Abstract
Background/Objectives: Chronic stress contributes to obesity through maladaptive eating behaviors, including emotional eating (eating due to negative emotions) and binge eating (consuming large amounts of food with a loss of control). A theoretical model suggests that emotional eating can escalate to binge eating along a severity continuum, but this sequential pathway from stress to higher body mass index (BMI) has remained empirically untested. Therefore, this study examined a serial mediation model in which perceived stress predicts BMI sequentially through emotional eating and then binge eating. Methods: In this cross-sectional study, 272 Korean adults completed the Perceived Stress Scale, the Dutch Eating Behavior Questionnaire (emotional eating subscale), and the Binge Eating Scale. The serial mediation model was tested using PROCESS macro model 6, with age, gender, and education as covariates. Results: The serial mediation pathway (stress → emotional eating → binge eating → BMI) was statistically significant (indirect effect B = 0.071, 95% CI [0.041, 0.112]). A separate simple mediation path through binge eating alone was also significant (B = 0.056, 95% CI [0.018, 0.102]), whereas the path through emotional eating alone was not significant. The total indirect effect (B = 0.108, 95% CI [0.052, 0.172]) was significant, indicating that the influence of stress on BMI was fully mediated by the eating behaviors modeled. Conclusions: This study provides the first empirical evidence supporting a sequential pathway from stress to elevated BMI via the progression from emotional to binge eating. The findings support the overeating continuum model and highlight binge eating as a pivotal mediator. This behavioral progression suggests that emotional and binge eating are distinct stages, offering crucial opportunities for tailored prevention and intervention.