“I am in the mood for . . .(fill in the blank.)“
How many times have we said this to ourselves or others as we plan lunch or dinner? (Very few people are in the mood for anything except more sleep in the morning.) Sometimes the “mood” for a particular type of ethnic cooking or a prime piece of beef is heightened because the meal is celebratory, or a respite between bouts of unrelenting work or home meal preparation. But this type of mood-influenced eating rarely lasts beyond a meal or two, and rarely leads to sustained overeating and weight gain. Too many calories may be consumed at a dinner celebrating the completion of a difficult project or an anniversary, but this type of eating rarely results in continued excessive calorie intake.
Not so the type of eating generated by moods we would rather not have. Boredom, and its frequent companion loneliness, may lead to an overly important focus on what to eat as a distraction from a long weekend, or evenings alone with little to do. Rainy vacation days with few places to go inside to escape the dreary weather often brings tourists into restaurants for meals for which they may not even be hungry. It is something to do. Long distance flights generate an appetite for foods that if served on the ground would be rejected immediately. Yet flyers that are not hungry will eat them because, again, it is something to do.
Bad moods are different. Anxiety, depression, premenstrual syndrome, and post-traumatic stress disorder are among negative or dysphoric moods that can provoke overeating, sometimes for days every month (PMS) or years (like PTSD when undiagnosed or untreated). Anxiety seems to trigger the excessive eating of binge eating disorder. But anxiety may also cause chronic overeating without the dramatic bouts of excessive food intake seen in binge disorder. In that case, the overeating may be enough to hinder successful weight loss and/or cause small, but continuous, weight gain.
Sometimes the obesity, which results from “bad mood” overeating, does not appear until years after the mood disorder appears. Researchers who examine the results of longitudinal health surveys have identified participants who have mood disorders at a young age and then become obese many years later. Data from the Nurses’ Health Study that began in 1989 was used to see whether women who were diagnosed with post-traumatic stress disorder during the early years of the survey were more likely to be obese in later years than women without this disorder. They found that having PTSD was a risk factor for obesity; women with this disorder gained more weight than women who experienced trauma, but not PTSD, and much more than women with neither.
Depression is also a predictor of obesity and, like PTSD, the obesity may not appear for years after the depressive episodes. Several research groups have used health surveys following male and female participants over many years to look at the weight status of people who were clinically depressed when they entered the study as older adolescents or young adults. A significant number of them became obese a few or several years after they no longer were depressed. Because the obesity appeared much later than the depression, the weight gain is probably not due to treatment with antidepressants, although the studies did not look at this specifically.
We know that obesity and emotional overeating are strongly linked; certainly eating in response to anxiety and stress is evidence of this. Sometimes an immediate response to a stress is to grab something to eat. A friend who was renovating an old house told me that the first thing she did after she found that the closets were too narrow to accept a normal-size hanger (after the renovation) was to go to a convenience store and buy candy.
But what explains the development of obesity years after women develop PTSD, or among depressed individuals years after the depression is gone?
The problem with looking at survey data as opposed to being able to talk to the people who provided the data is that these questions can’t be answered. Were levels of physical activity low because of stress-associated fatigue? Did the people who were depressed and then years later became obese suffer in the years in between from chronic “blue mood”? Might they too have been too tired to exercise? Was food a solution for their moods? Did they eat to feel better, heedless of the calories they were consuming? Did they eat what they wanted because they had had enough deprivation in their lives and did not want to add the deprivation of a diet to everything else?
More research is needed to know the answers. But what we do know is that when people overeat, the reasons are as likely to be due to their mood as to what is tempting them.
“Emotional eating, alexithymia and binge-eating disorder in obese women,” Pinaquy, S., Chabrol, H., Louvet, J., Barbe, P., Obes, Re., 2003 11:195-201.
“The association between obesity and anxiety disorders in the population: a systematic review and meta-analysis,” Gariepy, G., Nitka, D., and Schmitz, N., International J of Obesity 21;2010 34: 407-419
“The weight of traumatic stress: a prospective study of posttraumatic stress disorder symptoms and weight status in women,” Kubzansky, L., Bordelois, P., Jun, H., Roberrts, A., et al, AMA Psychiatry 2014; 71: 44-51.
“Trajectories of Change in Obesity and Symptoms of Depression: The CARDIA study,” Needham, B., Epel, E., Adler, N., Kiefe, C., Am J Public Health 2010; 100: 1040-106.
“Overweight, Obesity, and Depression,” Luppino, F., deWit, L., Bouvy, P., et al, Arch Gen Psychiatry 2010; 67: 220-229.