Stress-related helplessness is independently associated with reward-driven eating in adults with BMI-defined normal weight and obesity

Accumulating evidence indicates that stress is associated with reward-driven eating, yet the stress dimensions underlying this relationship remain insufficiently understood. Inconsistent findings may partly reflect conceptualizing stress as a unitary construct and insufficient consideration of weight status. This study examined the independent associations of perceived stress dimensions (Helplessness, Self-Efficacy) with hedonic hunger, trait food craving, and uncontrolled eating in adults with BMI-defined normal weight and obesity.

Ninety adults were enrolled, 47 with normal weight, 18 with overweight, and 25 with obesity (BMI ≥ 30 kg/m²). Primary inferential analyses included participants with normal weight and obesity (N = 72); participants with overweight were excluded. Participants completed questionnaires assessing perceived stress (Perceived Stress Scale, PSS), hedonic hunger (Power of Food Scale), trait food craving (Food Craving Questionnaire-Trait reduced), and uncontrolled eating (Three-Factor Eating Questionnaire). PSS Helplessness and Self-Efficacy subscales were derived. Associations were examined using Spearman correlations and multiple linear regression adjusted for age, sex, BMI, and current hunger. Helplessness and Self-Efficacy were entered simultaneously to estimate independent associations with reward-driven eating outcomes. PROCESS moderation analyses tested whether BMI or BMI-defined weight status influenced the association.

In the primary analysis sample, PSS Total was not independently associated with any reward-driven eating outcome after correction for multiple testing. In contrast, Helplessness was independently associated with greater hedonic hunger, food craving, and uncontrolled eating after FDR correction, whereas Self-Efficacy was not independently associated with any outcome after accounting for Helplessness. In subgroup analyses, associations were descriptively more consistent among participants with obesity than those with normal weight. However, no interaction effect remained significant after correction for multiple testing.

These findings highlight Helplessness, reflecting, perceived uncontrollability, as the perceived stress dimension most consistently associated with reward-driven eating and underscore the importance of distinguishing between stress dimensions rather than relying solely on overall perceived stress. There was no robust evidence in the present study that BMI or BMI-defined weight status modified these associations. Perceived uncontrollability may represent a potential target for interventions aimed at reducing maladaptive reward-driven eating behavior.