Binge eating, orthorexia nervosa, restrained eating, and quality of life: a population study in Lebanon

OBJECTIVES

To assess the implication of disordered eating behaviors (DEBs) on the quality of life (QOL) of a sample of the Lebanese population, after adjustment over sociodemographic characteristics of those participants. Secondary objective aimed to assess the role of body dissatisfaction (BD) in the association of DEBs and QOL.

METHODS

This cross-sectional study was done between January and May 2018 and enrolled 811 participants from the community. A proportionate random sample technique was used to select the sample from all Lebanese Mohafazat. The World Health Organization Quality-of-life (WHOQOL)-BREF was used to assess the QOL and it includes four domains: physical health, psychological health, social relations, and environment.

RESULTS

Body dissatisfaction was found to be a major confounding factor contributing to psychological and environmental HQOL impairments in patient with restrained eating. Nevertheless, orthorexia nervosa was associated with QOL impairments in its physical and environmental domains, regardless of body dissatisfaction that was shown to be a major contributor for QOL impairments. Similarly, ON was directly correlated with QOL of life impairment in its physical and environmental domains, independently of all other risk factors.

CONCLUSION

When adding body dissatisfaction as a confounding variable, restrained eating and orthorexia nervosa remained significantly associated with quality-of-life impairments.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

The effect of restrained eating on acute stress-induced food intake in people with obesity

Restrained eating, defined as a form of intense dieting or restrictive food intake of specific macronutrients or types of food with sporadic episodes of overeating, results in an increased risk of overweight and obesity. Acute stress situations cause irregular eating patterns and are connected to restrained eating. Therefore, the present study investigates the effect of high/low restrained eating on eating behavior in people with obesity after standardized acute stress induction as well as resting condition. Fifty men and women with obesity (BMI: 33.62 ± 3.93 kg/m²) were categorized into high restrained eaters (HRE) and low restrained eaters (LRE). The total energy intake was measured during a standardized laboratory meal after a resting and stress condition (Trier Social Stress Test) on two separate days. HRE and LRE showed differences in the total energy intake in response to acute stress but not after resting condition (F_{(1, 47)} = 9.188, p = .004, η2 = 0.164). Lower total energy intake after stress compared to resting condition could be observed in HRE (t (23) = -2.617, p = .015). LRE showed higher total energy intake after stress than after resting condition (t (25) = 2.155, p = .041). The present data suggest that restrained eating behavior might be an influencing factor for stress-induced eating in obesity. It is highly necessary to understand the association between restrained eating behavior, acute stress and obesity for the improvement of the behavioral intervention of dietary restriction.

More restriction, more overeating: conflict monitoring ability is impaired by food-thought suppression among restrained eaters

Numerous studies have shown that restrained eating is not an effective weight loss strategy. Restrained eaters often suppress their desires and thoughts about tasty food, which makes it more difficult to control themselves in subsequent eating behavior. The ego depletion impairs conflict monitoring abilities. Therefore, this study explored the effects of food thoughts suppression on restrained eaters' conflict monitoring. Therefore, this study used functional magnetic resonance imaging (fMRI) methods to explore changes in the activity of brain regions involved in conflict monitoring when restrained eaters choose between high- and low-calorie foods after either suppressing or not suppressing thoughts about food. The results showed that, compared to the control condition, after suppression of such thoughts, restrained eaters chose more high-calorie foods and displayed decreased activity in the dorsal anterior cingulate cortex-an important region in charge of conflict monitoring. At the same time, the functional coupling of the dorsal anterior cingulate cortex and the precuneus increased. Our findings suggest that restrained eaters' suppression of thoughts about tasty food could lead to a decline in their ability to monitor conflicts between current behaviors and goals, which in turn leads to unhealthy eating behavior.

Eating behaviour styles in Irish teens: a cross-sectional study

OBJECTIVES

To describe the eating behaviour styles of Irish teens and to explore the relationships between demographic factors, BMI and dietary intake and these eating behaviour styles.

DESIGN

Cross-sectional data from the Irish National Teens' Food Survey (2005-2006). The Dutch Eating Behaviour Questionnaire assessed three eating behaviour styles in teens: restrained, emotional and external eating. Data were stratified by sex and age groups.

SETTING

The Republic of Ireland.

PARTICIPANTS

Nationally representative sample of teens aged 13-17 years (n 441).

RESULTS

The highest scoring eating behaviour style was external eating (2·83 external v. 1·79 restraint and 1·84 emotional). Girls scored higher than boys on all three scales (Restraint: 2·04 v. 1·56, P < 0·001, Emotional: 2·15 v. 1·55, P < 0·001 and External: 2·91 v. 2·76, P = 0·03), and older teens scored higher than younger teens on the Emotional (1·97 v. 1·67, P < 0·001) and External scales (2·91 v. 2·72, P = 0·01). Teens classified as overweight/obese scored higher than those classified as normal weight on the Restraint scale (2·15 v. 1·71, P < 0·001) and lower on the External scale (2·67 v. 2·87, P < 0·03). Daily energy intake was negatively correlated with the Restraint (r -0·343, P < 0·001) and Emotional scales (r -0·137, P = 0·004) and positively correlated with the External scale (r 0·110, P = 0·02).

CONCLUSIONS

External eating is the predominant eating behaviour style among Irish teens, but sex, age, BMI and dietary differences exist for each eating behaviour style. Including measures of eating behaviour styles into future dietary research could help understand both how and why as well as what people eat.

Effects of food-related behavioral activation therapy on eating styles, diet quality and body weight change: Results from the MooDFOOD Randomized Clinical Trial

OBJECTIVE

Depression and obesity are bi-directionally related, eating styles and diet quality are two important factors associated with both. It remains uncertain if and how these two factors can be modified. Therefore the current study aims to investigate whether food-related behavioral activation therapy (F-BA), targeting mood, dietary habits and food related behavior, can improve eating styles, and diet quality and reduce body weight in adults with overweight or obesity and subsyndromal depressive symptoms.

METHODS

Data were derived from the MooDFOOD prevention trial, a 2x2 factorial RCT investigating the effect of nutritional strategies on prevention of depression. Changes in emotional, uncontrolled, and cognitive restrained eating (Three Factor Eating Questionnaire Revised), Mediterranean Diet Score (MDS), and body weight were analyzed among 1025 adults who either received F-BA or no intervention for 12 months. Intervention effect was tested by longitudinal analysis of covariance using mixed model analysis.

RESULTS

The F-BA group showed a small decrease in emotional (β=-5.68, p<.001) and uncontrolled eating (β=-4.05, p=.03), and increase in cognitive restrained eating (β=5.53, p<.01), compared to no F-BA. The effect of the F-BA therapy on emotional and uncontrolled eating was stronger in those with higher baseline depressive symptoms (IDS-SR). The F-BA did also lead to small improvements in MDS (β=1.95, p<.001), but not to change in body weight.

CONCLUSION

Our trial showed no reduction in bodyweight, but provides support for the possibility to improve both unhealthy eating styles and diet quality using an intervention targeting these specifically, although effects were small [Trial registration: clinicaltrials.gov NCT02529423].

Decreased emotional eating behavior is associated with greater excess weight loss five years after gastric banding

While significant weight loss has been observed in the first two years following adjustable gastric banding (AGB), research on the long-term effectiveness of gastric restriction (e.g., 5 years) both on weight loss and eating behavior changes is scarce. The present study examined obese patients' changes in eating behavior preoperatively and 5 years after AGB and examined their associations with excess weight loss (EWL). Specifically, we focused on the association between the modification of three eating behavior profiles (i.e., restrained eating, emotional eating and external eating) and %EWL at 5 years. Among the 197 participants who underwent AGB, 136 completed the clinical assessments (weight, depression with the BDI, eating behavior with the DEBQ) before surgery, and after 5 years. Resultsshowed that the mean percentage of EWL was 47% after 5 years. Moreover, patients reported lower emotional eating and external eating after 5 years in comparison to the baseline, whereas there were no differences concerning restrained eating. Importantly, patients who presented higher %EWL at 5 years also reported a greater decrease in emotional eating between the two sessions than those with low %EWL. Our study underlines that eating behaviors are major variables involved in weight loss after gastric restriction. Results showed that emotional and external eating decreased significantly at 5 years whereas restrained eating behaviors did not vary between the pre- and postoperative stages. Moreover, the data suggest that a decrease in emotional eating accounts for the extent of EWL.

Delineating the psychological and behavioural factors of successful weight loss maintenance

Overweight and obesity present alarming global health problems including detrimental health risks that call for effective interventions. Considerable research has examined behavioural and psychological factors associated with weight loss to advance the field of obesity and overweight. In line with the literature, this study aimed to develop a behavioural and psychological profile based on factors of personality, eating behaviours, emotional functioning, physical well-being, and psychopathology. The sample consisted of 105 community participants who had reduced their bodyweight by at least 10% and had either successfully maintained their weight loss for a minimum 12-month period (n = 41) or had regained their weight loss within 12 months (n = 64). Participants completed an online survey comprising demographic items and four empirical measures (Mini Marker Personality Scale, Patient Health Questionnaire, Three-Factor Eating Questionnaire-Revised, and a food screening tool). Based on significant bivariate correlations results, four factors (fat intake, restrained eating, uncontrolled eating, and emotional eating) were entered into a binary logistic regression. Restrained eating was the only factor that significantly increased the likelihood of predicting successful long-term weight loss. Findings have implications for overweight and obesity future research, which may guide the direction of obesity and overweight treatments.

Fear of fat and restrained eating: negative body talk between female friends as a moderator

PURPOSE

This study examined whether engagement in negative body talk would moderate the association between fear of fat and restrained eating among female friend dyads.

METHODS

Female friends (N_pairs = 130) were recruited from a Midwestern university in the United States. The dyadic data were examined with an Actor-Partner Interdependence Model (APIM).

RESULTS

Results showed that women's fear of fat was significantly related to their own restrained eating behaviors. In contrast, women's fear of fat was not significantly related to their friends' restrained eating behaviors. Negative body talk was significantly related to restrained eating, as reported by both friends. The interaction between negative body talk and women's own fear of fat was found to be significant. Although women with less fear of fat showed less restrained eating, engaging in more negative body talk with a friend increased their engagement in restrained eating. Women with more fear of fat engaged in more restrained eating, regardless of their engagement in negative body talk.

CONCLUSION

Given the detrimental role of body talk between fear of fat and restrained eating, interventions may target reducing body talk among young women.

NO LEVEL OF EVIDENCE FOR

Basic science, Animal study, Cadaver study, and Experimental study articles.

Eating behaviors and weight loss outcomes in a 12-month randomized trial of diet and/or exercise intervention in postmenopausal women

Background

Certain eating behaviors are common among women with obesity. Whether these behaviors influence outcomes in weight loss programs, and whether such programs affect eating behaviors, is unclear.

Methods

Our aim was to examine the effect of baseline eating behaviors on intervention adherence and weight among postmenopausal women with overweight or obesity, and to assess intervention effects on eating behaviors.

Four hundred and 39 women (BMI ≥25 kg/m²) were randomized to 12 months of: i) dietary weight loss with a 10% weight loss goal (‘diet’; n = 118); ii) moderate-to-vigorous intensity aerobic exercise for 225 mins/week (‘exercise’; n = 117); iii) combined dietary weight loss and exercise (‘diet + exercise’; n = 117); or iv) no-lifestyle change control (n = 87). At baseline and 12 months, restrained eating, uncontrolled eating, emotional eating and binge eating were measured by questionnaire; weight and body composition were assessed. The mean change in eating behavior scores and weight between baseline and 12 months in the diet, exercise, and diet + exercise arms were each compared to controls using the generalized estimating equation (GEE) modification of linear regression adjusted for age, baseline BMI, and race/ethnicity.

Results

Baseline restrained eating was positively associated with change in total calories and calories from fat during the dietary intervention but not with other measures of adherence. Higher baseline restrained eating was associated with greater 12-month reductions in weight, waist circumference, body fat and lean mass. Women randomized to dietary intervention had significant reductions in binge eating (− 23.7%, p = 0.005 vs. control), uncontrolled eating (− 24.3%, p < 0.001 vs. control), and emotional eating (− 31.7%, p < 0.001 vs. control) scores, and a significant increase in restrained eating (+ 60.6%, p < 0.001 vs. control); women randomized to diet + exercise reported less uncontrolled eating (− 26.0%, p < 0.001 vs. control) and emotional eating (− 22.0%, p = 0.004 vs. control), and increased restrained eating (+ 41.4%, p < 0.001 vs. control). Women randomized to exercise alone had no significant change in eating behavior scores compared to controls.

Conclusions

A dietary weight loss intervention helped women modify eating behaviors. Future research should investigate optimal behavioral weight loss interventions for women with both disordered eating and obesity.

Trial registration

NCT00470119 (https://clinicaltrials.gov). Retrospectively registered May 7, 2007.

Associations among eating behaviour traits, diet quality and food labelling: a mediation model

OBJECTIVE

To assess the associations among eating behaviour traits, food label use and diet quality and to evaluate if the association between eating behaviour traits and diet quality is mediated by food label use.

DESIGN

Eating behaviour traits were assessed using the Three-Factor Eating Questionnaire (TFEQ), the Restraint Scale and the Intuitive Eating Scale, whereas food label use was measured with the Label Reading Survey. Diet quality (Canadian Healthy Eating Index) was assessed with an FFQ.

SETTING

Cross-sectional study.

PARTICIPANTS

Adults (n 385; mean (sd): BMI = 26·0 (4·9) kg/m2, age = 41·1 (15·0) years) involved in two previous experimental studies.

RESULTS

When controlling for potential covariates, general food label use (β = 1·18 (se 0·26), P < 0·0001) was the main determinant of diet quality, explaining 6·7 % of its variance. General food label use partly mediated the association between TFEQ-cognitive restraint and diet quality; the indirect effect (βindirect (se); 95 % CI) was stronger in men (0·32 (0·10); 0·15, 0·55) than women (0·16 (0·05); 0·08, 0·27). General food label use also partly mediated the negative association between unconditional permission to eat and diet quality; the indirect effect (βindirect (se); 95 % CI) was also stronger in men (-1·88 (0·55); -3·11, -0·96) than women (-1·03 (0·33); -1·81, -0·49).

CONCLUSIONS

General food label use was the main determinant of diet quality and partly mediated the association between eating behaviour traits and diet quality. The stronger mediating effect observed in men suggests they rely more on food labelling when attempting to restrained themselves, which translates into better diet quality.

Dietary restraint and weight loss in relation to disinhibited eating in obese Veterans following a behavioral weight loss intervention

Ability to restrain one's dietary intake is a necessary skill for weight loss. However, dietary restraint has been shown to paradoxically increase disinhibited eating in certain populations, thereby negatively impacting weight loss and leading to worse overall health outcomes. The aim of this study was to address gaps in the literature regarding the relationships between separate facets of dietary restraint (intention; behavior) with weight loss and various types of disinhibited eating (binge eating, external eating, emotional eating) in overweight and obese adults who recently completed a weight loss intervention. A sample of mostly male Veterans with overweight and obesity (N = 88) self-reported their dietary restraint intention, restraint behavior, and current disinhibited eating following completion of an 8-week behavioral weight loss treatment. Greater dietary restraint intention was related to greater dietary restraint behavior, p < .05. Greater dietary restraint behavior was significantly related to greater recent weight loss, p < .05, while restraint intention was not, p > .05. Greater dietary restraint intention was related to greater current binge eating and external eating, while greater self-reported restraint behavior was related to less binge eating, p < .05. Thus, dietary restraint behavior appears to be adaptive for this population, whereas rigid dietary restraint intention may increase risk for disinhibited eating. To decrease disinhibited eating and improve weight loss outcomes in Veterans, interventions might specifically address rigid rule-following associated with abandonment of weight loss goals and help Veterans develop specific yet flexible eating plans. Future research should examine whether dietary restraint intention and behavior differentially predict disinhibited eating and weight loss outcomes prospectively.

Brain structures associated with eating behaviors in normal-weight young females

Eating behaviors play an important role in individuals' development, and restrained eaters have a higher risk of obesity in the future. In the present study, we used the Three-Factor Eating Questionnaire to measure restrained eating, uncontrolled eating, and emotional eating in 158 young, normal-weight, Chinese women. We developed a multiple linear regression model to identify significant structural brain changes associated with the above-mentioned eating behaviors. Uncontrolled eating scores were positively associated with the gray matter volume (GMV) of the cerebellum, and negatively associated with the GMV on the left side of the anterior cingulate cortex, middle cingulate cortex, and supplementary motor areas, indicating that uncontrolled eating behaviors not only are less inhibitory but also appear to be associated with the low-level processing of appetite. Increased GMV on the right side of the precuneus was associated with a higher level of restrained eating, which might be thus related to a lower sensitivity to behavioral inhibition in young females who follow a diet. In addition, we did not find a relationship between emotional eating behavior and GMV. Our findings show that eating-behavior-related structural brain changes may lead to a decrease in inhibition and an increase in food sensitivity.

Stress-Induced Release of Eating-Related Hormones in Young Women Classified as Restrained and Unrestrained Eaters

BACKGROUND/AIMS

Restrained eating has been linked to binge eating under disinhibited circumstances and is therefore considered a risk factor to develop clinical eating disorders such as bulimia nervosa or binge eating disorder. The present study investigated the release of gastrointestinal peptides such as ghrelin and PYY after stress, as well as cortisol in young females classified as restrained and unrestrained eaters.

METHODS

The study was done in the laboratory of the Department for Biological and Clinical Psychology at the University of Trier. The sample consisted of 48 females, and the stressor was the Trier Social Stress Test. Blood samples for peptides and salivary cortisol were taken.

RESULTS

Higher ghrelin, but lower cortisol after stress was obtained for restrained eaters; no stress-related changes for PYY were observed.

CONCLUSION

Restrained eaters suffer from a possible stress-related biological dysregulation of eating, posing them at risk for eating and weight disorders.

Personality, emotion-related variables, and media pressure predict eating disorders via disordered eating in Lebanese university students

PURPOSE

Disordered eating behaviors are on the rise among youth. The present study investigates psychosocial and weight-related variables as predictors of eating disorders (ED) through disordered eating (DE) dimensions (namely restrained, external, and emotional eating) in Lebanese university students.

METHODS

The sample consisted of 244 undergraduates (143 female) aged from 18 to 31 years (M = 20.06; SD = 1.67). Using path analysis, two statistical models were built separately with restrained and emotional eating as dependent variables, and all possible direct and indirect pathways were tested for mediating effects. The variables tested for were media influence, perfectionism, trait emotional intelligence, and the Big Five dimensions.

RESULTS

In the first model, media pressure, self-control, and extraversion predicted eating disorders via emotional eating. In the second model, media pressure and perfectionism predicted eating disorders via restrained eating.

DISCUSSION

Findings from this study provide an understanding of the dynamics between DE, ED, and key personality, emotion-related, and social factors in youth. Lastly, implications and recommendations for future studies are advanced.

Prospective relations among internalization of beauty ideals, body image concerns, and body change behaviors: Considering thinness and muscularity

Common models propose that the internalization of societal beauty ideals influences disordered eating behaviors and muscularity-oriented behaviors via body image concerns. However, previous studies addressing these pathways have been mainly cross-sectional and primarily included female samples. We investigated these pathways prospectively in male and female adolescents and young adults, examining two pathways: a 'weight/shape pathway,' linking thin-ideal internalization, weight/shape concern, and restrained eating, and a 'muscularity pathway,' linking athletic-ideal internalization, muscularity concern, and muscularity-oriented behavior. Across three time points, 973 participants from the German general population were assessed. Although the hypothesized pathways could not be supported in their complete temporal sequence, several hypothesized pathways occurred across two time points. Among others, weight/shape concern predicted restrained eating and the athletic ideal played a prominent role in the prediction of muscularity-oriented behavior in both genders.

Factors associated with restrained eating and validation of the Arabic version of the restrained eating scale among an adult representative sample of the Lebanese population: a cross-sectional study

BACKGROUND

Previous research suggests that restrained eating is problematic in Lebanon and is associated with the occurrence of clinically diagnosed eating disorders. Because of the alarming prevalence and severity of these disorders, the aim of this study is to investigate factors that may contribute to restrained eating in adults among a representative sample of the Lebanese population.

METHODS

This is a cross-sectional study conducted between January and May 2018; 811 adult participants were enrolled from all Lebanese districts. The Dutch Restrained Eating scale was used to measure body disturbance. The factors that were assessed in the questionnaire were body dissatisfaction, self-esteem, perceived stress, anxiety, depression, emotion regulation, emotional eating and adult attachment styles.

RESULTS

The mean age of the participants was 27.59 ± 11.76 years, and included 66.5% females. In the absence of a cutoff value for the Dutch Restrained Eating scale, we took the median (2.6) as the cutoff value. The results showed that 391 (48.3%) had restrained eating. The Dutch Restrained Eating scale items converged over a solution of one factor that had an Eigenvalue over 1, explaining a total of 60.69% of the variance (Cronbach's alpha was high =0.928). The linear regression results, taking the Dutch restrained eating scale as the dependent variable, showed that being a female (Beta = 0.31), increased age (Beta = 0.01), higher body mass index (Beta = 0.01), an intermediate monthly income (Beta = 0.25), higher body dissatisfaction scores (Beta = 0.03), higher adult anxiety attachment style (Beta = 0.008), higher emotion regulation cognitive reappraisal facet (Beta = 0.01), feeling pressure from TV/magazine to lose weight (Beta = 0.45) and practicing sport activities (Beta = 0.41) were associated with higher restrained eating scores.

CONCLUSION

Our findings show that numerous factors are associated with restrained eating in the Lebanese community. They include body dissatisfaction, cognitive reappraisal, female gender, eating attitudes, social media pressure and adult attachment. Therefore, the development of prevention strategies directed at an improved body image perception and increasing knowledge about factors that might influence this body image and critical thinking regarding media images is warranted, with the ultimate goal of promoting healthier choices in the Lebanese population.

Depression and eating styles are independently associated with dietary intake

Depression and eating styles are two important, interrelated factors associated with dietary intake. However, it remains unclear whether depression and eating styles are independently associated with dietary intake, and whether associations between depression and dietary intake are mediated by eating styles. Therefore, the aim of the current study was to investigate the associations of, and interplay between depression and eating styles in relation to different aspects of dietary intake. Cross-sectional data from 1442 participants (healthy controls (22.7%), remitted (61.0%) and current patients (16.3%)) from the Netherlands Study of Depression and Anxiety were used. Linear regression analyses were used to determine associations of depressive disorders (DSM-IV based psychiatric interview), self-reported depressive symptoms (Inventory of Depressive Symptomatology), emotional, external and restrained eating (Dutch Eating Behavior Questionnaire) with 4 measures of dietary intake (total energy intake (kcal/d), Mediterranean diet score (MDS), intake of sweets foods (g/d), and snack/fast-food (g/d)) measured with a 238-item food frequency questionnaire. Statistical mediation analyses were used to study whether associations between depression and dietary intake were mediated by eating styles. Current depression diagnosis and severity were associated with lower MDS and higher intake of sweet foods and snack/fast-food. Emotional and external eating were associated with higher intakes of snack/fast-food; external eating was also associated with higher total energy intake. Restrained eating was associated with lower total energy and intake of sweet foods, and higher MDS. Associations between current depression or severity and intake of snack/fast-food were mediated by external eating. In general, depression and eating styles contributed independently to poorer diet quality and higher intake of sweet and snack/fast-food. The association between depression and higher intake of snack/fast-food was mediated by external eating.

Reinforcement sensitivity and restrained eating: the moderating role of executive control

PURPOSE

As the prevalence of overweight and obesity are still increasing, it is important to help individuals who encounter difficulty with losing weight. The current study was set out to further investigate characteristics of individuals who are highly motivated to restrict their food intake to lose weight, but fail to do so (i.e., restrained eaters). The motivation to lose weight might stem from high punishment sensitivity, whereas the failure to succeed in restricting food intake might be the result of high reward sensitivity. Thus, it was examined whether restrained eaters are characterized by both high reward sensitivity and high punishment sensitivity. Additionally, this is the first study to examine executive control as a potential moderator of this relationship.

METHODS

Female undergraduates (N = 60) performed a behavioral measure of executive control, and completed the Restraint Scale to index level of restrained eating as well as two questionnaires on reinforcement sensitivity; the Behavioral Inhibition Scale/Behavioral Activation Scale, and the Sensitivity to Punishment and Sensitivity to Reward Questionnaire.

RESULTS

There was a positive relationship between restrained eating and punishment sensitivity as indexed by both questionnaires. Reward sensitivity as measured by both indices was not directly related to restrained eating. Executive control moderated the relation between reward responsivity (but not reward-drive) and restrained eating; specifically in women with relatively weak executive control there was a positive relationship between reward responsivity and restrained eating behavior.

CONCLUSION

In women with low executive control, restrained eating is associated with both heightened sensitivity to punishment and heightened responsivity to reward.

Orthorexic and restrained eating behaviour in vegans, vegetarians, and individuals on a diet

PURPOSE

Orthorexic eating behaviour, restrained eating, and veganism/vegetarianism are food selection strategies sharing several characteristics. Since there are no studies investigating their interrelationships, aim of the present study was to analyse orthorexic and restrained eating behaviour in (1) a sample of vegans and vegetarians and (2) a sample of individuals on a diet to lose weight.

METHOD

Division of samples according to pre-defined criteria in (1) vegans (n = 114), vegetarians (n = 63), individuals with rare meat consumption (n = 83) and individuals with frequent meat consumption (n = 91) and in (2) participants on a diet with dietary change (n = 104), without dietary change (n = 37) and a control group of individuals not on a diet (n = 258). Orthorexic eating behaviour was assessed with the Düsseldorfer Orthorexie Skala and restrained eating was assessed with the Restraint Eating Scale.

RESULTS

Vegans and vegetarians do not differ in orthorexic eating behaviour, but both groups score higher in orthorexic eating behaviour than individuals consuming red meat. There are no differences regarding restrained eating. Individuals on a diet with dietary change score higher in both orthorexic and restrained eating, than individuals without dietary change and individuals not on a diet.

CONCLUSIONS

Individuals who restrict their eating behaviour, either predominantly due to ethical reasons or with the intention to lose weight, display more orthorexic eating behaviour than individuals not limiting their food consumption. Further research is needed to investigate whether veganism, vegetarianism, or frequent dieting behaviour serve as risk factors for orthorexia.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

How brain response and eating habits modulate food energy estimation

The estimates we do of the energy content of different foods tend to be inaccurate, depending on several factors. The elements influencing such evaluation are related to the differences in the portion size of the foods shown, their energy density (kcal/g), but also to individual differences of the estimators, such as their body-mass index (BMI) or eating habits. Within this context the contribution of brain regions involved in food-related decisions to the energy estimation process is still poorly understood. Here, normal-weight and overweight/obese women with restrained or non-restrained eating habits, received anodal transcranial direct current stimulation (AtDCS) to modulate the activity of the left dorsolateral prefrontal cortex (dlPFC) while they performed a food energy estimation task. Participants were asked to judge the energy content of food images, unaware that all foods, for the quantity presented, shared the same energy content. Results showed that food energy density was a reliable predictor of their energy content estimates, suggesting that participants relied on their knowledge about the food energy density as a proxy for estimating food energy content. The neuromodulation of the dlPFC interacted with individual differences in restrained eating, increasing the precision of the energy content estimates in participants with higher scores in the restrained eating scale. Our study highlights the importance of eating habits, such as restrained eating, in modulating the activity of the left dlPFC during food appraisal.

The role of craving in emotional and uncontrolled eating

This study presents a novel application of the cognitive processing model of alcohol craving (CPMA) from the addictions field to the role of food craving in the well-established restrained eating-overeating relationship associated with binge eating disorder (BED). A community sample (N = 1058, ages 18-66) completed an online survey assessing four core domains: restrained eating, trait food craving, uncontrolled eating, and emotional eating. In accordance with the CPMA, food craving emerged as a significant indirect effect of the association between restrained eating and both uncontrolled and emotional eating. Gender did not significantly moderate any direct or indirect associations, suggesting that gender may not change the pattern of association between restrained eating and different facets of overeating. Results suggest that treatments targeting binge eating behaviors may benefit from 1) explicitly addressing the activation of food craving rather than concentrating on reducing restrained eating and 2) recognizing that food craving may be an important gender-neutral target with the potential to reduce binge and overeating behaviors. Future research should extend these preliminary findings by examining the application of the CPMA to eating behaviors while jointly investigating antecedents and contextual factors.

Stress-related cortisol response and laboratory eating behavior in obese women

Stress-related cortisol secretion has been linked to increased appetite and subsequent food intake in overweight individuals. The present study addresses this relationship in a repeated-measures randomized controlled laboratory experiment. Nineteen obese women were compared to 36 normal weight controls with respect to stress-induced salivary cortisol and laboratory eating behavior, measured by a universal eating monitor. The trier social stress test served as stressor. Stress-induced cortisol levels were significantly higher in the obese compared to the normal weight controls. Unexpectedly, a corresponding increase in laboratory food intake was not detected. The results are interpreted and discussed with regard to restrained eating, which was found to be present to a significant degree in the obese women.

Impulse control and restrained eating among young women: Evidence for compensatory cortical activation during a chocolate-specific delayed discounting task

Theory and associated research indicate that people with elevated restrained eating (RE) scores have higher risk for binge eating, future bulimic symptom onset and weight gain. Previous imaging studies have suggested hyper-responsive reward brain area activation in response to food cues contributes to this risk but little is known about associated neural impulse control mechanisms, especially when considering links between depleted cognitive resources related to unsuccessful RE. Towards illuminating this issue, we used a chocolate-specific delayed discounting (DD) task to investigate relations between RE scores, behavior impulsivity, and corresponding neural impulse control correlates in a functional magnetic resonance imaging (fMRI) study of 27 young women. Specifically, participants were required to choose between more immediate, smaller versus delayed, larger hypothetical chocolate rewards following initial consumption of a chocolate. As predicted, RE scores were correlated positively with behavior impulse control levels. More critically, higher RE scores were associated with stronger activation in impulse control region, the dorsal-lateral prefrontal cortex (DLPFC) during the completion of difficult decision trials reflecting higher cognitive demands and resource depletion relative to easy decision trials. Exploratory analyses revealed a positive correlation between RE scores and activity in a reward system hub, the right striatum. Moreover, a positive correlation between left DLPFC and striatum activation was posited to reflect, in part, impulse control region compensation in response to stronger reward signal among women with RE elevations. Findings suggested impulse control lapses may contribute to difficulties in maintaining RE, particularly when cognitive demands are high.

Impact of Perceived Healthiness of Food on Food Choices and Intake

Healthy eating is an important determinant of health, but adherence to dietary guidelines remains a public health concern. Identifying factors that impact dietary habits is therefore important to facilitate healthy eating. One widely used strategy to help consumers make healthier food choices is nutrition information, such as labeling and claims. Despite the intention of these strategies to improve decision making, they can also be misunderstood or misinterpreted by consumers. The aim of this review is to explore food perceptions by examining how cognitive factors influence perceived healthiness of food, and the impact of perceived healthiness of food on food choices and intake. Overall findings of this review suggest that cognitive factors, such as type of food and branding, significantly contribute to judgmental bias and have an impact on perceived healthiness while not consistently or systematically influencing choice and intake.

Stress-induced release of GUT peptides in young women classified as restrained or unrestrained eaters

Basal release of GUT peptides has been found to be altered in restrained eaters. Stress-induced secretion, however, has not yet been described, but could be a biological basis of overeating that exposes restrained eaters to a higher risk of becoming obese. The aim of the present study was to compare restrained and unrestrained eaters with respect to stress-induced release of the GUT peptides ghrelin and PYY. 46 young women were studied. Blood sampling for peptides was done before and after the Trier Social Stress Test. Ghrelin secretion after stress was significantly elevated in the restrained eaters, whereas no significant differences were detected for PYY. Stress-induced release of GUT peptides can be interpreted as a cause as well as a consequence of restrained eating.