The ideal body prototype, the self-imposed canons of beauty in society and/or the fear of gaining weight is a widespread contemporary feeling. All of these affect the emotional relationship with food.

In fact, the caloric or nutrient content of food, even if false, can alter emotions toward food. Macht et al 2003 conducted a study where they observed that negative emotions occurred more frequently when the energy content of food increased. In other words, when the subjects were told that the food they had eaten was higher in calories, the subjects’ happiness decreased, especially in women who were obese. Therefore, we confuse the energy value of food with its healthiness, thinking that the higher the energy content of food, the more “unhealthy” and “dangerous” that food is considered to be.

This undoubtedly contributes to the emotion/food relationship, and when we eat certain foods that are initially attractive and pleasurable, when consumed they generate a feeling of guilt for being too high in calories. This tends to be common, especially after excessive restriction of food for aesthetic purposes. In fact, very rigid dietary approaches have been shown to be associated with binge eating, especially in the presence of disinhibitors such as alcohol or stress (Sainsbury K 2017; Evans EH 2018).

This emotion/food relationship undoubtedly is one of the problems to be addressed in the treatment of obesity and/or eating disorders. Difficulties in emotion regulation are associated with binge eating and may represent a barrier to the effectiveness of long-term intervention in obesity.

Inadequate emotion regulation can result in overeating in response to negative emotions and using food to suppress unpleasant emotional experiences. This is known as “emotional hunger” (Evers et al, 2010). Emotional hunger is associated with worse prognoses in dealing with obesity, with worse weight loss outcomes (Canetti et al 2009).

Therefore, in some individuals, a vicious circle is generated that maintains or worsens the state of obesity, being that their negative emotional state increases food intake and as a consequence, an increase in body weight, causing greater dissatisfaction with their physique, lower self-esteem and enhancing this negative emotional state.

On the other hand, a healthy and balanced diet translates into greater satisfaction on a psychological level, greater energy and, in turn, can be linked to a healthy lifestyle, which can be translated into the practice of physical exercise and, in this way, intervene in an increase in satisfaction and self-esteem.

In terms of gender, women tend to present greater rejection and negative emotions towards food, which is related to weight gain (Narchi et al 2008), but this circumstance is increasingly seen among men.

What can dietitians and/or dietitian-nutritionists do?
Obviously, referral to professional psychologists is a must in most cases, at least the most profound ones. In our duty, we must take into account some premises that can help. For a correct compliance with the diet, in all patients, but fundamentally in the “emotionally fragile” patient, or who eats as a response to emotions, we must:

• Resort to techniques of motivation and reinforcement of self-esteem and self-confidence.
• Identify those emotions related to eating.
• Restructure erroneous thoughts and demystify concepts.
• Establish the maintenance of healthy nutritional habits.
• Establish achievable goals to avoid early frustrations.
• To be part of a multidisciplinary team that includes medical, nutritional and psychological aspects.

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