Emotion regulation among bariatric seeking patients with obesity and food addiction: a cross-sectional, unmatched nested case-control comparison.

BACKGROUND: Emotion dysregulation, alexithymia and attentional biases toward food or emotional stimuli have been reported in patients with obesity and food addiction (FA), but the relative contribution of obesity or FA to these characteristics remains unclear. Our objectives were to compare patients with obesity and FA, patients with obesity without FA and patients without obesity regarding cognitive emotion regulation strategies, alexithymia, emotion regulation difficulties, and attentional biases. METHODS: We included 37 bariatric seeking patients (18 FA, 19 without FA) and 37 controls in a cross-sectional, unmatched nested case-control design. We assessed food addiction (YFAS 2.0), emotional regulation strategies (CERQ), emotion regulation difficulties (DERS), alexithymia (TAS-20), and attentional biases (Stroop and Emotional Stroop tasks). RESULTS: Among patients with obesity, those with FA differed from non-FA only in terms of cognitive emotion regulation strategies: less refocus on planning (p = .04), more catastrophizing (p = .02), and more positive refocusing (p < .001). Patients with obesity (with or without FA) presented higher scores regarding emotion regulation strategies (p < .05), alexithymia (p < .001) and emotion regulation difficulties (p < .001). Neither obesity nor FA were associated with attentional bias toward food or negative emotional stimuli and cognitive inhibition. CONCLUSIONS: Among patients with obesity, having a FA was related to cognitive avoidance toward negative events, but not to change in the saliency of emotional or food stimuli. Alexithymia was more related to obesity than to FA.