Understanding and effectively addressing disparities in obesity: A systematic review of the psychological determinants of emotional eating behaviours among Black women

Abstract

Emotional eating may be a particularly important contributor to differences in body weight and weight loss response to behavioural interventions among non-Hispanic Black women. We performed a systematic review on the impact of psychological factors (stress, anxiety, depression, and discrimination) upon emotional eating and weight among non-Hispanic Black women, applying the Preferred Reporting Items for Systematic Reviews and Meta-analysis for relevant studies. The initial search yielded 4593 articles with 15 accepted for review. Based on this review, there is a suggestion that negative emotions, in particular, perceived stress, may be predictive of emotional eating among non-Hispanic Black women. Results from the only two longitudinal studies identified by the review indicate that stress influences emotional eating, and emotional eating predicts weight gain over time. Findings from this review highlight the need for more studies that examine various negative emotions that may lead to emotional eating and weight gain among non-Hispanic Black women. Findings from this review also highlight the need for more rigorous studies to differentiate the effects of emotional eating from that of the physiologic (ie, activation of the hypothalamic-pituitary axis) responses to stress and its impact on highrisk groups. K E Y W O R D S emotional eating behaviours, depression, stress 1 | INTRODUCTION More than 80% of non-Hispanic Black women are overweight (body mass index [BMI] of >25-29 kg/m 2 ) and/or obese (BMI of >30 kg/m 2 ) compared with 61% of White women. 1 Excess weight is a risk factor for cardiovascular disease (CVD), dyslipidemia, type II diabetes, sleep apnoea, osteoarthritis, and multiple cancers (ie, endometrial, breast, colon, kidney, gallbladder, and liver). 1-3 Adults with obesity have a 20% or higher risk of dying of all-cause mortality or CVD compared with adults of normal weight. 4 These health consequences are disproportionately linked to disparities in obesity prevalence among non-Hispanic Black women. 1,5 Causes of overweight and obesity among non-Hispanic Black women are multifactorial. Empirical evidence indicates that non-Hispanic Black women experience high levels of socioeconomic deprivation in childhood, obesogenic built environments, 6perceived racial discrimination, 7,8 and chronic psychosocial stress, [9][10][11][12][13][14][15][16][17] which are all associated with weight gain and obesity.Weight loss response to behavioural treatment among non-Hispanic Black women significantly differs from that of other groups.Results from the Diabetes Prevention Study at 12 months demonstrated similar weight loss results of 7.1% to 8.4% among White and Hispanic men and women and non-Hispanic Black men but

Responding to Health Disparities in Behavioral Weight Loss Interventions and COVID-19 in Black Adults: Recommendations for Health Equity

“…Black men and women who report experiencing racial discrimination have higher BMI [33,[36][37][38], and discrimination predicts the incidence of obesity and weight gain in Black women [32]. Experiencing discrimination can also have implications for obesity-related behaviors [34,35,[39][40][41]. Studies show that discrimination is associated with obesogenic dietary behaviors among Black women and men [34,35,39,42], and worry about discrimination or racial vigilance has been cited as a barrier to physical activity among Black men [41].…”

Food Addiction and Psychosocial Adversity: Biological Embedding, Contextual Factors, and Public Health Implications

“…It has been recognized that the processes which mediate the relationship between ELA and adult obesity might differ between men and women [110][111][112]. For example, a recent systematic review found that perceived stress from structural racism and weight stigma among black women creates negative emotions which predict emotional eating [113]. These stressors may then increase metabolic disturbance.…”

Perceived racial discrimination and eating habits: Systematic review and conceptual models

“…Food consumption represents food and nutrients intake per se and eating behavior involves the psychological and cultural aspects of eating and its practices 12 . Several studies have demonstrated an association between racial discrimination experiences throughout life and poor eating habits in the last decade 4,[13][14][15] . In 2020, a systematic review of the impact of psychological factors (stress, anxiety, depression, and discrimination) on emotional eating and weight among American Black women suggested that negatively perceived stress may be predictive of emotional eating 15 .…”

“…Several studies have demonstrated an association between racial discrimination experiences throughout life and poor eating habits in the last decade 4,[13][14][15] . In 2020, a systematic review of the impact of psychological factors (stress, anxiety, depression, and discrimination) on emotional eating and weight among American Black women suggested that negatively perceived stress may be predictive of emotional eating 15 . As a recent manuscript published in the American Journal of Clinical Nutritional recommended, researchers should consider more seriously the impact of race and the effects of racism and racial discrimination in nutritional outcomes.…”