Mechanisms of maladaptive eating behavior among individuals with obesity and pain: exploring rumination.

Upwards of 40% of adults in the United States (US) meet criteria for obesity, highlighting obesity as a critical, ongoing public health crisis. Pain affects 33-40% of individuals with obesity, contributing to increased distress and added burden which necessitates a higher degree of coping resources. Individuals with obesity often manage distress through maladaptive eating behaviors, yet it is unclear what mechanisms may contribute to these individual differences in eating behaviors. One mechanism that is relevant to both obesity and pain is rumination, an aspect of repetitive negative thinking that is focused on past negative thoughts or problems and can influence behavioral responses. However, the role of rumination in terms of eating behavior among adults with obesity and pain is unexplored. The present study examined the role of rumination, including its sub-facets (brooding and reflection) in relation to emotional, external, and restrained eating behavior and related cognitions among individuals with comorbid obesity and pain. Participants were 137 adults with comorbid obesity and pain (Mage = 31.96 years, SD = 10.82, age range 18-75 years; 62.0% female). Results indicated that rumination was statistically significantly associated with emotional and external eating, such that higher levels of rumination were related to increased engagement in these specific eating behaviors and related cognitions. These findings indicate that rumination, and ruminative brooding specifically, may serve as a modifiable, clinically actionable mechanism, highlighting a novel opportunity to improve outcomes for maladaptive eating in individuals with comorbid obesity and pain.Trial Registration Number: NCT03917901. Registered 13 April 2019.