Investigating the complex dynamics of psychological stress and sociocultural influences on unhealthy meal frequency as a subclinical indicator of disordered eating behaviours

Unhealthy meal frequency (UMF), including meal skipping, irregular timing, and maladaptive eating patterns, is increasingly recognised as a major contributor to poor nutritional and mental health outcomes worldwide. In low- and middle-income countries such as Pakistan, rapid urbanisation, shifting gender roles, and strong sociocultural norms may uniquely shape eating behaviours, yet empirical evidence integrating psychological and sociocultural determinants remains limited. Previous research has largely focused on dietary quality or caloric intake, leaving the broader behavioural structure of meal frequency and its contextual drivers insufficiently understood. This study addresses the need for a comprehensive, culturally grounded examination of UMF in Pakistan by integrating demographic, psychological, and sociocultural factors within a single analytical framework. Using a cross-sectional sample of 412 Pakistani adults and a culturally adapted assessment of eating behaviours, we examined the prevalence, patterns, and predictors of UMF, with particular attention to gender and regional differences. Here we show that nearly half of participants (46.1%) met criteria for UMF, with markedly higher prevalence among females than males (52.2% vs 31.1%). Irregular meal timing and meal skipping were the most common patterns. Multivariate analyses revealed that sociocultural factors, especially cultural pressures, family food rules, and gender role expectations, were the strongest independent predictors of UMF, exceeding the influence of psychological factors such as emotional eating. Emotional eating partially mediated the relationship between cultural pressures and UMF, while gender significantly moderated this association, with substantially stronger effects observed in females. Regional disparities were evident, with the highest UMF prevalence in Punjab. These findings extend prior knowledge by demonstrating that UMF in Pakistan is driven less by individual psychological traits alone and more by embedded sociocultural structures that shape daily eating practices, particularly for women. More broadly, this work highlights UMF as a culturally patterned behaviour rather than a purely personal choice, underscoring the need for nutrition and public health interventions that move beyond individual-level education to address gender norms, family dynamics, and cultural expectations within rapidly changing societies.