The influence of stress on the neural underpinnings of disinhibited eating: a systematic review and future directions for research

Disinhibited eating involves overconsumption and loss of control over food intake, and underpins many health conditions, including obesity and binge-eating related disorders. Stress has been implicated in the development and maintenance of disinhibited eating behaviours, but the mechanisms underlying this relationship are unclear. In this systematic review, we examined how the impact of stress on the neurobiological substrates of food-related reward sensitivity, interoception and cognitive control explains its role in disinhibited eating behaviours. We synthesised the findings of functional magnetic resonance imaging studies including acute and/or chronic stress exposures in participants with disinhibited eating. A systematic search of existing literature conducted in alignment with the PRISMA guidelines identified seven studies investigating neural impacts of stress in people with disinhibited eating. Five studies used food-cue reactivity tasks, one study used a social evaluation task, and one used an instrumental learning task to probe reward, interoception and control circuitry. Acute stress was associated with deactivation of regions in the prefrontal cortex implicated in cognitive control and the hippocampus. However, there were mixed findings regarding differences in reward-related circuitry. In the study using a social task, acute stress associated with deactivation of prefrontal cognitive control regions in response to negative social evaluation. In contrast, chronic stress was associated with both deactivation of reward and prefrontal regions when viewing palatable food-cues. Given the small number of identified publications and notable heterogeneity in study designs, we propose several recommendations to strengthen future research in this emerging field.

Automated summary

Disinhibited eating is linked to various health conditions, such as obesity and binge-eating disorders, and stress plays a role in its development. However, the specific mechanisms behind this relationship are not well understood. This systematic review examined how stress impacts the neurobiological substrates related to food-related reward sensitivity, interoception, and cognitive control, explaining its role in disinhibited eating behaviors. The review identified seven studies using functional magnetic resonance imaging to investigate the neural effects of stress on individuals with disinhibited eating. The results showed mixed findings, with acute stress being associated with deactivation of cognitive control regions, while chronic stress was related to deactivation of reward and cognitive control regions when viewing palatable food cues. Overall, more research is needed to strengthen understanding in this field.