Abstract
BACKGROUND: Psychological vulnerabilities, including early maladaptive schemas (EMSs), emotion regulation difficulties, perceived stress, and limited social support, are increasingly recognized as drivers of maladaptive eating and obesity. These findings underscore the need for health education and health promotion strategies that address psychological determinants of eating behavior. However, few studies integrate these psychological mechanisms with dietary and lifestyle indicators in both community and medical populations. METHODS: A total of 1500 adults (aged 18-65 years; 53% women) recruited from community and medical settings participated in the study. Data were collected between January 2018 and February 2025 using standardized paper-based questionnaires. Participants completed validated measures of EMSs (YSQ-S3), emotion regulation (DERS), stress (PSS-10), social support (MSPSS), eating-related behaviors (QERB), diet (FFQ-6; Unhealthy Diet Index [UDI]), and physical activity (IPAQ-SF). Anthropometric indices included body mass index (BMI) and waist circumference (WC) as an indicator of central adiposity. Analyses involved multivariate regression, mediation, and moderation models. RESULTS: EMSs were associated with emotional overeating and higher UDI scores. Difficulties in emotion regulation mediated the EMS-eating relationship (β_indirect = 0.27, p < 0.001). Perceived stress amplified, while social support attenuated, the association between EMSs and emotion regulation difficulties. UDI was inversely related to physical activity (β = -0.14, p < 0.01) and positively to sedentary time (β = 0.12, p < 0.01). Both BMI and WC were higher among participants reporting greater stress, emotion dysregulation, and unhealthy eating. All effects remained robust after adjustment for age, gender, and BMI. CONCLUSIONS: Early maladaptive schemas and emotion regulation difficulties contribute to unhealthy dietary patterns and central adiposity, with stress and social support acting as contextual moderators. Integrating psychological assessment with validated dietary and lifestyle measures provides a comprehensive framework for obesity prevention and schema-informed interventions. From a lifespan perspective (18-65 years), these findings highlight the need for multidomain strategies targeting cognitive-emotional and behavioral mechanisms of weight regulation.