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PLOS ONE logoLink to PLOS ONE
. 2023 Aug 31;18(8):e0286439. doi: 10.1371/journal.pone.0286439

Emotional overeating affected nine in ten female students during the COVID-19 university closure: A cross-sectional study in France

Aymery Constant 1,2,#, Alexandra Fortier 1,#, Yann Serrand 1, Elise Bannier 3,4, Romain Moirand 1,5, Ronan Thibault 1,6, Nicolas Coquery 1, Ambre Godet 1,, David Val-Laillet 1,‡,*
Editor: Roberto Ariel Abeldaño Zuñiga7
PMCID: PMC10470954  PMID: 37651411

Abstract

Objectives

To estimate the proportion of female university students reporting overeating (EO) in response to emotions during the COVID-19 university closures, and to investigate social and psychological factors associated with this response to stress.

Design

Online survey gathered sociodemographic data, alcohol/drugs use disorders, boredom proneness and impulsivity using validated questionnaires, and EO using the Emotional Overeating Questionnaire (EOQ) assessing eating in response to six emotions (anxiety, sadness, loneliness, anger, fatigue, happiness), whose structure remains to be determined.

Participants

Sample of 302 female students from Rennes University, France.

Main outcome measure

Frequencies of emotional overeating.

Analysis

The frequency of emotional overeating was expressed for each emotion as percentages. Exploratory Factor analyses (EFA) were used to determine EOQ structure and provide an index of all EOQ items used for further analysis. Linear regression models were used to explore relationships between EO and others covariates.

Results

Nine in ten participants reported intermittent EO in the last 28 days, mostly during 6 to 12 days, in response to Anxiety (75.5%), Sadness (64.5%), Happiness (59.9%), Loneliness (57.9%), Tiredness (51.7%), and to a lesser extent to Anger (31.1%). EFA evidenced a one-factor latent variable reflecting “Distress-Induced Overeating” positively correlated with internal boredom proneness, tobacco use, attentional impulsivity, inability to resist emotional cues, and loss of control over food intake, and negatively with age and well-being. EO was unrelated to body mass index or substance abuse.

Conclusion and implications

Nine in ten female students reported emotional overeating during the COVID-19 university closure. This response to stress was related to eating tendencies typical of young women, but also to personality/behavioral patterns such as boredom and impulsivity proneness. Better understanding of the mechanisms underlying EO in response to stress and lack of external/social stimulation would improve preventive interventions.

Introduction

Studying at a university is a period of socialization for young adults, and studies show that contacts with others positively influence well-being [1]. But in the early stages of the COVID-19 crisis, universities and other educational establishments switched from classroom to online teaching, precluding social/external stimulations and support. Apart from a short period between September and October 2021, universities across France remained fully closed between March 2020 and August 2021, and students were already vulnerable to mental health problems [2, 3] when they had to face this unprecedented situation, which drastically changed their social and professional lives [4, 5]. As a result, French students showed higher depressive symptoms than non-students during the first national lockdown (March-May 2020), comparable rates during the easing phase (August-October 2020), and again dramatic increases during the second lockdown (October-December 2020).

When individuals have difficulty adapting to stressful situations, they may display coping responses susceptible to jeopardize their health and well-being [6], such as addictive and other maladaptive behaviours [7]. In France, The COVID-19 pandemic and lockdown resulted in frequent and mostly unhealthy changes in lifestyle among the general population, but addictive behaviour such as drinking and smoking remained under control [8, 9]. When it comes to eating habits, however, findings from a systematic review of 23 studies indicated a shift towards modified eating behaviours, characterized by an increased snack frequency and a preference for sweets and ultra-processed food rather than fruits, vegetables, and fresh food [10]. Changes in eating habits amid stressful situations may be related to “emotional eating”, traditionally defined as (over)eating in response to negative emotions [11]. This behaviour may occur as a time-limited response to emotions in individuals without clinical condition [12], but may also correlate with binge frequency, eating disorder features, and depression. From a clinical perspective, emotional eating has received increasing attention, particularly because a negative emotional state is the most widely reported antecedent to binge eating episodes [11].

Young women could have been particularly vulnerable to emotional overeating during the COVID-19 crisis. Firstly, they were more likely to report the negative impacts of COVID-19 on stress levels to be very much or an extreme amount compared to males, whereas males were more likely to report the negative impacts to be not at all or a little compared to females [13]. Secondly, research suggests a gender difference in stress-related eating, with women choosing more palatable food [14, 15] and being more prone than men to turn to food for psychological comfort rather than physiological need [1619]. Thirdly, one review highlighted that women have genetic predisposition for higher impulsivity and higher reward sensitivity, which are associated with dopamine dysregulation during comfort eating [20]. Impulsivity could be defined as a predisposition toward rapid, unplanned reactions to internal or external stimuli without regard to the negative consequences of these reactions [21], which has been found associated with stress eating [22, 23]. Finally, young women are more likely than men to eat while bored, especially when boredom-prone [24], and a review suggested that quarantine, reduced social and physical contacts with others were frequently shown to cause boredom [25]. Altogether, as women were more likely to report social isolation as being difficult or very difficult compared to men during the COVID-19 crisis [13], the COVID-19 university closures may have increased emotional eating in female students, particularly among those prone to boredom and/or impulsivity.

Characterizing emotional overeating during the COVID-19 pandemic university closure is of importance, since this coping response could further lead to addictive and health problems [26]. We chose female students as the sample of interest since they share personality/behavioural patterns that could increase the likelihood of emotional overeating during the COVID-19 university closures. The specific objectives of our study were to estimate the proportion of female university students reporting overeating (EO) in response to emotions during the COVID-19 university closures, and to investigate social and psychological factors associated with this response to stress.

Materials and methods

Participants and procedure

To meet the study objectives, we conducted an online survey between February and May 2021. Female students from the University of Rennes (France) aged 18–24 years who responded to a call for volunteers via students’ mailing lists were eligible. A study number was attributed to each participant for pseudonymisation in a secured database to ensure confidentiality, as email addresses and personal information were recorded in a separate file in a locked computer. Only two researchers implicated in the study had access to the secured file, which was not accessible for the researcher who performed data analyses. In order to obtain consent, participants agreed to participate in the study by sending us an e-mail of acceptance, and then they received their pseudonymisation number and the link to complete the questionnaire. This reply email was then deleted. After free and informed written consent, participants completed questionnaires assessing psychological and behavioural variables, together with sociodemographic characteristics such as age (in year), weight (in kg), height (in cm), tobacco use (never, occasional, regular), and housing (living alone, with a partner, family or with roommates). Being aged less than 18 and more than 24 years old were the only non-inclusion criteria. Any medical information was excluded from data collection. The INRAE data protection agent approved the declaration of conformity of this online questionnaire study, which was used for the selection of volunteers to be included in a laboratory neurocognitive study conducted in the Rennes University Hospital and approved by an independent national research ethics committee under the supervision of the French Ministry of Higher Education, Research and Innovation (Comité de Protection des Personnes “Ile de France XI”, project N°21.02859.000020–21071; N°ID-RCB/EUDRACT 2021-A02314-37; National Clinical Trial number: NCT05200182). This study was conducted in accordance of the principles of the Declaration of Helsinki.

Measures

Frequency of overeating episodes in response to emotions

The Emotional Overeating Questionnaire (EOQ) is a six-item self-report questionnaire that assesses frequency of overeating episodes in response to six emotions, namely anxiety, sadness, loneliness, tiredness, anger, and happiness, previously used in a French study [27]. Its factor structure in French young women remains however to be determined using Exploratory Factor analyses (EFA). Each item begins with, “Have you eaten an unusually large amount of food given the circumstances in response to feelings of (…)”. Each of the six emotions is presented in all capital letters, followed by three more synonyms in parentheses and in lower case. The response set for the six items is a 7-point scale reflecting the frequency of days on which the behaviour occurred in the past 28 days (i.e., 0 = no days, 1 = 1–5 days, 2 = 6–12 days, 3 = 13–15 days, 4 = 16–22 days, 5 = 23–27 days, and 6 = every day).

Alcohol or substance abuse

The CRAFFT Screening Test consists of a series of six questions developed to screen adolescents for high-risk alcohol and other drug use disorders [28, 29]. It is a short, effective screening tool meant to assess whether a longer conversation about the context of use, frequency, and other risks and consequences of alcohol and other drug use is warranted. The questions are the following. 1) Have you ever ridden in a car driven by someone (including yourself) who was "high" or had been using alcohol or drugs? 2) Do you ever use alcohol or drugs to relax, feel better about yourself, or fit in? 3) Do you ever use alcohol/drugs while you are by yourself, alone? 4) Do you ever forget things you did while using alcohol or drugs? 5) Do your family or friends ever tell you that you should cut down on your drinking or drug use? 6) Have you gotten into trouble while you were using alcohol or drugs? A score of two positive answers or above indicates a potential drug issue. Diagnostic threshold for regular substance use in the French version of the CRAFFT was fixed at two positive answers with a sensitivity of 90.3% and a specificity of 77.7%.

Boredom proneness

The Boredom Proneness Scale (BPS) was developed by Farmer and Sundberg as a measure of the tendency to become bored. In the French validation study, factorial analyses yielded a two-factor structure including 26 items out of 28. The boredom proneness (BP) due to a lack of internal stimulation, or “internal BP” subscale includes 14 items related to one’s inability to generate interesting activities, while the boredom proneness due to a lack of external stimulation, or “external BP” subscale includes 12 items related to the perception of low environmental/social stimulation. Internal-consistency reliability coefficients (Cronbach’s α) for each of the two scales were above the 0.70 standard (α = 0.78 and 0.77, respectively). These two dimensions found support in the majority of studies on BP.

Impulsivity

The Barratt Impulsiveness Scale (BIS) is a 30-item self-report scale that is commonly used to measure impulsiveness and was validated in French [30]. Participants responded to each item using a 4-point frequency scale: 1 (rarely/never), 2 (occasionally), 3 (often), and 4 (almost always/always). Factor analysis revealed six primary factors of the scale: 1) attention (e.g., “I am restless at the theatre or lectures”), 2) motor impulsiveness (e.g., “I do things without thinking”), 3) self-control (e.g., “I say things without thinking”), 4), cognitive complexity (e.g., “I get easily bored when solving thought problems”), 5) perseverance (e.g., “I change jobs”), and 6) cognitive instability (e.g., “I have ‘racing’ thoughts”). Three secondary factors have been identified: attentional impulsiveness (mixture of primary factors 1 and 6), motor impulsiveness (mixture of primary factors 2 and 5), and non-planning impulsiveness (mixture of primary factors 3 and 4). Internal-consistency reliability coefficients (Cronbach’s α) for each of the three secondary factors were 0.70, 0.69 and 0.67, respectively. Attentional impulsiveness is defined as the difficulty focusing on a task at hand, motor (or behavioural) impulsiveness is defined as acting without thinking or on the spur of the moment, while non-planning impulsivity is characterized as present-moment focus without regard for future consequences.

Well-being

The World Health Organization Well-Being Index (WHO-5) is a 5-item questionnaire assessing subjective psychological well-being in research and clinical settings, and available in 30 languages including French. The WHO-5 consists of five statements, which respondents rate according to a frequency scale (0 = at no time; 5 = all the time) indicative of positive mood (good spirits, relaxation), vitality (being active and waking up fresh and rested), and general interest (being interested in things). Item response theory analyses in studies of younger persons and elderly persons indicate that the measure has good construct validity as a unidimensional scale measuring well-being in these populations [31]. The total raw score, ranging from 0 to 25, is multiplied by 4 to give the final score, with 0 representing the worst imaginable well-being and 100 representing the best imaginable well-being. A score below 50 can indicate poor well-being which may be secondary to a depressive disorder or other etiology and is an indication for further evaluation.

Cognitive and behavioural components of eating

According to another study [32], we used the Three-Factor Eating Questionnaire Revised, 18-item (TFEQ-R18) to measure cognitive and behavioural components of eating. Three subscales are included in this questionnaire: (1) Cognitive Restraint (conscious restriction of food intake in order to control body weight or to promote weight loss) comprised of six items (e.g., “I consciously hold back at meals in order not to gain weight), (2) Uncontrolled Eating (tendency to eat more than usual due to a loss of control over intake accompanied by subjective feelings of hunger), comprised of nine items (e.g., “When I see a real delicacy, I often get so hungry that I have to eat right away”), and (3) Emotional Eating (inability to resist emotional cues), comprised of three items (e.g., “When I feel blue, I often overeat”). Internal-consistency reliability coefficients (Cronbach’s α) for each of the three scales were above the 0.70 standard and below the 0.90 limit recommended for individual assessment. Responses are scored on a 4-point scale and anchors can vary across items (e.g., definitely true to definitely false, or never to at least once a week). The raw scale scores are transformed to a 0–100 scale. Higher scores in the respective scales are indicative of greater cognitive restraint, uncontrolled, or emotional eating.

Statistical analyses

We used the same statistical approach as in our previous work on the same topic/population [12]. Categorical data were expressed as numbers (N) and percentages (%) and numerical data were expressed as means (M) and standard deviations (±SD). An exploratory factor analysis was performed on the EOQ items using an Unweighted Least-Square factor analysis. This method was found to provide accurate and conservative parameter estimates when using ordinal data. A Promax rotation, a non-orthogonal (oblique) solution in which the factors are allowed to be correlated followed the factor. in order to establish which of the 6 items in EOQ belonged to latent domains or conceptual areas and which items should be maintained in factor scores. Factor scores are composite linear variables which provide information about an individual’s placement on the factor(s), and can be used as an index of EOQ items for further analysis. A generalized linear regression model to estimate the strength of the association between emotional overeating and each covariate (univariate analysis) as the factor score was a linear variable. In order to determine variables independently associated with EO, all variables that demonstrated an association with p < 0.05 in the univariate analysis were considered as candidate variables in the multiple linear regression model. The pseudo R-squared is not discussed in generalized linear models texts [33]. Statistical analyses were performed using the SPSS statistical package, version 19 (SPSS, Chicago, Illinois, United States).

Results

Descriptive analysis

Survey questionnaires were filled by 320 university women students between February and May 2021, but 18 (4.8%) were rejected because of missing data in EOQ. The 302 remaining respondents were aged 20.9 years on average (Table 1), with a minority living alone (37.4%). The mean Body Mass Index (±SD) was 21.7±3.4, and most of participants were normal-weight students (75.8%) while 11.3% were underweight and 12.9% had overweight/obesity. Standardized subscales mean scores (ranging from 0 to 100) of the TFEQ-R18 were 37.0±24.4 for Cognitive Restraint, 43.1±22.4 for Uncontrolled Eating, and 55.5±30.9 for Emotional Eating. Boredom Proneness (BP) Standardized subscales mean scores were 29.2±20.8 for internal and 44.9±21 for external BP, while Barratt Impulsiveness Scale (BIS) Standardized subscales mean scores were 39.9±15.5 for attentional, 28.4±10.1 for motor, and 37.9±13.12 for non-planning impulsivity.

Table 1. Characteristics of the respondents (N = 302).

Variables N (%)
Age 20.9±1.8
Living condition
 Flatshare 61 (20.2)
 In family 74 (24.5)
 In couple 54 (17.9)
 Alone 113 (37.4)
BMI (mean±SD) index 21.7±3.4
Weight status (BMI)
 Obesity (>30) 8 (2.6)
 Overweight (25–29.9) 31 (10.3)
 Normal (18–24.9) 229 (75.8)
 Underweight (<18) 34 (11.3)
Tobacco use 40 (13.2)
Boredom proneness (range 0–100)
 Internal 29.2±20.8
 External 44.9±21.2
Impulsivity (range 0–100)
 Attentional 39.9±15.5
 Motor 28.4±10.1
 Non planning 37.9±13.1
WHO Well-being score (range 0–100) 55.8±19.8
Alcohol/Substance abuse (CRAFTT) 44 (14.6)
Components of Eating (TFEQ-R18)
 Cognitive restraint 37.0±24.4
 Uncontrolled eating 43.1±22.4
 Emotional eating 55.5±30.9

Note: BMI = Body Mass Index; SD = standard deviation.

: The raw scale scores were transformed to a 0–100 scale [((raw score − lowest possible raw score)/possible raw score range) × 100]. Higher scores in the respective scales are indicative of greater cognitive restraint, uncontrolled, or emotional eating.

Emotional overeating frequency in the last 28 days

Nine in ten respondents (91.4%) reported Emotional overeating episodes during at least 1–5 days in the past month. EO episodes reached at least 6 days in 60.3% of cases, and 13–15 days in 38.4% of cases. One in four (24.8%) reported EO episodes exceeding 15 days in the last 28-day period. They reported emotional overeating episodes mostly in response to anxiety (75.5%), sadness (64.9%), happiness (59.9%), loneliness (57.9%) and tiredness (51.7%). Only 31.1% of them reported OE episodes in response to anger (Table 2). Unweighted Least-Square exploratory factor analysis followed by a Promax rotation was performed on the 6 EOQ items. After the first rotation, the “Happiness” item was removed because it loaded relatively low (< 0.40) on the two-factor solution (Eigen values > 1). A final extraction was performed on the remaining 5 items (Anxiety; Loneliness; Sadness; Anger; and Fatigue), resulting in a one-factor solution explaining 66% of the common variance of the data (Table 3). This latent variable was interpreted as “Distress-Induced Overeating” (DIO), and a factor score was computed and used as dependent variable in the multivariate analysis. Frequency of overeating episodes in response to Happiness was used as a single outcome.

Table 2. Emotional eating days in the last 28 days in response to six emotional states among the study sample (N = 302).

Data are expressed as Number and Percentages (%).

0 day 1–5 days 6–12 days 13–15 days >16 days
Anxiety 74 (24.5) 115 (38.1) 44 (14.6) 19 (6.3) 50 (16.6)
Sadness 106 (35.1) 101 (33.4) 39 (12.9) 23 (7.6) 33 (10.9)
Loneliness 127 (42.1) 87 (28.8) 39 (12.9) 23 (7.6) 26 (8.6)
Anger 208 (68.9) 65 (21.5) 13 (4.3) 4 (1.3) 13 (4.0)
Tiredness 146 (48.3) 80 (26.5) 25 (8.3) 15 (5.0) 36 (11.9)
Happiness 121 (40.1) 87 (28.8) 37 (12.3) 27 (8.9) 30 (9.9)

Table 3. EOQ items and factor loadings for the two- and the one-factor solutions.

EOQ Items First rotation 1 factor solution ‡
Factor 1 Factor 2
Anxiety 0.72 0.11 0.70
Sadness 0.89 -0.28 0.91
Loneliness 0.79 -0.35 0.79
Anger 0.67 -0.07 0.69
Tiredness 0.76 0.34 0.69
Happiness 0.44 0.51
Eigen value 3.50 1.01 3.3
% of variance 58.3 16.7 66.0
Cronbach Alpha 0.86

: Rotated factor loadings following unweighted least square extraction and oblique (promax) rotation; ‡ Unrotated factor loadings following unweighted least square extraction, after the “Happiness” item was removed.

Multivariate analysis

In univariate analysis (Table 4; Univariate estimates), the DIO factor score was positively associated with tobacco use, boredom proneness, substance abuse, inability to resist emotional cues (EE), and loss of control over food intake (uncontrolled eating, UE). It was negatively associated with age and well-being. In multivariate analysis (Table 4; Multivariate estimates), the DIO factor score was positively associated with tobacco use, boredom proneness, the inability to resist emotional cues (EE), and loss of control over food intake (uncontrolled eating, UE). It was negatively associated with age. In univariate and multivariate analyses, overeating in response to happiness (Table 5) was positively associated with well-being and uncontrolled eating, and more frequent in participant living in family as compared to those living alone.

Table 4. Factors associated with distress-induced overeating factorial score, generalized linear model.

Variables Univariate estimates Multivariate model
B p-value B p-value
Age -0.085 0.006 -0.072 0.004
Living condition
 Flat share -0.112 0.458
 In family -0.007 0.963
 In couple -0.043 0.785
 Alone Ref
Body Mass Index
 >25 0.203 0.215
 <18 -0.114 0.511
 18–24.9 Ref
Boredom proneness
 Internal 0.146 <0.001 0.070 <0.001
 External 0.147 <0.001 0.027 0.250
Impulsiveness
 Attentional 0.075 <0.001 0.029 0.038
 Motor 0.017 0.410
 Non Planning 0.046 <0.001 -0.001 0.903
Tobacco use
 Yes 0.444 0.006 0.325 0.014
 No Ref Ref
WHO Well-being score -0.018 <0.001 -0.007 0.130
Alcohol/Substance abuse (CRAFTT)
 Yes 0.353 0.024 0.003 0.772
 No ref Ref
Components of Eating (TFEQ-R18)
 Cognitive restraint -0.023 0.761
 Uncontrolled eating 0.064 <0.001 0.033 0.001
 Emotional eating 0.141 <0.001 0.046 0.029

Table 5. Factors associated with the overeating frequency in response to happiness, generalized linear model.

Variables Model 1 Model 2
Estimate p-value Estimate p-value
Age -0.078 NS
Living condition
 Flat share -0.196 NS -0.155 NS
 In family 0.578 0.009 0.547 0.011
 In couple 0.421 NS 0.418 0.079
 Alone Ref Ref
Weight status
 Overweight /obesity 0.058 NS
 Underweight -0.301 NS
 Normal weight Ref
Boredom proneness
 Internal -0.007 NS
 External -0.035 NS
Tobacco use
 Yes 0.404 NS
 No Ref
WHO Well-being score 0.013 0.002 0.014 0.001
Impulsivity
 Attentional 0.028 NS
 Motor 0.062 0.017
 Planning 0.061 0.002
Alcohol/Substance abuse (CRAFTT)
 Yes -0.242 NS
 No ref
Components of Eating (TFEQ-R18)†
 Cognitive restraint 0.016 NS
 Uncontrolled eating 0.047 0.001 0.051 <0.001
 Emotional eating 0.020 NS

Discussion

Our results showed that 9 in 10 female students included in our study reported intermittent Emotional Overeating in the last 28 days, mostly during 6 to 12 days, in response to Anxiety (75.5%), Sadness (64.5%), Happiness (59.9%), Loneliness (57.9%), Tiredness (51.7%), and to a lesser extent in response to Anger (31.1%). Exploratory factor analysis evidenced a one-factor latent variable reflecting “Distress-Induced Overeating” (DIO) including all EOQ items except Happiness, as previously described in a comparable population before the COVID-19 pandemic [12]. In multivariate analysis, the DIO factor score correlated positively with internal boredom proneness, tobacco use, attentional impulsivity, inability to resist emotional cues, and loss of control over food intake. It correlated negatively with age and well-being. Overeating in response to happiness correlated positively with living in family, well-being and loss of control over food intake. Overeating was not significantly related to BMI or substance abuse.

Studies on the effects of the pandemic on student mental health showed significant levels of stress, anxiety, depressive symptoms, concerns for oneself and one’s family’s health, reduced social interactions, and increased concerns over academic achievements [34]. Accordingly, the standardized well-being score in our study population was barely above the average of 50 (over 100) in our participants. In normal situations, students may use social and physical activities to cope with stress [35], but the reduction in social (collective training sessions or sport events) and physical (restricted access to exercise facilities, sport grounds and parks) opportunities to exercise increased sedentary behaviour [8]. The proportion of female student reporting alcohol or substance abuse (12.2%) or regular smoking (7.2%) was however quite low in our study sample and similar to pre-pandemic levels [12]. While addictive disorders remained relatively under control, it seems that the COVID-19 crisis affected deeply eating behaviours in female students, since 91.4% of female students reported emotional overeating in the last month against half of the female students from the same university surveyed three years before [12]. Environmental constraints are likely to influence the type of coping strategies available such as social drinking, given that access to pubs and outdoor gatherings were restricted. And overeating was perhaps perceived as a coping response safer than alcohol consumption in female students continuing their courses and programs online amid social disruptions, which would need to be confirmed by specific questionnaires on individual motivation and perception. These behaviours were however not significantly related to short-term weight outcomes since the proportion of female students with overweight/obesity in our study sample was similar to national estimates prior the COVID-19 crisis [36].

Previous studies have underscored the specific role of anxiety on overeating [3739], but descriptive and factor analyses indicated that sadness and loneliness also contributed greatly to distress-induced overeating (DIO) in our participants, reflecting the particular situations of students working remotely. In addition, personality/behavioural patterns typical of our French young women such as uncontrolled eating (UE) and inability to resist emotional cues (EE) were also related to DIO, together with BP and impulsivity. In univariate analysis, DIO had the strongest independent association with internal and external BP. Under non-pandemic circumstances, boredom-prone individuals tend to experience varying degrees of hopelessness, loneliness, distractibility, lack of motivation, and general dissatisfaction, and may use unhealthy and potentially addictive behaviours as coping mechanisms [24, 4042]. It must be noted that eating in response to happiness was related but distinct from DIO, and seemed to influence food intake in relation to normal (i.e., uncontrolled eating, well-being, and family life) rather than pathological forms of eating tendencies [43, 44].

In multivariate analysis, our findings suggest that emotional overeating was related to the inability to generate interesting activities during the pandemic in a context of limited social/external stimulations. This is in line with a study conducted in France showing that failure in engaging in a creative activity to overcome uncertainty and solitude fostered responses not requiring special or creative skills, such as overeating, particularly in women [45]. When it comes to impulsivity, higher impulsivity scores in healthy normal-weight women tend to predict higher food intake [46], and attentional impulsivity (i.e., the difficulty focusing on a task at hand) is consistently related to various measures related to overeating, because of attention diverted to palatable food [47]. In contrast, non-planning impulsivity, when the immediately available small reward is preferentially chosen over a delayed larger reward [48], seems to be only weakly related to overeating [49]. Our results are in line with these studies, as only attentional impulsivity was related to DIO in the multivariate analysis. Finally, DIO seemed more frequent in smokers, which may correlate with indicators of academic stress [50], and less frequent in older students.

This study must be interpreted in light of its limitations. First, the cross-sectional design did not allow determining causal inferences about relationships between Emotional Overeating and other covariates under investigation, although personality/behavioural patterns theoretically precede current behaviours. Better understanding of the interactions between stress, coping, personality/behavioural patterns, emotional overeating and the risk of diseases, such as metabolic diseases, overweight and obesity, among students warrants a prospective study and follow-up assessments over the university year or cycle. Second, the EOQ has a single item for assessing each emotion-related eating. Although the factor structure and psychometrics properties of the EOQ were investigated in the present study, it still warrants a full validation study including diverse subgroups from the French general population. Finally, eating and psychological disorders, which may be influential on emotional overeating, could Third, some behavioural factors related to emotional overeating (e.g. sleep and physical activity) were not assessed, and BMI estimates could have been biased due to self-reported data. Finally, we must reckon that the 302 respondents included in this study represented only a small percentage of the whole student population in our target University, but our recruitment campaign was performed in only one campus of the University and only female volunteers aged 18-24yo who expressed an interest in this study were recruited. To note, comparable descriptive studies were previously published with a similar number of volunteers [12].

Implications for research and practice

Nine in ten female students reported emotional overeating during the COVID-19 university closure. This response to stress was related to eating tendencies typical of young women, such as uncontrolled eating or inability to resist emotional cues, but also to personality/behavioural patterns such as boredom and impulsivity proneness. In terms of perspective, a better understanding of the attentional, neurobiological and neurocognitive mechanisms underlying emotional eating in response to stress/emotions and lack of external/social stimulation would improve preventive interventions related to disordered eating in women coping with stress and/or isolation [51, 52].

Data Availability

The datasets generated and analyzed for this study are available from the following address: https://doi.org/10.57745/87KZFH.

Funding Statement

The present research was funded by the University of Rennes 1, Fondation de l’Avenir, the Benjamin Delessert Institute, and INRAE. A. Godet received a PhD grant from the University of Rennes 1. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Decision Letter 0

Roberto Ariel Abeldaño Zuñiga

10 Jul 2023

PONE-D-23-13686Emotional overeating affected nine in ten female students during the COVID-19 University closure: A cross-sectional study in FrancePLOS ONE

Dear Dr. Val-Laillet,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.Kindly address the reviewers' suggestions.

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2. We noticed you have some minor occurrence of overlapping text with the following previous publication(s), which needs to be addressed:

- https://hal.science/hal-01856971v1/document

- https://doi.org/10.3389/fnut.2022.920170

- https://doi.org/10.1186/s12889-021-10531-3

In your revision ensure you cite all your sources (including your own works), and quote or rephrase any duplicated text outside the methods section. Further consideration is dependent on these concerns being addressed.

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“The present research was funded by the University of Rennes 1, Fondation de l’Avenir, the Benjamin Delessert Institute, and INRAE. A. Godet received a PhD grant from the University of Rennes 1.”

Please state what role the funders took in the study.  If the funders had no role, please state: "The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript."

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Kindly address the reviewers' suggestions

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Reviewers' comments:

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Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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Reviewer #1: Yes

Reviewer #2: No

Reviewer #3: Yes

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Reviewer #2: Yes

Reviewer #3: Yes

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Reviewer #1: INTRODUCTION: in line 74 where it is stated: “Thirdly, women have genetic predisposition for higher impulsivity and higher reward sensitivity, which are associated with dopamine dysregulation during comfort eating”.

I suggest substantiating the assertion, using more studies supporting it, or in any case affirm that this was observed in “one” particular study, instead of generalizing.

DISCUSSION: in line 308 it is affirmed: “Finally, DIO seemed more frequent in smokers and less frequent in younger students, which may correlate with indicators of academic stress”

I suggest reviewing this affirmation, because the linear regression analysis shows a negative association between DIO and age

Reviewer #2: I suggest the following aspects be completed or appear in the article:

It does not appear as a criterion for non-inclusion of participants, if they having a diagnosis of depression or antidepressant treatment or sleeping pills.

It isn't clear whether physical activity and hours of sleep were evaluated as a control variable, it is important because they could be different in each participant and may affect the study variables.

The results do not present the R2 of the regression models, it is important to include the data to know the fit of the model.

The limitations of the study are recognized, but the inaccuracy of the weight and height measurements to calculate the BMI must be recognized, this could be under or over estimated, also if the control variables of physical activity, diagnosis of depression or treatment were not considered with antidepressants or sleeping pills, you should clarify it in the limitations.

Reviewer #3: The objective of the present investigation was to estimate the proportion of college women who reported overeating in response to emotions during the COVID-19 closure of universities, and to investigate the social and psychological factors associated with this stress response. This topic is extremely important, firstly because there are few studies that deal with the psychological state and secondly because this population already tends to have various affectations at this level.

To obtain their data, they applied an online questionnaire, which is a good method to obtain data remotely in an isolation situation, such as the COVID-19 pandemic.

The authors use adequate and validated tools for the population studied.

The University of Rennes has an enrollment of approximately 30,000 students, the authors recruited 300 students, this is one of the limitations of the study.

This study is important as it confirms that isolation due to the COVID-19 pandemic had a negative impact at different levels, especially in the psychological aspect. That 9 out of 10 students reported emotional overeating behaviors is alarming. This study will help to design interventions aimed at improving the psychological state of students, since many of the disorders adopted during the isolation due to the pandemic are still maintained today

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Reviewer #1: Yes: Graciela F Scruzzi

Reviewer #2: No

Reviewer #3: Yes: Sabina López Toledo

**********

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PLoS One. 2023 Aug 31;18(8):e0286439. doi: 10.1371/journal.pone.0286439.r002

Author response to Decision Letter 0


13 Jul 2023

#1 Response to the editor

Journal requirements:

When submitting your revision, we need you to address these additional requirements.

1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at

https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and

https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf

ANSWER: Heading levels were corrected according to the submission guidelines, as well as table’s title. Manuscript’s text was double-spaced. A short title (<100 characters) was added. The names of the files were modified to fit with the standards.

2. We noticed you have some minor occurrence of overlapping text with the following previous publication(s), which needs to be addressed:

- https://hal.science/hal-01856971v1/document

- https://doi.org/10.3389/fnut.2022.920170

- https://doi.org/10.1186/s12889-021-10531-3

In your revision ensure you cite all your sources (including your own works), and quote or rephrase any duplicated text outside the methods section. Further consideration is dependent on these concerns being addressed.

ANSWER: These three references were added in the manuscript and rephrasing was made in some instances, except for the methods where the appropriate quotation was made without deeply modifying the text. The first two references were cited on the M&M section while the third one was added in the introduction, where evoking the higher prevalence of emotional eating in women compared to men.

3. "Thank you for stating the following financial disclosure:

“The present research was funded by the University of Rennes 1, Fondation de l’Avenir, the Benjamin Delessert Institute, and INRAE. A. Godet received a PhD grant from the University of Rennes 1.”

Please state what role the funders took in the study. If the funders had no role, please state: "The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript."

If this statement is not correct you must amend it as needed.

Please include this amended Role of Funder statement in your cover letter; we will change the online submission form on your behalf."

ANSWER: The following statement was added in the funding section and in the cover letter: “The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.”

4. We note that you have stated that you will provide repository information for your data at acceptance. Should your manuscript be accepted for publication, we will hold it until you provide the relevant accession numbers or DOIs necessary to access your data. If you wish to make changes to your Data Availability statement, please describe these changes in your cover letter and we will update your Data Availability statement to reflect the information you provide.

ANSWER: The data are already available and we provided the corresponding weblink in the “Data Availability Statement” section (p.26): “The datasets generated and analyzed for this study are available at the following address: https://doi.org/10.57745/87KZFH”

5. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

ANSWER: Two studies (Brooks et al. 2020 and Topp et al., 2015) were corrected in the required citing style, and three other studies were added in the reference list: Coquery et al. (2022), McCullagh, P., & Nelder, J.A (1989) and Sze et al. (2021).

2. Review Comments to the Author

Reviewer #1: INTRODUCTION: in line 74 where it is stated: “Thirdly, women have genetic predisposition for higher impulsivity and higher reward sensitivity, which are associated with dopamine dysregulation during comfort eating”.

I suggest substantiating the assertion, using more studies supporting it, or in any case affirm that this was observed in “one” particular study, instead of generalizing.

ANSWER: This assumption was based on a review article; we accordingly added this precision, thank you for the clarification.

DISCUSSION: in line 308 it is affirmed: “Finally, DIO seemed more frequent in smokers and less frequent in younger students, which may correlate with indicators of academic stress”

I suggest reviewing this affirmation, because the linear regression analysis shows a negative association between DIO and age

ANSWER: Thank you for highlighted this mistake, the sentence was corrected accordingly “Finally, DIO seemed more frequent in smokers, which may correlate with indicators of academic stress (Nichter et al. 2007), and less frequent in older students.” (p.19)

Reviewer #2: I suggest the following aspects be completed or appear in the article:

It does not appear as a criterion for non-inclusion of participants, if they having a diagnosis of depression or antidepressant treatment or sleeping pills.

ANSWER: Thank you for your comment. This precision was added in the manuscript lines [105-106] “Being aged less than 18 and more than 24 years old were the only non-inclusion criteria. Any medical information was excluded from data collection.”

It isn't clear whether physical activity and hours of sleep were evaluated as a control variable, it is important because they could be different in each participant and may affect the study variables.

ANSWER: These variables were not controlled in the present study. We added this statement in the limits section lines [326]. “Third, some behavioural factors related to emotional overeating (e.g. sleep and physical activity) were not assessed”

The results do not present the R2 of the regression models, it is important to include the data to know the fit of the model.

ANSWER: The R2 are not indicated nor interpreted in the generalized linear models (GLM). A sentence and reference have been added accordingly in the M&M: “The pseudo R-squared is not discussed in generalized linear models texts (McCullagh & Nelder, 1989).”

The limitations of the study are recognized, but the inaccuracy of the weight and height measurements to calculate the BMI must be recognized, this could be under or over estimated, also if the control variables of physical activity, diagnosis of depression or treatment were not considered with antidepressants or sleeping pills, you should clarify it in the limitations.

ANSWER: We added this precision following the limitations of the lack of reported physical activity and sleeping information, line [327] “, and BMI estimates could have been biased due to self-reported data.”

Reviewer #3: The objective of the present investigation was to estimate the proportion of college women who reported overeating in response to emotions during the COVID-19 closure of universities, and to investigate the social and psychological factors associated with this stress response. This topic is extremely important, firstly because there are few studies that deal with the psychological state and secondly because this population already tends to have various affectations at this level.

To obtain their data, they applied an online questionnaire, which is a good method to obtain data remotely in an isolation situation, such as the COVID-19 pandemic.

The authors use adequate and validated tools for the population studied.

The University of Rennes has an enrollment of approximately 30,000 students, the authors recruited 300 students, this is one of the limitations of the study.

This study is important as it confirms that isolation due to the COVID-19 pandemic had a negative impact at different levels, especially in the psychological aspect. That 9 out of 10 students reported emotional overeating behaviors is alarming. This study will help to design interventions aimed at improving the psychological state of students, since many of the disorders adopted during the isolation due to the pandemic are still maintained today

ANSWER: Thank you for your comment. Even though we reckon that the potential of recruitment at the University of Rennes 1 is around 30,000 male and female students, it is important to precise that our recruitment campaign was performed in only one campus of the University (Beaulieu) and that only female volunteers aged 18-24yo who expressed an interest in this study were recruited. Previous descriptive studies have been performed and published with a similar number of volunteers (e.g. Constant et al. 2018).

Attachment

Submitted filename: Response_to_reviewers_FINAL.docx

Decision Letter 1

Roberto Ariel Abeldaño Zuñiga

15 Aug 2023

Emotional overeating affected nine in ten female students during the COVID-19 University closure: A cross-sectional study in France

PONE-D-23-13686R1

Dear Dr. Val-Laillet,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org.

If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Roberto Ariel Abeldaño Zuñiga

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

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4. Have the authors made all data underlying the findings in their manuscript fully available?

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Reviewer #1: Yes

Reviewer #2: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

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Reviewer #1: Yes

Reviewer #2: Yes

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: I believe that this article is ready to be published, it makes a contribution to the changes in diet during the pandemic. In addition, my suggestions were taken into account and carried out

Reviewer #2: I confirm that the observations I made have been clarified and incorporated in the corresponding sections.

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Reviewer #1: Yes: Graciela Fabiana Scruzzi

Reviewer #2: No

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Acceptance letter

Roberto Ariel Abeldaño Zuñiga

24 Aug 2023

PONE-D-23-13686R1

Emotional overeating affected nine in ten female students during the COVID-19 University closure: A cross-sectional study in France

Dear Dr. Val-Laillet:

I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department.

If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org.

If we can help with anything else, please email us at plosone@plos.org.

Thank you for submitting your work to PLOS ONE and supporting open access.

Kind regards,

PLOS ONE Editorial Office Staff

on behalf of

Dr. Roberto Ariel Abeldaño Zuñiga

Academic Editor

PLOS ONE

Associated Data

    This section collects any data citations, data availability statements, or supplementary materials included in this article.

    Supplementary Materials

    Attachment

    Submitted filename: Response_to_reviewers_FINAL.docx

    Data Availability Statement

    The datasets generated and analyzed for this study are available from the following address: https://doi.org/10.57745/87KZFH.


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