The research, reported in BMC Psychology, included adults with obesity recruited from a psychiatric outpatient clinic and healthy-weight hospital employees serving as controls. Obesity was defined as a body mass index of at least 30 kg/m², while controls had a body mass index no greater than 25 kg/m². Current DSM-5 psychiatric disorders were excluded through a Structured Clinical Interview for DSM-5. All participants completed the Three-Factor Eating Questionnaire-21, Automatic Thoughts Questionnaire, Metacognitions Questionnaire-30, and Depression Anxiety Stress Scales-21. Researchers used multi-group path analysis to estimate direct and indirect associations, with 5,000 bootstrap samples used for indirect effects.

Adults with obesity had higher emotional eating scores than controls, with a standardized mean difference of d = 1.05, and higher uncontrolled eating scores, with d = 1.10. They also had higher automatic thoughts scores, d = 0.58, and metacognitive beliefs scores, d = 0.55. Depression, anxiety, and stress scores were also higher in the obesity group, with standardized differences ranging from d = 0.69 to d = 0.96. The group difference in cognitive restraint was minimal and not statistically significant, at d = −0.07. These findings describe differences measured between the groups rather than changes over time.

The main result concerned the association between metacognitive beliefs and emotional eating in the obesity group. The estimated standardized coefficient was β = 0.46, p = .006, indicating that higher metacognitive-belief scores were associated with higher emotional-eating scores. The corresponding estimate in healthy-weight controls was not statistically significant, at β = −0.06, p = .688, and a Wald-type test indicated a significant difference between the two coefficients. The principal finding also remained after adjustment for education. In controls, automatic thoughts showed an indirect association with uncontrolled eating through anxiety, but the researchers did not formally compare that indirect association between groups.

Most other paths examined in the multi-group analysis were not statistically significant. The investigators also noted that the path analyses were exploratory because the sample size had been calculated for the primary group comparison rather than for the structural model. The relatively small sample and its recruitment from a psychiatric outpatient clinic and a hospital workplace may also limit how broadly the results can be applied. The authors concluded that metacognitive beliefs showed a selective association with emotional eating in adults with obesity, while emphasizing the need for larger longitudinal and interventional studies. The study does not establish metacognitive beliefs as a causal treatment target or show that metacognitive therapy is effective for obesity.

Subject of Research: Associations among metacognitive beliefs, psychological distress, and eating behavior in adults with obesity

Article Title: Associations of cognitive beliefs and metacognitive processes with eating behavior in adults with obesity and healthy-weight controls: a cross-sectional study

Article References: Kayıkcı, S., Gül, A., Karakuş, B. S., Büyükkasap, A. Ç., & Battal, S. (2026). Associations of cognitive beliefs and metacognitive processes with eating behavior in adults with obesity and healthy-weight controls: a cross-sectional study. BMC Psychology. https://doi.org/10.1186/s40359-026-05148-3

Image Credits: AI Generated

DOI: 10.1186/s40359-026-05148-3

Keywords: metacognitive beliefs, emotional eating, obesity, uncontrolled eating, automatic thoughts, psychological distress, path analysis, cross-sectional study, Associations, cognitive, beliefs, metacognitive