Emotional eating is eating in reaction to an emotion. Emotional eating has drawn particular interest because it frequently results in binge eating episodes and consumption of high-calorie, high-fat food ( Oliver et al., 2000 ; APA, 2013 ). There is a link between these behaviors and a higher risk of obesity, as well as significant health issues such as eating disorders (EDs), diabetes, heart disease, and hypertension ( van Strien et al., 2012 ; McCuen-Wurst et al., 2018 ). It is a well-known fact that emotions influence human behavior and decision-making ( Peters et al., 2006 ). Several studies show that a person’s emotional state can affect their food intake ( Geliebter & Aversa, 2003 ) and that unpleasant feelings such as sadness, anxiety, loneliness, and anger frequently precede emotional eating ( Bydlowski et al., 2005 ; Corstorphine et al., 2007 ; Svaldi et al., 2012 ). Studies show that negative mood is more linked to binge episodes than exposure to palatable food and calorie restriction ( Cardi et al., 2015 ). According to research, obese individuals who binge eat report urges to eat when they are experiencing negative emotions ( Chua et al., 2004 ).

It is argued that emotional eating is a learned behavior. Emotions can become addictive stimuli and trigger eating behaviors ( Bongers & Jansen, 2017 ). Eating after a negative emotion seems to function to reduce emotional tension or as an attempt to detach, relieve, or change the emotion ( Spoor et al., 2007 ; Safer et al., 2009 ; Gianini et al., 2013 ; Havermans et al., 2015 ). Emotion regulation seems to play an essential role in maintaining emotional eating and eating psychopathology in obese individuals who suffer from BED ( Gianini et al., 2013 ; Fernandes et al., 2018 ).

Emotional eating scales have been developed to measure a person’s urge to eat when they experience specific emotions ( Masheb & Grilo, 2006 ; Garaulet et al., 2012 ; Cassioli et al., 2022 ). These scales have been used to assess therapeutic progress related to obesity and EDs ( Safer & Jo, 2010 ; Garaulet et al., 2012 ). The self-administered questionnaire, Emotional Eating Scale (EES), is one of the tools used to measure emotional eating. EES, developed by Arnow et al. (1995) , examines the relationship between negative emotions and disordered eating in people with obesity and binge eating. EES has been successfully translated into various languages and used in studies with adult populations with or without EDs ( Duarte & Pinto-Gouveia, 2015 ; Rahme et al., 2021 ). It has also been adapted for use with children and adolescents ( Tanofsky-Kraff et al., 2007 ). There are also adaptations of the EES focusing on a specific emotion ( Koball et al., 2012 ) or adaptations of the scale adding positive emotions ( Zhu et al., 2013 ).

Arnow et al. (1995) proposed a three-factor solution: anger/frustration, anxiety, and depression. Different studies reported different factors. In the Lebanese validation study of EES in a sample of adults, four factors were identified: sadness and irritability, exhaustion, excitement, and distress. Also, body dissatisfaction was positively correlated with emotional eating and self-esteem ( Rahme et al., 2021 ). The Portuguese study of EES in a sample of female college students and women from the general population presented a three-factor structure: depression, anxiety, and anger ( Duarte & Pinto-Gouveia, 2015 ). Four factors were identified in the Goldbacher et al. (2012) study, which looked at the factor structure of the EES and its correlations with anthropometric characteristics in individuals who were overweight or obese: somatic arousal, depression, anger, and anxiety.

The emotional Eating Scale has not been validated in Greek and its psychometric properties have not been assessed in the BED population.

The purpose of the present study was to assess the validity of the Greek version of the EES (Appendix) and test its factor structure and correlations with eating psychopathology and anthropometric measures, specifically BMI and age, in a sample of adults suffering from BED.

Ethical approval for the research was granted by the Bioethics Committee of the Medical School, National and Kapodistrian University of Athens (NKUA), Greece (approval number 5993/5.62018). The study was conducted under the Declaration of Helsinki.

Quantitative variables were expressed as mean values (Standard Deviation) and median (Interquartile Range), while qualitative variables were expressed as absolute and relative frequencies. Confirmatory factor analysis (CFA), with a maximum likelihood estimation method, was conducted to test how well the EES three-factor model fits the data. We used the chi-square by degrees of freedom ratio (χ²/df), the Comparative Fit Index (CFI), the Tucker-Lewis Index (TLI), the Root Mean Square Error of Approximation (RMSEA), and the Standardized Root Mean Square Residual (SRMR) as goodness-of-fit indices ( Mueller, 1996 ), and these parameters were considered adequate when CFI ≥ 0.90, TLI ≥ 0.90 RMSEA ≤ 0.05 and SRMR < 0.08 ( Bentler, 1992 ; Nunnally & Bernstein, 1994 ; Greenspoon & Saklofske, 1998 ; Hu & Bentler, 1999 ). Internal consistency reliability was determined by the calculation of Cronbach’s alpha and McDonald’s omega coefficients ( Malkewitz et al., 2022 ). Scales with reliabilities equal to or greater than 0.70 were considered acceptable. We tested the extent to which the EES scale was correlated with the EDE-Q scale via Pearson’s correlation coefficient. All reported p values are two-tailed. Statistical significance was set at p < 0.05, and analyses were conducted using SPSS statistical software (version 26.0).

This study is the first to validate the Greek version of the EES scale and test its factor structure in a sample of adults seeking therapy for BED. Emotional eating is associated with binge eating episodes and increases the intake of high-fat food, which can result in weight gain and health problems ( Ricca et al., 2009 ; Koenders & van Strien, 2011 ; Péneau et al., 2013 ). Among our 160 participants seeking therapy for BED, 80% were obese, and 13.1% were overweight. In our sample, 4.5% had been hospitalized for severe adverse events related to their eating disorder. Most of the sample (80.2%) had visited a specialist for mental health issues in the past, 12.6% had attempted suicide, and 6.3% had suicidal thoughts in the past but had never attempted suicide. In their study, Grilo et al. (2009) found that 73.8% of treatment-seeking patients with BED had at least one psychiatric disorder in the past, and 43.1% had at least one psychiatric disorder at the time of seeking therapy.

The purpose of our study was first to assess the validity of the Greek version of the EES in a sample of adults suffering from BED. The three-factor solution proposed by Arnow et al. (1995) was found to have an acceptable model fit: anger/frustration, anxiety, and depression. There were no significant correlations between EES scores and anthropometric measures. Different studies of EES’ s factor structure reported different factors ( Goldbacher et al., 2012 ; Duarte & Pinto-Gouveia, 2015 ; Rahme et al., 2021 ). Given that culture impacts how people perceive and use their emotions, we might speculate that the study variations can be attributed to cultural and linguistic differences. Additionally, different populations and recruitment techniques were employed in the studies. Therefore, it is important to validate tools like EES in the language of the target group to develop effective therapies for EDs.

The study’s second aim was to examine the correlation between EES and eating psychopathology. All three EES subscales were significantly and positively correlated with eating concern, shape concern, weight concern, and the global EDE-Q scoring. There was no significant correlation between the EES and Restraint subscale. Emotion regulation difficulties are an important factor in eating psychopathology. It is important to teach individuals emotion regulation skills to decrease disordered eating behaviors, such as binge eating ( Safer et al., 2009 ).

The study’s third objective was to analyze the relationship between EES and anthropometric characteristics, specifically age and BMI. It was found that age was significantly and negatively associated only with depression subscale. Unlike the findings of Goldbacher et al. (2012) , who reported no significant connections between the EES scores and BMI, our research also found that BMI showed a significant and positive correlation with all EES subscales.

The study’s limitations were the lack of test-retest reliability assessment and the low percentage of male participants. The study sample mostly consisted of women (90%), because the majority of individuals seeking treatment for BED in Greek EDs units are women. Thus, the findings can mainly be applied to adult females diagnosed with BED. Also, using a self-administered questionnaire may lead to information bias.

Nonetheless, this study presents data showing that the Greek version of the EES can be a reliable tool used in clinical practice and research with Greek-speaking individuals who suffer from BED. Future studies should be conducted on different populations to validate the broader applicability of the Greek EES.

The current study presents data indicating that the Greek version of the EES can be a reliable tool for assessing emotional eating in Greek-speaking individuals with BED in clinical practice and research. Also, the study’s results add to the existing literature on the link between emotional eating and eating disorders, as well as the association between emotional eating and BMI.

Ελληνική Εκδοχή της Κλίμακας Συναισθηματικού Φαγητού

Καραπατσιά, Μ., Τζαβάρα, Χ., Μιχόπουλος, Γ., Γονιδάκης, Φρ., 2024

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