Presently, an estimated 46 percent of Americans will meet the criteria for a diagnosable mental health issue at some point in their lifetime.1 With the significant increase in mental health disorders, such as anxiety and depression, in the past decade, we have also seen an increase in stress eating. Stress eating is also referred to as emotional eating, which occurs when we overindulge in food in response to our emotions.2 Most commonly, the type of food that is being overconsumed in times of stress is highly palatable, ultra-processed food. Think about it. If you’re feeling stressed about your current financial situation, you likely aren’t reaching for celery and peanut butter. In times of high stress, you may be more inclined to indulge in chocolate or candy. Research has found that frequent stress can result in a change in eating patterns—resulting in the overindulgence of ultra-processed foods.3 Over time, this type of behavior can prompt neurobiological changes that result in compulsiveness and may contribute to the development of uncontrollable behaviors surrounding food—such as food addiction or binge eating.3
How Does Stress Eating Develop
Whenever we experience stress, the body is pushed into the fight-or-flight state, which is the same instinct that would’ve been activated when our ancestors were running from a bear. Stress produces cortisol, which is what allows the fight-or-flight response to occur. Cortisol increases appetite in an effort to promote eating as our ancestors needed fuel to survive when in this state of high stress. In today’s world, we no longer have to stress about running from bears; however, stress has never been more apparent than it is in today’s society.4
Research has been conducted to explore the relationship between stress and overeating, and various theories have been developed in an effort to explain the etiology of stress eating. An interoception-based theory on stress eating supports the idea that individuals overeat in response to negative emotions due to the lack of interoceptive awareness—the feeling of hunger. In other words, this theory suggests that individuals who struggle with overeating in response to stressful situations may mistake their emotions for hunger instead of regulating their emotions with alternative strategies.5
Another theory is referred to as the restrain theory, which is the idea that individuals who chronically diet are more likely to develop strict rules around food—such as never eating pizza. With this, straying slightly from this rule can result in overindulgence as emotions interfere with cognitive control.5
Learning-based emotional eating theories have proposed the idea that highly palatable foods counter the negative feelings associated with stress and negative emotions. Whenever stress eating is repeated, classical conditioning can result in the increased motivation to eat in response to negative emotions.5 It makes sense why an individual would want to consume something indulgent whenever stressed as the release of dopamine counteracts the negative emotions by prompting a feeling of pleasure.
How Emotional Eating Can Contribute to Binge Eating
Emotions play a large role in instances of binge-eating disorders. Binge-eating disorder is characterized by frequent and recurring episodes of excessive caloric intake over a period of time due to a lack of control. Episodes of bingeing are often followed by distress, which can contribute to maintaining these compulsive tendencies.6 Symptoms associated with binge-eating disorder include feeling ashamed about one’s eating behaviors, eating despite hunger cues or lack thereof, eating larger than normal portions at meals, feeling discomfort and fullness, and/or feeling as if one lacks control when engaging in these behaviors.6
One study found that participants who experienced greater anxiety and stress were more likely to score high on binge-eating tendency measures than their counterparts who had lower levels of anxiety and stress.7 One theory on binge eating supports the idea that binge episodes are engaged in as a way to dissociate from negative experiences and emotions, which can be linked to stress.7 High levels of stress, paired with anxiety, may be a risk factor for binge-eating behaviors.7 During a binge episode, one may feel a sense of euphoria; however, this feeling is often shortly followed by guilt and shame.
Some of the main risk factors that drive binge eating include “enhanced food cravings, impaired decision making and diminished executive function.”8 When discussing binge eating, it is important to discuss the role of dopamine. Dopamine is released by neurons located in the midbrain, which send projections to the ventral striatum—forming the mesolimbic dopaminergic system.9 The mesolimbic dopaminergic system is involved in behaviors that are specifically associated with reward.9 The release of dopamine results in feelings of pleasure, satisfaction and reinforcement.9 The intense feeling that results when dopamine is released can lead to these compulsive behaviors and even food addiction.
How Stress Eating May Impact Food Addiction
As previously referred to, stress and anxiety are common sources of overeating. For some individuals, “self-medicating” with food has become their way of coping with the stress and hardships endured in everyday life. Although there are many factors that can contribute to why someone overeats, the types of food that are being overconsumed are typically highly palatable, ultra-processed foods—containing added sugar. As previously mentioned, stress activates the nervous system and stimulates the release of cortisol. The increase in cortisol levels can lead to appetite stimulation, which can result in the consumption or overconsumption of high caloric foods in stressful instances. Whenever individuals continually turn to eating in times of stress, this can result in complications overtime and may increase their risk of developing an addiction to food—or sugar.
Similar to dopamine’s role in binge eating, it acts in instances of food addiction through its impact on the brain. Whenever an individual is stressed or emotional and indulges in something sweet—like candy—the brain releases dopamine, which produces that rewarding feeling of pleasure. Originally, dopamine aided in the ability to decipher which foods were safe or unsafe. For example, whenever we ate an apple for the first time, dopamine was released as a way to deem the apple as safe—giving the green light to continue eating it in the future. As we continue to eat more apples. the release of dopamine subsides over time. The difference with ultra-processed foods is that we don’t see this same reduction in dopamine release. When individuals indulge in highly palatable foods, dopamine is always released and never decreases—which is similar to what we see in instances of drug abuse. Essentially, our brains release dopamine in response to highly processed foods in the same way they release them in response to using a drug.
Treatment Approaches to Stress Eating
If we look at the root cause of stress or emotional eating, it typically stems from feelings of stress or anxiety. In order to address the etiology of emotional eating, we must address how an individual copes with stress and/or anxiety. Controlling these emotions will assist in preventing emotional eating. Identifying coping strategies when these emotions do arise is also of great importance. Failure to address stress can lead to a variety of mental health disorders, such as chronic stress, anxiety and depression.10 In extreme situations, chronic diseases may develop—such as cardiovascular disease or obesity.10
The type of stress management technique that produces success for someone is extremely individualized. Some individuals may turn to breathing techniques, while others may engage in high-intensity exercise movements. Examples of established stress management techniques that have proven to be effective through research include yoga, Tai Chi, meditation, mindfulness and cognitive behavior therapy.10 Identifying the most effective form of stress management for an individual is essential to managing emotional eating and directing the behaviors of overindulgence toward positive and healthy behaviors.
Concluding Thoughts
As life becomes more stressful and the access of highly palatable, ultra-processed foods becomes more available in the American food supply, stress eating has become a growing health concern. According to the American Psychological Association, 33 percent of adults report overeating or engaging in unhealthy eating habits as a way to distract them from everyday stress.11 With both chronic diseases and mental health disorders on the rise, addressing stress eating is vital to ensure enhanced health and longevity in the American population.
Health care practitioners have the ability to make an impact on their patients and guide them toward healthy lifestyle choices surrounding food. Connecting patients with a mental health therapist or registered dietitian can be an effective way to ensure the root cause of their stress eating is being identified and addressed. In order to decrease the percentage of Americans impacted by emotional eating, practitioners must do their part and prioritize providing individualized, patient-centered care that is focused on the prevention of the health consequences associated with emotional eating.
References:
1 Mental Health America. Quick Facts and Statistics About Mental Health. Mhanational.org. www.mhanational.org/mentalhealthfacts. Accessed July 2024.
2 Godet A, Fortier A, Bannier E, Coquery N, Val-Laillet D. Interactions between emotions and eating behaviors: Main issues, neuroimaging contributions, and innovative preventive or corrective strategies. Rev Endocr Metab Disord. 2022;23(4):807-831. doi:10.1007/s11154-021-09700-x.
3 Yau YH, Potenza MN. Stress and eating behaviors. Minerva Endocrinol. 2013;38(3):255-267.
4 Cleveland Clinic. Why You Stress Eat and How to Stop. Health.clevelandclinic.org. https://health.clevelandclinic.org/how-to-stop-stress-eating. Published January 26, 2023. Accessed July 2024.
5 Reichenberger J, Schnepper R, Arend AK, Blechert J. Emotional eating in healthy individuals and patients with an eating disorder: evidence from psychometric, experimental and naturalistic studies. Proc Nutr Soc. 2020;79(3):290-299. doi:10.1017/S0029665120007004.
6 Lim MC, Parsons S, Goglio A, Fox E. Anxiety, stress, and binge eating tendencies in adolescence: a prospective approach. J Eat Disord. 2021;9(1):94. Published 2021 Aug 3. doi:10.1186/s40337-021-00444-2.
7 Yu Y, Miller R, Groth SW. A literature review of dopamine in binge eating. J Eat Disord. 2022;10(1):11. Published 2022 Jan 28. doi:10.1186/s40337-022-00531-y.
8 Mayo Clinic. Binge-eating disorder. Mayoclinic.org. www.mayoclinic.org/diseases-conditions/binge-eating-disorder/symptoms-causes/syc-20353627. Published February 23, 2024. Accessed July 2024.
9 Lewis RG, Florio E, Punzo D, Borrelli E. The Brain’s Reward System in Health and Disease. Adv Exp Med Biol. 2021;1344:57-69. doi:10.1007/978-3-030-81147-1_4.
10 Can YS, Iles-Smith H, Chalabianloo N, et al. How to Relax in Stressful Situations: A Smart Stress Reduction System. Healthcare (Basel). 2020;8(2):100. Published 2020 Apr 16. doi:10.3390/healthcare8020100.
11 American Psychological Association. Stress and Eating. Apa.org. www.apa.org/news/press/releases/stress/2013/eating. Created 2013. Accessed July 2024.
Dr. Nicole Avena is an associate professor of neuroscience at Mount Sinai School of Medicine in New York, NY, and a visiting professor of health psychology at Princeton University in New Jersey. She is a research neuroscientist and expert in the fields of nutrition, diet and addiction, with a special focus on nutrition during early life and pregnancy, and women’s health. In addition to more than 100 peer-reviewed scholarly publications, Dr. Avena has written several popular books, including Why Diets Fail: Because You’re Addicted to Sugar, What to Eat When You’re Pregnant, What to Feed Your Baby and Toddler and What to Eat When You Want to Get Pregnant. Her latest book, Sugarless, was released in December 2023. She frequently appears as a science expert in the media, including regular appearances on Good Day NY, The Doctors, and the former Dr. Oz Show, as well as many news programs.
