Bidirectional longitudinal associations between adiposity and emotional and uncontrolled eating in an observational United Kingdom population-based cohort

Background Eating behavior traits (EBTs), including uncontrolled eating (UE) and emotional eating (EE), are associated with higher body weight and adiposity. However, evidence on temporal and bidirectional relationships between EBTs and adiposity in adults is limited. Objectives This study aimed to examine longitudinal, bidirectional associations between EBTs and adiposity in a large population-based cohort of middle-aged adults. Methods Data were from phase 1 (2005‒2015) and phase 2 (2014‒2020) of the Fenland cohort, a prospective study of adults living in Cambridgeshire, United Kingdom, born between 1950 and 1975. UE and EE were analyzed in relation to objectively measured body mass index (BMI, in kg/m2) and dual-energy X-ray absorptiometry–derived percent body fat (%BF). Bidirectional associations between baseline EBTs and changes in adiposity, and between baseline adiposity and changes in EBTs, were examined using bivariate latent change score models. Analyses were stratified by sex and adjusted for age, education, and household income. Results In both females and males, higher BMI at phase 1 was associated with greater increases in UE [e.g., females: γ1: 0.13; 95% confidence interval (CI): 0.006, 0.25; P = 0.04] and EE (e.g., females: γ1: 0.54; 95% CI: 0.34, 0.74; P < 0.0001) from phase 1 to phase 2, whereas baseline UE and EE were not associated with subsequent changes in BMI. Similar patterns were observed for %BF, with higher baseline adiposity associated with increases in UE and EE over time, but not vice versa. Sensitivity analyses generally supported the primary findings, although associations between adiposity and subsequent UE in females were attenuated and no longer statistically significant. Conclusions Findings challenge assumptions that UE and EE are drivers of adult weight gain and instead suggest that higher adiposity may contribute to the development or escalation of dysregulated eating behaviors. Interventions may benefit from addressing the behavioral and psychological consequences of higher body weight alongside traditional weight-focused strategies.