Chronic Stress, Reward Processing, and Emotional Eating as Neurobehavioral Predictors of Incident Obesity: A Retrospective Cohort Study
DOI:
https://doi.org/10.66687/jebmr.2.02.2026.39Keywords:
retrospective cohort, neurobehavioral risk, emotional eating, reward processing, chronic stress, obesityAbstract
Background: Chronic stress, altered reward processing, and emotional eating may jointly promote positive energy balance, but their longitudinal contributions to the transition from non-obese weight status to obesity are incompletely characterized.
Methods: We conducted a retrospective cohort analysis of 750 adults aged 18-70 years without obesity at baseline. BMI was calculated from recorded height and weight, and incident obesity was defined as the first follow-up BMI >=30 kg/m². Participants contributed 2,609.8 person-years (median follow-up, 43 months). The primary analysis used person-month complementary log-log regression with annual baseline-hazard indicators and participant-clustered robust standard errors. Baseline stress, reward-processing, and emotional-eating scores were standardized; models adjusted for age, sex, baseline BMI, and family history of obesity. An exploratory standardized neurobehavioral index summarized the three exposure scores.
Results: Ninety-eight participants (13.1%) developed obesity, an incidence rate of 37.6 per 1,000 person-years. In unadjusted models, stress (HR 1.45 per SD, 95% CI 1.20-1.75) and emotional eating (HR 1.41, 95% CI 1.17-1.70) predicted incident obesity, whereas reward processing did not (HR 1.14, 95% CI 0.95-1.38). In the complete-case multivariable model (n=619; 81 events), associations attenuated for stress (adjusted HR 1.21, 95% CI 0.92-1.59), reward processing (0.98, 0.74-1.30), and emotional eating (1.26, 0.96-1.67), while baseline BMI remained strongly predictive (4.63 per SD, 3.10-6.92). The exploratory neurobehavioral index was independently associated with incident obesity (adjusted HR 1.42 per SD, 1.13-1.79; p=0.003); crude incidence increased from 26.1 to 52.4 per 1,000 person-years from the lowest to highest tertile.
Conclusions: Individual neurobehavioral scores were attenuated after adjustment for baseline adiposity, whereas their combined standardized profile retained prognostic information. These findings support integrated assessment of stress-related, reward-related, and emotional-eating processes while emphasizing baseline BMI as the dominant near-term predictor of incident obesity.
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