Research has established complex associations between diet and nutrition, psychological stress, and mental health. Psychological stress and poor mental health can lead to coping mechanisms that can manifest into poor dietary choices and/or behaviors, which can lead to nutritional imbalances or excess weight gain over the long term, and may also impact eating competence. Poor diet and nutrition have been associated with indicators of poor emotional, cognitive, and mental health. If unaddressed, this can lead to a continuing cycle in which poor mental health and inadequate/excess nutrition worsen one another, further harming both mental and physical well-being.  

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Background 

Bidirectional: Stress Influences Diet and Diet Influences Stress

Psychological stress is associated with changes in one’s dietary choices, moods, behaviors, and mental and physical health states. This association is multi-faceted and complex as stress has been shown to influence eating behaviors and dietary habits, and diet and nutrition have, in turn, been observed to influence the stress experience. To fully understand the complexity, one has to take life experiences into account as an individual's dietary, behavioral, mental, and physical health histories can help inform a better understanding of one’s stress-diet relations (Adan et. al., 2019; Thanarajah et al., 2023). Dietary habits begin early in life and stress-related eating behaviors are no different, with some finding that stress-related eating can begin as early as eight years old (Henderson et. al., 2022).

 

The Stress Response: Nutrition and the Brain 
The stress response affects an individual’s eating behaviors, appetite, food choices and metabolism through complex mechanisms (Yau & Potenza, 2014; Adam & Epel, 2007; Chiu and Tomiyama, 2023). Eating in response to negative states like stress is known as stress-induced eating, stress eating, or comfort eating (Gibson, 2012; Dakanalis et al., 2023). Emotional eating is closely related, though it also includes eating in response to positive emotions (Evers et al., 2013). Regardless, this type of behavior is often used as a coping mechanism (Serin and Sanlier, 2018; Ulrich-Lai et. al., 2015) that can be learned or passed down through generations (Lee et. al., 2023) and can also contribute to both over and undereating (Tsofliou et al., 2023; Adam & Epel, 2007; Ulrich-Lai et. al., 2015).

After exposure to a stressor, the stress response is triggered, releasing epinephrine (more commonly known as adrenaline) through the sympathetic-adrenal-medullary (SAM) axis and cortisol through the hypothalamic-pituitary-adrenal (HPA) axis in the body (Ulrich-Lai et. al., 2015). Epinephrine, a “fight or flight” hormone, serves to conserve energy expenditure in the body, working to suppress digestion. Contrarily, cortisol acts to increase fuel substrate availability, motivating eating behaviors by reducing sensitivity to leptin, an appetite-suppressing hormone; increasing neuropeptide Y (NPY) expression, which increases appetite; and potentiating reward processing pathways that increase pleasure derived from particularly palatable (“hyperpalatable”) foods like sweet and fatty foods (Chiu and Tomiyama, 2023). A number of other hormones (e.g., insulin, glucose, etc.) and biologically active entities (e.g., visceral adipose tissue, gut microbiota) are also involved in this complex pathway (Chiu and Tomiyama, 2023; Yau and Potenza, 2014).

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During experiences of stress, palatable foods are preferred for the way they activate the brain’s reward system and interact with the body’s metabolic stress response (Yau & Potenza, 2014). Additionally, sugar itself has been found to lower cortisol activity through a metabolic-brain-negative feedback loop (Tryon et al., 2015), and high fat diets have been associated with producing cognitive deficits through corticosterone within the hippocampus (Spencer et. al, 2017). This can foster poor food consumption regulation and stress-related overeating (Yau & Potenza, 2014; Thanarajah et al., 2023; Adam & Epel, 2007; Tsofliou et al., 2023). While stress-eating cycles can temporarily lower discomfort related to perceived stress, these behaviors have also been associated with later feelings of shame and guilt, which can add to stress levels, perpetuating a cycle of stress-eating and adverse metabolic and health-related consequences (Adam & Epel, 2007; Segal & Gunturu, 2024). Moreover, given the nature of the foods preferred in times of stress, this can set one down the path towards excess caloric intake and weight gain and diet-related chronic disease (Dallman et al., 2003; Adam & Epel, 2007; Yau and Potenza, 2014; Thanarajah et al., 2023). Indeed, obesity persists as a public health concern affecting more than 2 in 5 adults in the United States (NIH, 2021), and stress-eating involving palatable “comfort” foods have been hypothesized as one driver of the obesity epidemic (Dallman et al., 2003).

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Some individuals may alternatively restrict their eating during times of stress, in some cases causing weight loss. This is a behavior seen particularly in women (Adam & Epel, 2007) and underweight individuals (Tsofliou et al., 2023). A recent study connects stress-related undereating to emotion-focused coping, a stress management approach through behaviors that do not address the root cause (Dakanalis et. al., 2023; Adam & Epel, 2007; Segal & Gunturu, 2024). The etiology of undereating in response to stress remains inconclusive, though activity of the sympathetic nervous system and SAM axis are of particular focus (Tsofliou et al., 2023). 

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Diet Quality and the Stress Response 
Diet quality and nutrition also impact experiences of psychological stress through neuropsychiatric processes that involve cognitive, emotional, mental and physical health processes (Adan et al., 2019). The 2025 Dietary Guidelines for Americans advise that a nutritious diet is one that is rich in fruits and vegetables; this diet has been associated with higher levels of happiness, elevated mood, improved cognitive functioning, and reduced stress (Phillips, J. A, 2021; Adan et al., 2019). Both excessive caloric intake and nutrient deficiencies stemming from consumption of energy dense, nutrient poor foods can lead to chronic diet-related conditions, such as obesity or heart disease. Obesity has been shown to have an impact on an individual’s well-being through depression, anxiety, disordered eating, substance abuse, lower quality of life, and negative body image issues, which all add to increasing stress levels (Sarwer & Polonsky, 2018). Healthy brain function relies on adequate nutrition, making diet mediation a critically important strategy for lowering perceived stress that has a direct impact on mental health (Varghese et al., 2020; Adan et al., 2019). Emerging evidence suggests that these diet-cognition links may be more pronounced in more stressed populations (Sala-Vila et al., 2020; Boyle et al., 2019). Both aspects of nutrition, excessive and deficient, affect an individual's mood, energy levels, and cognition, which inevitably impact behaviors (Adam & Epel, 2007; Adan et al,. 2019).

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Mitigation of risks associated with stress-related eating behaviors can be achieved through improved nutrition and healthier dietary patterns. Systematic reviews of randomized clinical trials have found reasonable evidence to support the relationship between improved cognitive function with dietary patterns that are more plant-based and replete with healthy fats such as omega-3 fatty acids as well as phytotherapeutic compounds such as polyphenols (Gutierrez et al 2021; Spencer et al., 2017). The Mediterranean Diet is most commonly known for its neuroprotective effects, though other diets fitting similar nutrient profiles (e.g., the Okinawan diet with high anti-inflammatory and anti-oxidative capacities have also been recognized) (Varghese et al., 2020). A growing body of research recognizes diet and nutrition as risk factors, modifiers, and mediators of stress and mental health (Firth et al., 2020). The complex interplay of these factors also highlights the simultaneous importance of maintaining healthy diets and promoting healthy coping mechanisms for mental and physical health.

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Conclusion
Overall, a negative cycle could foreseeably result where stress-related behaviors could inspire unhealthy dietary intakes, which then serve to increase adverse changes in mood, unhappiness, and stress. Importantly, the relationship between mental health and stress with diet and nutrition is bidirectional. Epidemiological evidence supports an association between diet quality and mental health measures (Marx et al., 2017). Dietary interventions have been shown to be an effective component in the treatment of depression and anxiety (Burrows et al., 2022). In an effort to address this prevalence in obesity, considerations in mental health programming need to be made as stress-related eating patterns contribute to chronic disease risk. Accordingly, nutrition education and dietary intervention should be considered for integrative mental health treatment plans. 
 

Collection and Measurement

We acknowledge two main pathways of association between diet/nutrition and stress/mental health: 1) stress on diet and nutrition behaviors, and 2) diet and nutrition on stress. Key dietary, nutrition, and related stress assessments specific to this space (e.g. stress eating, emotional eating, food addiction, etc.) are detailed below.

 

Diet-related Tools:
 

24-hour Dietary Recall
Trained nutrition professionals use the 24-hour dietary recall method to understand an individual’s dietary intake over the last 24 hours. This method involves asking an individual detailed questions about everything they have consumed, whether it be food or beverage, within the last 24 hours. For an accurate measure, this process requires a minimum of at least three recalls, with one being a weekend day. In this analysis, time of consumption, portion size, and preparation methods are all documented for analyses and a recommendation of a summary score. This recall can help develop a means for improving dietary habits, managing weight, or addressing specific health conditions while creating dietary goals for tracking the intervention over time (NIH, 2025). 

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Food Frequency Questionnaire
A food frequency questionnaire (FFQ) is a survey used to understand an individual’s general dietary habits and nutrient intake. This questionnaire may be a better alternative than short-term scales, like the 24-hour dietary recall, since the survey asks individuals how often they eat certain foods and drinks over a specific period of time. This measurement consists of a list of foods and beverages with response categories to indicate frequency of consumption over time; more intensive assessments include portion size images to enhance accuracy in these diet histories. The benefit of using this scale for nutrition is to improve the understanding of the relationship between diet history and health outcomes and to understand risk factors associated with disease (NIH, 2025).

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Food Record 
A food record is a self-reported account of all foods and beverages, even dietary supplements, that are consumed over one or more days. This method is a record of the respondent’s diet, which can be used to track and identify eating habits and food intolerances or assess how they are feeling before and after a meal. Details that are required for an accurate assessment include brand name, preparation methods, and consumption times. The information from an individual’s food record can be beneficial when assessing dietary habits and behaviors, risk of chronic illness, and finding healthier alternatives and triggers (like stress-induced eating, for example). Records can be kept in a journal, on a device, or through a smartphone application, validity requires several (5-7) days of logging (NIH, 2025).

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Overall Dietary Pattern or Diet Quality Indices
It is often informative to gain an understanding of an individual’s diet relative to established guidelines or characterizations of dietary patterns or measures of diet quality. Researchers can utilize data from the dietary assessment tools described above to evaluate intakes relative to recommended or established amounts corresponding to dietary patterns or diet quality measures of interest. For stress and diet studies, dietary pattern and diet quality measures (including scoring information for each), that are particularly pertinent include the Healthy Eating Index (HEI) for overall adherence to the Dietary Guidelines for Americans (https://www.fns.usda.gov/cnpp/how-hei-scored), the Alternate Healthy Eating Index (AHEI) for chronic disease (Chiuve et al., 2012), the Mediterranean Diet Score (Trichopoulou et al., 2003), the Mediterranean–DASH Diet Intervention for Neurogenerative Delay (MIND) Diet Score (Morris et al., 2015), and the Dietary Inflammatory Index (DII) (Shivappa et al., 2014). 

 

Nutrition Screeners: Frequency and Behavioral 
Nutrition screeners are used as a basic measurement scale of foods and beverages consumed or dietary practices over a period of time, usually in the past months or years. These tools are used to identify patients who may be at risk for malnutrition. The two approaches for this measurement scale are “frequency” and “behavioral” screenings. A frequency screening is a short food frequency questionnaire (FFQ) that does not include portion size questions. This scale is used to capture the usual pattern of food and beverage consumption. This scale is used to get a general sense of what the patient’s diet looks like rather than a detailed snapshot of meals on a specific day. The behavioral screening asks about general dietary practices, habits, or lifestyle factors that may impact their nutritional status. An example of this on a questionnaire would be, “Do you generally butter your bread?” or “Do you usually eat dessert or pudding if there is one available?”. The purpose of this screening is to get a better understanding of an individual’s health habits to assess nutrient imbalances and improve health outcomes by reducing the risk of chronic diseases. This screening approach is a more personalized understanding of creating nutrition plans based on the individual’s needs and preferences (NIH, 2025).

 

Stress, Food Behavior and Eating Psychology-Related Measures:
 

Child and Adult Eating Behavior Questionnaire
The Child and Adult Eating Behavior Questionnaires are a measurement used to understand an individual's eating habits, frequency, and behaviors and experiences with food. The 35-item scale is assessed on four subscales: enjoyment of food, emotional overeating, food responsiveness and hunger. These subscales are then broken down into food avoidance subscales, such as: emotional undereating, food fussiness, slowness in eating, and satiety responsiveness. This measurement is beneficial when it comes to understanding individual eating styles, assessing obesity and related eating behaviors, potential feeding difficulties or disordered eating, and guiding intervention strategies (Kuno et. al., 2024; PhenX, 2025)

 

Weight-Related Eating Questionnaire 
The Weight-Related Eating Questionnaire is a 16-item self-reported questionnaire used to assess various aspects of eating behaviors and attitudes related to weight management and body weight concerns. This measurement is used to understand factors that may influence eating and weight management, identify if disordered eating or other weight-related problems may be present, and to monitor the effectiveness of weight loss interventions through tailored programs addressing specific eating patterns and behaviors (James et. al., 2017). 

 

Satter Eating Competence Model (ecSatter)
The Satter Eating Competence Model is a self-administered measurement that focuses on an internally regulated approach to eating. This measurement assesses the four components of eating competence, such as: eating attitudes, food acceptance, regulation of food intake and body weight, and management of the eating context (including family meals). This measurement emphasizes the importance of joy and pleasure with eating rather than the conventional approach that often involves restriction and external control over food intake (Satter, 2007). 

Emotional Eating Scale (EES); Salzburg Emotional Eating Scale (SEES); Dutch Eating Behavior Questionnaire; Emotional Overeating Questionnaire, Emotional Appetite Questionnaire, Three Factor Eating Questionnaire,The

 

Emotional Eater Questionnaire (EEQ)
This subset of questionnaires uses self-reported measures that consist of at least 10 questions used to assess eating as a coping mechanism in response to a wide range of emotions that are clustered into four subcategories: sadness, anxiety, depression, and happiness. It works on a 5-point Likert scale: no desire, small desire, moderate desire, strong urge, and overwhelming urge to eat. The Emotional Eater Questionnaire (EEQ) uses self-reported measures that consist of at least 10 questions used to assess emotional eating, but focuses on three subscales that assess (1) disinhibition, (2) type of food, and (3) guilt. Response options range from 1 (never) to 4 (always) and a lower total score indicates healthier eating behaviors (Garaulet et al., 2012). Higher scores indicate a greater desire to eat in response to negative mood states. This screening approach allows professionals to understand an individual's eating habits in response to stress while allowing an individual to understand their eating habits (Arnow et al, 1995; Ghafouri et al., 2022; Karlsson et al., 2000; Meule, 2019; Nolan et al., 2010; Tanofsky-Kraff et al., 2007; Van Strein et al, 1986;).

 

Eating Questionnaire (EDE-Q)
The Eating Questionnaire is a self-reported measure that consists of 28 questions that are concerned about eating habits and behaviors in the past 28 days. This examination goes deeper into the personal emotions individuals may face with their eating habits and behaviors. These questions range from personal emotion, body image, and portion sizes. It is ranked on a 7-point scale: no days, 1-5 days, 6-12 days, 13-15 days, 16-22 days, 23-27 days, and every day. It is scored on 4 subscales: restraint, eating concern, shape concern, and weight concern. This form of measurement is highly accurate when discriminating between individuals with and without an eating disorder (Mond et al., 2006).

 

Go/No Go (https://www.psytoolkit.org/experiment-library/go-no-go.html)
This is a computerized psychological test that measures inhibition and impulsiveness, reflecting self-control. A food-related version exists (Teslovich et al., 2014), which assesses impulses relevant to eating behavior. Food-related modifications include using pictures of low- and high-calorie foods along with nonfood images to generate cues based on how appetizing an item may or may not be and stimulate self-control (Teslovich et al., 2014). 

Food Stroop 
This is a computerized psychological test for attentional bias customized for studies relevant to food and eating (Nijs et al., 2010). In a traditional Stroop test, respondents are asked to name the font color of a printed word, which may be a color itself that may or may not match. In a food-modified version, printed words can consist of food-related words as well as neutral words. It is of interest to observe differences in reaction times to name the font color of food-related and neutral words, with the difference interpreted as attentional differences associated with food. For example, slower reaction times related to naming the color of food-related words vs. neutral words is thought to be due to distraction or bias arising from food-related words that may distract some participants, such as those more attuned to eating and/or related behaviors from the font color naming task (Nijs et al., 2010). 

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Cognitive Related Measures:
 

NIH Cognition Toolbox (Dimensional Change Card Sort Test, Flanker Inhibitory Control and Attention Test, Visual Reasoning Test)
All of these tools can be tested on individuals three years and older and take no more than ten minutes to complete. These tools measure attention, executive function, language, memory, and processing speed. The Dimensional Change Card Sort Test assesses cognitive flexibility and attention, where the participant is asked to match a series of picture pairs to a target picture. The Flanker Inhibitory Control and Attention Test assesses inhibitory control and attention. The participant is asked to focus on a particular stimulus while inhibiting attention to the stimuli flanking it. The last assessment is the visual reasoning test. This assessment tests nonverbal and visual reasoning, in which participants are asked to select which of the response options is most like or missing from the target images at the top of the screen (NIH Toolbox, 2025).

 

Montreal Cognitive Assessment (MoCA)
The Montreal Cognitive Assessment is a brief and efficient screening tool for detecting mild cognitive impairment and assessing cognitive function. This assessment quickly and accurately assesses short term memory, visuospatial abilities, executive function, attention, concentration, working memory, language, and orientation to time and place. The assessment is scored with the maximum and most severe case being 30, and a generally lower cognitive decline with a score of 26 or less. This assessment has been adapted for hearing or visual impairments, low education, and administration by telephone or videoconference (MoCA, 2024; CDC, 2024).
 

Strengths and Limitations

 

Dietary Assessment Tools
Dietary assessment tools each offer unique strengths and limitations depending on the goal of the evaluation. The 24-hour dietary recall provides detailed, short-term dietary information but is time-consuming and subject to memory bias unless repeated multiple times. This measurement requires a minimum of at least three recalls, with one being a weekend day, which can open the door for recall error. The Food Frequency Questionnaire (FFQ) is efficient for capturing long-term dietary patterns and identifying diet-disease relationships, though it may miss specifics like portion sizes or preparation methods. Food records allow for real-time tracking and can uncover patterns or triggers like stress eating, but require high participant compliance over multiple days for accuracy. Nutrition screeners, whether frequency or behavior based, are useful for identifying at-risk individuals and general dietary habits but lack the depth of more comprehensive tools. Strengths of the Overall Dietary Pattern or Diet Quality Indices measures include the flexibility with which many types of dietary patterns or diet quality indices can be calculated relatively quickly, and the ability to provide a rigorous and sound summary measure for diet. Limitations of these measures include the large amount of data that needs to be collected to generate data to calculate these diet-related variables, as well as the respondent and staff burden required to complete the dietary assessments for diet data.

 

Stress-Related Dietary Measurements 
Stress-related assessments evaluate emotional triggers and maladaptive coping through food. Tools like the Emotional Eating Scale (EES), Salzburg Emotional Eating Scale (SEES), and Dutch Eating Behavior Questionnaire are effective in identifying eating behaviors in response to mood states like sadness or anxiety. These tools are insightful for understanding psychological factors behind eating but rely on self-reporting, which can limit objectivity. The Emotional Eater Questionnaire (EEQ) further categorizes responses by guilt, disinhibition, and type of food consumed, offering targeted data for emotional eaters. The Child and Adult Eating Behavior Questionnaires and Weight-Related Eating Questionnaire assess deeper behavioral traits like emotional overeating, satiety responsiveness, and food avoidance—crucial for tailoring interventions—but may overlook situational or environmental factors. The Eating Disorder Examination Questionnaire (EDE-Q) is a validated clinical tool that captures cognitive and emotional eating concerns, but it is longer and may be emotionally challenging for participants (Arnow et al., 1995; Ghafouri et al., 2022; Garaulet et al., 2012; Kuno et al., 2024; James et al., 2017; Mond et al., 2006).The Satter Eating Competence Model adds value by measuring food acceptance, emotional regulation, and eating context, but may not detect disordered eating symptoms in clinical populations. The Child and Adult Eating Behavior Questionnaire is strong in identifying specific eating traits like emotional overeating, food fussiness, and satiety responsiveness, making it useful for understanding individual eating styles and feeding difficulties; however, its reliance on self-reporting can introduce bias and may not capture environmental or contextual influences. The Weight-Related Eating Questionnaire effectively assesses attitudes and behaviors related to weight control and disordered eating risk, but its focus on weight management may overlook broader psychological or cultural factors influencing eating behavior (NIH, 2025; Satter, 2007; Kuno et. al., 2024; PhenX, 2025; James et. al., 2017). 

 

Cognitive Assessments
Cognitive assessments offer valuable insight into mental functioning related to memory, executive control, and attention. The NIH Cognition Toolbox includes brief, validated tasks like the Dimensional Change Card Sort and Flanker Test that assess flexibility, attention, and reasoning in participants as young as age three. These are efficient and standardized but can be affected by environmental distractions or testing conditions. The Montreal Cognitive Assessment (MoCA) is widely used to screen for mild cognitive impairment and assesses multiple cognitive domains including memory, visuospatial ability, and language. It is sensitive and adaptable across diverse populations but may require adjustment for individuals with lower education or cultural variation (NIH Toolbox, 2025; MoCA, 2024; CDC, 2024). Strengths of these measures include the ability to modify some to be more relevant to foods and eating behaviors. Measure limitations include the fact that food-related modifications may not necessarily fulfill their intent. For example, for the food-related Go/No Go exercise, testmakers may use pictures of high and low calorie foods to elicit a food-related effect, but the difference may not be sufficiently distinct for test takers to identify and interpret. Also, while testmakers have previously focused on calories, it could also be palatability vs. caloric content that people may respond to more (Teslovich et al., 2014). A similar phenomenon may also befall the Food Stroop. 
 

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Author(s) and Reviewer(s):

Prepared by Sabina Malik, PhD, Dorothy Chiu, PhD, Jazmine Perez, Danielle Lee, MPH, RD. Reviewed by Grace Shearrer, PhD., and the Mental Health Nutrition Network Evaluation leadership team with Laura Sant, and Kristen Herlosky, PhD. If you have any comments on these measures, email smalik@unr.edu.

 

Version July 2025. 

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