Overeating And Alcohol Use As Different Coping Strategies Against Negative Emotions In Female University Students

High school and university students can be exposed to social, financial, or environmental difficulties during their academic course¹. To cope with these issues, some of them might invest time and resources in sport, art, or social activities², which are recognized to provide beneficial effects in terms of physical and mental health. But many of them also engage in maladaptive coping behaviors³. Amongst these detrimental habits, substance abuse is relatively frequent in students. While men are more at risk for alcohol misuse⁴, several studies showed that women are more vulnerable to disordered eating⁵ and are more prone to “emotional overeating,” that is, consuming food as a source of psychological comfort⁶.

Regular overeating or a problematic relationship with food in normal-weight young people could further lead to weight gain⁷, obesity, and eating disorders⁸ such as binge eating or food addictions. Characterizing emotional overeating in normal-weight students, especially young women, and understanding its relationship with other individual behavioral features such as alcohol misuse or distress management might improve risk diagnostic and preventive interventions.

In an article published in Appetite, researchers from the NuMeCan Institute (INRA, INSERM, Univ Rennes, CHU Rennes, EHESP) investigated, using dedicated questionnaires, the relationship between emotional overeating, physical activity, disordered eating symptoms, loss of control over food intake, and alcohol use in 335 French female university students aged 18-24 years with a healthy body mass index (comprised between 18.5 and 24.9). In this community sample, 68.0% were classified as moderately active, 32.5% had excessive alcohol consumption, and 15.8% were subjected to disordered eating symptoms. Cognitive restraint (i.e. conscious restriction of food intake in order to control body weight or lose weight), uncontrolled eating (i.e. tendency to eat more than usual accompanied by subjective feelings of hunger), and emotional eating (i.e. inability to resist emotional cues) were identified in 31.0%, 37.8%, and 46.5% of normal-weight female students, respectively. Emotional eating consequently represented the preponderant cognitive component in this community sample. A factor analysis on emotional overeating led to the definition of distress-induced overeating, defining overeating in response to anxiety, loneliness, sadness, anger, and fatigue, while a sixth factor, happiness, was analyzed apart. Distress-induced overeating was positively associated with the inability to resist emotional cues, eating disorder symptoms, and loss of control over food intake. It was also negatively associated with moderate and excessive drinking.

Even though the proportion of respondents reporting emotional overeating in response to anxiety, loneliness, and sadness was relatively high (45-51%), it is important to highlight that this behavior occurred only during relatively short periods of time (1- to 5-day over the past 28 days). This intermittent coping response to negative emotions consequently appeared under control for a large majority of subjects, but it was aggravated in the minority of students with disordered eating symptoms, and correlated with loss of control over food intake. This advocates the need for a systematic screening in normal-weight young students for better management of emerging eating disorders and further weight problems, as previously supported by other studies^9,10, and especially in individuals experimenting difficulties to deal with negative emotions.

An unexpected result of this work was the negative correlation between distress-induced overeating and alcohol use, meaning that female students engaging in distress-induced overeating were less prone to alcohol misuse, and conversely. The authors suggested that some students experiencing negative emotions might consider alcohol drinking as an alternative coping strategy in replacement of distress-induced overeating, as previously described in the context of anxiety for example¹¹. Interestingly, the replacement of overeating by alcohol was more important with moderate drinking than with excessive drinking. This might be explained by the individual motives and expectations towards alcohol. Moderate drinking is associated with social drinking and is often confounded with pleasurable interactions with peers, which usually increase well-being, while excessive drinking is more related to issues avoidance, impulsivity, social and academic difficulties^11,12. Be that as it may, intermittent distress-induced overeating and moderate drinking appear to be considered by female normal-weight students as relatively exclusive ways of coping with negative emotions. The “lesser of two evils” is not easily identifiable, nor the reason for which some individuals might move from these non-pathological coping strategies to more deleterious habits characterized by eating disorder symptoms or excessive drinking.

Further research is needed to disentangle the complex relationship between emotion management and food or substance abuse, with the aim to understand why some individuals engage in maladaptive coping strategies and why some others manage to keep under control intermittent overeating or alcohol use. Identifying psychological or cognitive profiles at risk might help in improving screening and care strategies, especially in the context of preventive medicine in the higher education system.

This work was funded by the Hed-O-Shift INRA Priority Action of the AlimH Division (Nutrition, Chemical Food Safety and Consumer Behaviour) and coordinated by David Val-Laillet. The Ph.D. grant of Yentl Gautier was provided by INRA and Région Bretagne, France.

References:

1. Adams, D. R., Meyers, S. A., & Beidas, R. S. (2016). The relationship between financial strain, perceived stress, psychological symptoms, and academic and social integration in undergraduate students. Journal of American College Health, 64(5), 362–370.
2. Decamps, G., Boujut, E., & Brisset, C. (2012). French college students’ sports practice and its relations with stress, coping strategies and academic success. Frontiers in Psychology, 3, 104.
3. Deasy, C., Coughlan, B., Pironom, J., Jourdan, D., & McNamara, P. M. (2015). Psychological distress and lifestyle of students: Implications for health promotion. Health Promotion International, 30(1), 77–87.
4. Verger, P., Guagliardo, V., Gilbert, F., Rouillon, F., & Kovess-Masfety, V. (2010). Psychiatric disorders in students in six French universities: 12-month prevalence, comorbidity, impairment and help-seeking. Social Psychiatry and Psychiatric Epidemiology, 45(2), 189–199.
5. Tavolacci, M. P., Grigioni, S., Richard, L., Meyrignac, G., Dechelotte, P., & Ladner, J. (2015). Eating disorders and associated health risks among university students. Journal of Nutrition Education and Behavior, 47(5), 412–420.
6. Kandiah, J., Yake, M., Jones, J., & Meyer, M. (2006). Stress Influences appetite and comfort food preferences in college women. Nutrition Research, 26, 118–123.
7. Koenders, P. G., & van Strien, T. (2011). Emotional eating, rather than lifestyle behavior, drives weight gain in a prospective study in 1562 employees. Journal of Occupational and Environmental Medicine, 53(11), 1287–1293.
8. De Young, K. P., Zander, M., & Anderson, D. A. (2014). Beliefs about the emotional consequences of eating and binge eating frequency. Eating Behaviors, 15(1), 31–36.
9. Bourdier, L., Orri, M., Carre, A., Gearhardt, A. N., Romo, L., Dantzer, C., et al. (2018). Are emotionally driven and addictive-like eating behaviors the missing links between psychological distress and greater body weight? Appetite, 120, 536–546.
10. Sanlier, N., Baser, F., Mortas, H., Navruz Varli, S., Macit, M. S., & Tatar, T. (2017). Structural modeling the relationship of food addiction and eating attitudes of young adults with emotional appetite and self-esteem. Ecology of Food and Nutrition, 56(6), 514–529.
11. Brook, C. A., & Willoughby, T. (2016). Social anxiety and alcohol use across the university years: Adaptive and maladaptive groups. Developmental Psychology, 52(5), 835–845.
12. Tembo, C., Burns, S., & Kalembo, F. (2017). The association between levels of alcohol consumption and mental health problems and academic performance among young university students. PLoS One, 12(6), e0178142.