Mediation of emotional and external eating between dieting and food intake or BMI gain in women

Objective: Dieting to control body weight is often associated with weight gain, particularly so in women; however, the underlying mechanisms are unclear. In a series of studies on women, we examined whether the relationship between dieting and weight gain can be explained by (serial) mediation of emotional eating (EE) and/or subsequent external eating (EX). Methods: In a pilot study (116 women), we first assessed this (serial) mediation between dieting or dietary restraint and actual food consumption in the laboratory. In Study 1, a four-year follow up on patients with newly diagnosed type 2 diabetes (51 women), we assessed this (serial) mediation between dietary restraint and change in BMI and intake of energy (Kcal; Food Frequency Questionnaire). In Study 2, a three-year follow up study in a representative Dutch sample (287 women), we assessed this (serial) mediation between dieting and change in BMI. Results: There was consistent support for (serial) mediation: In the pilot study, frequency of dieting and dietary restraint were both indirectly associated with grams of crackers eaten through EE and EX. In study 1, dietary restraint had a significant (95% CI) indirect association with subsequent change in measured BMI and a marginally (90% CI) significant indirect association with intake of energy through EE and EX. In study 2, EE marginally (90% CI) acted as a mediator between frequency of dieting and subsequent self-reported change in BMI. In the subsample of overweight women (n = 146) frequency of dieting was indirectly associated with subsequent self-reported change in BMI through EE and EX. Conclusion: The possibility that female dieters may gain weight through EE and/or subsequent EX should be taken into account when treating women with overweight or obesity.