Internal disinhibition predicts weight regain following weight loss and weight loss maintenance
Open accessAbstract
Objective: The disinhibition scale of the Eating Inventory predicts weight loss outcome; however, it may include multiple factors. The purpose of this study was to examine the factor structure of the disinhibition scale and determine how its factors independently relate to long‐term weight loss outcomes. Research Methods and Procedures: Exploratory factor analysis of the disinhibition scale was conducted on 286 participants in a behavioral weight loss trial (TRIM), and confirmatory factor analysis was conducted on 3345 members of the National Weight Control Registry (NWCR), a registry of successful weight loss maintainers. Multivariate regressions were used to examine the relationships between the disinhibition scale factors and weight over time in both samples. Results: Using baseline data from TRIM, two factors were extracted from the disinhibition scale: 1) an “internal” factor that described eating in response to internal cues, such as feelings and thoughts; and 2) an “external” factor that described eating in response to external cues, such as social events. This factor structure was confirmed using confirmatory factor analysis in the NWCR. In TRIM, internal disinhibition significantly predicted weight loss at 6 months (p = 0.03) and marginally significantly predicted weight loss at 18 months (p = 0.06), with higher levels of internal disinhibition at baseline predicting less weight loss; external disinhibition did not predict weight loss at any time‐point. In NWCR, internal disinhibition significantly predicted one‐year weight change (p = 0.001), while external disinhibition did not. Discussion: These results suggest that it is the disinhibition of eating in response to internal cues that is associated with poorer long‐term weight loss outcomes.
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High disinhibition is linked to worse results in weight-loss programs.
“it has been found that those with high disinhibition display poorer outcomes in weight loss programs.39,40”
From The mind your health project: a randomized controlled trial of an innovative behavioral treatment for obesity (2013) · cites this paper as [39]
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“A longitudinal study found internal but not external disinhibition after weight loss to predict one-year weight loss maintenance (Niemeier et al., 2007).”
Salad and satiety. The effect of timing of salad consumption on meal energy intake
Roe, L. S., Meengs, J. S., & Rolls, B. J. (2011) · Appetite · doi:10.1016/j.appet.2011.10.003 · Cited by 43 · see citing works
Wiedemann, A. A., Ivezaj, V., & Barnes, R. D. (2018) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2018.09.003 · Cited by 37 · see citing works
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A Randomized Pilot Study of a Phone-Based Mindfulness and Weight Loss Program
Carpenter, K., Vickerman, K. A., Salmon, E. E., Javitz, H. S., Epel, E. S., & Lovejoy, J. C. (2017) · Behavioral Medicine · doi:10.1080/08964289.2017.1384359 · Cited by 33 · see citing works
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Emotional eating in patients attending a specialist obesity treatment service
Wong, L., Stammers, L., Churilov, L. P., Price, S., Ekinci, E. I., & Sumithran, P. (2020) · Appetite · doi:10.1016/j.appet.2020.104708 · Cited by 30 · see citing works
Feller, S., Müller, A., Mayr, A. J., Engeli, S., Hilbert, A., & de Zwaan, M. (2015) · Obesity · doi:10.1002/oby.21054 · Cited by 29 · see citing works
Schaumberg, K., Schumacher, L. M., Rosenbaum, D. L., Kase, C. A., Piers, A. D., Lowe, M. R., Forman, E. M., & Butryn, M. L. (2016) · Eating Behaviors · doi:10.1016/j.eatbeh.2016.01.003 · Cited by 27 · see citing works
“A 26-item version of the disinhibition subscale (Niemeier et al., 2007)wasutilized in the current study.”
BackgroundMethodRevisiting the Compensatory Theory as an explanatory model for relapse in obesity management
Martins, C., Dutton, G. R., Hunter, G. R., & Gower, B. A. (2020) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/nqaa243 · Cited by 27 · see citing works
Vieira, P. N., Silva, M. N., Mata, J., Coutinho, S. R., Santos, T., Sardinha, L. B., & Teixeira, P. J. (2012) · Journal of Behavioral Medicine · doi:10.1007/s10865-012-9454-9 · Cited by 27 · see citing works
“In a study with participants of the National Weight Control Registry, eating disinhibition in response to internal cues, such as feelings and thoughts, was associated with poorer long-term weight loss outcomes (Niemeier et al., 2007).”
BackgroundLillis, J., Niemeier, H. M., Ross, K. M., Thomas, J. G., Leahey, T., Unick, J., Kendra, K. E., & Wing, R. R. (2015) · BMC Psychology · doi:10.1186/s40359-015-0075-2 · Cited by 26 · see citing works
“(Niemeier et al. 2007) and a smaller decrease in internal disinhibiton early in weight loss treatment (Butryn et al.”
BackgroundSelf-citationBraden, A. L., Anderson, L., Redondo, R. A., Watford, T. S., Emley, E. A., & Tilstra-Ferrell, E. L. (2020) · Journal of Health Psychology · doi:10.1177/1359105320942860 · Cited by 26 · see citing works
“Despite its association with overweight/obesity (Gibson, 2012) and difficulty losing weight (Niemeier et al., 2007), emotional eating is also common among individuals who are normal weight (Sultson and Akkermann, 2019).”
BackgroundBraden, A. L., Redondo, R. A., Tilstra-Ferrell, E. L., Anderson, L., Weinandy, J. T. G., Watford, T. S., & Barnhart, W. R. (2022) · Behavior Therapy · doi:10.1016/j.beth.2022.01.008 · Cited by 25 · see citing works
Mindfulness-Based Interventions for Weight Loss and CVD Risk Management
Fulwiler, C., Brewer, J. A., Sinnott, S. M., & Loucks, E. B. (2015) · Current Cardiovascular Risk Reports · doi:10.1007/s12170-015-0474-1 · Cited by 25 · see citing works
Chong, M. F., Ayob, M. N. M., Chong, K. J., Tai, E. S., Khoo, C. M., Leow, M. K., Lee, Y. S., Tham, K. W., Venkataraman, K., Meaney, M. J., et al. (2016) · Appetite · doi:10.1016/j.appet.2016.03.005 · Cited by 25 · see citing works
Early predictors of weight loss in a 1‐year behavioural weight‐loss programme
James, B. L., Roe, L. S., Loken, E., & Rolls, B. J. (2017) · Obesity Science & Practice · doi:10.1002/osp4.149 · Cited by 24 · see citing works
“Subsequent to the development of the TFEQ, other researchers have proposed subscales of the main scales, such as flexible and rigid restraint (20) and internal and external disinhibition (21), which were also assessed in this study.”
MethodDonofry, S. D., Erickson, K. I., Levine, M. D., Gianaros, P. J., Muldoon, M. F., & Manuck, S. B. (2020) · Nutrients · doi:10.3390/nu12113414 · Cited by 22 · see citing works
“For instance, depressive symptoms have been associated with reduced likelihood of maintaining weight loss [16], and eating as a means of regulating mood is predictive of weight regain following a weight loss attempt [17].”
InfluentialHutchesson, M., Morgan, P. J., & Collins, C. E. (2011) · Public Health Nutrition · doi:10.1017/s1368980011003090 · Cited by 22 · see citing works
A 1-day acceptance and commitment therapy workshop leads to reductions in emotional eating in adults
Frayn, M., Khanyari, S., & Knäuper, B. (2020) · Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity · doi:10.1007/s40519-019-00778-6 · Cited by 17 · see citing works
“1 3 studied in the context of weight concerns, such as weight gain over time [8, 9] and difficulties with weight loss [8, 10].”
BackgroundFlølo, T. N., Andersen, J. R., Nielsen, H. J., & Natvig, G. K. (2014) · PeerJ · doi:10.7717/peerj.565 · Cited by 16 · see citing works
“Former studies have emphasized the association between emotional eating and poor weight loss maintenance (Niemeier et al., 2007, Phelan et al., 2009).”
BackgroundManaging the Risk of Childhood Overweight and Obesity in Primary Care Practice
Murray, R. D., & Battista, M. (2009) · Current problems in pediatric and adolescent health care · doi:10.1016/j.cppeds.2009.03.002 · Cited by 16 · see citing works
Older adults fighting obesity with bariatric surgery: Benefits, side effects, and outcomes
Marihart, C. L., Brunt, A. R., & Geraci, A. A. (2014) · SAGE Open Medicine · doi:10.1177/2050312114530917 · Cited by 16 · see citing works
Fasting diets: what are the impacts on eating behaviors, sleep, mood, and well-being?
Hosseini, E., Ammar, A., Josephson, J., Gibson, D. L., Askari, G., Bragazzi, N. L., Trabelsi, K., Schöllhorn, W., & Mokhtari, Z. (2024) · Frontiers in Nutrition · doi:10.3389/fnut.2023.1256101 · Cited by 11 · see citing works
Examination of the Eating Behavior of the Hungarian Population Based on the TFEQ-R21 Model
Szakály, Z., Kovács, B., Szakály, M., Nagy-Pető, D. T., Gál, T., & Soós, M. (2020) · Nutrients · doi:10.3390/nu12113514 · Cited by 15 · see citing works
“Of the three factors of the TFEQ-R18, only two (emotional and uncontrolled eating) showed good internal consistency, while none of the Niemeier D (disinhibition) factors [40] showed good internal consistency.”
BackgroundThomas, J. G., Goldstein, C. M., Bond, D. S., Lillis, J., Hekler, E. B., Emerson, J. A., Espel‐Huynh, H., Goldstein, S. P., DUNSIGER, S. I., Evans, E. W., et al. (2020) · Contemporary Clinical Trials · doi:10.1016/j.cct.2020.106217 · Cited by 15 · see citing works
Self-citationMediation of Weight Loss and Weight Loss Maintenance through Dietary Disinhibition and Restraint
JaKa, M. M. (2015) · Journal of Obesity & Weight loss Therapy · doi:10.4172/2165-7904.1000253 · Cited by 14 · see citing works
“This includes the lack of ability to control eating when in certain situations, for example, eating too much at social events and the inability to control eating while experiencing certain internal emotions or thoughts wherein eating is a way of coping with emotions or feelings [9].”
Braden, A. L., & O’Brien, W. H. (2020) · Journal of Contemporary Psychotherapy · doi:10.1007/s10879-020-09477-1 · Cited by 14 · see citing works
“Emotional eating prior to (Niemeier et al. 2007), during (Teixeira et al.”
BackgroundPhysical activity is unrelated to cognitive performance in pre-bariatric surgery patients
Langenberg, S., Schulze, M., Bartsch, M., Gruner‐Labitzke, K., Pek, C., Köhler, H., Crosby, R. D., Marschollek, M., de Zwaan, M., & Müller, A. (2015) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2015.03.008 · Cited by 14 · see citing works
An examination of emotional and loss-of-control eating after sleeve gastrectomy surgery
Wiedemann, A. A., Ivezaj, V., & Grilo, C. M. (2018) · Eating Behaviors · doi:10.1016/j.eatbeh.2018.07.008 · Cited by 13 · see citing works
Lillis, J., Thomas, J. G., Niemeier, H. M., & Wing, R. R. (2017) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2017.07.005 · Cited by 13 · see citing works
Self-citationA qualitative analysis of the role of emotions in different patterns of long-term weight loss
Ingels, J. S., & Zizzi, S. (2018) · Psychology and Health · doi:10.1080/08870446.2018.1453511 · Cited by 12 · see citing works
“This hypothesis is consistent with prior studies that have shown that those who regain weight struggle with regulating emotions (Byrne et al., 2003; Duarte et al., 2017; Niemeier et al., 2007).”
The Pain of Regain: Psychosocial Impacts of Weight Regain Among Long-Term Bariatric Patients
Geraci, A. A., Brunt, A. R., & Hill, B. (2015) · Bariatric Surgical Practice and Patient Care · doi:10.1089/bari.2015.0011 · Cited by 10 · see citing works
Internal disinhibition predicts 5‐year weight regain in the National Weight Control Registry (NWCR)
Lillis, J., Thomas, J. G., Niemeier, H. M., & Wing, R. R. (2016) · Obesity Science & Practice · doi:10.1002/osp4.22 · Cited by 11 · see citing works
“Niemeier and colleagues (10) conducted a new factor analysis of the EI disinhibition scale using two samples of individuals who had participated in longitudinal weight loss research studies (total N=3,631) and found that disinhibition, as measured by the EI, is better represented by two factors: internal disinhibition…”
MethodInfluentialSelf-citationMalkki-Keinänen, K., Lankinen, M. A., Karhunen, L. J., & Schwab, U. (2022) · Nutrition and Health · doi:10.1177/02601060221112178 · Cited by 10 · see citing works
Williams‐Kerver, G. A., Schaefer, L. M., Hawkins, M. A. W., Crowther, J. H., & Duncan, J. (2019) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2019.07.028 · Cited by 9 · see citing works
“, eating in response to internal thoughts and feelings, equating eating with reductions in negative affect) and weight trajectories among individuals seeking weight loss (13,14).”
BackgroundMurray, H. B., Zhang, F., Manasse, S. M., Forman, E. M., Butryn, M. L., & Juarascio, A. S. (2021) · Appetite · doi:10.1016/j.appet.2021.105680 · Cited by 9 · see citing works
Butryn, M. L., Crane, N. T., Lufburrow, E., Hagerman, C. J., Forman, E. M., & Zhang, F. (2022) · Annals of Behavioral Medicine · doi:10.1093/abm/kaac028 · Cited by 9 · see citing works
Maladaptive Eating in Children and Adolescents With Obesity: Scrutinizing Differences in Inhibition
Naets, T., Vervoort, L., Tanghe, A., Guchtenaere, A. D., & Braet, C. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.00309 · Cited by 8 · see citing works
“Our observation that weight loss is highest in adolescents with strong inhibitory capacities (in combination with high external eating), dovetails with earlier studies showing that inhibition does play a role in which inhibition problems are known to hinder treatment (38) and stronger inhibition predicts more favorabl…”
ResultLedoux, T. A., Gallagher, M. R., Ciampolini, M., & Sampson, M. (2014) · Open Journal of Preventive Medicine · doi:10.4236/ojpm.2014.410088 · Cited by 9 · see citing works
“Disinhibited Eating (DE) is the inconsistent ability to resist the urge to overeat in the absence of hunger [9], negative emotions and external stimuli trigger DE [8]-[11].”
BackgroundBartsch, M., Langenberg, S., Gruner‐Labitzke, K., Schulze, M., Köhler, H., Crosby, R. D., Marschollek, M., de Zwaan, M., & Müller, A. (2016) · Obesity Surgery · doi:10.1007/s11695-016-2208-y · Cited by 8 · see citing works
“geous decision-making could facilitate behavioral factors that promote effective weight loss after bariatric surgery, including the resistance to alimentary stimuli, control of eating behavior, and adherence to healthy diet recommendations [27, 33, 34].”
BackgroundRandomized Trial Examining the Effect of a 12-wk Exercise Program on Hedonic Eating
Unick, J. L., DUNSIGER, S. I., Leblond, T. L., Hahn, K., Thomas, J. G., Abrantes, A. M., Stroud, L. R., & Wing, R. R. (2021) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0000000000002619 · Cited by 7 · see citing works
Self-citationFulwiler, C., Siegel, J. A., Allison, J. J., Rosal, M. C., Brewer, J. A., & King, J. A. (2016) · BMJ Open · doi:10.1136/bmjopen-2016-012573 · Cited by 7 · see citing works
“55 Health behaviours Health behaviours will be assessed using the Eating Behaviour Inventory, 56 the Internal Disinhibition Subscale of the Eating Inventory, 57 the Paffenbarger Physical Activity Scale 58 and the Pittsburgh Sleep Quality Index (PSQI), 59 respectively.”
MethodEvans, E. H., Sainsbury, K., Marques, M. M., Santos, I., Pedersen, S., Lähteenmäki, L., Teixeira, P. J., Stubbs, R. J., Heitmann, B. L., & Sniehotta, F. F. (2019) · Journal of Human Nutrition and Dietetics · doi:10.1111/jhn.12666 · Cited by 7 · see citing works
Factors Associated With Long Term Weight Regain After Bariatric Surgery
Digiorgi, M. (2012) · doi:10.7916/d8kd253m · Cited by 5 · see citing works
Weight-Related Eating Behavior Questionnaires: Applying Theory to Measurement
Schembre, S. M. (2011) · Springer eBooks · doi:10.1007/978-0-387-92271-3_218 · Cited by 6 · see citing works
Braden, A., Ferrell, E., Redondo, R., & Watford, T. (2020) · Journal of Contemporary Psychotherapy · doi:10.1007/s10879-020-09451-x · Cited by 5 · see citing works
Thomas, J. G., Goldstein, C. M., Bond, D., Lillis, J., Hekler, E. B., Goldstein, S. P., Butryn, M., Cao, Z.-H., & Wing, R. (2025) · Obesity · doi:10.1002/oby.70039 · Cited by 5 · see citing works
Self-citationSung, J., Lee, K., & Song, Y. (2014) · Yonsei Medical Journal · doi:10.3349/ymj.2014.55.4.1138 · Cited by 4 · see citing works
Lillis, J., & Wing, R. R. (2015) · Obesity Science & Practice · doi:10.1002/osp4.1 · Cited by 4 · see citing works
“A reanalysis of the widely used and well-established Eating Inventory disinhibition scale showed that it is better represented by two factors: internal disinhibition (ID), which is the tendency to eat in response to cognitive or emotional cues, a construct similar to emotional eating; and external disinhibition, which…”
BackgroundMethodSelf-citationPrecision Prevention, Diagnostics, and Treatment of Obesity: Pipedream or Reality?
Woolf, E. K., Diktas, H. E., Acosta, A. J., Apolzan, J. W., Ard, J. D., Boyle, K. E., Gilbert, J. A., Katzmarzyk, P. T., Laurienti, P. J., Lobstein, T., et al. (2025) · Obesity · doi:10.1002/oby.70015 · Cited by 5 · see citing works
“Studies demonstrate that behavioral weight loss outcomes are influenced by factors such as disinhibition [139, 140], nutrition and exercise self-efficacy, motivation, emotional dysregulation, and impulsivity [141].”
Self-citationBuehler, A. E., Flatt, S. W., Barkai, H., Pakiz, B., Heath, D. D., & Rock, C. L. (2017) · Journal of Obesity & Weight loss Therapy · doi:10.4172/2165-7904.1000348 · Cited by 3 · see citing works
“These behaviors are often evaluated using the Eating Inventory Questionnaire (EI) [8], and subscales have been developed [9-11] that further define and interpret aspects of these factors, which can inform understanding of the impact of these factors on long-term weight management.”
BackgroundExploring the impact of genetic beliefs about specific eating behaviors on dietary self-efficacy
Gbenro, M. O., Martingano, A. J., & Persky, S. (2022) · Journal of Behavioral Medicine · doi:10.1007/s10865-022-00290-w · Cited by 3 · see citing works
Binge Eating, Disinhibition and Obesity
Ulijaszek, S. J., & Bryant, E. J. (2016) · Springer eBooks · doi:10.1007/978-3-319-29716-3_8 · Cited by 3 · see citing works
Evaluating the Efficacy of Neurofeedback in Post-Bariatric Surgery Patients: A Pilot Study
Scaramuzzino, C., Lombardo, C., Esposito, G., Muscatello, M. R. A., Bruno, A., Populin, M., Navarra, G., Guccione, F., & Mento, C. (2025) · Journal of Personalized Medicine · doi:10.3390/jpm15100454 · Cited by 2 · see citing works
“Higher levels of emotional eating have been associated with higher BMI, indicating a direct link between this behaviour and the risk of obesity [7].”
Mathialagan, S., & Lau, P. L. (2023) · Journal of Health and Translational Medicine · doi:10.22452/jummec.vol26no1.9 · Cited by 2 · see citing works
Eating behavior disinhibition predicts insulin resistance in the Old Order Amish.
Schwab, S. E., Xu, T., Ryan, K. A., & Steinle, N. (2017) · PubMed · Cited by 2 · see citing works
Health Promotion and Weight Management for Obesity
Lillis, J., & Lee‐Baggley, D. (2022) · Oxford University Press eBooks · doi:10.1093/oxfordhb/9780197550076.013.18 · Cited by 2 · see citing works
la Peña-Armada, R. D., Longo‐Silva, G., Rodríguez‐Martín, M., Yang, H., & Garaulet, M. (2026) · Obesity · doi:10.1002/oby.70113 · Cited by 1 · see citing works
WEIGHT MAINTENANCE FOLLOWING THE COMPLETION OF A WEIGHT LOSS TRIAL: EXPLORING RACIAL DIFFERENCES
Turk, M. T. (2008) · D-Scholarship@Pitt (University of Pittsburgh) · Cited by 1 · see citing works
Spitznagel, M. B., Alosco, M. L., Strain, G. W., Devlin, M. J., Cohen, R. A., Paul, R. H., Crosby, R. D., Mitchell, J. E., & Gunstad, J. (2013) · Cited by 1 · see citing works
Niemeier, H. M., Lillis, J., & Wing, R. R. (2016) · Obesity Science & Practice · doi:10.1002/osp4.93 · Cited by 1 · see citing works
“In several samples, ID, but not external disinhibition (ED; eating in response to social or food cues), has been shown to predict weightrelated outcomes (6,7).”
BackgroundMethodInfluentialSelf-citation
- Authors
- Niemeier, H. M., Phelan, S., Fava, J. L., & Wing, R. R.
- Affiliations
- Brown University (US)
- Corresponding author
- Niemeier, Heather M.
- Venue
- Obesity
- Publisher
- Wiley
- Published
- 2007-10
- Volume
- 15
- Issue
- 10
- Pages
- 2485-2494
- ISSN
- 1930-7381 (ISSN-L)
- 1930-739X
- OpenAlex
- W2070752861
- Cited by
- 114
- References
- 53
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 2 · 2023: 1 · 2022: 6 · 2021: 2 · 2020: 12 · 2019: 7 · 2018: 6 · 2017: 7 · 2016: 12 · 2015: 11 · 2014: 10 · 2013: 4 · 2012: 5
- FWCI
- 4.36
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Obesity (publishedVersion)
- PubMed (publishedVersion)
- DigitalCommons - CalPoly (California State Polytechnic University) (submittedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (K23DK073536)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Keywords
- weight regain, weight loss maintenance, factor structure, behavioral weight loss
- MeSH terms
- Adult, Body Weight, Feeding Behavior, Female, Humans, Male, Middle Aged, Weight Gain, Weight Loss, Body Mass Index, Overweight
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