Discussion
weight gain, overweight, weight reduction, chronic disease
REGRESSION, RECRUITMENT, CHRONIC DISEASE
The Healthy Lifestyle Community Program (HLCP, cohort 1) resulted in a change of stress-related eating behaviour after 8 weeks, which was measured by emotional and external eating, which decreased, and restraint eating, which increased. This is in line with our hypotheses before the onset of the study. Although, multiple linear regression modelling did not confirm a significant impact of the HLCP on emotional and external eating behaviour, its impact on restrained eating was significant. Moreover, we found that a greater weight reduction was associated with a smaller change of external eating scores in the intervention group, especially in participants who were overweight.In the control group, an increase of emotional eating was predictive for weight gain.In our sample, a higher BMI was linked to higher levels of emotional and external eating behaviour. Scores of emotional and external eating decreased significantly in the intervention group compared to baseline and more than in the control group. As these two eating styles are related to overeating in stressful situations and to overweightHere, a more intuitive and mindful eating behaviour may contribute to the reduction of stress-eatingAnd yet, although we observed a reduction of emotional and external eating as well as weightMoreover, the mediating effect of changes in stress-eating on weight change should be clarified in mediation models to give insights in the complex interaction of stress-related eating behaviour and weight reduction in the context of comprehensive lifestyle interventions.Notably, the intervention group started with significantly higher levels of emotional and external eating behaviour than the control group. This might have influenced the results, as adjusting for baseline values did not identify the HLCP to be a significant predictor of stress-eating changes. Further research with more comparable groups may give valuable insights into the effect of the HLCP on emotional and external eating behaviour and their impact on weight change.Importantly, the role of restrained eating behaviour as a dimension of stress-eating needs to be further explored. It is generally agreed, that cognitive control of food intake is necessary to successfully reduce weight, and results from the German Weight Control Registry underline, that weight-loss maintenance is associated with higher dietary restraintMoreover, rigid restraint may lead to the above-mentioned vicious cycle, but flexible restraint was shown to not promote weight gainIn accordance with other studiesSome limitations of the study have to be mentioned. First, recruiting from the general population with regard to participation in the Healthy Lifestyle Community Program (HLCP, cohort 1) may have contributed to the considerable higher baseline levels of emotional and external eating, BMI and perceived stress in the intervention group (IG). Despite efforts to enrol comparable participants in both groups, it seems possible that recruitment of participants in the intervention group was influenced by the fact that they had a greater need for interventions to improve weight, eating behaviour, and their general chronic disease risk profile. Second, the mostly female sample might limit the generalizability of these findings. Third, in statistical analysis, subgroups (i.e. normal and overweight as well as high and low stress level) were built retrospectively and were not considered in the calculation of the sample size. Future studies examining the effect of the HLCP on stress-related eating should aim for a replication in a larger sample.