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Obesity and Health Practices / Diabetes Management and Education · Journal article
Frontiers in Nutrition · September 9, 2026
A consensus or society position rather than new primary data.
This narrative review synthesizes evidence on bidirectional relationships between psychological factors and dietary behaviors across chronic diseases (obesity, T2DM, CVD, chronic gastrointestinal diseases, CKD). The authors propose an integrated psychological–dietary management framework involving psychological screening, individualized nutrition, behavioral support, mindful eating, digital monitoring, and multidisciplinary collaboration. However, the review explicitly states that clinical effectiveness and implementation approaches of this framework require further evaluation through prospective studies, RCTs, and real-world implementation research.
Narrative review. Individuals with chronic disease across five disease categories: obesity, type 2 diabetes mellitus, cardiovascular disease, chronic gastrointestinal diseases, and chronic kidney disease. Intervention: Proposed integrated psychological–dietary management framework: psychological screening, individualized nutritional guidance, behavioral support, mindful eating, digital monitoring, and multidisciplinary collaboration.
Psychological distress (stress, anxiety, depression, reduced self-efficacy) may be related to emotional eating, preference for energy-dense foods, excessive dietary restriction, and reduced dietary adherence Dietary behaviors may affect psychological status and chronic disease management through pathways involving the HPA axis, reward processing, inflammation, the gut-brain axis, and metabolic changes Psychological and dietary management challenges differ across chronic diseases: obesity, T2DM, CVD, chronic gastrointestinal diseases, and CKD
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Clinicians should consider the bidirectional relationship between psychological factors and dietary behaviors when managing chronic disease, and may consider screening for psychological distress and implementing integrated psychological-dietary interventions; however, the evidence supporting specific implementation strategies remains preliminary and requires further rigorous evaluation.
A narrative review synthesizing evidence on psychological-dietary interactions in chronic disease, proposing an integrated management framework; presents current understanding but explicitly acknowledges that clinical effectiveness and implementation require further evaluation.
As stated by the source record.
Clinicians should consider the bidirectional relationship between psychological factors and dietary behaviors when managing chronic disease, and may consider screening for psychological distress and implementing integrated psychological-dietary interventions; however, the evidence supporting specific implementation strategies remains preliminary and requires further rigorous evaluation.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
What is missing. This record has no reported figures. That is a gap in the analysis, not a judgement about the study.
Objective This narrative review aims to summarize evidence from nutritional psychiatry, behavioral medicine, and chronic disease management, examine the relationship between psychological factors and dietary behaviors in chronic disease management, and discuss potential mechanisms, disease-specific manifestations, and clinical management approaches. Background Chronic disease management involves not only the control of disease-related indicators but also the long-term maintenance of dietary behaviors, treatment adherence, and self-management. Stress, anxiety, depression, reduced self-efficacy, and disease-related distress may affect food choices, eating behaviors, and dietary adherence, while dietary patterns, nutrient intake, and dietary restriction may also be associated with emotional and cognitive status. Therefore, psychological factors and dietary behaviors may influence each other during long-term chronic disease management. Results Existing evidence suggests that psychological factors and dietary behaviors may be bidirectionally associated. Psychological distress may be related to emotional eating, preference for energy-dense foods, excessive dietary restriction, and reduced dietary adherence, while dietary behaviors may also be associated with psychological status and chronic disease management through pathways involving the hypothalamic–pituitary–adrenal (HPA) axis, reward processing, inflammation, the gut-brain axis, and metabolic changes. These relationships may differ across chronic diseases, with obesity, type 2 diabetes mellitus (T2DM), cardiovascular disease (CVD), chronic gastrointestinal diseases, and chronic kidney disease (CKD) presenting different psychological and dietary management challenges. Psychological screening, individualized nutritional guidance, behavioral support, mindful eating, digital monitoring, and multidisciplinary collaboration may provide additional support for long-term chronic disease management. Conclusion Existing evidence suggests a potential bidirectional relationship between psychological factors and dietary behaviors in chronic disease management. Based on this evidence, this review further proposes an integrated psychological–dietary management framework, although its overall clinical effectiveness and specific implementation approaches still require further evaluation. More prospective studies, randomized controlled trials (RCTs), and real-world implementation studies are needed before this approach can be further developed for routine or standardized chronic disease management.
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