Associations of cognitive beliefs and metacognitive processes with eating behavior in adults with obesity and healthy-weight controls: a cross-sectional study

Résumé fourni par la source

Emotional and uncontrolled eating are common in obesity and may persist despite pharmacological or surgical treatment. Automatic thoughts and metacognitive beliefs may contribute to maladaptive eating, but have rarely been examined together while accounting for depression, anxiety, and stress. We examined whether metacognitive beliefs were associated with eating behaviors in adults with obesity and whether these associations differed from healthy-weight controls. This cross-sectional study included 67 adults with obesity (body mass index [BMI] ≥ 30 kg/m²) from a psychiatric outpatient clinic and 70 healthy-weight hospital employees (BMI ≤ 25 kg/m²). Current DSM-5 psychiatric disorders were excluded using the Structured Clinical Interview for DSM-5. Participants completed the Three-Factor Eating Questionnaire-21, Automatic Thoughts Questionnaire, Metacognitions Questionnaire-30, and Depression Anxiety Stress Scales-21. Multi-group path analysis assessed direct and indirect associations, adjusting for age and sex. Indirect effects used 5,000 bootstrap samples, and selected coefficients were compared with Wald-type z tests. Because sample size was calculated for the primary group comparison rather than the structural model, path analyses were exploratory. Participants with obesity had higher emotional eating (d = 1.05), uncontrolled eating (d = 1.10), automatic thoughts (d = 0.58), metacognitive beliefs (d = 0.55), and depression, anxiety, and stress scores (d = 0.69–0.96), whereas cognitive restraint did not differ (d = − 0.07). In the obesity group, metacognitive beliefs were associated with emotional eating independently of emotional symptoms (β = 0.46, p = .006); the corresponding association was not statistically significant in controls (β = −0.06, p = .688), and the between-group difference was significant. In controls, automatic thoughts were indirectly associated with uncontrolled eating through anxiety, although indirect effects were not formally compared. The principal finding remained after adjustment for education. Metacognitive beliefs showed a selective association with emotional eating in adults with obesity. Most other associations were non-significant, and the cross-sectional design precludes causal inference. These findings require confirmation in larger longitudinal and interventional studies and do not establish metacognitive beliefs as a causal treatment target or the effectiveness of metacognitive therapy for obesity.

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