Emotional eating, body mass index, and sex differences: a national cross-sectional study of Saudi adults

Emotional eating (EE), eating in response to emotions rather than physiological hunger, is associated with higher energy-dense food intake and greater body weight. Population-scale estimates of EE prevalence, its association with body mass index (BMI), and how these differ by sex are scarce in the Middle East, limiting region-specific prevention efforts. In this cross-sectional study spanning all 13 administrative regions of Saudi Arabia, 4,412 adults (2,648 women and 1,764 men), aged 18–65, completed an online survey including the validated Arabic Emotional Eating Scale (subscales: sadness/irritability, exhaustion, excitement, distress), and self-reported height and weight. High EE was defined as a total score at or above the 75th percentile. Differences by sex, BMI category, and age group were tested non-parametrically; the EE-BMI association was analyzed using generalized linear models with a gamma distribution and log link, adjusted for sociodemographic, behavioral, and clinical factors. Approximately 25% of participants met the high-EE criterion, with marked regional variation (ranging from 17.1% in Qassim to 31.4% in Northern Borders). EES scores varied significantly across sex, BMI categories, and age groups (all p < 0.001). EE was associated with higher BMI (Exp(B) = 1.001, 95% CI 1.000–1.001), although statistically significant, the observed effect sizes were small in magnitude. Thus, prevents overinterpretation of statistical significance. Among EES subscales, the most pronounced association was observed for the distress subscale (Exp(B) = 1.004, 95% CI 1.002–1.005). The EE–BMI association was consistent across all subscales among women (all p < 0.001), whereas no significant associations were observed among men; sex × emotional eating interaction terms confirmed that the association differed significantly by sex (all p < 0.001). In this national sample, higher emotional eating, particularly distress-related eating, was associated with higher BMI among women but not men, suggesting sex-specific patterns that warrant further research in diverse populations. The observed significant regional differences in EE prevalence and the higher EES scores among women suggest the need for regionally personalized, sex-sensitive interventions that reflect local dietary behaviors and social norms. National longitudinal prospective studies including clinically measured anthropometrics are needed to further establish the relationship between EE and obesity-related outcomes in this population.