Uncontrolled eating is associated with higher impulsiveness, risk taking and novelty-seeking

Previous studies suggest that trait disinhibition as measured by the Three Factor eating Questionnaire (TFEQ) is related to selected measures of impulsivity and risk taking. However, the factor validity of the original trait disinhibition measure has been questioned, and a revised scale of uncontrolled eating consequently developed. To date few studies have revisited the relationship between impulsivity and the uncontrolled and emotional eating scales of the revised TFEQ. In the present study, 283 participants (208 women) completed the revised TFEQ alongside a battery of measures of impulsivity and risk taking in an online study. The total and all subscale scores on the Barratt Impulsiveness Scale were significantly associated with scores on the uncontrolled, but not emotional or restrained, TFEQ scale. Likewise, risky behaviour indexed by the average number of pumps per trial on the Balloon Analogue Risk Task were also associated with uncontrolled, but not emotional or restrained, eating, and the same pattern of associations were also found for the novelty, but not intensity, subscales of the Arnetts Inventory of Sensation Seeking. Overall these data suggest that uncontrolled eating is related to wider personality traits of risky decision making, novelty seeking and wider cognitive impulsivity, which may in turn increase of future weight gain.

Testing Go/No-Go training effects on implicit evaluations of unhealthy and healthy snack foods

OBJECTIVE

Despite intending to eat healthy foods, people often yield to temptation. In environments rife with unhealthy food options, a positive implicit evaluation of unhealthy foods may inadvertently influence unhealthy choices. This study investigates if and under which conditions implicit evaluations of unhealthy and healthy foods can be influenced by a computer-based Go/No-Go (GNG) training.

DESIGN

Undergraduate student participants (N = 161 participants; 117 females, 44 males; Mage = 19 years, SD = 2 years) completed a GNG training with two healthy (grape and nut) and two unhealthy (potato chip and cookie) stimuli. Participants were either instructed to inhibit their responses to the potato chip (No-Go Chips/Go Grape) or to a grape (No-Go Grape/Go Chips).

MAIN OUTCOME MEASURE

Implicit evaluations of chips and grapes were assessed using the Extrinsic Affective Simon Task.

RESULTS

This GNG training impacted implicit evaluations of chips, but not grapes. GNG training effects were stronger for participants with lower sensitivity for behavioural inhibition measured with the Behavioural Inhibition System scale.

CONCLUSION

GNG training might help people change implicit food evaluations. More research is needed to understand how individual and training characteristics affect outcomes with the goal of tailoring and optimising the GNG training to produce the strongest effect.

Bodily sensations and bariatric surgery: Links between interoceptive sensibility, intuitive and disordered eating behaviour in obesity and obesity surgery

OBJECTIVE

This study evaluated interoceptive sensibility, intuitive and disordered eating among bariatric candidates, operated individuals and individuals with obesity seeking non-surgical treatment.

METHOD

We recruited 57 individuals with obesity seeking nonsurgical weight-loss (IOB), 84 bariatric candidates (Pre) and 22 individuals post-bariatric surgery (Post) who responded to questionnaires: Multidimensional Assessment of Interoceptive Awareness, Intuitive Eating Scale-2 (IES-2), Dutch Eating Behaviour Questionnaire, Binge Eating Scale, State-Trait Anxiety Inventory, Beck's Depression Inventory.

RESULTS

Overall, the Post group manifested higher scores on 'Body-Listening' (F = 4.95, p = 0.01), 'Emotional Awareness' (F = 8.83, p < 0.001) and 'Trusting' (F = 6.71, p = 0.002) interoceptive dimensions, on the IES-2 total score (F = 5.48, p = 0.007) and 'Reliance on hunger and satiety cues' (F = 31.3, p < 0.001) when age was controlled. The IOB group presented higher scores on emotional (F = 3.23, p = 0.047) and binge eating (F = 5.99, p = 0.004). Among operated individuals, intuitive eating mediated the relationship between interoceptive sensibility dimensions and binge eating: 'Attention regulation' (54%) 'Self-regulation' (75.1%), 'Body listening' (94.09%) and 'Trusting' (84.9%).

CONCLUSIONS

Our results suggest the therapeutic potential of interoceptive sensibility and intuitive eating in obesity management in/beyond the bariatric context.

From Restriction to Intuition: Evaluating Intuitive Eating in a Sample of the General Population

Intuitive eating (IE) is a non-dieting approach that promotes listening to internal cues of hunger and satiety, rather than adhering to external dietary restrictions aimed at weight loss. However, the role of IE in dieting behaviors related to weight-loss approaches is still unclear. To address this issue, the aim of this study was to compare IE levels between dieting and non-dieting individuals, exploring the relationship between IE and dieting-related psychological and physical factors. A sample of 2059 females was recruited via social media and self-reported questionnaires were administered to measure IE, eating psychopathology, self-efficacy, and quality of life. Individuals with a history of dieting exhibited lower IE levels, a higher BMI, and a greater eating psychopathology, as well as a reduced self-efficacy and quality of life, compared to non-dieters. IE showed a protective effect against dieting behaviors, with higher IE levels being associated with a lower likelihood of dieting. Additionally, higher BMI and eating psychopathology were predictors of dieting. Promoting IE could represent a relevant clinical target strategy to address disordered eating and enhance overall well-being, underscoring the need for interventions that foster a healthier relationship with food and bodily internal sensations.

Early Effects of Body Satisfaction on Emotional Eating: Tailored Treatment Impacts via Psychosocial Mediators in Women with Obesity

It was proposed that emotional eating is a critical factor to address early in a behavioral obesity treatment for women to improve their long-term weight-loss, which has been problematic. Poor body image/body satisfaction is a likely predictor of emotional eating. Possible social cognitive theory-based mediators of the body satisfaction-emotional eating relationship having treatment implications include disturbed mood and self-efficacy for controlled eating. Women with obesity volunteered for a community-based weight loss program. After confirming salience of disturbed mood and self-efficacy for controlling one's eating as mediators of the body satisfaction-emotional eating relationship at baseline, a 3-month protocol emphasizing exercise and targeting those mediators through a focus on self-regulation was developed and administered to the treatment group (n = 86). The control group (n = 51) received matched time in typical, educationally based weight-loss processes. Improvements in body satisfaction, emotional eating, disturbed mood, and self-efficacy for controlled eating from baseline-month 3 were each significantly greater in the treatment group. Further analysis of the treatment group found that changes in disturbed mood and self-efficacy completely mediated the body satisfaction change-emotional eating change relationship and neither age nor race (White/Black) were significant moderators. Improvement in emotional eating from baseline-month 3 significantly predicted lost weight over both 3 months and with changes incorporating a 6-month follow up. Findings confirmed the importance of addressing the relationship between body satisfaction and emotional eating over the critical initial months of a behavioral obesity treatment for women through targeting improvements in mood and controlled eating-related self-efficacy.

Mindful eating questionnaire: Validation and reliability in Brazilian adults with type 2 diabetes mellitus

OBJECTIVE

The objective was to evaluate the psychometric properties of the Mindful Eating Questionnaire (MEQ) in Brazilian subjects with type 2 diabetes mellitus (T2DM) and validate a Brazilian version of the MEQ for adults with T2DM (MEQ-DM).

METHODOLOGY

Baseline data from the multicentre Nutritional Strategy for Glycaemic Control in Patients with Type 2 Diabetes Mellitus (NUGLIC) trial were used. Construct validity was assessed using exploratory factor analysis (EFA). The root mean square error of approximation (RMSEA), comparative fit index (CFI) and Tucker‒Lewis index (TLI) fit indices indicated the adequacy of the model. The reliability of the questionnaire was evaluated considering the different factor loadings. Criterion validity was tested by correlating the MEQ-DM with sociodemographic variables, body mass index (BMI) and physical activity levels.

RESULTS

A total of 370 participants were included, who were mostly female (60.8 %) and had a median age of 61 (54-67) years. The EFA results supported the two-factor structure of the 25-item MEQ-DM: disinhibition and awareness. The results of the fit indices (RMSEA = 0.04; CFI = 0.95 and TLI = 0.94) and composite reliability (disinhibition = 0.84 and awareness = 0.81) were consistent. The criterion validity analysis indicated a significant association between MEQ-DM scores and age, sex, civil status, education level, BMI and physical activity (p < 0.05).

CONCLUSION

When explored with Brazilian adults with T2DM, the MEQ-DM presented a factorial model with two dimensions: disinhibition and awareness. This model must be confirmed in future studies with Brazilians with T2DM.

Eating behavior in atypical anorexia nervosa

OBJECTIVE

Atypical anorexia nervosa (AN) has been increasingly identified in the community and in clinical settings. Initial studies indicate that psychological symptoms are similar or more severe among patients with atypical AN, as compared with AN. This study examined whether eating behavior differed among patients with AN (n = 98), patients with atypical AN (n = 18), and healthy controls (HC, n = 75).

METHOD

Adults and adolescents chose what to eat from a standardized, laboratory-based multi-item meal. Total intake, macronutrient composition, diet variety, and energy density were compared between groups.

RESULTS

Both AN and atypical AN severely restricted caloric intake as compared with HC (431 ± 396 kcal and 340 ± 338 kcal vs. 879 ± 350 kcal, F2,188 = 35.4, p < .001). Individuals with AN and atypical AN did not differ in the mean intake of total calories or percentage of calories from fat (15.2 ± 25.2% vs. 11.5 ± 16.9%).

DISCUSSION

This study demonstrates that individuals with atypical AN are at least as restrictive in their food intake as individuals with AN, and the restriction of dietary fat is particularly notable. Examination of eating behavior in a larger sample would be useful to replicate these findings. The current study highlights the need to understand maladaptive eating behavior in atypical AN in order to develop appropriate treatment recommendations.

PUBLIC SIGNIFICANCE

Atypical anorexia nervosa is emerging as a prevalent eating disorder in community and clinical populations. The findings that patients with atypical anorexia nervosa limit calorie and fat intake in a pattern similar to that of patients with anorexia nervosa highlights the need for research to identify appropriate treatment strategies for normalization of eating patterns.

Prospective associations between early childhood parental feeding practices and eating disorder symptoms and disordered eating behaviors in adolescence

OBJECTIVE

Nonresponsive parental feeding practices are associated with poorer appetite self-regulation in children. It is unknown whether this relationship extends beyond childhood to be prospectively associated with the onset of eating disorder (ED) symptoms in adolescence. This exploratory study therefore investigated prospective associations between early childhood parental feeding practices and adolescent ED symptoms and disordered eating behaviors.

METHODS

Data were from two population-based cohorts with harmonized measures: Generation R (Netherlands; n = 4900) and Gemini (UK; n = 2094). Parents self-reported their pressure to eat, restriction and instrumental feeding (i.e., using food as a reward) at child age 4-5 years. Adolescents self-reported their compensatory behaviors (e.g., fasting, purging), binge-eating symptoms, restrained eating, uncontrolled eating, and emotional eating at 12-14 years. Associations between feeding practices and ED symptoms were examined separately in each cohort using generalized linear models.

RESULTS

In Gemini, pressure to eat in early childhood was associated with adolescents engaging in compensatory behaviors. In Generation R, parental restriction was associated with adolescents engaging in compensatory behaviors, restrained eating, uncontrolled eating, and emotional eating. Instrumental feeding was associated with uncontrolled eating and emotional eating in Generation R.

DISCUSSION

Nonresponsive parental feeding practices were associated with a greater frequency of specific ED symptoms and disordered eating in adolescence, although effect sizes were small and findings were inconsistent between cohorts. Potentially, the cultural and developmental context in which child-parent feeding interactions occur is important for ED symptoms. Further replication studies are required to better understand parents' role in the development and maintenance of ED-related symptoms.

PUBLIC SIGNIFICANCE

Prospective research examining how early childhood parental feeding practices might contribute to adolescent ED symptoms is limited. In two population-based cohorts, nonresponsive feeding practices (restriction, instrumental feeding, pressure to eat) predicted increased frequency of some ED symptoms and disordered eating behaviors in adolescence, although associations were small and further replication is required. Findings support the promotion of responsive feeding practices, which may benefit young children's developing relationship with food.

Are decreased cocaine- and amphetamine regulated transcript and Agouti- related peptide levels associated Eating behavior in medication-free children with attention deficit and hyperactivity disorder?

This study aimed to investigate plasma levels of cocaine- and amphetamine-regulated transcript (CART), agouti-related protein (AgRP), cholecystokinin (CCK) and peptide YY (PYY) and their relationship with eating behaviors among children with attention deficit hyperactivity disorder (ADHD) and healthy controls. A total of 94 medication-free children with ADHD and 82 controls aged 8-14 years were included in this study. The Plasma levels of CART, AgRP, CCK and PYY were measured using enzyme-linked immunosorbent assay kits. The Children's Eating Behavior Questionnaire (CEBQ) was used to assess eating behaviors in children. CART and AgRP levels were found to be significantly lower in the ADHD group than in the control group, while CCK levels were found to be significantly higher in the ADHD group than in the control group. However, there was no significant difference in PYY levels between the groups. Compared to controls, those with ADHD demonstrated significantly higher scores on the CEBQ subscales of food responsiveness, emotional overeating, desire to drink, enjoyment of food, and food fussiness, and significantly lower scores on the slowness of eating subscale. CART was significantly correlated with emotional overeating and enjoyment of food scores, while AgRP was significantly correlated with emotional undereating scores. Covariance analysis was performed by controlling potential confounders such as body mass index, age and sex, and the results were found to be unchanged. It was concluded that CART, AgRP, and CCK may play a potential role in the pathogenesis of ADHD.

Adaptive and maladaptive emotion regulation skills are associated with food intake following a hunger-induced increase in negative emotions

Many individuals would like to lose weight and often attempt to do so by dieting. However, dieting attempts often backfire and contribute to the risk of weight gain and obesity. Food restriction inevitably leads to hunger and hunger, in turn, induces negative emotions. The inability to regulate such a hunger-induced increase in negative emotions in an adaptive way may be responsible for overeating. The current study aimed to gain a better understanding of this potential psychological mechanism underlying failed dieting attempts. Adaptive and maladaptive emotion regulation (ER) were assessed with an online questionnaire in women with a healthy weight. Subsequently, participants were assigned to the fasted condition (fasting for 14h, n = 49) or the satiated condition (eating between 2 h and 30 min before the lab session, n = 59) and attended a lab session in which they completed tasks while given the opportunity to eat chips and M&M's. We did not find an association between any ER variable and the likelihood to begin eating. Among those who began eating, higher scores on adaptive cognitive ER and on maladaptive behavioral ER were associated with lower caloric intake in fasted individuals. Higher scores on adaptive behavioral ER were associated with higher caloric intake in fasted individuals. Utilizing adaptive cognitive ER when experiencing a hunger-induced increase in negative emotions may help individuals manage their food intake and maintain a healthy weight.

Practice makes perfect: Restrained eaters' heightened control for food images

OBJECTIVE

Restrained eaters (RE) show behaviourally unregulated food intake, which is often explained by a deficit in inhibitory control. Despite evidence for general inhibitory deficits in RE, it remains unclear how the variety of (food) cues in our environment can influence cognitive control.

METHOD

In this re-analysis, we explored the inhibitory capacity of RE and unrestrained eaters (URE) on a stop-signal task with modal (pictures) and amodal (word) food and non-food stimuli.

RESULTS

Although we did not find the expected inhibitory deficits in RE compared to URE, we found a significant Group × Modality × Stimulus Type interaction. This indicated that RE have relatively good inhibitory control for food, compared to non-food modal cues, and that this relationship is reversed for amodal cues.

CONCLUSIONS

Hence, we showed differential processing of information based on food-specificity and presentation format in RE. The format of food cues is thus an important new avenue to understand how the food environment impedes those struggling with regulating their eating behaviour.

Perceived Stress and Depressive Symptoms Are Associated With Emotional Eating but Not Nutritional Intake During Pregnancy: A Prospective Cohort Study

INTRODUCTION

Pregnancy is a major life event during which women may experience increased psychological distress and changes in eating behaviors. However, few studies have investigated the influence of psychological distress on pregnant women's eating behaviors. The primary objective of this prospective study was to examine the associations of changes in perceived stress and depressive symptoms with emotional eating and nutritional intake during pregnancy. In addition, we examined the direct and moderating effects of perceived social support.

METHODS

Participants were racially diverse pregnant women (14-42 years) from 4 clinical sites in Detroit, MI, and Nashville, TN (N = 678). We used multiple linear and logistic regression models to determine if changes in stress and depressive symptoms across pregnancy were associated with changes in emotional eating and nutritional intake. We examined residualized change in stress and depressive symptoms from second to third trimester of pregnancy; positive residualized change scores indicated increased stress and depressive symptoms.

RESULTS

Participants showed significant improvement in emotional eating and nutritional intake from second to third trimester of pregnancy (P < .001 for both). At second trimester, higher depressive symptoms were associated with a greater likelihood of emotional eating (P < .001) and worse nutritional intake (P = .044) at third trimester. Increased stress and depressive symptoms during pregnancy were both associated with increased risk, whereas increased perceived social support reduced risk of emotional eating at third trimester (stress: adjusted odds ratio [AOR], 1.17; 95% CI, 1.08-1.26; depressive symptoms: AOR, 1.05; 95% CI, 1.01-1.08; social support: AOR, 0.93; 95% CI, 0.88-0.99). None were associated with changes in nutritional intake. Perceived social support did not show any moderating effects.

DISCUSSION

Increased psychological distress during pregnancy may increase emotional eating. Efforts to promote healthy eating behaviors among pregnant women should consider and address mental health.

State-level working memory and dysregulated eating in children and adolescents: An exploratory ecological momentary assessment study

BACKGROUND

Children with loss of control (LOC) eating and overweight/obesity have relative deficiencies in trait-level working memory (WM), which may limit adaptive responding to intra- and extra-personal cues related to eating. Understanding of how WM performance relates to eating behavior in real-time is currently limited.

METHODS

We studied 32 youth (ages 10-17 years) with LOC eating and overweight/obesity (LOC-OW; n = 9), overweight/obesity only (OW; n = 16), and non-overweight status (NW; n = 7). Youth completed spatial and numerical WM tasks requiring varying degrees of cognitive effort and reported on their eating behavior daily for 14 days via smartphone-based ecological momentary assessment. Linear mixed effects models estimated group-level differences in WM performance, as well as associations between contemporaneously completed measures of WM and dysregulated eating.

RESULTS

LOC-OW were less accurate on numerical WM tasks compared to OW and NW (ps < .01); groups did not differ on spatial task accuracy (p = .41). Adjusting for between-subject effects (reflecting differences between individuals in their mean WM performance and its association with eating behavior), within-subject effects (reflecting variations in moment-to-moment associations) revealed that more accurate responding on the less demanding numerical WM task, compared to one's own average, was associated with greater overeating severity across the full sample (p = .013). There were no associations between WM performance and LOC eating severity (ps > .05).

CONCLUSIONS

Youth with LOC eating and overweight/obesity demonstrated difficulties mentally retaining and manipulating numerical information in daily life, replicating prior laboratory-based research. Overeating may be related to improved WM, regardless of LOC status, but temporality and causality should be further explored.

PUBLIC SIGNIFICANCE STATEMENT

Our findings suggest that youth with loss of control eating and overweight/obesity may experience difficulties mentally retaining and manipulating numerical information in daily life relative to their peers with overweight/obesity and normal-weight status, which may contribute to the maintenance of dysregulated eating and/or elevated body weight. However, it is unclear whether these individual differences are related to eating behavior on a moment-to-moment basis.

A complex relationship between intuitive eating and diet quality among university students

Intuitive Eating (IE) theory posits eating in response to internal hunger, and satiety cues minimize impulses to over-consume foods. To assess this relationship, 758 university students (55% male) completed the Intuitive Eating Scale 2 (IES-2) and the Diet History Questionnaire II (DHQ). The IES-2 includes a total score and four subscale scores; unconditional permission to eat (UPE), reliance on hunger and satiety cues (RHSC), eating for physical rather than emotional reasons (EPR), and body food choice congruence (BFCC). Using multiple regression analysis, IE total was not related to diet quality. EPR (ß =0.10, p ≤ .01) and BFCC (ß =0.29, p ≤ .001) were positively related to diet quality. UPE (ß = -0.15, p ≤ .001) and RHSC (ß = -0.08, p ≤ .05) were negatively related to diet quality. This study found an antipodal relationship between the subscales of IE and diet quality among university students.

Intuitive Eating Scale-2-EA: Psychometric properties and factor structure of the adapted IES-2 for early adolescents

PURPOSE

Intuitive Eating (IE) is an approach to eating characterised by attunement to intrinsic cues, and using those cues to guide behaviours related to food and eating. Tylka and Kroon Van Diest's (2008) Intuitive Eating Scale (IES-2) is well-validated in adults, but not yet among early adolescents. The current study was designed to adapt and validate a version suited for use in early adolescence (IES-2-EA).

METHODS

Data collected from two independent samples of adolescents aged 11 to 13 (N = 471) were structurally examined using exploratory factor analysis (EFA), with a subsequent confirmatory factor analysis (CFA) to confirm hypothesised model fit. Relationships between scores on the IES-2-EA and validated measures of actual-ideal body size discrepancy, body appreciation, interoceptive awareness, and psychological distress were also examined.

RESULTS

The adapted 17-item IES-2-EA had a three-factor structure with several key differences from the original version developed for adults. Moderate-to-strong correlations were found between scores on the IES-2-EA, body appreciation, interoceptive awareness, actual-ideal body size discrepancy, and psychological distress in the first sample of adolescents (n = 245). Secondary CFA showed good model fit in the second sample of adolescents (n = 226).

CONCLUSION

The IES-2-EA is well-suited to measure intuitive eating behaviour among early adolescents. The 17 items reflect a three-component structure similar to that seen in adults completing the IES-2. These early data suggest the adapted IES-2-EA has evidence of reliability and validity; it may be an effective measure for research and clinical use.

The Intuitive Eating Scale-2 Adapted for Mexican Pregnant Women: Psychometric Properties and Influence of Sociodemographic Variables

A weight-inclusive approach to health involves the promotion of intuitive eating, i.e., the individual's ability to be aware of their physiological hunger and satiety cues to determine when and how much to eat, while paying attention to how certain foods affect their body. The second version of the Intuitive Eating Scale (IES-2) evaluates four interrelated traits of intuitive eating: Unconditional Permission to Eat (UPE), Eating for Physical rather than emotional Reasons (EPR), Reliance on internal Hunger/Satiety Cues (RHSC), and Body-Food Choice Congruence (BFCC). In this study, our aim was to evaluate the psychometric properties of a Mexican Spanish adaptation of the IES-2 for pregnant women and examine the relationship between intuitive eating traits and maternal sociodemographic characteristics. A sample of 514 pregnant women answered our IES-2 adaptation and a sociodemographic questionnaire. We determined the quality, validity, and reliability of our adaptation through descriptive measures, frequency distributions, intra-class correlations, and extreme answer group comparison for each item, eliminating those with weak technical properties. We then performed an exploratory principal component analysis and a confirmatory factor analysis. Last, we analyzed the association between intuitive eating and maternal sociodemographic and reproductive variables through correlation tests and multivariable linear regressions. Psychometric tests confirmed the validity and reliability of our IES-2 adaptation, which comprised 18 out of the 23 original items. Notably, both the exploratory and confirmatory factor analyses yielded not four but five factors, due to the EPR subscale splitting in two (the "emotional" and "physical" components of EPR). We attribute this novel finding to the emotional manifestations that naturally accompany pregnancy, which may incline pregnant women to base their eating behaviors more on the emotional than the physical component that would otherwise dominate their EPR trait. Further research is also needed about the UPE subscale during pregnancy, due to item removal and subtle changes in meaning. Finally, the influence of sociodemographic variables on the IES-2 score was extremely low, suggesting that other variables, possibly of a psychological nature, may have greater influence on a pregnant woman's intuitive eating.

[Sensory food aversion in the context of a modern approach to eating disorders in early childhood]

Sensory food aversion, an early childhood eating disorder, is a serious, permanent form of picky eating, in which the infant or the child consistently and persistently refuses certain foods based on specific characteristics, following one or more previous aversive experiences. Biological (sensory processing disorder, taste sensitivity) and environmental factors contribute to its development. Due to limited diet, specific dietary deficiencies may occur but weight gain is usually normal. Behavioral problems, anxiety disorder, autism spectrum disorder are often associated. Diagnosis can usually be made based on a detailed history, but further assessment may include pediatric examination, nutritionist consultation, and psychologic and occupational therapy assessment. Treatment is based on parent education and support in order to minimize mealtime battles and anxiety and to think together about strategies for expanding the child's diet and to help them to accept new foods. As part of the interdisciplinary team, the pediatrician's role is to monitor appropriate growth and development, exclude dietary deficiencies or prescribe supplementation if necessary. In our article, the screening and treatment of sensory processing disorder as part of the assessment of eating problems are introduced as an example of good clinical practice at the Early Childhood Eating and Sleep Disorder Outpatient Clinic at the Heim Pál National Institute of Pediatrics. Orv Hetil. 2023; 164(45): 1767-1777.

Depression symptoms and sweet foods consumption in Mexican college men: the role of emotional eating

Introduction

Objective: to evaluate the association between depression symptoms and frequency of unhealthy food consumption, and to explore the mediation effect of emotional eating in this relationship in college men. Method: a cross-sectional study was performed on 764 men at a public university in Mexico City. To assess emotional eating (EE), a validated Spanish-language version of the Eating and Appraisal Due to Emotions and Stress Questionnaire (EADES) was applied. Depression symptoms were evaluated using the scale elaborated by the Center for Epidemiologic Studies (CES-D) and a Questionnaire of Frequency of Food Consumption was used to measure frequency of food consumption. Path and mediation analysis were applied. Results: one-fifth (20.42 %) of college men reported depression symptoms (CES-D ≥ 16). Students with depression symptoms had a higher mean EE score (p < 0.001), a higher frequency of fried food (p = 0.049), sweetened beverages (p = 0.050), and sweet foods consumption (p = 0.005) than students with low CES-D score. According to the mediation analysis, the effect of depression symptoms on the frequency of sweet foods consumption was partially mediated by EE (23.11 % of the total effect). Conclusion: the prevalence of depression symptoms was high. EE is an important mediator in the relationship between depression symptoms and the consumption of sweet foods. Understanding the manifestation of eating behaviors in men and their relationship with depression symptoms may help clinicians and health authorities develop treatment and prevention programs aimed to decrease the risk of obesity and eating disorders.

Affect, Body, and Eating Habits in Children: A Systematic Review

The present review investigates the complex associations between children's affective states, body perceptions, and eating habits, thus providing crucial insights for potential health interventions. Following PRISMA guidelines, three databases were searched for peer-reviewed studies exploring the relationship between eating habits, emotional states, and body image perceptions in a population of children (5 to 11 years old). A total of seven articles were included. Our findings revealed a pattern of associations between negative emotional states, like anxiety and depressive feelings, and maladaptive eating behaviors. Additionally, explicit influences from parental feeding practices, peer pressure, socioeconomic factors, and children's body perceptions were observed to shape eating habits, with a pronounced tendency among older girls towards dieting and food preoccupation. Our results underline the intertwining nature of age, gender, and emotional states. Furthermore, our findings accentuate the urgency for comprehensive interventions that acknowledge and address the complex interplay of emotional, familial, and socioeconomic factors alongside children's body image perceptions. The criticality of continued research, particularly ones employing longitudinal designs and diverse demographic samples, is highlighted as we strive to understand and navigate such multifaceted relationships to enhance children's health and well-being.

Effects of women's age on their emotional eating changes within a self-regulation-focused obesity treatment

Results of behavioral obesity treatments have generally been unsuccessful. Reduction of participants' emotional eating (EE) might be essential. Women with obesity within age-groups of emerging adult, young adult, and middle-aged adult - participating in a community-based obesity treatment centered around self-regulatory skills to control eating - were evaluated over 6 months. There were significant reductions in participants' EE and eating-related self-regulation. Participants' change in self-regulation significantly predicted their changes in depression-related, anxiety-related, and total EE. Participants' age group did not significantly affect either their degree of improvement or self-regulation-EE change relationships. Emphasizing self-regulatory skills development for the control of EE, regardless of age-group in women, was suggested by the study authors.

The Association of Emotional Eating with Overweight/Obesity, Depression, Anxiety/Stress, and Dietary Patterns: A Review of the Current Clinical Evidence

(1) Background: Emotional eating is considered as the propensity to eat in response to emotions. It is considered as a critical risk factor for recurrent weight gain. Such overeating is able to affect general health due to excess energy intake and mental health. So far, there is still considerable controversy on the effect of the emotional eating concept. The objective of this study is to summarize and evaluate the interconnections among emotional eating and overweight/obesity, depression, anxiety/stress, and dietary patterns; (2) Methods: This is a thorough review of the reported associations among emotional eating and overweight/obesity, depression, anxiety/stress, and dietary patterns. We compressively searched the most precise scientific online databases, e.g., PubMed, Scopus, Web of Science and Google Scholar to obtain the most up-to-date data from clinical studies in humans from the last ten years (2013-2023) using critical and representative keywords. Several inclusion and exclusion criteria were applied for scrutinizing only longitudinal, cross-sectional, descriptive, and prospective clinical studies in Caucasian populations; (3) Results: The currently available findings suggest that overeating/obesity and unhealthy eating behaviors (e.g., fast food consumption) are associated with emotional eating. Moreover, the increase in depressive symptoms seems to be related with more emotional eating. Psychological distress is also related with a greater risk for emotional eating. However, the most common limitations are the small sample size and their lack of diversity. In addition, a cross-sectional study was performed in the majority of them; (4) Conclusions: Finding coping mechanisms for the negative emotions and nutrition education can prevent the prevalence of emotional eating. Future studies should further explain the underlying mechanisms of the interconnections among emotional eating and overweight/obesity, depression, anxiety/stress, and dietary patterns.

Eating Behavior and Obesity in a Sample of Spanish Schoolchildren

From the point of view of prevention, it is convenient to explore the association between eating behavior and the obese phenotype during school and adolescent age. The aim of the present study was to identify eating behavior patterns associated with nutritional status in Spanish schoolchildren. A cross-sectional study of 283 boys and girls (aged 6 to 16 years) was carried out. The sample was evaluated anthropometrically by Body Mass Index (BMI), waist-to-height ratio (WHtR) and body fat percentage (%BF). Eating behavior was analyzed using the CEBQ "Children's Eating Behavior Questionnaire". The subscales of the CEBQ were significantly associated with BMI, WHtR and %BF. Pro-intake subscales (enjoyment of food, food responsiveness, emotional overeating, desire for drinks) were positively related to excess weight by BMI (β = 0.812 to 0.869; p = 0.002 to <0.001), abdominal obesity (β = 0.543-0.640; p = 0.02 to <0.009) and high adiposity (β = 0.508 to 0.595; p = 0.037 to 0.01). Anti-intake subscales (satiety responsiveness, slowness in eating, food fussiness) were negatively related to BMI (β = -0.661 to -0.719; p = 0.009 to 0.006) and % BF (β = -0.17 to -0.46; p = 0.042 to p = 0.016).

The Relationship Between Eating-Attitudes and Clinical Characteristics, Agouti-Related Peptide, and Other Biochemical Markers in Adult-Attention Deficit Hyperactivity Disorder

OBJECTIVE

In our study, we aimed to evaluate eating-attitudes in adult-ADHD, and to examine its relationship with sociodemographic, clinical, AgRP, and biochemical parameters.

METHOD

The study included 70 adult-patients and 47 healthy-controls. The DIVA2.0, SCID-1 was administered to the participants. Eating-Attitudes Test (EAT), Night-Eating Questionnaire (NEQ), Barratt Impulsivity Scale (BIS-11) were filled by the participants.

RESULTS

We found that psychological state affect eating-attitudes in adult-ADHD (p = .013), emotional eating is more common, nocturnal chronotype is dominant (p < .001), NES is more frequent (p < .001), waist circumference measurement is higher (p = .030), and lipid profile is deteriorated (p < .001). AgRP levels were significantly lower in patients treated with methylphenidate (p = .021). Those who received methylphenidate treatment had less NES than those who did not. Deterioration in eating-attitudes and symptom severity of night eating in ADHD, it was positively correlated with clinical severity of ADHD and impulsivity. In addition, age and increase in night eating symptoms were predictors of deterioration in eating attitudes in adult-ADHD. We found that impaired eating-attitudes and impulsivity severity were also predictors of NES (p = .006, p = .034).

CONCLUSION

The necessity of adult-ADHD treatment has been demonstrated by the deterioration in eating-attitudes and cardiometabolic risk dimensions and the underlying mechanisms.

The association of self-efficacy and coping strategies with body mass index is mediated by eating behaviors and dietary intake among young females: A structural-equation modeling approach

Globally, around three billion people are either under- or overweight. Speculating the different roles of psychological factors in body weight between over- and underweight people, it was first hypothesized that whether or not the effects of self-efficacy and coping strategies on body mass index (BMI) is different between these two groups. We secondly predicted that their association is mediated by nutritional factors. Therefore, the present cross-sectional study was conducted to model the impact of self-efficacy and coping strategies on eating behaviors, dietary intake and BMI, using structural equation modeling in two BMI groups: low-to-normal-BMI (LBMI: BMI<21.75 kg/m2) and normal-to-high-BMI (HBMI: 21.75 kg/m2 ≤ BMI). Female participants (N = 250, aged ≥18) were included using convenience sampling method and data of self-efficacy, coping strategies, eating behaviors and dietary intake were collected via questionnaires. The model fit was evaluated and confirmed by fit indices. The analysis revealed in both groups the participants tended to adopt emotion-focused coping strategy (EFCS) more than problem-focused coping strategy (PFCS) (mean score: 61.82 (7.96) vs 49.21 (6.73)). The HBMI group tended to use EFCS more than the LBMI group (P<0.001). In the LBMI group, self-efficacy, PFCS and EFCS had positive effects on BMI. Only the direct effect of self-efficacy (β = 0.314, P<0.001) and the indirect effects of PFCS and EFCS (through increasing unhealthy eating behaviors; β = 0.127, P<0.01, β = 0.095, P<0.05, respectively) were significant. In the HBMI group, self-efficacy had negative effect on BMI (both directly (β = -0.229, P<0.05) and indirectly (β = -0.103, P<0.05) by decreasing unhealthy eating behaviors). PFCS had no effect and EFCS had an indirect, positive effect on BMI (through increasing unhealthy eating behaviors, β = 0.162, P = 0.001). In conclusion, these findings suggest that improving self-efficacy and coping-strategies seems helpful to have a healthy BMI in both BMI groups and further interventions to reduce EFCS should be limited to overweight people.

Contrasts of Initial and Gain Scores in Obesity Treatment-Targeted Psychosocial Variables by Women Participants' Weight Change Patterns Over 2 Years

The typical pattern of weight change associated with behavioral obesity treatments has been some loss in weight through approximately 6 months, followed by near complete regain. However, patterns vary widely across individuals. The objectives are to determine whether recent prediction model-based indications of relations among changes in psychosocial correlates of the weight loss behaviors of physical activity and controlled eating vary by patterns of weight change. Women with obesity enrolled in a community-based behavioral obesity treatment who failed to lose at least 5% of their baseline weight (Minimal Effect group, n = 44), lost 5% or greater and then regained most during months 6 to 24 (Loss/Regain group, n = 42), or lost 5% or greater and then maintained/continued loss (Loss/Loss group n = 42) were evaluated. Improvements in physical activity- and eating-related self-regulation and self-efficacy, mood, and emotional eating over 6 months were significant overall and generally most favorable in the Loss/Loss group and least favorable in the Minimal Effect group. Expected model-based relationships between 6-month changes in the aforementioned psychosocial variables were significant and generally not significantly affected by weight change group. However, group substantially affected the prediction of self-regulation of eating at month 24-a key correlate of long-term weight loss. Findings suggested community-based obesity treatment targets and emphases.

Changes in eating pathology symptoms during initial military training in men and women and associations with BMI and injury risk

Nutritional fitness, which comprises food choices, meal timing, and dietary intake behaviors, is an important component of military service member health and performance that has garnered recent attention. This study utilized generalized linear mixed effects modeling (GLMM) to investigate changes in eating pathology symptoms in men and women during initial military training (Marine Corps Officer Candidates School (OCS)). Associations among eating pathology, musculoskeletal injury risk and BMI were also assessed. This investigation includes data from the Eating Pathology Symptoms Inventory (EPSI) and BMI at the start of OCS (n = 598: Male n = 469, Female n = 129) and end of the 10-week program (n = 413: Male n = 329, Female n = 84), and injury surveillance throughout. At baseline, female candidates presented with greater body dissatisfaction, binge eating, purging, and restricting, but lower negative attitudes toward obesity compared to male candidates (p < 0.001). Eating symptoms changed during military training indicated by decreased body dissatisfaction in women (p = 0.003), decreased excessive exercise and negative attitudes toward obesity in men (p < 0.001), decreased cognitive restraint (p < 0.001), restricting (p < 0.001), purging (p = 0.013), and muscle building (p < 0.001) and increased binge eating (p < 0.001) in both sexes. Changes in restricting were significantly related to changes in BMI during training (p < 0.05). The likelihood of future injury was 108 % higher in female candidates than males and decreased by 5 % for each unit increase in excessive exercise. Eating attitudes and behaviors change during military training environments and are associated with military health and readiness outcomes including BMI and injury risk.

Trait Anxiety and Unhealthy Eating in Adult Women: The Mediating Role of Cognitive Instability

Previous studies have demonstrated the influence of affective states on unhealthy eating. Heightened impulsivity has also been recognized as a risk factor for unhealthy eating. The objective of the present study was to investigate the relationship between trait anxiety and unhealthy eating and to test whether cognitive instability (trait impulsivity component) might mediate this relationship among adult women.

METHOD

The sample was composed of 225 women (M_age = 29.70 ± 9.23; M_{BodyMass Index} = 23.39 ± 4.43). The State-Trait Anxiety Inventory (STAI), the Food Frequency Questionnaire (FFQ), and the Barratt Impulsiveness Scale (BIS) were used. We first conducted a principal components analysis to reduce the dimensionality of the FFQ data, finding four principal components. For our primary analyses, we focused on unhealthy eating. We then conducted a mediation analysis to examine whether trait anxiety was associated with unhealthy eating and, if so, whether cognitive impulsivity mediated this relationship.

RESULTS

Trait anxiety was positively associated with cognitive instability, and cognitive instability was positively associated with unhealthy eating. Trait anxiety was also positively associated with unhealthy eating, but only when controlling for cognitive instability. Consistent with our proposed mediation model, trait anxiety was positively associated with cognitive instability, which in turn predicted unhealthy eating among adult women.

CONCLUSION

Adult women who reported higher levels of trait anxiety experienced higher levels of cognitive instability and engaged in poor dietary behaviors. Identifying the factors related to unhealthy eating represents a crucial step toward findings ways of reducing their impact on food intake and replacing them with more productive ones.

Development and Psychometric Characteristics of an Instrument to Assess Parental Feeding Practices to Promote Young Children's Eating Self-Regulation: Results with a Portuguese Sample

A parental child-centered feeding approach is likely to keep children’s biological mechanisms activated while eating, protecting them in an obesogenic context. However, few feeding practice measures assess parents’ behaviors to guide and prompt children to identify and respond appropriately to their signs of hunger and satiety. We aimed to develop and study the reliability, validity, and measurement invariance of a new scale to assess parental feeding practices to promote children’s self-regulation of food intake. To pursue this aim, we conducted two descriptive, cross-sectional, online studies in Portugal in an online format; a total of 536 parents of 2- to 6-year-old children completed the evaluation protocol. Factorial analysis findings support the theoretical organization proposed for the scale. The confirmatory factorial analysis supported a first-order factor structure with two subscales, Prompting for eating self-regulation and Teaching about eating consequences, with eight items in total. Both scales presented good internal consistency and adequate temporal stability, with a significant, positive, and moderate relationship. The results showed metric invariance for the child’s sex. Both types of practices were positively correlated with the child’s enjoyment of food. Prompting for eating self-regulation showed negative associations with parents’ emotional lack of control, children’s satiety responsiveness, slowness in eating, and fussiness. Preliminary studies confirmed both the validity and reliability of the instrument and the adequacy of adopting a self-regulatory approach when assessing child-centered feeding practices. Combining this instrument with others that assess coercive practices can be beneficial to capture ineffective parents’ behaviors on children’s eating self-regulation.

A Comparison of Emotional Triggers for Eating in Men and Women with Obesity

OBJECTIVE

Emotional eating (EE) is prevalent in people seeking obesity treatment and is a contributor to poor weight loss outcomes. We aimed to delineate the emotions most associated with this type of eating, and whether they differ by sex in people undergoing obesity treatment.

METHODS

A cross-sectional study recruiting 387 adults from a hospital obesity management service. Emotional eating was measured using the Emotional Eating Scale (EES). Separate analyses included all participants, and those undergoing lifestyle interventions alone or in combination with obesity medication and/or bariatric surgery.

RESULTS

A total of 387 people (71% women) participated in the study (n = 187 receiving lifestyle modification alone; n = 200 in combination with additional treatments). Feeling 'bored' was most commonly and most strongly associated with the urge to eat, regardless of sex or treatment. Women had higher scores for total EES, for subscales of depression and anger, and individual feelings of 'blue', 'sad' and 'upset' compared to men.

CONCLUSIONS

Understanding why certain emotions differentially trigger an urge to eat in men and women, and finding strategies to break the link between boredom and eating may enable better personalisation of lifestyle interventions for people with obesity.

"Neurotic people tend to eat less when disinhibited": The mediating role of food-related cognitive flexibility in restrained eaters

OBJECTIVES

This study aims to reveal the individual differences in Neuroticism and cognitive flexibility among successful restrained eaters (SREs), unsuccessful restrained eaters (UREs), and non-restrained eaters (NREs). Moreover, this study is dedicated to investigating whether certain personality traits and cognitive flexibility could concurrently influence disinhibited eating behaviors among restrained eaters and reveal the pathways through which they interact.

METHODS

Female participants aged 17 and 24 years (NREs = 23; SREs = 24; UREs = 23) were assessed with body mass index (BMI) and appetite state measurement, the Dutch Eating Behavior Questionnaire (DEBQ), the NEO Five-Factor Inventory (NEO-FFI), and the Positive and Negative Affect Schedule. To measure behavioral and neural responses related to cognitive flexibility, participants were required to complete a food-related switching task, and their brain activities were recorded through the technique of electroencephalography (EEG). Here we analyzed two widely investigated components-the N2 and P3 components that separately relate to conflict monitoring and response inhibition.

RESULTS

The behavioral performance of food-related task switching did not show significant between-group differences. However, in comparison to NREs and SREs, UREs elicited larger N2 and lower P3 amplitudes during task switching. In addition, UREs exhibited a lower level of Neuroticism than SREs and NREs. Furthermore, food-related task switching induced N2 amplitude fully mediated the association between Neuroticism and disinhibited eating behavior in restrained eaters controlled for BMI and negative affect. Importantly, when a parallel mediation model with N2 and P3 was built concurrently, N2 was still able to fully mediate the association.

CONCLUSION

According to behavioral and neural evidence, increased N2 amplitude induced by food-related task switching totally mediated the negative association between Neuroticism and disinhibited eating in restrained eaters.

Direct Yet Opposite Effects of Stress-related and Mindful Eating on Diet Quality

OBJECTIVE

Examine the relationships among dietary quality, mindful eating, and constructs of the Transactional Model of Stress and Coping.

METHODS

In this cross-sectional study, women (n = 67) aged 25-50 years, with a body mass index of 25-40 kg/m² completed 3 days of 24-hour recalls and a survey that included the Perceived Stress Scale, Eating and Appraisal Due to Emotions and Stress Questionnaire, and the Mindful Eating Questionnaire. Structural equation modeling assessed relationships among all constructs with the dependent variable, the Healthy Eating Index-2015.

RESULTS

Mindful Eating Questionnaire (β = 0.60, P = 0.001) and Emotion and Stress-related Eating scores from Eating and Appraisal Due to Emotions and Stress Questionnaire (β = -0.69, P < 0.001) (r² = 0.50) were directly associated with Healthy Eating Index-2015, but no indirect effects were identified.

CONCLUSIONS AND IMPLICATIONS

Overall dietary quality is associated with greater mindful eating but more emotion and stress-related eating scores among women who were overweight or obese. Future studies could assess model constructs using other diet quality scores and including additional coping mechanisms such as substance use, physical activity, and meditation.

Indoor nature integration for stress recovery and healthy eating: A picture experiment with plants versus green color

AIM

Urbanized environments may stimulate unhealthy food choices and stress. Several theories explain that exposure to green nature can counter these stress effects. Since we spend most time indoors, integrating nature in the interior could be a promising health promotion tool. Hence, we tested whether the beneficial effect of nature for stress recovery is also present in indoor settings via the use of plants or green colors, and whether it is applicable on eating behavior as a new outcome.

METHODS

The 92 participants (18-30y, 16% men) were divided into four groups. Each viewed a 6-min slideshow with room pictures containing either green plants, green objects, greyscale plants or greyscale objects to allow distinction between color- and plant-effects. Group differences were tested for the perceived restorativeness scale, psychological recovery and eating behavior. To allow psychological recovery testing, participants were exposed to a stressor before the picture slideshow via the Trier Social Stress Test. The change of self-reports (stress, positive and negative affect) and psychophysiology (heart rate and vagal-induced heart rate variability RMSSD) post-slideshow versus pre-slideshow was checked. Eating behavior outcomes included change in hunger, craving, and food choice (for fruits, vegetables and snacks).

RESULTS

From the four picture sets, the green plants pictures were reported as most mentally restorative and appeared most beneficial for post-stressor recovery of positive affect, but not for negative affect or stress recovery. The green plants group also had higher preference for vegetables and lower preference or craving for (unhealthy) snacks. Those significant group differences were mainly due to the presence of plants and only occasionally due to the green color.

CONCLUSION

Indoor green plant pictures were associated with higher mental restorativeness and healthier food choices. Integrating plants in the interior seems to be a relevant health promotion approach, while applying green colors seems less relevant.

Prevalence of Emotional Eating in Groups of Students with Varied Diets and Physical Activity in Poland

Background: Emotional eating (EE) is not a separate eating disorder, but rather a type of behavior within a group of various eating behaviors that are influenced by habits, stress, emotions, and individual attitudes toward eating. The relationship between eating and emotions can be considered on two parallel levels: psychological and physiological. In the case of the psychological response, stress generates a variety of bodily responses relating to coping with stress. Objective: Therefore, the main objective of this study was to evaluate and compare the prevalence of emotional eating in groups of students in health-related and non-health-related fields in terms of their differential health behaviors—diet and physical activity levels. Material and Methods: The cross-sectional survey study included 300 individuals representing two groups of students distinguished by their fields of study—one group was in health-related fields (HRF) and the other was in non-health-related fields (NRF). The study used standardized questionnaires: the PSS-10 and TFEQ-13. Results: The gender of the subjects was as follows: women, 60.0% (174 subjects) (HRF: 47.1%, n= 82; NRF: 52.9%, n = 92); men, 40.0% (116 subjects) (HRF: 53.4%, n = 62; NRF: 46.6%, n = 54). The age of the subjects was 26 years (±2 years). Based on the results of the TFEQ-13, among 120 subjects (41.4%) there were behaviors consistent with limiting food intake (HRF: 72.4%; NRF: 11.0%), while 64 subjects (20.7%) were characterized by a lack of control over food intake (HRF: 13.8%, 20 subjects; NRF: 27.4%, 20 subjects). Emotional eating was characteristic of 106 students (37.9%), with the NRF group dominating (61.6%, n = 90). It was observed that a high PSS-10 score is mainly characteristic of individuals who exhibit EE. Conclusions: The results obtained in the study indicate that lifestyle can have a real impact on the development of emotional eating problems. Individuals who are characterized by elevated BMI values, unhealthy diets, low rates of physical activity, who underestimate meal size in terms of weight and calories, and have high-stress feelings are more likely to develop emotional eating. These results also indicate that further research in this area should be undertaken to indicate whether the relationships shown can be generalized.

Examining a mediation model of body image-related cognitive fusion, intuitive eating, and eating disorder symptom severity in a clinical sample

PURPOSE

This study sought to explore the associations between Intuitive Eating (IE), eating disorder (ED) symptom severity, and body image-related cognitive fusion within a clinical sample. IE was also examined as a possible mediator in the relationship between body image-related fusion and ED symptoms.

METHODS

This study includes cross-sectional analyses with data from 100 adult females and 75 adolescent females seeking residential treatment for an ED. Self-reported demographic information, ED symptoms, IE behaviors, and body image-related cognitive fusion were collected from participants within the first week of treatment following admission to the same residential ED treatment facility.

RESULTS

ED symptom severity was significantly negatively associated with three of the four domains of IE; unconditional permission to eat, reliance on hunger and satiety cues, and body-food choice congruence. A significant mediational effect of IE on the relationship between body image-related fusion and ED symptoms through IE behaviors was observed (β = 11.3, SE = 0.003, p < 0.001). This effect was only observed for the unconditional permission to eat (β = 0.13, p = 0.003) and reliance on hunger and satiety cues (β = 0.10, p = 0.005) domains of IE when the domains were subsequently analyzed individually.

CONCLUSION

Unconditional permission to eat and reliance on hunger and satiety cues appear to be particularly influential domains of IE in the relationship between body image-related fusion and ED symptom severity. It is possible that changes in these IE domains may be mechanisms through which body image-related fusion influences ED symptoms. Future longitudinal research is needed to better understand the relationship between body image-related cognitive fusion and IE and the potential for targeting these constructs specifically in the context of ED treatment.

LEVEL OF EVIDENCE

Level V, cross-sectional analysis from descriptive study.

Reward sensitivity, eating behavior, and obesity-related outcomes: A systematic review

INTRODUCTION

Previous research has identified reward sensitivity as an important factor that may contribute to the engagement in eating behavior (e.g., binge eating, emotional eating, etc.) and increase obesity risk. In the current study, we conducted a systematic review of the literature to determine the relationships between reward sensitivity, eating behavior, and obesity-related outcomes. The study focused on two commonly used measures of reward sensitivity in the literature: the Sensitivity to Punishment and Sensitivity to Reward Questionnaire (SPSRQ) and the Behavioral Inhibition Scale/Behavioral Activation Scale (BIS/BAS Scale).

METHOD

We conducted a systematic search to identify studies that analyzed reward sensitivity as a predictor of eating behavior or obesity-related outcomes, and measured reward sensitivity using the SPSRQ or BIS/BAS Scale. The search yielded N=19 total publications included in the review.

RESULTS

Findings indicated that reward sensitivity, primarily measured by summary scores on the SPSRQ or BIS/BAS Scale, were positively associated with a variety of eating behaviors and obesity-related outcomes with small to moderate effect sizes. Findings were most consistent across studies that examined the association between reward sensitivity and eating behavior outcomes (e.g., binge eating, emotional eating) (r values= .08 to .41; p values < .001 to p < .05) and food consumption outcomes (e.g., palatable food intake) (r values = .21 to .40; p < .001 to p values < .05). Findings were less consistent for food craving and BMI outcomes, and revealed these relationships may depend on individual-level factors and/or environment-related factors, (e.g., food cues). A quality evaluation using the Critical Appraisal Tool for Cross-Sectional Studies (AXIS tool) indicated that most studies were rated as moderate to strong quality (84%).

CONCLUSION

Findings indicate that elevated reward sensitivity may be a risk factor for engagement in eating behaviors that may increase obesity risk.

Self-compassion, Stress, and Eating Behaviour: Exploring the Effects of Self-compassion on Dietary Choice and Food Craving After Laboratory-Induced Stress

BACKGROUND

Stress has been linked to high-fat and high-sugar food consumption. Self-compassion is associated with better emotional and physiological responses to stress. The current study explored whether trait self-compassion or induced state self-compassion could improve dietary choice and food craving after a stress induction.

METHOD

Fifty-three university students completed an online survey assessing self-compassion, eating restraint, and general perceived stress before attending a laboratory visit. In the laboratory, participants were randomised to a neutral writing control or a self-compassion letter writing condition before a stress induction. Measures of heart rate, heart rate variability, state self-compassion, dietary choice, and state food cravings were taken.

RESULTS

The brief self-compassion intervention did not sufficiently increase state self-compassion in the intervention group compared to the neutral writing condition. There was no effect of the written self-compassion intervention on heart rate, heart rate variability, dietary choice, or food craving. However, higher trait self-compassion was associated with healthier dietary choices (F(1, 49) = 5.35, p = .025, R² = .098).

CONCLUSION

Results suggest that higher trait self-compassion improved dietary choice after stress in a controlled environment in a university population. Further research is warranted to explore whether brief self-compassion interventions can improve state self-compassion and thereby influence dietary choices and food cravings after a stress induction.

Loss-of-Control Eating and Cardiometabolic Health in Relation to Overweight and Obesity

PURPOSE OF REVIEW

Loss-of-control (LOC) eating, the subjective feeling of being unable to control what or how much is being consumed, is common. The purpose of this review was to examine the relationships among LOC eating, cardiometabolic health, and weight management intervention outcomes.

RECENT FINDINGS

In youth and adults, LOC eating is associated with and predictive of psychological symptoms, high weight, and worsened cardiometabolic health. While LOC eating pre-intervention does not appear to impact outcomes, LOC eating during or following is associated with worsened outcomes from behavioral and surgical weight management interventions. When individuals are undergoing weight management interventions, it may be important to regularly assess for LOC eating. There is limited research on the examined relationships in diverse populations (e.g., males, individuals of a lower socio-economic status, racial/ethnic minority groups). Future research should examine these relationships across the lifespan in diverse populations, with a focus on how these relationships can be impacted through targeted interventions.

Night Eating Among Latinos With Diabetes: Exploring Associations With Heart Rate Variability, Eating Patterns, and Sleep

OBJECTIVES

We explored associations between night eating and health outcomes in Latinos with type 2 diabetes.

METHODS

Participants (n = 85) completed surveys, were measured for anthropometrics, provided blood samples, and wore Holter monitors for 24 hours to assess heart rate variability.

RESULTS

Participant mean age was 60.0 years, hemoglobin A1c was 8.7%, most preferred Spanish (92%), and had less than a high school education (76%). Compared with their counterparts who denied night eating, night eaters had lower heart rate variability in the low (Cohen's d = -0.55; P = 0.04) and very-low-frequency bands (d = -0.54, P = 0.05), and reported more emotional eating (d = 0.52, P = 0.04), and poorer sleep quality (Cohen's h = 0.64). They did not differ on beverage intake or depressive symptoms. In regression that included depressive symptoms, associations between night eating and outcomes became nonsignificant.

CONCLUSIONS AND IMPLICATIONS

Night eaters demonstrated worse health outcomes. If results are replicated, nutrition education for this population might focus on night eating.

Bidirectional Associations between Parental Non-Responsive Feeding Practices and Child Eating Behaviors: A Systematic Review and Meta-Analysis of Longitudinal Prospective Studies

Background: Parental non-responsive feeding practices and child eating behaviors both play significant roles in childhood obesity. However, their longitudinal relationships are less clear. This systematic review aimed to examine their bidirectional associations. Methods: A systematic search of five databases was conducted from inception to February 2022. Data synthesis was performed using a semi-quantitative and quantitative approach. Results: A total of 14 studies with 15348 respondents were included. A total of 94 longitudinal effects from 14 studies of parental non-responsive feeding practices on child eating behaviors were investigated, and 19 statistically significant effects were discovered. Seventy-seven longitudinal effects from nine studies of child eating behaviors on parental feeding practices were examined, with fifteen being statistically significant. The pooled results of meta-analysis showed five statistically significant associations: parental restrictive feeding positively predicted child enjoyment of food (β = 0.044; 95% CI: 0.004, 0.085); use of food as a reward positively predicted child emotional eating (β = 0.09; 95% CI: 0.04, 0.15); child food responsiveness positively predicted restrictive feeding (β = 0.04; 95% CI: 0.02, 0.06); use food as a reward (β = 0.06; 95% CI: 0.03, 0.10). In addition, the pooled effects showed that child satiety responsiveness negatively predicted restrictive feeding (β = −0.05; 95% CI: −0.08, −0.01). Conclusions: The bidirectional relationships between parental non-responsive feeding practices and child eating behaviors are inconsistent and a few showed statistical significance. Theory-driven longitudinal studies using validated instruments and controlling for potential confounders are needed to unveil their relationships and provide evidence for obesity prevention interventions.

Polish Adaptation and Validation of the Intuitive (IES-2) and Mindful (MES) Eating Scales—The Relationship of the Concepts with Healthy and Unhealthy Food Intake (a Cross-Sectional Study)

Intuitive (IE) and mindful (ME) eating share internally focused eating, yet previous studies have shown that these concepts are not strongly correlated, which suggests that they might be differently related to food intake. The study aimed to adapt the original Intuitive (IES-2) and Mindful (MES) Eating Scales to the Polish language, to test their psychometric parameters and, further, to examine associations of IE and ME with an intake of selected food groups, i.e., healthy foods (fresh and processed vegetables, fresh fruit) and unhealthy foods (sweets, salty snacks). A cross-sectional study was conducted in 2020 in a group of 1000 Polish adults (500 women and 500 men) aged 18–65 (mean age = 41.3 ± 13.6 years). The factor structure was assessed with exploratory (EFA) and confirmatory (CFA) factor analysis as well as structural equation modeling (SEM). Measurement invariance across gender was assessed with multiple-group analysis. Internal consistency and discriminant validity of the two scales was tested. Spearman’s correlation coefficient was used to examine the correlation between IES-2 and MES subscales with food intake. A 4-factor, 16-item structure was confirmed for IES-2, while EFA and CFA revealed a 3-factor, 17-item structure of MES. Both scales demonstrated adequate internal consistency and discriminant validity. Full metric and partial scalar invariance were found for IES-2, while MES proved partial invariances. “Awareness” (MES) and “Body–Food Choice Congruence” (IES-2) positively correlated with intake of healthy foods and negatively with the intake of unhealthy ones. “Eating For Physical Rather Than Emotional Reasons” (IES-2) and “Act with awareness” (MES) favored lower intake of unhealthy foods, whereas “Unconditional Permission to Eat” and “Reliance on Hunger and Satiety Cues” (IES-2) showed an inverse relationship. A greater score in “Acceptance” (MES) was conducive to lower intake of all foods except sweets. The results confirmed that adapted versions of the IES-2 and MES are valid and reliable measures to assess IE and ME among Polish adults. Different IE and ME domains may similarly explain intake of healthy and unhealthy foods, yet within a single eating style, individual domains might have the opposite effect. Future studies should confirm our findings with the inclusion of mediating factors, such as other eating styles, childhood experiences, dieting, etc.

Association between lifestyle and emotional aspects of food consumption during the COVID-19 pandemic

BACKGROUND AND AIMS

Adequate nutrition during infectious outbreaks require a personal management strategy, especially when there are emotional factors involved. To evaluate the association between lifestyle and emotional aspects of food consumption during the pandemic COVID-19.

METHODS AND RESULTS

Cross-sectional study using online self-applied questionnaire with 15,372 active schoolteachers who worked in primary education (kindergarten, elementary and high school) from Minas Gerais, Brazil. Poisson Regression model with robust variance was used to determine the association between lifestyle and emotional aspects and food consumption. Greater adherence to the healthy consumption profile showed a statistically significant association with decreased weight (PR = 1.58; p = 0.000), decreased physical activity (PR = 1.27; p = 0.000), reduced income, (PR = 1.26; p = 0.000), reduced alcohol consumption (PR = 1.22; p = 0.000), and changes in mental health (PR = 1.19; p = 0.000). Unhealthy consumption profile was significantly correlated with weight gain (PR = 1.54; p = 0.000), consuming more alcohol, or started drinking during the pandemic (PR = 1.44; p = 0.000), increased physical activity (PR = 1.43; p = 0.000); increased cigarette consumption (PR = 1.17; p = 0.000), and being a younger adult (PR = 1.17; p = 0.000).

CONCLUSIONS

The COVID-19 pandemic influenced the food profiles of basic education teachers in the Minas Gerais state education system in a bidirectional manner, favoring the practice of consuming healthy or unhealthy foods.

Intergeneration transfer of diet patterns? Parental self-report of diet and their report of their young adult children with ASD

Autism Spectrum Disorder (ASD) affects two percent of American children and often results in neophobia, hypersensitivity to foods, and firmly set food preferences, leading to higher proportions of individuals suffering from diet-related chronic diseases. Our objective was to conduct an explorative pilot study to examine parents’ perception of food intake for themselves and their young adult children with ASD. We employed comparative analysis to discover potential pathways to improve diet quality and lower the risk for chronic disease in individuals with ASD. Data from an online survey in n = 493 parent-child dyads on parentally reported intake patterns, food group, and food consumption was analyzed using kappa statistics to determine the level of agreement between reported parental and child intake patterns, body weight status and activity level. Average age was 48 years for parents and 22 years for their children, respectively. Parent-child agreement for obesity was high. We found very strong agreement between the reported diet variety (kappa = 0.82) and changing daily intake (kappa = 0.63) and strong agreement for some vegetable intake patterns (kappa = 0.61 for orange, white, and starchy vegetables) but not in meat intake (no agreement). Results of this study indicate evidence for perceived intergenerational transfer of dietary intake patterns, which may offer effective approaches to change parental diet, to subsequently improve diet quality in young adults with ASD and prevent diet-related chronic diseases in individuals with ASD.

General versus hunger/satiety-specific interoceptive sensibility in predicting disordered eating

Dysfunctional interoceptive processing of hunger and satiety cues is particularly relevant to disordered eating behaviors. However, researchers often rely on general measures of interoceptive sensibility (IS¹; self-reported experience of internal bodily cues) which conflate interoceptive processes across biological systems (e.g., gastric, cardiac) when assessing the role of interoception in disordered eating. Participants (N = 213; 50% female, age M = 20.77 years) were recruited from a large southeastern university for this online study and completed the Intuitive Eating Scale-2 (hunger/satiety-specific), the Multidimensional Assessment of Interoceptive Awareness-2 (general), and the Eating Disorder Inventory Interoceptive Awareness Subscale (general) as measures of IS. The Eating Pathology Symptoms Inventory was used to assess disordered eating attitudes and behaviors. Controlling for sex and body mass index, hunger/satiety-specific IS was associated with binge eating, purging, and cognitive restraint over and above general IS measures and emerged as the dominant predictor of each. Hunger/satiety-specific IS did not predict restricting behavior. Dysfunctional processing of hunger and satiety cues may be a particularly important risk factor to target in screenings and interventions for disordered eating. Findings highlight the importance of careful selection of IS measures in research and targeting hunger/satiety-specific IS in clinical interventions for disordered eating.

Changes in Total Energy, Nutrients and Food Group Intake among Children and Adolescents during the COVID-19 Pandemic-Results of the DONALD Study

The COVID-19 pandemic may have changed the habitual lifestyles of children and adolescents, in particular, due to the closure of kindergartens and schools. To investigate the impact of the pandemic on nutrients and food intake of children and adolescents in Germany, we analyzed repeated 3-day weighed dietary records from 108 participants (3–18 years; females: n = 45, males: n = 63) of the Dortmund Nutritional and Anthropometric Longitudinally Designed (DONALD) study. Polynomial mixed-effects regression models were used to identify prospective changes in dietary intake (total energy (TEI), carbohydrates, fat, protein, free sugar, ultra-processed foods, fruits and vegetables, sugar sweetened beverages and juices) before and during the first months of the COVID-19 pandemic. For the current analysis, we have chosen the first months of the pandemic (March 2020–August 2020), as this was the period with the most restrictions in Germany so far (kindergarten, school and restaurant closures; contact and outdoor activity restrictions). No significant changes in either the selected nutrients or food groups were observed. However, children and adolescents recorded a significantly lower TEI during the pandemic (β = −109.65, p = 0.0062). Results remained significant after the exclusion of participants with under-reported records (β = −95.77, p = 0.0063). While macronutrient intake did not change, descriptive data indicate a non-significant decrease in sugar sweetened beverages and ultra-processed foods intake. We suggest that children and adolescents from high socioeconomic families may have adapted lifestyle changes during the pandemic.

Protein Intake among Community-Dwelling Older Adults: The Influence of (Pre-) Motivational Determinants

An adequate protein intake is important for healthy ageing, yet nearly 50% of Dutch community-dwelling older adults do not meet protein recommendations. This study explores protein intake in relation to eight behavioral determinants (I-Change model) among Dutch community-dwelling older adults. Data were collected through an online questionnaire from October 2019–October 2020. Protein intake was assessed by the Protein Screener 55+, indicating a high/low chance of a low protein intake (<1.0 g/kg body weight/day). The behavioral determinants of cognizance, knowledge, risk perception, perceived cues, attitude, social support, self-efficacy and intention were assessed by evaluating statements on a 7-point Likert scale. A total of 824 Dutch community-dwelling older adults were included, recruited via online newsletters, newspapers and by personal approach. Poisson regression was performed to calculate quartile-based prevalence ratios (PRs). Almost 40% of 824 respondents had a high chance of a low protein intake. Univariate analyses indicated that lower scores for all different behavioral determinants were associated with a higher chance of a low protein intake. Independent associations were observed for knowledge (Q4 OR = 0.71) and social support (Q4 OR = 0.71). Results of this study can be used in future interventions aiming to increase protein intake in which focus should lie on increasing knowledge and social support.

Caregiver Perceptions of Child Diet Quality: What Influenced Their Judgment

This study aimed at assessing the correctness of a caregiver’s perception of their child’s diet status and to determine the factors which may influence their judgment. 815 child-caregiver pairs were recruited from two primary schools. 3-day 24-h recall was used to evaluate children’s dietary intake, Chinese Children Dietary Index (CCDI) was used to evaluate the dietary quality. Multivariate logistic regression models were used to explore the factors that could influence the correctness of caregiver’s perception. In the current study, 371 (62.1%) children with “high diet quality” and 35 (16.1%) children with “poor diet quality” were correctly perceived by their caregivers. Children who were correctly perceived as having “poor diet quality” consumed less fruits and more snacks and beverages than those who were not correctly perceived (p < 0.05). Obese children were more likely to be correctly identified as having “poor diet quality” (OR = 3.532, p = 0.040), and less likely to be perceived as having “high diet quality”, even when they had a balanced diet (OR = 0.318, p = 0.020). Caregivers with a high level of education were more likely to correctly perceive children’s diet quality (OR = 3.532, p = 0.042). Caregivers in this study were shown to lack the ability to correctly identify their children’s diet quality, especially amongst children with a “poor diet quality”. Obesity, significantly low consumption of fruits or high consumption of snacks can raise caregivers’ awareness of “poor diet quality”.

Maternal Knowledge, Attitude and Practices toward Free Sugar and the Associations with Free Sugar Intake in Children

Research addressing factors related to free sugar (FS) consumption among children in Saudi Arabia is lacking. We aimed to evaluate maternal knowledge, attitude, and practices toward FS and the associations with children's intake of FS. This cross-sectional study included 424 Saudi children aged 6-12 years and their mothers. Data related to maternal knowledge, attitude, and practices were collected using an online survey. Data concerning children's habitual intake of FS were collected through phone interviews using a validated food frequency questionnaire. Limited knowledge on FS was observed among mothers of children [median 7.00 [interquartile range 6.00-8.00] out of 11.0. Maternal knowledge was not correlated with maternal attitude or practices toward FS. Maternal knowledge towards FS did not predict children's intake of FS, whereas maternal attitude and practices toward limiting the consumption of FS predicted lower intake of FS among Saudi children, particularly the FS consumed from solid food sources (B: -5.73 [95% confidence interval (CI): -9.79 to -1.66]) and (B: -6.85 [95% CI: -11.9 to -1.80]), respectively. Despite the limited knowledge pertaining to FS among mothers in Saudi Arabia, they were making efforts to limit their children's consumption of FS.

Text Messages to Curb Sugar-Sweetened Beverage Consumption among Pregnant Women and Mothers: A Mobile Health Randomized Controlled Trial

Racial, ethnic, and socioeconomic disparities in childhood obesity in the United States (U.S.) originate in early life. Maternal sugar-sweetened beverage (SSB) consumption is an early life risk factor for later offspring obesity. The goal of this study was to test the effects of policy-relevant messages delivered by text messages mobile devices (mHealth) on maternal SSB consumption. In this three-arm 1-month randomized controlled trial (RCT), pregnant women or mothers of infants in predominantly Hispanic/Latino New York City neighborhoods were randomized to receive one of three text message sets: graphic beverage health warning labels, beverage sugar content information, or attention control. The main outcome was change in maternal self-reporting of average daily SSB consumption from baseline to one month. Among 262 participants, maternal SSB consumption declined over the 1-month period in all three arms. No intervention effect was detected in primary analyses. In sensitivity analyses accounting for outliers, graphic health warning labels reduced maternal SSB consumption by 28 kcal daily (95% CI: −56, −1). In this mHealth RCT among pregnant women and mothers of infants, graphic health warning labels and beverage sugar content information did not reduce maternal SSB consumption.

Using an app to count calories: Motives, perceptions, and connections to thinness- and muscularity-oriented disordered eating

The number of people counting calories through apps is increasing, yet concerns have been raised that this could trigger symptoms of eating disorders. Although associations between calorie tracking and eating disorder symptomatology have been identified, further research is needed to understand motives for, and the perceived impact of, using a calorie tracking app. This study addressed these gaps with data collected from 1357 adults. A high percentage of participants (n = 964; 71%) had used a calorie tracking app; 531 participants (39%) reported currently using a calorie tracking app. Prior users reported higher levels of thinness- and muscularity-oriented disordered eating than non-users. Those using a calorie tracking app for weight-control/shape reasons were more likely to report that the app had contributed to several eating disorder symptoms (i.e., food preoccupation, all-or-none thinking around food, food anxiety, purging behaviours) than those using an app for health/disease prevention reasons. Engaging in a calorie tracking app for weight/shape reasons was associated with higher perceived helpfulness of calorie tracking app ratings and higher symptom severity. Findings suggest that underlying motives may be important to consider in research investigating the use of calorie tracking apps, as well as for health professionals working with clients engaging in these dietary monitoring tools.