Eating behavior correlates of adult weight gain and obesity in
healthy women aged 55–65 y1–3
Nicholas P Hays, Gaston P Bathalon, Megan A McCrory, Ronenn Roubenoff, Ruth Lipman, and Susan B Roberts
ABSTRACT
Background: The specific underlying causes of adult weight
gain remain uncertain.
Objective: The objective was to determine the association of
3 measures of eating behavior with weight gain and body mass
index (BMI; in kg/m2) in adults.
Design: Current dietary restraint, disinhibition, and hunger were
assessed with the use of the Eating Inventory in 638 healthy, non-
smoking women aged 55–65 y. In addition, subjects reported their
current weight and height, their weight for 6 age intervals, and
changes in voluntary dietary energy restriction over the past 10 y.
Current weight and height were validated in 10% of subjects.
Results: Current disinhibition strongly predicted weight gain
and current BMI (partial r = 0.27 and 0.34, respectively, both
P < 0.001). Neither restraint nor hunger was a significant inde-
pendent predictor of either variable, but the positive associations
between disinhibition and both weight gain and BMI were atten-
uated by restraint (P = 0.016 and 0.010, respectively, after
adjustment for confounding variables). In the subpopulation of
women who reported a stable level of voluntary dietary energy
restriction, disinhibition also strongly predicted weight gain and
higher BMI, and restraint was negatively associated with weight
gain (partial r = –0.17, P = 0.019).
Conclusions: Higher disinhibition is strongly associated with
greater adult weight gain and higher current BMI, and dietary
restraint may attenuate this association when disinhibition is
high. These findings suggest that eating behavior has an impor-
tant role in the prevention of adult-onset obesity and that further
studies are warranted. Am J Clin Nutr 2002;75:476–83.
KEY WORDS Dietary restraint, disinhibition, body weight,
BMI, obesity, overweight, postmenopausal women, body mass
index, women
INTRODUCTION
The prevalence of obesity has increased worldwide in the past
decade (1–3), and > 55% of the adult US population is now con-
sidered overweight or obese (4, 5). National statistics show that
weight gain during adulthood has increased by > 50% in the past
30 y (1). Considerable uncertainty remains, however, over the
specific causes (6).
Eating behavior may be important in the prevalence of obe-
sity. The Eating Inventory (EI) of Stunkard and Messick (7) is a
476 Am J Clin Nutr 2002;75:476–83. Printed in USA. © 2002 American Society for Clinical Nutrition
recognized instrument for quantifying eating behavior, specifi-
cally 3 constructs termed restraint, disinhibition, and hunger.
Dietary restraint is defined as a tendency to consciously restrict
food intake either to prevent weight gain or to promote weight
loss by control over both energy intake and types of foods eaten (8),
disinhibition is the tendency to overeat in the presence of palat-
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able foods or other disinhibiting stimuli such as emotional dis-
tress (9), and hunger is the susceptibility to perceived body
symptoms that signal the need for food (9).
Previous studies using the EI found that high disinhibition
scores were consistently associated with high body mass index
(BMI) (10–12), whereas associations of dietary restraint scores
with BMI were more contradictory. Several studies found a
significant positive association of restraint scores with BMI
(13–15), but others found a negative association (16, 17). How-
ever, differences in BMI between individuals with high and low
dietary restraint scores appear to be minimal, with perhaps an
overall trend toward the association of higher scores with higher
BMI values. Higher restraint scores are more clearly associated
with greater weight loss during dieting (10, 17–19) and better
weight maintenance after weight loss (18). However, there is no
published information on associations between long-term weight
gain and eating behavior from studies using a valid instrument to
separate the different aspects of eating behavior. Thus, the indi-
cation from current data that disinhibition promotes weight gain
remains speculative. Moreover, many previous studies did not
exclude smokers and individuals with chronic diseases or eating
disorders (factors that are highly likely to confound the relation
between eating behavior and body weight), which makes the
validity of the existing data uncertain.
The present study was designed to investigate the association
of eating behavior with weight change over 20 y and current
1
From the Jean Mayer US Department of Agriculture Human Nutrition
Research Center on Aging at Tufts University, Boston.
2
Supported in part by NIH grants T32AG00209 (to NPH), DK09747 (to
MAM), and AG12829 and DK46124 (to SBR) and by the USDA, Agriculture
Research Service, under cooperative agreement 58-1950-9-001.
3
Address reprint requests to SB Roberts, Energy Metabolism Laboratory,
Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts Uni-
versity, 711 Washington Street, Boston, MA 02111. E-mail: sroberts@hnrc.
tufts.edu.
Received August 21, 2000.
Accepted for publication April, 2001.
 EATING BEHAVIOR AND WEIGHT GAIN
body weight at 55–65 y of age in a retrospective, cross-sectional
investigation of a large sample of healthy women. The study was
specifically designed to test the hypothesis that lower restraint
and higher disinhibition and hunger are associated with greater
weight gain and higher body weight.
SUBJECTS AND METHODS
Survey
Women aged 55–65 y and living in New England were recruited
by advertisement in local newspapers and by direct mail via
commercially available mailing lists of names originally obtained
from state motor vehicle registration records (Donnelley Mar-
keting, Omaha) for a study described as examining nonspecified
eating habits and health. After indicating their willingness to par-
ticipate, subjects were mailed questionnaires and an informed
consent form. Although not compensated for their completion of
the survey questionnaires, subjects received a stipend if chosen
to participate in the validation study component (see below).
Ethical approval for the survey and the validation study was
given by the New England Medical Center–Tufts University
Human Investigations Review Committee.
A total of 2088 women (representing a response rate of
60%) completed a medical and lifestyle history questionnaire,
which included questions on current height and weight, the EI (7),
and 12 supplementary questions (Appendix A). The supplemen-
tary questions concerned changes in body weight and food
intake, including mean body weight at 6 age intervals (20–29,
30–39, 40–49, 50–55, 55–60, and 60–65 y; question 12) and
change in estimated extent of self-imposed dietary energy
restriction over the past 10 y (question 11).
Initial scoring of the EI, which consists of 36 true or false and
15 multiple-choice questions, with 3 separate groups of ques-
tions used to calculate dietary restraint, disinhibition, and hunger
scores, was completed according to published guidelines (7). For
the analysis of eating behavior and weight change, a modified
disinhibition score was calculated, omitting question 25 (“My
weight has hardly changed at all in the last 10 y”), because this
question might have undue influence on this analysis (ie, a
response of “false” to this question correlates both with disinhi-
bition and with weight change). To compensate for missing answers
on some returned EI questionnaires, we calculated proportional
scores ([raw score/(total number of possible answers  number
of missing answers)]  total number of possible answers) for
each eating behavior scale. Subjects with ≥ 4 missing answers for
the restraint scale (out of 21 total questions), ≥ 3 missing answers
for the disinhibition scale (out of 16 total questions), ≥ 3 missing
answers for the modified disinhibition scale (out of 15 total
questions), or ≥ 3 missing answers for the hunger scale (out of 14
total questions) were excluded from the data analysis. Because
these criteria were used, a small number of subjects with incom-
plete questionnaires were included in the analysis after the cal-
culation of proportional scores (n = 50, 41, 40, and 46 for
restraint, disinhibition, modified disinhibition, and hunger
scales, respectively). Although we are not aware that this scoring
method has been described previously to compensate for the
common problem of missing answers on EI questionnaires, its
use is routine in other questionnaire studies.
A total of 653 subjects were excluded because they were cur-
rent smokers or reported having a medical disorder that might
477
influence weight or eating behavior or both (cancer, heart dis-
ease, glandular disorder, or eating disorder). Forty-two subjects
were excluded because of incomplete EI questionnaires (exceed-
ing the described limits), and 754 were excluded because of miss-
ing demographic or anthropometric information. One woman who
reported an unusually large weight loss over the specified period
(70 kg) was excluded as well, providing a final sample size of
638, which was 95% white, non-Hispanic; 1% black; 1% Asian;
and < 1% Hispanic and American Indian.
Validation study
Of the final sample, 10% (n = 67) were invited to participate
in a more detailed study, described elsewhere (20), in which
reported weights and heights were validated in women with a
high level of restraint (EI restraint score ≥ 13) and with a low
level of restraint (score ≤ 5). Fasting body weight was measured
while the subject was wearing a preweighed gown, and height
was measured with the use of a wall-mounted stadiometer.
The difference between reported and measured weights was
not significant in the women with a low level of restraint
(0.28 ± 0.47 kg) but was significant in the women with a high
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level of restraint (0.88 ± 0.35 kg; P = 0.017). No significant
differences were found between reported and measured heights
(data not shown). There was a small but significant difference
between BMI calculated with the use of reported and measured
values in the group with a high level of restraint (0.44 ± 0.17;
P = 0.013) but not in the group with a low level of restraint
(0.015 ± 0.22). The relatively small underestimation of body
weight in eaters who exercise restraint is consistent with previ-
ous reports suggesting a generally good correlation between self-
reported and measured body weights (21–23) and relatively little
effect of restraint on the accuracy of reporting (24).
Statistics
Statistical analyses were performed with SPSS 10.0.7 for
WINDOWS and SYSTAT 9.0.1 (SPSS Inc, Chicago). Values are
expressed as means ± SEMs. For the validation study analyses of
reported compared with measured heights and weights, differ-
ences between groups were analyzed by using Student’s inde-
pendent t tests and comparisons between reported and measured
variables were performed by using paired t tests. Differences
were considered significant at P < 0.05, except for differences
between groups, which were considered significant at P < 0.0125
after Bonferroni correction for the comparison of 4 restraint
quartiles. For the survey, multiple linear regression was used to
examine the relation between scores on the restraint, disinhibi-
tion, and hunger scales of the EI and both weight change from
the age interval 30–39 to 55–60 y (calculated by subtracting the
answer to question 12b from the answer to question 12e; Appen-
dix A) and current BMI. Visual inspection of the residuals result-
ing from the regression models using normal probability plots
failed to show any serious departures from normality.
Analyses were performed on 3 data sets. The primary survey
analyses presented are on the healthy individuals who had com-
plete information on anthropometric measurements and eating
behavior and who did not smoke or report medical problems or
eating disorders (n = 638). Although nearly 70% of the initial
sample was excluded in this data set, this was only for the pur-
pose of obtaining a clean sample without potential confounding
factors such as missing data and inclusion of smokers and indi-
viduals with health or eating disorders. As described below, the
478
TABLE 1
Characteristics of the 3 data sets of the survey population1
Age (y)
Reported body weight (kg)
Reported height (cm)
BMI (kg/m2)
Weight change from the age intervals 30–39 to 55–60 y (kg)
Restraint score6
Disinhibition score6
Hunger score6
1–
x ± SEM. Values in the same row with different superscript letters are significantly different, P < 0.05.
2
All women with valid data.
3
Nonsmoking women with no health disorders.
4
Nonsmoking women with no health disorders and no or minimal change in reported energy restriction over the past 10 y.
5
n = 1458.
6
See reference 7.
entire valid data set was also analyzed (n = 1959 for BMI and
1458 for weight change), and the results were essentially identi-
cal to those from the main analyses. The third data set consisted
of the subset of individuals who reported no or only a slight
change in level of energy restriction during the past 10 y
(response 2, 3, or 4 to question 11) and for whom weight change
data were available for the same period (n = 199). There were
428 subjects reporting no or only a slight change in the level of
energy restriction during the past 10 y, but only the 199 women
aged 60–65 y could be used in this component of the analysis
because the younger women fell into an age group for which we
did not have reported body weight for the same 10-y interval.
This subset was analyzed to determine whether similar results
would be obtained in individuals reporting relatively stable
energy restriction. Differences in basic demographic character-
istics between the 3 data sets were examined with the use of
one-way analysis of variance, and Tukey’s honestly significant
difference test was used for post hoc comparisons of significant
mean group differences.
Both main effects and interactions between independent vari-
ables were examined. Analyses were performed both with and
without covariates of current age (y), years since menopause,
parity, current hormone replacement therapy (no, yes), education
level (low: postsecondary education = none, vocational school,
or 2 y of college; high: postsecondary education = 4 y of college,
graduate school, or professional school), initial BMI (BMI at age
30–39 or 50–55 y, depending on sample subset analyzed), and
past smoking status (never, ever) to adjust for the potential influ-
ences of these variables.
RESULTS
Survey: comparison of 3 data sets
Characteristics of the 3 data sets of the women in the survey
population are shown in Table 1. There were no significant dif-
ferences in BMI between the total sample of subjects (n = 1959)
and the healthy women whose responses made up the primary
data set (n = 638). The BMI of the subsample who reported no
change or a minimal change in dietary energy restriction over the
past 10 y and who also reported weight change during the same
period (n = 199) was significantly lower than the total sample, but
HAYS ET AL
Total sample2 Primary analysis sample3 Subsample4
(n = 1959) (n = 638) (n = 199)
59.2 ± 0.1a 60.1 ± 0.1a 62.8 ± 0.1b
70.6 ± 0.4a 69.0 ± 0.5a,b 67.5 ± 0.9b
163.4 ± 0.1 a
162.9 ± 0.3a 162.7 ± 0.4a
26.6 ± 0.1a 26.2 ± 0.2a,b 25.6 ± 0.4b
9.3 ± 0.3 5,a,b
9.3 ± 0.4a 7.8 ± 0.7b
10.7 ± 0.1a 10.7 ± 0.2a 9.7 ± 0.3b
7.0 ± 0.1a 6.6 ± 0.2a,b 6.0 ± 0.3b
5.1 ± 0.1a 4.8 ± 0.1a 4.7 ± 0.2a
only by a small amount. All 3 groups had mean BMI values that
closely approximated the mean BMI of older women in a national
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survey (25). In addition, the mean reported weight changes from
30–39 to 55–60 y were consistent with previous reports (26).
The primary data set and the entire study population
In the group of healthy subjects used for the primary study analy-
ses, 87% gained weight, 8% lost weight, and 5% maintained a con-
stant weight over time. Disinhibition and hunger scores ranged from
the minimum to the maximum possible score (0–16 and 0–14,
respectively), with the range of restraint scores nearly as wide (0–20
out of 0–21 possible). Higher scores reflect a greater tendency to
exhibit that particular eating behavior characteristic.
Results of the multiple linear regression to evaluate current
dietary restraint, disinhibition, and hunger scores as correlates of
weight change from the age interval 30–39 to 55–60 y are shown
in Table 2. Disinhibition (calculated with the omission of ques-
tion 25 from the EI, as explained in Methods, although use of
standard disinhibition scores in this model did not change the
basic relation) was the only significant independent predictor of
weight change, and there was a significant interaction between
restraint and disinhibition. Also shown in Table 2 is an adjusted
model predicting weight change, in which current age, parity,
and education level were all significant. However, the inclusion
of these variables did not alter the basic relation between eating
behavior and weight change. In this analysis, current age proba-
bly served as a surrogate variable for demographic changes in
weight gain that occurred over the 10-y age interval of the study
population [ie, younger women may have gained more weight
between the age intervals 30–39 and 55–60 y than did older
women because their time interval occurred more recently (1)].
Past smoking status and BMI at the age interval 30–39 y were
also examined as potential confounders but were not significant;
their inclusion in the model did not significantly alter the
restraint, disinhibition, or interaction coefficients.
The adjusted interaction between restraint and disinhibition in
predicting weight change is illustrated in Figure 1. Higher disinhi-
bition was associated with greater weight gain, but higher restraint
attenuated weight gain at high levels of disinhibition. Overall, dis-
inhibition and restraint accounted for 19% of the variance in weight
change in the unadjusted model and together with the confounding
variables accounted for 23% in the adjusted model.
 EATING BEHAVIOR AND WEIGHT GAIN 479

TABLE 2
Multiple linear regression analyses of factors associated with reported change in weight from the age intervals 30–39 to 55–60 y in nonsmoking,
healthy women1
Variable  SE Partial r P Adjusted R2
Unadjusted model
Constant 2.811 1.667 — 0.092 —
Restraint score2 0.021 0.151 0.006 0.889 —
Disinhibition score2,3 1.662 0.238 0.267 < 0.001 —
Restraint  disinhibition interaction 0.053 0.021 0.099 0.013 —
Overall model — — — < 0.001 0.19
Adjusted model
Constant 30.057 7.385 — < 0.001 —
Restraint score 0.031 0.148 0.008 0.835 —
Disinhibition score 1.605 0.234 0.263 < 0.001 —
Restraint  disinhibition interaction 0.051 0.021 0.096 0.016 —
Current age (y) 0.445 0.121 0.145 < 0.001 —
Parity 0.415 0.183 0.090 0.024 —
Education level4 2.392 0.713 0.132 0.001 —
Overall model — — — < 0.001 0.23
1
n = 638.
2
See reference 7.

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3
Modified disinhibition score [excluding question 25 of the Eating Inventory (7); see Methods].
4
Considered “low” if subject had no postsecondary education or attended vocational school or 2 y of college; considered “high” if subject completed
4 y of college, graduate school, or professional school.

Unadjusted and adjusted eating behavior models predicting
current BMI are shown in Table 3. The models predicting BMI
were very similar to the models predicting weight change. The
unadjusted model showed that disinhibition was the major inde-
pendent predictor of BMI, with greater disinhibition predicting
higher BMI. Hunger and restraint were not independently signi-
ficant, but there was a significant interaction between restraint
and disinhibition. An adjusted model predicting BMI—in which
current age, current hormone replacement therapy, parity, and
education level were all significant—is also shown in Table 3,
but the inclusion of these confounding variables did not alter
the basic relation between eating behavior and BMI that was
observed in the unadjusted model. Past smoking status and num-
ber of years since menopause were also initially included in the
model, but were not significant; their inclusion in the model did
not alter the restraint, disinhibition, or interaction coefficients.
The adjusted relation between current BMI and tertiles of
dietary disinhibition and restraint are presented in Figure 2.
Women with a high level of disinhibition and high restraint scores
had a lower BMI than did women with a high level of disinhibi-
tion and low restraint scores. Restraint influenced BMI in women
with a high and medium level of disinhibition, but had little influ-
ence on BMI in women with a low level of disinhibition. Overall,
disinhibition and restraint accounted for 29% of the variance in
BMI in the unadjusted model and together with the confounding
variables accounted for 32% in the adjusted model.
For the complete study population—including those women
excluded on the basis of chronic diseases, smoking, and reported
eating disorders—the results were essentially identical to those
of the primary study. In particular, regression models predicting
weight change and BMI using the larger samples gave essentially
the same results as those reported here, and only very small
changes in the unstandardized  coefficients were observed (data
not shown).

Subjects with a stable level of energy restriction over 10 y

FIGURE 1. Mean (± SEM) weight change between the age intervals
30–39 and 55–60 y in relation to tertiles of dietary disinhibition and
restraint (7) in the primary survey population of healthy women
(n = 638). Values are adjusted for current age, parity, and education level.
In the 199 subjects who reported no or only a slight change in
dietary energy restriction over the past 10 y and for whom data
on weight change for the same period were available, disinhibi-
tion was again a significant independent predictor of weight
change (Table 4 and Figure 3; P < 0.001). In this analysis, there
was no significant effect of the potential confounders used in the
primary analysis, and restraint was a weakly independent pre-
dictor of weight change (P = 0.019) in contrast with its signifi-
cant interaction with disinhibition in the primary analysis. Note
that the reason that weight gain appears to be lower in this analy-
sis than in the analysis of the primary data set is that the time
480 HAYS ET AL

TABLE 3
Multiple linear regression analyses of factors associated with BMI at age 55–65 y in nonsmoking, healthy women1
Variable  SE Partial r P Adjusted R2
Unadjusted model
Constant 21.056 0.782 — < 0.001 —
Restraint score2 0.081 0.069 0.046 0.244 —
Disinhibition score2 0.931 0.103 0.339 < 0.001 —
Restraint  disinhibition interaction 0.027 0.009 0.115 0.004 —
Overall model — — — < 0.001 0.29
Adjusted model
Constant 29.321 3.587 — < 0.001 —
Restraint score 0.068 0.068 0.040 0.320 —
Disinhibition score 0.884 0.102 0.327 < 0.001 —
Restraint  disinhibition interaction 0.024 0.009 0.103 0.010 —
Current age (y) 0.132 0.058 0.090 0.024 —
Current hormone replacement therapy (no = 0, yes = 1) 0.737 0.333 0.088 0.027 —
Parity 0.261 0.088 0.117 0.003 —
Education level3 0.937 0.343 0.108 0.006 —
Overall model — — — < 0.001 0.32
1
n = 638.
2
See reference 7.

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3
Considered “low” if subject had no postsecondary education or attended vocational school or 2 y of college; considered “high” if subject completed 4 y
of college, graduate school, or professional school.

between measurements is less (10 y compared with 20 y). Dis-
inhibition, but not restraint, also significantly predicted current
BMI in this subpopulation (partial r = 0.61, P < 0.001).
DISCUSSION
The results of this study are consistent with the suggestion that
eating behavior may be an important factor determining excess
weight gain during adulthood. In particular, we found a strong
positive association between current scores on the EI disinhibition
scale and reported adult weight gain. To our knowledge, this is the
first report of an association between adult weight gain and eating
FIGURE 2. Mean (± SEM) current BMI in relation to tertiles of
dietary disinhibition and restraint (7) in the primary survey population of
healthy women (n = 638). Values are adjusted for current age, current
hormone replacement therapy, parity, and education level.
behavior when the 3 constructs of eating behavior (restraint, dis-
inhibition, and hunger) (7) were assessed separately. We also
found a strong positive association between disinhibition and cur-
rent BMI, with a substantial 15.2-kg weight difference (normal-
ized for height) between groups of subjects with high (≥ 8) and
low (≤ 3) scores for disinhibition. An association between current
BMI and disinhibition was observed by Williamson et al (12) in a
smaller study of women aged 17–78 y and by Westenhoefer et al
(10) in a study of readers of a women’s magazine. In those stud-
ies, other factors influencing weight status were not taken into
account or used to exclude unsuitable subjects; thus, the findings
were uncertain. However, we obtained very similar results after
excluding individuals reporting known factors that might con-
found the relation between eating behavior and body weight,
including current smoking, eating disorders, and major diseases.
The combination of our new findings and those of previous
research suggests that disinhibition promotes adult weight gain
and that strategies aimed at reducing disinhibition may be broadly
effective in curbing the current epidemic of obesity.
Our results also suggest a role for dietary restraint in adult
weight regulation. In the primary analysis of survey data from the
healthy women, dietary restraint was not itself an independent
predictor of current weight and adult weight change but instead
moderated the association of disinhibition with obesity and weight
gain. In the women who reported a stable level of self-imposed
dietary energy restriction over the past 10 y, restraint was a weak
independent predictor of weight change, with upper and lower
tertiles for restraint predicting average weight gains of 3.0 and
5.3 kg, respectively. Viewed from these perspectives, dietary
restraint is either beneficial in preventing weight gain in all indi-
viduals (ie, the subpopulation analysis) or beneficial only in those
with high levels of disinhibition (ie, the primary survey analysis).
Dietary restraint has been suggested to be an undesirable trait
because of its reported association with increased body weight in
some studies (13–15), neuroticism (27), subclinical menstrual dis-
turbances (28), lower bone mineral content (29), and higher cor-
tisol excretion (30). The results of the present study alternatively
 EATING BEHAVIOR AND WEIGHT GAIN
TABLE 4
Multiple linear regression analysis of factors associated with reported change in weight from the age intervals 50–55 to 60–65 y in nonsmoking, healthy
women with no or only a slight change in the reported level of dietary energy restriction over the past 10 y1
Variable  SE
Constant 2.843 1.011
Restraint score2 0.180 0.076
Disinhibition score2,3 0.524 0.101
Overall model — —
1
n = 199. Adjustments for current age, parity, education level, past smoking status, and BMI at age 50–55 y were not significant.
2
See reference 7.
3
Modified disinhibition score [excluding question 25 of the Eating Inventory (7); see Methods].
suggest that restraint may be a critical moderator of adult weight
gain; thus, they support and extend previous consistent findings
(10, 12) made in studies that did not exclude individuals with
medical disorders or smokers.
There are some strengths of our study that deserve mention. In
particular, to our knowledge this is the first study to examine eating
behavior predictors of adult weight gain using the most current
instrument for assessing eating behavior that is not confounded by
concern for dieting and weight fluctuation. In addition, we excluded
smokers and subjects with eating disorders or chronic health
problems, who may have confounded associations between eating
behavior and body weight in previous studies.
There are also several important limitations to our findings.
First, our approach of combining cross-sectional and retrospective
study components cannot distinguish between eating behavior
constructs as consequences or causes of weight gain, and further
studies are needed in which subjects are followed over time. Sec-
ond, the possibility exists that the population studied may not rep-
resent the general population of healthy women aged 55–65 y.
Finally, we were not able to validate the self-reports of past body
weight. Concerning the question of whether our study population
was representative of the general population, the recruiting infor-
mation given to subjects was purposely vague to minimize selec-
tion bias. In addition, the mean reported weight change and BMI
FIGURE 3. Mean (± SEM) weight change between the age intervals
50–55 and 60–65 y in relation to tertiles of dietary disinhibition and
restraint (7) in the subset of women with a stable level of energy restric-
tion over 10 y (n = 199).
481
Partial r P Adjusted R2
— 0.005 —
0.166 0.019 —
0.349 < 0.001 —
— < 0.001 0.14
of our sample were very similar to those of other study popula-
tion medians (25, 26). The further concern that subjects did not
accurately report past body weight cannot be avoided. However,
several previous studies suggested that underestimation of past
weight is relatively minor (0–3 kg between reported and actual
weight) (31–34), indicating that the results of the present study
are likely to be accurate.
Because of the observational nature of this study, no firm con-
Downloaded from ajcn.nutrition.org by guest on March 28, 2013
clusions can be drawn regarding the direction of the association
between eating behavior variables and weight gain. However, it is
possible that disinhibition is both a cause and a consequence of
excess weight, analogous to the interrelation between physical
activity and body weight (35). Evidence suggesting that disinhibi-
tion promotes weight gain comes from studies showing that disin-
hibition is associated with both increased energy intake (36) and
increased frequency of consumption of such high-energy foods as
sweets, pastries, and butter or margarine (37). Moreover, because
energy intake is known to be higher in overweight than in
nonoverweight individuals (38), factors such as disinhibition that
promote increased energy intake may also contribute to mainte-
nance of excess weight. To address the issue of causality, we also
analyzed a subpopulation of the total sample in whom reported
level of self-imposed dietary energy restriction was stable over the
past 10 y, anticipating that this might identify a group in whom
dietary restraint had also been relatively stable, although not all
studies have found a significant negative correlation between
dietary restraint and energy intake (11, 39). In this analysis, both
disinhibition and restraint were independent predictors of weight
gain (with disinhibition again being strongly predictive), suggest-
ing again that high levels of disinhibition may contribute to weight
gain over time and further that high levels of restraint may help
prevent weight gain. Further studies are needed to directly test the
hypothesis that disinhibition leads to weight gain.
There are many possible reasons for the reported association of
overeating with disinhibited eating (36), including an individual’s
attitude toward overeating (40), which may partly be mediated by
the eating environment during childhood (41) and cultural norms.
Another possibility is that the overeating associated with disinhi-
bition is partly an inadvertent consequence of unhealthy dietary
patterns, a high dietary variety from highly energy-dense foods,
or both. In studies unrelated to disinhibition, high dietary fat con-
sumption consistently increases energy intake (42), and high
dietary variety is one of the strongest predictors of greater food
consumption (43–46) and body fatness (47) in humans. Studies of
the relation between dietary disinhibition, dietary composition,
and dietary variety are thus warranted.
In conclusion, the rising prevalence of obesity in the United
States (4, 5) underscores the need for a better understanding of
482 HAYS ET AL
the causes of excess weight gain. Our results, combined with
previous work in the field, suggest that high levels of dietary dis-
inhibition and low levels of dietary restraint may be important
contributors to the current high levels of adult weight gain and
maintenance of that excess weight. Further studies in this area are
warranted—especially longitudinal and intervention studies—to
provide more conclusive evidence on the direction of association
between eating behavior characteristics and weight change.
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APPENDIX A
Supplemental questions on eating behavior
1. Personal desired weight (pounds): __________
2. What is your maximum weight (pounds) ever? If applicable, do not include pregnancy weight or weight one year after birth of each child. _________
3. How would you describe your current weight status?
__ (1) Losing weight
__ (2) Gaining weight
__ (3) Weight is stable and am satisfied
__ (4) Weight is stable but would like to lose weight
__ (5) Weight is stable but would like to gain weight
The following questions refer to your normal eating pattern and weight fluctuations. Please answer by circling or checking the appropriate response that
best describes you.

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4. How often are you dieting?
(1) Never (2) Rarely (3) Sometimes (4) Usually (5) Always
5. In the past 5 years, how much has your weight fluctuated (in pounds)?
(1) 0-5 (2) 6-10 (3) 11-20 (4) 21-49 (5) 50+
6. Which statement best describes how much food you usually eat?
__ (1) A little less food than I would like to eat
__ (2) Somewhat less food than I would like to eat
__ (3) Much less food than I want to eat
__ (4) I eat what I want when I want to eat it
7. If you have dieted in the past year, please estimate the number of days you have been actively trying to lose weight: __________ days
8. If you ate as much as you wanted to eat whenever you wanted to eat how do you think your weight would change?
(1) Lose weight (2) No change in weight (3) Gain weight
9. If you answered gain weight, please estimate the amount you would gain:
(1) 0-5 (2) 5-15 (3) 15-25 (4) 25-50 (5) 50+
10. Do you consider yourself a “dieter” to the extent that you limit your food intake to either maintain or lose weight?
(1) Yes (2) No
11. Which statement below best describes how your eating restraint1 (level of caloric restriction) has changed over the past 10 years?
__ (1) Much more restrained today compared to 10 years ago
__ (2) Slightly more restrained today compared to 10 years ago
__ (3) Restraint has not changed
__ (4) Slightly less restrained today compared to 10 years ago
__ (5) Much less restrained today compared to 10 years ago
12. Please estimate your average weight for the following age ranges; if applicable, do not include pregnancy weight or weight one year after birth of each
child. As well, indicate which statement below best describes how much food you usually ate for the same age ranges by placing the number of the
statement in the column.
1. I ate what I wanted when I wanted to
2. I ate much less food than I wanted to
3. I ate somewhat less food than I wanted to
4. I ate a little less food than I wanted to
Age range (years) Weight (pounds) Statement describing usual food intake
a. 20-29 _______ ___________________________________
b. 30-39 _______ ___________________________________
c. 40-49 _______ ___________________________________
d. 50-55 _______ ___________________________________
e. 55-60 _______ ___________________________________
f. 60-65 _______ ___________________________________
1
The term restraint in this context should be understood to mean restriction, and does not specifically refer to cognitive dietary restraint as defined by
Stunkard and Messick (1).

REFERENCE
1. Stunkard AJ, Messick S. The three-factor eating questionnaire to measure dietary restraint, disinhibition, and hunger. J Psychosom Res 1985;29:71–83.