Stress and Food Choice: A Laboratory Study GEORGINA OLIVER,PHD, JANE WARDLE,PHD, AND E. LEIGH GIBSON,PHD Objective: This study investigated experimentally whether acute stress alters food choice during a meal. The study was designed to test claims of selective effects of stress on appetite for specific sensory and nutritional categories of food and interactions with eating attitudes. Methods: Sixty-eight healthy men and women volunteered for a study on “the effects of hunger on physiology, performance, and mood.” Eating attitudes and food preferences were measured on entry to the study. The stressed group prepared a 4-minute speech, expecting it to be filmed and assessed after a midday meal, although in fact speeches were not performed. The ad libitum meal included sweet, salty, or bland high- and low-fat foods. The control group listened to a passage of neutral text before eating the meal. Blood pressure, heart rate, mood, and hunger were measured at baseline and after the 10-minute preparatory period, when appetite for 34 foods and food intake were recorded. Results: Increases in blood pressure and changes in mood confirmed the effectiveness of the stressor. Stress did not alter overall intake, nor intake of, or appetite for the six food categories. However, stressed emotional eaters ate more sweet high-fat foods and a more energy-dense meal than unstressed and nonemotional eaters. Dietary restraint did not significantly affect appetitive responses to stress. Conclusions: Increased eating of sweet fatty foods by emotional eaters during stress, found here in a laboratory setting, may underlie the previously reported finding that dietary restraint or female gender predicts stress-induced eating. Stress may compromise the health of susceptible individuals through deleterious stress-related changes in food choice. Key words: stress, food choice, emotional eating, dietary restraint, appetite, nutrition. ANOVA = analysis of variance; DBP = diastolic blood pressure; DEBQ = Dutch Eating Behavior Question- naire; PANAS = Positive and Negative Affect Sched- ule; SBP = systolic blood pressure; STAI = State-Trait Anxiety Inventory. INTRODUCTION There is increasing evidence that stress may affect health not only through its direct biological effects but also through changes in health behaviors that them- selves influence health (1, 2). Clearly, one such health behavior is food choice: that is, stress may lead to ill health through unhealthy changes in diet as well as more general effects on appetite (3). Stress and diet associations are particularly com- plex. Stress is associated with biological changes that might be expected to reduce food intake, at least in the short-term, such as adrenaline-induced glycogenoly- sis, slowed gastric emptying, autonomic shunting of blood from gut to musculature, and activation of the hypothalamic-pituitary-adrenal axis (4, 5). Yet the ex- perimental results have been inconsistent. Animal studies have produced evidence of both hyperphagia and hypophagia in response to stress (5–7). Research on everyday food intake in human subjects under low- and high-stress conditions has also produced inconsis- tent results. Stress in the workplace has been associ- ated with higher energy intake in two studies (8, 9), examination stress has produced mixed results (10, 11), and surgical stress, probably the most extreme stressor examined, has been found to have no consis- tent effect (12). These varying results may be related to the nature of the stressor; for example, mild stressors could induce hyperphagia, and more severe stressors, hypophagia (7, 13). Alternatively, there could be significant individual differences in responses to stress, with the study sam- ples varying in the proportions of the different re- sponse types. Pollard et al. (11) found that students who were high on anxiety and low on social support were more likely to show a hyperphagic response, and Wardle et al. (9) found that dietary restraint levels moderated the response to work stress. An individual difference model is supported by data from both pro- spective (14) and retrospective (15, 16) self-report studies, showing either increased, decreased, or no change in eating during stress but with consistent ef- fects within individuals. The importance of individual differences in the eat- ing response to stress has also been borne out by a number of laboratory studies (13). Such studies typi- cally induce stress through one of a number of stan- dard procedures while assessing food intake, ostensi- bly as incidental to some other task, such as making taste ratings. A consistent pattern is that participants scoring highly on a measure of dietary restraint eat more under stress, whereas intake is the same or lower in unrestrained eaters (17–22). This rather complex pattern of results suggests that more attention needs to be directed toward specifying the nature and intensity of the stress response, and the From the Imperial Cancer Research Fund (ICRF) Health Behaviour Unit, Department of Epidemiology and Public Health, University College London, London, United Kingdom. Address reprint requests to: Professor Jane Wardle, ICRF Health Behaviour Unit, Department of Epidemiology and Public Health, University College London, 2-16 Torrington Place, London WC1E 6BT, United Kingdom. Email: j.wardle@ucl.ac.uk Received October 18, 1999; revision received May 3, 2000. 853 Psychosomatic Medicine 62:853– 865 (2000) 0033-3174/00/6206-0853 Copyright © 2000 by the American Psychosomatic Society