Construct validity of the Emotional Eating Scale Adapted for Children and Adolescents

Emotional eating has been defined as an enduring behavioral pattern characterized by eating in response to a range of negative emotions [1]. Approximately 10 to 60% of children and adolescents report emotional eating, with higher estimates in adolescent samples [2-4], weight-loss treatment-seeking populations [5], and in youth who report other forms of disinhibited eating [6, 7]. Longitudinal data suggest that pediatric emotional eating is a stable appetitive trait that persists over time [8-10]. Among children and adolescents, emotional eating has been linked to the onset of binge eating episodes [11] and associated with greater eating disorder psychopathology, elevated depressive symptoms, and more internalizing and externalizing problem behaviors [2, 12]. Some [2, 12], but not all [7, 13, 14], studies have found that overweight youth endorse greater emotional eating than non-overweight youth. Despite the adverse psychosocial and physical correlates of emotional eating, few easily administered and validated methods are available to assess emotional eating in youth. As previously published, we adapted the Emotional Eating Scale (EES) for adults to be used with children and adolescents (EES-C) [7]. An examination of its psychometric properties in a community sample of overweight and non-overweight youth suggested that the EES-C has good internal consistency, temporal stability, and convergent and discriminant validity [7]. However, the construct validity of the EES-C remains unknown. To date, there are no known studies that have examined the construct validity of any self-report measure of pediatric emotional eating. Laboratory studies of emotional eating in the adult literature typically have involved the employment of negative mood induction paradigms, during which individuals are randomized to either a negative or neutral mood induction (e.g., using a brief film clip) and subsequently given access to food. Most adult studies have demonstrated null findings, such that there was no relationship between self-reports of emotional eating and energy intake in the laboratory following negative (vs. neutral) mood inductions [15, 16]. In the few studies that have reported a positive relationship, self-reported emotional eating was associated with energy intake following a negative mood induction, but only among a subset of participants who actually reported experiencing the intended negative affective state [17, 18]. Indeed, one of the drawbacks of mood induction paradigms is the high degree of inter-individual variability in response to laboratory stressors (e.g., individuals have different levels of emotional reactivity to a standardized negative mood paradigm) [19-21]. Therefore, an alternative approach to capturing “emotional eaters” is to examine the relationship of state negative affect immediately prior to eating with objective assessments of energy intake at a laboratory test meal, in the absence of an artificial mood induction. In a secondary analysis of a study that investigated normal and disinhibited eating behaviors in youth [22], we aimed to test the construct validity of the EES-C by examining the associations among EES-C scores, pre-meal state negative affect, and measured energy consumption. Specifically, we hypothesized an interaction between the EES-C and pre-meal state negative affect, such that the association between pre-meal state negative affect and energy intake would be more positive among youth with high EES-C scores than among those with low EES-C scores. We expected to observe these associations independent of BMI-z and other relevant demographic covariates.