Obesity is a challenging and increasingly prevalent medical concern worldwide. The relationship between obesity and numerous other medical conditions including diabetes, cardiovascular concerns, and certain types of cancer is well established. The etiology of obesity is multifaceted; medical, biological, psychological, social, and cultural influences differentially contribute to its development and persistence. As such, it is important to approach obesity and weight loss with the aim of optimizing metabolic health through individualized treatment plans addressing its multiple contributing factors. In contrast, when patients interact with health care systems for support related to obesity or weight management, treatment recommendations generally consist of behavior changes related to diet and exercise. Yet certain behaviors or psychological experiences may undermine patients’ attempts at incorporating such changes, and it is imperative to better understand these factors to improve outcomes for individuals with obesity.

One highly prevalent behavior that is implicated as a barrier to incorporating behavior-based interventions is the increased consumption of palatable foods (i.e. foods high in fat, sugar, or caloric content) in response to painful emotional experiences or stress, commonly referred to as emotional eating. Emotional eating is a commonly reported eating behavior in the general population. An analysis of the 2011 Family Health Habits Survey data found that roughly 20.5 percent of the nearly 9,000 adult participants reported “often” or “very often” feeling the desire to eat in response to feeling emotionally distressed. The frequency of emotional eating is found to be greater in adults with obesity. Additionally, more frequent emotional eating is predictive of increased fluctuations in weight and greater difficulty losing weight. In one study, non-emotional eaters were two times more likely to sustain targeted 10 percent weight loss than their counterparts who eat in response to emotions or stress.

Individuals who report emotional eating tend to do so especially in response to depression, anxiety, and both chronic and acute stress. For individuals with obesity, negative self-evaluation and experience of external and internalized stigma related to one’s weight and shape significantly contribute to such distress, which, in turn, increases vulnerability to emotional eating. Crucially, weight-related stigma within health care settings remains an especially impactful stressor for those who experience obesity. Such stigma has been found to negatively impact patients’ expectations of receiving comprehensive or effective care, which leads to decreased health care utilization and subsequently contributes to poorer health outcomes for these patients. Experience of health care stigma is further linked to reported increased emotional eating, particularly for patients with obesity who already endorse low self-evaluation.

Given its effect on the experience of obesity, it is important to consider potential psychological mechanisms that underlie emotional eating to better tailor interventions for these individuals. For instance, self-reported experience of emotional eating is positively associated with a decreased ability to identify internal sensations such as hunger or satiety cues. It is also linked to alexithymia, the impaired ability to label emotion and mood states. Following stressful life events, difficulties with describing how one feels can exacerbate distress and lead to subsequent increased food intake for comfort. Similarly, difficulties with regulating strong emotions can lead to increased emotional eating. For example, those who are more avoidant of stress, work to suppress emotional experiences, or ruminate about negative experiences report greater emotional eating, which functions as a maladaptive emotion regulation strategy.

In order to optimize health outcomes for those with obesity, it is important to bolster psychological processes that protect against increased emotional eating. Psychological interventions that promote adaptive emotion regulation, increased interoceptive awareness, and greater ability to identify current mood states should therefore be prioritized. Mindfulness-based interventions (MBIs) have been increasingly supported by related research, as they are linked with increased awareness of emotional states and improved emotion regulation. Mindfulness as a practice emphasizes intentional focus on the present moment without judgment of the thoughts, emotions, urges, or sensations that arise. While it may appear to be a relatively simple practice in theory, mindfulness can at times feel quite challenging as it asks participants to allow, notice, and sit with internal experiences without working to change, shift, or reject what surfaces. This is an especially important skill for individuals who experience difficulty regulating or accepting painful internal experiences, as experiential avoidance can lead to increased vulnerability for maladaptive emotion regulation strategies such as emotional eating.

MBIs may be especially effective when combined with other psychological interventions that provide more explicit guidance and psychoeducation around the role of awareness and adaptive responding, such as Acceptance and Commitment Therapy (ACT, pronounced like the word, “act”). ACT is a transdiagnostic intervention that focuses on acceptance of the full range of internal experiences (e.g. thoughts, feelings, urges), while also committing to action as guided by one’s own values. The theoretical framework of ACT would conceptualize emotional eating as a form of emotional avoidance – specifically, the individual is unwilling to experience the discomfort of whatever painful internal experience has arisen (e.g. emotion, memory, thought, urge), and works to avoid having to do so, in this case via the use of emotional eating. ACT is shown to increase awareness of action urges (e.g. eating) in response to unwanted emotion or stress, improve the ability to name present internal experience or emotion (i.e. improved alexithymia), and facilitate subsequent engagement in alternative, values-oriented action (i.e. adaptive regulation).

Emotional eating and primary care

Given their longitudinal relationships with patients, primary care providers (PCPs) are well positioned to address emotional eating. If a patient presents with concerns around achieving or sustaining weight loss, it may be helpful to screen for increases in difficult emotional experiences or stress. PCPs may wish to incorporate commonly used brief screening instruments such as the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder 7 (GAD-7), or the Screen for Disordered Eating (SDE) to assess for current mental health symptoms associated with increased vulnerability for, or the presence of, emotional eating. For example, question #5 on the PHQ-9 – a screening questionnaire routinely used to assess for the presence of depressive symptoms – asks whether the patient has experienced poor appetite or over-eating over the past two weeks. If the patient endorses appetite changes, the PCP may then probe further regarding the nature of the change.

PCPs may also implement brief interventions that increase awareness of stress and mood states and their link to eating habits. Assessing the patient’s level of insight into this relationship and offering brief psychoeducation to address knowledge gaps and increase awareness of its impact can be an important initial intervention. PCPs may then follow up by asking patients to keep a food and mood diary, which helps to identify patterns of emotions or stress and eating behavior over time. Providers may use this data to help patients plan adaptive coping strategies in the eventuality that triggering events or internal experiences occur. Finally, maintaining a directory of available technologies such as smartphone applications that offer self-guided emotion regulation and mindfulness interventions in support of adaptive coping allows patients to increase insight and develop adaptive coping strategies between appointments. Ongoing advancements in artificial intelligence technologies may soon be available to assist patients and providers in these endeavors as well.

The complex interplay of biopsychosocial factors that contribute to the development and maintenance of obesity underscores the necessity for multifaceted and individualized approaches to treatment. Addressing psychological barriers such as emotional eating requires a more nuanced understanding of the underlying mechanisms that drive these behaviors and impede progress toward patient goals. By implementing psychological interventions that promote awareness of uncomfortable internal experiences, increase emotional vocabulary, and identify values-oriented, adaptive emotion regulation strategies, providers may work with their patients to move toward patient goals with an eye on sustainable progress.

Additional resources for clinicians and patients

Screen for Disordered Eating (SDE)  — This screening form can be used in the primary care setting. 

Smartphone applications

Below are applications available for download that purport to have the ability to track mood and/or food intake. The authors of this article are not affiliated with these companies or their applications, and have not evaluated their content or offerings. Purchase and/or use of the applications is at the discretion of the individual users. The information provided is for general purposes only and should not be considered as medical advice. The subsequent quotes are pulled directly from the applications’ websites.

Mood/Food journaling

• • Ate — “Photo journal lets you track food in 3 taps. AI insights and mindful questions will guide you from there.”
  • Recovery Record  — “Recovery Record is a smart eating disorder recovery app that fits into your life and links with your treatment team to help you achieve lasting recovery. The app, which has been evaluated in clinical trials, is now available for you to use in connection with your treatment team.”
  • Daylio Journal  — “You can create a daily entry in two taps – pick mood and activities. We crunch data and display them in stats, charts, and correlations.”

Mindfulness

• • Waking Up  — “Go beyond simple relaxation techniques and experience the freedom of real mindfulness—without any New Age fluff.”
  • Oxford Mindfulness App  — “The new Oxford Mindfulness app has been designed for you to develop and maintain your mindfulness practice for your mental health and well-being. It offers a library of mindfulness meditations, live sessions, self-paced courses, resources and materials.”

Additionally, a curated list of behavioral health support applications is available through the Cambridge Health Alliance.

This article was published as part of a series for Obesity for World Obesity Day, March 4, 2025. View the full Special Series for more articles and messages from the editors regarding language and content.

Special Series

About the authors

Jana DeSimone Wozniak, PhD, is an Instructor of Psychiatry at Harvard Medical School. She is a clinical psychologist in the General Mental Health clinic at the VA Boston Healthcare System in Jamaica Plain, Boston, Massachusetts.

Hsiang Huang, MD, MPH is an Assistant Professor of Psychiatry at Harvard Medical School. He is the Director of the Consultation-Liaison Psychiatry Fellowship and the Primary Care Behavioral Health Integration Program at the Cambridge Health Alliance in Massachusetts. He is the founder of Safineia Psychiatry, PLLC.

**Feature photo obtained with a standard license on Shutterstock. 

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