Does the type of weight loss diet affect who participates in a behavioral weight loss intervention? A comparison of participants for a plant-based diet versus a standard diet trial

Dietary misreporting: a comparative study of recalls vs energy expenditure and energy intake by doubly-labeled water in older adults with overweight or obesity

BACKGROUND

Self-report methods are widely used to assess energy intake but are prone to measurement errors. We aimed to identify under-reported, over-reported, and plausible self-reported energy intake by dietary recalls (rEI) using a standard method (Method 1) that calculates the rEI ratio against measured energy expenditure (mEE) by doubly-labeled water (DLW), and compare it to a novel method (Method 2), which calculates the rEI ratio against measured energy intake (mEI) by the principle of energy balance (EB = mEE + changes in energy stores).

METHODS

The rEI:mEE and rEI:mEI ratios were assessed for each subject. Group cut-offs were calculated for both methods, using the coefficient of variations of rEI, mEE, and mEI. Entries within ± 1SD of the cutoffs were categorized as plausible, < 1SD as under-reported, and > 1SD as over-reported. Kappa statistics was calculated to assess the agreement between both methods. Percentage bias (bβ) was estimated by linear regression. Remaining bias (dβ) was calculated after applying each method cutoffs.

RESULTS

The percentage of under-reporting was 50% using both methods. Using Method 1, 40.3% of recalls were categorized as plausible, and 10.2% as over-reported. With Method 2, 26.3% and 23.7% recalls were plausible and over-reported, respectively. There was a significant positive relationship between mEI with weight (ß = 21.7, p < 0.01) and BMI (ß = 48.8, p = 0.04), but not between rEI with weight (ß = 13.1, p = 0.06) and BMI (ß = 41.8, p = 0.11). The rEI relationships were significant when only plausible entries were included using Method 1 (weight: ß = 17.4, p < 0.01, remaining bias = 49.5%; BMI: ß = 44.6, p = 0.01, remaining bias = 60.2%) and Method 2 (weight: ß = 19.5, p < 0.01, remaining bias = 24.9%; BMI: ß = 44.8, p = 0.03, remaining bias = 56.9%).

CONCLUSIONS

The choice of method significantly impacts plausible and over-reported classification, with the novel method identifying more over-reported entries. While rEI showed no relationships with anthropometric measurements, applying both methods reduced bias. The novel method showed greater bias reduction, suggesting that it may have superior performance when identifying plausible rEI.

CLINICAL TRIALS REGISTRATION

NCT04465721.

Elements Influencing User Engagement in Social Media Posts on Lifestyle Risk Factors: Systematic Review

BACKGROUND

The high prevalence of noncommunicable diseases and the growing importance of social media have prompted health care professionals (HCPs) to use social media to deliver health information aimed at reducing lifestyle risk factors. Previous studies have acknowledged that the identification of elements that influence user engagement metrics could help HCPs in creating engaging posts toward effective health promotion on social media. Nevertheless, few studies have attempted to comprehensively identify a list of elements in social media posts that could influence user engagement metrics.

OBJECTIVE

This systematic review aimed to identify elements influencing user engagement metrics in social media posts by HCPs aimed to reduce lifestyle risk factors.

METHODS

Relevant studies in English, published between January 2006 and June 2023 were identified from MEDLINE or OVID, Scopus, Web of Science, and CINAHL databases. Included studies were those that examined social media posts by HCPs aimed at reducing the 4 key lifestyle risk factors. Additionally, the studies also outlined elements in social media posts that influenced user engagement metrics. The titles, abstracts, and full papers were screened and reviewed for eligibility. Following data extraction, narrative synthesis was performed. All investigated elements in the included studies were categorized. The elements in social media posts that influenced user engagement metrics were identified.

RESULTS

A total of 19 studies were included in this review. Investigated elements were grouped into 9 categories, with 35 elements found to influence user engagement. The 3 predominant categories of elements influencing user engagement were communication using supportive or emotive elements, communication aimed toward behavioral changes, and the appearance of posts. In contrast, the source of post content, social media platform, and timing of post had less than 3 studies with elements influencing user engagement.

CONCLUSIONS

Findings demonstrated that supportive or emotive communication toward behavioral changes and post appearance could increase postlevel interactions, indicating a favorable response from the users toward posts made by HCPs. As social media continues to evolve, these elements should be constantly evaluated through further research.

Validity and reproducibility of the Prime Diet Quality Score (PDQS) against a four-day food diary in adults at risk of cardiovascular disease on the island of Ireland

There is an increasing need for valid, rapid diet screening tools. A significant association between the Prime Diet Quality Score (PDQS) and reduced risk of cardiovascular disease (CVD) has been demonstrated in the US but evidence of its use in Europe is lacking. The aim of this study was to amend the PDQS for a UK/Irish population and determine validity and reliability in those at risk of CVD. Participants were recruited via online adverts across the island of Ireland. The PDQS was amended for a UK/Irish population and participants completed PDQS and reference measure (4-day food diary (FD)) on two occasions. PDQS score was calculated directly from PDQS and indirectly from FDs. Validity was determined using Spearman correlation coefficients (SCCs) (r), intraclass correlation coefficients (ICCs) and weighted kappa. Reliability was determined using SCCs (r), ICCs, weighted kappa and coefficient of variation. 'Data were available for n = 115 (Month 0) and n = 108 (Month 3) participants for validity and n = 110 for reliability assessment (PDQS completed at both timepoints)'. PDQS score from PDQS was significantly correlated with PDQS score from FDs at months 0 (r = 0.59, P < 0.01) and 3 (r = 0.65, P < 0.01), with similar associations observed via ICCs. Weighted kappa indicated moderate agreement. PDQS score at month 0 was significantly correlated with PDQS score at month 3 (r = 0.78, P < 0.01), with similar associations observed via ICCs. Weighted kappa indicated moderate agreement. Results indicate that the amended PDQS is a valid and reliable tool to determine diet quality in a UK/Irish population at risk of CVD.

Association between pro-vegetarian dietary pattern and the risk of protein-energy wasting and sarcopenia in patients with chronic kidney disease

BACKGROUND

Chronic kidney disease (CKD) is characterized by structural abnormalities in nephrons, loss of functional nephrons, and impaired renal excretory function. A pro-vegetarian dietary pattern (PDP) is a gradual and progressive approach to vegetarianism. The current study aimed to assess the association between PDP and the odds of protein-energy wasting (PEW) and sarcopenia in patients with CKD.

METHODS

The present cross-sectional study was conducted on kidney disease patients (n = 109) referred to two clinics in Shiraz, Iran. The diagnosis of sarcopenia and PEW was made according to the guidelines of the Asian Working Group for Sarcopenia (AWGS) and the International Society of Renal Nutrition and Metabolism (ISRNM) criteria, respectively. The participants' dietary intake was evaluated using a 168-item semi-quantitative food frequency questionnaire (FFQ). For PDP index calculation, plant and animal food sources were categorized into 12 subgroups. The association between sarcopenia and PEW with PDP was evaluated using logistic regression.

RESULTS

The PDP was significantly associated with a lower risk of PEW in the second tertile compared to the first in the crude model (odds ratio (OR) = 0.225; confidence interval (CI): 0.055-0.915; p-value = 0.037). After adjusting for potential confounders, lower significant odds of PEW were observed in the second and last tertiles of PDP compared to the first (T2: OR = 0.194; CI: 0.039-0.962; p-value = 0.045, and T3: OR = 0.168; CI: 0.030-0.950; p-value = 0.044). In contrast, no significant relationship was observed between PDP and the odds of sarcopenia (p-value ˃ 0.05).

CONCLUSIONS

Overall, the findings indicated that greater adherence to PDP was negatively associated with the odds of PEW. Additionally, the results showed no association between PDP and the odds of sarcopenia. Further studies are needed to support these findings.

Behavioral and Psychological Factors Affecting Weight Loss Success

PURPOSE OF REVIEW

There is a large variability between individuals in the weight loss response to any given diet treatment, which fuels interest into personalized or precision nutrition. Although most efforts are directed toward identifying biological or metabolic factors, several behavioral and psychological factors can also be responsible for some of this interindividual variability.

RECENT FINDINGS

There are many factors that can influence the response to dietary weight loss interventions, including factors related to eating behavior (emotional eating, disinhibition, restraint, perceived stress), behaviors and societal norms related to age and sex, psychological and personal factors (motivation, self-efficacy, locus of control, self-concept), and major life events. The success of a weight loss intervention can be influenced by many psychological and behavioral constructs and not merely by physiological factors such as biology and genetics. These factors are difficult to capture accurately and are often overlooked. Future weight loss studies should consider assessing such factors to better understand the underlying reasons for the large interindividual variability to weight loss therapy.

What makes a plant-based diet? a review of current concepts and proposal for a standardized plant-based dietary intervention checklist

Within the last decades, plant-based diets have received increasing interest for their potential benefits to human and environmental health. The concept of plant-based diet, however, varies widely in its definition. Current definitions range from the exclusion of all animal products to diets that include meat, fish, and dairy in varying quantities. Therefore, the main objectives of this review were twofold: (a) to investigate how researchers use the term plant-based diet in nutrition intervention studies and (b) what types of food a plant-based diet may include. Searching two databases, we found that the term "plant-based diet" evokes varying ideas to researchers and clinicians. Fifty percent of the retrieved studies that included a plant-based dietary intervention completely proscribed animal products and used the term plant-based diet interchangeably with a vegan diet. In contrast, an ~33% of trials included dairy products and 20% of dietary interventions emphasized a semi-vegetarian dietary pattern. Based on specific examples, we point out how the usage of the umbrella term "plant-based diet" may cause significant ambiguity. We often encountered incomplete descriptions of plant-based dietary interventions, which makes comparison and reproducibility of studies difficult. As a consequence, we urge others to use the term "plant-based diet" only in conjunction with a detailed dietary description. To facilitate this process, we provide a template of a standardized plant-based intervention reporting checklist. Finally, the present review also highlights the urgent need for a consensus definition of the term plant-based diet and its content.

Adherence to a Mediterranean Diet Is Associated with Lower Depressive Symptoms among U.S. Adults

Depression is a leading cause of disability, yet current prevention and treatment approaches have only had modest effects. It is important to better understand the role of dietary patterns on depressive symptoms, which may help prevent depression or complement current treatments. This study examined whether adherence to a Mediterranean diet (Med Diet), determined by the Alternate Med Diet score (aMED), was associated with depressive symptoms in a representative sample of U.S. adults. The aMED score (range 0–9) was calculated from a 24-h diet recall with gender-specific quartiles (Q) estimated. The Patient Health Questionnaire-9 (PHQ-9) was used to define depressive symptoms, which was dichotomized as no to mild (0–9) versus moderate to severe symptoms (10–27). Logistic regression was used to investigate the association between quartiles of aMED and depressive symptoms when controlling for sociodemographics, total calories, and the time of year of diet recall; 7.9% of the sample had moderate to severe depressive symptoms. Compared to individuals with the lowest aMED (Q1), individuals in Q3 and Q4 had 40% and 45% lower odds of moderate to severe depressive symptoms (odds ratio [OR] = 0.60, 95% confidence interval [CI]: 0.50, 0.74; OR = 0.55, 95% CI: 0.36, 0.84, respectively). This study provides modest support of Med Diet’s role in supporting positive mental health.

Prevalence of fermented foods in the Dutch adult diet and validation of a food frequency questionnaire for estimating their intake in the NQplus cohort

Background

Humans have a long history of consuming fermented foods. However, their prevalence in human diets remains largely undetermined, and there is a lack of validated dietary assessment tools assessing the intake of different fermented products. This study aimed to identify fermented foods consumed in The Netherlands and determine the relative validity of a food frequency questionnaire (FFQ) compared to multiple 24-h recalls for estimating their intake.

Methods

The validation population consisted of 809 participants (53.1 ± 11.9 years) from a Dutch observational cohort (NQplus) who completed a FFQ and multiple 24-h recalls. Fermented foods from the FFQ and recalls were identified and aggregated into conventional food groups. Percent difference in mean intakes, quintile cross-classification, Spearman’s correlations, and Bland-Altman analyses were used to evaluate the agreement between the two dietary assessment methods.

Results

Approximately 16–18% of foods consumed by this population were fermented, and a further 9–14% were dishes containing a fermented ingredient. Fermented foods with the highest consumption included coffee (~ 453 g/day;~ 0.5% of daily energy intake), yoghurts (~ 88 g/day;~ 2.2%), beer (~ 84 g/day;~ 1.7%), wholegrain bread (~ 81 g/day;~ 9.4%), wine (~ 65 g/day;~ 2.7%), and cheese (~ 32 g/day;~ 5.0%). Mean percent difference between the FFQ and recalls was small for fermented beverages (coffee), breads (brown, white, wholegrain, rye), and fermented dairy (cheeses) (0.3–2.8%), but large for buttermilk and quark (≥53%). All fermented food groups had > 50% of participants classified into the same or adjacent quintile of intake (58%-buttermilk to 89%-fermented beverages). Strong Spearman’s correlations (crude/energy-adjusted r_s ≥ 0.50) were obtained for fermented beverages (coffee, beer, wine), cereals/grains (wholegrain bread), and dairy (yoghurts). For ‘other bread’, quark, and buttermilk, correlations were low (r_s < 0.20). Bland-Altman analyses revealed good agreement for fermented beverages (coffee, beer), breads (brown, wholegrain, rye, other), pastries, chocolate, and fermented dairy (cheeses) (mean difference: 0.1–9.3).

Conclusions

Fermented food groups with acceptable or good validity across all measures included commonly consumed foods in The Netherlands: fermented beverages (coffee), wholegrain and rye bread, and fermented dairy (cheeses). However, for less frequently consumed foods, such as quark and buttermilk, the levels of agreement were poor and estimates of intake should be interpreted with caution. This report provides the basis for developing a FFQ specific for fermented foods.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40795-020-00394-z.

Scientific evidence of diets for weight loss: Different macronutrient composition, intermittent fasting, and popular diets

New dietary strategies have been created to treat overweight and obesity and have become popular and widely adopted. Nonetheless, they are mainly based on personal impressions and reports published in books and magazines, rather than on scientific evidence. Animal models and human clinical trials have been employed to study changes in body composition and metabolic outcomes to determine the most effective diet. However, the studies present many limitations and should be carefully analyzed. The aim of this review was to discuss the scientific evidence of three categories of diets for weight loss. There is no one most effective diet to promote weight loss. In the short term, high-protein, low-carbohydrate diets and intermittent fasting are suggested to promote greater weight loss and could be adopted as a jumpstart. However, owing to adverse effects, caution is required. In the long term, current evidence indicates that different diets promoted similar weight loss and adherence to diets will predict their success. Finally, it is fundamental to adopt a diet that creates a negative energy balance and focuses on good food quality to promote health.

Users, Uses, and Effects of Social Media in Dietetic Practice: Scoping Review of the Quantitative and Qualitative Evidence

BACKGROUND

Social media platforms are increasingly used by registered dietitians (RDs) to improve knowledge translation and exchange in nutrition. However, a thorough understanding of social media in dietetic practice is lacking.

OBJECTIVE

The objective of this study was to map and summarize the evidence about the users, uses, and effects of social media in dietetic practice to identify gaps in the literature and inform future research by using a scoping review methodology.

METHODS

Stages for conducting the scoping review included the following: (1) identifying the research question; (2) identifying relevant studies through a comprehensive multidatabase and gray literature search strategy; (3) selecting eligible studies; (4) charting the data; and (5) collating, summarizing, and reporting results for dissemination. Finally, knowledge users (RDs working for dietetic professional associations and public health organizations) were involved in each review stage to generate practical findings.

RESULTS

Of the 47 included studies, 34 were intervention studies, 4 were descriptive studies, 2 were content analysis studies, and 7 were expert opinion papers in dietetic practice. Discussion forums were the most frequent social media platform evaluated (n=19), followed by blogs (n=13) and social networking sites (n=10). Most studies targeted overweight and obese or healthy users, with adult populations being most studied. Social media platforms were used to deliver content as part of larger multiple component interventions for weight management. Among intervention studies using a control group with no exposition to social media, we identified positive, neutral, and mixed effects of social media for outcomes related to users' health behaviors and status (eg, dietary intakes and body weight), participation rates, and professional knowledge. Factors associated with the characteristics of the specific social media, such as ease of use, a design for quick access to desired information, and concurrent reminders of use, were perceived as the main facilitators to the use of social media in dietetic practice, followed to a lesser extent by interactions with an RD and social support from fellow users. Barriers to social media use were mostly related to complicated access to the site and time issues.

CONCLUSIONS

Research on social media in dietetic practice is at its infancy, but it is growing fast. So far, this field of research has targeted few social media platforms, most of which were assessed in multiple-component interventions for weight management among overweight or obese adults. Trials isolating the effects and mechanisms of action of specific social media platforms are needed to draw conclusions regarding the effectiveness of those tools to support dietetic practice. Future studies should address barriers and facilitators related to the use of social media written by RDs and should explore how to make these tools useful for RDs to reach health consumers to improve health through diet.

Examining Plausibility of Self-Reported Energy Intake Data: Considerations for Method Selection

Self-reported dietary intake data contain valuable information and have long been used in the development of nutrition programs and policy. Some degree of measurement error is always present in such data. Biological plausibility, assessed by determining whether self-reported energy intake (rEI) reflects physiological status and physical activity level, must be examined and accounted for before drawing conclusions about intake. Methods that may be used to account for plausibility of rEI include crude methods such as excluding participants reporting EIs at the extremes of a range of intake and individualized methods such as statistical adjustment and applying cutoffs that account for the errors associated with within-participant variation in EI and total energy expenditure (TEE). These approaches allow researchers to determine how accounting for under- and overreporting affects study results and to appropriately address misreporting in drawing conclusions with data collected and in interpreting reported research. In selecting a procedure to assess and account for plausibility of intake, there are a number of key considerations, such as resources available, the dietary-report instrument, as well as the advantages and disadvantages of each method. While additional studies are warranted to recommend one procedure as superior to another, researchers should apply one of the available methods to address the issue of implausible rEI. If no method is applied, then at minimum, mean TEE or rEI/TEE should be reported to allow readers to ascertain the degree of misreporting at a gross level and better interpret the data and results provided.

Dietary adherence and acceptability of five different diets, including vegan and vegetarian diets, for weight loss: The New DIETs study

The goal of the present study was to examine dietary adherence and acceptability among participants from the New DIETs study who were randomized to one of four plant-based diets (vegan, vegetarian, pesco-vegetarian, semi-vegetarian) or an omnivore diet. Primary outcomes at two- and six months included dietary adherence (24-hour dietary recalls), weight loss and changes in animal product intake (mg cholesterol) by adherence status, Three-Factor Eating Questionnaire (TFEQ), Power of Food Scale (PFS), dietary acceptability (Food Acceptability Questionnaire), and impact of diet preference on adherence. No differences were found in dietary adherence or changes in FAQ, TFEQ, or PFS among the groups. At six months, non-adherent vegan and vegetarian participants (n=16) had a significantly greater decrease in cholesterol intake (-190.2 ± 199.2 mg) than non-adherent pesco-vegetarian/semi-vegetarian (n=15, -2.3 ± 200.3 mg, P=0.02) or omnivore participants (n=7, 17.0 ± 36.0, P=0.04). Non-adherent vegan/vegetarian participants lost significantly more weight at six months (-6.0 ± 6.7%) than non-adherent omnivore participants (-0.4 ± 0.6%, P=0.04). Dietary preference had no impact on adherence at six months. Due to equal rates of adherence and acceptability among the diet groups, instructing participants to follow vegan or vegetarian diets may have a greater impact on weight loss and animal product intake than providing instruction in more moderate approaches even among non-adherent participants.

Varying social media post types differentially impacts engagement in a behavioral weight loss intervention

The purpose of this study was to examine whether different types of posts differentially affect participant engagement and if engagement with social media enhances weight loss. Data are a subanalysis from a randomized weight loss study with a 4-month follow-up support period via private Facebook groups and monthly meetings. Counselors posted five different post types/week based on social cognitive theory (weight-related, recipes, nutrition information, poll votes, or requests for suggestions). Types of participant engagement (likes, comments/poll votes, and views) were assessed. Poll votes were the most engaging (mean number of votes or comments/poll 14.6 ± 3.4, P < 0.01) followed by suggestions (9.1 ± 2.7 posts, P < 0.01) and weight-related posts (7.4 ± 3.1 posts, P < 0.01). Engagement with Facebook was significantly associated with weight loss during the 4-month maintenance period (B = -0.09, P = 0.04). The findings provide evidence for ways to provide social support during weight loss interventions using remote methodology.

Randomization to plant-based dietary approaches leads to larger short-term improvements in Dietary Inflammatory Index scores and macronutrient intake compared with diets that contain meat

Studies have examined nutrient differences among people following different plant-based diets. However, all of these studies have been observational. The aim of the present study was to examine differences in nutrient intake and Dietary Inflammatory Index (DII) scores among overweight and obese (body mass index 25.0-49.9 kg/m(2)) adults randomized to receive dietary instruction on a vegan (n = 12), vegetarian (n = 13), pescovegetarian (n = 13), semivegetarian (n = 13), or omnivorous (n = 12) diet during a 6-month randomized controlled trial. Nutrient intake, nutrient adequacy, and DII score were assessed via two 24-hour dietary recalls (Automated Self-Administered 24-Hour Dietary Recall) at baseline and at 2 and 6 months. Differences in nutrient intake and the DII were examined using general linear models with follow-up tests at each time point. We hypothesized that individuals randomized to the vegan diet would have lower DII scores and greater improvements in fiber, carbohydrate, fat, saturated fat, and cholesterol at both 2 and 6 months as compared with the other 4 diets. Participants randomized to the vegan diet had significantly greater changes in most macronutrients at both time points, including fat and saturated fat, as well as cholesterol and, at 2 months, fiber, as compared with most of the other diet groups (Ps < .05). Vegan, vegetarian, and pescovegetarian participants all saw significant improvements in the DII score as compared with semivegetarian participants at 2 months (Ps < .05) with no differences at 6 months. Given the greater impact on macronutrients and the DII during the short term, finding ways to provide support for adoption and maintenance of plant-based dietary approaches, such as vegan and vegetarian diets, should be given consideration.

Comparative effectiveness of plant-based diets for weight loss: a randomized controlled trial of five different diets

OBJECTIVE

The aim of this study was to determine the effect of plant-based diets on weight loss.

METHODS

Participants were enrolled in a 6-mo, five-arm, randomized controlled trial in 2013 in South Carolina. Participants attended weekly group meetings, with the exception of the omnivorous group, which served as the control and attended monthly meetings augmented with weekly e-mail lessons. All groups attended monthly meetings for the last 4 mo of the study. Diets did not emphasize caloric restriction.

RESULTS

Overweight adults (body mass index 25-49.9 kg/m(2); age 18-65 y, 19% non-white, and 27% men) were randomized to a low-fat, low-glycemic index diet: vegan (n = 12), vegetarian (n = 13), pesco-vegetarian (n = 13), semi-vegetarian (n = 13), or omnivorous (n = 12). Fifty (79%) participants completed the study. In intention-to-treat analysis, the linear trend for weight loss across the five groups was significant at both 2 (P < 0.01) and 6 mo (P < 0.01). At 6 mo, the weight loss in the vegan group (-7.5% ± 4.5%) was significantly different from the omnivorous (-3.1% ± 3.6%; P = 0.03), semi-vegetarian (-3.2% ± 3.8%; P = 0.03), and pesco-vegetarian (-3.2% ± 3.4%; P = 0.03) groups. Vegan participants decreased their fat and saturated fat more than the pesco-vegetarian, semi-vegetarian, and omnivorous groups at both 2 and 6 mo (P < 0.05).

CONCLUSIONS

Vegan diets may result in greater weight loss than more modest recommendations.

Dietary intake, eating behaviors, and quality of life in women with polycystic ovary syndrome who are trying to conceive

The Healthy Eating for Reproductive Health study was conducted among 18 (45% non-white) mostly obese (BMI 39.9 ± 6.1) women with polycystic ovary syndrome (PCOS) who were experiencing infertility and interested in losing weight. A variety of markers were measured at baseline: body mass index (BMI), diet, physical activity, eating behaviors (using an Eating Behavior Inventory, a questionnaire which assesses both positive and negative eating behaviors associated with weight status, with a higher score indicating adoption of eating behaviors which have been shown in prior weight-loss research to promote a healthy weight (EBI) and the Three-Factor Eating Questionnaire, which assesses cognitive and behavioral components of eating among overweight adults), and a quality of life (PCOS Health-Related Quality of Life (PCOSQ)) index, which assesses satisfaction around five 'domains': emotional health, presence of body hair, infertility, weight, and menstrual problems). A comparison group of overweight women without PCOS (n = 28) was used to examine differences in measured outcomes between women with and without PCOS. Participants' habitual diets were high in fat and saturated fat and low in fiber, folate, and iron and contained significantly lower amounts of carbohydrate, iron, and whole grains compared with women without PCOS who had enrolled in a behavioral weight loss programme. Participants had a low EBI (indicating that most were not adopting eating behaviors associated with achieving a healthy weight), disinhibition (indicating participants had a tendency to overeat in the presence of highly palatable foods or were susceptible to emotional cues for eating, such as stress), and hunger scores (indicating participants did not report being susceptible to hunger, prompting overeating) and moderate dietary restraint (indicating they were not consistently attempting to restrict food intake consciously). PCOSQ scores were lowest for infertility and weight domains (indicating low satisfaction with current infertility and weight status); however all domains received low scores (emotional health, body hair, and menstrual problems). Higher energy intakes (kcal/day) were associated with a lower EBI score (r = - 0.60, P = 0.02), lower dietary restraint (r =- 0.50, P = 0.04), and higher disinhibition (r = 0.63, P = 0.01). Greater energy expenditure (kcal/day) was associated with lower PCOSQ scores for body weight (r =-0.54, P = 002) and infertility (r =- 0.51, P = 0.003) domains. Results suggest that overweight women with PCOS-related infertility have poor dietary intake, particularly in terms of whole grains, fiber, and iron, and eating behaviors inconsistent with achieving a healthy body weight, as well as low scores for PCOS-related quality of life.