A cross-cultural analysis of 'motivation for eating' as a potential factor in the emergence of global obesity: Japan and the United States

Characterizing Healthy Dietary Practices in Japan: Insights from a 2024 Nationwide Survey and Cluster Analysis

The increasing burden of lifestyle-related diseases highlights the need to address unhealthy dietary habits. This study aims to explore the latest dietary patterns in Japan following the COVID-19 pandemic, focusing on trends in health-promoting food choices. A web-based survey was conducted among 27,154 Japanese adults, selected via quota sampling to mirror national demographics. The study evaluated dietary diversity, measured through the Dietary Variety Score (Outcome 1), and the prioritization of nutritional and health considerations in food selection, assessed via a Likert scale (Outcome 2). Uniform Manifold Approximation and Projection (UMAP) and Ordering Points To Identify the Clustering Structure (OPTICS) algorithms were used to delineate patterns in health-centric food selections. OPTICS clustering revealed four distinct clusters for each outcome. Cluster 3, with a diverse diet, comprised older, predominantly female individuals with higher well-being and lower social isolation compared to Cluster 4, which lacked distinct dietary patterns. Cluster 3 also engaged more in snacking, treat foods, home cooking, and frozen meals. Similarly, a divide emerged between those prioritizing dietary considerations (Cluster C) and those indifferent to such aspects (Cluster D). The findings underscore the need for holistic post-COVID-19 public health initiatives addressing socioeconomic and cultural barriers to healthier dietary practices.

Effect of age and gender on dietary patterns, mindful eating, body image and confidence

The emergence of 'Diet Culture' came into existence with the era of pop culture, which emphasized the idea of body improvement by embracing the portrayal of unrealistic beauty standards set by the thin-ideal media. This growing and trending culture gained its popularity in India with the COVID pandemic and the imposed lockdown, wherein the prevalence of obesity and binge eating resulted from counter-regulatory eating behaviors and restrictive food intake to a greater extent of skipping meals to achieve the desired body type. The present empirical investigation focuses on understanding the gender and age-based differences (between the ages 18 to 55) among Indian population on dietary patterns, body image, mindful eating and physical appearance confidence using 2 × 3 factorial design. The tools used were Eating Behavior Pattern Questionnaire (EBPQ) [43], Body Self- image Questionnaire (BSIQ) [40], Mindful Eating Questionnaire (MEQ) [18] and Personal Evaluation Inventory (PEI) [44] were administered on a sample size of 120, selected using convenience sampling technique. The collected data was analyzed using SPSS Version 20.0. Results of the study reveal non-significant age and gender differences for mindful eating and appearance confidence. Significant age- differences were observed for Snacking and convenience F(2,114) = 6.22, p < .05; social dependence F(2,114) = 3.87, p < .05 and height dissatisfaction F(2,114) = 8.79, p < .05. And, significant gender differences were observed for Meal Skipping F(1,114) = 6.46, P < .05; snacking and convenience F(1,114) = 4.19, p < .05; fatness evaluation F(1,114) = 5.94, p < .05 and fitness evaluation F(1,114) = 5.33, p < .05. The only significant interaction effect observed was for social dependence dimension F(2, 114) = 3.96, p < .05. Thus, high exposure to social media and diet-related content contributed significantly to changing dietary patterns, and how they look, feel or perceive their body.

Measurement and Correlates of Food Selection Motivations in a United States Sample

Background: In this study, we explored the factors that motivate food choice, and evaluated the psychometric properties and demographic correlates of the Eating Motivation (EATMOT) questionnaire in adults in the United States (US). Methods: This cross-sectional survey involved 905 adults in 6 sites across the US. The EATMOT questionnaire measures participants' self-reported motivations for food selection, demographic, and anthropometric data. Analyses included exploratory and confirmatory factor analyses, correlations, Welch's t-tests, and logistic regressions. Results: We established a 3-factor model (health-related, emotional, and environmental/political motivations) as the best fit to the data (CFI = .983, RMSEA = .049, SRMR = .054). Gender differences were found within the 3 factors, as well as in the intercorrelations between factors. Higher levels of health-related motivations (B = .10, SE = .04, OR = 1.11 (95% CI: 1.03, 1.19), p = .006) were associated with increased reports of weight loss dieting, whereas higher levels of environmental/political motivations (B = -.09, SE = .04, OR = 0.91, p = .02) were associated with fewer reports of weight-loss dieting. Conclusion: An abbreviated version of the EATMOT scale is appropriate for use in a US sample and identifies 3 categories of factors that impact dietary choices. These factors may be important in building interventions to improve diets.

Testing of a model for risk factors for eating disorders and higher weight among emerging adults: Baseline evaluation

Although a range of risk factors have been identified for disordered eating and weight status, the breadth of risk factors have been rarely considered within a single, comprehensive model. The robustness of these findings across countries also remains an open question. The present study sampled 6272 participants aged 18-30 years from eight countries in an attempt to evaluate combined and unique predictors for these two conditions, and to explore possible cross-country differences in these models. Participants completed a range of demographic, biological, behavioral, psychological, and sociocultural measures to test a comprehensive model of the contributions of these predictors for disordered eating and weight-related constructs (binge eating, body mass index, compensatory behaviors, dietary restraint, drive for muscularity, and drive for leanness). Structural invariance testing within a multigroup path analysis framework revealed that a single model across the eight countries provided poor model fit. Freeing of 22% of parameters across countries provided excellent fit and a satisfactory compromise for country-invariant and country-variant parameters in the model. Overall, predictors accounted for between 15% and 60% of variance in the outcome measures, with lowest explained variance for the disordered eating outcomes. Significant unique contributions to prediction were observed for each of the five risk factor variable types and across the eight countries. Thus, the findings show strong support for this model as an explanatory framework of both disordered eating and weight status.

Cross-National Outcomes of a Digital Weight Loss Intervention in the United States, Canada, United Kingdom and Ireland, and Australia and New Zealand: A Retrospective Analysis

Mobile health (mHealth) interventions are ubiquitous and effective treatment options for obesity. There is a widespread assumption that the mHealth interventions will be equally effective in other locations. In an initial test of this assumption, this retrospective study assesses weight loss and engagement with an mHealth behavior change weight loss intervention developed in the United States (US) in four English-speaking regions: the US, Australia and New Zealand (AU/NZ), Canada (CA), and the United Kingdom and Ireland (UK/IE). Data for 18,459 participants were extracted from the database of Noom's Healthy Weight Program. Self-reported weight was collected every week until program end (week 16). Engagement was measured using user-logged and automatically recorded actions. Linear mixed models were used to evaluate change in weight over time, and ANOVAs evaluated differences in engagement. In all regions, 27.2–33.2% of participants achieved at least 5% weight loss by week 16, with an average of 3–3.7% weight loss. Linear mixed models revealed similar weight outcomes in each region compared to the US, with a few differences. Engagement, however, significantly differed across regions (P < 0.001 on 5 of 6 factors). Depending on the level of engagement, the rate of weight loss over time differed for AU/NZ and UK/IE compared to the US. Our findings have important implications for the use and understanding of digital weight loss interventions worldwide. Future research should investigate the determinants of cross-country engagement differences and their long-term effects on intervention outcomes.

Perfectionism and Eating Behavior in the COVID-19 Pandemic

The novel coronavirus disease 2019 (COVID-19) represents a massive global health crisis leading to different reactions in people. Those reactions may be adaptive or not depending on situational or psychological processes. Disordered eating attitudes and behaviors are likely to be exacerbated by the pandemic through multiple pathways as suggested by Rodgers et al. (2020). Among the psychological variables that may have increased dysfunctional eating attitudes and behaviors as a consequence of the social distancing and isolation, we looked at perfectionism. Perfectionism is a well-recognized risk and maintaining factor of eating-related symptoms and interact with stress increasing the probability of dysfunctional reactions (e.g., Wang and Li, 2017). The present study investigated the relationship between multidimensional perfectionism and eating behaviors by considering the mediating role of psychological distress. Data were collected from two countries (Italy and Spain) by means of an online survey. The samples included 465 (63.4% female) participants from Italy and 352 (68.5% female) from Spain. Participants completed the short form of the Hewitt and Flett Multidimensional Perfectionism Scale (Lombardo et al., 2021) to assess self-oriented, other-oriented and socially prescribed perfectionism, as well as the short form of Three Factors Eating Questionnaire (Karlsson et al., 2000) and the Italian version of Depression Anxiety and Stress Scale-21 (Bottesi et al., 2015), respectively used to assess restrictive, emotional and uncontrolled eating on one hand, and depression, anxiety and stress on the other. Multigroup analysis was performed to test the hypothesized model. Results showed that other-oriented and socially prescribed perfectionism were indirectly related to most of the dysfunctional eating aspects through the mediation of psychological distress, and the pattern obtained was consistent in both countries. These findings evidence that the psychological distress potentially related to the COVID-19 disease mediates the negative impact of interpersonal perfectionism and the tendency to eat in response to negative emotions.

Mobile Health Interventions Addressing Childhood and Adolescent Obesity in Sub-Saharan Africa and Europe: Current Landscape and Potential for Future Research

Child and adolescent overweight is a growing public health problem globally. Europe and low and middle-income (LMIC) countries in Sub-Saharan Africa provide sufficiently suitable populations to learn from with respect to the potential for mobile health (mHealth) interventions in this area of research. The aim of this paper is to identify mHealth interventions on prevention and treatment of childhood and adolescent obesity in Sub-Saharan Africa and Sweden and report on their effects, in order to inform future research in this area. A search of peer-reviewed publications was performed using PubMed, ScienceDirect, EBSCOhost, and Scopus. The search included all articles published up to August 2019. The search strings consisted of MeSH terms related to mHealth, overweight or obesity, children, adolescents or youth and individual countries in Europe and Sub-Saharan Africa. Second, a combination of free-text words; mobile phone, physical activity, exercise, diet, weight, BMI, and healthy eating was also used. Seven studies were reported from Europe and no eligible studies from Sub-Saharan Africa. The results of this narrative review indicate a lack of research in the development and testing of mHealth interventions for childhood and adolescent obesity. There is a need for an evidence base of mHealth interventions that are both relevant and appropriate in order to stem the epidemic of overweight and obesity among children and adolescents in these countries. Uptake of such interventions is likely to be high as there is high penetrance of mobile phone technology amongst adolescents, even within poor communities in Africa.

Consumers' Motives for Eating and Choosing Sweet Baked Products: A Cross-Cultural Segmentation Study

This study aimed to examine consumers' motives for eating and choosing sweet baked products (SBPs). A cross-cultural segmentation study on a South African (SA) and Swiss population sample (n = 216), was implemented using the Motivation for Eating Scale (MFES) and the Food Choice Questionnaire (FCQ). Cluster analyses provided three consumer segments for each population sample: the balanced and the frequenters for both countries, the deniers for SA, and the health conscious for Switzerland. South Africans liked SBPs more than the Swiss respondents, however the Swiss sample consumed SBPs more often. Environmental and physical eating were the most relevant motives when eating SBPs for the SA and Swiss group, respectively. For both samples, sensory appeal was the deciding factor when choosing SBPs. Cross-cultural studies of food choices are important tools that could help improve the current understanding of factors that influence the eating behavior of ultra-processed foods to promote healthy food choices through local and global perspectives. This paper highlights that more research is needed on consumers' motives for choosing and eating ultra-processed foods in order to develop specific integrative cultural exchange actions or intervention strategies to solve the obesity issue.

Dimensions of national culture associated with different trajectories of male and female mean body mass index in countries over 25 years

Cultural determinants of obesity prevalence have been little studied but could explain significant variations in body mass index (BMI) trajectories among countries. This ecological study quantified longitudinal associations between six dimensions of national culture and mean population BMI over 25 years. National mean male and female BMI data 1990 to 2014 provided dependent variables. National dimensions of culture (from the Hofstede database for up to 87 countries) were independent variables: Individualism, Uncertainty avoidance, Indulgence, Long-term orientation, Power distance, and Masculinity. Analyses used mixed models for repeated measures for each dimension of national culture with male and female adult BMI trajectories, controlling for confounders. A higher mean BMI was significantly associated with higher Individualism, Uncertainty avoidance, Indulgence, and Masculine orientation and with lower Power distance (males only) and lower Long-term orientation (males only). Overall, the national cultural dimensions explained 62.4% (males) and 53.5% (females) of the variance in mean BMI among countries. National cultural characteristics, especially Individualism and Uncertainty avoidance, are strongly related to obesity prevalence, explaining over half of the variance among countries. More research and theory development is needed to understand the pathways for these associations so that cultural contexts can be better accounted for in policies, social marketing messages, and community-based actions for obesity prevention.

Sitting time and associated factors among Portuguese older adults: results from Nutrition UP 65

Older adults are particularly susceptible to sedentary behaviours. Sitting time has been increasingly referred to as a potentially modifiable risk factor in the prevention of chronic diseases. Identifying factors associated with sitting time, particularly those that are modifiable, will allow for more effective public health strategies. This study aimed to describe sitting time among Portuguese older adults and to evaluate associated factors. A cross-sectional study including 1423 older adults ≥ 65 years old was conducted. Sitting time was assessed with the International Physical Activity Questionnaire. Socio-demographic, health, anthropometric and functional variables were collected. Bivariate and multivariate linear regression models were conducted to study the association between these variables and sitting time. The median of sitting time was 300 min/day (interquartile range = 240 min/day), which is equal to 5 h/day. The following factors were directly associated with longer sitting time: being male, age ≥ 80 years, living in Central or Southern Portugal, being retired from work, as well as presenting low physical activity, obesity or longer time to walk 4.6 metres. On the other hand, being married, having higher education and higher household income were inversely associated with longer sitting time. It can be concluded that Portuguese older adults spend a considerable amount of time sitting per day. Potentially modifiable risk factors associated with longer sitting time in this population were related to nutritional status and functional ability.

Effect of national culture on BMI: a multilevel analysis of 53 countries

Background

To investigate the association between national culture and national BMI in 53 low-middle- and high-income countries.

Methods

Data from World Health Survey conducted in 2002–2004 in low-middle- and high-income countries were used. Participants aged 18 years and over were selected using multistage, stratified cluster sampling. BMI was used as an outcome variable. Culture of the countries was measured using Hofstede’s cultural dimensions: Uncertainty avoidance, individualism, Power Distance and masculinity. The potential determinants of individual-level BMI were participants’ sex, age, marital status, education, occupation as well as household-wealth and location (rural/urban) at the individual-level. The country-level factors used were average national income (GNI-PPP), income inequality (Gini-index) and Hofstede’s cultural dimensions. A two-level random-intercepts and fixed-slopes model structure with individuals nested within countries were fitted, treating BMI as a continuous outcome variable.

Results

A sample of 156,192 people from 53 countries was included in this analysis. The design-based (weighted) mean BMI (SE) in these 53 countries was 23.95(0.08). Uncertainty avoidance (UAI) and individualism (IDV) were significantly associated with BMI, showing that people in more individualistic or high uncertainty avoidance countries had higher BMI than collectivist or low uncertainty avoidance ones. This model explained that one unit increase in UAI or IDV was associated with 0.03 unit increase in BMI. Power distance and masculinity were not associated with BMI of the people. National level Income was also significantly associated with individual-level BMI.

Conclusion

National culture has a substantial association with BMI of the individuals in the country. This association is important for understanding the pattern of obesity or overweight across different cultures and countries. It is also important to recognise the importance of the association of culture and BMI in developing public health interventions to reduce obesity or overweight.

The obesity transition: stages of the global epidemic

The global prevalence of obesity has increased substantially over the past 40 years, from less than 1% in 1975, to 6-8% in 2016, among girls and boys, and from 3% to 11% among men and from 6% to 15% among women over the same time period. Our aim was to consolidate the evidence on the epidemiology of obesity into a conceptual model of the so-called obesity transition. We used illustrative examples from the 30 most populous countries, representing 77·5% of the world's population to propose a four stage model. Stage 1 of the obesity transition is characterised by a higher prevalence of obesity in women than in men, in those with higher socioeconomic status than in those with lower socioeconomic status, and in adults than in children. Many countries in south Asia and sub-Saharan Africa are presently in this stage. In countries in stage 2 of the transition, there has been a large increase in the prevalence among adults, a smaller increase among children, and a narrowing of the gap between sexes and in socioeconomic differences among women. Many Latin American and Middle Eastern countries are presently at this stage. High-income east Asian countries are also at this stage, albeit with a much lower prevalence of obesity. In stage 3 of the transition, the prevalence of obesity among those with lower socioeconomic status surpasses that of those with higher socioeconomic status, and plateaus in prevalence can be observed in women with high socioeconomic status and in children. Most European countries are presently at this stage. There are too few signs of countries entering into the proposed fourth stage of the transition, during which obesity prevalence declines, to establish demographic patterns. This conceptual model is intended to provide guidance to researchers and policy makers in identifying the current stage of the obesity transition in a population, anticipating subpopulations that will develop obesity in the future, and enacting proactive measures to attenuate the transition, taking into consideration local contextual factors.

The My Body Knows When Program Increased Intuitive Eating Characteristics in a Military Population

Introduction

The purpose of this pilot study was to assess the effectiveness of the revised My Body Knows When (MBKW) program to promote intuitive eating behaviors within a sample of a military population through an online or in-person delivery mode.

Materials and Methods

Fifty-six overweight or obese adults (70% female); military service members (20%), retirees (38%) and family (42%) participated in the 10-week MBKW program at two military installations from 2012 to 2014. Body Mass Index, Intuitive Eating Scale-2 (IES-2; 23-item) and Motivation for Eating scale (MFES; 43-item) were collected at baseline and 10-weeks. Data were stratified by sex. Descriptive data were reported as mean ± standard deviation (SD), frequency, or percentage. A paired t-test was conducted with data at baseline and 10 weeks (α = 0.05, 80% power).

Results

Participants were predominantly female (70%); mean age of 51 ± 13 years; and BMI of 34.1 ± 5.5 kg/m2. There were no demographic, MFES, or IES-2 baseline differences between groups (in-person vs. online) or location. All subjects were collapsed into one group for a pre-post MBKW implementation assessment due to small sample size despite the original intent to stratify by online and in-person grouping. At 10 weeks, the remaining 26 participants exhibited a significant improvement (mean ± SD) in BMI (−0.4 ± 0.6 kg/m2; p = 0.012), environmental/social eating score (2.7 ± 0.4 points [pts]; −0.5 pt change; p < 0.001), emotional eating score (2.2 ± 0.5 pts; −0.6 pt change; p = 0.001), unconditional permission to eat score (3.4 ± 0.4 pts; +0.3 pt change; p = 0.017), eating for physical rather than emotional eating score (3.7 ± 0.8 pts; +1.0 pt change; p < 0.001), and reliance on hunger and satiety cues score (3.6 ± 0.5 pts; +0.8 pt change; p = 0.001). High attrition rates at the 10-week follow-up assessment precluded accurate assessment of long-term intervention effects.

Conclusions

The MBKW program was associated with improved intuitive eating behaviors and with less external eating influence on behavior; however, a larger sample is required to assess the effectiveness of MBKW delivery mode. Modest weight loss was attained but testing the efficacy of the MBKW program in a large diverse sample with alternate scenarios may be worthwhile (e.g., primary prevention against weight gain, or during weight maintenance to prevent weight regain).

Cultural and Western Influences on the Nutrition Transition in Thailand

The impact of economic development and urbanisation on nutrition and dietary changes in transitional countries has been well researched. It generally has been found that there is a positive correlation between economic development, urbanization, and negative nutrition transitions with the result of growing levels of obesity and diet related non-communicable diseases. However, the impact of Western influences and culture on specific eating styles associated with the nutrition transition has been less studied. There is limited information about cultural and Western influences on eating styles in Thailand. Recent findings suggest that Thailand may have progressed further along the nutrition transition model, in terms of unhealthy eating styles, than would be expected based on economic development. This study was designed to determine the prevalence of current eating styles and eating motivations among Thai university students. University students were chosen for evaluation as they are thought to represent the forefront of dietary trends and nutrition changes in a population. Convenience samples from four different universities in south-central and northern Thailand were selected. The following scales were used to assess eating and dieting styles and attitudes among 662 Thai undergraduate and graduate students: Motivation For Eating Scale (MFES), Eating Attitudes Test-26 (EAT-26), and Cognitive Dieting Behavior Scale (CBDS). All scales have been shown to be reliable and valid in previous research. For this study, scales were translated into Thai, reverse translated, and pilot tested to ensure cultural relevancy and the conveyance of intended meanings. Basic demographic information was also obtained, including age, gender, year in school, marital status, height and weight, and income. Results indicated that Thai students exhibit significant levels of dieting behaviour and extrinsic eating based on CBDS and MFES scores (with the exception of environmental eating). For most negative eating styles, females scored higher than males. It was also found that high levels of dieting and extrinsic eating were positively correlated with body mass index, suggesting the possible risk of future weight gain and obesity. While the occurrence of eating disordered attitudes based on EAT-26 scores was low (13%), analysis of EAT-26 scores indicated that the occurrence of eating disordered attitudes was strongly correlated with dieting behaviour among this population. The results support the need for a programme to educate Thai students, especially females, regarding healthy patterns of dieting and eating attitudes in order to prevent future weight gains and eating disorders predicted by the nutrition transition model.

The Relationship Between Hofstede's Cultural Dimensions, Schwartz's Cultural Values, and Obesity

According to the World Health Organization, obesity is a major public health issue. In 2014, there were more than 600 million obese people around the world. According to the data of the World Health Organization, obesity rates differ among countries. One possible underlying reason of the difference can be culture, more specifically shared cultural values. The strategies and policies regarding obesity were developed; however, the effect of culture is not adequately considered. The aim of the study is to investigate the relationship between obesity rates of countries, Hofstede's cultural dimensions, Schwartz's values, and Gross National Income per capita per country. The data consist of obesity ranking (i.e., the percentage of the population with a body mass index of 30 kg/m² or higher), Gross National Income per capita for each country, and cultural variables (i.e., Hofstede's cultural dimensions for 54 nations and Schwartz's cultural values for 57 nations). Hierarchical regression analysis results revealed that Gross National Income per capita was not a significantly related obesity at the aggregated level. Among Hofstede's dimensions, individualism and uncertainty avoidance were positively associated with obesity, and long-term orientation was negatively associated with obesity. The relationship between Schwartz's cultural values and obesity was not found to be significant. Findings suggest that Hofstede's cultural dimensions should be considered when developing national level strategies and campaigns to decrease obesity.

Culture and Healthy Eating: The Role of Independence and Interdependence in the United States and Japan

Healthy eating is important for physical health. Using large probability samples of middle-aged adults in the United States and Japan, we show that fitting with the culturally normative way of being predicts healthy eating. In the United States, a culture that prioritizes and emphasizes independence, being independent predicts eating a healthy diet (an index of fish, protein, fruit, vegetables, reverse-coded sugared beverages, and reverse-coded high fat meat consumption; Study 1) and not using nonmeat food as a way to cope with stress (Study 2a). In Japan, a culture that prioritizes and emphasizes interdependence, being interdependent predicts eating a healthy diet (Studies 1 and 2b). Furthermore, reflecting the types of agency that are prevalent in each context, these relationships are mediated by autonomy in the United States and positive relations with others in Japan. These findings highlight the importance of understanding cultural differences in shaping healthy behavior and have implications for designing health-promoting interventions.

Personality Traits and Body Mass Index in Asian Populations

Research on personality and adiposity has focused primarily on Western samples; less is known about the personality correlates of BMI in Asian populations. We examined the association between personality and Body Mass Index (BMI) among community-dwelling Japanese adults (N=380), Chinese adolescents (N=5,882), and a meta-analysis inclusive of a published Korean sample (total N=10,304). In the new samples and meta-analysis, Extraversion and Agreeableness were associated with higher BMI among men. In contrast to what is often found in Western samples, Conscientiousness was mostly unrelated to adiposity. These findings link pro-social tendencies to overweight among Asian men; Conscientiousness may be less relevant for BMI in Eastern societies with a low prevalence of obesity and strong social norms for eating but not thinness.

The associations of sociocultural attitudes towards appearance with body dissatisfaction and eating behaviors in Hong Kong adolescents

OBJECTIVES

Western culture has great influences on body dissatisfaction and related eating behaviors in adolescents. This study aimed to assess the sociocultural influences on eating attitudes and motivations among Hong Kong Chinese adolescents.

METHODS

In 2007, 909 adolescents (mean age = 14.7 years, 55.3% boys) completed a survey with Stunkard's Figure Rating Scale (FRS), Motivation for Eating Scale (MFES), Eating Attitudes Test (EAT), Revised Restraint Scale (RRS), and Sociocultural Attitudes Towards Appearance Scale (SATAQ). In addition, their body mass index (BMI) was objectively measured.

RESULTS

Our results indicated that Hong Kong adolescents, particularly girls exhibited a remarked level of body dissatisfaction, external, emotional, restrained and disordered eating behaviors. Hierarchical regression analyses indicated that age, sex and BMI were the most common contributing factors to individual eating styles. SATAQ significantly accounted for an additional variance of body dissatisfaction (2%), physical eating (2%), external eating (1%), emotional eating (3%), restrained eating (5%), and disordered eating (5%).

CONCLUSIONS

In Hong Kong, the sociocultural influences on body image and eating disturbance were supported.

Intuitive eating in young adults. Who is doing it, and how is it related to disordered eating behaviors?

Intuitive eating (i.e., reliance on physiologic hunger and satiety cues to guide eating) has been proposed as a healthier, more effective, and more innate alternative to current strategies of weight management. The current study explored intuitive eating among young adults according to socio-demographic characteristics and body mass index (BMI), and examined associations between intuitive and disordered eating behaviors. Data were drawn from Project EAT-III, a population-based study of 2287 young adults (mean age: 25.3 years). More males reported trusting their bodies to tell them how much to eat than did females. Intuitive eating was inversely associated with BMI in both genders. Males and females who reported trusting their body to tell them how much to eat had lower odds of utilizing disordered eating behaviors compared to those that did not have this trust. Females who reported that they stop eating when they are full had lower odds of chronic dieting and binge eating than those who do not stop eating when full. Overall, this study found that intuitive eating practices are inversely associated with a number of harmful outcomes. Clinicians should discuss the concept of intuitive eating with their young adult patients to promote healthier weight-related outcomes.

Acculturation, immigration status and cardiovascular risk factors among Portuguese immigrants to Luxembourg: findings from ORISCAV-LUX study

Background

No previous study has examined the prevalence of cardiovascular risk factors and explored the influence of immigration status and acculturation on overweight/obesity among the Portuguese immigrants to Luxembourg. Our objectives were to (1) compare the prevalence of cardiovascular risk factors between native Luxembourgers and Portuguese immigrants, (2) examine the relationship between immigrant generation status, proportion of life spent in Luxembourg and language proficiency or preference (as proxy variables of acculturation) and overweight/obesity among Portuguese immigrants, and (3) elucidate the role of underlying socioeconomic, behavioral and dietary factors in overweight/obesity differences among the two populations.

Methods

Recent national cross-sectional data from ORISCAV-LUX survey 2007–2008, composed of 843 subjects were analyzed. Overweight/obesity was defined as body mass index (BMI) >25kg/m². Acculturation score was measured by using immigrant generation status, proportion of life spent in Luxembourg, and language proficiency or preference. Univariable and multivariable logistic regression analyses were performed to examine the association between acculturation markers and overweight/obesity. Further, a series of successive models were fitted to explore the separated and added impact of potential mediators (socioeconomic status, physical activity, dietary factors) on overweight/obesity among Luxembourgers and Portuguese immigrants.

Results

Compared to Luxembourgers, Portuguese immigrants of first and second generation were younger and currently employed. About 68% of first generation Portuguese had only primary school, and about 44% were living below poverty threshold. Although the cardiovascular risk factors were comparable, Portuguese immigrants were more frequently overweight and obese than Luxembourgers, even after age and gender standardization to the European population. Overweight/obesity was significantly higher among Portuguese of first generation compared to second generation (P=0.028). Although we observed a tendency of lower risk with higher acculturation, none of the acculturation markers, both individually and taken together as a score, was statistically significant after controlling for age and gender. Compared to Luxembourgers, odds of overweight/obesity were significantly higher among Portuguese immigrants, in unadjusted model 1 (P=0.043), in age and gender-adjusted model 2 (P<0.0001), in socioeconomic status adjusted model 3 (P= 0.01), in physical activity adjusted model 4 (P=0.007). However, this difference was attenuated and statistically disappeared after controlling for dietary factors (P=0.09).

Conclusions

These findings address a lack of heterogeneity between Portuguese immigrants and Luxembourgers regarding hypertension, hyperlipidemia, diabetes mellitus, physical inactivity, and current cigarette smoking. However, Portuguese immigrants to Luxembourg were more likely to be overweight/obese than Luxembourgers participants. This risk may be explained by different dietary practice. An in-depth comparative assessment of dietary habits of Luxembourgers and Portuguese immigrants is warranted.

Assessment of health-promoting lifestyle profile in Japanese university students

OBJECTIVES

This descriptive study of 314 students was conducted to determine whether there were any relationships of their demographic variables with a health-promoting lifestyle profile.

METHODS

The Japanese version of the Health Promoting Lifestyle Profile II (HPLP-II) questionnaire was used to investigate students' lifestyles. One-way analysis of variance (ANOVA) and multiple comparison procedures using the Scheffe test were conducted to identify significant differences among university year (first, second, etc.) groups. The t-test independent participants was utilized to compare the HPLP-II scores according to gender and living with family (yes/no). Multiple regression analysis was used to analyze the effects of various demographics on the overall HPLP-II score and the six health-promoting lifestyle subscales.

RESULTS

The whole cohort of participants had an overall HPLP-II mean score of 2.50 (SD = 0.29), with the highest mean score being for interpersonal relations (3.05 ± 0.44), and the lowest mean score being for health responsibility (2.01 ± 0.53). The overall HPLP-II score of the students during the first university year was 2.59 (SD = 0.29), and this score progressively declined in their second year (2.49 ± 0.29), third year (2.47 ± 0.28), and fourth year (2.45 ± 0.30). Female students practiced significantly better health responsibility, interpersonal relations, and nutrition than males, and male students practiced significantly better physical activity than females. The students who were living with family had significantly higher nutrition scores than those not living with family.

CONCLUSIONS

These significant findings linking the HPLP-II, university year level, and living with family (yes/no) in university students will enable healthcare providers to develop interventions to assist students in improving their health lifestyles in the university environment and will help in devising suitable education programs.

Asian Motivators for Health Promotion

Change in health behaviors requires motivation on the part of the individual. The aim of this article is to compare elements of the motivation process across cultures. A secondary aim is to determine whether a Western model of behavior change for health promotion, such as the PRECEDE–PROCEED model, can be applied to Asian populations. An integrative review and critical analysis of research literature was done by reviewing 20 studies with observational survey design and 6 integrative literature reviews. Findings show that the motivation process is similar for Eastern and Western cultures, but the motivators are different. The findings identify 10 motivators, congruent with Asian culture, that would allow the PRECEDE–PROCEED model to be used in Asian settings.

Exceso de peso, aspectos económicos, políticos y sociales en el mundo: un análisis ecológico

Se analizaron las prevalencias de exceso de peso, según índice de masa corporal (IMC), en adultos y su asociación con algunas variables demográficas, socioeconómicas e índice de democracia. Se realizó un diseño ecológico que consideró un total de 105 países, con datos de IMC de 2000 a 2006. Las demás variables se obtuvieron en correspondencia con el año del dato de estado nutricional, o su referente más cercano. Se utilizaron los puntos de corte de la Organización Mundial de la Salud (OMS) para IMC. Se calcularon correlaciones de Spearman y modelos de regresión múltiple. El sobrepeso y la obesidad se correlacionaron en ambos sexos con la disponibilidad energética y con el Índice de Desarrollo Humano (IDH) y sus variables constitutivas. En cuanto a las variables relacionadas con democracia, la correlación fue inversa y más fuerte con el nivel ponderal de los hombres. En conclusión, indicadores de condiciones de vida más favorables en los países se asociaron de forma directa con mayores prevalencias de exceso de peso poblacional, con comportamientos diferentes en función del género.

Effects of mild calorie restriction and high-intensity interval walking in middle-aged and older overweight Japanese

We investigated whether a combination of mild calorie restriction (MCR) and high-intensity interval walking (HIW) improved physical fitness more than HIW alone in middle-aged and older overweight Japanese (40-69years old, BMI23.6kg/m(2)). Forty-seven women and 16 men were divided into MCR+HIW and HIW groups. All subjects performed HIW: 5 sets of 3-min low-intensity walking (40% peak aerobic capacity for walking, VO(2peak)) and 3-min high-intensity walking (70% VO(2peak)) per day, 4days per week, for 16weeks while energy expenditure was monitored with a tri-axial accelerometer. The MCR+HIW group consumed meal replacement formula (240kcal): a mixture of low-carbohydrates and -fat and high-protein, for either lunch or dinner everyday and therefore, had approximately 87% of the energy intake of the HIW group during the intervention period. Although the HIW group showed improvements in BMI, blood pressure, and several blood chemicals, the MCR+HIW group had greater improvement. Moreover, the medical expenditure for the 6months including the intervention period was 59% lower in the MCR+HIW group than in the HIW group. Our strategy of a short-term combination of MCR and HIW may thus prevent lifestyle-associated diseases and improve health in middle-aged and older overweight Japanese.

The Japanese national health screening and intervention program aimed at preventing worsening of the metabolic syndrome

Similar to the healthcare systems in other industrialized countries, the Japanese healthcare system is facing the problem of increasing medical expenditure. In Japan, this situation may be primarily attributed to advanced technological developments, an aging population, and increasing patient demand. Japan also faces the problem of a declining youth population due to a low birth rate. Taken together, these problems present the healthcare system with a very difficult financial situation. Several reforms have been undertaken to contain medical expenditure, such as increasing employee copayment for health insurance from 10% to 20% in 1997 and from 20% to 30% in 2003 in order to curb unnecessary visits to medical institutions. Since the aging of the Japanese population is inevitable, a suitable method to contain medical expenditure may be to screen individuals who are likely to develop lifestyle-related diseases and conduct early intervention programs for them to prevent the development of diseases such as myocardial infarction or stroke that are costly to treat. If this goal is attained, it may contribute to the containment of medical expenditure as well as to improving the quality of life of the elderly. Therefore, the Japanese Ministry of Health, Labor and Welfare has decided to introduce a nationwide health screening and intervention program specifically targeting the metabolic syndrome commencing April 2008. Here, we discuss (1) the background of the Japanese healthcare system and the problems facing it, (2) the underlying objective and details of the new screening program, and (3) the expected impact of the program.

The impact of body mass index and Western advertising and media on eating style, body image and nutrition transition among Jordanian women

OBJECTIVES

To identify the impact of body mass index (BMI) and Western advertising and media on the stage of the nutrition transition among Jordanian women, and to evaluate their impact on eating styles and body image.

DESIGN

A randomised cross-sectional survey that included a variety of culturally measured Likert-type scales and body size images. In addition, BMI was calculated based on measured height and weight.

SETTING

In the homes of the participants. The data were collected by female interviewers who worked for the Jordan Department of Statistics.

SUBJECTS

The sample was based on a random and representative selection of 800 mostly urban Jordanian women. A pre-test sample of 100 women was also used to validate the instruments.

RESULTS

Women tended to agree that they ate based on emotional cues. They had high levels of disordered eating attitudes and behaviours and 42.1% were considered restrained eaters. However, these women also had higher than expected body esteem levels and desired a healthy body size. As expected, being obese was associated with a desire to lose weight, being a restrained and emotional eater, and having more disordered eating attitudes and behaviours. Similarly, Western advertising and media were associated with restrained and emotional eating, desired weight loss, and disordered eating attitudes and behaviours.

CONCLUSIONS

There is a need to develop health education materials that explain the influence of obesity on health and the negative psychological and physical consequences of restrained and emotional eating, building on the current cultural preferences of healthy body size. Further implications and suggestions for future research are discussed.

A cross-cultural study of disordered eating attitudes among Filipino and Caucasian Americans

The present study examines the symptom levels of eating disorders among Filipino and Caucasian college students residing in Hawaii. The study also examines what variables are associated with disordered eating. A self-report questionnaire that included measures of anger discomfort, self-dissatisfaction, body dissatisfaction, and symptoms of eating disorders was administered to Filipino and Caucasian college students. As predicted, females reported higher eating disorder symptom scores than males. However, Filipino males reported higher levels of disordered eating, dieting, and body dissatisfaction than Caucasian males. No association was found between disordered eating and anger discomfort among Filipinos. The results support previous findings of females reporting higher disordered eating attitudes than males, however, Filipino males reported higher disordered attitudes than Caucasian males. Anger discomfort was not associated with disordered eating among Filipinos, supporting past studies that suggest anger management may not be an appropriate treatment for disordered eating among some Asian groups.