BINGE EATING IN A SLOVENIAN POPULATION-BASED SAMPLE OF ADULTS
Maša ČERNELIČ BIZJAK1*, Katarina ADAMIČ1
1University of Primorska, Faculty of Health Sciences, Polje 42, 6310 Izola, Slovenia
Received: Sep 5, 2022
Accepted: Nov 17, 2022
Original scientific article
*Corresponding author: Tel. + 386 41 964 157; E-mail: masa.cernelic@fvz.upr.si
10.2478/sjph-2023-0006 Zdr Varst. 2023;62(1):39-47
39
HRANJENJE Z IZGUBO NADZORA NA SLOVENSKEM 
POPULACIJSKEM VZORCU ODRASLIH
© National Institute of Public Health, Slovenia. 
Černelič Bizjak M, Adamič K. Binge eating in a Slovenian population-based sample of adults. Zdr Varst. 2023;62(1):39-47. doi: 10.2478/sjph-2023-0006.
ABSTRACT
Keywords: 
binge eating, anxiety, 
emotional eating, 
obesity, public health 
IZVLEČEK
Ključne besede: 
hranjenje z izgubo 
nadzora, anksioznost, 
čustveno hranjenje, 
debelost, javno 
zdravje
Introduction: Binge eating is the most common form of disordered eating associated with obesity, reduced 
quality of life, and medical and psychological comorbidities. It therefore affects the well-being of individuals. 
This underscores the fact that it is a serious public health problem. The study aimed to investigate binge eating 
and anxiety across gender, age and body mass index in a large population sample of adults in Slovenia.
Methods: A total of 3,310 adult volunteers participated in this cross-sectional study. Questionnaires, including a 
binge eating and anxiety scale and an eating behaviour questionnaire, were completed by 1,487 subjects (90.9% 
female, ages 18 to 69).
Results: The frequency of reported binge eating was 29.9%, with 9.8% of participants reporting severe binge 
eating, and the presence of overweight and obesity was high (41.8%). BMI was associated with this problematic 
eating, and explained 5.4% of the variation in binge eating. Importantly, anxiety was the most important factor 
related to binge eating, with younger participants and women reporting significantly more anxiety.
Conclusion: The high presence of binge eating, obesity and anxiety in the Slovenian population-based sample 
is worrying. Anxiety is clearly an important factor in understanding the relationship between negative affect 
and binge eating, as it accounts for a greater proportion of the variance in binge eating symptoms than BMI. 
Particularly concerning was the fact that the youngest participants showed the greatest anxiety. Targeting 
anxious adolescents and females is important from a health perspective because it can impact the physical and 
mental health of the population in the long term.
Uvod: Hranjenje z izgubo nadzora (angl. binge eating) je najpogostejša oblika motenega prehranjevanja, 
povezana z debelostjo, zmanjšano kakovostjo življenja, zdravstvenimi komorbidnostmi in psihološko disfunkcijo 
ter tako vpliva na dobro počutje posameznika. Gre torej za resen javnozdravstveni problem. Namen raziskave 
je bil raziskati to moteno prehranjevanje in anksioznost glede na spol, starost in indeks telesne mase na 
velikem populacijskem vzorcu odraslih v Sloveniji.
Metode: V tej presečni študiji je sodelovalo 3.310 odraslih prostovoljcev. 1.487 (90,9 % žensk, starih od 18 do 
69 let) je izpolnilo vprašalnike v celoti. Uporabili smo vprašalnik hranjenja z izgubo nadzora, anksioznosti in 
vprašalnik o prehranjevalnem vedenju.
Rezultati: Pogostost motenega prehranjevanja je bila 29,9-odstotna, pri čemer je 9,8 % udeležencev poročalo 
o hudem hranjenju z izgubo nadzora. Prisotnost prekomerne telesne mase in debelosti je bila visoka (41,8 %). 
ITM je bil povezan s tem problematičnim prehranjevanjem. Anksioznost je bila statistično pomembno povezana 
z motenim prehranjevanjem, izgubo nadzora, pri čemer so mlajši udeleženci in ženske poročali o znatno višji 
anksioznosti.
Sklep: Zaskrbljujoče je visoko poročanje o hranjenju z izgubo nadzora, debelosti in anksioznosti med odraslimi 
v Sloveniji. Predvsem pa rezultati opozarjajo na pomen anksioznosti, saj je očitno pomembno povezana s 
problematičnim hranjenjem, ki skupaj z visokim ITM lahko dolgoročno vpliva na fizično in psihično zdravje v 
populaciji. Skrb vzbujajoč je rezultat, da so bili mladi tisti, ki so izkazovali najvišjo anksioznost. Usmerjanje 
na anksiozne mladostnike in ženske tako ni pomembno samo z vidika duševnega zdravja, zdi se, da tudi za 
preprečevanje potencialno resnih posledic, kot so debelost ali druge zdravstvene komorbidnosti.
1 INTRODUCTION 
Many constructs related to eating have been proposed 
to explain obesity, such as binge eating and emotional 
eating, both of which emphasise loss of control over food 
intake. Because food intake and eating behaviours are 
the result of numerous complex regulatory mechanisms 
involving both homeostatic and hedonic/non-homeostatic 
processes, obesity may manifest as eating in the absence 
of energy or metabolic deficits (1). A typical aspect of non-
homeostatic eating (i.e. eating outside the physiological 
sensation of hunger) is binge eating, which is classified 
as disordered eating behaviour because it describes a 
type of inappropriate behaviour pattern and habit. It 
is characterised by eating more than normal in a given 
period of time and feeling a loss of control while eating 
(2). Because is characterised by episodes of overeating, 
it is a form of compulsive overeating (3). Binge eating is 
a major public health problem (4), in and of itself and 
because of the negative psychological and physical health 
complications associated with it (5), such as increased risk 
of mental disorders and obesity.
Studies report very high prevalence rates of binge eating 
in young adults, especially those whose weight status is 
classified as overweight/obese. In a recent study, 48.6% 
of young adults with overweight/obesity reported higher 
rates of binge eating than their normal-weight peers (29.3 
vs. 15.8% in women, 15.4 vs. 7.5% in men) (6). A meta-
analysis has estimated the prevalence of binge eating 
among adolescents with overweight/obesity to be 31.2%, 
and exploratory analyses have suggested that prevalence 
increases among adolescents who receive weight 
management treatment (7).
In adults, binge eating has also been associated with 
overweight/obesity, both cross-sectionally (8) and 
longitudinally (9). In a sample of 2,134 adolescents, binge 
eating reported at baseline predicted the onset of obesity 
at ten-year follow-up, demonstrating the importance of 
understanding the relationship between binge eating and 
weight across an individual’s lifespan (10). Disordered 
eating behaviours are more common in women than in 
men (11). A previous study of binge eating in a sample of 
Slovenian adults showed that women had higher levels of 
binge eating symptomatology and emotional eating than 
men (12), and according to some data, 62% of middle-aged 
participants in Slovenia have inappropriate eating habits 
(13). A study of a sample of adolescents showed that the 
number of individuals with binge-eating problems was 
relatively high among secondary school students (14).
In addition, binge eating is a key behaviour in eating 
disorders, such as binge eating disorder (BED), bulimia 
nervosa and the binge-purge type of anorexia nervosa (2, 
15). BED is the most common eating disorder, occurring 
in approximately 10–15% of people in the community (16, 
10.2478/sjph-2023-0006 Zdr Varst. 2023;62(1):39-47
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17) and is associated with food addiction, as they share 
a common symptom – binge eating (18–20). Importantly, 
BED is associated with adverse medical and psychosocial 
outcomes and is often associated with multiple somatic 
and psychiatric conditions, including obesity, metabolic 
syndrome, substance use disorders and mood disorders 
(21–23).
Despite the strong association with binge eating, some 
factors have received little attention in the general 
population and beyond. These include emotional eating, 
anxiety, and demographic factors such as gender and body 
weight, which are thought to be important contributors to 
the association with binge eating (24–26). The concept of 
emotional eating refers to the tendency to eat in response 
to emotional triggers, such as negative/positive emotions 
or stress (27–28), and may be associated with overeating 
in response to food-related stimuli such as the sight and 
smell of attractive foods (29). Overall, emotional distress 
(e.g. depression, anxiety) may be associated with binge 
eating and could predispose individuals to develop and/or 
maintain inappropriate eating behaviours.
The prevalence of obesity and eating disorders is 
increasing worldwide (30). It is estimated that 51% of the 
population will be obese by 2030 (31), with prevalence 
expected to peak between 2026 and 2054. The US and the 
UK are projected to reach the highest levels first, followed 
by other European countries (32). Because obesity is one 
of the greatest health challenges of the 21st century in 
many countries (33), it is worthwhile examining individual 
differences in eating behaviours. These are likely, at least 
in part, to explain individual differences in obesity (34). 
Considering that both conditions are related to many 
other health problems, the main objective of the study 
was to examine binge eating in a sample of adults from 
the general population and to explore the factors that 
might be related to food intake.
2 METHODS
2.1 Study protocol
Male and female volunteers from the general Slovenian 
population were invited to participate in the study. 
The inclusion criteria were a minimum age of 18 and 
active informed consent obtained through voluntary 
participation by anonymous participants. This study 
was conducted in accordance with the guidelines of the 
Declaration of Helsinki. All procedures were approved by 
the Commission for Scientific and Research Work, Faculty 
of Health Sciences, University of Primorska (No 011544-
609-32/2021). The study was conducted between April 
and May, 2021. 
10.2478/sjph-2023-0006 Zdr Varst. 2023;62(1):39-47
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2.2 Instruments
2.2.1 Binge Eating Scale (BES) 
To assess binge-eating symptoms a 16-item scale was used 
(35) to measure binge eating behaviour (e.g. eating large 
amounts of food) and affective/cognitive symptoms (e.g. 
feelings of guilt, feelings of loss of control) that occur 
before or after eating with loss of control. The scale was 
translated into Slovenian. The sum scores were calculated 
so that a higher score/number indicated a higher severity 
of binge-eating symptoms, and the sum of the items 
identified 18 or more individuals who exhibited binge-
eating behaviours. In our study, Cronbach’s alpha was 0.91.
2.2.2 State-Trait Anxiety Inventory (STAI-X2)
The STAI-X2 questionnaire has been used as a reliable 
measure to assess anxiety as a trait (36). It measures the 
amount of anxiety experienced in a stressful situation. 
The STAI-X2 contains 20 items, which are scored on a 
four-point scale, with subscale scores ranging from 20 to 
80 and higher scores indicating higher anxiety. Previous 
studies have used 45 points or higher as an indicator of 
high anxiety levels (37). In our study, Cronbach’s alpha 
was 0.93.
2.2.3 Dutch Eating Behaviour Questionnaire (DEBQ) 
The DEBQ contains 33 items for identifying three possible 
types of overeating: emotional, restricted and external 
(38, 39). It was translated into Slovenian. In our study, we 
focused on assessing emotional eating (e.g. ‘Do you crave 
food when you are angry?’) and therefore used 13 items. 
Participants rated the extent to which a single item or 
statement applied to them on a five-point scale, with a 
higher score indicating higher emotional overeating. In our 
study, Cronbach’s alpha was 0.95.
2.2.4 BMI
BMI was determined based on self-report data, following 
the example of extensive and reputable research using 
subjective methods, i.e. based only on height/mass 
reporting rather than direct anthropometric measurements 
(40). Although studies point to the possibility of reporting 
bias, self-reported height and weight data show good 
agreement with direct anthropometric measurements. 
Criticism of self-reported data is therefore considered 
unjustified. BMI based on self-reported height and 
weight data is therefore a valid measure when direct 
measurements are not possible (41, 42). Participants’ BMI 
was calculated using the following formula: BMI=body 
weight (kg)/(body height (m2)).
2.3 Data collection and procedure 
Participants completed the questionnaire via an online 
survey site 1KA (43), and the link to the survey was 
disseminated via the faculty website, social networks, 
internet forums (e.g. Med.Over.Net.), and local radio. 
The goal was to obtain as many responses as possible. 
Online data collection also allowed for greater geographic 
heterogeneity in the sample, potentially leading to a more 
open presentation of sensitive topics and reducing the 
burden on participants, as some researchers have pointed 
out (26). Data collection followed ethical requirements: 
no personal information was collected, respondents had 
the freedom to decline participation or withdraw from the 
study at any time, and participants were informed of the 
objectives of the study before the survey began. Because 
the study involved only self-report questionnaires, no risks 
were anticipated. Because we did not have information 
on the proportion of individuals who engaged in binge 
eating, we used 0.5 to estimate the sample size as 
follows: n=0.5 (1-0.5) 1.96/0.05)=384.2 To ensure that the 
estimated 95% confidence interval for the proportion of 
individuals engaged in binge eating was within 5% of the 
true proportion, a sample size of 385 was required for the 
purposes of the study.
2.4 Statistical analysis
All variables were tested for normal distribution 
(Kolmogirov-Smirnov or Shapiro-Wilk test). Cronbach’s 
alphas were calculated to assess the internal consistency 
of the measurement instruments. The Mann-Whitney t-test 
was used to examine differences between groups. Analysis 
of variance (ANOVA) was used to test the hypotheses for 
the comparison of means between age groups and BMI 
groups. If a significant p-value was statistically significant, 
a post hoc test (multiple comparisons) was performed. 
Homogeneity of variances between groups was tested 
using Levene’s test and Bonferroni’s method for multiple 
comparisons. Spearman’s correlation analyses were 
performed to examine the associations between the 
studied variables. Hierarchical multiple regression was 
used to determine the relationships between the studied 
variables. P-values <0.05 were considered statistically 
significant, and the confidence level was 95%. All these 
analyses were performed using IBM SPSS Statistics 20.
3 RESULTS
3.1 Subjects’ characteristics 
A total of 3,310 subjects participated in the study, 1,487 
of whom completed the entire survey. The characteristics 
of the subjects are shown in Table 1. The final analytical 
sample included 1,352 women (90.9%) and 135 men (9.1%) 
aged between 18 and 69. 
10.2478/sjph-2023-0006 Zdr Varst. 2023;62(1):39-47
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Calculated BMI ranged from 14.86 kg/m2 to 52.97 kg/m2, 
with an average BMI of 25.14 kg/m2 (SD=5.35). Participants 
were divided into four groups according to BMI. The 
results showed that the majority of participants (54.8%) 
were classified as normal weight, 3.4% as underweight, 
25.1% as overweight and 16.6% as obese (Table 3).
n (%)
Age group: n (%)
18–19
20–29
30–39
40–49
50–59
60–69
Body weight (kg)
Body height (cm)
BMI (kg/m2)
Binge eating (score) 
Absent to minimal binge eating (%)
Mild to moderate binge eating (%)
Severe binge eating (%)
Anxiety (score)
Mild (very low/low) (%)
Moderate (normal) (%)
Severe (high) (%)
Very high (%)
Emotional eating (score)
Low emotional (%)
Average (%)
High (%)
Very high emotional (%)
1352 (90.9)
71 (5.2)
519 (38.4)
369 (27.3)
260 (19.2)
108 (7.9)
25 (1.8)
60.04±13.61*
161.53±6.6*
25.72±5.4*
13.14 (9.15) *
70
20.1
9.8
40.50 (10.78) *
21.4
33.8
23.8
20.7
30.73 (12.26) *
5.2
58.1
15.2
21.5
135 (9.1)
4 (2.9)
54 (39.7)
30 (22.8)
28 (20.6)
15 (11.0)
4 (2.9)
87.49±18.70*
180.74±7.12*
26.72±5.3*
Characteristics
Measure
Female
Mean (SD)
Male
Table 1.
Table 2.
Characteristics of subjects included in the study 
(n=1,487).
Descriptive statistics of reported binge eating, 
anxiety and emotional eating measures (n=1,487).
Note: *Values are expressed as means ± SD 
Abbreviation: BMI, body mass index.
*Values are expressed as means ± SD. 
3.3 Descriptive statistics and differences in studied 
variables
The mean of the BES total score was 13.14 (SD=9.15), 
ranging from 0 to 42. A total of 70.1% (n=1,042) of 
participants reported no to minimal binge eating, 20.1% 
(n=299) reported mild to moderate binge-eating, and 
9.8% (n=146) reported severe binge eating. Anxiety scores 
ranged from 20 to 80, with a score of 45 or higher indicating 
a clinically significant level of anxiety (26).  A high level 
of anxiety were experienced by 31% of participants. 
Emotional eating scores ranged from 13 to 65, with a 
higher score indicating higher emotional eating (Table 2). 
On average, participants exhibited low/average levels of 
emotional eating (M=30.73; SD=12.26) and, according to 
the available norms for the emotional eating subscale 
(28), 37.7% exhibited high to very high levels of emotional 
eating behaviour.
Women were significantly more likely to report binge eating 
(t=4.41, p<0.001), more anxiety symptoms (t=2.59, p<0.01) 
and more emotional eating (t=6.02, p<0.001), and younger 
participants reported more anxiety symptoms than older 
participants (F=6.6, p=0.001) (Table 3). Participants who 
were obese or overweight were significantly more likely 
to report binge eating (F=58.6, p=0.001) and emotional 
eating (F=35.6, p=0.001) than participants who were 
normal weight or underweight (Table 3).
3.4 Relations between binge eating, anxiety, emotional 
eating, age and BMI 
The Spearman analysis revealed that binge eating was 
significantly correlated with anxiety (r=0.46, p<0.001), BMI 
(r=0.40, p<0.001), gender (r=-0.12, p<0.001) and age (r=-
0.06, p<0.01) (Table 4). A hierarchical multiple regression 
analysis, with binge eating as the dependent variable, 
revealed that age and gender contributed significantly 
to the regression model (F(2, 1487)=11.41, p>0.00) and 
explained 1.5% of the variation in binge eating (gender 
β=-0.11; p=0.00; age β=-0.05; p=0.05). BMI explained an 
additional 5.4% and anxiety an additional 18.3% (β=0.45; 
p=0.000) of the variation in binge eating. Together, these 
variables explained 26.7% of the variation in binge eating 
(total R2=0.267; p=0.000). 
4 DISCUSSION
The main objective of this study was to investigate the 
association between binge-eating behaviour, anxiety and 
emotional eating in a population-based sample of adults 
in Slovenia, and to assess differences by gender, BMI, and 
age. In this study, self-reported binge eating was 29.9%, 
with 20.1% of participants reporting moderate binge eating 
and 9.8% reporting severe binge eating. The self-reported 
frequency is higher than some reports, e.g. 9.9% (44) and 
5% (45), but lower than the highest frequency of binge 
eating recorded to date, i.e. 44% (46). The differences 
in reporting of binge eating might be related to the 
demographic diversity of the sample studied. The sample 
in this study was dominated by women (90.9%), and the 
majority of participants were between 20 and 39 years 
old. In addition, the proportion of overweight and obese 
individuals was high (41.8%), which may explain the high 
number of reported binge-eating behaviours in our sample. 
10.2478/sjph-2023-0006 Zdr Varst. 2023;62(1):39-47
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Gender
Males
Females
Age group
18–19
20–29
30–39
40–49
50–59
60–69
Body mass index
BMI<18.5:  
underweight
BMI 18.5-24.9:  
normal weight
BMI≥25.0:  
overweight 
BMI≥30.0:  
obesity
Step 1
Age (years)
Gender
Step 2
BMI
Step 3
Emotional eating
Anxiety 
Total R2
1352 
(90.9)
135 
(9.1)
75 
(5.0)
565 
(38.0)
400 
(26.9)
286 
(19.2)
122 
(8.2)
39 
(2.7)
50 
(3.4)
816 
(54.9)
374 
(25.2)
247 
(16.6)
 
-0.06*
-0.12**
0.40**
0.01
0.46**
11.41
37.15
108.60
 
-0.19
-4.28
9.35
0.72
20.04
0.015
0.069
0.267
0.267
 
-0.05*
-0.11***
0.24***
0.02
0.45***
0.00
0.00
0.00
 
0.05*
0.00***
0.00***
0.471
0.00***
9.85 
(7.7)
13.47 
(9.2)
13.4 
(8.6)
13.3 
(8.8)
13.7 
(9.3)
12.5 
(9.6)
12.2 
(9.1)
11.4 
(9.3)
8.62 
(7.7)
11.14 
(8.3)
14.27 
(8.9)
18.9 
(9.4)
38.21 
(10.1)
40.73 
(10.8)
44.8 
(11.1)
41.7 
(10.6)
40.2 
(10.9)
38.0 
(9.8)
39.8 
(11.5)
39.1 
(11.6)
43.2 
(11.8)
40.0 
(10.3)
40.1 
(10.9)
42.1 
(11.7)
1.90 
(0.8)
2.41 
(0.9)
2.3 
(0.8)
2.4  
(0.9)
2.4  
(0.9)
2.3  
(0.9)
2.2 
(0.8)
2.2
(1.1)
1.9  
(0.7)
2.2 
(0.8)
2.4  
(0.9)
2.8  
(1.0)
<0.001***
0.33
<0.001***
 
<0.01**
<0.001***
0.02
 
<0.001***
 
 
0.5
<0.001***
 
t = 4.4
F= 1.1
F=58.6
 
t=2.6
F=6.6
F=3.5
 
t=6.0
F=0.9
F=35.6
n (%)
r F tΔR2 βp p
Predictor
M (SD) M (SD) M (SD)
Binge eating (score)
Dependent variable
Binge eating
Anxiety (score) Emotional eating (score)
p-value p-value p-value
Difference 
between 
groups
Difference 
between 
groups
Difference 
between 
groups
Table 3.
Table 4.
Frequencies and percentages of the survey participants by gender, age and BMI group, and the differences between the 
analysed scores and demographic characteristics (n=1,487).
Linear and hierarchical multiple regression analysis with binge eating as the dependent variable.
Abbreviation: t-value denotes the difference between two groups using a Student’s paired samples t-test. F-value denotes difference 
between the groups using ANOVA.
*p<.05. **p<.01. ***p<.001.    
Notes: n=1,487; *Hierarchical regression involving the entry of predictor variables into the analysis in steps (stepwise). Linear 
correlation obtained from Spearman (r). ΔR2=the change in R2 value for each subsequent step of the model resulting from the addition 
of a predictor to the regression equation. β=the beta values in regression are the estimated coefficients of the explanatory variables. A 
p-value of less than 0.05 was considered to be statistically non-significant.
10.2478/sjph-2023-0006 Zdr Varst. 2023;62(1):39-47
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Indeed, the results of this study showed a significant 
association between binge eating and higher BMI. 
Furthermore, they show a statistically significant positive 
association between anxiety and binge eating in a large 
sample of adults. This finding is consistent with previous 
studies that have shown a positive association between 
anxiety and binge-eating symptoms (47, 48) in the general 
population (26). Our results also show that anxiety 
accounted for 18.3% of the variation in this problematic 
eating behaviour. Similarly, previous research has shown 
that anxiety has a significant impact on the severity 
of binge eating (47, 49), and that loss of control is an 
important feature of both anxiety and binge eating (24, 
25, 49). The mechanisms by which anxiety promotes binge 
eating are not fully understood (47). One explanation 
is that binge eating is a calming behaviour for anxious 
people, comparable to nail biting, smoking, alcohol use or 
drug use, or that eating is a means of coping with these 
anxieties (25). In fact, anxiety is a component of negative 
affect that has been shown to play an important role in the 
development and maintenance of eating disorders such as 
binge eating (30), and is the most common precursor to 
disordered eating (49). In general, there is still a need for 
a better understanding of the role of anxiety, as anxiety 
symptoms are generally high in individuals who engage in 
binge eating. 
Moreover, participants with higher BMI who reported 
more anxiety were more prone to binge eating and had 
a more pronounced tendency to overeat. The results of 
our study of the general population sample show that 
women had statistically significant higher rates of binge 
eating, anxiety and emotional eating than men. The lower 
rates of binge eating among men in our study can be 
explained by the findings that risk factors for binge eating 
differ between genders (26, 30). Moreover, participants 
with higher BMI had statistically significant higher levels 
of emotional eating and binge eating. Given that obesity 
has become a major health problem in Slovenia (50) and 
worldwide (18), and that, according to some data, 62% of 
middle-aged participants in Slovenia have inappropriate 
eating habits (13), the binge eating revealed in our sample 
is cause for concern. Moreover, younger participants 
reported significantly higher anxiety scores than older 
participants. Interestingly, a recent study (51) on binge 
drinking found that this risky behaviour is very common 
among young adults. Because the term ‘binge’ refers 
not only to eating but also to extreme and uncontrolled 
activities (e.g. drinking, eating, fasting), this overall 
finding warns us that risky behaviours among the young 
population are a serious health problem.
Importantly, BMI is one variable that has been linked to 
binge eating. It has been proposed as a relevant causal 
factor in disordered eating in conjunction with emotional 
eating (12), although BMI has often been treated as an 
outcome (52). A potential complication with BMI is that 
binge eaters who engage in frequent intense exercise are, 
due to their high calorific expenditure, not necessarily 
overweight (53).
Since we conducted the study after the third wave of 
Covid-19 and the subsequent lockdown in Slovenia, the 
higher levels of anxiety and disordered eating could also 
be related to that particular time and to the lockdown. 
Indeed, during the early phase of the spread of Covid-19, 
researchers (54) demonstrated a relationship between 
population anxiety levels, psychological distress and 
prevention efforts. Although some studies (55) observed 
a decrease in health-related habits, such as alcohol 
consumption, after the initial lockdown, it has been 
suggested that an increase in these problematic habits 
may follow in the future. The data to date shows that the 
higher percentage of meals consumed at home, such as 
pizza and pasta (56), affected individual behaviours. Many 
people reported having eaten more during the lockdown 
and having had more unhealthy eating habits, such as the 
consumption of comfort foods (57). Crucially, some of 
them attributed these changes to higher anxiety (57, 58).
This study has some limitations. The first limitation is that 
the results cannot be statistically extrapolated to the 
population, and that statistical inferences (e.g. hypothesis 
tests and p-values) cannot be drawn based on a sample 
of the population, with the error term based on sampling 
error. Second, the proportion of women and men was 
not equal, making it difficult to generalise about gender 
differences. Although this study showed that women have 
higher levels of binge eating than men, future studies 
should replicate this finding with a larger sample of men 
to increase the reliability of the group means. Moreover, 
data collection was based on self-reporting, which is a 
subjective method, and most questionnaire responses 
were given by young people. Similarly, other authors (59) 
have reported that the younger population are more likely 
to complete the questionnaire when it is posted online. 
In addition, self-reported height and weight were used to 
calculate BMI. Several studies indicate that self-reported 
weight and height should be used with caution, as middle-
aged men and women are more likely to have biases; in 
particular, weight tends to be underestimated and height 
overestimated. BMI is not an appropriate indicator of diet, 
as higher BMI may be due to other factors (e.g. increased 
muscle mass, pregnancy, postpartum), as well as mental 
illness and treatment with medications that increase 
appetite and decrease energy expenditure. 
As far as we know, this is the first study in Slovenia with a 
large sample of adult women and men with different BMI in 
the field of disordered eating research. The results of this 
study may be a starting point for the planning of appropriate 
interventions to identify at-risk individuals prone to 
negative emotionality and binge-eating symptoms at an 
early stage, as this may affect the individual’s subsequent 
mental and physical health. As mentioned previously (60), 
strategies to improve the overall health of the population 
rely on an adequate diagnosis of disease-causing factors 
so that educational interventions and targeted campaigns 
can be adapted with the aim of changing inappropriate 
eating habits, as well as accessible nutrition counselling 
provided as needed by qualified dietitians at primary 
health centres (59).  In addition, the study findings provide 
evidence for other areas of work, e.g. by refining both 
cognitive-behavioural approaches, which have been shown 
to be a successful way of addressing BE symptoms (26) and 
developing more comprehensive obesity prevention and 
treatment programmes. For example, in order to prevent 
the use of food as a coping mechanism, the incorporation 
of emotion recognition and understanding, as well as 
coping strategies, may be more effective than focusing 
on just one. The research on binge eating by Barnhradt et 
al. (61) suggests that learning mindfulness can help people 
use more appropriate ways to cope with stress. Some (62) 
studies of binge eating in the general population have 
even suggested the promotion of a Mediterranean diet in 
the general population may play a key role in preventing 
BE episodes and the resulting potential weight gain, but 
conclude that further research is needed for this.
5 CONCLUSION
This study contributes to a relevant line of research in 
the field of disordered eating behaviours, particularly 
binge eating, and helps us to better understand this 
widespread problem in today’s society. It provides data on 
the relationship between binge eating and other comorbid 
variables, and shows that dysfunctional eating habits, such 
as binge eating, are associated with negative emotions 
such as anxiety, BMI, gender and age. Female participants 
and those with overweight or obesity were significantly 
more likely to report binge eating and emotional eating, 
and younger participants and females were significantly 
more likely to report anxiety. As binge eating is a risk 
factor for adverse health outcomes, the goal is not only to 
identify vulnerable populations for targeted interventions 
(e.g. gender, age, weight status), but also to identify risk 
factors that can be modified for prevention purposes. 
Health professionals should therefore closely monitor 
not only the current weight status of adults, but also 
their coping strategies, as binge-eating behaviour can be 
understood as a coping strategy in response to emotions. In 
an anxious state (with a lower or absent ability to regulate 
emotions), failure to regulate eating may occur, leading to 
unhealthy eating habits and increasing the likelihood of 
binge eating. Future studies should emphasise the above 
relationship and include some additional individual factors 
that may underlie high levels of binge eating and fat intake, 
such as the drive for thinness, body dissatisfaction, some 
behavioural patterns (impulsivity, loss of control), and 
eating styles/habits. All of these could help advance the 
field of eating behaviours that distinguish anxiety-induced 
eating in obesity and binge eating. This study paves the 
way for future investigations of the causal structure of 
associations between dysfunctional eating, gender and 
anxiety in all age groups in population-based Slovenian 
samples.
CONFLICTS OF INTEREST
The authors declare no conflict of interest. 
FUNDING
The author(s) received no specific funding for this work. 
ETHICAL APPROVAL
The study was approved by the Commission for Scientific 
and Research Work, Faculty of Health Sciences, University 
of Primorska (No 011544-609-32/2021).
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