Skip to main content
  • Research article
  • Open access
  • Published:

Prevalence of negative emotional eating and its associated psychosocial factors among urban Chinese undergraduates in Hong Kong: a cross-sectional study



Emotional eating (EE), defined as eating in response to a range of emotions, has been previously associated with poor diet and obesity. Since there are limited data from non-Western populations, this study aims to examine the prevalence and factors associated with EE among urban Chinese university students.


A cross-sectional study was conducted on 424 university students (aged 18–24 years) from two large universities in Hong Kong in 2019. Respondents completed an anonymous online questionnaire that contained background questions, an emotional eating subscale of the Dutch Eating Behaviour Questionnaire (DEBQ), and Depression Anxiety and Stress Scales (DASS-21). Two-sample independent t-test and multiple regression analyses were conducted to test the association of study variables with negative emotional eating.


There was over a three-fold higher likelihood of negative EE among females (14.8%) when compared with their male counterparts (4.5%) (OR = 3.7, p < 0.05). Having at least mild depressive symptoms was the only independent factor associated with negative EE among males (OR = 10.1) while for females, negative EE was independently associated with not having a romantic partner (OR = 3.45), having depressive symptoms (OR = 44.5), and having at least mild stress (OR = 5.65). Anxiety levels were not independently associated with negative EE for either gender. Both male and female students with negative EE had significantly lower self-perceived health scores, higher body mass index, and lower life satisfaction scores.


This study revealed that negative EE is prevalent among female Chinese university students and not uncommon among male students. Management of negative EE should be included as a component of university mental health promotion programmes in the region.

Peer Review reports


Across cultures, university is often a highly stressful developmental period for young adults due to various academic and social pressures. In the literature, there exists an extensive body of research examining maladaptive behaviours in college students such as substance abuse and excessive alcohol consumption [1,2,3,4]. Although comparatively less studied, emotional eating (EE), eating in response to a range of emotions [5], has been gaining interest among college health researchers in recent years [5,6,7,8,9,10]. Both positive and negative emotions can lead to greater food intake and overeating [11,12,13,14]. Yet studies suggest that positive EE and negative EE are different constructs that are driven by different mechanisms. Positive EE is associated with external influences, higher intensity of positive emotions, lower likelihood of emotional regulation difficulties; moreover positive EE does not necessarily reflect disordered eating [13,14,15,16,17]. Positive emotions such as happiness, particularly in the context of celebrations and socializing, can trigger hedonic overeating and was noted to enhance the pleasure of food [18, 19]. On the other hand, negative EE is associated with emotional regulation difficulties, internal triggers such as poor mood, longer duration of negative feelings and higher risk of eating pathology such as binge eating [13,14,15,16,17]. According to the theory of maladaptive behaviour and affect regulation, individuals with negative EE consume food for the hedonic experience in an attempt to relieve negative emotions; however, excessive food consumption can, in turn, lead to negative consequences and effects (e.g. obesity and guilt), providing cues for further food consumption and lead to a vicious cycle [20, 21]. In fact, similar to many recreational drugs, food consumption can stimulate dopamine secretion in the brain, which controls the reward-related behaviours [22]. While episodes of EE may occur in response to positive emotions, studies of health-related effects of EE have predominantly examined EE behaviour as a response to negative emotional states such as stress, depression, boredom, and anxiety [6,7,8,9,10, 22, 23]. Studies from Western countries have reported that negative EE prevalence among college students ranges from 8.9 to 56% and negative EE was noted to be more common in females and those with higher levels of stress, depression, and anxiety [22, 24,25,26,27,28]. Since individuals with negative EE tend to binge eat and consume highly caloric foods, negative EE has been associated with weight gain, overweight/obesity, difficulty in losing weight and sustaining weight loss, and even metabolic disorders across many age groups [28]. Negative EE may be on the intermediate pathway between dysphoric mood and excessive food consumption, hence, management of negative EE may be a possible target for the prevention of obesity [29].

There have been very few studies examining EE in the Chinese populations although its cultural meanings of food and eating habits differ notably from the Western populations. Unlike many Western cultures, food consumption is a highly communal behaviour in Chinese society and eating alone is not a common practice [30]. Moreover, snacking between meals is not commonly seen in Chinese eating culture [30]. In the past two decades, however, there have been major shifts towards increased snacking and greater consumption of high-calorie food in economically developed areas of China, particularly among individuals with a higher socioeconomic status [31, 32]. Previous research conducted in Chinese adolescents living at home in Eastern China noted a negative EE prevalence of 18.6% among males and 36% among females [33]. In cities such as Hong Kong and other urban areas of China, university students may thereby represent a potential high-risk group for negative EE. In these regions, university is often the first time when young adults may live away from their parents and consume the majority of their food intake outside the family home whereas those entering the work force after secondary school would typically continue to live at home [34, 35].

There are few studies about negative EE in Chinese university populations. Recently conducted studies from central China have reported negative EE prevalence ranging from 14.5 to 52.7% among undergraduate students [36, 37]. These findings suggest that negative EE may be prevalent among Chinese youths but the generalizability to other urban areas is unknown. University life has been noted to be extremely stressful in Hong Kong [24, 38, 39]. In comparison to other cities in China, Hong Kong, a former British colony, has a long history of Westernized fast-food and convenience store pre-packaged foods that are highly conducive to impulsive food consumption. It is unclear whether the prevalence of negative EE is higher in cities such as Hong Kong and it is not known which emotions trigger episodes of negative EE. Moreover, there is limited information about its associations with psychosocial factors such as life satisfaction and self-perceived health and very limited data on the associations with physical health indicators such as body weight in young Chinese adults.

In order to inform health interventions for university students in the region, this cross-sectional study aimed to determine the prevalence of negative EE among university students in Hong Kong and to see whether the prevalence of negative EE differs by gender. In addition to determining the sociodemographic predictors of negative EE, this study will examine whether self-reported symptoms of depression, anxiety, and stress are significantly associated with negative EE in male and female students. We will also examine whether negative EE is associated with various self-reported indicators of physical health and mental well-being to provide insight into possible outcomes of negative EE. In addition to informing regional university health promotion, these findings can also provide a springboard for more focused, theory-based studies in the future.



This study recruited university students through face-to-face intercept survey in large public areas of the two major universities in Hong Kong (The University of Hong Kong and The Chinese University of Hong Kong) between April and June 2019. The researchers also sent out a mass email with a link to the online survey in August 2019. The normative study period in Hong Kong university is typically 4–6 years, depending on the study major, and the normative age of university enrolment is 18 years of age. In order to capture undergraduate students, participants were only included if they were (i) of 18–24 years of age and (ii) studying an undergraduate degree. International and exchange students were excluded from this study. Sample size calculations were conducted based on an estimated 20% EE prevalence (α = 0.05). In order to obtain a precision of 4%, a sample size of 385 was required. The study recruited 424 participants to allow for possible missing data and non-completion of the survey. All participants were invited to fill in a standardized questionnaire on the Google survey platform (details see below). Ethical approval was obtained from the Survey and Behavioural Research Ethics Committee of the university sponsoring the study prior to participant recruitment (Approval #043–19).


Dutch eating behaviour questionnaire (DEBQ)

The 13-item Emotional Eating Subscale of the Dutch Eating Behaviour Questionnaire (DEBQ) was the primary outcome of the current study and was one of the most commonly used instruments to examine negative EE in research [40]. Each statement in the DEBQ was rated with a 5-point Likert scale (ranging from 1 “never” to 5 “very often”). The scores from each statement were summated and averaged to obtain the final score. From a study of Chinese adolescents, the DEBQ was previously shown to have high internal consistency (Cronbach’s alpha = 0.964) [41]. Higher DEBQ scores suggest more severe symptoms of negative EE and scores > 3.25 are recommended to be used in research to identify individuals with negative EE [40].

Depression, anxiety, and stress scales (DASS-21)

Depression Anxiety and Stress Scales (DASS-21) consist of depression, anxiety, and stress subscales that each have seven items. All three subscales of DASS-21 had high internal consistency; the Cronbach’s alphas were 0.83, 0.80, 0.82, and 0.92 for depression, anxiety, stress, and overall scale respectively in Chinese students [42]. Each statement was rated on a 4-point Likert scale; the score of the subscales can be calculated by summation of scores from respective individual items, with higher scores indicative of higher levels of depression, anxiety, and stress. Participants with depression score > 9, anxiety score > 7, and stress score > 14 are identified as having depression, anxiety, and stress symptoms, respectively [42]. The distribution of these scores in our sample is shown in Table 1.

Table 1 Background characteristics of the study sample by gender (n = 424)

Covariates and secondary outcomes

Demographic and background data including age (years), sex (male/female), place of birth (Hong Kong, China, other countries), faculty of study, and presence of romantic relationship (yes/no) were collected. The instrument also asked whether the student engaged in weekly exercise (yes/no) which has been shown to have adequate validity and reliability [43]. As the questionnaire was conducted in an open area in the universities without measurement instruments, the weight and height of the participants were self-reported. Body mass index (BMI) was calculated by weight in kilograms divided by height in meters squared and obesity was defined as body mass index of > 23 kg/m2, which was the international cut-off for Southeast Asians [44].

In order to maintain the brevity of the survey instrument, life satisfaction, and self-perceived health were each asked using a single question: “You are satisfied with your life” and “You perceive yourself as healthy”, respectively. These items used a 5-point Likert Scale response (ranging from “1”: totally disagree to “5”: totally agree) to the statements. Both items have been used extensively in health research and shown to have adequate psychometric qualities [45, 46].

Statistical analysis

Demographic data and psychosocial factors among female and male students were described by the mean and standard deviation (SD) and by percentage and absolute number for continuous and categorical variables respectively. We stratified all data analyses by gender since past studies have noted gender differences in the prevalence and predictors of negative EE [25, 47]. The prevalence estimates of negative EE were shown for males and females separately with their respective 95% confidence intervals (CI). For all univariable analyses, the relationship between negative EE and various psychosocial and health factors was explored by Chi-Square and Fisher-exact test as appropriate.

In order to determine variables independently associated with negative EE, all variables that demonstrated an association with p < 0.20 in the unadjusted analysis were considered as candidate variables in the backward multiple logistic regression model. We used a conservative cut-off of p < 0.20 since the traditional cut-off of p < 0.05 will often miss independent factors [48]. Mann-Whitney U test was performed to compare the mean BMI, self-perceived health score, and life satisfaction scores while χ2-test was used to compare the prevalence of obesity in students with and without negative EE. Statistical significance was set at α. = 0.05 and all data were analysed using SPSS v25.0 (IBM Corp. Released 2017. IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: IBM Corp).


Participants characteristics

Of the 424 participants, a similar number of males (n = 201) and females (n = 223) were recruited. The mean age for the study sample was 20.2 years (SD = 1.6). Of the sample, the majority were born in Hong Kong (82.1%), had no religion (73.1%), were living away from home (55.2%), had a part-time job (51.9%), had a boyfriend/girlfriend (58.3%), and had no/little exercise (70.3%) (Table 1). The vast majority of students had DASS-21 subscale scores indicating normal levels of depressive symptoms (74.5%), anxiety symptoms (80.2%), and stress symptoms (89.4%). Male students reported better perceived health, higher mean BMI, and lower emotional eating score (p < 0.001), while female students reported higher depression, anxiety, and stress scores (p < 0.05) (see Table 1).

Prevalence of emotional eating

In our university student sample, 9.9% (95% CI: 7.1–12.8%) of university students were classified as an individual with negative EE. Female students revealed a much higher prevalence of negative EE (14.8%; 95% CI: 10.1–19.5%) than male students (4.5%; 95% CI: 1.6–7.4%). Females had more than three times the likelihood of having negative EE when compared with males (OR = 3.7, p < 0.05).

Psychosocial factors associated with emotional eating

In the univariable analysis, there was a higher likelihood of negative EE in male students who lived at home (odds ratio (OR = 5.0), had a part-time job (OR = 3.73), had depressive symptoms (OR = 23.4), had anxiety symptoms (OR = 12.1), and had stress symptoms (OR = 21.1). In the backward multiple regression analysis of these candidate variables, EE was significantly associated only with the presence of depressive symptoms in male students (OR = 10.1).

In female students, there was a statistically significantly higher likelihood of negative EE among women who were not in a romantic relationship (OR = 3.51), had depression symptoms (OR = 106), had anxiety symptoms (OR = 9.2), and had stress symptoms (OR = 19.3) in the univariable analysis. The backward multiple regression of these variables revealed that negative EE was independently associated with the absence of a romantic partner (OR = 3.45), having at least mild depressive symptoms (OR = 44.5) and having at least mild stress (OR = 5.65) in female students (Table 2).

Table 2 Factors associated with negative emotional eating in Chinese university students (n = 424)

Associations of emotional eating with bodyweight, perceived health, perceived life satisfaction and obesity

Both male and female university students with negative EE reported higher BMI, poorer self-perceived health, and lower life satisfaction than their non-EE counterparts (p < 0.05) (Tables 3 and 4). Although obesity was more prevalent in students with negative EE for both genders, females showed a statistically significant difference (48.5% versus 11.1% in non-EE females; p < 0.001) while males students showed a marginally significant difference (66.7% versus 30.7% in non-EE males; p = 0.061) (non-tabulated).

Table 3 Body mass index, health perceptions and life satisfaction scores by negative emotional eating status for males (n = 201)
Table 4 Body mass index, health perceptions and life satisfaction scores by emotional eating status for females (n = 223)


This study revealed that nearly one in ten Chinese students in this Hong Kong university sample were classified as engaging in negative EE. Although students were sampled from only two universities, their demographic and lifestyle characteristics are not expected to differ from other tertiary institutes. This study, therefore, provides a rough estimate of the prevalence of negative EE among Hong Kong university students. Direct comparison with other studies, however, must be made with caution. Due to differences in the instruments used to assess negative EE, the underlying constructs being measured may not be directly comparable. While in our study, the DEBQ instrument assesses the motivation to eat in response to negative emotions like stress, a recently published study from central China that examined negative EE as a form of internal disinhibition or loss of control reported a prevalence of 52.7% [37]. By contrast, another recent study from China noted that 14.5% of its undergraduate sample reported emotional overeating in response to a smaller number of negative emotions rather than the range assessed by the DEBQ [36]. Use of other scales such as the Emotional Eating Scale (EES) which includes a wider range of 25 possible emotional triggers for negative EE would likely have increased the prevalence estimates of this study [23].

Our results confirmed findings from international studies that females were much more likely to have negative EE as compared with their same-age male counterparts [25,26,27,28, 36, 37]. Studies from China have also shown negative EE to be more prevalent among females. Although the reasons for the strong gender differential are unclear from this analysis, past studies have noted that females are less likely to eat in response to hunger/satiety cues than males but were more responsive to external signals (e.g. stress) or rules (dieting) [49]. A previous study also noted that females have genetic predisposition for higher impulsivity and higher reward sensitivity, which are associated with dopamine dysregulation during comfort eating [50]. Our study was one of the first Chinese studies to note that negative EE behaviours and its relationship with psychosocial factors differ between genders. In male students, negative EE was only associated with greater depression levels, while negative EE was also associated with higher stress levels among females. Having a romantic partner was protective for negative EE among female students only. Due to the cross-sectional nature of this study, it is unclear whether close interpersonal interactions from a romantic relationship may reduce reliance on emotional eating as a coping mechanism or if those who partake in behaviours such as negative EE are less likely to form these relationships. However, our study did not show that anxiety was independently associated with negative EE. It may reflect that negative EE is not a common coping/affect regulation mechanism for anxiety in Chinese university students or that the sample size was insufficient to detect an association. Additionally, unlike many other EE instruments, the EE subscale of the DEBQ instrument does not allow for the examination of overeating in relation to specific negative mood states such as anxiety or anger. The EE subscale of the DEBQ instead broadly defines negative EE in response to a wide range of negative emotions and the single subscale score may therefore not be correlated strongly with a specific mood state such as anxiety. Individual subscales of EE instruments that specify types of EE (such as emotional eating for anger or boredom) have been noted to be correlated with measures of poorer psychological well-being [51, 52]. Use of another EE instrument such as Emotional Eating Scale (EES) which is comprised of three subscales (anxiety, depression, anger/frustration) by contrast, may have resulted in significant associations with the DASS-21 anxiety score in our study [23].

Our findings reveal that negative EE is associated with poorer mental health, higher BMI, lower life satisfaction, and lower perceived health, which in turn, have been linked with a multitude of other health conditions. The results thereby suggest that screening and management of EE are needed among Chinese university students. Clinicians may consider screening for negative EE, especially when seeing young adults with negative emotions, and offer appropriate counselling and interventions. However, despite being associated with adverse physical and psychological consequences, there is a lack of guideline-based treatments for EE in Hong Kong and worldwide. As negative EE was conceptualized as a poor stress-coping strategy, treatments that enhance emotional coping skills may reduce negative EE [53]. For instance, the latest meta-analysis suggested that mindfulness-based interventions could reduce EE and body weight [54]. However, there is a lack of similar studies in the non-Western populations. High-quality randomized controlled trials will be needed to examine treatment modalities in the Chinese population.

The strength of the current study includes the use of widely validated questionnaires (DEBQ and DASS-21) and a large array of psychosocial and lifestyle factors. To the authors’ knowledge, the relationship between EE and self-reported health was not previously examined. Although the data were collected through self-report and may be prone to social desirability bias, the use of an anonymous questionnaire is likely to have limited social desirability in answering sensitive questions. Although the sample size was modest, this study has a larger sample size than most of the existing studies conducted on university populations [5,6,7, 9, 10, 25, 26, 55].

This study has several limitations. First, due to the cross-sectional study design, the direction of many of the significant associations (e.g. negative EE and depression) cannot be ascertained conclusively. Second, even though the sociodemographic background and general lifestyle habits of the study sample are not expected to differ appreciably from other undergraduates in the region, students from these two universities may not be fully representative of all tertiary institute students in Hong Kong. Third, although our sample size was adequate for negative EE prevalence estimations, only nine male participants engaged in negative EE and this could limit the power to detect the association between EE and psychosocial factors among male students. Moreover, spurious findings cannot be ruled out in a multivariable regression model that includes multiple covariates. Fourth, single item measures on life satisfaction, perceived health, and physical activity were used for capturing secondary outcomes in our study but future studies should consider using multi-item scales for detailed assessment. Fifth, in examining factors associated with EE, there were potential confounding variables that were not covered in this study such as social support and the presence of eating disorder psychopathology.

Future research in non-Western populations should address some of the ongoing methodological issues in EE research. Although self-reported scales are commonly used to assess EE, the validity of the DEBQ has been debated in some past studies [56, 57]. Specifically, there has been conflicting evidence of increased food intake in individuals scoring high on self-reported emotional eating scales such as the DEBQ [56,57,58]. Researchers have also questioned whether such scales simply measure uncontrolled eating rather than emotional eating [56]. Future studies in Chinese populations could thereby explore alternative methods of assessing negative EE such as ecological momentary assessment and real-time sampling of participant’s thoughts and behaviours, in conjunction with concurrent dietary assessments. As there is comparatively little research on disordered eating patterns in East Asian populations, future studies should thereby examine whether individuals with negative EE also engage in disordered eating behaviours. Finally, as most studies have only examined negative EE in relation to overeating, future studies in Chinese population should also include EE in response to positive emotions as well as undereating behaviours for a better understanding of this phenomenon.


Negative emotional eating is an underappreciated risk behaviour in urban Chinese university students. Given its associations with negative emotions and other aspects of health, screening and management of EE may improve multiple areas of health and well-being. More studies in young Chinese adult populations are thereby needed to determine the best treatment strategies for negative EE.

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.



Body mass index


Confidence interval


Emotional eating


Dutch Eating Behaviour Questionnaire


Depression Anxiety and Stress Scale


Standard deviation


  1. Ham LS, Hope DA. College students and problematic drinking: a review of the literature. Clin Psychol Rev. 2003;23(5):719–59.

    Article  PubMed  Google Scholar 

  2. Jia Z, Jin Y, Zhang L, Wang Z, Lu Z. Prevalence of drug use among students in mainland China: a systematic review and meta-analysis for 2003–2013. Drug Alcohol Depend. 2018;186:201–6.

    Article  PubMed  Google Scholar 

  3. Prendergast ML. Substance use and abuse among college students: a review of recent literature. J Am Coll Heal. 1994;43(3):99–113.

    Article  CAS  Google Scholar 

  4. Skidmore CR, Kaufman EA, Crowell SE. Substance use among college students. Child Adolesc Psychiatr Clin. 2016;25(4):735–53.

    Article  Google Scholar 

  5. Nolan LJ, Geliebter A. Night eating is associated with emotional and external eating in college students. Eat Behav. 2012;13(3):202–6.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Christodoulou M, Adonis M, Papageorgi I. Emotional eating in college student population. J Food Nutr Disord. 2020;9:3.

    Google Scholar 

  7. Darling KE, Fahrenkamp AJ, Wilson SM, Karazsia BT, Sato AF. Does social support buffer the association between stress eating and weight gain during the transition to college? Differences by gender. Behav Modif. 2017;41(3):368–81.

    Article  PubMed  Google Scholar 

  8. Lyzwinski LN, Caffery L, Bambling M, Edirippulige S. The relationship between stress and maladaptive weight-related behaviors in college students: a review of the literature. Am J Health Educ. 2018;49(3):166–78.

    Article  Google Scholar 

  9. Alalwan TA, Hilal SJ, Mahdi AM, Ahmed MA, Mandeel QA. Emotional eating behavior among University of Bahrain students: a cross-sectional study. Arab J Basic Appl Sci. 2019;26(1):424–32.

    Article  Google Scholar 

  10. Wilson SM, Darling KE, Fahrenkamp AJ, D’Auria AL, Sato AF. Predictors of emotional eating during adolescents’ transition to college: does body mass index moderate the association between stress and emotional eating? J Am Coll Heal. 2015;63(3):163–70.

    Article  Google Scholar 

  11. Cardi V, Leppanen J, Treasure J. The effects of negative and positive mood induction on eating behaviour: a meta-analysis of laboratory studies in the healthy population and eating and weight disorders. Neurosci Biobehav Rev. 2015;57:299–309.

    Article  PubMed  Google Scholar 

  12. Evers C, Adriaanse M, de Ridder DT, de Witt Huberts JC. Good mood food. Positive emotion as a neglected trigger for food intake. Appetite. 2013;68:1–7.

    Article  PubMed  Google Scholar 

  13. Barnhart WR, Braden AL, Jordan AK. Negative and positive emotional eating uniquely interact with ease of activation, intensity, and duration of emotional reactivity to predict increased binge eating. Appetite. 2020;151:104688.

    Article  PubMed  Google Scholar 

  14. Sultson H, Kukk K, Akkermann K. Positive and negative emotional eating have different associations with overeating and binge eating: construction and validation of the positive-negative emotional eating scale. Appetite. 2017;116:423–30.

    Article  PubMed  Google Scholar 

  15. Barnhart WR, Braden AL, Price E. Emotion regulation difficulties interact with negative, not positive, emotional eating to strengthen relationships with disordered eating: an exploratory study. Appetite. 2021;158:105038.

    Article  PubMed  Google Scholar 

  16. Barnhart WR, Braden A, Dial LA. Understanding the relationship between negative emotional eating and binge eating: The moderating effects of acting with awareness and non-reactive mindfulness. 2020.

  17. Bourdier L, Morvan Y, Kotbagi G, Kern L, Romo L, Berthoz S. Examination of emotion-induced changes in eating: a latent profile analysis of the emotional appetite questionnaire. Appetite. 2018;123:72–81.

    Article  CAS  PubMed  Google Scholar 

  18. Macht M, Roth S, Ellgring H. Chocolate eating in healthy men during experimentally induced sadness and joy. Appetite. 2002;39(2):147–58.

  19. Elfhag K, Rössner S. Who succeeds in maintaining weight loss? A conceptual review of factors associated with weight loss maintenance and weight regain. Obes Rev. 2005;6(1):67–85.

  20. Swerdlow BA, Pearlstein JG, Sandel DB, Mauss IB, Johnson SL. Maladaptive behavior and affect regulation: a functionalist perspective. Emotion. 2020;20(1):75.

  21. Baik JH. Dopamine signaling in food addiction: role of dopamine D2 receptors. BMB Rep. 2013;46(11):519.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Bennett J, Greene G, Schwartz-Barcott D. Perceptions of emotional eating behavior. A qualitative study of college students. Appetite. 2013;60:187–92.

    Article  PubMed  Google Scholar 

  23. Arnow B, Kenardy J, Agras WS. The emotional eating scale: the development of a measure to assess coping with negative affect by eating. Int J Eat Disord. 1995;18(1):79–90.

    Article  CAS  PubMed  Google Scholar 

  24. Kwok JM, Ng DK. A study of the perceived stress level of university students in Hong Kong. Int J Psychol Stud. 2016;8(4):91–106.

    Article  Google Scholar 

  25. Thompson SH. Gender and racial differences in emotional eating. In: Food addiction symptoms, and body weight satisfaction among undergraduates; 2015. p. 93–8.

    Google Scholar 

  26. Carlos M, Elena B, Teresa IM. Are adherence to the Mediterranean diet, emotional eating, alcohol intake, and anxiety related in university students in Spain? Nutrients. 2020;12(8):2224.

    Article  PubMed Central  Google Scholar 

  27. Yönder Ertem M, Karakaş M. Relationship between emotional eating and coping with stress of nursing students. Perspect Psychiatr Care. 2020.

  28. Lazarevich I, Camacho ME, del Consuelo Velázquez-Alva M, Zepeda MZ. Relationship among obesity, depression, and emotional eating in young adults. Appetite. 2016;107:639–44.

    Article  PubMed  Google Scholar 

  29. van Strien T, Konttinen H, Homberg JR, Engels RC, Winkens LH. Emotional eating as a mediator between depression and weight gain. Appetite. 2016;100:216–24.

    Article  PubMed  Google Scholar 

  30. Ma G. Food, eating behavior, and culture in Chinese society. J Ethn Foods. 2015;2(4):195–9.

    Article  Google Scholar 

  31. Wang Z, Zhai F, Du S, Popkin B. Dynamic shifts in Chinese eating behaviors. Asia Pac J Clin Nutr. 2008;17(1):123–30.

    PubMed  Google Scholar 

  32. Zhai FY, Du SF, Wang ZH, Zhang JG, Du WW, Popkin BM. Dynamics of the Chinese diet and the role of urbanicity, 1991–2011. Obes Rev. 2014;15:16–26.

    Article  PubMed  Google Scholar 

  33. Hou F, Xu S, Zhao Y, Lu Q, Zhang S, Zu P, Sun Y, Su P, Tao F. Effects of emotional symptoms and life stress on eating behaviors among adolescents. Appetite. 2013;68:63–8.

    Article  PubMed  Google Scholar 

  34. Yung KW. Identity formation in a multicultural university residential hall: an ethnographic narrative inquiry of a local–non-local ‘hybrid’. Lang Intercult Commun. 2016;16(4):519–34.

    Article  Google Scholar 

  35. Zhu H, Xie Y. Buying out of familial obligation: the tradeoff between financially supporting versus living with elderly parents in urban China. Chin J Sociol. 2017;3(1):56–73.

    Article  PubMed  PubMed Central  Google Scholar 

  36. He J, Chen G, Wu S, Niu R, Fan X. Patterns of negative emotional eating among Chinese young adults: a latent class analysis. Appetite. 2020;155:104808.

    Article  PubMed  Google Scholar 

  37. Liu H, Yang Q, Luo J, Ouyang Y, Sun M, Xi Y, Yong C, Xiang C, Lin Q. Association between emotional eating, depressive symptoms and laryngopharyngeal reflux symptoms in college students: a cross-sectional study in Hunan. Nutrients. 2020;12(6):1595.

    Article  PubMed Central  Google Scholar 

  38. Benitez MA. Depression, anxiety rife among university students in Hong Kong as academic pressure, career worries and social media take toll. Hong Kong: South China Morning Post; 2018.

  39. Cheung E, Chiu P. Students at breaking point: Hong Kong announces emergency measures after 22 suicides since the start of the academic year. Hong Kong: South China Morning Post; 2018.

  40. Frayn M, Knäuper B. Emotional eating and weight in adults: a review. Curr Psychol. 2018;37(4):924–33.

    Article  Google Scholar 

  41. Wu S, Cai T, Luo X. Validation of the Dutch eating behavior questionnaire (DEBQ) in a sample of Chinese adolescents. Psychol Health Med. 2017;22(3):282–8.

    Article  PubMed  Google Scholar 

  42. Wang K, Shi HS, Geng FL, Zou LQ, Tan SP, Wang Y, Neumann DL, Shum DH, Chan RC. Cross-cultural validation of the depression anxiety stress scale–21 in China. Psychol Assess. 2016;28(5):e88.

    Article  PubMed  Google Scholar 

  43. Milton K, Bull FC, Bauman A. Reliability and validity testing of a single-item physical activity measure. Br J Sports Med. 2011;45:203–8.

    Article  CAS  PubMed  Google Scholar 

  44. Consultation WE. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet (London, England). 2004;363(9403):157–63.

    Article  Google Scholar 

  45. Lucas RE, Donnellan MB. Estimating the reliability of single-item life satisfaction measures: results from four national panel studies. Soc Indic Res. 2012;105(3):323–31.

    Article  PubMed  Google Scholar 

  46. Macias C, Gold PB, Öngür D, Cohen BM, Panch T. Are single-item global ratings useful for assessing health status? J Clin Psychol Med Settings. 2015;22(4):251–64.

    Article  Google Scholar 

  47. Pascual A, Etxebarria I, Ortega I, Ripalda A. Gender differences in adolescence in emotional variables relevant to eating disorders. Int J Psychol Psychol Ther. 2012;12(1):59–68.

    Google Scholar 

  48. Hosmer DW, Lemeshow S. Applied logistic regression. New York: Wiley; 2000. Print

    Book  Google Scholar 

  49. Smith JM, Serier KN, Belon KE, Sebastian RM, Smith JE. Evaluation of the relationships between dietary restraint, emotional eating, and intuitive eating moderated by sex. Appetite. 2020;155:104817.

    Article  PubMed  Google Scholar 

  50. Gibson EL. The psychobiology of comfort eating: implications for neuropharmacological interventions. Behav Pharmacol. 2012;23(5 and 6):442–60.

    Article  CAS  PubMed  Google Scholar 

  51. Braden A, Musher-Eizenman D, Watford T, Emley E. Eating when depressed, anxious, bored, or happy: are emotional eating types associated with unique psychological and physical health correlates? Appetite. 2018;125:410–7.

    Article  PubMed  Google Scholar 

  52. Koball AM, Meers MR, Storfer-Isser A, Domoff SE, Musher-Eizenman DR. Eating when bored: revision of the emotional eating scale with a focus on boredom. Health Psychol. 2012;31(4):521.

    Article  PubMed  Google Scholar 

  53. Van Strien T. Causes of emotional eating and matched treatment of obesity. Curr Diab Rep. 2018;18(6):1–8.

    Google Scholar 

  54. Evers C, Dingemans A, Junghans AF, Boevé A. Feeling bad or feeling good, does emotion affect your consumption of food? A meta-analysis of the experimental evidence. Neurosci Biobehav Rev. 2018;92:195–208.

    Article  PubMed  Google Scholar 

  55. Strenger AM, Schnitker SA, Felke TJ. Attachment to God moderates the relation between sociocultural pressure and eating disorder symptoms as mediated by emotional eating. Ment Health Relig Cult. 2016;19(1):23–36.

    Article  Google Scholar 

  56. Bongers P, Jansen A. Emotional eating is not what you think it is and emotional eating scales do not measure what you think they measure. Front Psychol. 2016;7:1932.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Domoff SE, Meers MR, Koball AM, Musher-Eizenman DR. The validity of the Dutch eating behavior questionnaire: some critical remarks. Eat Weight Disord. 2014;19(2):137–44.

    Article  CAS  PubMed  Google Scholar 

  58. Braden A, Emley E, Watford T, Anderson L, Musher-Eizenman D. Self-reported emotional eating is not related to greater food intake: results from two laboratory studies. Psychol Health. 2020;35(4):500–17.

    Article  PubMed  Google Scholar 

Download references


Not applicable.


Not applicable.

Author information

Authors and Affiliations



KS designed the study and collected the data. KS and RC conducted the statistical analyses. KS, EL and JHK interpreted the results and wrote the manuscript. All authors were involved in the production of the manuscript and approved the final version.

Corresponding author

Correspondence to Jean H. Kim.

Ethics declarations

Ethics approval and consent to participate

Ethical approval was obtained from the Survey and Behavioural Research Ethics Committee of the Chinese University of Hong Kong. Informed consent was obtained from all participants from the online data collection platform.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sze, K.Y.P., Lee, E.K.P., Chan, R.H.W. et al. Prevalence of negative emotional eating and its associated psychosocial factors among urban Chinese undergraduates in Hong Kong: a cross-sectional study. BMC Public Health 21, 583 (2021).

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: