ABSTRACT
ACADEMIC-RELATED FACTORS AND EMOTIONAL EATING IN
ADOLESCENTS
By
Ashley Chamberlin
August 2015
Emotional eating is increasing food consumption in response to negative emotions
such as stress or anger, rather than physiological hunger. Many studies have found stress
to be related to emotional eating and weight gain in adults, yet few researchers have
examined the impact of school-related stress on emotional eating in adolescents. School
can be a large burden of anxiety which may lead to emotional eating as a method of
coping. The purpose of this study was to investigate the influence of different academic
factors on emotional eating, among a sample of minority adolescents (including both
males and females). Specifically, this study examined whether (1) academic self-esteem
(2) grade point average (GPA) and (3) academic worries were related to emotional eating.
The results showed that GPA, academic self-esteem, and academic worries
significantly predicted emotional eating in adolescents. Positive, significant relationships
were found for academic worries and GPA. The relationship between academic selfesteem was negative and significant. Age and gender were not found to be statistically
significant predictors. There were no significant differences in academic factors between
1
emotional eaters and non-emotional eaters. More research is needed to determine the
complex interaction between emotional eating behavior and academics.
2
ACADEMIC-RELATED FACTORS AND EMOTIONAL EATING IN
ADOLESCENTS
A THESIS
Presented to the Department of Family and Consumer Sciences
California State University, Long Beach
In Partial Fulfillment
of the Requirements for the Degree
Master of Science in Nutritional Sciences
Committee Members:
Virginia Gray, Ph. D. (Chair)
Selena Nguyen-Rodriguez, Ph. D.
Wendy Reiboldt, Ph. D.
College Designee:
Wendy Reiboldt, Ph. D.
By Ashley A. Chamberlin
B.S., 2012, California State University, San Bernardino
August 2015
UMI Number: 1594910
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ACKNOWLEDGEMENTS
Thank you to my committee members, Virginia Gray, Ph. D., Selena NguyenRodriguez, Ph. D., and Wendy Reiboldt, Ph. D., for their tremendous support and
guidance throughout the thesis process. For help with my statistical analyses, thank you
to Selena Nguyen-Rodriguez, Ph. D. I would also like to thank Donna Spruijt-Metz, Ph. D.,
M.F.A for kindly granting permission to use previously collected data for this study.
iii
TABLE OF CONTENTS
Page
ACKNOWLEDGEMENTS .........................................................................................
iii
LIST OF TABLES .......................................................................................................
vi
CHAPTER
1. INTRODUCTION ....................................................................................................................
1
Introduction ................................................................................................
Statement of the Problem ...........................................................................
Purpose of the Study ..................................................................................
Hypotheses .................................................................................................
Definition of Terms ....................................................................................
Assumptions...............................................................................................
1
3
3
4
4
5
2. REVIEW OF LITERATURE ...............................................................................................................
6
Background ................................................................................................
Worries in Youth........................................................................................
Impact of Stress on Dietary Intake in Youth ..............................................
Complexity of Emotional Eating..............................................................................................
Effect of Academic Stress on Eating Behaviors in Students......................
Summary ....................................................................................................
6
7
8
9
10
11
3. METHODOLOGY............................................................................................
12
Sample........................................................................................................
School Selection .........................................................................................
Student Recruitment ...................................................................................
Procedure ...................................................................................................
Instrumentation ..........................................................................................
Data Analysis .............................................................................................
12
12
13
13
14
15
iv
CHAPTER
Page
4. RESULTS ...........................................................................................
17
Characteristics of Sample ..........................................................................
Differences in Academic Factors and Emotional Eating between
Subjects ..........................................................................................
Academic Factors as Predictors of Emotional Eating................................
Summary ....................................................................................................
17
5. DISCUSSION, CONCLUSIONS, AND RECOMMENDATIONS .................
22
Discussion of Findings ...............................................................................
Limitations .................................................................................................
Conclusions ................................................................................................
Recommendations for Future Research .....................................................
Summary ....................................................................................................
22
25
26
26
27
APPENDICES
17
19
21
........................................................................................................
29
A. SURVEY ITEMS .............................................................................................
30
B. LETTERS OF APPROVAL.............................................................................
35
REFERENCES ............................................................................................................
38
v
LIST OF TABLES
TABLE
Page
1. Characteristics of the Sample............................................................................
18
2. Differences in Academic Factors between Emotional and Non-Emotional
Eaters..........................................................................................................
19
3. Associations between Emotional Eating and Academic Factors ......................
20
vi
CHAPTER 1
INTRODUCTION AND STATEMENT OF THE PROBLEM
Introduction
Researchers have stated there needs to be a clearer understanding of the linkage
between stress and obesity in youth; emotional eating may be a large, often overlooked
part of the picture (Wilson & Sato, 2014). Emotional eating, comfort eating, and stressinduced eating are terms to describe the repeated response of increasing food
consumption as a way to cope with unpleasant psychological emotions (Arnow, Kenardy,
& Agras, 1995). Although emotional eating encompasses a variety of psychological
feelings prompting intake, research in this area has largely focused on stress (Greeno &
Wing, 1994). Whether experienced acutely or chronically, stress impacts the individual
on a psychological and physiological level (Wilson & Sato, 2014). During times of stress
eating behaviors have been found to vary; 30% of individuals decrease intake, but the
majority increase food intake when they are stressed (Adam & Epel, 2007).
Emotional eating in childhood and adolescence has been linked to higher
incidence of developing binge eating, eating disorders, depressive symptoms, and
problem behaviors, both internally and externally (Braet & van Stier, 1997; Braet et al.,
2008). The longstanding research on emotional eating has been primarily focused on
Caucasian, adult females, but it is likely that emotional eating occurs in people of all
ages, genders, and ethnicities. A national survey found that 43% of Americans report
overeating or
1
consuming unhealthy foods in response to stress (American Psychological Association,
2007). Research recently began focusing on larger culturally-diverse samples of children
and adolescents; revealing that approximately 10-60% of youth emotionally eat (Braet et
al., 2008; Nguyen-Rodriguez, Unger, & Spruijt-Metz, 2009).
Many questions remain unanswered about stress-induced eating among
adolescents. Nguyen-Rodriguez et al. (2009) found perceived stress and worries to be
correlated with emotional eating in Latino adolescents, but the origin of stress and
worries in adolescents was not determined. Hispanic and African American children
have reported using food as a helpful coping mechanism for stress (Jenkins, Rew, &
Sternglanz, 2005). Specific factors that support emotional eating in adolescence are not
clearly understood yet, nor are the particular differences between emotional eaters and
non-emotional eaters.
School is a source of stress in adolescents’ lives (Wahab et al., 2013); anxiety
stems from examinations, homework, deadlines, grades, and preparing for college. Thus,
the stress and anxiety associated with school may be a trigger for emotional eating
behavior in youth. In a recent study, female college students were found to increase food
consumption when they felt stressed about school (Bennett, Greene, & Schwartz-Barcott,
2013). University students are often the focus of studies relating academic stress to
emotional eating, yet these eating patterns may have been well-established as children or
adolescents. Some studies have focused on high school students to examine the impact
of academic stress on eating behavior. Michaud et al. (Laugesen, Dugas, & Bukowski,
2003) found that both genders changed eating habits in response to a stressful academic
exam. Another study found Korean high school students with high academic stress ate
2
more at meals and had higher overall sugar intake than students with low academic stress
(Kim, Yang, Kim, & Lim, 2013). It is probable that academic factors play a role in
emotional eating of adolescents, and this is an area that needs to be more extensively
investigated.
Statement of the Problem
The association between worries, stress, and emotional eating has been identified
in adolescents (Braet et al., 2008; Nguyen-Rodriguez et al., 2009). Additionally, and
perhaps most pressing, is that emotional eating is frequently established in early
childhood or adolescence and remains stable over time (Ashcroft, Semmler, Carnell, van
Jaarsveld, & Wardle, 2008; van Strien, van der Zwaluw, & Engels, 2010). Thus, eating
in response to negative emotions is likely to persist throughout life and negatively impact
one’s health. By developing a more robust understanding of the etiology of this eating
behavior, multi-disciplinary approaches can be established to assist adolescents in
developing healthier responses to stress. School is an often overlooked factor that can
contribute stress, anxiety, and worry to students’ lives and has the potential to elicit
emotional eating (Bennett et al., 2013; Kim et al., 2013; Michaud et al, 1990).
Nevertheless, the impact of academic-related factors on stress and emotional eating has
yet to be fully explored, especially in minority adolescents (Braet et al., 2008; NguyenRodriguez et al., 2009).
Purpose of the Study
The purpose of this study was to investigate the influence of different academic
factors on emotional eating, among a sample of minority adolescents (including both
3
males and females). Specifically, this study examined whether (1) academic self-esteem,
(2) grade point average (GPA) and (3) academic worries were related to emotional eating.
Hypotheses
H01: There will be no significant difference in academic self-esteem status
between emotional eaters and non-emotional eaters.
H02: There will be no significant difference in grade point average between
emotional eaters and non-emotional eaters.
H03: There will be no significant difference in academic worries between
emotional eaters and non-emotional eaters.
H04: Academic self-esteem will not significantly predict emotional eating
behavior in minority adolescents.
H05: GPA will not significantly predict emotional eating behavior in minority
adolescents.
H06: Academic worries will not significantly predict emotional eating behavior in
minority adolescents.
Definition of Terms
Academic self-esteem: An individual’s overall feelings of academic success and
his or her satisfaction of their accomplishments (Skaalvik, 1990).
Adolescence: A period of life from puberty to adulthood, beginning at roughly 11
years old; characterized by physiological, emotional, social, and neurological changes
and maturity (J.E. Brown et al., 2011).
4
Emotional eating: Increasing food intake in response to negative emotions such
as anger, fear, or anxiety (Heatherton & Baumeister, 1991; Spoor, Bekker, Van Strien, &
van Heck, 2007), rather than physiological hunger.
Stress: The negative response that results from stimuli, happenings, or conditions
that adversely affect an individual’s welfare (De Vriendt, Moreno, & De Henauw, 2009;
Gundersen,Mahatmya, Garasky, & Lohman, 2010).
Grade point average (GPA): A measure of academic achievement calculated by
dividing the total number of grade points received by the total number of credits or hours
of course work taken (Grade point average, 2015).
Worries: A chain of negative, intrusive inner thoughts that are relatively
uncontrollable (Borkovec, Robinson, Pruzinsky, & 1983).
Assumptions
This study assumed that the study participants understood the survey questions
and responded honestly. It also assumed that the academic factors measured will
represent facets of academic-related stress in the population.
5
CHAPTER 2
REVIEW OF LITERATURE
The purpose of this study was to investigate the influence of different academic
factors on emotional eating, among a sample of minority adolescents (including both
males and females). Specifically, this study examined whether (1) academic self-esteem,
(2) GPA and (3) academic worries were related to emotional eating.
Many studies have found stress to be related to emotional eating and weight gain
in adults, yet few researchers have focused on the impact of school-related stress and
emotional eating in adolescents (Epel, Lapidus, McEwen, & Brownell, 2001; Ozier et al.,
2008; Rutters, Nieuwenhuizen, Lemmens, Born, & Westerterp-Plantenga, 2009). School
can be a large burden of responsibility and anxiety which may lead to emotional eating in
some students (Bennett et al., 2013; Wahab et al., 2013). Research has attempted to
understand the complexity of emotional eating by examining factors related to
individuals’ eating patterns and differences between emotional eaters and non-emotional
eaters
Background
Increasing food intake in response to negative emotions, otherwise known as
emotional eating, has been established as a common, yet “inapt” response (Spoor et al.,
2007). Although emotional eating can involve a variety of unfavorable emotions such as
sadness and frustration, stress appears to play a significant role, resulting in a large body
of literature focused on stress-induced eating. Adam and Epel (2007) found that 70% of
6
people increase food intake when stressed. The stress hormone cortisol elicits a
biological response as it influences food cravings toward highly palatable, energy-dense
foods laden with fat and sugar that help to alleviate psychological stress (Hou et al.,
2013).
Several other studies conducted in adults support the notion that stress
significantly increases emotional eating behavior and weight gain (Epel et al., 2001;
Ozier et al., 2008; Rutters et al., 2009). Ozier et al. (2008) found that adults who are
most likely to eat in response to stress and emotions were 13 times more likely to be
overweight or obese than adults who have low tendencies to eat in response to emotions.
Although most research in this area has focused on adults, dietary habits may be
established in childhood. Ashcroft et al. (2008) demonstrated this concept as they found
emotional eating in early childhood to be a stable trait that continues over time.
Therefore, if poor dietary habits such as repeated emotional overeating occur for long
periods of time, they may contribute to weight gain and obesity. Because emotional
eating appears to frequently manifest prior to adulthood, identifying perpetuating factors
of emotional eating in youth can help identify methods of prevention. Thus, the study of
emotional eating during formative years of adolescence is warranted.
Worries in Youth
Very few studies have examined the potential impact of worries on emotional
eating in adolescents. A pioneer study by Belcher et al. (2011) found that worries about
self-image, relationships, and school significantly predicted emotional eating in Latina
female adolescents. This study also found that emotional eating significantly moderated
7
the relationship between baseline worries and body mass index (BMI) percentile at
follow-up.
Another study focused on worries in adolescents and found that 42% of students
worried about school grades every day (S. Brown, Teufel, Birch, & Kancherla, 2006).
Grades were the highest frequency of daily worry, followed by physical appearance and
problems at home. Additionally, researchers asked students what they usually do when
they are stressed or worried and gave the following options: talk to parents or friends,
keep worries to self, take action towards cause of worries, or none of the above. Students
who responded that they usually keep worries to themselves had higher rates of worrying
about grades weekly. Although the survey did not include the choice of eating/snacking
in response to stress, 16.5% of students answered “none of the above.” A portion of
these responses may have included those who increase food intake. Additionally,
students who answered that they keep worries to themselves (24.4%) may also engage in
emotional eating, intentionally or unintentionally. Those who emotionally eat
unintentionally may not be aware that eating is how they express or manifest stress.
Impact of Stress on Dietary Intake in Youth
Life stress has been shown to modify dietary intake in children and adolescents.
Cartwright et al. (2003) investigated the relationship between stress and dietary patterns
in a diverse population of children and found that increased stress was associated with
elevated intake of high fat foods and more frequent snacking. In addition, they found
high stress decreased frequency of healthy behaviors such as consuming fruits,
vegetables, and daily breakfast. Another study conducted in China by Hou et al. (2013)
found life stress and emotional symptoms were correlated with unhealthy eating patterns,
8
including emotional eating, in junior and high school students. This association between
stress and maladaptive eating behaviors remained significant after adjusting for gender,
age, BMI, parental education level, and family socioeconomic status.
Nguyen-Rodriguez and colleagues (2009) discovered that perceived stress and
emotional eating were significantly correlated in adolescents, independent of BMI.
Researchers from the University of Texas in Austin found a significant correlation
between perceived stress and unhealthy eating habits, such as using food to cope with
stress, in school-age children and early adolescents. There were no differences in coping
behaviors by school grade, but results varied by ethnicity. Hispanic and African
American youth reported using food more often as a helpful tool to deal with stress than
Caucasian children (Jenkins et al., 2005). These studies add to the growing body of
evidence that dietary intake and emotional eating may increase during times of stress and
worry beginning in adolescence.
Complexity of Emotional Eating
Despite the strong linkage between stress, worry, and emotional eating, these
relationships are not necessarily linear nor unidimensional. One trial by Roemmich,
Wright, and Epstein (2002) looked at the role dietary restraint has on stress-induced
eating in children. Results found that children who usually self-limit food consumption
(high dietary restraint) actually increased snacking under stress. Those with low dietary
restraint had the opposite reaction to stress and decreased snack intake. Other studies
have shown that the type of stressor experienced (i.e., physical threat vs. interpersonal
stress) may impact whether or not a restrained eater will increase food consumption
(Cattanach, Phil, & Malley, 1988; Tanofsky-Kraff, Wilfley, & Spurrell, 2000). These
9
studies portray that despite the inherent physiological effects of stress on the body, the
impact on dietary intake is both multifactorial and individualized. According to Wilson
and Sato (2014), researchers should continue examining the relationship between
emotional eating and stress due to the complexity of the topic.
Effect of Academic Stress on Eating Behaviors in Students
Growing research has shown that perceived stress often increases emotional
eating behaviors in children and adolescents (Cartwright et al., 2003; Hou et al., 2013;
Wichianson, Bughi, Unger, Spruijt-Metz, & Nguyen-Rodriguez 2009). However, the
source(s) and types of stress impacting diet have yet to be thoroughly identified and
surveyed. Few studies have focused on academic stress as an influence on emotional
eating in adolescents and children, despite school being a mandatory and often stressful
obligation in their lives.
The limited research aimed at understanding academic stress and its relationship
with eating behaviors has targeted populations generally regarded as having increased
levels of perceived stress, such as university students. These studies have found that
college students with higher stress levels had poorer nutrition habits, increased emotional
eating, and night-eating than those with less stress (Bennett et al., 2013; Fogle &
Pettijohn, 2013; Wichianson et al., 2009). In a Korean study, similar results were found
in high-school students. Students who reported high academic stress ate larger meals and
consumed more sugar than those reporting low academic stress (Kim et al., 2013).
During periods of major exams, students’ diets appear to be influenced as well.
One study found that on the day of the exam, females increased total energy intake and
males increased intake of fat as a percentage of calories (Michaud et al.,1990). Another
10
study’s results showed that students with high trait anxiety and low social support
increased energy intake between exam sessions (Pollard, Steptoe, Canaan, Davies, &
Wardle, 1995). It is apparent that elements related to school often influence the eating
patterns of students, but more evidence is needed to understand which particular
academic factors are associated with emotional eating.
Summary
Based on the available studies, school-related stress and worries may alter eating
behavior or predict emotional eating in adolescents. Despite the fact that school can be a
major source of stress for youth, it is currently unknown what school-related elements
may contribute to emotional eating in adolescents. No known studies have examined
whether academic factors such as grade point average, academic stress, and schoolrelated worries predict emotional eating behavior in adolescents. Since adults have been
the primary focus of emotional eating research, it is necessary to study what drives
adolescents to emotionally eat in order to help develop healthier behaviors for lifelong
health.
11
CHAPTER 3
METHODOLOGY
The purpose of this study was to investigate the influence of different academic
factors on emotional eating, among a sample of minority adolescents (including both
males and females). Specifically, this study examined whether (1) academic self-esteem,
(2) GPA and (3) academic worries were related to emotional eating.
Sample
The study utilized cross-sectional data from a sample containing 666 middle
school students in Los Angeles County. The data were obtained from seven schools, both
public and private, as part of a larger physical activity intervention in minority students
(Get Moving!). Seventh and eighth graders completed a psychosocial survey that
included scales to assess a variety of aspects related to physical and mental health. A
multitude of areas were assessed including, but not limited to: physical activity, body
image, smoking, and weight concerns. Emotional eating, academic self-esteem, and
frequency of school-related worries were assessed in the questionnaire and will be the
focus of the proposed study. Demographic information such as age, ethnicity, and sex
were also included.
School Selection
Sampling methods were focused on selecting Los Angeles County schools based
on ethnic makeup and socioeconomic status. Data were obtained from the California
12
Board of Education and the Roman Catholic Archdiocese. The schools that agreed to
participate had high numbers of Latino students and were mixed socioeconomically.
Eight of the nine schools that the primary researcher approached agreed to participate.
However, data were only collected from seven schools as one later declined to
participate.
Student Recruitment
Physical education instructors at each school were approached to invite their
classrooms to take part in the study. Of the 18 physical education teachers approached to
participate, 17 agreed to participate. All students in the class were invited to complete
the surveys.
Student recruitment lasted 3 days; the principal investigator explained the study
and distributed parental consent forms on the first day. All forms were available in both
English and Spanish. A separate parent refusal form was distributed on day 3 to those
students who had not returned the consent forms. Students with implied consent,
meaning those who did not provide parental consent or parental refusal, were given an
abbreviated version of the survey. Student active assent was also required for
participation. Eighty-five percent of students consented (active and implied) to
participate. Study procedures were approved by the University of Southern California
Institutional Review Board and the boards of participating schools and school districts.
Procedure
Data collection manual procedures and scripts were followed by trained data
collectors. The paper-and-pencil survey was given over two class periods and took
approximately 45 minutes in total for students to complete. Confidentiality was
13
explained to students and maintained by assigning individual, arbitrary identification
numbers to each student. Permission to use the collected data in the proposed study was
attained by a signed consent letter from the principle investigator.
Instrumentation
Emotional Eating
Emotional eating was measured using the Emotional Eating Subscale of the Dutch
Eating Behavior Questionnaire (DEBQ), a 13-item questionnaire assessing eating
behaviors in response to emotions (van Strien, Frijters, Bergers, & Defares, 1986). A 5point Likert scale was used to measure responses ranging from “never” to “very often.”
The mean scores of the 13 items were calculated in order to obtain a continuous score for
emotional eating behavior (Cronbach α = 0.95). The emotional eating subscale shows
high internal consistency and high factorial validity in samples of obese and normal
weight men and women (van Strien et al., 1986). Based on age and gender cut-off values
available in the DEBQ manual (van Strien, 2005), students were further categorized as
“emotional eaters” or “non-emotional eaters,” creating a nominal variable for analysis.
Academic Self-Esteem
Academic self-esteem was measured using a subscale of the Self-Image
Questionnaire for Young Adolescents (SIQYA) created by Marsh, Parker, and Smith
(1983). The academic confidence (AC) subscale of the SIQYA consists of 10-items and
was used to determine students’ attitudes and perceptions about their academic ability
and performance. A 4-point Likert scale was used to measure responses ranging from
“no, always” to “yes, always.” The mean scores of the ten items were calculated in order
to obtain a continuous score for academic self-esteem (Cronbach α = 0.81). Rasch
14
analysis indicates that the academic confidence subscale of the SIQYA fits the Rasch
model and is a one-dimensional instrument (Marsh, 1990).
Grade Point Average (GPA)
After approval from the school district and school, students’ GPA from student
records (de-identified, labeled only by study ID number) were provided to the
investigator. Grade point average is used as a measurement of academic achievement
through grades and is calculated by dividing the total amount of grade points and divided
by amount of attempted credit units (Grade point average, 2015). The values for GPA
range from 0.00 to 4.00, with 4.00 indicating the highest academic performance.
Academic Worries
A scale developed by Spruijt-Metz and Spruijt (1997) was utilized to measure
worries, which are internal and often uncontrollable negative thoughts. The questions
assessed how often the adolescent worried about each item over the past month. A 4point Likert scale was employed with responses ranging from “I never worry about this”
to “I worry about this a lot.” The worry scale shows good internal consistency in
adolescent populations including both genders (Spruijt-Metz & Spruijt, 1997). Two
items that were specifically related to school were used to create an academic worries
subscale. The purpose of the academic worries subscale is to quantify adolescent
worrying in order to assess how often students worry about school. These items were
averaged to obtain a scale score (Cronbach α = 0.70).
Data Analysis
All statistical analyses were conducted using SPSS, version 21.0 (IBM Corp,
Armonk, NY). Descriptive statistics were used to describe demographic factors of
15
participants. Independent-samples t-tests were used to examine potential differences in
variables between emotional eaters and non-emotional eaters for Hypotheses 1-3. Forced
entry multiple linear regressions were used for testing of Hypotheses 4-6.
Since data are nested within schools, multi-level modeling was performed to
control for the random effect of school, addressing the violation of the assumption of
independence encountered with the use of nested data. Residual analysis and influence
diagnostics indicated the model was a good fit to the observed data. Further model
analyses supported cross-validation of the model as there was no substantial shrinkage.
The majority of assumptions of multiple linear regression were met, although normality
of the residuals may be problematic. However, based on central limit theorem, the
sample is likely large enough to meet normality and the model would likely generalize to
other samples within the targeted adolescent population.
16
CHAPTER 4
RESULTS
The purpose of this study was to investigate the influence of different academic
factors on emotional eating, among a sample of minority adolescents (including both
males and females). Specifically, this study examined whether (1) academic self-esteem,
(2) GPA and (3) academic worries were related to emotional eating.
Characteristics of Sample
In total, 666 students completed surveys and their responses were included in data
analyses; Table 1 provides data to describe the sample. The age of the sample ranged
from 11 to 15 years, with a mean of 12.5 years. Nearly three-fourths of the sample was
females (73%) and over half were Latino (61%). Roughly 20% of participants were
classified as emotional eaters. Considering the possible range of scores, the mean values
for both academic self-esteem and worries were moderately high.
Differences in Academic Factors and Emotional Eating between Subjects
Null hypotheses 1 through 3 stated there would be no significant difference in
academic factors between emotional eaters and non-emotional eaters. Two-tailed
independent samples t-tests were used to test these hypotheses and results are presented
in Table 2. Hypothesis 1 was accepted; there was not a statistically significant difference
when comparing grade point average for the emotional eater group to the non-emotional
eater group (p = .547, r = .02).
17
TABLE 1. Characteristics of the Sample (N = 666)
Variable
N
%
Male
179
26.9
Female
487
73.1
Asian/PI
107
16.1
Latino
407
61.1
Multi-ethnic
77
11.6
Other
44
6.6
White
24
3.6
Emotional eaters
124
19.8
M
SD
Range
155.67
7.81
138-184
Emotional eating score
1.83
0.82
1–5
GPA
2.77
0.86
0.0 – 4
Academic Self-Esteem
3.06
0.56
1–4
Academic Worries
3.14
0.90
1–4
Sex
Ethnicity
Variable
Age in months
18
Hypothesis 2 was also accepted which examined differences in academic self-esteem
between emotional eaters and normal eaters. There was no statistically significant
difference (p = .278, r = .04). Hypothesis 3 compared academic worries between those
who were classified as emotional eaters and those who were not. There was no
statistically significant difference between groups, (p = .633) or real effect (r = .02).
TABLE 2. Differences in Academic Factors between Emotional and Non-Emotional
Eaters
Emotional
eaters
Non-emotional
eaters
Mean (SE)
Mean (SE)
Academic factors
t
p-value
Academic Self-Esteem
3.01 (0.05)
3.08 (0.03)
-1.09
.278
GPA
2.81 (0.08)
2.76 (0.04)
-0.60
.547
Academic Worries
3.18 (0.08)
3.14 (0.04)
-0.48
.633
Note: Statistical significance set at p < .05.
Academic Factors as Predictors of Emotional Eating
Forced entry multiple linear regression was performed to identify predictors of
emotional eating. Multi-level modeling was performed and analyses controlled for age
and sex. Results indicate that the model significantly explained 2.8% of the variance in
emotional eating, F(5,601) = 3.479, p = .004, as shown in Table 3.
19
Null hypotheses 4 through 6 stated that GPA, academic self-esteem, and academic
worries would not significantly predict emotional eating; all hypotheses were rejected.
Grade point average (95% CI: .016, .206), academic self-esteem (95% CI: -.336, -.060)
and academic worries (95% CI: .006, .152) significantly predicted emotional eating.
Age and gender were not statistically significant predictors. Relationships were positive
for academic worries and GPA. Thus, as academic worries and GPA increased,
emotional eating increased. The relationship between academic self-esteem and
emotional eating, however, was negative; as academic self-esteem increased emotional
eating decreased.
TABLE 3. Associations between Emotional Eating and Academic Factors
Emotional Eating
Β1
SE
p-value2
Academic Self-Esteem
-0.144
0.007
.005
GPA
0.142
0.048
.022
Academic Worries
0.084
0.037
.035
Age
-0.047
.253
Gender
0.006
.945
Note: R2= .028
1
All parameter estimates (betas) are adjusted for age, sex, and random effect of school.
2
Statistical significance set at p < .05.
20
Summary
Although there were no differences between emotional eaters and non-emotional
eaters in terms of GPA, academic self-esteem, and academic worries, regression analysis
indicated that each of these three factors were significant predictors of emotional eating.
Relationships were positive for academic worries and GPA; the relationship between
academic self-esteem and emotional eating was negative. The covariates, age and
gender, were not statistically significantly related to emotional eating.
21
CHAPTER 5
DISCUSSION, CONCLUSIONS, AND RECOMMENDATIONS
The purpose of this study was to investigate the influence of different academic
factors on emotional eating, among a sample of minority adolescents (including both
males and females). Specifically, this study examined whether (1) academic self-esteem,
(2) GPA and (3) academic worries are related to emotional eating.
Discussion of Findings
Previous studies have indicated a relationship between stress, emotional eating,
and weight gain in adults, yet few studies have explored academic-related factors, which
may perpetuate stress, and emotional eating in adolescents (Epel et al., 2001; Ozier et al.,
2008; Rutters et al., 2009). The current study explored this relationship using two
analytical approaches. First, differences in GPA, academic self-esteem, and academic
worries were examined between emotional eaters and non-emotional eaters through
independent-samples t-tests. Secondly, forced entry multiple linear regression was
employed to test whether these factors predicted emotional eating; forced entry allowed
for the effects of all variables to be controlled for the other, simultaneously.
Results of the t-tests indicated there were no significant differences in GPA,
academic self-esteem, and academic worries between emotional eaters and non-emotional
eaters, supporting null hypotheses 1 through 3. One possible explanation for the null
results may be that the bivariate analyses failed to control for additional factors; these
22
analyses only capture simple associations, however, the relationship between academic
factors and emotional eating appears to be more complex. Additionally, t-tests are less
able to capture linear relationships, potentially contributing to the non-significant results.
The study performed by Belcher et al. (2011) illustrated that worries significantly
predicted emotional eating in adolescents; the findings in the present study are similar,
but specific to school-related worries. Additionally, the trial by Belcher et al. included
entirely female subjects whereas the current study included both sexes, although the
sample was predominantly female. The current study lends to the generalizability of
findings in the area of emotional eating to both sexes (as historically studies have been
largely focused on females). The present study found no association between emotional
eating and sex, indicating that the problem may affect both genders equally.
Regression analyses revealed a positive, significant relationship between GPA
and emotional eating. It was unexpected that the relationship was positive; it was
assumed that the relationship would be negative because students with poor grades (low
GPA) may have higher stress levels about school, which would increase the likelihood of
emotional eating as a coping response. However, those with higher GPA scores actually
had higher scores on emotional eating. One possible explanation for this result may be
that individuals maintaining noble grades through dedication to their school work may
have high levels of stress and engage in emotional eating to deal with the pressures of
earning and maintaining high grades. Results from Kim et al. (2013) indirectly support
this idea as they found high-school students who reported higher academic stress ate
larger portions and more sugar than those who were less stressed. Earning high grades
23
has the possibility of causing high academic-related stress, but the direct relationship of
these variables was not examined in the present study.
Results of the linear regression also showed a negative, significant association
between academic self-esteem and emotional eating. As overall feelings of academic
success and satisfaction of accomplishments increased, emotional eating decreased.
Although no known studies have specifically examined academic self-esteem, these
findings are also in line with previous similar research. One study scrutinized
relationships among self-esteem, stress, coping, and eating behavior in adolescents
(Martyn-Nemeth, Penckofer, Gulanick, Velsor-Friedrich, & Bryant, 2009). Martyn et al.
found that those with higher self-esteem reported less unhealthy eating behaviors and
used less avoidant coping behaviors than adolescents with lower self-esteem. Although
Martyn et al. studied overall self-esteem, their results are similar to the present study
which used academic self-esteem, focusing only on feelings related to school.
Additionally, the present study identified 19.8% of the sample were emotional eaters
which is similar to the results by Martyn et al.; they stated that 25% of adolescents
utilized food as a coping mechanism to deal with problems.
The current study revealed intriguing information that has been largely
overlooked; school is a common thread for all youth and may be a major contributor to
emotional eating behavior. It is possible that emotional eating behavior is wellembedded long before students enter universities, where the majority of research between
academics and eating patterns have been studied. Discovering the etiologies of emotional
eating in youth may help develop programs that can emphasize the development of
healthier eating habits and alternative coping mechanisms. Although the present study
24
did not specifically focus on emotional coping mechanisms in adolescents, emotional
eating, by definition, is an avoidant coping behavior in response to negative feelings.
Results from previous research suggest that adolescent coping mechanisms may be
lacking; teaching teenagers healthy alternatives to managing negative feelings may help
decrease emotional eating behaviors.
A meta-analysis of school-based stress management programs concluded that
primary prevention programs should be promoted for children and adolescents, as overall
results show positive outcomes including improved coping and stress reduction (Kraag,
Zeegers, Kok, Hosman, & Abu-Saad, 2006). Successful reductions in psychological
stress and anxiety have also been found by Tai Chi and Yoga programs for youth (Frank,
Bose, & Schrobenhauser-Clonan, 2014; Wall, 2005). Although these programs aim to
reduce overall stress, no known programs have targeted academic-related stress in an
effort to reduce emotional eating in adolescence. Educating youth on the potential
consequences of emotional eating and teaching healthier alternatives to deal with
academic stress could help change unhealthy eating behaviors before they become
embedded, lifelong habits.
Limitations
The cross-sectional design of this study allowed the associations between
academic factors and emotional eating to be described, however, it did not establish
causality. In addition, results may not be easily extrapolated to the general population as
the sample was largely composed of minority adolescents with a high number of females.
Data was self-reported which may not have accurately captured data, however self-report
is the best means available for psychosocial information to be collected.
25
Conclusions
Previous researchers have examined academic stress and eating behavior of
students on a limited basis. This study was the first known to investigate specific schoolrelated factors that affect academic stress and how they relate to emotional eating in
adolescents. Given that GPA, academic self-esteem, and academic worries significantly
predicted emotional eating, it is important to continue research in this area and promote
programs that can help adolescents develop healthier coping mechanisms that are not
food-related. Although analyses aimed to assess the influence of each individual factor,
it must be noted that the overall model only significantly explained 2.8% of the variance
in emotional eating. This highlights the fact that academic-related factors only account
for a small portion of this behavior, supporting the notion that the influences on this
response are multifactorial.
Recommendations for Future Research
More research is needed to fully investigate the relationship between academicrelated factors and emotional eating in adolescents. Studying additional factors that may
be related to academic stress such as examinations, workload, parental pressure, and
personality type may provide information that could help further elucidate the
relationship between academic stress and emotional eating. Conducting further studies
focusing on academic-related factors in different populations will provide additional
information about the generalizability of these relationships. Longitudinal studies are
needed to determine if the association between academic-related factors and emotional
eating is causal. In addition, long term studies may provide insight as to how emotional
eating can impact adolescents’ lives and health over time; and if students who
26
emotionally eat in response to academic stress at a young age continue to do so at the
university level. Furthermore, effective ways to reduce overall academic stress and teach
healthier management techniques to adolescents should continue to be examined.
Summary
The purpose of this study was to investigate the influence of different academic
factors on emotional eating, among a sample of minority adolescents (including both
males and females). Specifically, this study examined whether (1) academic self-esteem,
(2) GPA and (3) academic worries were related to emotional eating.
There were no significant bivariate differences in academic factors between
emotional eaters and non-emotional eaters. However, positive, significant linear
relationships were found for academic worries and GPA. Further, the relationship
between academic self-esteem was negative and significant. Considering the disparate
findings resulting from the two analytic approaches, more research is needed to better
understand the complex association between academics and emotional eating behavior.
Although current results mimic trends found in previous research, this is the first study to
identify specific, individual academic factors related to academic-stress and how they
may influence emotional eating behavior. This unique and novel research suggests that
emotional eating is not limited to a small demographic group of adult, Caucasian females
as previously studied; but occurs in both sexes of minority youth as well and may be
triggered by school-related stressors. Considering that academics are an integral aspect
of the lives of all youth, the importance of addressing negative health behaviors
associated with academic stress is underscored. The current study sheds light on the
importance of examining the motives for emotional eating and identifying when these
27
patterns may initiate in order to teach alternative behaviors that promote lifelong health
and effective stress management to youth.
28
APPENDICES
29
APPENDIX A
SURVEY ITEMS
30
You and school
H1. People come to me for help in most
school subjects
1  False
2  Mostly false
3  Mostly true
4  True
H2. I am too stupid at school to get into
a good university
1  False
2  Mostly false
3  Mostly true
4  True
H3. If I work really hard I could be one
of the best students in my school year
1  False
2  Mostly false
3  Mostly true
4  True
H4. I get bad marks in most school
subjects
1  False
2  Mostly false
3  Mostly true
4  True
H5. I learn things quickly in most
school subjects
1  False
2  Mostly false
3  Mostly true
4  True
H6. I am stupid at most school subjects
1  False
2  Mostly false
3  Mostly true
4  True
H7. I do well in tests in most school subjects
1  False
2  Mostly false
3  Mostly true
4  True
H8. I have trouble with most school subjects
31
1
2
3
4
 False
 Mostly false
 Mostly true
 True
H9. I am good at most school subjects
1  False
2  Mostly false
3  Mostly true
4  True
H10. Most school subjects are just too hard for me
1  False
2  Mostly false
3  Mostly true
4  True
Eating and Emotions
Think about how you usually feel before you start eating. Check the answer that matches how
often the following statements apply to you:
P1. I feel like eating when I am irritated.
1
2
3
4
5
 Never
 Rarely
 Sometimes
 Often
 Very often
P2. I feel like eating when I have nothing to do.
1
2
3
4
5
 Never
 Rarely
 Sometimes
 Often
 Very often
P3. I feel like eating when I am depressed or discouraged.
1
2
3
4
5
 Never
 Rarely
 Sometimes
 Often
 Very often
P4. I feel like eating when I am feeling lonely.
1
2
3
4
5
 Never
 Rarely
 Sometimes
 Often
 Very often
P5. I feel like eating when somebody lets me down.
32
1
2
3
4
5
 Never
 Rarely
 Sometimes
 Often
 Very often
P6. I feel like eating when I am angry.
1
2
3
4
5
 Never
 Rarely
 Sometimes
 Often
 Very often
P7. I feel like eating when something unpleasant happens.
1
2
3
4
5
 Never
 Rarely
 Sometimes
 Often
 Very often
P8. I feel like eating when I am anxious, worried or tense.
1
2
3
4
5
 Never
 Rarely
 Sometimes
 Often
 Very often
P9. I feel like eating when things are going against me or have gone wrong.
1
2
3
4
5
 Never
 Rarely
 Sometimes
 Often
 Very often
P10. I feel like eating when I am frightened.
1
2
3
4
5
 Never
 Rarely
 Sometimes
 Often
 Very often
P11. I feel like eating when I am disappointed.
1
2
3
4
5
 Never
 Rarely
 Sometimes
 Often
 Very often
P12. I feel like eating when I am emotionally upset.
1  Never
33
2
3
4
5
 Rarely
 Sometimes
 Often
 Very often
P13. I feel like eating when I am bored or restless.
1
2
3
4
5
 Never
 Rarely
 Sometimes
 Often
 Very often
How much have you worried about things in the past month?
K5. My grades
1
 I never worry about this
2
 I worry about this a little bit
3
 I worry about this sometimes
4 I worry about this a lot
K6. Getting into a good school or college
1
 I never worry about this
2
 I worry about this a little bit
3
 I worry about this sometimes
4
 I worry about this a lot
34
APPENDIX B
LETTERS OF APPROVAL
35
September 15, 2014
Ashley Chamberlin
215 Belmont Ave. Apt 8
Long Beach, CA 90803
Donna Spruijt-Metz, PhD, MFA
University of Southern California
635 Downey Way, Suite 305
Los Angeles, CA 90089-3332
Dear Dr. Spruijt-Metz,
My name is Ashley Chamberlin and I am a candidate for the Master of Science in Nutritional
Science degree from California State University, Long Beach (CSULB). I am currently working
on my thesis proposal titled, The Relationship between Emotional Eating and Academic
Measures in Adolescents. I plan to examine the relationship between emotional eating, GPA, and
academic self-esteem in middle school students. I would like to use baseline demographic and
survey data from the Get Moving project for data analysis.
If you agree to allow me to access your participant database for the first wave of the Get Moving
project for this study, please sign the pre-written consent letter that has been written on your
behalf by Monday, October 5, 2014.
I appreciate your consideration regarding my request. If you have further questions, please feel
free to contact me via e-mail at ashleychamberlin@gmail.com or at (951) 834-3638.
Sincerely,
Ashley Chamberlin
September 23, 2014
36
Ashley Chamberlin
215 Belmont Ave. Apt# 8
Long Beach, CA 90803
To Whom It May Concern:
I grant permission for Ashley Chamberlin to conduct the study entitled, The Relationship between
Emotional Eating and Academic Measures in Adolescents using our baseline database from the
first wave of the Get Moving project to examine the relationship between emotional eating, GPA,
and academic self-esteem in adolescents attending middle school. I understand that this study is
in partial fulfillment of the requirement for the Master of Science in Nutritional Science for
Ashley Chamberlin.
I am granting Ashley Chamberlin permission to conduct the appropriate analyses for the study.
These analyses will be conducted during the spring semester in 2015.
Sincerely,
Donna Spruijt-Metz, PhD, MFA
University of Southern California
635 Downey Way, Suite 305
Los Angeles, CA 90089-3332
37
REFERENCES
38
REFERENCES
Adam, T. C., & Epel, E. S. (2007). Stress, eating and the reward system. Physiology & Behavior,
91(4), 449–58. doi:10.1016/j.physbeh.2007.04.011
American Psychological Association. (2007). Stress a major health problem in the US warns
APA. Retrieved November 11, 2014, from http://www.apa.org/print-this/aspx
Arnow, B., Kenardy, J., & Agras, W. S. (1995). The emotional eating scale: The development of
a measure to assess coping with negative affect by eating. The International Journal of
Eating Disorders, 18(1), 79–90. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/
7670446
Ashcroft, J., Semmler, C., Carnell, S., van Jaarsveld, C. H. M., & Wardle, J. (2008). Continuity
and stability of eating behaviour traits in children. European Journal of Clinical Nutrition,
62(8), 985–90. doi:10.1038/sj.ejcn.1602855
Belcher, B. R., Nguyen-Rodriguez, S. T., McClain, A. D., Hsu, Y.-W., Unger, J. B., & SpruijtMetz, D. (2011). The influence of worries on emotional eating, weight concerns, and body
mass index in Latina female youth. The Journal of Adolescent Health : Official Publication
of the Society for Adolescent Medicine, 48(5), 487–92. doi:10.1016/j.jadohealth.2010.
08.008
Bennett, J., Greene, G., & Schwartz-Barcott, D. (2013). Perceptions of emotional eating
behavior. A qualitative study of college students. Appetite, 60(1), 187–92.
doi:10.1016/j.appet.2012.09.023
Borkovec T.D., Robinson E., Pruzinsky T., & Depree, J. (1983). Preliminary exploration of
worry: Some characteristics and processes. Behaviour Research and Therapy, 21, 9–16.
Braet, C., Claus, L., Goossens, L., Moens, E., Van Vlierberghe, L., & Soetens, B. (2008).
Differences in eating style between overweight and normal-weight youngsters. Journal of
Health Psychology, 13(6), 733–43. doi:10.1177/1359105308093850
Braet C. & van Stier, T. (1997). Assessment of emotional, externally induced and restrained
eating behaviour in non to twelve-year-old obese and non-obese children. Behavior
Research and Therapy, 35, 863– 873.
39
Brown, J. E., Issacs, J. S., Krinke, U.B., Lechtenberg, E., Murtaugh, M., Sharbaugh, C., & Splett,
P. (2011). Nutrition through the life cycle. Belmont, CA: CENGAGE Learning.
Brown, S.L., Teufel, J.A., Birch, D.A., & Kancherla, V. (2006). Gender, age and behavior
differences in early adolescent worry. Journal of School Health, 76(8), 430–437.
Cartwright, M., Wardle, J., Steggles, N., Simon, A. E., Croker, H., & Jarvis, M. J. (2003). Stress
and dietary practices in adolescents. Health Psychology, 22(4), 362–369. doi:10.1037/02786133.22.4.362
Cattanach, L., Phil, M., & Malley, R. (1988). Psychologic and physiologic reactivity to stressors
in eating disordered individuals. Appetite, 599, 591–599.
De Vriendt, T., Moreno, L. A., & De Henauw, S. (2009). Chronic stress and obesity in
adolescents: Scientific evidence and methodological issues for epidemiology research.
Nutrition, Metabolism and Cardiovascular Diseases, 19, 511–519.
Epel, E., Lapidus, R., McEwen, B., & Brownell, K. (2001). Stress may add bite to appetite in
women: a laboratory study of stress-induced cortisol and eating behavior.
Psychoneuroendocrinology, 26(1), 37–49. doi:10.1016/S0306-4530(00)00035-4
Fogle, G. E., & Pettijohn, T. F. (2013). Stress and health habits in college students. Open Journal
of Medical Psychology, 61–68.
Frank, J. L., Bose, B., & Schrobenhauser-Clonan, A. (2014). Effectiveness of a school-based
yoga program on adolescent mental health, stress coping strategies, and attitudes toward
violence: Findings from a high-risk sample. Journal of Applied School Psychology, 30(1),
29–49. doi:10.1080/15377903.2013.863259
Grade point average. (2015). In Merriam-Webster online dictionary. Retrieved from
http://www.merriam-webster.com/info/copyright.htm
Greeno, C. G., & Wing, R. R. (1994). Stress-induced eating. Physiological Bulliten, 115(3), 444–
464.
Gundersen, C.,Mahatmya, D., Garasky, S., & Lohman, B. (2010). Linking psychosocial stressors
and childhood obesity. Obesity Reviews, 12, 54–63.
Heatherton, T. F., & Baumeister, R. F. (1991). Binge eating as escape from self-awareness.
Psychological Bulletin, 110(1), 86–108. doi:10.1037//0033-2909.110.1.86
Hou, F., Xu, S., Zhao, Y., Lu, Q., Zhang, S., Zu, P., … Tao, F. (2013). Effects of emotional
symptoms and life stress on eating behaviors among adolescents. Appetite, 68, 63–8.
doi:10.1016/j.appet.2013.04.010
40
Jenkins, S. K., Rew, L., & Sternglanz, R. W. (2005). Eating behaviors among school-age
children associated with perceptions of stress. Issues in Comprehensive Pediatric Nursing,
28(3), 175–91. doi:10.1080/01460860500227580
Kim, Y., Yang, H. Y., Kim, A.-J., & Lim, Y. (2013). Academic stress levels were positively
associated with sweet food consumption among Korean high-school students. Nutrition,
29(1), 213–8. doi:10.1016/j.nut.2012.08.005
Kraag, G., Zeegers, M. P., Kok, G., Hosman, C., & Abu-Saad, H. H. (2006). School programs
targeting stress management in children and adolescents: A meta-analysis. Journal of
School Psychology, 44(6), 449–472. doi:10.1016/j.jsp.2006.07.001
Laugesen, N., Dugas, M. J., & Bukowski, W. M. (2003). Understanding adolescent worry: The
application of a cognitive model. Journal of Abnormal Child Psychology, 31(1), 55–64.
Marsh, H. W. (1990). The structure of academic self-concept: The Marsh/Shavelson model.
Journal of Educational Psychology, 82(4), 623–636. doi:10.1037//0022-0663.82.4.623
Marsh, H. W., Parker, J. W., & Smith, I. D. (1983). Preadolescent self-concept: Its relation to
self-concept as inferred by teachers and to academic ability. British Journal of Educational
Psychology, 53(1), 60–78. doi:10.1111/j.2044-8279.1983.tb02536.x
Martyn-Nemeth, P., Penckofer, S., Gulanick, M., Velsor-Friedrich, B., & Bryant, F. B. (2009).
The relationships among self-esteem, stress, coping, eating behavior, and depressive mood
in adolescents. Research in Nursing & Health, 32(1), 96–109. doi:10.1002/nur.20304
Michaud, C., Kahn, J., Musse, N., Burlet, C., Nicolas, J., & Mejean, L. (1990). Relationships
between a critical life event and eating behaviour in high-school students. Stress Medicine
Journal, 6, 57–64.
Nguyen-Rodriguez, S. T., Unger, J. B., & Spruijt-Metz, D. (2009). Psychological determinants
of emotional eating in adolescence. Eating Disorders, 17(3), 211–24. doi:10.1080/1064
0260902848543
Ozier, A. D., Kendrick, O. W., Leeper, J. D., Knol, L. L., Perko, M., & Burnham, J. (2008).
Overweight and obesity are associated with emotion- and stress-related eating as measured
by the eating and appraisal due to emotions and stress questionnaire. Journal of the
American Dietetic Association, 108(1), 49–56. doi:10.1016/j.jada.2007.10.011
Pollard, T. M., Steptoe, A., Canaan, L., Davies, G. J., & Wardle, J. (1995). Effects of academic
examination stress on eating behavior and blood lipid levels. International Journal of
Behavioral Medicine, 2(4), 299–320. doi:10.1207/s15327558ijbm0204_2
Roemmich, J. N., Wright, S. M., & Epstein, L. H. (2002). Dietary restraint and stress-induced
snacking in youth. Obesity Research, 10(11), 1120–6. doi:10.1038/oby.2002.152
41
Rutters, F., Nieuwenhuizen, A. G., Lemmens, S. G. T., Born, J. M., & Westerterp-Plantenga, M.
S. (2009). Acute stress-related changes in eating in the absence of hunger. Obesity, 17(1),
72–7. doi:10.1038/oby.2008.493
Skaalvik, E. M. (1990). Gender differences in general academic self-esteem and in success
expectations on defined academic problems. Journal of Educational Psychology, 82(3),
593–598. doi:10.1037//0022-0663.82.3.593
Spoor, S. T. P., Bekker, M. H. J., Van Strien, T., & van Heck, G. L. (2007). Relations between
negative affect, coping, and emotional eating. Appetite, 48(3), 368–76.
doi:10.1016/j.appet.2006.10.005
Spruijt-Metz, D., & Spruijt, R. J. (1997). Worries and health in adolescence : A latent variable
approach. Journal of Youth and Adolescence, 26(4), 485–501.
Tanofsky-Kraff, M., Wilfley, D. E., & Spurrell, E. (2000). Impact of interpersonal and egorelated stress on restrained eaters. The International Journal of Eating Disorders, 27(4),
411–8. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/10744847
Van Strien, T. (2005). Nederlandse vragenlijst voor eetgedrag handleiding en verantwoording
[Dutch eating behaviour questionnaire, manual]. Amsterdam: Boomtestpublishers.
Van Strien, T., Frijters, J., Bergers, G., & Defares, P. (1986). The Dutch eating behavior
questionnaire ( DEBQ ) for assessment of restrained , emotional , and external eating
behavior. International Journal of Eating Disorders, 5(2), 295–315.
Van Strien, T., van der Zwaluw, C. S., & Engels, R. C. M. E. (2010). Emotional eating in
adolescents: A gene (SLC6A4/5-HTT) - depressive feelings interaction analysis. Journal of
Psychiatric Research, 44(15), 1035–42. doi:10.1016/j.jpsychires.2010.03.012
Wahab, S., Rahman, F. N. A., Wan Hasan, W. M. H., Zamani, I. Z., Arbaiei, N. C., Khor, S. L.,
& Nawi, A. M. (2013). Stressors in secondary boarding school students: Association with
stress, anxiety and depressive symptoms. Asia-Pacific Psychiatry : Official Journal of the
Pacific Rim College of Psychiatrists, 5 (Suppl 1), 82–9. doi:10.1111/appy.12067
Wall, R. B. (2005). Tai Chi and mindfulness-based stress reduction in a Boston Public Middle
School. Journal of Pediatric Health Care, 19(4), 230–7. doi:10.1016/j.pedhc.2005.02.006
Wichianson, J. R., Bughi, S. A., Unger, J. B., Spruijt-Metz, D., & Nguyen-Rodriguez, S. T.
(2009). Perceived stress, coping and night-eating in college students. Stress and Health,
25(3), 235–240. doi:10.1002/smi.1242
Wilson, S. M., & Sato, A. F. (2014). Stress and paediatric obesity: What we know and where to
go. Stress and Health : Journal of the International Society for the Investigation of Stress,
30(2), 91–102. doi:10.1002/smi.2501
42