People with anorexia, bulimia, and binge eating disorder BED tend to show either greater basal cortisol or greater cortisol reactivity.

Obesity is associated with HPA axis dysregulation that may originate from increased forward drive, decreased sensitivity to negative feedback regulation, or altered peripheral tissue sensitivity of fat and skeletal muscle tissue to glucocorticoids.

Glucocorticoids also affect visceral fat via their effect on lipid metabolism. Acutely, physiological cortisol concentrations stimulate whole body lipolysis. In the presence of insulin, increased cortisol concentrations inhibit lipid mobilization and favor lipid accumulation either directly by stimulation of lipoprotein lipase, or indirectly by inhibiting the lipolytic effects of growth hormone.

When eating is restrained, the person is making an attempt to control food intake. Restrained eaters tend to eat more compared with free eaters who do not control what they eat when they are under chronic stress. Restrained eaters do not just eat more overall when stressed; they specifically eat more sweet and fatty foods during the high-stress period.

According to Wardle, a reason for this response is that individuals who habitually attempt to control their weight by regulating their food intake restrained eaters may eventually lose this control under stressful situations.

Hunger and appetite are related to an individual's desire to eat food. Both directly trigger eating. Hunger is commonly described as the psychological and biological need for food.

It is a condition that results from consuming less than the recommended daily intake of calories. Hunger sensations range from slight discomfort to real stomach pangs. Appetite is the instinctive physical desire or craving for food. Appetite motivates an individual to eat at a particular time and also what to eat.

Furthermore, appetite has an emotional component, given that it is a learned response that is closely associated with memories of past food experiences. Emotional hunger comes on suddenly: It hits in an instant and feels overwhelming and urgent.

Physical hunger, on the other hand, comes on more gradually. Emotional hunger craves specific comfort foods: When physically hungry, almost anything sounds good, including healthy stuff like vegetables.

But emotional hunger craves fatty foods or sugary snacks that provide an instant rush. Emotional hunger often leads to mindless eating: Before one knows it, he has eaten a whole bag of chips or an entire pint of ice cream without really paying attention or fully enjoying it.

When ones eating in response to physical hunger, he is typically more aware of what he is doing. Physical hunger, on the other hand, doesn't need to be stuffed. One feel satisfied when his stomach is full. Emotional hunger often leads to regret, guilt, or shame: When one eat to satisfy physical hunger, he is unlikely to feel guilty or ashamed because he is simply giving his body what it needs.

If one feels guilty after eating, it's likely because he knows deep down that he is not eating for nutritional. With women, perceived constraints in daily life and strains within family relationships are associated with greater weight gain.

It appears that men are more likely to deal with chronic stress with other oral behaviours, such as alcohol consumption and smoking, as opposed to overeating. However, Block state that a lack of decision-making authority may also be associated with weight gain in men. Epinephrine: This hormone is also known as adrenaline.

It is secreted by the adrenal medulla in response to stress and acts on all body tissues. When produced in the body, it participates in the fight or-flight response of the sympathetic nervous system by stimulating several physiological processes.

Norepinephrine: Also identified as nor adrenaline. A fight-or-flight hormone that directly increases heart rate, triggers the release of glucose from energy stores, and increases blood flow to skeletal muscle. Norepinephrine serves a role in the suppression of appetite during acute stress.

Leptin: Leptin have an important effect on regulation of body weight, metabolism and reproductive function. Leptin serves an important role in long-term regulation of body weight, which is controlled by the hypothalamus in the brain.

Neuropeptide-Y: A hormone involved in the regulation of energy balance and feeding behavior, including food intake and preference. Neuropeptide-Y increases the proportion of energy stored as fat and thus may contribute to the development of obesity.

Corticotrophin-Releasing Hormone and Adrenocorticotrophic Hormone CRH : This hormone is secreted by the hypothalamus in response to stress. CRH is then transferred to the anterior lobe of the pituitary, where it stimulates the secretion of adrenocorticotrophic hormone ACTH and other biologically active substances.

ACTH's principal effects are increased production and release of cortisol from the adrenal cortex outer layer of adrenal glands, which sit on top of the kidneys.

Cortisol: A steroid hormone secreted by the adrenal gland in response to stress. Cortisol increases blood sugar levels when low and during endurance exercise through a process called gluconeogenesis formation of new glucose that occurs in the liver.

It suppresses the immune system and aids in fat, protein and carbohydrate metabolism. The amount of cortisol hormone present in the blood undergoes daily cyclic variation, with the highest levels present in the early morning approximately am , and the lowest levels present around midnight to am, or 3—5 hours after the onset of sleep.

Higher levels of cortisol are a contributing factor to the storage of body fat, particularly visceral, or intra-abdominal fat. Exercise: Exercise provides a distraction from stressful situations, as well as an outlet for frustrations.

In many ways it acts as a buffer to the overflow of hormones that accumulate from daily stress. A combination of cardiovascular exercise, resistance training and mind-body programs helps optimize health and well-being.

Meditation: Stoppler suggests that in a meditative state, deep centering occurs with a focusing on the core of our being; this allows for a quieting of the mind and emotions, which helps relax tension in the body.

During meditation, the brain enters an area of functioning similar to sleep, but with added benefits that we cannot achieve in any other state; these benefits include the release of certain hormones that promote health. Progressive muscle regulation: Progressive muscle relaxation involves tightening and then relaxing of the muscles in the body in succession.

This technique is based on the idea that mental relaxation will be a natural outcome from the physical relaxation.

Time management: One of the biggest causes of stress is poor time management. Good organization of time is central to effective stress control. By learning to prioritize tasks and avoid over commitment, we avoid the stress of being overscheduled, with too many responsibilities at work and in the family.

Stoppler recommends using a daily planner and calendar to prioritize tasks and stay focused on those at hand; identifying regular time-wasting activities and eliminating them; and banishing procrastination.

Support systems: According to Stoppler, studies indicate that people with a positive and helpful social structure consisting of friends, family, loved ones and pets experience fewer stress-related symptoms.

Strong support systems make it easier to manage stress more efficiently. Healthy food and drink: Dehydration and hunger tend to provoke feelings of stress and anxiety.

Drinking plenty of water throughout the day and eating a nutritious diet can reduce stress. Posture check: Poor standing and sitting posture lead to muscle tension, pain and increased stress.

Recharging: Recharging means setting aside some time each day for energizing the mind. Purposely planning relaxation breaks as special incentives can help us cope with the daily challenges that often lead to chronic stress. Speaking slowly: Speaking slowly can be helpful in stressful or overwhelming situations.

When you speak slowly, you think more clearly and often respond much more reasonably to a stressful situation. Visualization: Gratifying or relaxing images calm the mind and body. Visualizing a soothing setting e.

outdoors in a meadow, by the ocean, along a mountain stream while breathing in a slow, controlled way brings about a state of calm and relaxation. Enjoy Aromatherapy: Aromatherapy has proven benefits for stress relief. It can help to become energized, more relaxed, or more present. Reduce caffeine intake: Consuming caffeine too late in the day can affect sleep quality, which impacts stress levels.

Consuming too much caffeine in general can make more emotionally reactive to stress. One often things many people forget is that they need sleep healthy diet, and lots of exercise.

If people balance these things each day their body will build a strong system and be able to handle those everyday stressors that come along.

Develop relaxation skills: Due to the fast paced world many people have forgotten how to relax. It's really in the small things you do each day that you need to focus on. Taking a small walk during lunch hour, meditation, massage or yoga has been known to greatly help people with stress.

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Advances in. Review Article Volume 4 Issue 4. Stress, food intake and obesity Stress and food intake Evidence is accumulating rapidly that excess glucocorticoids play a role in the development of obesity via increased food intake as well as via facilitating visceral fat deposition.

Restrained eating When eating is restrained, the person is making an attempt to control food intake. Difference between emotional hunger and physical hunger Emotional hunger comes on suddenly: It hits in an instant and feels overwhelming and urgent.

If one feels guilty after eating, it's likely because he knows deep down that he is not eating for nutritional Difference between men and women who experience chronic stress With women, perceived constraints in daily life and strains within family relationships are associated with greater weight gain.

A few stress and obesity hormones Epinephrine: This hormone is also known as adrenaline. Strategies to cope with acute and chronic stress Exercise: Exercise provides a distraction from stressful situations, as well as an outlet for frustrations.

Stress is associated with emotional eating and an unhealthy dietary pattern Stress can lead to decreased and increased eating, which may be related to stressor severity. Almost any part of the human body can be affected by stress. The most important parts that can be affected are the brain, nervous system, digestive system and the heart.

Elevated stress is a risk factor for cancer, high blood pressure and cardiovascular disease and could thus be a trigger to overweight. Overweight people have more depressive symptoms than normal and underweight people Elevated stress levels are associated with a greater desire for hedonic, highly palatable foods which are energy dense.

Responses to acute stress are associated with physiological changes that might be expected to reduce food intake in the short term, for instance slowed gastric emptying and shunting of blood from the gastrointestinal tract to muscles. Chronic stress elicits a more passive response driven by the HPA axis, with increases in cortisol which may entice people toconsume hedonic, energy dense foods and potentially lead to unwanted weight gain and obesity.

Cortisol may also contribute to the accumulation of abdominal fat mass. Disturbed eating attitudes are more prevalent in females than males. Female adolescents appear to experience stress more than male adolescents in terms of being need of social support and less optimistic Higher levels of stress have been associated with a lack of adherence to physical activity.

It is revealed that age group perceive less stress than the age groups. Stress can lead to binge eating in restrained eaters. Menza V, Probart C. Eating well for good health, Lessons on nutrition and healthy diets.

FAO; Sadler, Williams BR. Interferon—inducible antiviral effectors. Nat Rev Immunol. Kouvonen A, Kivimäki M, Virtanen M, et al. Work stress, smoking status, and smoking intensity: an observational study of 46, employees. J Epidemiol Community Health.

Nowson CA, McGrath JJ, Ebeling PR, et al. Vitamin D and health in adults in Australia and New Zealand: a position statement. Med J Aust. Hay DF, Susan P. Prosocial Development in Relation to Children's and Mothers' Psychological Problems.

Child Development. Brownell K, Epel E, Lapidus R, et al. Stress may add bite to appetite in women: a laboratory study of stress—induced cortisol and eating behavior.

Sanlier N, Ogretir AD. The Relationship Between Stress and Eating Behaviors among Turkish Adolescence. World Appl Sci J. World Health Organization WHO. The world health report —shaping the future. World Health Organization; To understand how stress undermines good nutrition it is helpful to think about how the body reacts in both an active emergency and in long-lasting stressful situations.

Humans are designed for survival. In the past, that largely meant escaping predators. Adrenaline quickly shifted the blood from the gut to muscles to help the body run away from the predator. That explains that sinking feeling you may experience in your belly when frightened. Escape is the priority.

Digestion becomes a low priority in a crisis. This is exactly as it should be for escaping real crises. But when stress levels remain high — even if they are based on thoughts and feelings rather than a real predator — attempting to eat can bring on physical discomfort.

Cortisol increases anxiety, nervousness and alertness precisely to keep the body ready. It revs up appetite in a effort to store additional energy. Stress can also affect food preferences. Emotional distress like sadness or anger can increase cravings for food high in fat, sugar, or both.

The reason? Fatty and sugary foods may have short-term benefits such as triggering feel-good emotions. But they also lead to long-term problems like storing fat around the midsection and heart disease.

The body is hard to outsmart. It was built to manage crises that threaten survival. Eating can be more than just something to do to survive. It can give pleasure and offer moments to connect with others. In this increasingly rushed world, too often it becomes something to just fit in.

Rushing while eating or grabbing food on-the-go often leads to eating a larger amount of food and less nutritious meals. In this fast-paced world eating often becomes one thing done while multitasking many other things — like homework, texting, or watching TV. As tweens and teens, we want to be healthy.

We also want to have fun and to eat food that tastes good. Here are some quick tips to build strong, healthy bodies.

Stress, emotions, and boredom are some common reasons for turning to food. Eating is meant to fill nutritional needs. Listen to your body when eating.

What makes you feel good? What gives you energy? Mindful and healthful eating is important but food itself should not be a source of stress. Food should be enjoyed and should make your body feel good. If you find yourself overthinking your eating habits or constantly worrying about how and what you eat, reach out to a parent, guardian, or health care professional about how to make food and eating less stressful.

It's important to be healthy. And to have fun and eat food that tastes good. CPTC is fortunate to receive editorial contributions from a range of multi-disciplinary experts, journalists, youth, and more. Sign up for the weekly CPTC newsletter and get parenting tips delivered right to your inbox.

Join the growing movement to change how our community sees teens. Stress Management Plan. Facebook-f Twitter Instagram Youtube.

Build a Teen Stress Management Plan. Search Search. Eating Well Helps Teens Manage Stress. This article was written by Nora Laberee, a former CPTC research assistant.

Stress Management Includes Eating Well Eating well builds healthy, resilient bodies better able to live life to the fullest. How Stress Undermines Good Nutrition To understand how stress undermines good nutrition it is helpful to think about how the body reacts in both an active emergency and in long-lasting stressful situations.

Stress Management Plan for Teens. Take action today to create your own stress management plan. Everything you need is right here. Get started now!

Start plan. Intentional Eating: Outsmart Hormones The body is hard to outsmart. Healthy Eating Tips Enjoy eating. The pleasure of eating should be your focus. Rather than just shoveling things in your mouth, taste the food.

Besides, daily stress was positively correlated with daily desire to eat and hunger eating; but not with daily snacking; and these three indicators of daily eating behavior were all significantly positively correlated.

The correlations are in line with the reported positive associations between levels of stress and levels of desire to eat- and hunger eating motives by De Vriendt et al. Children and youngsters might not have the autonomy to decide what they will eat, especially snacks.

Gevers et al. All three indicators of eating behavior showed bilateral significant positive correlations, which is in line with our expectations. Although the motivation differs in desire and hunger eating, a positive correlation is not unexpected since in both hedonic and homeostatic eating the ghrelin secretion hunger hormone is elevated, and the cholecystokinin secretion satiety hormone is decreased Monteleone et al.

Concluding, variables measured on trait questionnaires FEEL-KJ and DEBQ correlated bilateral; and the variables measured on a daily basis daily stress and the indicators of eating behavior correlated with each other, but no correlations between the trait variables and daily measurements were found.

For this, a potential explanation could be found in that the used questionnaires were not sensitive enough for capturing these momentary daily fluctuations. Second, we found evidence for the hypothesis that daily stress was significantly associated with the trajectories of desire to eat and hunger eating motives, which is in line with De Vriendt et al.

With higher levels of daily stress, desire to eat and hunger eating motives showed a less steep decrease throughout the week. As the trajectories of the eating behavior indicators decreased significantly throughout the week for every participant, the steepness of these decreases were of interest. The decreases of the hunger eating motives trajectories and of the desire to eat motives trajectories were significantly less steep in persons reporting higher levels of stress than in persons reporting lower levels of stress.

This effect was not found for snacking. Third, for both eating motives and snacking, no effect of maladaptive emotion regulation nor an interaction between daily stress and maladaptive emotion regulation was found.

These findings are in contradiction with Evers et al. A possible explanation is the methodology of the study, as above mentioned studies are longitudinal, cross-sectional questionnaires or experimental studies while the current research is a diary study.

Still, the moderating factor, maladaptive emotion regulation, was measured as a trait variable and therefore might not be sensitive enough to capture momentary daily effects. Next, the participants only filled out the diary during 7 days, three times a day, but only the measurement point after school was taking into account in the analysis.

We could question if using one data time point a day during 7 days is enough to capture the momentary daily fluctuations.

To approach these methodological shortcomings, it is recommended to include a daily measurement of emotion regulation and to include signal- or event-contingent sampling. Fourth, we found marginally significant evidence for the hypothesis that daily stress in interaction with trait emotional eating is associated with the trajectories of desire to eat and snacking; but not for hunger eating.

These results mean that in youngsters with a high emotional eating style, when experiencing high stress, a less steep decrease in desire to eat and snacking occurs in comparison with youngsters with a lower emotional eating style. Fifth, analyses of the daily diary data also revealed that daily stress and daily eating behavior decreased as the week progressed.

This was not expected and has to be explored in the future. One of the explanations can be the possibility of the contributing factor of the stress-levels fitting the day of the week. These stress-levels may play a role in the findings in this study Areni et al. In future research, it is recommended to start the diary study on different days, to control for this order effect.

This study has several notable strengths. First, we used a daily diary design, enabling a more momentary inspection of the relation between stress and eating behavior in a naturalistic environment.

Having a good reliability, validity and generalizability, diary studies are able to determine experiences, mood, behavior and contextual factors more detailed Moskowitz and Young, ; Suveg et al.

Second, we recruited a fairly large sample of youngsters between 10 and 17 years of age given that research in this age group is lacking. Yet, researching the effects of stress on wellbeing in this critical developmental period is of utmost importance given the heightened risk for developing overweight and eating pathology in particular Giedd et al.

Third, because of the highly demanding design of the study for the youngsters diary for 7 days , a lot of efforts by the researchers were made to increase the persevered motivation of the youngsters. During a home visit the rationale was explained, a reward at the end of the study was promised and the youngsters received a personalized smartphone as incentive during the study.

During the study reminders were sent for all assessing points and youngsters received a motivating phone call in between. Despite these strengths, several limitations of the current study warrant discussion. The first limitation of the present study design is the limited number of data points each day, more specifically at breakfast, after school and before bedtime.

Using signal- or event-contingent data sampling would be better to capture the daily relationship between stress and eating behavior. However, a diary-study for 7 consecutive days might be a long period for children and adolescents between 10 and 17 years old and a great burden.

This was confirmed by the missing values in the diary reports. As the ability and willingness of participants are determining factors for the success of a diary study, only three diary data points were used Moskowitz and Young, ; Engel et al.

Besides, practical barriers prevented us from using signal- or event contingent sampling as schools did not give an authorization to fill out the diary during school time.

To answer the research questions, only one measurement point a day was included in the analysis, more specifically the data point after school. First of all, two important stressors for youngsters, school and peer related stress Sotardi, could be captured at that data point.

Second, previous research showed the importance of the food availability preceding the snacking, which is higher at home or the way to home in contrast with a school environment. Due to the age of the participants, 10—17 years, and the possibility of having a greater food availability at home or the way to home , the choice was made to include only this data time point here Chopra et al.

Whether emotional eating might be even more prevalent later in the evening, remains to be studied. A second limitation of the study concerns the use of self-report measurements of eating behavior. In future research, it is recommended to use more objective methods, such as taking pictures of the snacks participants ate.

This requires the use of event-contingent data sampling. A third limitation, in addition to the one-time point, is the retrospective character of these daily measures. As mentioned above, including a signal-contingent design of the daily measures would be more suitable in order to investigate the causal daily relationship between stress and eating behavior.

A fourth limitation concerns the little variance in the emotion regulation and emotional eating scores. All mean scores are in accordance with the norm scores of the questionnaires, except for maladaptive emotion regulation in boys between 12 and 18 years Braet and Beyers, ; Braet et al.

In future research, it might be interesting to include youngsters with overweight or obesity, as emotional eating is more prevalent among overweight and obese youngsters Braet and Beyers, As mentioned above, a fifth limitation concerns the same start day for all participants of the diary- measures, namely on Monday.

To control for week-effects, it might be better to randomize the start day for filling in the diary over the participants Areni et al. In future research, it is recommended to include sources of daily hassles to have more specified information. Different types of stress are of interest in youngsters, e.

Seventh, in the current study, stress intensity was measured subjectively. As the variance within persons is rather small, the question could raise if youngsters have difficulties reporting on their stress level.

In the future, we will analyze with more stringent research whether the level of the stress experience of children is related with more objective measurements, like heart rate variability.

Eighth, all daily variables e. To conclude, we found that daily stress is significantly associated with the trajectories of desire to eat and hunger eating motives. But no moderation effects of maladaptive emotion regulation were found; while emotional eating has marginally significant effects on desire to eat and snacking.

In the research on stress and eating behavior, there are still a lot of gaps. The current research is a first step in reducing these gaps by investigating the underlying mechanism in the relationship between daily stress and eating behavior as a predictor of weight gain by including the moderators of emotion regulation, and more specifically emotional eating.

This study was carried out in accordance with the recommendations of Ghent University with written informed consent from all subjects.

All subjects gave written informed consent in accordance with the Declaration of Helsinki. The protocol was approved by the Ethical Committee of Ghent University. All authors listed have made a substantial, direct and intellectual contribution to the work, and approved it for publication.

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Ansari, W. Nutritional correlates of perceived stress among university students in Egypt. Public Health 12, — doi: PubMed Abstract CrossRef Full Text Google Scholar.

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Work Stress 28, — CrossRef Full Text Google Scholar. Bey, G. Gendered race modification of the association between chronic stress and depression among black and white US. Orthopsychiatry 88, — Braet, C. Subtyping children and adolescents who are overweight: different symptomatology and treatment outcomes.

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Inpatient treatment of obese children: a multicomponent programme without stringent calorie restriction. Assessment of emotional, externally induced and restrained eating behaviour in nine to twelve-year-old obese and non-obese children.

Burke, L. Ecological momentary assessment in behavioral research: addressing technological and human participant challenges. Internet Res. Chopra, M. A global response to a global problem: the epidemic of overnutrition. World Health Organ. Cohen, S. Cohen, R. Kessler, and L. Underwood New York, NY: Oxford University Press , 3— Cracco, E.

Validation of the FEEL-KJ: an instrument to measure emotion regulation strategies in children and adolescents. PLoS One e Dallman, M. Stress-induced obesity and the emotional nervous system. Trends Endocrinol.

De Decker, A. Fat tissue accretion in children and adolescents: interplay between food responsiveness, gender, and the home availability of snacks. Palatable food consumption in children: interplay between food reward motivation and the home food environment. De Vriendt, T. Chronic stress and obesity in adolescents: scientific evidence and methodological issues for epidemiological research.

Enders, C. Centering predictor variables in cross-sectional multilevel models: a new look at an old issue. Methods 12, — Engel, S. Ecological momentary assessment in eating disorder and obesity research: a review of the recent literature. Psychiatry Rep. Erermis, S. Is obesity a risk factor for psychopathology among adolescents?

Evers, C. Feeding your feelings: emotion regulation strategies and emotional eating. Faith, M. Dalton Gaithersburg, MD: Aspen Publishers , — Ferraro, K. Cumulative disadvantage and health: long-term consequences of obesity?

Field, A. Snack food intake does not predict weight change among children and adolescents. Gevers, D. Nutrients 7, — Gibson, E. Emotional influences on food choice: sensory, physiological and psychological pathways.

Giedd, J. Why do many psychiatric disorders emerge during adolescence. Gluck, M. Cortisol, hunger, and desire to binge eat following a cold stress test in obese women with binge eating disorder.

Goldschmidt, A. Ecological momentary assessment of maladaptive eating in children and adolescents with overweight or obesity. Goodman, E. A prospective study of the role of depression in the development and persistence of adolescent obesity.

Graziano, P. Toddler self-regulation skills predict risk for pediatric obesity. Grob, A. FEEL-KJ: Manual und Fragebogen zur Erhebung der Emotionsregulation bei Kindern und Jugendlichen. Gross, J. The emerging field of emotion regulation: an integrative review. Gustafsson, H. Hope and athlete burnout: stress and affect as mediators.

Sport Exerc. Hill, D. Stress and eating behaviors in children and adolescents: systematic review and meta-analysis. Data were collected from students of class 9, 10, 11, and 12 grades aged 13—19 years. A multistage sampling technique was employed to recruit respondents for this study.

Hence, from every eight divisions, we selected four high schools and colleges. Then in each of the selected high schools and colleges, two classes were selected conveniently.

In the third phase, 75 students were selected randomly from each selected class, and a pretested structured questionnaire was distributed to all of the selected students in that class.

The students were enrolled to ensure an equal number of males and females for all divisions. The questionnaire was pretested in a sample of 20 college-going students before implementation in the final study.

The questionnaire contained six sections. Section C includes Turconi Physical Activity Questionnaire PAQ. Adolescent Stress Questionnaire ASQ and Dutch Eating Behavior Questionnaire DEBQ are included in Sections D and E, respectively.

Section F contains anthropometric measurements such as body weight, height, mid-upper arm circumference MUAC , and waist circumference to assess BMI and overall nutritional status. The questionnaire was translated into Bangla and then translated back to English by different persons to assess validity.

The data collectors interviewed students about food intake using the h recall method, including types and amounts of foods. After completion of the questionnaire, students were approached for anthropometric measurements. After removing incomplete questionnaires from respondents, a dataset of respondents was kept for the final analysis.

They were provided with the necessary guidance and supportive supervision. On another level, investigators of the study from the central level provided frequent visits to the field to oversee the activities.

The ASQ is a broadly based instrument and has a good validity to assess adolescent stressor experience [ 22 , 24 , 25 , 26 , 27 , 28 , 29 ]. A relative score for each stress component scale was calculated by summing the items belonging to that scale and dividing by the number of scale items.

Besides, a stress summary score perceived stress was obtained by adding the individual scores of all 56 items [ 27 ]. The higher ASQ total score represents the higher level of stress.

Eating behavior was assessed using the Dutch Eating Behavior Questionnaire DEBQ by Van Strein T. in for assessing eating behaviors [ 30 ]. The DEBQ scale has been extensively used and has proven to be a useful and reliable tool [ 18 , 30 , 31 , 32 ]. This instrument was also successfully used for Bangladeshi adolescents [ 8 ].

It consists of 33 items and three scales, with 13 items assigned to emotional eating overeating in response to emotions , 10 items to externally induced eating eating in response to food-related stimuli, regardless of the internal states of hunger and satiety , and 10 items for restrained eating attempts to refrain from eating.

They rated on a 5-point Likert scale: 1 never to 5 very often. For example, in the emotional eating subscale score of 1 means that the adolescent did not eat in response to emotions, and a score of 5 indicated overeating due to emotional statuses such as nervousness, happiness, or excitement.

In external eating, the maximum score represented eating in response to stimuli such as color, smell, and taste of the food and 1 score means that they did not pay any attention to these stimuli and only eat when they are starving. As for the last subscale, restrained eating, the maximum score showed that the person has more control over eating behavior and tries to refrain from eating.

Scores on each of the three scales were obtained by dividing the sum of items scored by the total number of items on that scale. All answers were structured to quantify the time spent weekly in physical activity, to investigate the activities spent during the free time, and to quantify the hours spent daily on the computer or in watching TV [ 33 ].

Each score ranges from 0 to 3, with the maximum score assigned to the healthiest habit. The PAQ scale was previously used by the International Centre for Diarrheal Disease Research, Bangladesh icddr,b in a survey on adolescents of Bangladesh in Trained data collectors carried out the weight and height measurements of students in the morning with their school uniform and without shoes.

Weight measurement was recorded to the nearest 0. Waist circumference was measured at the level midway between the lowest rib margin and the iliac crest using a measuring tape. The BMI cutoff points at age 18, in particular, This study aimed to determine the prevalence of obesity and assess the association of obesity with perceived stress, eating behaviors, and physical activities among urban adolescents in Bangladesh.

Hence, the primary outcome variable was BMI categories, and the secondary outcomes were stress and eating behaviors of adolescents. Sociodemographic characteristics and physical activities were considered as predictors. The stress summary score of the adolescents was obtained by adding the individual scores of all 56 items from the ASQ.

We also categorized the ASQ total stress score as low stress, moderate stress, and high stress. Eating behavior scores on each of the broad three scales emotional eating, externally induced eating, and restrained eating were obtained by the average score on that scale from the DEBQ.

The associations between overweight and obesity with all other related variables were tested using appropriate measures of associations. A p value of less than 0. All statistical analyses were performed using IBM SPSS Statistics for Windows, version Only the performance of logistic regression models was illustrated with the receiver operating characteristic ROC and the k-fold cross-validation using the Scikit-learn module in Python version 3.

A total of eligible high school and college-going adolescents in urban areas completed the self-structured questionnaires, of whom participants were excluded for incompleteness.

Among participants, The majority of adolescents had HSC or below educated fathers More than one-fourth of participants were overweight and obese Therefore, the major Among the highly stressed adolescents, Overall, urban adolescents had a high tendency for external eating 2.

Table 1 reveals summary information of the item ASQ scores, and perceived stress, and their relationship with the outcome variable BMI, the smoking habit of adolescents, and two essential demographic variables—sex and age.

Adolescents reported the highest levels of stress from future uncertainty and school performance, whereas the lowest levels of stress were seen from peer pressure and romantic relationships.

Similar highest and lowest levels of stress domains were reflected for girls and boys adolescents. The average perceived stress of urban adolescents was Considering the average perceived stress, we found that female adolescents Perceived stress of adolescents was positively significantly correlated with their BMI.

Observing the evaluated value of the Eta statistic, which is a more appropriate measure of association between a categorical variable and an interval scale variable that ranges from 0 to 1, with 0 indicating no association and values close to 1 indicating a high degree of association [ 38 ], a very strong association was also revealed for the smoking habits of adolescents with their all stress domains and perceived stress.

Eating behaviors were assessed by using the summated scores of three individual subscales, where higher scores indicate higher levels of restrained, external, and emotional eating behaviors.

Urban adolescents had a high tendency for external eating 2. Examining the values of Eta, a significant association was revealed for emotional and external eating behaviors of adolescents with their stress categories.

Table 2 also exhibits the frequency distribution of physical activity level according to sociodemographic characteristics of urban adolescents. Only 2. Though most adolescents had moderate physical activity levels, more than two-thirds of the students A higher proportion Using the stress categories, we observed that the major Furthermore, highly stressed participants were also more likely to be male In contrast, external and emotional eating behaviors were significantly associated with the prevalence of high stress.

Conversely, the sociodemographic characteristics gender, age, residence, BMI categories as control variables, along with the significantly associated variables, for instance, smoking habit, physical activity and lifestyle, and external and restrained eating behaviors were used as predictors in the logistic regression model to predict the prevalence of high stress.

Logistic regression analysis further revealed that female adolescents were less likely OR 0. Adolescents aged less than 16 years OR 0. Respondents who had less educated fathers less likely to be overweight and obese than those who had higher educated fathers OR 0.

Adolescents who had service holder fathers OR 1. Students who had a sedentary lifestyle were 2. Restrained eating behavior was a significant predictor for overweight and obesity OR 1. To predict the prevalence of high stress, logistic regression model also illustrated that female adolescents were less likely OR 0.

Cigarette smoker adolescents were 1. Adolescents who had a sedentary lifestyle were 3. Respondents who were more fascinated by the restrained eating behavior were 1. In contrast, smoking habit, physical activity and lifestyle, restrained and external eating behaviors were observed significantly to estimate the prevalence of high stress of adolescents.

Adjusted logistic models with adjusted odds ratio [ 39 , 40 ] were also run using the Scikit-learn module in Python 3. The area under the ROC curve AUC was estimated and is plotted in Fig.

To predict the prevalence of high stress using an unadjusted model—the AUC was 0. Moreover, to estimate overweight and obesity prevalence using unadjusted and adjusted logistic regression models, the AUC was 0.

To evaluate the performance of unadjusted and adjusted logistic regression models based on several runs, we used the k-fold cross-validation for fold, fold, and fold repetitions using the Scikit-learn module in Python 3. Evaluating the performance of adjusted and unadjusted logistic models using the accuracy scores, the ROC Fig.

Therefore, the result of unadjusted models in Table 3 remains tenable. Stress is not a psychiatric diagnosis, but it is closely linked to mental health conditions including depression, anxiety, psychosis, and post-traumatic stress disorder PTSD [ 41 ].

The consequences of not addressing adolescent mental health conditions extend to adulthood, impairing both physical and mental health and limiting opportunities to lead fulfilling lives as adults [ 42 ].

Despite widespread and increasing awareness of the mental health challenges facing adolescents, their needs in this area are largely unmet and particularly in developing countries [ 2 ].

Hence, this study was conducted to investigate the association between stress, eating behavior, and physical activity with BMI among urban adolescent students. It was conducted in randomly selected schools and colleges in eight Divisions of Bangladesh.

For ease of our discussion, we have referred BMI categories into three groups: underweight, normal weight and overweight and obesity, and stress categories also into three groups: low, moderate, and high stress. The study findings reveal that more than half of adolescents were in moderate-to-extremely-severe levels of stress, two-seventh were overweight and obese, one-fourth were underweight, only one-fifty had a very active lifestyle, while more than one-fourth had a sedentary lifestyle.

Among the highly stressed adolescents, almost two-seventh were overweight and obese, less than one-tenth were cigarette smokers, more than two-sixth had a sedentary lifestyle, and were more fascinated by external eating behavior.

Adolescents reported the highest stress levels from future uncertainty and school performance, whereas the lowest stress levels were seen from peer pressure and romantic relationships. Urban adolescents had a high tendency by external eating behavior, compared to restrained and emotional eating behaviors, which manifested in all categories.

Though common thinking about emotional eating is that it has often been linked to overweight and obesity, we found only restrained eating behavior had a significant association for adolescents with overweight and obesity. Few of the respondents had a very active lifestyle, while more than one-fourth showed a sedentary physical activity level, and the remaining large percentage more than three-fifth of respondents were moderately active, not consistent with a healthy lifestyle.

The prevalence of high stress among urban adolescents was significantly associated with their smoking habit, physical activity and lifestyle, and external eating behavior, whereas significant predictors for estimating the prevalence of high stress were smoking habit, physical activity and lifestyle, restrained and external eating behaviors.

The result showed that while girls reported systematically higher levels of stress compared with boys, their stress profiles were similar, with the highest levels for school-related stress followed by future uncertainty.

Only in girls, perceived stress was significantly associated with increased measures of general and abdominal adiposity. In boys, no relationship between perceived stress and adiposity measures was observed [ 27 ].

A study was conducted among Japanese university students to investigate the association of anthropometric status, perceived stress, and personality traits with eating behavior. The result shows that associations between eating behavior and anthropometric status or psychological factors are different by each eating behavior, which is partly influenced by gender differences [ 44 ].

In a longitudinal study of adolescents in London, prospective associations between perceived stress and changes in waist circumference and BMI were examined. Perceived stress in any year was not related prospectively to increases in waist circumference or BMI.

However, waist circumference and BMI were significantly higher in the moderate and higher stress groups than the lower stress group across the whole 5-year period [ 45 ]. A study in Los Angeles showed no differences in emotional eating between normal-weight and overweight students.

Perceived stress was indeed a significant correlate of emotional eating, but emotional eating is not an issue only for overweight and obese persons. This study shows that some children in this population at increased risk for obesity and related chronic disease have already incorporated emotional eating as a learned response to stress by the time they enter into adolescence [ 46 ].

Common mental health problems and overweight and obesity of adolescents have emerged as the major public health concerns and can contribute to adult physical and mental health risks. Moreover, this risk could also increase the burden of chronic non-communicable diseases NCDs of adults, such as diabetes, hypertension, and cardiovascular diseases [ 43 ].

This study reveals that among the respondents, more than half of adolescents were in moderate to extremely severe levels of stress, two-seventh were overweight and obese, only one-fifty had a very active lifestyle and were more fascinated by external eating behavior.

This situation is very alarming, as adolescence is a period of physical and mental development. High stress and obesity can cause a harmful effect on the mental and physical development of adolescents.

Many awareness programs are being conducted by the government and non-government organizations, which need to identify their impact. This study was conducted among urban adolescents who are studying in school and colleges, but those adolescents are missing who are not going to school or colleges and those who are in rural households.

Though the pandemic has a significant influence on our study topic, conducting research during the pre-pandemic context is responsible for this limitation. A reasonable number of researchers is carried out to address that issue during the COVID pandemic [ 47 , 48 , 49 ]. Counseling and support from parents, teachers, and friends can be very effective in overcoming this situation.

The secondary and higher secondary education period has been regarded as a stressful environment for students. Adolescents reported the highest stress level from future uncertainty and school performance, whereas a low level of stress from peer pressure and romantic relationship.

Besides stress and eating behavior, physical activity also plays a vital role in determining the body mass index. This study found that more than half of adolescent boys or girls were in moderate-to-extremely-severe levels of stress.

Stress on secondary school and college students needs to be recognized, and strategies need to be developed to improve the mental and social health of adolescents. Student counseling on stress factors, increase opportunities for play and recreation, increased support from teachers and parents could be effective.

Intervention studies can be undertaken to see the effect of counseling and support from parents, teachers, and friends.

Further research needs to be conducted on adolescents who are not going to educational institutions and who are residing in the rural area. A second chance in the second date.

Geneva: World Health Organization. Samuels F, Jones N, Abu HB. Psychosocial support for adolescent girls in post-conflict settings: beyond a health systems approach. Add: Prebiotics are fibers that help the good bacteria in your gut grow. This kind of fiber is found in foods such as garlic, bananas, onions, apples, leafy greens, and whole oats.

Probiotics which are live bacteria and yeast good for your digestive system. The best sources of probiotics are fermented foods such as yogurt, kimchi, pickled vegetables, miso, and kombucha. Polyphenols are food compounds that fight inflammation, infection, and bacteria bad for your gut. Look out for colorful foods and drinks, such as nuts, berries, tea, and coffee.

Omega-3 Fatty Acids have been found to promote greater microbial gut diversity , lowering inflammation and reducing depressive symptoms. You can find this in fatty fish and some shellfish. Avoid: Processed foods can lead to inflammation in the body and increased disease risk, including depression and anxiety.

This includes sugar, starch, hydrogenated fats, and lab-made chemical additives like flavor enhancers and food colorings. Red meat can lead to the growth of bad bacteria that can negatively impact immune function and emotional state, with studies showing a correlation between high red meat intake and depressive symptoms.

Because of this, stick to the recommended three portions per week of red meat, or choose leaner meats such as chicken and seafood. Saturated fat is commonly found in red meats and high-fat dairy. This could lead to an excess of bilophila , a microbe that can cause inflammation. Because of this, enjoy cheese and fatty meats such as bacon, ribs, and ribeye in moderation.

Simple carbs are stripped of their fiber and most of its nutrients. Due to this, they are digested quickly and spike blood sugar levels while giving gut bacteria very little to eat. Refined grains are one of the most popular simple carbs, including white flour, white bread, and white rice.

Balance is key when it comes to eating; help your teen develop mindful eating habits. So How Should My Teen Eat? Some foundations of mindful eating are: Engaging all the senses while eating, such as paying attention to the texture, smell, sounds, and experiences of their food.

Slowing down and taking the time to mindfully appreciate the food. Getting rid of distractions during meals, such as watching television or being on your phone. There are many ways you can promote mindful eating in your household.