Primary care providers are key to treating emotional eating

Primary care physicians are well positioned to treat emotional eating because of their long-standing relationships with patients, noted Jana DeSimone Wozniak, PhD, and Hsiang Huang, MD, MPH, of Harvard Medical School and Cambridge Health Alliance in Cambridge, Massachusetts. According to their study in Harvard Review of Psychiatry, Emotional eating is part of Wolters Kluwer’s Lippincott portfolio and is linked to a myriad of health problems, including being overweight or obese, increasing difficulty losing and maintaining weight, diabetes, and heart disease.

Traditional approaches to weight control do not adequately take emotional eating into account

“Emotional eating is characterized by an increased motivation to eat in response to stress and/or emotional and mood states,“Dr. Wozniak and Dr. Huang explain.”People who eat due to negative emotions and stimuli report a tendency to consume so-called ‘palatable foods’ (i.e. foods high in sugar, fat and calories).”

Some individuals without obesity report eating in response to negative emotions or stress, the authors say, but emotional eating is more commonly associated with higher body fat percentage, waist circumference, and body mass index. In addition, emotional eating is associated with lower success with traditional, behavior-based weight loss treatments (e.g., reducing portion size, calorie and fat intake, and/or the amount of carbohydrates consumed).

Family doctors are well positioned to recognize emotional eating

Emotional eating often overlaps with depression, anxiety, and eating disorders, note Dr. Wozniak and Dr. Huang. They recommend using the Patient Health Questionnaire–9 (PHQ-9) and the Generalized Anxiety Disorder–7 (GAD-7) to identify eating disorders related to negative emotional states or psychosocial stressors. For example, if a patient presents with weight problems and reports “poor appetite or overeating” on the PHQ-9, the clinician can further explore the type of eating disorder and emotion coping patterns.

Primary care physicians can use screening tools that identify eating disorders and life stressors. Examples for primary care include the Screen for Disordered Eating, the Perceived Stress Scale–10, and the Eating Disorder Examination Questionnaire.

Dr. Wozniak and Dr. Huang point out that people who meet the criteria for binge eating disorder (BED) can also suffer from emotional eating, but that not everyone who suffers from emotional eating meets the diagnostic criteria for BED (episodes of compulsive eating that recur on average once per week for at least three months).

Clinical considerations for primary care physicians in dealing with emotional eating

Psychological interventions, particularly cognitive behavioral therapy and mindfulness-based interventions, are the standard first-line approaches to treating emotional eating, the authors say. However, acceptance and commitment therapy and dialectical behavior therapy also reduce emotional eating in adults who are overweight or obese, and research suggests that improvements are sustainable.

The U.S. Food and Drug Administration has not approved any medications to treat emotional eating. However, underlying mental health conditions may require psychopharmacological treatment, with special attention to comorbid conditions.

Dr. Wozniak and Dr. Huang recognize that psychological interventions specifically designed to treat emotional eating may not be readily available to all patients in primary care. “Encouraging patients to track their moods and eating habits to develop a greater awareness of the causes of emotional eating, engaging in mindfulness exercises via the internet or phone-based applications, and helping them find alternative, adaptive strategies for emotion regulation can all help to increase awareness of internal and external factors that contribute to and maintain emotional eating and promote non-judgmental, adaptive management of it.”