Impact of a Weight Management Intervention on Eating Competence: Importance of Measurement Interval in Protocol Design

Eating competence is related to executive function skills in college students

PURPOSE

This study aimed to determine the relationship between eating competence (EC) and executive function (EF) skills in college students.

METHODS

This cross-sectional study was part of a larger study in which an online survey was administered during autumn quarter 2020 to undergraduate students at a northwestern U.S. public university. Sociodemographic data were collected, along with measures of EC (16-item Satter Eating Competence Inventory, ecSI-2.0™) and EF skills (27-item Executive Function Index, EFI). Multiple linear regression was used to examine the ecSI-2.0™ total score and its four domain scores with each of the five EF skills.

RESULTS

Of the 1996 respondents included in the final analyses, 40.2 % were eating competent (total ecSI-2.0™ ≥32). The mean ecSI-2.0™ score among participants was 28.7. Gender distribution was 72.0 % women, 23.3 % men, and 4.7 % trans-and-gender non-conforming (TGNC) or preferred not to answer. EFI scores were higher among women (70.9) than among men (68.2) and TGNC (64.9). Both total ecSI-2.0™ score and the contextual skills domain were significantly associated with four of the EFI subscales. Internal regulation was related to impulse control and motivational drive. Further significant associations were found with other domains of ecSI-2.0™ and specific EFI subscales.

CONCLUSION

EF skills are associated with EC in college students, particularly skills related to food management and internal regulation. Since both EF and EC can be developed, this study offers promise for future research in an increasingly gender-diverse and neurodiverse college population during a time of increasing independence and autonomy.

Validation of the French-Canadian Translation of the ecSatter Inventory 2.0 in an Adult Sample

OBJECTIVE

Evaluate the psychometric proprieties of the French-Canadian translation of the Satter Eating Competence Inventory (FrCanada ecSI 2.0).

DESIGN

Cross-sectional validation study.

PARTICIPANTS AND SETTING

424 French-Canadian adult Facebook users (61.8% women, 96.0% White).

VARIABLES MEASURED

Eating competence and variables related to eating or body image.

ANALYSIS

Factor analyses to assess the structural validity. Cronbach α and intraclass correlation coefficient to estimate reliability. Chi-square test of independence, Student t test, and Pearson's correlations to assess construct validity.

RESULTS

The mean eating competence score was 33.0 ± 7.8; 62.0% of participants were considered competent eaters (total score ≥ 32/48). The original 4-factor structure was not reproduced (unsatisfactory fit indices and/or factor loadings). Therefore, it is recommended to use the global score-but not the subscale scores-of the FrCanada ecSI 2.0. The questionnaire showed good internal consistency (Cronbach α = 0.86) and test-retest reliability (intraclass correlation = 0.81). Competent and noncompetent eaters differed according to gender (39.5% vs 27.3% male; P = 0.03), age (49.3 ± 13.6 vs 42.7 ± 14.2 years; P < 0.01), education (62.3% vs 50.6% with a university degree; P = 0.03), intuitive eating (3.6 ± 0.5 vs 3.1 ± 0.6; P < 0.001), cognitive restraint (12.3 ± 3.3 vs 13.8 ± 3.7; P < 0.001), and body esteem (3.3 ± 0.8 vs 2.5 ± 0.8; P < 0.001).

CONCLUSION AND IMPLICATIONS

Results suggest that the FrCanada ecSI 2.0 is a valid and reliable tool to measure eating competence in French-Canadian adults.

Effects of a Culinary Boot Camp intervention on food/nutrition aptitudes and dietary intake of college students

OBJECTIVE

College is characterized by transition, students shifting from dependence to independence in numerous roles/responsibilities. Deficiencies in food/nutrition aptitudes and dietary intake exist, evidenced by declining physical well-being and poor eating patterns/practices within the population. Studies examining interventions to improve food/nutrition aptitudes and dietary intake among college students are limited. Participants/methods: A nutrition education program, Culinary Boot Camp (CBC), was developed and delivered to college students at a land-grant university. Online surveys assessed food/nutrition aptitudes and dietary intake pre-/post-/follow-up intervention. Results: Of 86 CBC participants, 71 pre-, 46 post-, and 20 follow-up surveys were completed. Several food/nutrition aptitudes improved (p ≤ 0.05), with greatest improvements in cooking skills/attitudes and healthy eating/grocery shopping self-efficacy (p < 0.01). Additionally, dietary intake of various micronutrients (vitamin C, magnesium, potassium) and fiber increased with statistical significance (p < 0.01). Conclusions: Results suggest CBC is an effective nutrition education program to improve food/nutrition aptitudes and dietary intake amomg college students.

Disordered eating and eating competence in members of online irritable bowel syndrome support groups

BACKGROUND

This study seeks to evaluate eating competence and disordered eating likelihood among members of online support groups for irritable bowel syndrome (IBS) and determine whether eating competence and disordered eating likelihood varies according to IBS symptom severity and subtype.

METHODS

This cross-sectional study is based on an anonymous survey conducted from August to September 2021. Adults with IBS (N = 225) were recruited from online and social media IBS support forums. IBS symptom severity was assessed using the validated IBS Severity Scoring System (IBS-SSS), likelihood of disordered eating was assessed using the validated Eating Attitudes Test (EAT-26), and eating competence was assessed using the validated Satter Eating Competence Inventory (ecSI 2.0™). Multiple linear regression was used to predict EAT-26 total score from IBS-SSS score, age, and IBS subtype. ANOVAs were used to examine the relationships between IBS severity level, IBS subtype, and ecSI 2.0™ total score.

KEY RESULTS

Eating competence among the sample was low at 17% while 27% was classified as likely or very likely disordered eating. IBS severity was positively associated with EAT-26 score (p = 0.011) and ecSI 2.0™ score was significantly lower in the severe IBS group compared to the moderate IBS group (p = 0.016). No relationship was detected between IBS subtype and EAT-26 or ecSI 2.0™ scores.

CONCLUSIONS & INFERENCES

IBS severity was positively associated with disordered eating likelihood and negatively associated with eating competence. This sheds light on the importance of assessing eating competence and screening for disordered eating prior to selecting therapies for patients with IBS, particularly in females with severe symptoms.

Behavioral approaches to nutrition and eating patterns for managing type 2 diabetes: A review

Nutritional interventions are a key component of type 2 diabetes management; making health-supporting changes in eating patterns can improve postprandial glycemic excursions and lower HbA1c to reduce diabetes-related morbidity and mortality. Research around implementing calorie-restricted and/or low-carbohydrate diets is plentiful, though the ability to sustain physiologic and behavioral changes for longer than 12 months is a concern. An understanding of intervention goals and adherence is needed to apply this research to patient care and translate expectations to real-world living contexts. Diverse dietary patterns including a Mediterranean eating pattern, vegetarian or plant-based eating pattern, or others that emphasize high-quality carbohydrates (e.g., whole grains), vegetables, whole fruits, legumes, and fish can support achievement of glycemic targets. Counseling strategies like motivational interviewing can be used to build eating competence. These approaches prioritize collaborative decision-making with the goal of increasing patient empowerment and self-efficacy. Strategies for incorporating these tools and frameworks in a clinical setting are highlighted. Providing ongoing diabetes and nutrition education, paired with appropriate support to address the challenges in implementing and sustaining behavior changes, is warranted. Further, social determinants of health including environmental context, education, socioeconomic status, access to healthcare, and experiences of systemic stigma (e.g., racism or weight bias) can interfere with individuals' diabetes self-care and nutrition behaviors. Providing medical nutrition therapy and tailoring nutrition interventions to individual needs and circumstances can be an important way physicians, dietitians, and diabetes providers can support individuals with type 2 diabetes.

Eating Competence among Brazilian College Students

Eating competence (EC) is a biopsychosocial concept related to a healthier eating pattern. Studies have shown that weight gain and body shape and weight dissatisfaction are typical among college students, contributing to low self-esteem, risky eating behaviors, and a propensity to develop eating disorders. As eating habits are determinant factors for food choices that can be modified by eating behavior, this study aimed to evaluate EC in college students from Brazil, using the Brazilian version of the EC Satter Inventory (ecSI2.0™BR), and EC's association with health data. This cross-sectional study was conducted using an online survey spread using the snowball method. The self-report instrument was divided into three parts (socioeconomic and demographic data; health data; and ecSI2.0™BR). Recruitment took place through social networks, and 593 students from public and private universities from all five regions of Brazil participated in the survey. The EC average was 29.46 ± 8.67, and 46.2% of the sample were considered competent eaters. Total EC did not differ among gender and Brazilian region. Younger participants (up to 20 y/o) presented higher scores for total EC, contextual skills and food acceptance. The total EC and contextual skills of health sciences students did not differ from those of students in other areas, except for agricultural sciences in which students had lower total EC. Obese individuals and the participants who perceived themselves to be overweight had low scores for EC. This study confirmed the hypothesis that college students have low EC, causing worse health outcomes related to BMI, perceived body weight, and occurrence of hypertension and dyslipidemia.

Eating Competence, Food Consumption and Health Outcomes: An Overview

Eating Competence (EC) is one behavioral perspective of eating practices that has been associated with a healthy lifestyle. It emphasizes eating pleasure, self-regulation of eating, body weight satisfaction, and regular meal frequency that includes food variety without focusing on dietary guidelines. EC is composed of four components (Eating Attitude, Food Acceptance, Internal Regulation, and Contextual Skill), and its assessment is performed using the Eating Competence Satter Inventory (ecSI2.0™), developed and validated in English for an adult population. EC has been associated with diet quality and health indicators for various population groups and the development of skills that increase EC might be a strategy to improve nutritional health, and prevent obesity and other chronic diseases. In this sense, this study presents an overview of the background, concepts, features, and possible associations among EC, food consumption, and health outcomes. The high prevalence of diseases associated with food/nutrition draws attention to the necessity to broaden the view on food and its relationship with health and well-being, considering not only nutrients and food combinations but also the behavioral dimensions of eating practices. Healthy nutritional recommendations that take into account attitudes and behaviors are in accordance with the EC behavioral model. Studies on eating behavior emphasize the need to better understand attitudes towards food and eating in the general population using validated instruments. In this context, measuring EC and its association with health outcomes seems to be relevant to nutritional health. The complexity of food choices has been examined in social, behavioral, and biological sciences, representing a great challenge for applying unique and simple theoretical models. Multiple methods are required, as no single theory can fully explain food selection.

Enhanced Eating Competence Is Associated with Improved Diet Quality and Cardiometabolic Profile in Finnish Adults with Increased Risk of Type 2 Diabetes

Eating competence (EC) is characterized by positive attitudes towards food and eating, having regular meals, eating a variety of foods, and internally regulated eating. We investigated the associations of changes in EC with changes in lifestyle, anthropometrics and biomarkers of glucose and lipid metabolism in 2291 adults at increased risk of type 2 diabetes as part of the StopDia study conducted in primary healthcare. EC and diet quality were assessed with validated digital questionnaires. During the intervention, the participants received either (1) the digital lifestyle intervention, (2) the combined digital and face-to-face group-based lifestyle intervention, or (3) standard care. EC increased among the participants independent of the intervention type. Increase in EC was associated with an increase in diet quality, high-density lipoprotein (HDL) cholesterol, and with a decrease in body mass index and waist circumference, regardless of baseline EC. Of the subdomains of EC, the contextual skills, food acceptance and eating attitudes were associated with various of these changes. Our results thus suggest that EC could be a potential target in lifestyle interventions aiming to improve the cardiometabolic health of people at type 2 diabetes risk.

Eating Competence among Brazilian Adults: A Comparison between before and during the COVID-19 Pandemic

The coronavirus pandemic started a worldwide emergency, and tight preventive actions were necessary to protect the population, changing individuals' daily habits. Dwelling and working at home can change dietary habits, affect food choice and access, as well as the practice of physical activity. In this regard, this study's goal was to compare eating competence (EC) among Brazilian adults before and during the coronavirus pandemic, using the Brazilian version of the eating competence Satter inventory (ecSI2.0™BR) with the "retrospective post-then-pre" design. This cross-sectional study was performed from 30 April to 31 May 2021 among a convenience sample of the Brazilian adult population using an online platform (Google® Forms). In the studied sample (n = 302 in which 76.82% were females), EC total score lowered during the pandemic (31.69 ± 8.26 vs. 29.99 ± 9.72; p < 0.005), and the decrease was worst after the beginning of the pandemic among those who reported weight gain, decreased the consumption of fruit and vegetables, and increased the consumption of sugary beverages. The contextual skill component seems relevant in this scenario, where our life and routines were changed entirely, demonstrating that the ability to manage the food context is essential, especially when sanitary and economic situations represent a new challenge.

Eating Competence Associated with Food Consumption and Health Outcomes among Brazilian Adult Population

This study aimed to associate Eating Competence (EC) with food consumption and health outcomes in the Brazilian adult population. Researchers developed a questionnaire to associate EC with sociodemographic information, health outcomes, and food consumption. Data on body weight and height was referred to by participants in the questionnaire, and body mass index (BMI) was calculated and classified. A question to evaluate the perception of body size was included. After constructing the questionnaire items, content validation and semantic evaluation were performed following the Delphi method with a group of judges composed of 26 health professionals. The judges evaluated the sociodemographic information, health outcomes, and food consumption items associated with the eating competence instrument (previously validated in Brazilian-Portuguese). The final version of the questionnaire was composed of 33 items. Our results confirmed good reliability, responsiveness, and internal consistency. A total of 1810 Brazilians answered the questionnaire. Most of the participants were female, up to 40 years old, with a high education level and high income. Most of the participants did not report diabetes or hypertension. The EC total score did not differ among males and females. Individuals up to 40 years old presented a lower total score. The increase in educational level and income also increased EC total score. Excess weight individuals showed lower EC compared to the normal weight/underweight. Individuals who consumed fruits and/or vegetables five or more days/week presented the best scores for total EC.

The Weight Optimization Revamping Lifestyle using the Dietary Guidelines (WORLD) Study: Sustained Weight Loss Over 12 Months

OBJECTIVE

This study aimed to compare two energy-restricted, nutrient-dense diets at the upper or lower ends of the dietary fat recommendation range (lower fat [20% energy from fat] versus moderate fat [35%]) on weight loss using behavioral theory-based nutrition education.

METHODS

A total of 101 premenopausal women with overweight or obesity were randomized to an energy-restricted lower-fat or moderate-fat diet for 1 year. Interventions included 28 behavioral theory-based nutrition education sessions plus weekly exercise sessions.

RESULTS

Both treatment groups experienced weight loss (-5.0 kg for lower fat and -4.3 kg for moderate fat; P < 0.0001), but there was no difference in weight loss or fat intake between groups. Total and low-density lipoprotein cholesterol decreased (-3. 4 mg/dL and -3.8 mg/dL; P < 0.05), and high-density lipoprotein cholesterol increased (1.9 mg/dL; P < 0.05) in both groups at 12 months. Diet quality, assessed by the Healthy Eating Index, increased significantly at 4 months versus baseline (70.8 [0.9] vs. 77.8 [1.0]) and was maintained through 12 months. Higher Healthy Eating Index scores were associated with greater weight loss at 4 months (r = -0.2; P < 0.05).

CONCLUSIONS

In the context of a well-resourced, free-living weight-loss intervention, total fat intake did not change; however, theory-based nutrition education underpinned by food-based recommendations resulted in caloric deficits, improvements in diet quality, and weight loss that was sustained for 1 year.

Eating Competence Is Associated with Lower Prevalence of Obesity and Better Insulin Sensitivity in Finnish Adults with Increased Risk for Type 2 Diabetes: The StopDia Study

A healthy diet prevents type 2 diabetes but is often difficult to adhere to. This cross-sectional study aimed to investigate whether eating competence is associated with diet or risk factors and prevalence of type 2 diabetes in individuals screened for type 2 diabetes risk. Eating competence is an indicator of food acceptance, positive attitudes, internal regulation and contextual skills related to food and eating. In total, 3147 Finnish adults aged 18-74 at an increased risk for type 2 diabetes identified via online risk screening participated in the baseline examinations of the Stop Diabetes (StopDia) study. The participants filled out the digital questionnaire on food intake, physical activity and sleep, and the Satter Eating Competence Inventory 2.0^TM (ecSI 2.0^TM). In addition, anthropometric and laboratory measurements were performed at primary healthcare centres. Eating competent individuals (37%, classified by ecSI 2.0^TM) had a better quality of diet (p < 0.05 for all). Additionally, eating competence was associated with a lower prevalence of previously undiagnosed type 2 diabetes, abdominal obesity, metabolic syndrome and hypertriglyceridaemia, and with better insulin sensitivity (p < 0.05 for all). However, these associations, except for metabolic syndrome, were at least partly mediated by body mass index. Eating competence is associated with a healthy diet and could, thus, in the long term, support the prevention of type 2 diabetes.

Eating Competent Parents of 4th Grade Youth from a Predominantly Non-Hispanic White Sample Demonstrate More Healthful Eating Behaviors than Non-Eating Competent Parents

The purpose of this study was to determine if the associations between eating competence (EC) and eating behaviors that were found in a USA sample of predominantly Hispanic parents of 4th grade youth could be replicated in a USA sample of predominantly non-Hispanic white parents of 4th graders. Baseline responses from parents (n = 424; 94% white) of youth participating in a year-long educational intervention were collected using an online survey. Validated measures included the Satter Eating Competence Inventory (ecSI 2.0^TM), in-home fruit/vegetable (FV) availability, healthful eating behavior modeling, and FV self-efficacy/outcome expectancies (SE/OE). Data were analyzed with general linear modeling and cluster analyses. The findings replicated those from the primarily Hispanic sample. Of the 408 completing all ecSI 2.0^TM items, 86% were female, 65% had a 4-year degree or higher, and 53% were EC (ecSI 2.0^TM score ≥ 32). Compared with non-EC parents, EC modeled more healthful eating, higher FV SE/OE, and more in-home FV availability. Behaviors clustered into those striving toward more healthful practices (strivers; n = 151) and those achieving them (thrivers; n = 255). Striver ecSI 2.0^TM scores were lower than those of thrivers (29.6 ± 7.8 vs. 33.7 ± 7.6; p < 0.001). More EC parents demonstrated eating behaviors associated with childhood obesity prevention than non-EC parents, encouraging education that fosters parent EC, especially in tandem with youth nutrition education.