|Year : 2021 | Volume
| Issue : 2 | Page : 132-138
Perceived stress and emotional overeating during COVID-19 pandemic
Shrusty Mohapatra1, Mamta Mohapatra2, Sujita Kumar Kar3, Bheemsain Tekkalaki1
1 Department of Psychiatry, KAHER's Jawaharlal Nehru Medical College, Belagavi, Karnataka, India
2 Professor and Dean, International Management Institute, New Delhi, India
3 Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, India
|Date of Submission||12-Feb-2021|
|Date of Decision||16-Mar-2021|
|Date of Acceptance||22-Apr-2021|
|Date of Web Publication||28-Oct-2021|
Dr. Bheemsain Tekkalaki
Department of Psychiatry, KAHER's Jawaharlal Nehru Medical College, Belagavi - 590 010, Karnataka
Source of Support: None, Conflict of Interest: None
Background: Obesity due to inappropriate eating habits, including overeating, has recently been discussed during this COVID pandemic crisis in the context of stress. Emotional overeating (EOE) is sometimes considered as a strategy for emotion regulation. Considering this fact, this study used a snowball technique to analyze the prevalence of EOE caused due to stress during this pandemic situation. Methodology: The present cross-sectional online study of 607 respondents across all regions of India attempts to assess the perceived stress levels during COVID-19, evaluate their tendency to engage in emotional eating, and examine the relationship between perceived stress and emotional eating during COVID-19 situation. Results: Stress perception is significantly associated with EOE and such phenomenon is marginally more prominent in females more than males. A negative association of age, though weak (r = −0.34, p< 0.05), has been found with both perceived stress levels and EOE, signifying that the youngsters are more prone to stress and overeating than older persons, during these COVID times. The study also evidenced that people with psychiatric conditions are significantly more affected than others. Similarly, the average EOE scores for such persons were also higher, and they may be more vulnerable to emotional eating. Conclusion: EOE is significantly associated with perceived stress; the association is more prominent in females. Younger people and people with mental illness display significantly more emotional eating behavior during stress.
Keywords: COVID-19, emotional overeating, mental health, perceived stress
|How to cite this article:|
Mohapatra S, Mohapatra M, Kar SK, Tekkalaki B. Perceived stress and emotional overeating during COVID-19 pandemic. Ann Indian Psychiatry 2021;5:132-8
|How to cite this URL:|
Mohapatra S, Mohapatra M, Kar SK, Tekkalaki B. Perceived stress and emotional overeating during COVID-19 pandemic. Ann Indian Psychiatry [serial online] 2021 [cited 2021 Dec 6];5:132-8. Available from: https://www.anip.co.in/text.asp?2021/5/2/132/329429
| Introduction|| |
The COVID-19 crisis emerged into one of the most difficult global socioeconomic situations of our times and has been quite disruptive. It is but natural to be stressed in such an unforeseen and difficult situation. Staying healthy both physically and mentally is of utmost importance during these uncertain times as it plays a very crucial role in handling the ongoing crisis and ensuring smooth living. A study by Wegner et al. found that during binge eating days, participants reported having significantly worse mood than on nonbinge days.
During any outbreak of an infectious disease, the population's psychological reactions play a critical role in shaping both the spread of the disease and the occurrence of emotional distress and social disorder during and after the outbreak. Studies show that COVID crisis has had psychological impact with associated conditions of depression, posttraumatic stress disorder, and even suicide.,, The COVID-like pandemic also affects a person in terms of confusion, anger, fear, boredom, stigma, and stress over the loss of life-sustaining resources according to some researches., Globally, at present, there are increased worries and apprehensions among the public regarding acquiring the COVID-19 infection, and therefore, people have higher perceived needs to deal with their mental health difficulties.
Psychological health becomes more important during these difficult days, due to the challenges like isolation, restricted social activities, fear of contracting illness etc. These challenges culminate into stress, anxiety, and depression. Novelle and Diéguez in their study have suggested that while the drug addiction process has been highly researched, eating addiction is a nascent field suggesting a need for such studies.
In the current scenario, where talks of preserving our health prevail every dinner table conversation, it has become inevitable to include concepts of good mental and physical health to help us fight the coronavirus pandemic. For containment of the outbreak, strategies adopted are isolation and physical distancing which disrupt personal and professional lives severely. To add to the misery, we are fed with a lot of misinformation via media and social media, fuelling stress, and mass hysteria. In addition, the “fear of transmission” begets stigma, marginalization and xenophobia, as well as the “fear of fellow humans.” Besides, adapting to lifestyle changes such as working from home, temporary unemployment, home-schooling of children, and lack of physical contact with other family members, friends, and colleagues and managing the fear of contracting the virus and worry about people close to us who are particularly vulnerable, are challenging for all of us says a WHO report (2020).
So the important questions to be considered in this situation are what stress is and how to manage it? The body's physical, mental, and emotional response to changes around and not being able to cope with the specific demands and events is termed as stress. Pressure and stress for a short period is sometimes healthy as it can improve productivity. It is usual to get short-term pressures and stress which can even catapult us to action or to change in a positive manner. However, chronic stress adversely affects a human being physically and may cause deterioration in their quality of life.
Different human beings respond differently to certain situations, which is subjective in nature. If a situation causes stress to some, it can affect their physical and mental health by producing chemicals and hormones with increased heart rate, faster brain, and energy burst. Severe acute stress can lead to mental health issues/disorders.
Studies have reported that psychological stress is often associated with greater food consumption, particularly consumption of high-fat foods. While it is obvious that emotional eating behavior is likely to be related positively to stress, yet, the process of this phenomenon has been a subject of little research. A study which induced negative emotions and regulated food intake suggests that the regulation strategies people use to deal with these emotions are responsible for increased eating. In the studies conducted by Epel et al., it is evidenced that on a stress day, cortisol reactivity predicted eating more and that such reactivity was related to greater intake of sweet food. Another research suggests that stress may play a critical role in obesity, specifically for persons with an increased glucocorticoid exposure or sensitivity.
Weight gain during self-quarantine can be associated with inadequate sleep, snacking after dinner, lack of dietary restraint, eating in response to stress, and reduced physical activity, as stated by Zachary et al. Loss of control in eating and overeating is evidenced to support the convergent and predictive validity of this relationship, through a number of anthropometric, psychosocial, and eating behavior-related factors.
Just as calorie intake restriction could help mitigate the deleterious impacts of a bout of physical inactivity, overeating under conditions of home confinement is very likely to exacerbate these consequences. Therefore, there is a need for a study which analyzes the direct association between overeating and stress during such tumultuous times.
The present study was primarily conducted to assess perceived stress levels in the Indian population related to COVID-19, evaluate their tendency to engage in emotional eating, and examine the relationship between perceived stress and emotional eating during COVID-19 situation. The theoretical constructs and analysis of results are depicted in the framework [Figure 1].
| Methodology|| |
This cross-sectional descriptive study was undertaken in India using snowball sampling technique. Ethical clearance was obtained from the institutional ethics committee. Two standardized questionnaires were used to collect data. Google Forms was used for developing the online questionnaire, and the same was shared through E-mail, WhatsApp, and LinkedIn with the respondents to elicit responses. Respondents were also requested to further circulate to their family members and friends, to give a diverse base to the set of responses.
Only participants with access to the Internet could participate in the study. Participants with age more than 18 years, able to understand English, and willing to give informed consent were included. Filling up the study questionnaire was voluntary and was in simple English for easy understanding by all the respondents. Informed consent was obtained before the participant proceeded to respond to survey questions. The participants were encouraged to roll out the survey to as many people as possible. The link was forwarded to people apart from the first point of contact. The data were collected during a period of 7 days, during 6.00 p.m. June 13, 2020–6.00 p.m. June 20, 2020. The number of responses received was 607. We were able to collect data from across various states of India. The sociodemographic variables included age, gender, occupation, education, and area of residence.
The questionnaire had three main parts. The first part elicited information on demographic data, where mention of name was optional. A total of twenty questions were asked, apart from the sociodemographic section. The second part dealt with a set of questions that evaluated the perceived stress levels in a scale of 4 using the Perceived Stress Scale (PSS) by Cohen et al. reporting of the respondents on what they have gone through in the last 1 month on a five-point scale: Never, almost never, sometimes, fairly often, and very often. There were ten multiple-choice questions in this section which measured the degree to which situations in one's life are appraised as stressful. Items were designed to tap how unpredictable, uncontrollable, and overloaded respondents find their lives. The scale also included a number of direct queries about current levels of experienced stress. PSS scores were obtained by reversing responses (e.g. 0 = 4, 1 = 3, 2 = 2, 3 = 1, and 4 = 0) to the four positively stated items (items 4, 5, 7, and 8) and then summing across all scale items.
The third section evaluated the levels of emotional eating tendencies using the Emotional Eating Questionnaire developed and validated by Garaulet et al., which consisted of ten questions to measure the relation between food intake and emotional stress, with responses scaling from “0” = never, value “1” = sometimes, value “2” = generally, and value “3” = always.
Score between 0 and 5: You are a nonemotional eater. Your emotions have little or nothing to do in your eating behavior. You are a person with great stability with respect to your feeding behavior. You eat when you feel hungry, regardless of external factors or emotions.
Score between 6 and 10: You are a low emotional eater. It is rare that you solve your problems with food. However, you feel that certain foods affect your will.
Score between 11 and 20: You are an emotional eater. Your responses indicate that to some extent your emotions influence your diet. Feelings and mood in some moments of your life determine how much and how you eat.
Score between 21 and 30: You are a very emotional eater. If you're not careful, food will control your life. Your feelings and emotions constantly rotate around your food.
The data were entered into Microsoft Excel spreadsheet. Data were described in terms of percentage and average with standard deviation (SD). A comparison of sociodemographic characteristics between male and female participants was done by applying Chi-square test. The association of perceived stress and emotional overeating (EOE) was done by correlational analysis.
Ethical clearance was obtained from the institutional ethics committee, KAHER's J.N Medical College, Belagavi, Karnataka. With Ref no. MDC/DOME/357.
| Results|| |
The online study surveyed a total of 607 sample responses distributed across various regions of India having a marginal majority of males at 51.1%. For the total sample, the mean age is 36.3 (SD = 13.9) years and median of 29 years, with the age of respondents ranging widely from 13 years to 78 years. For males, the mean age is 38.2 (SD = 14.5), and for females, the same being less at 30.2 (SD = 11.6). The educational attainment levels show that majority (79.4%) are either postgraduates (53.2%) or graduates (26.2%). Only 3% of the sample population had studied up to secondary level. One-third of the sample constituted students, followed by government employees (16.8%), educators, homemakers, and also health-care providers. Out of a sample of 607 respondents, 53.3% of the respondents belonged to North India whereas 16.6% were from South India. There were also representations from East India 13.3% and West India 11.9%. Central India and northeast states of India also had representation in the sample [Table 1].
A question was asked about the preexisting health conditions, and it was found that an overwhelming 79.4% of the sample did not have any preexisting medical condition while 20.6% had some preexisting medical problems or the other. It is also reported that around 2.3% had preexisting psychiatric conditions [Table 1].
[Table 2] shows the total distribution of the responses across gender in terms of the extent of perceived stress. It can be observed that most of the participants had expressed existence of stress perception during the COVID times. The relation between food intake and emotional stress is summarized in [Table 3].
The PSS and EOE score intervals were taken, and individual respondents were placed in five score intervals of 0–5, 6–10, 11–20, 21–30, and 31–40. The number of persons falling in various scores shows their varying degrees of stress perception (PSS) or the vulnerability to emotional eating (EOE). It is observed that 511 persons (84%) came in the scoring range of 11 and above indicating that they had perceived stress sometimes or often. There is a significant difference in the PSS levels of males and females (χ2: 40.3867; P < 0.00001).
Mild form of EOE was seen among 36.73% of males and 33.22% of females. Moderate degree of EOE was seen with 30.61% of males and 41.93% of females. Severe EOE is reported among 2.04% of males and 7.42% of females. Moderate-to-severe EOE was reported in 42.22% of the total participants. There is a significant difference in the EOE behavior of males and females (χ2: 25.9511; P < 0.00001).
The average perceived stress score which theoretically ranged between 0 and 40 was observed to be around 19.5 (SD = 6.3) on an average for all the respondents, and separately, the perceived stress score for males was lower at 19.4 (SD = 5.7) and that for females was at 20.4 (SD = 5.4). The measure for EOE due to stress had a range of 0–30. It was observed that the average EOE score was 9.5 (SD = 5.6). In case of this measure, there was a striking difference in the average score of males at 8.7 (SD = 5.1) as compared with females at 11.2 (SD = 5.9), establishing the fact that females are more prone to EOE than males.
Age and perceived stress are likely to be negatively correlated as, with age and experience, one learns how to face challenges and manage stress in life, in general. The study also corroborates these with a negative correlation between age and perceived stress as also between age and EOE. A correlation between age and perceived stress score as well as EOE score was analyzed for all the respondents, gender-wise, and it was found that there exists a negative correlation between age and PSS (r = −0.34) as also similarly a negative correlation was observed between age and EOE at r = −0.31.
In our study, we found that perceived stress and EOE are correlated. The correlation found between perceived stress and EOE stood at r = 0.44. Such correlation was a tad stronger for males (r = 0.46) as compared with female respondents (r = 0.37) [Table 4].
It is observed that though there is a weak correlation in the perceived stress as also EOE parameters across age, a strikingly significant difference is observed between males versus females in all the age groups, in terms of stress perception and EOE, both. Young females in the age group between 13 and 30 years exhibited around 23.5% higher stress perception than their male counterparts with an accompanied 27.94% higher average EOE score than males in the same age group. Similarly, females in the age group of 31–50 years evidenced average PSS and EOE scores higher by 23.3% and 29.75% as compared with males. Even at the older age group of 51 years and above, a similar trend was observed, signifying that basically, females have had substantially higher stress perception accompanied by almost equally higher vulnerability to EOE, as compared with males, during the present COVID pandemic situation.
The responses were analyzed specifically for persons with psychiatric condition and also for persons with some medical conditions such as diabetes and hypertension separately. It was found that the average perceived stress scores for people with psychiatric condition are significantly higher at 22.57 (SD = 6.99) as compared with the overall average PSS of 17.39 (SD = 7.38). Similarly, the average EOE scores for such persons with psychiatric condition were also higher at 15.36 (SD = 4.75) as compared with the overall average EOE score of only 9.49 (SD = 5.57) for the entire population. This shows that people with psychiatric conditions are significantly affected more in terms of stress perception and also are more vulnerable to EOE.
Analysis was undertaken in terms of comparing the average PSS and EOE scores of persons with any medical condition versus the overall population. It is observed that while the stress levels are not so different than overall population, the average EOE scores of persons with medical conditions (such as diabetes and hypertension) are higher at 10.1 (SD = 5.60) as compared with overall average EOE of all persons at 9.49 (SD = 5.57). This shows that those people who are under some medical conditions or other are apparently marginally more vulnerable than the overall population in terms of EOE.
| Discussion|| |
The results of the study reveal that stress perception is significantly associated with EOE and such phenomenon is more prominent in females than males, during this pandemic. There exist multiple positive prospective associations between negative affect (such as stress) and subsequent binge eating, as binge eating or EOE often acts as a coping mechanism for certain individuals.
A negative association of age, though weak, has been found with both perceived stress levels and EOE, signifying that the youngsters are more prone to stress and overeating than older persons, during these COVID times. Studies in the past have also suggested that being in charge of one's emotions comes with higher level of emotional intelligence and emotional maturity which grows with age leading to a belief of being in control of life and a belief in the ability to attain goals by well-directed efforts.
The study also evidenced that people with psychiatric conditions are significantly more affected than others in terms of stress perception and also are more vulnerable to EOE whereas otherwise medically ill persons are only marginally more affected than overall population. This observation, read with the positive correlation between perceived stress and EOE, strongly suggests that during the COVID-19 pandemic, there is a need for taking extra care of persons with psychiatric condition in terms of managing the stress level and containing EOE. However, this observation should be interpreted with the limitation in mind that, the number of individuals with psychiatric conditions being small (n=14), and no formal diagnostic tests were used to diagnose psychiatric illnesses. Another study has found that lifestyle-related risk factors such as smoking, obesity, and inactivity endanger medical conditions leading to an increased mortality and morbidity among patients with mental disorders and such preexisting mental disorders, coupled with added pandemic situation, aggravate the stress levels more in such population with accompanying EOE and other manifestations.
The results thus point out to the fact that there is a general need to contain stress, to avoid EOE and related problems, which is more specifically required in case of persons with mental disorders, females, and also youngsters, during this pandemic. This study hopes to contribute significantly toward putting thrust on the mental health-care area and bring awareness among the public in general to take into account the role of stress management and emotional control in this corona pandemic situation.
The present study has found a positive and significant relationship between perceived stress and EOE. However, the study admittedly has some limitations. Being an online survey, we have adopted convenience sampling, only those who have access to the Internet and are in direct or indirect contact of the researchers. The study also has not alienated the other causative factors that would have gone into the pattern of EOE apart from stress as other reasons for overeating have not been sought from the participants. Besides, unlike an in-person survey, participants did not have the opportunity to ask any query, if any for clarifications. The concentration of sample is biased toward North India as over half of the responses are from that region. Therefore, the generalizability of the study findings is, to the above extent, weak. Being an online survey, the proportion of graduates and postgraduates is whopping high at around 79.4% giving a bias toward educated population.
| Conclusion|| |
EOE is significantly associated with perceived stress; the association is more prominent in females. Younger people and people with mental illness display significantly more emotional eating behavior during stress. This is an important area of further research with wider scope in terms of expanded coverage and wider range of questions that can investigate other parameters that affect stress as also EOE. Besides, the study can also be done to differentiate behavior pattern of rural versus urban population, as also across states of India.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]