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    Stress, Anxiety, and Emotional Eating Predict Maladaptive Eating Patterns in Obese Women
    (2016-03-23) Franks, Susan; Lee, Michelle; Alahmady, Ahmed
    Background: Growing evidence suggests that stress contributes to obesity and its metabolic dysregulation through influences on food intake and choice. With high rates of stress and over 25% of the population suffering from significant anxiety, it is important to identify their effects on eating patterns. This study aims to identify relationships of increased stress and anxiety with eating patterns in obese women. It was hypothesized that recent stress, general anxiety, and a tendency to emotionally eat (EE) will be associated with (1) increases in eating in response to hunger cues [HN], (2) lower use of cognitive restraint [CR], and (3) increases in unplanned or impulsive eating (disinhibition) [DI]. Methods: A secondary analysis was performed on data obtained from a study investigating stress-related eating in obese women (n=30). Mean age was 36.17 years. Mean BMI was 40.21 kg/m2. Self-report surveys included the Perceived Stress Scale (PSS), State-Trait Anxiety Inventory (trait anxiety used; T-ANX), Eating and Appraisal Due to Emotions and Stress (EE scale used), and the Eating Behavior Scale (HN, CR, DI). Pearson correlation was used to determine relationships of EE with PSS, T-ANX, HN, CR, and DI. HN, CR, and DI were divided into high and low groups based on median splits. Logistic regressions were used to evaluate the ability of PSS, T-ANX, and EE to correctly classify HN, CR, and DI. Results: HN was significantly correlated with EE (r=-.539, p=.002), PSS (r=.393, p=.032) and T-ANX (r=.465, p=.010). Logistic regression was significant for HN (X2 =13.235, p=.004) correctly classifying 76.7% of the cases. Variance due to EE was significant in the model (p=0.17). CR was significantly correlated with EE (r=.440, p=0.15), but not PSS or T-ANX. Logistic regression was not significant for CR. DI was significantly correlated with EE (r=-.622, p2=11.872, p=.008). Variance due to EE was significant in the model (p=.037). Conclusion: The extent to which obese women eat in response to hunger cues or engage in unplanned eating is significantly related to life stress, tendency toward a general state of anxiety, and a propensity to eat in response to stress. Emotional eating carries a particularly significant liability toward maladaptive eating patterns in obesity. Anxiety and emotional eating appear to be viable therapeutic targets for obese women.
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    Relationship between Hostility-Irritability and Measures of Glucose Metabolism
    (2016-03-23) Dunn, Amy; Franks, Susan; Lee, Michelle; Dunks, Leah
    Purpose Hostility as a personality trait has been implicated as having a potential role in diabetes through its relationship to glucose metabolism. Research to date has consistently found a relationship primarily for women between hostility characterized by cynicism and mistrust with fasting glucose. Whether this connection extends to other aspects of glucose metabolism, or to other subtypes of hostility has not been determined. The purpose of this study was to investigate the relationship of hostility characterized by irritability on broader measures of glucose regulation. It was hypothesized that higher levels of hostility-irritability would be associated with higher fasting glucose (FG), fasting insulin (FI) and homeostatic model assessment index (HOMA-IR). Method A secondary data analysis was conducted on data from a 1-year prospective study in a community bariatric surgical setting. Data used for the present analysis was from the pre-surgical assessment of 71 bariatric surgery candidates (OB) and 30 age- and gender-matched normal weight controls. Mean age was 44.6 years. Mean BMI was 43 kg/m2. Irritability was measured through self-report using the Buss Hostility Inventory. FG, FI, and postprandial glucose (PG) and insulin (PI) were analyzed at a commercial laboratory. Fasting HOMA-IR score was derived according to standard calculation. FG, FI, PG, PI, and HOMA-IR were divided into high and low categories based on a median split. Logistic regression analyses were used to evaluate the ability of Irritability and gender to predict FG, FI, PG, PI, and HOMA-IR. Pearson correlation was used to explore relationships among variable, including individual Irritability scale items. Results Results of logistic regression models were non-significant for all indicators of glucose regulation. There were several significant correlations among individual items of the Irritability scale with FI, PI, and HOMA-IR. Conclusion Irritability as a subtype of the broader personality trait of hostility was not associated with measures of glucose regulation examined in this study. However, several individual items of the scale were significantly correlated with insulin, suggesting that specific aspects of hostility may be more disruptive to glucose regulation than others and should be further explored.
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    The Relationship Between Physiological and Psychological Indicators of Stress in Emotional Eaters
    (2016-03-23) Franks, Susan; Lee, Michelle; Ortiz, Daniel
    Background: Obesity has become an increasing problem in the United States with obesity-related conditions growing in number over the last few decades. Growing evidence proposes that stress influences food intake and food choice which contributes to obesity in many people, particularly women. The purpose of this study was to examine how physiological and psychological indicators of stress are associated with emotional eating (EE) in obese women (OB). Hypotheses: (1) Perceived stress, anxiety, and cortisol are associated with EE; (2) Coping mediates the relationship between perceived stress, anxiety, and cortisol with EE. Methods: This study is a secondary analysis of data obtained from an experimental study investigating stress-related eating in OB. Thirty obese but otherwise healthy women who report that they eat in response to stress were included in the study. Average BMI was 40.21 kg/m2. Average age was 36.17. Self-report surveys included the Perceived Stress Scale (PSS), State Anxiety from the State-Trait Anxiety Inventory (state anxiety; S-ANX), and Eating and Appraisal Due to Emotions and Stress (EE and Coping; COP). Fasting serum cortisol was analyzed in-house. Pearson correlation was used to determine associations between EE with PSS, S-ANX, COP, and cortisol. Subjects were categorized as high or low in EE based on the mean value. Logistic regression was used to ascertain the ability of PSS, S-ANX, and cortisol to predict high EE. Results: EE was significantly correlated with S-ANX (r=-.514, p=.004) and COP (r=.614, p=.000) and approached significance with cortisol (r=.356, p=.058). Logistic regression for PSS, S-ANX, and cortisol significantly predicted high EE (X2=12.845, p=.005) and correctly classified 79.3% of the cases. S-ANX provided significant variance to the model (p=.02). The addition of COP improved the model (X2=23.212, p=.000) and classification rate (82.8%). S-ANX provided significant variance (p=.03) and variance accounted for by COP approached significance (p=.065). Conclusions: The extent of emotional eating in obese women appears to be significantly related to a combination of life stress, degree of transient anxiety, and cortisol levels. However, this relationship appears to be mediated by the utilization of healthy coping skills. Stress and anxiety appear to show promise as evidence based targets for emotional eating in obesity.