This is one of the first studies to describe the prevalence of EE in Chinese college students and found that EE was present in around 10% of the college students. A striking gender difference was found in terms of prevalence of EE (14.8% in female and 4.5% in male students) and its associated psychosocial factors. In male students, EE was only predicted by depression and stress scores, but EE was also predicted by the absence of a romantic relationship among females. Also, all other demographic data did not associate with EE. Furthermore, the current study showed that EE was associated with obesity, mood problem, poor self-rated health and poor life/study satisfaction.
The prevalence of EE in the current study was 10%, which was similar or lower to the prevalence reported in Western countries (2, 3, 25); however, this was substantially higher than the prevalence of EE in secondary school-age students in Hong Kong (17). The underlying reasons could not be concluded from the current study – it could be a genuine change so that EE was increasingly prevalent or that EE was more common in college students than in secondary school-age students. However, this may also be due to the use of different definitions and instruments used to define EE in different studies (17). This could be investigated in longitudinal studies. Yet, in concordance with other studies, EE was more common in female than male and was associated with poorer health, mood, and life satisfaction(26, 27).
Our study was one of the first Chinese study to note that emotional eating behaviors and its relationship with psychosocial factors differ between genders. For instance, having a romantic partner was protective for emotional eating among female students only. Due to the cross-sectional nature of this study, it is unclear whether close interpersonal interactions from a romantic relationship may reduce reliance on emotional eating as a coping mechanism or if those who partake in maladaptive coping behaviors are less likely to form these relationships. Similar to previous studies (47,50), EE was associated with dysphoric mood. However, our study did not show that anxiety was an independent trigger for EE. It may reflect that EE is not a common coping mechanism for anxiety in Chinese adolescents or that the sample size was insufficient to detect an association.
The current research suggested that EE was common among university students, especially affecting female students. Therefore, clinicians may consider screening for EE, especially when seeing young adults with mood problems, and offer appropriate counseling and interventions. However, despite being associated with adverse physical and psychological consequences, there is a lack of guideline-based treatments for EE in Hong Kong and worldwide. As EE was conceptualized as a poor stress-coping strategy, treatments that enhance emotional coping skills may reduce EE (28). For instance, the latest meta-analysis suggested that mindfulness-based interventions could reduce EE and body weight; however, the current evidence was limited by unclear/high risk of bias and there was a lack of similar studies in the Chinese population (29). Further research could be conducted to delineate the prevalence of EE in other populations. Moreover, longitudinal studies will clarify the relationship between mood problems and EE; and similarly, high-quality randomized controlled trials will be needed to examine treatment modalities in the Chinese population.
The strength of the current study included adequate sample size and the use of the widely validated questionnaire (DEBQ) so that our results could be compared to international studies. It also examined multiple psychosocial factors and, to our knowledge, the relationship between EE and self-reported health was not previously examined. The questionnaire was completely anonymous so that sensitive answers (i.e. emotional eating behaviors) were least affected by social desirability.
Yet, several limitations could be discussed. First, as a common limitation to all cross-sectional studies, the causality between EE and other factors could not be concluded. For example, EE could have a bi-directional relationship with the self-reported level of health - people with EE may overeat or eat unhealthy food and led to poor health; yet, poor health could be a stressor that facilitated EE. The students from these two universities are more academic achieving and may be more likely to experience stress because of high expectations as compared to other tertiary institutes in Hong Kong. However, the age distribution and socio-economic backgrounds of students from the sample are not expected to be appreciably different from other universities in the region. Second, although our sample size was adequate for the primary outcome, only a few male participants had EE (n = 9) and this might limit the power to detect the association between EE and psychosocial factors, especially among male students. Moreover, many outcomes, including BMI, were self-reported and were prone to reporting bias. Similarly, as the underlying causes of emotional eating could be multifactorial, there are likely other confounding variables that were not covered in this study such as aspects of social support.