Sanderson, Guthrie, Rapoport, & Plomin, 2002).

14 Emotional Eating 9 In addition to the research that suggests that the occurrence of eating in the absence of hunger in young children is related to parental feeding practices, children have also been shown to evidence eating styles independent of parental feeding by the age of seven. In a study examining eating in the absence of hunger in normal and overweight children between the ages of 7 and 13, Moens and Braet (2007) found that parent reports of the child s eating behavior were more strongly related to EAH than parental feeding practices (restriction and modeling). This study found emotional and external eating to be most predictive of overeating. This suggests that emotional eating may also be due to characteristics of the individual. Emotional eating in children and adolescents has been documented and has been associated with individual differences such as weight status, dysfunctional coping styles, and race. For example, obese children ages 9 to 12-years-old were found to score higher on scales of emotional, external, and restrained eating than non-obese children (Braet & van Strien, 1997). Furthermore, a relationship was found between emotional eating and problem behaviors indicative of psychopathology as measured by the Child Behavior Check List, and emotional eating and negative self-evaluation of physical competence. In a different study with a sample of obese adolescents, emotional eating was found to be associated with ruminative thinking (Kubiak, Vögele, Siering, Schiel, & Weber, 2008). Striegel-Moore et al. (1998) found that Black girls between the ages of 9 and 10 scored higher on emotional eating than White girls, with emotional eating receiving low levels of endorsement overall. However, an inverse relationship was found between emotional eating and BMI, suggesting that thinner girls emotionally ate more. The authors speculated that this inverse relationship between BMI and emotional eating might have been due to self-serving bias as overweight girls may have been less likely to report emotional eating.

15 Emotional Eating 10 Very little is known about whether preschoolers demonstrate emotional eating. In one of the few studies known to the author to examine emotional eating in preschoolers, Jahnke & Warschburger (2008) found that children of overweight mothers scored higher on emotional eating than children whose mothers were of normal weight. This study suggests that according to maternal evaluation of their children s eating behavior, emotional eating occurs in preschoolers, and varies across individuals. However, stated limitations of the study by the researchers included concern that self-serving biases could not be excluded from these reports. The mothers were asked to report their eating behavior as well as their children s, which could have influenced the results. In another study examining emotional eating in 3- to 5-year-olds, Blissett, Farrow, and Haycraft (2009) used a mood induction task to compare behaviorally measured emotional eating data to parent-report measures of emotional overeating and feeding practices. Overall, the author found that maternal reports of the child s emotional overeating reflected the child s actual behavior. In addition, a relationship was found between the behavioral measure of the child s emotional eating and parental feeding practices (food as reward, feeding for emotion regulation, restriction for weight, restriction for health). After parental report of child emotional eating, the method most often used to assess emotional eating is self-report. Emotional eating is usually measured with self reports such as the Dutch Eating Behavior Questionnaire (DEBQ), but the child version of the DEBQ has not been thought to be a reliable means of gaining information from children under the age of seven (Van Strien & Oosterveld, 2008). As there are concerns with parental report of child eating behavior as well, the current study will utilize a behavioral measure of emotional eating. In the proposed study, experimental manipulation of mood across two conditions and observed eating will strengthen the support for evidence of emotional eating in preschoolers.

16 Emotional Eating 11 The Current Study The primary aim of the current study was to determine whether emotional eating occurs in preschoolers using a behavioral measure. Because self-report measures of emotional eating are not thought to be reliable with very young children, an experimental eating in the absence of hunger paradigm was used to assess whether children ate more after an experimental negative mood condition compared to a baseline condition of neutral mood. It was hypothesized that there would be individual differences in emotional eating, as some participants would eat more during the negative mood condition. Experimental manipulation of mood was accomplished through the viewing of a sad or neutral movie clip. Before and after the viewing of the movie clip, mood checks determined whether that mood had been induced. Children were then given free access to highly palatable snack foods. The snacks were weighed before and after child access as a measure of eating in the absence of hunger. After a participant had finished both the experimental and baseline conditions (negative and neutral), self-report ratings of emotional eating were elicited. It was hypothesized that children at this age would not accurately report whether they engaged in emotional eating while parents would. A further aim of the present study was to evaluate parental feeding and eating practices as well as individual differences associated with children who evidence emotional eating. Of interest was whether parental endorsement of emotional feeding practices and own emotional eating would account for a significant amount of the variation in the child s emotional eating behavior. It was hypothesized that children who engage in emotional eating would have parents who endorse emotional eating and feeding practices. These relationships were examined using both the behavioral measure of emotional eating as well as the parent report of the child s

17 Emotional Eating 12 emotional eating as outcome variables to determine if there were different findings depending on the source of emotional eating data. Parent report of the child s emotion regulation skills were also collected. It was hypothesized that poorer emotion regulation skills would also account for a significant amount of the variation in emotional eating behavior of the child.

18 Emotional Eating 13 METHOD Participants Letters were sent home to parents of all 4- to 6-year-old children at three local day care centers (N = 160), describing the study and asking for consent for their child to participate. The parent most involved with feeding the child was also asked to participate. Consent forms were returned for 35 children. Of these 35 children only 30 were included in the study, 11 girls and 19 boys. Five children were not included in the study because of scheduling conflicts or lack of interest in participating. The mean age of the children who participated was 4.7 (SD =.46). The children ranged in age from 3.8 to 6.2. Each child s height and weight was measured and used to calculate their body mass index (BMI; weight [kg]/height [m] 2 ). Because BMI is age and sex specific, BMI percentiles were calculated based on standard growth charts from the Centers for Disease Control and Prevention (2000). The mean BMI percentile was 57.7 (SD = 29.83), ranging from.10 to The sample consisted of 24 normal-weight (defined as BMI percentile < 85), 3 at risk of overweight (defined as BMI percentile > 85 and < 95), and 3 overweight children (defined as BMI percentile > 95). Parent Measures Demographic Information. Demographic information was obtained from the parents. Of the parents who participated 26 (86.7%) were mothers and 4 (13.3%) were fathers. All participating families were White. That majority of the families reported a yearly family income (YFI) over $95,000 (66.7%), 1 family reported a YFI under $15,000 (3.3%), 1 family reported a YFI between $35,000 and $55,000 (3.3%), 5 families reported a YFI between $55,000 and $75,000 (16.7%), and 2 families reported a YFI between $75,000 and $95,000 (6.7%). Most parents reported being a college graduate (40%), having some graduate or professional school

19 Emotional Eating 14 experience (3.3%), or a Master s Degree (46.7%). One parent reported some college (3.3%) and 2 parents reported being a high school graduate or equivalent (6.7%). Each parent s height and weight was requested and used to calculate their body mass index (BMI). Two parents failed to report either their height or weight and BMI could not be computed for them. The mean parent BMI was (SD = 3.21) ranging from to Based on Centers for Disease Control and Prevention (1999) adult BMI classifications, a BMI of less than 18.5 is considered underweight, a BMI of 18.5 to 24.9 is normal weight, a BMI between 25 and 29.9 is overweight, and a BMI greater than 30 is considered obese. Thus, the current sample of parents ranged from normal weight to obese with the mean BMI falling in the normal weight range. Thirty percent of the 28 parents for whom BMI could be calculated were overweight. Upon returning signed consent and completed questionnaires, parents were given a five-dollar gift card to a local grocery store. Parental Feeding Practices. Feeding practices of the parent or caregiver were measured using the Comprehensive Feeding Practices Questionnaire (CFPQ, Musher-Eizenman & Holub, 2007). The CFPQ (see Appendix A) contains 49 items that comprise 12 subscales used to better understand the feeding practices employed by parents. These items are scored on a 5-point Likert-type scale with response options of never, rarely, sometimes, mostly, or often; or disagree, slightly disagree, neutral, slightly agree, or agree. Of particular interest for this study was the emotion regulation subscale. Previous Cronbach s alphas for this subscale ranged from.74 to.78. In this study, Cronbach s alpha was.83. Sample items include When this child gets fussy, is giving him/her something to eat or drink the first thing you do? and Do you give this child something to eat or drink if s/he is upset even if you think s/he is not hungry? Child Emotional Eating. An emotional eating questionnaire was created for this study that could be used with both parents and children. This questionnaire includes items of interest

20 Emotional Eating 15 from the Emotional Eating Scale, Adapted for Children and Adolescents (EES-C; Tanofsky- Kraff et al., 2007) with altered response options that allow for the report of either emotional over- or undereating (see Appendix B). In addition to the items selected from the EES-C, having fun was added. Response options for parents included eat a lot less, eat a little less, eat the same, eat a little more, and eat a lot more. Because this measure was new, an exploratory factor analysis was conducted to examine the structure of the items. A principal component method of extraction with oblique (Promax) rotation was used on the parents data. The principal component analysis resulted in a threefactor solution accounting for 80.2% of the variance. The first factor, with items reflecting negative emotion (sad, frustrated, upset, angry, lonely), had an Eigenvalue of 4.8; the second factor, with items reflecting positive emotion (happy, having fun), had an Eigenvalue of 2.2; the third factor, with items reflecting emotional arousal (excited, worried), had an Eigenvalue of 1.1. These three factors accounted for 47.6, 21.7 and 10.9% of the variance respectively. A total of nine of the ten items loaded on these three scales. The item for bored loaded.4 or higher on all scales and was not included as an item in any of the final factors. The internal consistencies (α) for the five items on negative emotions, three items on positive emotions, and two items on emotional arousal were.92,.67, and.48 respectively. Parental Eating Style. Parent or guardian self-report of his or her own eating behavior was measured using the Dutch Eating Behavior Questionnaire (DEBQ; Van Strien, Frijters, Bergers, & Defanes, 1986). The DEBQ (see Appendix C) consists of 33 items used to comprise emotional eating, external eating, and restrained eating subscales, of which the emotional eating subscale was of primary interest in this study. The Cronbach s alpha value for the emotional eating subscale is.94. In this study the Cronbach s alpha was.98. Items are scored using a 5-

21 Emotional Eating 16 point Likert-type scale ranging from 1 (never) to 5 (very often). Sample items include Do you have a desire to eat when you are depressed or discouraged? and Do you have the desire to eat when you are irritated? Emotion Regulation Skills. Parent or guardian report of their child s emotion regulation skills was measured using the Emotion Regulation Checklist (ERC; Shields & Cichetti, 1997). The ERC (see Appendix D) is a 24-item other-report measure containing two subscales: emotion regulation and dysregulation (lability/negativity). Cronbach s alpha values are.83 for emotion regulation and.96 for lability/negativity. These subscales can be combined to form a composite ERC score with Cronbach s =.89. The composite ERC score was used in this study and had a Cronbach s alpha of.92. Items on this checklist include questions on the situational appropriateness and valence of children s emotional reactions. Items are scored on a 4-point Likert-type scale ranging from 1 to 4 with the following response options: rarely/never, sometimes, often, and almost/always. Sample items include Is prone to angry outbursts/tantrums easily, and Can recover quickly from upset or distress. Child Measures Self-Report of Emotional Eating. The child s self-reported endorsement of emotional eating was also assessed. The child emotional eating questions asked of the parents were adapted into self-report questions for the children (see Appendix E). The child participants had the following response options: eat less, eat the same, and eat more. Weight and height. The children s weight and height was measured after the second data collection time point.

22 Emotional Eating 17 Caloric Intake. Weighed snack intake data was collected before and after the free access to snack protocol (see below). Total caloric intake was computed by subtracting the amount eaten from the amount offered. Behavioral Measure of Emotional Eating. The difference in caloric intake between the experimental and baseline conditions was used as the measure of emotional eating. This score was obtained by subtracting the caloric intake in the neutral condition from the caloric intake during the negative mood condition. A positive value indicated emotional overeating while a negative value indicated emotional undereating. Procedure Two trained experimenters were present for the following procedures. All procedures with the child participants took place in the daycare center after breakfast or afternoon snack to ensure satiety. Children participated in the mood induction procedure in groups no larger than five. Each child took part in two mood induction procedures (neutral and negative) that were conducted at two different time points at least one week apart. Order of presentation of conditions was counterbalanced. After a child participated in both conditions their weight and height was measured. Children were brought from their classroom to a separate testing location at the daycare center. Each child was shown to an assigned seat. Nametags set on placemats indicated the space in which the child s assigned materials would be located for later individual activity. The children were then assessed for hunger using images depicting the response options of hungry, half-full, or full (see figure 2). This step was to ensure that the children were full before continuing with the mood induction procedure. Any child who reported being hungry or

23 Emotional Eating Figure 2. Hunger assessment figure array.

24 Emotional Eating 19 half-full was offered a 100 calorie granola bar. Of the children who reported being hungry or half-full in the negative mood condition (n = 15), most children (n = 13) ate the granola bar when offered. In the neutral mood condition, of the children who reported being hungry or half-full (n = 19), most children also (n = 18) ate the granola bar. In the neutral mood condition, the children who ate the granola bar (M = 27.63, SD = 20.19) ate significantly less than those who did not report being hungry or half-full (M = 64.23, SD = 8.84), t(27) = 3.99, p <.05. There was not a significant difference in the amount eaten between those who ate the granola bar (M = 46.51, SD = 24.39) and those who did not report being hungry or half-full (M = 39.51, SD = 26.60) in the negative mood condition, t(26) = 3.99, p <.05. Before the mood induction procedure, the children s mood was also assessed. The children s mood was assessed using a smiley face array (see figure 3) representing the following response options: very happy, a little happy, not happy or sad, a little sad, and very sad. This face scale is the most frequently used self-report measure of mood and is particularly useful when used with young children who s verbal abilities are not as good as adults (Brenner, 2000). While validation data is not available for the smiley face array, a five-face anchor has been used previously with young children (Blissett, Farrow, & Haycraft 2009; Hom & Arbuckle, 1988). Upon completion of this quick mood check, the children were moved to a location in front of a computer monitor to begin the mood induction procedure. The mood induction procedure involved watching a short (approximately 5 minute) negative or neutral movie clip. Negative mood was induced through the viewing of a sad, animated, child-appropriate movie clip while a neutral mood was induced through the viewing of a nature documentary that was neither overly stimulating nor boring. While the children were viewing the movie clip, researchers placed pre-weighed snacks as well as a coloring sheet and

25 Figure 3. Mood assessment smiley face array. Emotional Eating 20

26 Emotional Eating 21 crayons at each participant s placemat. When the film clip ended a second mood check was conducted to determine the outcome of the mood induction procedure. Upon completion of the mood induction procedure, the free access to snack protocol began. The children were instructed to return to their placemats. At each placemat was a coloring page depicting the sad or neutral theme of the movie just presented, crayons, and a snack dish with 130 calories of Chocolate Teddy Grahams, 120 calories of Pretzels, and 120 calories of Animal Crackers. The children were told that they could color and eat snacks while the researchers put away the movie viewing equipment. After 5 minutes passed the children were told that they could return to their class, and each child s remaining food was weighed and recorded.

27 Emotional Eating 22 RESULTS Preliminary Analyses SPSS (version 17) for Windows was used for all statistical analyses. Means and standard deviations of key study variables can be found in Table 1. Because this was a fairly novel area of study, an alpha level of.10 was used to report any small sample trends. Paired-sample t-tests were conducted to compare mood ratings before and after the mood manipulation in the negative mood and neutral mood conditions to determine if the mood manipulation worked. There was a significant difference in the mood rating scores before (M = 1.4, SD =.7) and after (M = 2.3, SD = 1.6) the negative mood induction procedure, t(29) = 3.12, p <.05, whereas there was not a significant difference in the mood rating scores before (M = 1.3, SD =.5) and after (M = 1.6, SD = 1.0) the neutral mood induction procedure, t(29) = 1.72, p >.10. These results support the validity of the mood induction procedures as children reported significantly greater negative mood following the negative mood condition, while mood ratings did not differ in the neutral mood condition. An independent t-test was conducted to determine if males and females differed in the amount of calories consumed. There was a significant difference in calories consumed in Pretzels between males (M = 35.3, SD = 28.8) and females (M = 38.2, SD = 26.9), t(27.6) = 2.35, p <.05. There were no mean differences between the groups for the total number of calories consumed across snacks or calories consumed of the other individual snacks (all p s >.10). Therefore, gender was controlled for in later analyses using calories consumed in Pretzels as an outcome variable. Additionally, Pearson product-moment correlation coefficients were computed to assess the relationship between calories consumed and child age, parent BMI, and child BMI

28 Emotional Eating 23 percentiles. There was a positive correlation between child age and calories consumed in Chocolate Teddy Grahams, r(28) =.41, p <.05. There were no other relationships between age and total calories consumed or calories consumed of the individual snacks (all p s >.10). In regard to calories consumed and parent BMI and child BMI percentiles there was not a significant relationship between calories consumed and the other two variables (all p s >.10). Because there was a positive relationship between child age and calories consumed in Chocolate Teddy Grahams, child age was controlled for in later analyses using calories consumed in Chocolate Teddy Grahams as an outcome variable. Primary Analyses Overall, the sad movie was effective at reducing the children s mood. However, this effect was driven by a subset of children who reported a decrease in mood. As decreased mood was a critical component of the behavioral measurement of emotional eating, results will be reported for the 14 children who reported a decrease in mood, as the remaining children did not report a decrease in mood. For the subsample the mean mood rating after the negative mood induction procedure was 3.57 (SD = 1.4), placing their average mood rating in the sad affective range. This subsample did not differ significantly from the full sample in age, gender, or BMI percentile. The full sample results will be reported in footnotes. To test the first hypothesis that there would be significant differences in caloric intake between the negative and neutral conditions, repeated-measures t-tests were conducted. See Table 2 for a breakdown of the caloric intake by snack foods in the negative and neutral conditions. It was predicted that on average participants would have greater caloric intake in the negative mood condition than in the neutral mood condition. For total calories consumed, there was not a significant difference between the sad mood condition (M = 45.47, SD = 25.47) and

29 Emotional Eating 24 neutral mood condition (M = 48.91, SD = 31.55), t(13) =.357, p >.10. In addition, there were no significant differences between conditions for calories consumed of any of the individual snacks (all p s >.10). These results suggest that overall, emotional eating was not prevalent among preschool aged children in this study. 1 To test the second hypothesis that parent report of emotional eating would account for more variation in emotional eating than child report, several multiple regression analyses were conducted looking at total caloric intake and caloric intake of the individual snack foods. If in the preliminary analyses it was determined that certain variables needed to be controlled for, those variables were entered first, followed by parent report of emotional eating and then child report of emotional eating. For total caloric intake, child report of emotional eating predicted greater caloric intake in the negative mood condition than in the neutral mood condition (ß =.62, p <.05), while parent report did not (ß = -.26, p >.10). Although parent report was not significant, the model accounted for 53% percent of the variance. For the individual snacks, child report did not predict greater caloric intake of Chocolate Teddy Grahams (ß =.29, p >.10) or Animal Crackers (ß =.39, p >.10) in the sad condition, but child report did predict greater caloric intake of Pretzels (ß =.74, p <.05) in the sad condition as opposed to the neutral condition. Parent report did not predict variation in caloric intake for any of the individual snacks 2 (all p s >.10). When examining individual snacks, the amount of variance accounted for by the model ranged from 21% to 43%. These results suggest that child report of emotional eating was associated with 1 Similar results were found in analyses with the full sample (N = 30). See Table 3 for a breakdown of caloric intake by snack foods in the negative and neutral conditions. 2 In a regression analysis with the full sample (N = 30) looking at calories consumed of Animal Crackers, parent report of emotional eating significantly predicted child emotional overeating (ß = -.39, p <.05). However, this relationship was in the opposite direction as expected. Parental report of their child eating less during negative emotions was associated with greater caloric intake of Animal Crackers during the negative mood condition.

30 Emotional Eating 25 greater total caloric intake, and greater caloric intake of Pretzels, in the negative mood condition than in the neutral mood condition. Thus, child self report of their eating behavior was predictive of their actual behavior. These findings were contrary to our hypothesis that parent report of emotional eating would be related to the behavioral measure of emotional overeating, while child report would not be. Several multiple regression analyses were conducted to test the final hypothesis that parental feeding for emotional reasons, parental emotional eating, and poorer emotion regulation skills would account for significant variation in emotional overeating. Variables to be controlled for were entered first, followed by the emotion regulation composite score, parental emotional eating, and parental emotional feeding variables to ascertain the effects of these variables on emotional overeating. For total caloric intake, poorer emotion regulation skills significantly predicted greater caloric intake in the negative mood condition than in the neutral mood condition (ß = -.68, p <.05), while parental emotional eating and feeding practices did not (ß = -.11, p >.10; ß = -.09, p >.10, respectively). While parental emotional eating and feeding practices were not significant, the model accounted for 39% of the variance. Using specific foods as the dependent variable, poorer emotional regulation skills significantly predicted more caloric intake of Chocolate Teddy Grahams after the negative mood manipulation (ß = -.82, p <.05), while parental emotional feeding practices were marginally predictive (ß = -.51, p =.095). This marginal relationship between greater caloric intake in the negative mood condition and parental emotional feeding was in the opposite direction as expected. Parental report of feeding their child less for emotion regulation reasons was associated with more caloric intake of Chocolate Teddy Grahams after the negative mood manipulation. Parental emotional eating did not predict more caloric intake of Chocolate Teddy Grahams after the negative mood induction (ß = -.09, p >.10).

31 Emotional Eating 26 Using Chocolate Teddy Grahams as the outcome variable, the model accounted for 66% of the variance in emotional eating. Poorer emotion regulation skills and parental emotional eating and feeding practices were not associated with caloric intake of Animal Crackers or Pretzels 3 (p s >.10). Using Animal Crackers and Pretzels as the outcome variables, the model accounted for 19% and 7% of the variation respectively. These results suggest that individual differences in children s emotion regulation skills were more predictive of emotional eating than were parents emotional eating behaviors or feeding as an emotion regulation strategy. In addition, when parental emotional feeding practices were marginally associated with greater caloric intake in the sad condition using calories consumed of Chocolate Teddy Grahams as the outcome variable, this relationship was in the opposite direction as expected. The final hypothesis that poorer emotion regulation skills, parental emotional eating, and parental feeding for emotional reasons would account for significant variation in emotional eating was also conducted using parent report of the child s emotional eating as the outcome variable. As previous research on emotional eating in children has often utilized parent report of emotional eating, we were interested in whether there would be differential influences of the parents own behavior depending on the source of the emotional eating data: behavioral measure versus parent report. A regression analyses was conducted using the full sample, as a reduction in mood was not essential to the use of this outcome variable. Feeding for emotion regulation marginally predicted parent report of the children s emotional eating (ß =.34, p =.09), while emotion regulation skills and parent emotional eating did not (ß =.18, p >.10; ß =.29, p >.10, respectively). Although parent emotional eating and emotion regulation skills were not 3 In regression analyses with the full sample, poorer emotion regulation skills marginally predicted greater caloric intake of Chocolate Teddy Grahams (ß = -.38, p =.06) and Animal Crackers (ß = -.38, p =.06) during the negative mood condition.

32 Emotional Eating 27 significant predictors, the model accounted for 23% of the variance. It is interesting to note that when parent report of emotional eating was used as the outcome variable, as opposed to the behavioral measure of emotional eating, parent emotional feeding was marginally predictive in the direction expected. This is in contrast to the previous finding that parent emotional feeding practices were predictive of emotional overeating of Chocolate Teddy Grahams in the opposite direction as expected. Thus, parental feeding for emotion regulation was most predictive of emotional eating when using parent report as the outcome variable.

33 Emotional Eating 28 DISCUSSION The primary purpose of the present study was to determine the prevalence of emotional overeating in a sample of preschool-age children using a behavioral measure. Utilizing an experimental eating in the absence of hunger paradigm, it was found that emotional overeating was not pervasive in this sample as there were not significant differences in caloric intake between the sad and neutral conditions. However, there were noteworthy individual differences associated with greater caloric intake in the sad condition than in the neutral condition. It is important that a behavioral measure of emotional overeating was used in this study as self-report eating questionnaires have not been considered a reliable means of gaining information on this issue from children under the age of seven (van Strien & Oosterveld, 2008). However, contrary to our hypothesis that parents would be better reporters of children s emotional overeating than children themselves would be, we found the opposite. Child selfreport of emotional eating significantly predicted eating more calories during the negative mood condition, while parent-report did not. In addition, child self-report accounted for a large amount (53%) of the variance in calories consumed. To the extent that it is true that preschool-aged children can successfully report their eating behaviors, and other studies can replicate this finding, researchers should not overlook preschool children s self-report when studying the eating behavior of children at this age. The use of self-report measures with preschool children is particularly helpful when studying the intergenerational transmission of eating behavior between parents and children. A major limitation of one of the few previous studies that examined emotional eating in preschoolers and their mothers was the use of the mother s report for both their own eating behaviors and the eating behavior of their child (Jahnke & Warschburger, 2008). Thus, using