Biological Psychology 131 (2018) 96–106

Contents lists available at ScienceDirect

Biological Psychology
journal homepage: www.elsevier.com/locate/biopsycho

Stress-induced eating in women with binge-eating disorder and

obesity
Rebecca R. Klatzkin a,∗ , Sierra Gaffney a , Kathryn Cyrus a , Elizabeth Bigus a ,
Kimberly A. Brownley b
a
Department of Psychology, Rhodes College, TN, USA
b
Department of Psychiatry, The University of North Carolina at Chapel Hill, NC, USA

a r t i c l e i n f o a b s t r a c t

Article history: The purpose of the current study was to investigate stress-induced eating in women with binge-eating
Received 24 May 2016 disorder (BED) and obesity. Three groups of women [obese with BED (n = 9); obese non-BED (n = 11); and
Received in revised form normal weight (NW) non-BED (n = 12)], rated their levels of hunger and psychological distress before and
27 September 2016
after completing the Trier Social Stress Test, followed by food anticipation and then consumption of their
Accepted 3 November 2016
preferred snack food. We differentiated between the motivational and hedonic components of eating
Available online 9 November 2016
by measuring the amount of food participants poured into a serving bowl compared to the amount
consumed. Stress did not affect poured and consumed calories differently between groups. Across all
Keywords:
Binge eating
subjects, calories poured and consumed were positively correlated with post-stress hunger, but calories
Obesity poured was positively correlated with post-stress anxiety and negative affect. These results indicate that
Stress stress-related psychological factors may be more strongly associated with the motivational drive to eat
Hunger (i.e. amount poured) rather than the hedonic aspects of eating (i.e. amount consumed) for women in
general. Exploratory correlation analyses per subgroup suggest that post-stress hunger was positively
associated with calories poured and consumed in both non-BED groups. In the obese BED group, calories
consumed was negatively associated with dietary restraint and, although not significantly, positively
associated with stress-induced changes in anxiety.These findings suggest that stress-induced snacking
in obese BED women may be influenced by psychological factors more so than homeostatic hunger
mechanisms. After controlling for dietary restraint and negative affect, the NW non-BED women ate
a greater percentage of the food they poured than both obese groups, suggesting that obesity may be
associated with a heightened motivational drive to eat coupled with a reduction in hedonic pleasure
from eating post-stress. Further studies that incorporate novel approaches to measuring the motivational
versus hedonic aspects of stress-induced eating may expose nuanced eating behaviors that differentiate
BED and obesity. If confirmed, our findings would support prevention and treatment strategies that target
subsets of women based on obesity and BED status.
© 2016 Elsevier B.V. All rights reserved.

1. Introduction ogy of obesity and its comorbid conditions is imperative in order

Obesity is a global health epidemic that directly affects 20% of
the worldwide population and one-third of adults in the United
States (World Heath Statistics, 2015). Obesity is also a leading
risk factor for mortality among noncommunicable diseases such
as metabolic syndrome, cancer, and cardiovascular disease (World
Health Organization, 2009). A greater understanding of the etiol-
∗ Corresponding author at: Rhodes College, 2000 North Parkway, Memphis, TN
38112, USA.
E-mail address: klatzkinr@rhodes.edu (R.R. Klatzkin).
to inform prevention and treatment efforts.
Binge eating involves the consumption of an amount of food
that is larger than most people would consume under like circum-
stances over a relatively brief, discrete period of time (e.g., ≤2 h).
When binge eating occurs with sufficient regularity and is accom-
panied by various hallmark symptoms such as loss of control, an
individual may be diagnosed with binge-eating disorder (BED). BED
is characterized by recurrent (at least 1 day per week for 3 months)
binge-eating episodes that occur in the absence of regular compen-
satory behaviors such as purging. These binge-eating episodes are
likely to be associated with feeling depressed, disgusted, or guilty
after overeating and often involve eating more rapidly than nor-

https://doi.org/10.1016/j.biopsycho.2016.11.002
0301-0511/© 2016 Elsevier B.V. All rights reserved.
 R.R. Klatzkin et al. / Biological Psychology 131 (2018) 96–106
mal and until uncomfortably full (American Psychiatric Association,
2013). In the United States, approximately 3.5% of women and
2.0% of men suffer from BED in their lifetimes (Hudson, Hiripi,
Pope, & Kessler, 2007). BED is more common than anorexia ner-
vosa and bulimia nervosa and represents an equally substantial, if
not greater, public health burden with respect to physical health-
related quality of life, psychiatric comorbidity, and the stable and
chronic nature of the disorder (Ágh et al., 2015; Hudson et al.,
2007). BED is highly correlated with obesity (Hudson et al., 2007),
and among obese individuals, BED is a marker for greater impair-
ment in health-related quality of life (Ágh et al., 2015; Rieger,
Wilfley, Stein, Marino, & Crow, 2005) and greater medical and psy-
chiatric morbidity (Bulik, Sullivan, & Kendler, 2002; Greeno, Wing,
& Shiffman, 2000; Peterson, Latendresse, Bartholome, Warren, &
Raymond, 2012; Ramacciotti et al., 2008; Striegel-Moore & Franko,
2008; Wonderlich, Gordon, Mitchell, Crosby, & Engel, 2009).
Stress has been implicated in both the etiology of BED (Moore
& Cunningham, 2012; Pinaquy, Chabrol, Simon, Louvet, & Barbe,
2003; Simon et al., 2006) as well as in the onset and mainte-
nance of obesity (for review, see Sominsky & Spencer, 2014).
Perceived life stress correlates positively with binge eating fre-
quency (Pinaquy et al., 2003; Wolff, Crosby, Roberts, & Wittrock,
2000; Woods, Racine, & Klump, 2010) and is a precursor to binge
eating in clinical (Goldschmidt et al., 2014) and non-clinical pop-
ulations (Crowther, Sanftner, Bonifazi, & Shepherd, 2001; Freeman
and Gil, 2004; Groesz et al., 2012; Pike et al., 2006). Labora-
tory studies of stress responses and stress-related eating in obese
individuals with and without BED have yielded mixed results, how-
ever. Observations include increased hunger, desire to binge eat,
and consumption rates of highly palatable foods (Gluck, Geliebter,
Hung, & Yahav, 2004; Rosenberg et al., 2013; Schulz & Laessle,
2012) as well as no differences in stress-induced hunger or over-
all food intake (Klatzkin, Gaffney, Cyrus, Bigus, & Brownley, 2015;
Schulz and Laessle, 2012; Telch & Agras, 1996) in obese BED groups.
In addition, compared with obese individuals without BED, those
with BED have been shown to exhibit heightened (Gluck et al.,
2004), blunted (Rosenberg et al., 2013), or no differences (Schulz
& Laessle, 2012) in hypothalamic–pituitary–adrenal (HPA) axis
stress responses as well as greater reductions in parasympathetic
activity (Friederich et al., 2006), blunted autonomic responses
to stress (Messerli-Bürgy, Engesser, Lemmenmeier, Steptoe, &
Laederach-Hofmann, 2010), and no differences in cardiovascular
stress responses (Klatzkin et al., 2015).
These studies differed methodologically and only two of them
included a normal weight non-BED control group to facilitate
understanding of the unique and additive effects of obesity and BED
on physiological stress reactivity (Klatzkin et al., 2015; Rosenberg
et al., 2013). Using a 3-group design, we recently reported elevated
blood pressure and psychological distress throughout rest and
mental stress in obese women with BED compared with obese and
normal weight women without BED, who did not differ from each
other (Klatzkin et al., 2015). Thus, it appears that the stress-related
psychophysiological dysfunction in BED occurs independently of
obesity, although further examination of the mechanisms by which
the stress-related dysfunction contributes to the eating disorder is
warranted.
Stress may have a long-lasting influence on eating behaviors,
as individuals with BED tend to experience binge cravings and
binge eating in the evening in the privacy of their own homes and
when alone (Abraham & Beumont, 1982; Masheb, Grilo, & White,
2011; Pla-Sanjuanelo et al., 2015) long after the acute stressor has
subsided. Furthermore, stress-induced hunger, desire to eat, and
cortisol have been shown to continually rise up to 60 min following
stress in both BED and non-BED obese women (Gluck et al., 2004).
To our knowledge, assessment of eating behaviors and eating-
related psychological factors following laboratory-induced mental
97
stress has only been assessed immediately following a stressor
(Gluck et al., 2004; Rosenberg et al., 2013; Rutters, Nieuwenhuizen,
Lemmens, Born, & Westerterp-Plantenga, 2009; Schulz & Laessle,
2012; van Strien, Roelofs, & de Weerth, 2013). The present study
extends the current literature by examining eating behaviors
45 min post-stress.
The current study also explores the possibility of distinct phys-
iological and psychological moderators of stress and snacking as a
function of BED and obesity status. The restraint model of binge eat-
ing posits that concerns about shape and weight lead to restrained
eating, which promotes binge eating and, in turn, leads to a circular
pattern of further restriction and binge eating (Lowe, 1993; Polivy
& Herman, 1985). Dietary restraint is correlated with obesity and
binge-eating behaviors (Andrés & Saldaña, 2014) as well as labora-
tory stress-induced eating in non-clinical samples (for review, see
Greeno & Wing, 1994). Obese individuals with BED report greater
dietary restraint than obese non-BED individuals (Bas, Bozan, &
Cigerim, 2008; Klatzkin et al., 2015), but less dietary restraint than
individuals with bulimia nervosa (Elran-Barak et al., 2015). Fur-
thermore, dietary restraint is correlated with reduced activation
of brain regions associated with impulse control in obese indi-
viduals with BED, but not in their non-BED counterparts (Balodis
et al., 2013). Similarly, negative affect is strongly associated with
palatable food intake (Epel, Lapidus, McEwen, & Brownell, 2001;
Rutters et al., 2009; Telch & Agras, 1996) and binge eating (Haedt-
Matt & Keel, 2011; Hilbert & Tuschen-Caffier, 2007; Stickney,
Miltenberger, & Wolff, 1999; Wolff et al., 2000), and has been shown
to mediate the relationship between stress and binge eating in
bulimia (Goldschmidt et al., 2014). The relationship between neg-
ative affect and binge eating has been shown to differ between
clinical and non-clinical samples (Hilbert & Tuschen-Caffier, 2007;
Wolff et al., 2000), underscoring the need to explore differences in
the relative influence of negative affect on eating behaviors in both
obesity and BED. In this manner, a recent study reported that cop-
ing motives (e.g. the need to cheer up when in a negative mood)
were associated with binge-eating severity irrespective of obesity
(Boggiano et al., 2014). Thus, moderators of stress and eating may
have differential effects based on obesity and binge-eating status. A
greater understanding of the separate predictors of stress-induced
eating for obesity and BED may inform the development of tailored
relapse prevention strategies.
Taken together, the evidence for distinct stress-related pheno-
types for obesity and BED (Klatzkin et al., 2015; Rosenberg et al.,
2013) and for the strong association between stress and binge eat-
ing (Crowther et al., 2001; Freeman & Gil, 2004; Goldschmidt et al.,
2014; Groesz et al., 2012; Pike et al., 2006; Pinaquy et al., 2003;
Wolff et al., 2000; Woods et al., 2010) suggests that additional stud-
ies to tease apart the underlying mechanisms of stress-induced
eating between these populations are warranted. In order to
gain a better understanding of the BED phenotype, we examine
stress-induced eating behaviors as well as the psychophysiologi-
cal moderators of the relationship between stress and snacking in
women with and without BED across the weight spectrum.
Given that stress-induced cortisol activates brain reward path-
ways (Adam & Epel, 2007) and that binge eating and obesity share
neurobiological and behavioral traits with food and other drug
addictions (Kalon, Hong, Tobin, & Schulte, 2016; Smith & Robbins,
2013), we sought to determine the impact of stress on the hedonic
components of eating in BED and obesity. In order to differentiate
between the motivational and pleasurable aspects of eating (’want-
ing’ versus ‘liking’, respectively; Berridge, 2009; Dalton & Finlayson,
2014; Robinson & Berridge, 1993), we measured the amount of
snack food that participants voluntarily poured into a serving
bowl as well as the amount consumed. In light of the inconsis-
tencies in the literature, we anticipated that this nuanced analysis
of reward-based eating would lead to a greater understanding of
98 R.R. Klatzkin et al. / Biological Psychology 131 (2018) 96–106
stress-induced food consumption in obese women with BED com-
pared to obese and normal weight non-BED women. Furthermore,
in our exploratory analysis, we hypothesized that psychophysio-
logical moderators of the relationship between stress and snacking
would differ in obese women with BED compared to their non-BED
counterparts.
2. Materials and methods
2.1. Participants
We recruited women (18–50 years of age) via newspaper
and posted advertisements (both online and in local businesses)
targeting women who were overweight and not taking blood pres-
sure, stimulant, or psychoactive medications. A small percentage
of advertisements eliminated the term “overweight” in order to
obtain our normal weight (NW) sample. Importantly, no advertise-
ments specifically targeted women with BED or any eating disorder.
Both our recruitment strategies and the clinical assessment of DSM-
IV Axis I eating, mood, and anxiety disorders (see Methods section)
ensured that participants remained blind to the study’s main vari-
able of interest, BED diagnostic status, in order to diminish demand
characteristics. Participants were told that the purpose of the study
was to investigate the influence of the menstrual cycle on responses
to mental stress in overweight and normal weight women.
The final sample of participants in the current report was com-
prised of three groups of women: (1) Obese BED (n = 9); (2) Obese
non-BED (n = 11); and (3) NW non-BED (n = 12). All women in the
BED group met full DSM-V criteria for BED while women in the non-
BED groups had no history of any eating disorders. Participants in
the two obese groups had a body mass index (BMI) between 31 and
47 and participants in the NW group had a BMI between 19 and
25. The protocol was approved by the Institutional Review Board
of Rhodes College and all participants provided informed, written
consent. Participants received $30 compensation for completing
the experimental protocol described in the current report and a
total of $75 for completing the full study (see below).
2.2. Preliminary screening protocol
Women responding to our advertisements received a link
via email directing them to a set of online screening questions
aimed at excluding prospective participants who were pregnant
or breastfeeding, postmenopausal, taking prescription medication
(excluding oral contraceptives, see Table 1), had a cardiovascular
disorder, or were regular smokers. Women were also excluded
if they reported seeking treatment for weight or eating issues.
This exclusionary criterion was intended to prevent the potentially
confounding influences of treatment-related coping strategies
regarding stress, mood, and eating. A preliminary indication of BED
diagnostic status was also assessed via completion of the Eating
Disorders Examination Questionnaire (EDE-Q) and later confirmed
via structured clinical interview (see below).
2.3. Determination of eligibility
Of the 340 women who completed the preliminary screening
protocol, 80 eligible participants (23.5%) proceeded to the lab-
oratory to determine eligibility via clinical interview. The small
percentage can be explained by both the exclusionary criteria as
well as the fact that prospective participants must have endorsed
substantial objective binge eating or lack thereof on the EDE-Q in
order to be eligible for the clinical interview portion of the study. If
prospective participants endorsed mild to moderate binge-eating
behaviors, they were excluded at this stage. During this session,
participants underwent the Structured Clinical Interview for DSM-
IV Axis I disorders (SCID-I/NP; First, Spitzer, Gibbon, & Williams,
2002) to determine BED diagnostic status and to assess current
Axis I mood and anxiety disorders. Height (cm) and weight (kg)
were also assessed to calculate BMI (kg/m2) and blood pressure
measurements were taken with the Oscar 2 oscillometric ambu-
latory blood pressure monitor (SunTech Medical Instruments, Inc.,
Raleigh, NC). Women were excluded from the study if they had a
resting blood pressure > 159/99, were underweight (BMI < 19) or
overweight (BMI between 26 and 28), or had a current Bipolar
Disorder, Substance Abuse Disorder, Panic Disorder, or an Eating
Disorder other than BED. Because mood (26%) and anxiety (24.5%)
disorders are the most common co-morbidities with BED (Grilo,
White, & Masheb, 2009), current Major Depressive Disorder and
Anxiety Disorders (other than Panic Disorder) were not considered
exclusionary criteria unless individuals were using psychotropic
medications. If inclusionary criteria were met, participants were
asked to call the laboratory on day 1 of the following menstrual
cycle to schedule their first testing session.
2.4. Procedure
In addition to the goals of the current report, the overarching
research study had additional aims that were addressed in the first
testing session and can be found in a recent report (Klatzkin et al.,
2015). The results from the second testing session are presented in
the current report.
Each testing session occurred during the follicular phase (days
1–7) of the menstrual cycle, which was assessed via self-report.
Participants called on day 1 of their menstrual cycles to schedule
each laboratory visit. The average time between testing sessions
was 37.75 days and did not significantly differ between groups. The
experimental protocols began between the hours of 2:00 p.m. and
5:00 p.m. The participants were asked to refrain from eating and
drinking anything other than water for at least one hour prior to
testing. Compliance was confirmed upon arrival.
The laboratory protocol for the second testing session described
in this report consisted of (1) a baseline rest period; (2) a mental
stress task; (3) a food anticipation period; and (4) and assessment of
eating behaviors. A blood pressure monitor with arm cuff provided
automated cardiovascular measurements throughout testing. Each
portion of the protocol is described in detail below (see Fig. 1).
2.4.1. Baseline rest
Participants completed questionnaires assessing binge-eating
symptoms, dietary restraint, perceived stress, depression symp-
toms, state anxiety, negative affect, and hunger (see below).
Participants then rested quietly for 10 min in order to establish a
baseline for stress testing.
2.4.2. The Trier Social Stress Test (TSST)
The TSST (Kirschbaum, Pirke, & Hellhammer, 1993) is a mental
stress test which reliably induces large and consistent cardiovascu-
lar and neuroendocrine responses and involves four components:
1) Pre- Task Instructions (5 min): The researcher informed the par-
ticipants that they will be giving a speech serving as an interview
for a job as a campaign manager for a local politician. Researchers
also explained that the speech will be audio- and video-recorded
for later analysis and will be followed by a serial subtraction task.
Participants were then introduced to the ‘selection committee’
who they were told would later listen to their job talk. This com-
mittee was composed of three well-trained research assistants
wearing white laboratory coats.
2) Speech Preparation Period (5 min): The experimenter asked par-
ticipants to imagine that they were applying for the job of a
 R.R. Klatzkin et al. / Biological Psychology 131 (2018) 96–106
Table 1
Mean (±SD) baseline demographic factors as a function of BED and obesity status.
NW non-BED
n = 12
Age 28.24 (±6.9)
Minority race (%) 7 (58%)
Body Mass Indexa 21.65 (±1.8)
Oral Contraceptive Use (%) 4 (33%)
Dietary Restraintb 0.22 (±0.29)
Perceived Stress Scaleb 12.0 (±8.8)
Binge Eating Scalec 2.33 (±1.5)
Beck Depression Inventoryd 8.42 (±9.3)
a
NW non-BED < Obese BED and Obese non-BED, p < 0.001.
b
Obese BED > NW non-BED, p < 0.05.
Obese BED > Obese non-BED and NW non-BED; c p < 0.001; d p < 0.05.
Fig. 1. Laboratory protocol.
campaign manager for a local politician and to take 5 min to
prepare their speech describing why they would be the ideal
candidate for the position.
3) Speech (5 min): Immediately following the preparation period,
the selection committee returned to the testing room and asked
the participants to deliver their speech. If the participant fin-
ished before 5 min, the committee responded in a standardized
way, with prepared questions to ensure that participants spoke
for the entire period.
4) Serial Subtraction (5 min): The experimenter asked the partic-
ipants to perform mental math by serially subtracting 13 from
1022 aloud as quickly and accurately as possible. Their progress
was monitored, and when an error was made, the experimenter
told the participants to start over from the beginning. Imme-
diately following the stress tasks, the participants completed
questionnaires measuring negative affect, anxiety, and hunger
to obtain post-stress self-report measures.
2.4.3. Food anticipation period
Following stress testing and self-report measurements, partici-
pants were asked to rank their preferences for palatable food items
they were to receive at a later time. In order to keep participants
blind to the nature of the study, written instructions explained
that due to the length of the experiment and the fact that par-
ticipants were asked to refrain from eating one hour prior to the
study, the Institutional Review Board mandated a snack be pro-
vided. The snack food preference form included pictures of six
palatable food items (peanut butter pretzels, chocolate covered
raisins, M&Ms, potato chips, baked cheese crackers, and jelly beans)
99
Obese non-BED Obese BED
n = 11 n=9
26.39 (±3.6) 33.25 (±9.4)
7 (64%) 7 (78%)
33.06 (±5.1) 37.88 (±4.7)
1 (9%) 0 (0%)
0.85 (±0.97) 1.42 (±1.16)
16.7 (±5.8) 20.1 (±6.3)
4.82 (±5.4) 24.11 (±10.6)
6.45 (±4.0) 20 (±14.4)
and asked participants to rank their preference from #1-6. Instruc-
tions also informed participants that they would receive their snack
towards the end of the stress recovery period. Participants then sat
and rested quietly, with the option to read magazines that were
unrelated to food, weight-related issues, etc.
Thirty minutes following the completion of stress testing,
participants completed questionnaires measuring negative affect,
anxiety, and hunger to obtain self-report measures during the food
anticipation period.
2.4.4. Assessment of eating behaviors
Forty-five minutes following the completion of stress test-
ing, researchers provided participants with the snack food item
ranked #1 on their snack food preference survey. Researchers
told participants that they were providing them with the food
that they had previously chosen and to eat with their dominant
hand so that the arm with the blood pressure cuff remained still
during ongoing readings. Researchers then presented a tray con-
taining one plastic food storage container filled with a total of
20 servings of their top ranked snack food item (peanut but-
ter pretzels = 800 g, 2800 cal; chocolate covered raisins = 800 g,
3800 cal; M&Ms = 840 g, 4200 cal; potato chips = 560 g, 3000 cal;
baked cheese crackers = 600 g, 3000 cal; and jelly beans = 800 g,
2800 cal) as well as a bowl in which to pour the food. Participants
were given either a large, medium, or small plastic food storage
container depending on the snack food chosen such that 20 serv-
ings filled the container. Participants were left alone in the testing
room to portion and consume their chosen snacks.
100 R.R. Klatzkin et al. / Biological Psychology 131 (2018) 96–106
After fifteen minutes with the food items, the tray was removed
and participants were once again asked to complete questionnaires
measuring negative affect, anxiety, and hunger to obtain self-report
measures following food consumption. Participants were then pro-
vided with $30 and debriefed.
In order to assess reward-based eating behaviors, servings and
calories were measured in the following ways: (1) total poured (i.e.
motivation for food or “wanting”; (2) total consumed (i.e. pleasure
from food consumption or “liking”; and (3) percentage of the pour
that was consumed. To assess the amount of snack food poured into
the bowl, the weight of the food left in the container (g) following
food consumption was subtracted from the original weight of the
food in the container. In order to calculate total food consumption,
the weight of the food left in the bowl was then subtracted from the
amount of food poured. Weight in grams was used to calculate the
number of servings poured and consumed and this was converted
to calories using the macronutrient content per serving provided
on the nutrition label of the chosen food item.
2.5. Self-report questionnaires
Participants completed the Eating Disorders Examination Ques-
tionnaire (EDE-Q; Fairburn & Beglin, 1994), adapted from the Eating
Disorders Examination Interview, during the preliminary screening
protocol. The EDE-Q is a 36-item self-report, but for the purposes of
the present study, only items 13–21 were used to provide a prelimi-
nary indication of BED diagnostic status. These items ask how many
times or how many days over the past four weeks participants have
engaged in binge-eating related thoughts and behaviors.
Questionnaires assessing dietary restraint, binge-eating symp-
toms, perceived stress, and depression symptoms were admin-
istered during the baseline rest period. Dietary restraint was
examined using the restraint subscale of the EDE-Q (Fairburn &
Beglin, 1994). The restraint subscale is comprised of five questions
assessing the number of days over the past 28 days that the par-
ticipant has displayed restraint over eating, avoidance of eating,
food avoidance, dietary rules, and empty stomach. The question-
naire is scored using a 0–6 forced-choice rating scale from no
days to 28 days. Greater scores indicate greater dietary restraint.
Binge-eating symptoms were assessed using the Binge Eating Scale
(BES; Gormally, Black, Daston, & Rardin, 1982) which consists
of 16 forced-choice questions, each with a set of three to four
answer choices. Higher scores indicate greater binge-eating sever-
ity. The overall level of perceived life stress was measured using
the Perceived Stress Scale (PSS; Cohen, Kamarck, & Mermelstein,
1983). Items assess how unpredictable, uncontrollable, and over-
loaded respondents view their lives, and directly inquire about
levels of experienced stress in the past month with answer choices
ranging from 0 (Never) to 4 (Very Often). Higher scores indi-
cate greater perceived stress. Self-reported depression symptoms
were assessed using the 21-item Beck Depression Inventory (BDI;
Beck & Beamesderfer, 1974). This scale comprehensively assesses
dysphoric symptoms, including affective, cognitive, somatic, overt
behavior, and interpersonal symptoms of depression. Each forced-
choice question has a set of at least four possible answer choices,
with increasing severity of depressive symptoms from 0 to 3. Higher
scores indicate greater depressive symptoms.
Questionnaires assessing state anxiety, negative affect, and
hunger were administered at four time points throughout the
study: (1) baseline rest, (2) the completion of stress testing, (3)
following food anticipation (i.e. 30 min after the completion of
stress testing), and (4) following food consumption (i.e. 60 min
after the completion of stress testing). The state anxiety portion
of the Spielberger State-Trait Anxiety Questionnaire (STAI state;
Spielberger, Gorsuch, Lushene, Vagg, & Jacobs, 1983) was used
to assess self-reported situational anxiety levels and contains 21
statements describing how an individual may feel at the present
moment. Participants rate how they currently feel on a scale from
1 (Not at all) to 4 (Very much so) and higher scores indicate
greater levels of state anxiety. Negative affect was assessed using
the Profile of Mood States (POMS-BI; Lorr & McNair, 1988) which
consists of 72 items related to mood and assesses both positive
and negative affective dimensions on a scale from 0 (Much unlike
this) to 3 (Much like this). The POMS items are composed of
six empirically derived sub-scales: Elated-Depressed, Composed-
Anxious, Agreeable-Hostile, Confident-Unsure, Energetic-Tired and
Clearheaded-Confused. Higher scores indicate greater negative
affect. Finally, participants rated their current level of hunger on
a numerical rating scale from 0 (Not hungry) to 6 (Very hungry).
2.6. Physiological measurements
The Oscar 2 oscillometric ambulatory blood pressure monitor
(SunTechMedical Instruments, Inc., Raleigh, NC) with an appropri-
ately sized arm cuff provided automated measurement of systolic
blood pressure (SBP), diastolic blood pressure (DBP) and heart rate
(HR) during the testing session. All measurements took place while
participants were in a comfortable seated position. Blood pressure
and heart rate measures were taken at minutes 0, 5, and 10 of
baseline rest and minutes 0, 2, and 4 of both the speech and serial
subtraction periods; values were averaged to compute task levels.
Measurements taken at 0, 5, and 10 min of the food anticipation
period and also the food consumption period were each averaged to
constitute cardiovascular functioning during the respective phases
of the study.
Saliva was collected in 1.5 mL Eppendorf tubes at the end of the
baseline rest period and 30 min following stress induction. Saliva
samples were frozen within 30 min of collection at −20◦ C until
assayed. On the day of testing, all samples were centrifuged at
3000 rpm for 15 min to remove mucins and were analyzed in dupli-
cate by enzyme immunoassay (Salimetrics, State College, PA). The
mean intra-assay coefficient of variation was 7.8% and the inter-
assay coefficient was 12.6%.
2.7. Data analysis
2.7.1. Demographics and baseline measures
Group differences in demographic factors and oral contra-
ceptive use were examined using a Multivariate ANOVA for
continuous variables and chi square analyses for dichotomous vari-
ables as appropriate. Where significant results emerged, post-hoc
analyses with Bonferroni corrections were conducted. Group differ-
ences in baseline dietary restraint, perceived stress, binge-eating
symptoms, and depression symptoms were investigated using a
Multivariate ANCOVA, with oral contraceptive use as the covariate.
Sidak corrected post-hoc comparisons were performed to deter-
mine specific group differences.
Oral contraceptive use was entered as a covariate in all subse-
quent ANOVAs due to its influence on cardiovascular factors (Shen,
Lin, Jiang, Li, & Zhang, 1994) and psychological variables (Shahnazi
et al., 2014) as well as the association of fluctuating female sex hor-
mones with eating behaviors (Edler, Lipson, & Keel, 2007; Klump,
Keel, Culbert, & Edler, 2008).
2.7.2. Self-reported psychological measures and physiological
measurements
Separate repeated measures ANCOVAs were used to analyze
group differences in negative affect, state anxiety, hunger and
cardiovascular factors over time, with Group (Obese BED, Obese
non-BED, NW-non-BED) as the between-subject factor, and Time
(Baseline, Stress, Food Anticipation, Food Consumption) as the
within-subject factor, with oral contraceptive use as the covari-
 R.R. Klatzkin et al. / Biological Psychology 131 (2018) 96–106
ate. Speech stress cardiovascular values were used because this
task was more effective at increasing cardiovascular measures
from baseline compared to the math task (main effect of stress
task [speech vs. math] for SBP, DBP, and HR: Fs(1,28) = 18.1–31.0,
ps < 0.001). When group differences emerged, Sidak corrected post-
hoc comparisons were performed.
A repeated measures ANCOVA was also used to analyze group
differences in cortisol over time, with Group (Obese BED < Obese
non-BED, NW non-BED) as the between-subjects factor and Time
(Baseline, Stress) as the within-subject factor, with oral contracep-
tive use at the covariate. Cortisol data was not provided by one
participant in the NW non-BED and one participant from the Obese
BED group.
2.7.3. Eating behaviors
A Multivariate ANCOVA was used to assess group differences in
the amount of calories and servings poured and consumed, as well
as the percentage of the pour that was consumed, with oral contra-
ceptive use as a covariate. Given that negative affect and dietary
restraint are associated with stress-induced eating behaviors in
women with disordered eating (Pike et al., 2006; Steiger et al., 2005)
as well as healthy controls (Epel et al., 2001; Zellner et al., 2006),
follow-up ANCOVAs were used to determine if group differences in
eating behaviors following stress emerged after adjusting for group
differences in these self-reported psychological factors. Due to the
fact that negative affect was heightened in obese BED women across
multiple time points (see Results below), area under the curve with
respect to ground (AUCg) for negative affect was used as the covari-
ate. When group differences were present, Sidak corrected post-hoc
comparisons were performed. Two obese non-BED participants did
not pour or consume any food and were thus eliminated from these
analyses.
We examined for outliers in all eating variables and determined
that one participant in the obese BED group consumed significantly
more calories (350 more) and servings (2.5 more) than the average
for that group (i.e. greater than the third quartile plus 1.5 times
the interquartile range). Following the removal of this outlier, the
results of the Multivariate ANCOVA for both calories and servings
did not change.
2.7.4. Relationship between eating behaviors and stress-related
psychological and cardiovascular factors
In order to determine if physiological factors and self-reported
psychological measures following stress were associated with eat-
ing behaviors, Pearson product–moment (Pearson’s r) correlations
were performed in each diagnostic group separately as well as the
entire sample as a whole. In order to decrease Type I error rate, only
calories consumed and poured, as well as the percentage of poured
snack food consumed, were used as measures of food consumption.
Changes in cortisol, SBP, DBP, and HR from baseline to speech stress,
as well as stress-related psychological factors of dietary restraint
and post-stress ratings of hunger, negative affect, and anxiety were
used as predictors in the correlational analyses.
Following the removal of the outlier for caloric consumption,
results of the correlational analyses in the entire sample as a whole
did not change. Significant results, however, did emerge following
outlier removal in the separate analysis of the obese BED group.
The results following outlier removal in this subgroup of women
are reported below.
3. Results
3.1. Demographics and baseline measures
As summarized in Table 1, main effects of Group emerged
for BMI, F(2,29) = 53.3, p < 0.001, dietary restraint, F(2, 28) = 4.0,
101
180
NW non-BED
160
Obese non-BED
140
Obese BED
120
Negave Affect
100
80
60
40
20
0
Baseline Stress Food Food
Ancipaon Consumpon
Fig. 2. Mean (SD) negative affect ratings across baseline, stress, food anticipation,
and food consumption as a function of BED and obesity status. Main effect of Group:
F(2, 28) = 3.6, p < 0.05, Obese BED > NW non-BED, regardless of Time (p < 0.05).
p < 0.05, perceived stress, F(2,28) = 4.53, p < 0.05, binge-eating
symptoms, F(2, 28) = 30.2, p < 0.001, and depression symptoms,
F(2,28) = 5.16, p < 0.05. As expected, BMI was lower in the NW non-
BED group compared to both the obese non-BED and obese BED
groups, who did not differ from each other (ps < 0.001). In addition,
the obese BED group endorsed greater binge eating and depres-
sion symptomatology than both obese and NW non-BED groups
(p < 0.001 and p < 0.05, respectively) and higher dietary restraint
and perceived stress than the NW non-BED group (ps < 0.05). No
main effects of Group were present for mean age, proportion minor-
ity race, or oral contraceptive use (ps < 0.05).
3.2. Self-reported psychological measures
The stress task induced significant increases in negative affect,
F(1, 28) = 7.2, p < 0.05, and anxiety, F(1, 28) = 5.2, p < 0.05, but not
hunger (p > 0.05) in the entire sample as a whole.
There was a main effect of Group for negative affect, F(2,
28) = 3.6, p < 0.05, as obese BED women showed greater nega-
tive affect compared to NW non-BED women, regardless of Time
(p < 0.05; see Fig. 2). There was not a main effect of Time or
a Group × Time interaction for negative affect (ps > 0.05). No
main effects or interactions emerged for state anxiety or hunger
(ps > 0.05).
3.3. Physiological measurements
Both the speech and math tasks induced significant increases
in SBP, DBP, and HR, but not cortisol, from baseline to stress,
Fs(1,29) = 30.16–110.67, ps < 0.001.
There was a main effect of Group for SBP, F(2, 28) = 5.18, p < 0.05,
as obese BED women showed heightened overall SBP compared to
NW non-BED women, irrespective of Time (p < 0.05; see Fig. 3).
There was not a main effect of Time or a Group × Time interaction
for SBP (ps > 0.05). No significant main effect or interactions were
found for cortisol, DBP, or HR.
3.4. Eating behaviors
Neither the amount of food consumed, the amount of food
poured, nor the percentage of poured food consumed (calories or
servings) differed significantly by Group or Time (ps > 0.05; see
Table 2). However, significant group main effects for the percentage
of poured snack food consumed emerged when dietary restraint
and negative affect were included as covariates in the analysis
(servings: F(2, 24) = 4.54, p < 0.05; calories: F(2, 24) = 4.58, p < 0.05).
The NW non-BED group consumed a larger percentage of the snack
102 R.R. Klatzkin et al. / Biological Psychology 131 (2018) 96–106

Table 2
Mean (±SD) eating behaviors as a function of BED and obesity status.

NW non-BED Obese non-BED Obese BED

n = 12 n=9 n=9

Calories poured 236.7 (±138.8) 360.6 (±176.8) 411.3 (±241.8)

Calories consumed 208.6 (±129.1) 282.1 (±192.6) 275.1 (±141.2)*
*
When outlier is removed (n = 8), Mean (±SD) = 231.4 (±55.8).

170 in HR from baseline to stress (r = −0.33, p = 0.07). Eating behav-

NW non-BED
iors were not associated with dietary restraint or stress-induced
160
Systolic Blood Pressure (mmHg)

Obese non-BED
changes in blood pressure or cortisol (ps > 0.05).
Obese BED
150
3.5.2. Sub-group analyses
140
Within the NW non-BED group, calories poured was nega-
130
tively associated with stress-induced changes in HR (r = −0.66,
p < 0.05) and cortisol (r = −0.60, p = 0.05) and positively associated
120 with post-stress hunger ratings (r = 0.76, p < 0.01). Calories poured
was also negatively associated with stress-induced changes in DBP
110
(r = −0.53, p = 0.08), although not significantly (Table 3). Calories
consumed was positively associated with post-stress hunger rat-
100
Baseline Stress Food Food ings (r = 0.66, p < 0.01), negatively associated with stress-induced
Ancipaon Consumpon changes in cortisol (r = −0.60, p = 0.05) and although not signifi-
cantly, negatively associated with stress-induced changes in HR
Fig. 3. Mean (SD) systolic blood pressure across baseline, stress, food anticipation,
(r = −0.55, p = 0.06). Eating behaviors were not associated with
and food consumption as a function of BED and obesity status. Main effect of Group:
F(2, 28) = 5.18, p < 0.05, Obese BED > NW non-BED, regardless of Time (p < 0.05). dietary restraint or post-stress negative affect and anxiety ratings
(ps > 0.05).
110
Within the Obese non-BED group, pouring more calories was
associated with greater post-stress hunger ratings (r = 0.73, p <
100
0.05; see Table 3). No eating behaviors were significantly associ-
Percentage of Poured Snack Food
Consumed (servings or calories)

90 ated with dietary restraint, post-stress hunger, anxiety, negative

80
70
60
50
40
30
20
10
NW non-BED Obese non-BED
Fig. 4. Mean (SD) percentage of poured snack food consumed as a function of BED
and obesity status, with dietary restraint and AUCg negative affect as covariates.
Main effect of Group for servings: F(2, 24) = 4.54, p < 0.05; calories: F(2, 24) = 4.58,
p < 0.05, NW non-BED > Obese non-BED and Obese BED (ps < 0.05).
food poured than both obese groups (ps < 0.05; see Fig. 4). Control-
ling for dietary restraint and negative affect did not change the lack
of group differences in the amount of food poured and consumed
(calories or servings).
Groups did not differ in their chosen snack food or the percent-
age of sweet versus salty snack foods chosen (ps > 0.05). All snacks
were ranked first at least once, while baked cheese crackers were
the most popular, and jelly beans the least popular choice.
3.5. Relationship between eating behaviors and stress-related
psychophysiological factors
3.5.1. Total group analyses
Pouring more calories was associated with greater post-stress
anxiety (r = 0.40, p < 0.05), negative affect (r = 0.41, p < 0.05), and
hunger ratings (r = 0.49, p < 0.01). Calorie consumption was posi-
tively associated with post-stress hunger ratings (r = 0.57, p < 0.01)
and although not significantly, negatively associated with changes
affect, or stress-induced physiological measures (ps > 0.05).
Within the Obese BED group, lower caloric consumption was
associated with greater dietary restraint (r = −0.72, p < 0.05; see
Table 3). Nonsignificant trends were found for a positive association
between post-stress anxiety and caloric consumption and (r = 0.65,
p = 0.08), and for a negative association between stress-induced
change in cortisol and the percentage of poured food consumed
(r = −0.62, p = 0.099). Eating behaviors were not significantly asso-
ciated with post-stress hunger or negative affect ratings, or with
stress-induced changes in cardiovascular factors (ps > 0.05).
Obese BED
4. Discussion
The current study examined stress-induced eating behav-
iors and the psychophysiological moderators of the relationship
between stress and snacking in three groups of women: normal
weight without BED, obese without BED, and obese with BED. Post-
stress hunger was positively associated with both calories poured
and consumed, while post-stress anxiety and negative affect were
positively associated only with calories poured. Although prelimi-
nary, these results indicate that psychological factors may be more
important predictors of the motivational aspects of snacking (i.e.
calories poured) than the pleasurable aspects for women in general.
When analyzed separately by group, post-stress hunger was posi-
tively associated with calories poured and calories consumed only
in the non-BED groups. Caloric consumption was negatively corre-
lated with dietary restraint and tended to correlate positively with
stress-induced changes in anxiety ratings in the obese BED group.
Results from these exploratory analyses suggest that psychological
factors rather than physiological hunger may be more salient pre-
dictors of stress-induced snacking among obese women with BED
than among women without BED. Finally, despite heightened blood
pressure in obese women with BED versus obese non-BED and nor-
mal weight non-BED women, total food intake 45 min following
stress did not differ between groups. Yet, the normal weight non-
 R.R. Klatzkin et al. / Biological Psychology 131 (2018) 96–106 103

% poured food
BED group consumed a larger percentage of the snack food they

(n = 31)

consumed
poured into their serving bowl than both groups of obese women

r = −0.22
r = −0.06
r = −0.10
r = −0.08
r = −0.05
r = 0.13
after controlling for negative affect and dietary restraint.
While previous studies have also reported no differences in total
food intake following stress in obese BED and non-BED individuals
Total Group
(Schulz & Laessle, 2012; Telch & Agras, 1996), our additional nor-

consumed
(n = 31)

r = −0.26
r = −0.20

r = −0.10
Calories

r = 0.48*
mal weight non-BED control group enabled the current study to

r = 0.24
r = 0.06
more effectively distinguish between the effects of BED and those
of obesity on stress-induced snack food consumption. The smaller
percentage of poured food that was consumed in the obese BED and
(n = 32)

r = −0.21
r = 0.49#

r = 0.41#
r = 0.40#
Calories

obese non-BED groups indicated that obesity may be associated

poured

r = 0.15
r = 0.08

with a heightened motivational drive to eat (i.e. ‘wanting’/amount

poured), coupled with a reduction in pleasure from eating (i.e.
‘liking’/amount consumed) following stress. In light of research
% poured food

showing sensitized ‘wanting’ without commensurate ‘liking’ in

(n = 8)

consumed

r = −0.62+
drug addictions (Berridge, 2009) and the amplification of palat-
r = −0.22
r = −0.25
r = −0.47
r = 0.21
r = 0.12

able food ‘wanting’ via injection of corticotropin-releasing factor

into brain reward centers (Peciña, Schulkin, & Berridge, 2006), our
results highlight the need to further investigate common underly-
Obese BED

ing mechanisms of stress-induced ‘wanting’ in drug addiction and

(n = 8)

consumed

r = −0.72#

obesity.
r = 0.65+
Calories

r = 0.54
r = 0.17

r = 0.52
r = 0.06

The incentive salience model proposes that the rewarding

nature of palatable food can be divided into two distinct com-
ponents, i.e. ‘liking’ and ‘wanting’ (Robinson & Berridge, 1993).
‘Wanting’ is operationalized as the reward-based desire for food,
(n = 9)

r = −0.31
Calories
poured

r = 0.21
r = 0.47
r = 0.42
r = 0.23

r = 0.39

while ‘liking’ has been defined as the pleasurable response to

receipt of palatable food (Berridge, 2009). Incentive salience mech-
anisms may be augmented by stress, thus playing a role in
stress-induced eating (Dallman et al., 2006). Schulz and Laessle
% poured food

(2012) reported heightened motivation for food in obese BED

consumed

r = −0.002

r = −0.14

versus obese non-BED subjects in their investigation of microstruc-

r = 0.48

r = 0.32

r = 0.13
r = 0.30

tural eating behaviors following stress. Although these group

differences were based on BED diagnosis rather than obesity sta-
Obese non-BED

tus as in the current study, the lack of a normal weight non-BED

Correlations between eating behaviors and psychophysiological factors as a function of BED and Obesity status.

control group did not allow for a full understanding of the impact
consumed

of BED above and beyond that of obesity. Future studies utilizing

r = −0.04

r = −0.07
Calories

r = 0.28
r = 0.48

r = 0.11
r = 0.11

this control in addition to a fourth normal weight BED group are

warranted in order to further isolate the effects of BED from the
effects of obesity on motivation for palatable food following stress.
Brain imaging studies have revealed the clinical relevance of
(n = 9)

r = −0.10

r = −0.01
r = 0.73#
Calories
poured

r = 0.13
r = 0.32
r = 0.10

differential activation in regions associated with ‘liking’ versus

‘wanting’. Recent reports have shown that obesity is associated
with increased brain activation in reward-based corticolimbic-
% poured food

striatal regions in response to palatable food and stress cues

(Jastreboff et al., 2013) as well as greater motivation for, but not
consumed

r = −0.34

r = 0.41
r = 0.10

r = 0.04
r = 0.08

r = 0.04

liking of, palatable food following stress and in the absence of

hunger (Lemmens, Rutters, Born, & Westerterp-Plantenga, 2011).
Additionally, Bohon and Stice (2012) found an association between
NW non-BED

greater negative affect and brain activity related to reward-based

learning and habit formation during anticipation of palatable food
consumed

r = −0.60#
r = −0.55+
r = −0.29
Calories

intake, but not during actual consumption in women with bulimia

r = 0.66*
r = 0.29
r = 0.34

(Bohon & Stice, 2012). Altogether, these findings suggest that the
relative strength of motivational versus pleasurable aspects of food
intake may be predictors of stress-induced eating in vulnerable
r = −0.66#

r = −0.60#
(n = 12)

r = −0.33

populations.
Calories

r = 0.76*
poured

r = 0.28
r = 0.29

Alternatively, it is possible that obese women in our study ate

a smaller percentage of the snack food they poured because they
felt more limited by the controlled laboratory environment and the
Post-Stress Negative Affect

time constraints of the food consumption period than the normal

weight group of women. As opposed to exhibiting a reduction in
Post-Stress Anxiety
Post-Stress Hunger

Change in Cortisol

pleasure from eating the food, they may have simply lacked the
Dietary Restraint

Stress-Induced

Stress-Induced

disinhibition to finish the snacks they poured. In contrast, the nor-

Change in HR

mal weight non-BED women showed positive correlations between

p ≤ 0.05.
p < 0.01.

p < 0.10.

post-stress hunger ratings and both calories poured and consumed,

Table 3

indicating that their stress-induced snacking behaviors were more

*

closely aligned with their level of hunger than the obese groups.
104 R.R. Klatzkin et al. / Biological Psychology 131 (2018) 96–106
Our findings that both anxiety and negative affect following
stress were associated with the amount of calories poured, but
not consumed, indicate that psychological factors may be more
relevant to the motivational aspects of snacking rather than the
pleasurable aspects for women in general. Because psychological
dysfunction such as heightened negative affect and anxiety are
more prevalent in obese BED versus obese non-BED individuals
(Klatzkin et al., 2015), a greater understanding of the mechanisms
by which motivation for food following stress contributes to the
etiology and maintenance of BED is needed to inform prevention
and treatment efforts.
Toward this end, one goal of the current study was to explore
the psychophysiological moderators of the relationship between
stress and eating behaviors as a function of BED and obesity sta-
tus. Findings revealed that hunger following stress was associated
with eating behaviors in both non-BED groups, but not in the obese
BED group, indicating a potential dysregulation of homeostatic reg-
ulation of energy intake in BED. Homeostatic mechanisms in the
hypothalamus and peripheral organs contribute to the regulation
of food consumption, but under certain circumstances (e.g. stress,
heightened emotion, or the presence of palatable food) the brain
reward system may override homeostatic control mechanisms to
promote food intake (Berthoud, 2011; Dallman, 2010). Our correla-
tional results in the obese BED group, coupled with studies showing
enhanced reward sensitivity to palatable food images in over-
weight BED women versus overweight and normal weight non-BED
women (Schienle, Schäfer, Hermann, & Vaitl, 2009), suggest that
the reward system may be overriding the influence of homeostatic
hunger mechanisms in BED to influence eating behaviors.
The uncoupling of physiological hunger mechanisms and food
intake in obese BED women may also be explained by the height-
ened impact of psychological factors on eating behaviors. Results
suggested that only in obese BED women is greater caloric intake
associated with lower dietary restraint as well as greater anxiety.
These findings are in line with evidence for a relationship between
disordered eating behaviors and increased dietary restraint (Davis,
Freeman, & Garner, 1988; Engelberg, Gauvin, & Steiger, 2005;
Steiger et al., 2005), negative mood (Goldschmidt et al., 2014;
Ivanova et al., 2015; Schulz & Laessle, 2010), and ratings of per-
ceived stress (Goldschmidt et al., 2014; Pinaquy et al., 2003;
Rosenberg et al., 2013) in BED as well as bulimia.
Although these psychological measures are also commonly
linked to stress-induced eating in non-clinical samples (Epel et al.,
2001; Freeman & Gil, 2004; Roberts, Troop, Connan, Treasure, &
Campbell, 2007; Wardle, Steptoe, Oliver, & Lipsey, 2000; Zellner
et al., 2006), their effects are potentiated in individuals with eat-
ing disorders. For instance, negative mood has been shown to be
a strong antecedent of binge eating in BED and bulimia, but not of
binge-eating episodes or regular eating in healthy controls (Greeno
et al., 2000; Hilbert & Tuschen-Caffier, 2007). Additionally, dietary
restraint is negatively associated with neural activation in brain
regions responsible for impulse control in obese BED, but not in
obese non-BED individuals (Balodis et al., 2013). Furthermore, a
relationship between desire to binge eat and anxiety ratings fol-
lowing stress was reported in obese BED patients, but not obese
or normal weight non-BED controls (Rosenberg et al., 2013). The
present study builds upon these previous reports by being the first
to assess the relationship between psychophysiological factors and
measurable snack food intake, as opposed to self-reported eating
behaviors, following a mental stress manipulation as a function of
obesity and BED status.
Our findings for a connection between psychological factors and
stress-induced snacking only in obese BED women may at first
seem to be a result of the heightened levels of dietary restraint,
negative affect, and anxiety found in this group. While obese BED
women did in fact report greater levels of dietary restraint, neg-
ative affect, and anxiety compared to normal weight non-BED
women, levels were not significantly different from obese non-BED
women. Consequently, overall greater psychological impairment is
unlikely to explain this distinction between obese BED and non-
BED groups. Instead, results indicate that dietary restraint, and
to a lesser extent, stress-induced changes in anxiety and cortisol,
are associated with snack food intake in obese women with BED.
Specifically, the smaller percentage of poured snack food that was
consumed in the obese BED group may be explained by an enhanced
stress-induced motivational drive to eat coupled with the influence
of dietary restraint on caloric consumption.
In contrast, physiological factors in addition to homeostatic
hunger were associated with stress-induced snacking in NW non-
BED women. Specifically, greater stress-induced changes in heart
rate and cortisol were associated with less calories poured and
consumed. Although heightened physiological responses to stress
are typically linked with enhanced food consumption, individ-
ual differences contribute to variance in the relationship between
stress and eating (Adam & Epel, 2007). Stress has been linked
to both under- and over-eating, a phenomenon known as the
stress-eating paradox. Individual difference factors such as obesity,
dietary restraint, and chronic perceived stress contribute to this
variance, with greater levels being associated with stress-induced
overeating (Adam & Epel, 2007). In the present study, these mea-
sures were lower in NW non-BED women compared to Obese BED
women and thus may have contributed to the negative relationship
between physiological stress and snacking behaviors in the NW
non-BED group. Future studies assessing the impact of psychophys-
iological factors on stress-induced eating as a function of obesity
and BED status are warranted to further explicate this notion.
Strengths of the current study include our nuanced analysis of
snacking behaviors. Incorporating new methods for the assessment
of eating are imperative in order to elucidate factors that distin-
guish obesity, BED, and other eating disorders, and subsequently
inform diagnostic and treatment strategies (Herzog, Douglas,
Kissileff, Brunstrom, & Halmi, 2016). An additional strength of
the current study was the strategy used to recruit women with
BED. Participant expectations susceptible to influencing food con-
sumption (Robinson, Kersbergen, Brunstrom, & Field, 2014) that
are inherent to studies recruiting from treatment facilities or clin-
ics were reduced by enrolling members of the community in a
metropolitan area who were blind to the study’s focus on BED.
Furthermore, the racial and ethnic diversity of our participants
increased the applicability of our findings to community samples,
particularly in light of the evidence that non-Hispanic black women
have the highest obesity rates in the United States, adjusting for age
(Flegal, Carroll, Kit, & Ogden, 2012). The present study also included
a food anticipation period post-stress to more closely resemble real
world scenarios in which the ability to consume palatable foods
may not be possible immediately following a stressor. Findings for
obesity- and BED-related differences in eating behaviors and dif-
ferential moderators of the relationship between stress and caloric
consumption were documented in light of this delay, indicating
that long term effects of acute stress may have unique implications
in obese and BED populations.
Despite its strengths, the present study was not without its
limitations, including the inability to compare eating behaviors
following both stress and rest. It is possible that the reported dif-
ferences in the ratio of snack food poured to consumed may have
been present regardless of the stress manipulation and this should
be investigated in future studies. In addition, we measured con-
sumption of only one preferred snack food 45 min post-stress, and
thus our findings cannot be extrapolated to stress-induced binge
eating, per se. The fact that our participants were not asked to binge
eat, but only given the option to eat, may alternatively be consid-
ered a strength given the demand characteristics associated with
 R.R. Klatzkin et al. / Biological Psychology 131 (2018) 96–106
asking individuals with BED to display eating behaviors associated
with their diagnosis (Robinson et al., 2014). Finally, our sample was
limited in size and our interpretations should be viewed cautiously
pending replication in larger and more diverse samples. Indeed,
cautious interpretation is warranted given the unexpected finding
of a nonsignificant stress-induced increase in cortisol.
In conclusion, our preliminary findings indicate that stress-
induced snacking in obese women may be associated with a
heightened motivational drive to eat, coupled with a reduced plea-
sure from eating. Furthermore, correlational results suggested that
psychological factors may be (1) more strongly associated with
the motivational, rather than the pleasurable, aspects of eating for
women in general, and (2) more salient indicators of stress-induced
snacking than physiological hunger among obese women with BED
than among women without BED. Differentiation in the moderators
of stress-induced snacking between obese women with BED and
both obese and normal weight non-BED women suggest that mul-
tiple, varying prevention and treatment strategies may be needed
for obesity and BED. Thus, future studies providing a more pre-
cise approach to measuring food intake may help advance the field
by uncovering nuanced eating behaviors that distinguish stress-
induced eating in obesity and BED.
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