BRIEF REPORT Decreased Emotional Perception in Obesity Katrin Elisabeth Giel 1 , Armin Hartmann 2 , Almut Zeeck 2 , Anna Jux 2 , Alexander Vuck 3 , Petra C Guess Gierthmuehlen 3 , Edda Wetzler-Burmeister 2 , Angelika Sandholz 2 , Goran Marjanovic 4 & Andreas Joos 2 * 1 Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany 2 Department of Psychosomatic and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany 3 Department of Prosthetic Dentistry, University Medical Center Freiburg, Freiburg, Germany 4 Center for Metabolic and Bariatric Surgery, Department of Visceral Surgery, University Medical Center Freiburg, Freiburg, Germany Abstract Background: There is hardly any empirical evidence on emotion processing by controlled studies in obesity. Material and Methods: Participants rated their emotions in response to visual emotional stimuli from the International Affective Picture System. Study 1 compared obese women with normal-weight controls and women with eating disorders. Study 2 compared obese men with normal-weight controls. Results: Obese women had reduced emotional intensity scores for all basic emotions and the mixed emotion sadness–fear. Obese men had reduced scores for all emotions except happiness and disgust; anger showed a trend towards significance. The results were mainly based on ratings from non-depressed obese individuals. Discussion: Obese men and women scored significantly lower on most basic and mixed emotions. Non-depressed obese subjects seem particularly affected. These new findings must be validated by further study, and longitudinal evaluation after weight loss, e.g. by bariatric surgery, will be of interest. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association. Keywords obesity; emotional perception; emotion processing; eating disorders; social cognition *Correspondence PD Dr. med. Andreas Joos, Department of Psychosomatic Medicine and Psychotherapy, University of Freiburg, Hauptstraße 8, D-79104 Freiburg, Germany. Email: andreas.joos@uniklinik-freiburg.de Published online 4 April 2016 in Wiley Online Library (wileyonlinelibrary.com) DOI: 10.1002/erv.2444 Introduction The umbrella term ‘social cognition’ sums up a variety of complex and intertwined processes that ‘… encode socially and emotionally relevant inputs, represent their meaning, and guide responses to them’ (Ochsner, 2008). A large body of evidence reports difficulties in social cognition in populations showing impaired regulation of eating behaviour and body weight, especially in patients with eating disorders (ED) (Caglar-Nazali et al., 2014; Joos, Cabrillac, Hartmann, Wirsching, & Zeeck, 2009; Renwick et al., 2015). Explanatory models of ED have included problems in the socio- emotional domain as a potential cause of developing these disorders (Schmidt & Treasure, 2006; Treasure & Schmidt, 2013). Similarly, some theories suggest that obesity might be associated with problem processing and regulating emotions (Leehr et al., 2015). Obesity is a growing health problem in Western countries (Val- Laillet et al., 2015). As Eastern European and developing countries adopt more Western life styles, these populations are also facing increasing incidences of obesity and its side effects (Olaya et al., 2015; Tekkel, Veideman, & Rahu, 2010; Wang & Lim, 2012). Obese people often develop a multitude of somatic and psychosocial problems. For decades, there were no effective treatments for obesity, but in recent years, bariatric surgery has become an effective option (Courcoulas et al., 2014). There is initial evidence that negative emotions might elicit overeating in obese individuals (Leehr et al., 2015). In obesity research, this association has mainly been investigated within the theory of emotional eating, suggesting eating as a coping strategy in response to emotional distress (Leehr et al., 2015). In line with this theory, a recent ecological momentary assessment of eating episodes in obese adults revealed that episodes of overeating and subjective loss-of-control over eating were associated with negative emotions (Goldschmidt et al., 2014). Self-report data suggest that this relationship might indeed be associated with emotion regulation difficulties as obese women who reported higher difficulty identifying feelings also reported more emotional eating (Zijlstra et al., 2012). Longitudinal data suggest that emotional eating is a negative predictor of weight loss after bariatric surgery (Canetti, Berry, & Elizur, 2009; Castellini et al., 2014), but might also be reduced after bariatric surgery (Hörchner, Tuinebreijer, & Kelder, 2002). While there are self-report data especially on the concept of emotional eating and though there have been some studies on emotion regulation in obesity, empirical data with controlled designs are few for the more basal abilities such as recognizing and responding to social-affective stimuli in the ‘socio-emotional processing stream’ (Ochsner, 2008). Some studies show impairments in facial emotion recognition (Koch & Pollatos, 2015) 341 Eur. Eat. Disorders Rev. 24 (2016) 341–346 © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.