Nutrition

30 American Journal of Health Education — January/February 2003, Volume 34, No. 1

Emotional eating is broadly defined as food consumption that occurs in response to various emotional states or cues such as boredom, loneliness, or anxiet y (Timmerman & Acton, 2001). Ongoing re- search supports the hypothesis that there is a relationship between this type of eating and such negative outcomes as ineffective weight control (Blair, Lewis, & Booth, 1990), binge eating (Waters, Hill, & Waller, 2001), bulimic eating attitudes (Waller & Osman, 1998), and higher caloric intake (Braet & Van Strein, 1997). Emotional eating there- fore may be an underlying factor that con- tributes to rising rates of overweight and obesity in the United States. A better un- derstanding of emotional eating and its de- terminants may be useful in planning health education interventions that can contrib- ute to obesity prevention efforts (Hawks & Gast, 1998).

As early as the 1950s, psychosomatic theory was used to suggest that emotional eating may arise from confusion between internal arousal states and hunger—a con- dition learned in early childhood (Bruch, 1961; Kaplan & Kaplan, 1957). It was hy- pothesized that this misinterpretation of

internal states might be a primary factor in the development of obesity for some indi- viduals (Blair et al., 1990; Robbins & Fray, 1980). Others have concluded that there are two dimensions of emotionality: diffuse (e.g., restless) and clearly labeled (e.g., frightened), and that experiences with dif- fuse emotions are most associated with overeating. It has been further determined that obese individuals may experience clearly labeled emotions as being diffuse and respond by overeating to both clearly labeled and diffuse emotions (Van Strien, Frijters, Bergers, & Defares, 1986). Other studies also have found that overweight participants have more difficulty than nor- mal weight participants in describing or la- beling specific emotional exper iences (Slochower, 1983).

But rather than confusion between emo- tional arousal and hunger, a more recent hypothesis suggests that emotional eating may arise from unmet basic needs such as the need for belonging or the need for self- esteem (Timmerman & Acton, 2001). In support of this theory one study found that 27.7% of the variance in emotional eating scores could be explained by self-esteem

scores—with higher self-esteem resulting in less emotional eating (r=-.49; p<.001) (Timmerman & Acton, 2001).

It has been argued in the health educa- tion literature that spiritual well-being, like self-esteem, is a basic human need (Hawks, 1994). Various authors have defined spiri- tual health in slightly different ways, but the spiritual dimension is generally thought to include such components as a unifying force within individuals, purpose and meaning in life, a common bond between individu- als, individual perceptions of faith (Banks, 1980), personal fulfillment (Pilch, 1988), and a strong personal value system (Sea- ward, 1991). In an attempt to combine many of these elements into a single defi- nition, one author suggests that spiritual health is a “high level of faith, hope and

Emotional Eating and Spiritual Well-Being: A Possible Connection?

Steven R. Hawks, Marylynn B. Goudy, and Julie A. Gast

ABSTRACT

The purpose of this exploratory study was to evaluate the relationship between emotional eating and spiritual well-being. It was found that among college women lower levels of spiritual well-being correlated with higher levels

of emotional eating (r=-.22, p=.0015). In other studies emotional eating has been found to contribute to higher

caloric intake, binge eating, and bulimic eating attitudes. A better understanding of the correlates of emotional eating may lead to health education strategies for preventing or managing overweight, obesity, and eating

disorders—which may be some of the major public health issues of the future. Implications for health education are

discussed, and research needs are suggested.

Steven R. Hawks, EdD., MBA, and Marylynn B. Goudy, MS, are with the Department of Health Science, 229-L Richards Building, Br igham Young University, Provo, Utah 84602; E-mail: steve_hawks@byu.edu. Julie A. Gast, PhD, is with the Department of HPER, Utah State University, Logan, Utah 84322.

Steven R. Hawks, Marylynn B. Goudy, and Julie A. Gast

American Journal of Health Education — January/February 2003, Volume 34, No. 1 31

commitment in relation to a well-defined worldview or belief system that provides a sense of meaning and purpose to existence in general, and that offers an ethical path to personal fulfillment with includes connect- edness with self, others, and a higher power or larger reality” (Hawks, 1994, p.6).

In support of the importance of spiritu- ality as an interactive dimension of health, preliminary research findings have demon- strated a positive relationship between spiri- tual well-being and the practice of a variety of health behaviors (Waite, Hawks, & Gast, 1999). Other research has found that spiri- tual well-being positively correlates with self-esteem, finding meaning and purpose in life, high assertiveness, physical health, hope, and emotional adjustment. At the same time, spiritual well-being is negatively associated with depression, ill health, emo- tional maladjustment, and dissatisfaction with life (Bufford, Paloutzian, & Ellison, 1991; Ellison & Smith, 1991). Based on these definitions and findings, there is growing support for the argument that spiritual well- being is an essential dimension of holistic health that should be studied more fully and integrated into the practice of health edu- cation (Hawks, Hull, Thalman, & Richins, 1995). From this perspective it seems plau- sible that low levels of spiritual well-being, like low self-esteem, might be related to poor emotional responsiveness—with emo- tional eating and excessive caloric intake as possible outcomes.

The aim of this exploratory study was to seek insight about the nature and pos- sible origins of emotional eating by evalu- ating the relationship between emotional eating, spiritual well-being, and body mass index (BMI). It was hypothesized that a negative correlation would be found be- tween spiritual health and emotional eat- ing, but that no correlation would be found between spiritual health and two other motivations for eating (i.e. physical hunger, environmental prompts). It was further hypothesized that BMI, an indicator of overeating, would correlate positively with emotional eating. Pursuing this line of re- search may have implications for under-

standing some types of overeating and for promoting healthy weight management.

METHODS

Subjects This study was approved by the appro-

priate institutional review board and used informed consent. A cross-sectional, corre- lational research design was used to mea- sure relationships among the variables of emotional eating, spiritual well-being, and BMI. The priority population for this study was female college students.

Instrument The Motivation for Eating Scale (MFES)

was used to measure various motivations for eating, including emotional, physical, and environmental motivations (Merrill, 1997). The MFES is a 43 item, Likert-type scale that includes five possible responses for each item (from strongly agree to strongly disagree). The emotional subscale (22 items) measured the degree to which eating was motivated by various emotional states such as loneliness, boredom, or anxiety. The physical subscale (9 items) measured responsiveness to hunger cues as a primary motivator for eating. The environment subscale (12 items) measured the degree to which cues in the environment (e.g., food advertisements, watching TV, seeing a plate of cookies) influenced food consumption. Higher scores on each subscale represent a stronger motivation for eating in that area. The MFES was particularly well suited for this study in that it was capable of evalu- ating the relationship between emotional eating and spiritual health, while addi- tional subscales (physical, environmental) were useful in assessing the specificity of the relationship.

Initial construction of the scale involved expert reviewers and pilot testing to ensure face and content validity (Merrill, 1997). For the present study, Chronbach’s alpha coef- ficients were calculated and a factor analy- sis was completed to assess the reliability and validity of the MFES. Cronbach’s alpha coefficients for subscales ranged from .77 (physical), to .81 (environmental), to .92

(emotional), indicating an acceptable level of internal consistency. Factor analysis dem- onstrated validity with individual items loading on intended subscales. These find- ings are consistent with those obtained dur- ing initial reliability and validity testing (Merrill, 1997).

Spiritual health was measured using the Spiritual Well-Being Scale (SWBS) (Ellison & Smith, 1991). The SWBS is a 20 item, six- point Likert-type scale that measures many elements of spiritual health as defined in the introduction. For example, the SWBS con- tains items that assess personal fulfillment, purpose and meaning in life, connectedness with a higher power or larger reality, and individual perceptions of faith. Higher scores represent higher levels of well-being. Numerous studies using the SWBS have consistently yielded test-retest reliability above .85, and alpha coefficients above .84 have been obtained in relation to internal consistency (Bufford et al., 1991). Initial construction of the SWBS insured good face validity, and subsequent research has shown that the scale is a good general index of well- being (Bufford et al., 1991).

BMI was calculated from self-report height/weight data. Although self-report height and weight data are known to be re- spectively over- and underreported, they are nevertheless used extensively in the research literature, including such national surveys as the Behavioral Risk Factor Surveillance Sur vey (Nelson, Holtzman, Bolen, Stanwyck, & Mack, 2001). Accurate self-re- ports are most typical of younger, lean par- ticipants such as those involved in this study (DelPrete, Caldwell, English, Banspach, & Lefebvre, 1992). Given that self-report in- accuracies are likely to be normally distrib- uted, and that this is a cross-sectional, cor- relational study (as oppose d to a prospective, pre- and posttest study), the use of self-report height/weight data seems war- ranted. Pencil and paper questionnaires were used to collect data. The normality assumption was reasonably satisfied for data distributions. Pearson correlation coeffi- cients were used to evaluate the strength and direction of relationships between study

Steven R. Hawks, Marylynn B. Goudy, and Julie A. Gast

32 American Journal of Health Education — January/February 2003, Volume 34, No. 1

variables. Two-tailed tests were used to es- tablish statistical significance.

RESULTS The selected convenience sample in-

cluded 225 female students and yielded a 96% response rate for a total of 216 par- ticipants. Students were enrolled in intro- ductory, general education courses at a re- gional, western university in the United States. The mean age of participants was 22 (SD= 4.2), most were single (84%), and most were White (88.4%). The n for re- sponses ranged from 203 to 210 on differ- ent subscales due to missing data in some categories. Mean values, standard devia- tions, and correlation coefficients for study variables are reported in Table 1. Two of the MFES subscales, emotional and environ- mental eating, demonstrated statistically significant correlations with spiritual well- being. Although the strength of correlation for emotional eating was only moderate, the level of statistical significance was high, and the negative relationship was in the pre- dicted direction. A somewhat weaker cor- relation between environmental eating and spiritual well-being also was negative.

The only correlation between an MFES subscale and BMI that approached signifi- cance occurred in relation to emotional eat- ing. The strength of the correlation was rela- tively weak, but the relationship was again in the predicted direction.

DISCUSSION Health promotion programs that en-

courage weight management through cog- nitive control over diet composition, caloric intake, and activity levels have had little suc- cess in reducing the prevalence of obesity at the population level (Kassirer & Angell, 1998; Miller, 1999). Not surprisingly, there is growing interest in new approaches that try to identify and address the underlying factors that may have created poor eating habits in the first place (Gast & Hawks, 1998). Research demonstrating the validity and importance of such constructs as emo- tional eating seems to lend support to this direction (Waller & Osman, 1998).

To date, most of the research dealing with emotional eating has focused on es- tablishing emotional eating as a valid con- struct (Arnow, Kenardy, & Agras, 1995; Waller & Osman, 1998), and then identify- ing relationships between emotional eating and various outcomes such as overeating (Telch & Agras, 1996), obesity (Riva, 1996), and eating disorders (Drobes et al., 2001; Waters et al., 2001). There was only one study identified in the literature that at- tempted to identify a potential determinant of emotional eating. In that study it was found that low self-esteem was related to hig h le vels of emotional eating (Timmerman & Acton, 2001).

In an exploratory effort to identify other potential correlates of emotional eating, this study evaluated relationships between emo- tional eating, spiritual well-being, and BMI. As hypothesized, a statistically significant relationship between emotional eating and spiritual well-being was found. The mod- erate negative correlation was in the pre- dicted direction and supports the possibil- ity that lower levels of spiritual well-being may be a factor associated with inappropri- ate emotional responses, including overeat- ing. This preliminary finding lends support to other research that links unmet needs (e.g., self-esteem) to patterns of emotional eating (Timmerman & Acton, 2001). Self-

esteem scores predicted 27.7% of the vari- ance in emotional eating scores in an ear- lier study (Timmerman & Acton, 2001), whereas this study found that spiritual well- being scores predicted 4.8% of the variance in emotional eating. In combination, these findings begin to build a case for the possi- bility that unmet needs in the areas of self- esteem and spiritual well-being may be con- tributing factors in the development of emotional eating.

It also was found in this study that envi- ronmental eating (e.g., impulsive eating in response to advertising, social gatherings, proximity to appetizing foods) was nega- tively linked to spiritual well-being (albeit weakly). As argued elsewhere, it seems more than probable that environmental eating, like emotional eating, contributes to over- eating and obesity (French & Jeffery, 2001). As hypothesized with emotional eating, it is possible that fulfillment of basic human needs such as self-esteem and spiritual health may also serve as a buffer that can protect individuals against the impulsive- ness of environmental eating (Gast & Hawks, 1998). If so, the potential link be- tween spiritual well-being and environmen- tal eating discovered in this study seems worthy of future investigation.

Although failing to achieve statistical sig- nificance, this study also found a positive

Table 1. Values and Correlations for Motivation for Eating Scale (MFES), Spiritual Well-Being Scale (SWBS),

and Body Mass Index (BMI) Measures (M, SD)

SWBS (96.4, 11.5) n 203 207 208 r -0.2211 -0.1647 -0.0575 p 0.0015** 0.0177* 0.4092

BMI (22, 3.4) n 204 209 210 r 0.1340 -0.0605 0.0699 p 0.0560 0.3840 1.9600

MFES Subscales Emotional (47.7, 13.5) Environmental (48.4, 8.6) Physical (30.8, 6.2)

* Significant at the .05 level ** Significant at the .01 level

Steven R. Hawks, Marylynn B. Goudy, and Julie A. Gast

American Journal of Health Education — January/February 2003, Volume 34, No. 1 33

trend between emotional eating and BMI. Other research has demonstrated that emo- tional eaters experience more difficulty in achieving a healthy target weight (Blair et al., 1990). Responding to emotional states without turning to food may be a key skill required by some individuals to achieve and maintain weight loss. The possible role of such psychosocial constructs as self-esteem and spiritual well-being in mediating this process is intriguing.

The nature of this research is prelimi- nary, and it is bound by limitations includ- ing a relatively small sample that was non- random and somewhat homogenous. At the same time, limited diversity within a small sample would make the identification of significant correlations more difficult, not easier. The fact that significant results were found suggests that identified relationships may be real. To increase generalizability, randomized samples with greater diversity will be necessary elements of future re- search. For example, it would be interest- ing to determine whether the findings would remain consistent with a noncollege sample that included a broad representation of married and minority women. Such ef- forts may be able to clarify the nature of these relationships, the direction of causal- ity (if any), and the possible implications for theory and practice in relation to healthy weight management and obesity prevention (Hawks & Gast, 1998). Given the possible relationship between spirituality and reli- giosity, future research in this area may also identify new avenues for faith-based ap- proaches to healthy weight management.

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