Stress, eating and the reward system

Stress-induced eating in rural adolescents: Unique variability among boys and adolescents with obesity

Stress may contribute to the development of obesity through its effects on dysregulated eating, although this has not yet been examined among low-income, rural adolescents. We examined adolescents' stress-induced changes in eating an ad libitum meal, and after, in the absence of hunger (EAH), and the extent to which these varied by sex, race, and weight status. Participants included 260 adolescents, drawn from a sample of rural households experiencing poverty. Adolescents completed two home visits while salivary cortisol was measured; during the control (low stress) visit, they completed questionnaires and procedures thought to elicit low levels of stress and had BMI assessed. During the stress visit, adolescents completed a 20-minute set of psychosocial stress challenges before eating. At each visit, adolescents consumed an ad-libitum meal after which they were additionally given large portions of snacks (EAH task). Results revealed that indeed cortisol was higher during the stress visit, across the sample. Boys showed stress-induced increases during ad-libitum meal intake (for calories, fat, and carbohydrates) whereas girls exhibited decreased intake. Further, adolescents with obesity showed stress-induced increases in fat intake, but only when hunger was satiated (EAH). There were no differences by race. These findings provide the first evidence of stress-induced alterations in food intake in a rural, low-income sample of adolescents and point to a strong vulnerability for stress-induced increases in eating in rural boys as well as stress-induced increases in fat intake when satiated as a possible contributor to obesity in youth.

Activation of α7 nicotinic receptors attenuated hyperalgesia and anxiety induced by palatable obesogenic diet withdrawal

Consumption of palatable food (PF) can alleviate anxiety, and pain in humans. Contrary, spontaneous withdrawal of long-term PF intake produces anxiogenic-like behavior and abnormal pain sensation, causing challenges to weight-loss diet and anti-obesity agents. Thus, we examined α7-nicotinic acetylcholine receptors (α7nAChR) involvement since it plays essential role in nociception and psychological behaviors.

METHODS

Adult male C57BL/6 mice were placed on a Standard Chow (SC) alone or with PF on intermittent or continuous regimen for 6 weeks. Then, mice were replaced with normal SC (spontaneous withdrawal). Body weight, food intake, and calories intake with and without the obesogenic diet were measured throughout the study. During PF withdrawal, anxiety-like behaviors and pain sensitivity were measured with PNU-282987 (α7nAChR agonist) administration.

RESULTS

Six weeks of SC + PF-intermittent and continuous paradigms produced a significant weight gain. PF withdrawal displayed hyperalgesia and anxiety-like behaviors. During withdrawal, PNU-282987 significantly attenuated hyperalgesia and anxiety-like behaviors.

CONCLUSION

The present study shows that a PF can increase food intake and body weight. Also, enhanced pain sensitivity and anxiety-like behavior were observed during PF withdrawal. α7nAChR activation attenuated anxiolytic-like behavior and hyperalgesia in PF abstinent mice. These data suggest potential therapeutic effects of targeting α7 nAChRs for obesity-withdrawal symptoms in obese subjects.

Lifetime stressor exposure is associated with greater rewarding effects of stress-related eating

Acute stressors tend to shift preferences toward comfort foods, yet they do not ubiquitously increase the amount of food consumed. Moreover, although many individuals eat more under stress, others eat less or show no change. Although the precise mechanisms explaining this variability in stress-related eating are unknown, they may be driven by individual differences in the rewarding effects of comfort eating, which are enhanced by greater lifetime stressor exposure. To investigate this possibility, we examined whether differences in lifetime stressor exposure predicted reductions in negative affect following snacking (i.e., negative reinforcement) and if this effect was specific to stress-related snacking or snacking in general. Participants were 26 women (23 % non-White) between 20 and 45 years old (M = 31), with a mean body mass index of 26, who completed three laboratory visits. Participants completed an assessment of lifetime stressor exposure (i.e., STRAIN) on the first visit and, on two subsequent laboratory visits in counterbalanced order, were given snacks after an acute social stress task (i.e., TSST) or rest period. Greater lifetime stressor exposure was related to greater post-ingestive decreases in negative affect following the acute social stressor but not following the rest period. If stress-related eating is more comforting for women with greater lifetime stressors and contributes to a stronger stress-eating association, then this may inform obesity-related clinical treatments that target behaviors and cognitions related to reward-based learning.

Parent's use of coercive control practices with food is associated with poorer emotion regulation and increased emotional overeating in preschoolers

Emotional overeating is defined as eating in response to emotions. Around the preschool years, there is a shift from emotional undereating to overeating, which suggests environmental influences in the development of overeating. The use of food by parents to control their child's emotions, rather than to teach them appropriate emotion regulation strategies, may impact the child's ability to regulate their own emotions, resulting in emotional overeating. We hypothesized that such coercive control practices with food by parents would be associated with poorer ability of the child to regulate their own emotions, which in turn would lead to increased emotional overeating, but not emotional undereating. Mothers of four- and five-year-olds (N = 221) were recruited through MTurk and Prolific to complete online questionnaires measuring food parenting practices (Comprehensive Feeding Style Questionnaire and Parent Feeding Style Questionnaire), child emotion regulation (Emotion Regulation Checklist), and child emotional eating (Child Eating Behavior Questionnaire). Several mediation models were tested. Parent's use of food to control emotions and behavior was associated with higher levels of emotional overeating, which was mediated by poorer child emotion regulation. However, child emotion regulation did not mediate the association between parent's use of food to control emotions and behavior and the child's emotional undereating. Taken together, these models suggest that parent's use of coercive control with food may lead to child emotional overeating, but not emotional undereating, by teaching children to regulate their emotions through eating rather than more adaptive regulation strategies. Future experimental and longitudinal studies are needed to directly test the nature and direction of these associations and whether coercive control with food teaches children to overeat in response to their emotions in lieu of using appropriate emotion regulation strategies.

Childhood adversity, accelerated GrimAge, and associated health consequences

Childhood adversity is linked to psychological, behavioral, and physical health problems, including obesity and cardiometabolic disease. Epigenetic alterations are one pathway through which the effects of early life stress and adversity might persist into adulthood. Epigenetic mechanisms have also been proposed to explain why cardiometabolic health can vary greatly between individuals with similar Body Mass Index (BMIs). We evaluated two independent cross-sectional cohorts of adults without known medical illness, one of which explicitly recruited individuals with early life stress (ELS) and control participants (n = 195), and the other a general community sample (n = 477). In these cohorts, we examine associations between childhood adversity, epigenetic aging, and metabolic health. Childhood adversity was associated with increased GrimAge Acceleration (GAA) in both cohorts, both utilizing a dichotomous yes/no classification (both p < 0.01) as well as a continuous measure using the Childhood Trauma Questionnaire (CTQ) (both p < 0.05). Further investigation demonstrated that CTQ subscales for physical and sexual abuse (both p < 0.05) were associated with increased GAA in both cohorts, whereas physical and emotional neglect were not. In both cohorts, higher CTQ was also associated with higher BMI and increased insulin resistance (both p < 0.05). Finally, we demonstrate a moderating effect of BMI on the relationship between GAA and insulin resistance where GAA correlated with insulin resistance specifically at higher BMIs. These results, which were largely replicated between two independent cohorts, suggest that interactions between epigenetics, obesity, and metabolic health may be important mechanisms through which childhood adversity contributes to long-term physical and metabolic health effects.

Emotional eating mediates the relationship between perceived stress and body appreciation in adult male and female: A cross-sectional study in Turkey

The aim of this study was to investigate the association between adults' perceived stress, emotional eating, and body appreciation. The Emotional Eater Questionnaire (EES), the Perceived Stress Scale (PSS), and the Body Appreciation Scale-2 (BAS-2) were completed by 710 adult participants. Emotional eating was found to be adversely related to body appreciation in both female (=-0.232, p: <.001) and male (β = -0.180, p < .05). The study's findings highlighted the harmful impacts of perceived stress and emotional eating on the range of body appreciation. This finding shows that stress and emotion management should be considered in the context of adult body appreciation practices.

Addiction to ultra-processed foods as a mediator between psychological stress and emotional eating during the COVID-19 pandemic

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic induced psychological distress, which is linked to emotional eating and symptoms of addiction to ultra-processed foods (UPFs).

OBJECTIVE

This study aimed to investigate whether symptoms of addiction to UPFs mediate the relationship between psychological stress due to the COVID-19 pandemic and emotional eating behaviour.

METHODS

A cross-sectional online study was conducted from May to November 2021 among 368 undergraduate Brazilian students. The participants answered demographic questions and completed validated scales, including the Coronavirus Stress Measure, Modified Yale Food Addiction Scale 2.0 and Emotional Eating Questionnaire. Mediation analysis was employed to examine the hypothesised relationships.

RESULTS

The results revealed a significant indirect effect, indicating that symptoms of food addiction mediated the association between perceived stress during the COVID-19 pandemic and emotional eating behaviour. Specifically, 61% of the influence of perceived stress on emotional eating during the pandemic was explained by symptoms of UPF addiction.

CONCLUSION

These findings suggest that addressing symptoms of UPF addiction could be pivotal in public health strategies aimed at promoting healthy eating habits among distressed undergraduate students in the post-COVID-19 era.

Development and preliminary validation of a modified Food Craving Inventory for Pregnancy (FCI-P) in U.S. military active-duty Service women

Food cravings during pregnancy are highly common, yet no measure of cravings has been validated among pregnant women. The current study evaluated the psychometric properties of the Food Craving Inventory (FCI) for use during pregnancy. U.S. military active-duty Service women (N = 192; 29.5 ± 3.8 years old; 44% Army, 36% Air Force, 15% Navy, and 4% Marine Corps) were recruited from the community at 12-27 weeks' gestation. Participants completed a modified version of the FCI validated for adults with binge-eating disorder, which included 13 additional items assessing cravings for foods that women commonly report experiencing during pregnancy (e.g., pickles, sour cream, hot or spicy wings). Additional measures also assessed disinhibited eating behaviors (i.e., loss of control eating and emotional eating). A series of confirmatory factor analyses were conducted to examine model fit for a four-factor structure of: (1) the FCI validated for binge-eating disorder (excluding the pregnancy-oriented food items) and (2) the FCI modified for pregnancy (with the pregnancy-oriented food items added). The previously validated four-factor structure of the FCI for binge-eating disorder demonstrated poor model fit in the current sample of pregnant women. After examining the structure of the FCI modified for pregnancy, several items were removed due to high cross-loading across multiple subscales. The resulting 16-item, four-factor (Fats, Sweets, Carbohydrates, Spicy/Strong foods) FCI for pregnancy (FCI-P) demonstrated generally good model fit (CFI = .95, TLI = .94, SRMR = .04, RMSEA = .09) and good-to-excellent internal consistency (Cronbach's alphas: .83-.96). Convergent validity was supported by significant correlations between the FCI-P scores and the disinhibited eating behavior scores (ps < .001). Results highlight the importance of psychometrically evaluating eating-related measures for use during pregnancy to appropriately capture the potentially unique experiences of the perinatal period.

Biopsychosocial pathways model of early childhood appetite self-regulation: Temperament as a key to modulation of interactions among systems

The widespread discrimination against individuals with obesity often stems from a simplistic perception of obesity as a mere consequence of personal choices of overeating and insufficient physical activity. This reductionist perception fails to acknowledge the complexity of the epidemic of obesity, which extends beyond diet and exercise decisions. The concept of appetite self-regulation (ASR) has been explored as a crucial element in identifying obesogenic behavioral approaches to food. Although an extensive understanding of ASR in children is essential as an early precursor and modifiable factor influencing obesity, the prevailing view of self-regulation of eating solely as a matter of cognitive and behavioral processing tends to overlook interacting systems of influences. This narrow approach attributes obesity to the lack of voluntary self-control in food consumption while neglecting to account for the biological, psychological, and social influences implicated in the developmental processes of ASR, which may further contribute to the stigmatization of obesity. The current critical analysis provides a comprehensive developmental framework that could guide future studies with testable hypotheses, outlining pathways of interactions among biopsychosocial systems, all of which contribute to the development of ASR in early childhood. Adopting developmental perspectives allows a holistic approach to investigating ASR, which accounts for intricate interactions between biological (B), psychological (P), and social (S) factors influential in the early manifestation of ASR.

Focusing attention on the important association between food insecurity and psychological distress: a systematic review and meta-analysis

BACKGROUND

Food insecurity has involved more than 750 million individuals worldwide. The association of food insecurity with socio-economic factors is also undeniable demand more consideration. Food insecurity will become a global priority by 2030. This systematic review and meta-analysis examined current literature concerning the association between food insecurity and psychological distress.

METHODS

Relevant researches were identified by searching databases including PubMed, EMBASE, Scopus, and Web of Science, ProQuest, and Cochrane Library up to June 2024 without language limitation. Then a snowball search was conducted in the eligible studies. The quality assessment was made through Newcastle-Ottawa Scale.

RESULTS

Data were available from 44 cross-sectional articles for systematic review and 17 eligible articles for meta-analysis with 2,267,012 and 1,953,636 participants, respectively. Findings support the growing segment of literature on the association between food insecurity and psychological distress. The highly represented groups were households with low income. Psychological and diabetic distress was directly associated with food insecurity as it increased the odds of distress to 329% (OR: 3.29; 95% CI: 2.46-4.40). Sleep problems, anxiety, depression, lower life satisfaction, obesity, and a higher rate of smoking were among the secondary outcomes.

CONCLUSION

Food insecurity was a common stressor that can have a negative impact on psychological well-being and even physical health. The findings should be considered in the public health and making policy-making process.

Prevalence of Obesity among Polish Primary Care Population Considered Healthy

Obesity is a complex disease with numerous health complications, influenced by factors such as genetics, lifestyle, mental health, societal impact, economic status, comorbidities, and treatments. This multicenter study included adults aged ≥35 years referred to a CVD prevention program, where sociodemographic data, anthropometric examinations, laboratory tests, and HLPCQ responses were collected. The study analyzed 1044 patients with a mean age of 47.9 years. Among them, 22.2% (232 patients) were diagnosed with obesity. These patients exhibited higher blood pressure, non-HDL cholesterol, triglycerides, and glucose levels (all p < 0.001). A comparative analysis showed that obese patients had significantly lower scores in healthy dietary choices, dietary harm avoidance, daily routine, organized physical exercise, and overall HLPCQ scores. These results indicate that individuals considered healthy were actually living with obesity and its associated complications. Consequently, family physicians should proactively identify patients at risk of obesity using existing programs. The Polish healthcare system urgently needs systemic solutions, including effective health promotion and the creation of obesity prevention programs at an early stage of adult life. These measures are essential to address the growing obesity epidemic and improve public health outcomes.

Exploring parental secretive eating of sugary foods and drinks, and its associations with food consumption in families

As a way of modeling healthier eating habits for their children, parents may intentionally avoid consuming sugary foods and drinks (SFDs) in their presence but consume these on other occasions (later referred to as parental secretive eating). This study aimed to 1) explore the prevalence of parental secretive eating, 2) investigate the associations between parental secretive eating and SFD consumption in parents and children, and 3) qualitatively explore the reasons for parental secretive eating. Participants were Finnish mothers (n = 362), fathers (n = 123), and their 3-6-year-old children (n = 403); this data was collected in 2017 as part of the baseline assessment of the DAGIS intervention. Parents reported how often they avoided eating SFDs in the presence of their child, completed food frequency questionnaires for themselves and their child, and responded to an open-ended question of explaining reasons for secretive eating. The overall prevalence of parental secretive eating was 68%. It was more common among mothers than fathers (p < 0.001) and most prevalent in chocolate (61%) and sweets (59%). Parental secretive eating was positively associated with SFD consumption both among mothers (ꞵ = 0.274, p < 0.001) and fathers (ꞵ = 0.210, p = 0.028) in linear regression models adjusted for parents' and child's age, child's gender, parental education level, and number of household members. Mothers' or fathers' secretive eating and child's SFD consumption were not associated (ꞵ = 0.031, p = 0.562; ꞵ = -0.143; p = 0.167). Three themes describing reasons for parental secretive eating were found: family food rules, avoiding child's requests, and aspiration for healthy modeling. In conclusion, parental secretive eating may play an important role in determining SFD consumption in families with preschoolers. Additional research is needed to determine whether parents can prevent their own eating habits from influencing their child through secretive eating.

Longitudinal associations of social jetlag with obesity indicators among adolescents - Shanghai adolescent cohort

OBJECTIVE

To explore the longitudinal association between social-jetlag (SJL) and obesity development among adolescents, sex-difference and related modifying factors in the association.

METHODS

Based on Shanghai-Adolescent-Cohort during 2017-2021, a total of 609 students were investigated. In grade 6, 7 and 9, the information on SJL was collected using questionnaires, and anthropometric measures were conducted. The fingernail cortisol and progesterone levels in grade 6 (using LC-MS/MS) and body composition in grade 9 (using Inbody-S10) were measured. By the latent-class-mixture-modeling, two trajectories for SJL (high-level vs. low-level) throughout 4 years were developed. The prospective associations of SJL trajectories and weight/fat gains were analyzed by sex and under different (high/moderate/low) cortisol/progesterone stratifications.

RESULTS

In grades 6-9, 39.00%-44.50 % of adolescents experienced at least 1 h of SJL. Compared with the low-level SJL trajectory, the high-level SJL trajectory was associated with greater differences in body-mass-index Z-scores and waist-to-height ratios across 4 years, higher levels of body-fat-percentage and fat-mass-index in grade 9 (P-values<0.05), and such associations were stronger among girls and under moderate-to-high (vs. low) baseline cortisol and progesterone levels. However, no significant associations among boys were observed.

CONCLUSIONS

High-level SJL in adolescents may be associated with the development of obesity, especially among adolescent girls and under relatively high baseline cortisol and progesterone levels.

Effects of Probiotic Supplementation Added to a Weight Loss Program on Anthropometric Measures, Body Composition, Eating Behavior, and Related Hormone Levels in Patients with Food Addiction and Weight Regain After Bariatric Surgery: A Randomized Clinical Trial

PURPOSE

Weight regain after metabolic bariatric surgery is a common problem. Food addiction is an eating disorder that can be one of the reasons for weight regain in these patients. This study aimed to evaluate the effects of probiotic supplementation with a weight loss program and cognitive behavioral therapy (CBT) on anthropometric measures, eating behavior, food addiction, and related hormone levels, in patients with food addiction and weight regain after metabolic bariatric surgery.

MATERIALS AND METHODS

This randomized, triple-blind, placebo-controlled clinical trial was conducted on patients with food addiction and weight regain after metabolic bariatric surgery. Participants (n = 50) received a weight loss program and CBT plus probiotic, or placebo for 12 weeks. Then, anthropometric measurements, biochemical markers, eating behavior, and food addiction were assessed.

RESULTS

Weight and body mass index (BMI) decreased significantly in the probiotic group compared to placebo (p = 0.008, p = 0.001, respectively). Fat mass was significantly decreased in the probiotic group (p < 0.001). Moreover, a significant improvement was observed in the probiotic group's eating behavior and food addiction compared to the placebo group (p < 0.001). Serum levels of leptin decreased significantly (p = 0.02), and oxytocin serum levels increased significantly (p = 0.008) in the probiotic group compared to the placebo group.

CONCLUSION

Adding probiotic supplements to the weight loss program and CBT is superior to the weight loss program and CBT alone in improving weight loss, eating behavior, and food addiction in patients with food addiction and weight regain after metabolic bariatric surgery.

Personal, external, and psychological factors influencing adherence to nutrition and diet in patients undergoing metabolic/bariatric surgery: a systematic synthesis of mixed methods research

AIMS

To offer a holistic view of the personal, external, and psychological factors influencing adherence to nutrition and diet in patients undergoing metabolic/bariatric surgery.

METHODS

This systematic synthesis of mixed methods research involved a comprehensive search for articles in English databases, including PubMed, Cochrane Library, Web of Science, EBSCO, Scopus, and Embase, as well as Chinese databases. The search encompassed articles published from the inception of the database up to June 2023. Following the evaluation of literature quality and extraction of relevant information from the selected studies, data from both quantitative and qualitative studies were integrated. The extracted data were analyzed separately, and themes were identified and summarized to elucidate the factors influencing adherence to nutritional and dietary guidelines. The methodology adhered to the guidelines recommended by the Joanna Briggs Institute (JBI) for mixed methods systematic evaluations.

RESULTS

Three themes and their corresponding descriptive elements were identified, including: (1) Personal factors: subjective factors (attitude, capability, awareness, behaviors), objective factors (age, sex, work status, economic level, physical activity, dietary habits, weight change); (2) External factors: medication (quantity of pills, complexity of intake times, side effects, unpleasant smell or taste), surgery factor, social influences (family members, dietitians, and peers); (3) Psychological factors: self-efficacy, attachment anxiety, and mental health problems.

CONCLUSIONS

The synthesis provided a comprehensive overview of the factors influencing postoperative compliance of nutrition and diet among patients undergoing metabolic and bariatric surgery. It emphasizes the necessity for clinical staff to tailor interventions based on these diverse factors, as well as to attach importance to patients' mental health, giving multidimensional dietary guidance and health care.

Pre-Surgery Cortisol Levels as Biomarker of Evolution after Bariatric Surgery: Weight Loss and Weight Regain

Background: Bariatric surgery (BS) is effective for achieving significant weight loss. However, weight regain (WR) is an emerging problem. Objective: To assess the prognostic value of morning serum cortisol, a 1 mg dexamethasone suppression test (DST), 24 h urinary free cortisol (UFC) and late-night salivary cortisol (LNSC) in a cohort of patients with severe obesity (pwSO) undergoing BS in terms of weight loss and WR. Methods: Patients scheduled for BS underwent the following procedures at baseline, 12 months and 24 months after BS: medical history, anthropometric data, blood analysis and cortisol tests. We evaluated total weight loss (TWL) ≥ 30% at 1 year and WR after 2 years as an increase of ≥10% of the maximum weight lost. Results: In total, 142 subjects were included; 101 (71.1%) were females and the mean age was 45.9 ± 9.2 years. Up to 76.8% of subjects achieved ≥30% TWL, without statistically significant differences in DST results or morning serum cortisol, UFC or LNSC levels. However, a higher pre-surgery morning serum cortisol level was a significant predictor of a WR ≥ 10% (cortisol 17.8 [IQR 13.1-18.5] vs. 12.0 [IQR 8.8-15.8] μg/dL; p < 0.01); OR of 1.216 (95% CI 1.069-1.384); AUC [0.761, CI: (0.616-0.906); p < 0.01]. A cut-off value of cortisol > 13.0 μg/dL was predictive of a WR ≥ 10% (sensitivity 0.71; specificity 0.63). Conclusions: No cortisol test was useful in predicting weight loss; however, the pre-surgery morning serum cortisol level was able to predict a WR ≥ 10% in a cohort of pwSO 2 years after BS. A cut-off value of cortisol > 13 μg/dL might be an easy tool to identify patients at higher risk of WR, enabling healthcare providers to implement tailored, long-term strategies to minimize this outcome.

The mediating role of ability to delay gratification in the relationship between emotional abuse and dieting behavior in healthy adolescents: Considering body mass index as a covariate

OBJECTIVES

In the present study we investigated the relationship between interpersonal childhood trauma, ability to delay gratification (DG), and disordered eating attitudes among adolescents.

METHODS

Data were collected from 145 adolescents aged 12 to 17 through an online survey distributed to parents and legal guardians. The sociodemographic data form, Childhood Trauma Questionnaire (CTQ), Eating Attitudes Test-26 (EAT-26), and Delaying Gratification Inventory were filled out by adolescents in the study.

RESULTS

Sociodemographic data revealed a mean age of 15.07 ± 1.64 years, with 62.8% females (n = 91). Correlation analyses revealed associations between body mass index (BMI), interpersonal childhood trauma experiences (measured by CTQ), and disordered eating attitudes (measured by EAT-26). Notably, emotional abuse correlated negatively with ability to DG and positively with dieting behavior. Mediation analysis showed that ability to DG partially mediated the relationship between emotional abuse and dieting behavior, even after controlling for BMI percentiles.

CONCLUSIONS

These findings suggest that emotional abuse may influence disordered eating attitudes especially dieting behavior through its impact on ability to DG. Further research is warranted to validate these findings and explore intervention strategies for adolescents affected by interpersonal childhood trauma and disordered eating attitudes.

Corticotropin-releasing hormone and obesity: From fetal life to adulthood

Obesity is among the most common chronic disorders, worldwide. It is a complex disease that reflects the interactions between environmental influences, multiple genetic allelic variants, and behavioral factors. Recent developments have also shown that biological conditions in utero play an important role in the programming of energy homeostasis systems and might have an impact on obesity and metabolic disease risk. The corticotropin-releasing hormone (CRH) family of neuropeptides, as a central element of energy homeostasis, has been evaluated for its role in the pathophysiology of obesity. This review aims to summarize the relevance and effects of the CRH family of peptides in the pathophysiology of obesity spanning from fetal life to adulthood.

Momentary stress-induced food craving: An ecological momentary assessment study comparing perceived interpersonal and non-interpersonal stressors

Daily-life stressors and food cravings are dynamic and vary within and across persons. Some evidence suggests interpersonal stressors increase appetite. However, little is known about the association of food craving with different types of stressors at the momentary level in the general population. We aimed to explore the momentary relationships between daily-life stressful events and food craving in a non-clinical community sample, and to compare the associations with food craving when the most stressful event was perceived as interpersonal versus non-interpersonal. We used ecological momentary assessment (EMA) to collect reports on the most stressful event, perceived stressor type, stressor appraisal, and food craving from 123 adults three times a day scheduled at fixed intervals over 10 days. Mixed effects random intercepts and slopes models examined the within- and between-person associations. Experiencing a stressor was significantly positively associated with within-person food craving at the same measurement. No differences in momentary food craving were found when the most stressful event was perceived as interpersonal or non-interpersonal (within-person level). However, frequently reporting the most stressful event as interpersonal (vs. non-interpersonal) was positively associated with food craving across the study (between-person level), particularly when the stressor was appraised as more unpleasant. Daily-life stressors were associated with momentary food craving. Individuals who generally perceived interpersonal stressors as their most stressful event tended to experience food cravings. Future research could further investigate the role of interpersonal stressors as a factor for overeating in daily life and the potential benefits of stress management in interventions.

Body weight in relation to hours of sleep, and physical activity in Latin American university students during the Covid-19 pandemic

Introduction: Short sleep, physical inactivity, and being locked up are risk factors for weight gain. Objective: We evaluated weight gain according to sex, age, hours of sleep and physical activity in university students from 10 Latin American countries during the COVID-19 pandemic. Methods: Cross-sectional and multicenter study (n = 4880). Results: The average age was 22.5 ± 4.4 years. 60.2% were currently locked up. 73.6% were women, 48.2% increased their body weight, 66% reported insufficient sleep hours, and 65.9% were inactive. Women gained more weight than men (73.2%) and younger students gained more weight (85.1%). Those who had insufficient sleep hours gained most weight (67.6%). Inactive participants gained most weight (74.7%). Students who have insufficient sleep are 21% more likely to have changes in body weight compared to students who have optimal sleep. Conclusion: The increase in body weight and its risk factors during confinement should be considered as emerging from public health.

Neurobehavioral and molecular changes in a rodent model of ACTH-induced HPA axis dysfunction

Hypothalamic-pituitary-adrenal (HPA) axis dysregulation is linked to the pathophysiology of depression. Although exogenous adrenocorticotropic hormone (ACTH) is associated with a depressive-like phenotype in rodents, comprehensive neurobehavioral and mechanistic evidence to support these findings are limited. Sprague-Dawley rats (male, n = 30; female, n = 10) were randomly assigned to the control (male, n = 10) or ACTH (male, n = 20; female n = 10) groups that received saline (0.1 ml, sc.) or ACTH (100 μg/day, sc.), respectively, for two weeks. Thereafter, rats in the ACTH group were subdivided to receive ACTH plus saline (ACTH_S; male, n = 10; female, n = 5; 0.2 ml, ip.) or ACTH plus imipramine (ACTH_I; male, n = 10; female, n = 5;10 mg/kg, ip.) for a further four weeks. Neurobehavioral changes were assessed using the forced swim test (FST), the sucrose preference test (SPT), and the open field test (OFT). Following termination, the brain regional mRNA expression of BDNF and CREB was determined using RT-PCR. After two-weeks, ACTH administration significantly increased immobility in the FST (p = 0.03), decreased interaction with the center of the OFT (p < 0.01), and increased sucrose consumption (p = 0.03) in male, but not female rats. ACTH administration significantly increased the expression of BDNF in the hippocampus and CREB in all brain regions in males (p < 0.05), but not in female rats. Imipramine treatment did not ameliorate these ACTH-induced neurobehavioral or molecular changes. In conclusion, ACTH administration resulted in a sex-specific onset of depressive-like symptoms and changes in brain regional expression of neurotrophic factors. These results suggest sex-specific mechanisms underlying the development of depressive-like behavior in a model of ACTH-induced HPA axis dysregulation.

Understanding food insecurity in Los Angeles County during the COVID-19 pandemic and its aftermath: A qualitative interview study

The COVID-19 pandemic brought increases in food insecurity in Los Angeles (L.A.) County, defined as lacking household access to adequate food because of limited money or other resources. Here, we aimed to understand the lived experiences of food insecurity during the COVID-19 pandemic and its aftermath. In August-December 2022, we interviewed 30 residents of L.A. County who were participants in an ongoing internet panel and had reported experiencing food insecurity between April 2020 and July 2021. A stratified-sampling approach was used to recruit a diverse sample with and without government food assistance. We report five key findings, which underscore the stress and worry associated with the experience of food insecurity, and the coping strategies people implemented: (1) The pandemic prompted food insecurity as well as stressful shifts in eating behaviors compared to before the pandemic, with some eating much less food, some eating less nutritious food, and some eating much more due to being stuck at home; (2) Buying food became more effortful and financially challenging; (3) Government food assistance from the Supplemental Nutrition Assistance Program (SNAP) was important for reducing food insecurity, but was sometimes insufficient, inconsistent, and didn't cover all retailers or food items; (4) Interviewees had to rely on their social networks, food banks or pantries, churches, and schools to meet their food needs and cope with food insecurity, but some faced barriers in doing so; (5) For some, food insecurity was worse in late 2022, almost two years after the pandemic started. We conclude with implications for policymakers and practitioners, emphasizing the importance of meeting the needs of diverse residents and addressing food insecurity in the aftermath of the COVID-19 pandemic.

Psychosocial Disadvantage During Childhood and Midlife Health: NIMHD Social Epigenomics Program

Importance

Low childhood socioeconomic status (SES) is a social hallmark of aging that contributes to adult health disparities and earlier morbidity and mortality. Childhood perceptions of stress are associated with child health outcomes and may contribute to premature biological aging into adulthood.

Objective

To describe the association of childhood SES and perceived stress with midlife insulin resistance and epigenetic age and to explore whether late adolescent adiposity mediates the observed associations.

Design, Setting, and Participants

The longitudinal cohort National Heart, Lung, and Blood Institute Growth and Health Study enrolled girls aged 10 years from January 1987 to May 1988, and followed them up to 19 years of age. Participants from Richmond, California, were recruited again at midlife in 2016 to assess insulin resistance and epigenetic age. Analyses were conducted from August 2, 2023, to March 18, 2024. A total of 433 participants were eligible and included in the analyses (specific sample sizes ranged across analyses from 303 to 391).

Exposures

Childhood levels of SES at 10 years of age (parental educational level and income) and perceived stress at 11 years of age.

Main Outcomes and Measures

The hypotheses tested were formulated after data collection. Outcomes included the homeostatic model assessment of insulin resistance (HOMA-IR) and the GrimAge and DunedinPACE epigenetic clocks. Waist circumference in late adolescence was tested as a mediator.

Results

Among the 433 participants, the mean (SD) age was 39.4 (1.2) years; 218 (50.3%) were Black and 215 (49.7%) were White; and 135 (31.2%) had parents with a college degree or higher. Higher parental educational level was associated with lower HOMA-IR (B = -0.22 [95% CI, -0.41 to -0.02]; P = .03), lower midlife GrimAge (B = -1.76 [95% CI, -2.85 to -0.66] years; P = .002), and slower midlife DunedinPACE (B = -0.03 [95% CI, -6.29 to -0.002]; P = .04). Childhood perceived stress was indirectly associated through late adolescent adiposity with midlife HOMA-IR (B = 0.01 [95% CI, 0.001-0.01]; P = .02) and midlife GrimAge (B = 0.02 [95% CI, 0.003-0.04] years; P = .01).

Conclusions and Relevance

In this longitudinal cohort study of midlife health and aging, childhood social hallmarks of aging were associated with midlife insulin resistance and epigenetic age (GrimAge and DunedinPACE). Future studies should identify malleable factors that may slow the impact of social hallmarks of aging.

Chronic Stress and Cardiovascular Events: Findings From the CARDIA Study

INTRODUCTION

Higher levels of perceived stress are associated with adverse cardiovascular health. It is plausible that these associations are attenuated among individuals with positive psychological factors such as social support and health-enhancing behaviors. Therefore, this study examined longitudinal associations of chronic stress with cardiovascular disease (CVD) events, and whether social support and physical activity (PA) modify these associations.

METHODS

Data from 3,401 adults (mean age 40.2 years; 46.7% Black; 56.2% women) from the Coronary Artery Risk Development in Young Adults (CARDIA) study, with no prior CVD event in 2000-2001 were analyzed. Chronic stress lasting ≥6 months across 5 life domains (work, financial, relationships, health of self, and health of close other) was self-reported. Adjudicated CVD events (fatal/or nonfatal CVD event) were ascertained yearly through 2020. PA and social support were self-reported via questionnaires. Statistical analyses were conducted in 2023 using multivariable stepwise Accelerated Failure Time analysis to assess associations between key study variables.

RESULTS

The mean chronic stress score was 1.30±1.33 stressors and, by 2020, 220 participants had experienced a CVD event. Chronic stress was associated with lowered survival (time ratio: 0.92; 95% CI: 0.854-0.989), when adjusted for sociodemographic and lifestyle variables but no longer significant when adjusting for clinical factors. Neither PA nor social support were significant modifiers (all ps>0.05).

CONCLUSIONS

Chronic stress was associated with the risk of having a CVD event among middle-aged adults, due at least in part to clinical mediators. Studies should continue exploring positive psychosocial and behavioral factors that may modify this association.

Exploring the impact of lifestyle and environmental exposures on appetite hormone levels in children and adolescents: An observational study

BACKGROUND

Appetite hormones are considered a promising target in fighting obesity as impaired appetite hormone levels have already been associated with obesity. However, further insights in the drivers of appetite hormone levels are needed.

OBJECTIVES

In this study, we investigated the associations of fasting appetite hormone levels with lifestyle and environmental exposures in children and adolescents.

METHODS

A total of 534 fasting blood samples were collected from children and adolescents (4-16y,50% boys) and appetite hormone levels (glucagon-like peptide-1 (GLP-1), peptide YY (PYY), pancreatic polypeptide (PP), leptin and ghrelin) were measured. Exposures included dietary quality (fiber-rich food intake, sugar propensity, fat propensity), psychosocial stress (happiness, negative emotions, negative life events and emotional problems), sleep duration, physical activity and environmental quality (long term black carbon (BC), particulate matter <2.5 μM (PM2.5), nitrogen dioxide (NO2) exposure, and green space in a 100 m and 2000 m radius around the residence). A multi-exposure score was calculated to combine all the exposures at study in one measure. Associations of individual exposures and multi-exposure score with appetite hormone levels were evaluated using linear mixed regression models adjusting for sex, age, socioeconomic status, waist-to-height ratio and multiple testing.

RESULTS

GLP-1 was associated with air pollution exposure (NO2 β* = -0.13, BC β* = -0.15, PM2.5 β* = -0.16, all p < 0.001). Leptin was associated with green space in a 100 m radius around the residence (β* = -0.11; p = 0.002). Ghrelin was associated with negative emotions (active ghrelin β* = -0.16; p = 0.04, total ghrelin β* = -0.23; p = 0.0051) and happiness (active ghrelin β* = 0.25; p < 0.001, total ghrelin β* = 0.26; p < 0.001). Furthermore, total ghrelin levels were associated with the multi-exposure score, reflecting unhealthy exposures and lifestyle (β* = -0.22; p = 0.036).

DISCUSSION

Our findings provide new insights into the associations of exposures with appetite hormone levels, which are of high interest for preventive obesity research. Further research is crucial to reveal the underlying mechanisms of the observed associations.

Altered neural representation of olfactory food reward in the nucleus accumbens after acute stress

Acute stress impairs reward processing. The nucleus accumbens (NAcc) plays an important role in the processing of primary rewards such as food. The present study investigates how acute stress affects the olfactory food reward processing in the NAcc using the representational similarity analysis. Forty-eight participants underwent an olfactory fMRI session following either an acute psychosocial stress (N = 24; stress group) or a control (N = 24; control group). Brain activation was recorded during the anticipatory and the perceptual phases of high-calorie food, low-calorie food, and non-food odor stimuli. Compared to the control group, the stress group rated the high-calorie food odor as significantly more pleasant (p = 0.005). In the NAcc, acute stress significantly reduced the dissimilarity of food and non-food odors in the perceptual phase (p = 0.027) and marginally reduced the dissimilarity of high- and low-calorie foods in the anticipatory phase (p = 0.095). Significant negative correlations were observed between the level of NAcc representational differentiation for high- and low-calorie food odors during perception and the difference in pleasantness ratings between high- and low-calorie food odors (r = -0.40, p = 0.005). These findings suggest that acute stress may impair participants' ability to discriminate between olfactory food rewards, leading individuals to seek out more palatable foods in stressful situations in order to maintain positive emotions.

The interplay between leptin, glucocorticoids, and GLP1 regulates food intake and feeding behaviour

Nutritional, endocrine, and neurological signals converge in multiple brain centres to control feeding behaviour and food intake as part of the allostatic regulation of energy balance. Among the several neuroendocrine systems involved, the leptin, glucocorticoid, and glucagon-like peptide 1 (GLP1) systems have been extensively researched. Leptin is at the top hierarchical level since its complete absence is sufficient to trigger severe hyperphagia. Glucocorticoids are key regulators of the energy balance adaptation to stress and their sustained excess leads to excessive adiposity and metabolic perturbations. GLP1 participates in metabolic adaptation to food intake, regulating insulin secretion and satiety by parallel central and peripheral signalling systems. Herein, we review the brain and peripheral targets of these three hormone systems that integrate to regulate food intake, feeding behaviour, and metabolic homeostasis. We examine the functional relationships between leptin, glucocorticoids, and GLP1 at the central and peripheral levels, including the cross-regulation of their circulating levels and their cooperative or antagonistic actions at different brain centres. The pathophysiological roles of these neuroendocrine systems in dysregulated intake are explored in the two extremes of body adiposity - obesity and lipodystrophy - and eating behaviour disorders.

Effect of emotional priming on eating willingness of women with restrictive diet

Background

There is controversy regarding whether negative or positive emotions have a greater impact on the eating behavior of restrictive dieters. Moreover, it is unclear whether unconscious emotional processing can predict the eating behavior of restrictive dieters. This study investigated the effects of conscious and unconscious emotional processing on the dietary behavior of women with restrictive diet.

Methods

Female student participants (N = 600) completed the Dutch Eating Behavior Questionnaire to screen 60 each of successful, unsuccessful restrictive and unrestricted eaters. They were randomly and equally divided into two groups for supra-threshold and subliminal emotional priming and carried out a behavioral task to index eating intentions.

Results

The restrictive dieters increase their willingness to eat when they are in a positive mood, even if they are not consciously aware of their happiness. Furthermore, the unsuccessful restrictive dieters are more intense.

Conclusion

This study presents empirical evidence on the impact of positive emotions on the eating intention of restrictive dieters and the cognitive characteristics of unsuccessful restrictive dieters. Additionally, it offers guidance for unsuccessful restrictive dieters to personalize their treatment goals.

The Effectiveness of Transcranial Direct Current Stimulation (tDCS) in Binge Eating Disorder (BED)-Review and Insight into the Mechanisms of Action

INTRODUCTION

Binge eating disorder (BED) is the most common eating disorder among those contributing to the development of obesity, and thus acts as a significant burden on the lives and health of patients. It is characterized by complex neurobiology, which includes changes in brain activity and neurotransmitter secretion. Existing treatments are moderately effective, and so the search for new therapies that are effective and safe is ongoing.

AIM AND METHODS

This review examines the use of transcranial direct current stimulation (tDCS) in the treatment of binge eating disorder. Searches were conducted on the PubMed/Medline, Research Gate, and Cochrane databases.

RESULTS

Six studies were found that matched the review topic. All of them used the anodal stimulation of the right dorsolateral prefrontal cortex (DLPFC) in BED patients. tDCS proved effective in reducing food cravings, the desire to binge eat, the number of binging episodes, and food intake. It also improved the outcomes of inhibitory control and the treatment of eating disorder psychopathology. The potential mechanisms of action of tDCS in BED are explained, limitations in current research are outlined, and recommendations for future research are provided.

CONCLUSIONS

Preliminary evidence suggests that the anodal application of tDCS to the right DLPFC reduces the symptoms of BED. However, caution should be exercised in the broader use of tDCS in this context due to the small number of studies performed and the small number of patients included. Future studies should incorporate neuroimaging and neurophysiological measurements to elucidate the potential mechanisms of action of tDCS in BED.

Stress-impaired reward pathway promotes distinct feeding behavior patterns

Although dietary behaviors are affected by neuropsychiatric disorders, various environmental conditions can have strong effects as well. We found that mice under multiple stresses, including social isolation, intermittent high-fat diet, and physical restraint, developed feeding behavior patterns characterized by a deviated bait approach (fixated feeding). All the tested stressors affected dopamine release at the nucleus accumbens (NAcc) shell and dopamine normalization reversed the feeding defects. Moreover, inhibition of dopaminergic activity in the ventral tegmental area that projects into the NAcc shell caused similar feeding pattern aberrations. Given that the deviations were not consistently accompanied by changes in the amount consumed or metabolic factors, the alterations in feeding behaviors likely reflect perturbations to a critical stress-associated pathway in the mesolimbic dopamine system. Thus, deviations in feeding behavior patterns that reflect reward system abnormalities can be sensitive biomarkers of psychosocial and physical stress.

Did a workplace sugar-sweetened beverage sales ban reduce anxiety-related sugar-sweetened beverage consumption during the COVID-19 pandemic?

OBJECTIVE

Workplace sugar-sweetened beverage (SSB) sales bans can reduce SSB consumption. Because stress and anxiety can promote sugar consumption, we examined whether anxiety among hospital employees during the COVID-19 pandemic was associated with changes in SSB consumption and explored whether this relationship varied by exposure to a workplace SSB sales ban.

DESIGN

In a prospective, controlled trial of workplace SSB sales bans, we examined self-reported anxiety (generalised anxiety disorder-7) and self-reported SSB consumption (fluid ounces/d) before (July 2019) and during (May 2020) the COVID-19 pandemic.

SETTING

Hospital sites in two conditions (four with SSB sales bans and three without sales bans) in Northern California.

PARTICIPANTS

We sampled 580 participants (hospital employees) from a larger trial of sales bans; all were regular consumers of SSB (minimum 3/week at main trial enrollment). This subsample was chosen based on having appropriately timed data for our study questions.

RESULTS

Across conditions, participants reduced SSB consumption over the study period. However, participants with higher pandemic-era anxiety scores experienced smaller reductions in SSB consumption after 9 months compared with those with lower anxiety scores (β = 0·65, P < 0·05). When the sample was disaggregated by sales ban condition, this relationship held for participants in the control group (access to SSB at work, β = 0·82, P < 0·05), but not for those exposed to an SSB sales ban (β = 0·42, P = 0·25).

CONCLUSIONS

SSB sales bans likely reduce SSB consumption through multiple pathways; buffering stress-related consumption may be one mechanism.

Characterization of adults concerning the use of a hypothetical mHealth application addressing stress-overeating: an online survey

BACKGROUND

About 40% of people respond to stress by consuming more unhealthy foods. This behavior is associated with increased energy intake and the risk of obesity. As mobile health (mHealth) applications (apps) have been shown to be an easy-to-use intervention tool, the characterization of potential app users is necessary to develop target group-specific apps and to increase adherence rates.

METHODS

This cross-sectional online survey was conducted in the spring of 2021 in Germany. Sociodemographic data and data on personality (Big Five Inventory, BFI-10), stress-eating (Salzburg Stress Eating Scale, SSES), and technology behavior (Personal Innovativeness in the Domain of Information Technology, PIIT; Technology Acceptance Model 3, TAM 3) were collected.

RESULTS

The analysis included 1228 participants (80.6% female, mean age: 31.4 ± 12.8 years, mean body mass index (BMI): 23.4 ± 4.3 kg/m2). Based on the TAM score, 33.3% (409/1228) of the participants had a high intention to use a hypothetical mHealth app to avoid stress-overeating. These persons are characterized by a higher BMI (24.02 ± 4.47 kg/m2, p < 0.001), by being stress-overeaters (217/409, 53.1%), by the personality trait "neuroticism" (p < 0.001), by having specific eating reasons (all p < 0.01), and by showing a higher willingness to adopt new technologies (p < 0.001).

CONCLUSION

This study suggests that individuals who are prone to stress-overeating are highly interested in adopting an mHealth app as support. Participants with a high intention to use an mHealth app seem to have a general affinity towards new technology (PIIT) and appear to be more insecure with conflicting motives regarding their diet.

TRIAL REGISTRATION

This survey was registered in the German Clinical Trials Register (Registration number: DRKS00023984).

Food Cravings and Obesity in Women with Polycystic Ovary Syndrome: Pathophysiological and Therapeutic Considerations

Polycystic ovary syndrome (PCOS), the most common endocrine disorder in women of reproductive age, constitutes a metabolic disorder frequently associated with obesity and insulin resistance (IR). Furthermore, women with PCOS often suffer from excessive anxiety and depression, elicited by low self-esteem due to obesity, acne, and hirsutism. These mood disorders are commonly associated with food cravings and binge eating. Hypothalamic signaling regulates appetite and satiety, deteriorating excessive food consumption. However, the hypothalamic function is incapable of compensating for surplus food in women with PCOS, leading to the aggravation of obesity and a vicious circle. Hyperandrogenism, IR, the reduced secretion of cholecystokinin postprandially, and leptin resistance defined by leptin receptors' knockout in the hypothalamus have been implicated in the pathogenesis of hypothalamic dysfunction and appetite dysregulation. Diet modifications, exercise, and psychological and medical interventions have been applied to alleviate food disorders, interrupting the vicious circle. Cognitive-behavioral intervention seems to be the mainstay of treatment, while the role of medical agents, such as GLP-1 analogs and naltrexone/bupropion, has emerged.

High perceived stress is associated with decreased sensory-specific satiety in humans

Previous studies have shown that chronic stress increases food intake. One possible mechanism may be due to altered sensory-specific satiety (SSS) among people with high level of chronic stress. In the current study, seventy-six participants were divided into either high-stress or low-stress groups according to their Perceived Stress Scale (PSS) scores. Participants were assigned to consume one of two foods (banana milk and corn soup) ad libitum until they felt comfortably satiated. Before and after eating, participants rated their liking and wanting for the flavor and the odor (via retronasal and orthonasal routes) of the eaten and uneaten foods. Individual interoceptive sensibility and eating behavior were measured using the Multidimensional Assessment of Interoceptive Awareness (MAIA) and Reasons Individuals Stop Eating Questionnaire (RISE-Q-15), respectively. Compared to the low-stress group, the high-stress group demonstrated blunted SSS to the whole food flavor. No significant difference was found for olfactory-specific satiety (retronasal or orthonasal) between the two groups. In addition, across the whole sample of participants, MAIA total score was positively associated with the magnitude of SSS (r = 0.29, p = 0.01). These results indicate that chronic perceived stress may play a role in the experience of reward during eating.

Clinical heterogeneity of sleep quality, emotional and behavioral characteristics, and eating habits in adolescents with obesity: A cluster analysis

This study aims to examine the role of sleep quality, emotional and behavioral characteristics, and eating behavior in adolescents with obesity by means of cluster analysis. One hundred ninety-four adolescents (78 girls, 116 boys) aged 12-17 (mean 14.3 ± 2.7) with obesity (ICD-10 code E 66.0) entered the study. The Adolescent Sleep Wake Scale was used to evaluate sleep quality. The Achenbach Youth Self-Report for Ages 11-18 questionnaire was used to evaluate emotional and behavioral disturbances. The Dutch Eating Behavior Questionnaire was used to assess maladaptive eating. k-Means cluster analysis was used to clarify heterogeneity. Four clusters were identified: the first included anxious, depressed, socially withdrawn adolescents with thought problems and somatic complaints, non-aggressive, obedient, and having mean values on the sleep quality scale, inclined to restrict their food consumption. The second consisted of rule-breaking youngsters with poor sleep quality, reluctant to restrict their food consumption. The third comprised subjects with the highest values on the sleep quality and lowest values on emotional and behavioral problems, aimed at restricting food consumption. The fourth comprised adolescents with obvious signs of emotional disorders, poorest sleep quality, disinhibited behavior, and emotional and external eating. No statistically significant difference was found between the clusters in sex distribution. Patient allocation to the second or fourth cluster was associated with significantly higher body mass index values, as opposed to the reference third cluster.    Conclusion: There is significant variation in teenagers with obesity who have divergent psychological profiles, which should be taken into account. What is Known: • Patients with obesity present with different clinical characteristics. What is New: • Adolescents with obesity may be partitioned into clusters described in terms of emotional, behavioral patterns, including sleep characteristics, and maladaptive eating habits.

Negative emotions increase unhealthy eating: Evidence from the Wuhan lockdown during COVID-19

This paper studies how negative emotions like stress, anxiety, and boredom can affect unhealthy food consumption. Using the Wuhan lockdown as an external shock, we examine the changes in food consumption in a city that was not in lockdown. We applied the difference-in-differences method to a large scanner dataset from a retail monopoly in China. Our findings reveal that negative emotions induced by the pandemic lockdown significantly elevated consumer spending on unhealthy food items such as crisps, sugary beverages, regular soda, and low-alcohol beverages. Notably, the effect of unhealthy food consumption was more pronounced among younger and wealthier demographics. Triggering factors, like information about confirmed new deaths and infections as well as proximity to local hospitals, were found to strongly influence the consumption of unhealthy foods. Overall, the lockdown's impact extended beyond short-term increases in snack consumption to substantial increases in overall dietary and nutritional intake.

Mindfulness meditation modulates stress-eating and its neural correlates

Stress-related overeating can lead to excessive weight gain, increasing the risk of metabolic and cardiovascular disease. Mindfulness meditation has been demonstrated to reduce stress and increase interoceptive awareness and could, therefore, be an effective intervention for stress-related overeating behavior. To investigate the effects of mindfulness meditation on stress-eating behavior, meditation-naïve individuals with a tendency to stress-eat (N = 66) participated in either a 31-day, web-based mindfulness meditation training or a health training condition. Behavioral and resting-state fMRI data were acquired before and after the intervention. Mindfulness meditation training, in comparison to health training, was found to significantly increase mindfulness while simultaneously reducing stress- and emotional-eating tendencies as well as food cravings. These behavioral results were accompanied by functional connectivity changes between the hypothalamus, reward regions, and several areas of the default mode network in addition to changes observed between the insula and somatosensory areas. Additional changes between seed regions (i.e., hypothalamus and insula) and brain areas attributed to emotion regulation, awareness, attention, and sensory integration were observed. Notably, these changes in functional connectivity correlated with behavioral changes, thereby providing insight into the underlying neural mechanisms of the effects of mindfulness on stress-eating.Clinical trial on the ISRCTN registry: trial ID ISRCTN12901054.

Prevalence and Correlates of Night Eating Syndrome, Insomnia, and Psychological Distress in Primary Care Patients with Obesity: A Cross-Sectional Study

INTRODUCTION

Management of obesity is challenging for both patients and healthcare workers. Considering the low success rate of current interventions, this study aimed to explore the prevalence and associated factors of night eating syndrome (NES), insomnia, and psychological distress among individuals with obesity in order to plan comprehensive obesity management interventions.

METHODS

A cross-sectional study on a convenient sample from five primary healthcare centers in Port Said, Egypt, was conducted from November 2020 to March 2021. Sociodemographic and clinical characteristics were collected in addition to the assessment of NES, insomnia, and psychological distress using the Arabic versions of the Night Eating Diagnostic Questionnaire (NEQ), the Insomnia Severity Index (ISI), and the Patient Health Questionnaire-4 (PHQ-4) scales, respectively. Associations of NES, insomnia, and psychological distress were assessed by multiple regression analysis. We performed Bonferroni adjustments for multiple comparisons.

RESULTS

We included 425 participants with obesity with a mean age of 45.52 ± 6.96 years. In all, 54.4% were females and the mean body mass index (BMI) was 35.20 ± 4.41 kg/m2. The prevalence rates of NES, insomnia, and psychological distress were 21.6% (95% CI: 17.7-25.6%), 15.3% (95% CI: 11.9-18.7%), and 18.8% (95% CI: 15.1-22.6%), respectively. NES was significantly associated with younger age (OR 0.974, p = 0.016), physical inactivity (OR 0.485, p = 0.010), insomnia (OR 2.227, p = 0.014), and psychological distress (OR 2.503, p = 0.002). Insomnia showed strong associations with NES (OR 2.255, p = 0.015) and psychological distress (OR 5.990, p < 0.001). Associated factors of psychological distress symptoms included insomnia (OR 6.098, p < 0.001) and NES (OR 2.463, p = 0.003).

CONCLUSION

The prevalence rates of NES, insomnia, and psychological distress were high among primary care patients with obesity, and these conditions were interrelated. Optimal obesity management necessitates individualized and targeted multidisciplinary care plans that take into consideration individual patients' mental, behavioral, and dietary habits needs.

Multiple mediation of the association between childhood emotional abuse and adult obesity by anxiety and bulimia - a sample from bariatric surgery candidates and healthy controls

Bulimia, which means a person has episodes of eating a very large amount of food (bingeing) during which the person feels a loss of control over their eating, is the most primitive reason for being overweight and obese. The extended literature has indicated that childhood emotional abuse has a close relationship with adverse mood states, bulimia, and obesity. To comprehensively understand the potential links among these factors, we evaluated a multiple mediation model in which anxiety/depression and bulimia were mediators between childhood emotional abuse and body mass index (BMI). A set of self-report questionnaires, including the Childhood Trauma Questionnaire (CTQ), Beck Anxiety Inventory, Beck Depression Inventory (BDI), and Eating Disorder Inventory (EDI), was sent out. Clinical data from 37 obese patients (age: 29.65 ± 5.35, body mass index (BMI): 37.59 ± 6.34) and 37 demographically well-matched healthy people with normal body weight (age: 31.35 ± 10.84, BMI: 22.16 ± 3.69) were included in the investigation. We first performed an independent t-test to compare all scales or subscale scores between the two groups. Then, we conducted Pearson correlation analysis to test every two variables' pairwise correlation. Finally, multiple mediation analysis was performed with BMI as the outcome variable, and childhood emotional abuse as the predictive variable. Pairs of anxiety, bulimia, and depression, bulimia were selected as the mediating variables in different multiple mediation models separately. The results show that the obese group reported higher childhood emotional abuse (t = 2.157, p = 0.034), worse mood state (anxiety: t = 5.466, p < 0.001; depression: t = 2.220, p = 0.030), and higher bulimia (t = 3.400, p = 0.001) than the healthy control group. Positive correlations were found in every pairwise combination of BMI, childhood emotional abuse, anxiety, and bulimia. Multiple mediation analyses indicate that childhood emotional abuse is positively linked to BMI (β = 1.312, 95% CI = 0.482-2.141). The model using anxiety and bulimia as the multiple mediating variables is attested to play roles in the relationship between childhood emotional abuse and obesity (indirect effect = 0.739, 95% CI = 0.261-1.608, 56.33% of the total effect). These findings confirm that childhood emotional abuse contributes to adulthood obesity through the multiple mediating effects of anxiety and bulimia. The present study adds another potential model to facilitate our understanding of the eating psychopathology of obesity.

Mothers with Dysregulated Eating and Their Offspring's Emotional/Behavioral Functioning during the COVID-19 Pandemic: A Descriptive Study

OBJECTIVE

Research on the psychopathological effects of the COVID-19 pandemic has not specifically focused on mothers with dysregulated eating and their children.

METHODS

This study aimed to observe whether the symptoms of mothers with binge eating episodes (assessed through the SCL-90/R and the TFEQ-R18) worsened from the pre-pandemic period (T1) to the pandemic period (T2). In addition, we sought to assess whether the levels of internalizing/externalizing and dysregulation symptoms in children (assessed through the CBCL 6-18) worsened from T1 to T2.

RESULTS

Our results showed that the values obtained for mothers in the SCL-90/R were significantly higher at T2 (during the pandemic), particularly for Depression, Phobic Anxiety, Interpersonal Sensitivity, and Obsessive-Compulsive subscales. Moreover, in both the Emotional Eating and Uncontrolled Eating subscales of the TFEQ-R18, mothers at T2 scored substantially higher than mothers at T1. The emotional/behavioral functioning of children was more maladaptive at T2, according to mothers, especially for the subscales of Withdrawn, Anxious/Depressed, and Aggressive Behavior. Children also had significantly higher scores on the Internalizing and Externalizing subscales, as well as greater symptoms of dysregulation.

CONCLUSIONS

This study contributes to demonstrating that the COVID-19 pandemic may have had increased maladaptive emotional/behavioral functioning in children and their mothers with dysregulated eating.

Almli V. Basic taste sensitivity, eating behaviour, food propensity and BMI of preadolescent children: How are they related?

Background

Taste sensitivity has been reported to influence children's eating behaviour and contribute to their food preferences and intake. This study aimed to investigate the associations between taste sensitivity, eating behaviour, food frequency and BMI (Body Mass Index) in preadolescents.

Methods

Preadolescents' taste sensitivity was measured by detection threshold of sweetness (sucrose), sourness (citric acid), saltiness (sodium chloride), bitterness (caffeine, quinine), and umami (monosodium glutamate). In addition, the Child Eating Behaviour Questionnaire (CEBQ), the Food Propensity Questionnaire (FPQ) measuring food frequency, and the children's body weight and height were completed by the parents. A total of 69 child-parent dyads participated (preadolescents mean age =10.9 years).

Results

Taste sensitivity to caffeine bitterness was significantly associated with eating behaviour in food responsiveness, emotional overeating, and desire to drink. The preadolescents who were less sensitive to caffeine bitterness had higher food responsiveness scores. Those who were less sensitive to caffeine bitterness and to sweetness had higher emotional overeating scores. In addition, preadolescents who were less sensitive to sourness and bitterness of both caffeine and quinine demonstrated to have higher scores in desire to drink. There was no association between taste sensitivity and FPQ, but significant differences were observed across preadolescents' BMI for FPQ of dairy food items, indicating higher consumption of low-fat milk in the overweight/obese compared to the underweight/normal-weight subjects. There was no significant difference in taste sensitivity according to BMI. Preadolescents' eating behaviour differed across BMI, demonstrating a positive association between BMI and food approach, and a negative association between BMI and food avoidance.

Conclusions

This study contributes to the preliminary understanding of the relationships between taste sensitivity and eating behaviour in preadolescents. The results may be used to develop effective strategies to promote healthy eating practices by considering taste sensitivity in preadolescents.

Direct and indirect associations of experience of racial discrimination, dietary patterns and obesity in adults from southern Brazil

OBJECTIVE

To analyse the direct and indirect associations of experience of racial discrimination on dietary patterns (DP), obesity and abdominal obesity.

DESIGN

This is a cross-sectional population-based study. The main exposure was self-reported experiences of racial discrimination (Experiences of Discrimination scale). The mediator variables were the DP: healthy, Brazilian traditional, sugar and carbohydrates, and fast food. The outcomes were obesity (BMI ≥ 30 kg/m2) and abdominal obesity (waist circumference ≥ 88 cm for women; ≥ 102 cm for men). Structural equation modelling was applied.

SETTING

Porto Alegre, Brazil.

PARTICIPANTS

Totally, 400 adults aged between 20 and 70 years were participated.

RESULTS

The mean age of participants was 47·2 years (sd = 13·9), and 75 % were women. Experiencing racial discrimination had a positive direct effect on obesity (healthy DP: β = 0·153, P < 0·05; Brazilian DP: β = 0·156, P < 0·05; sugar and carbohydrates DP: β = 0·156, P < 0·05; and fast-food DP: β = 0·153, P < 0·05) and abdominal obesity (healthy DP: β = 0·206, P < 0·01; Brazilian DP: β = 0·210, P < 0·01; sugar and carbohydrates DP: β = 0·204, P < 0·01; and fast-food DP: β = 0·204, P < 0·01). The experience of racial discrimination did not have a direct effect on DP, nor did it exert an indirect effect on obesity and abdominal obesity through any DP.

CONCLUSIONS

A higher experience of racial discrimination is associated with obesity and abdominal obesity, independent of diet.

Impact of Long-Term Dietary High Fat and Eicosapentaenoic Acid on Behavior and Hypothalamic-Pituitary-Adrenal Axis Activity in Amyloidogenic APPswe/PSEN1dE9 Mice

INTRODUCTION

Alzheimer's disease (AD) alters neurocognitive and emotional function and causes dysregulation of multiple homeostatic processes. The leading AD framework pins amyloid beta plaques and tau tangles as primary drivers of dysfunction. However, many additional variables, including diet, stress, sex, age, and pain tolerance, interact in ways that are not fully understood to impact the onset and progression of AD pathophysiology. We asked: (1) does high-fat diet, compared to low-fat diet, exacerbate AD pathophysiology and behavioral decline? And, (2) can supplementation with eicosapentaenoic (EPA)-enriched fish oil prevent high-fat-diet-induced changes?

METHODS

Male and female APPswePSdE9 mice, and their non-transgenic littermates, were randomly assigned to a diet condition (low-fat, high-fat, high-fat with EPA) and followed from 2 to 10 months of age. We assessed baseline corticosterone concentration during aging, pain tolerance, cognitive function, stress coping, and corticosterone response to a stressor.

RESULTS

Transgenic mice were consistently more active than non-transgenic mice but did not perform worse on either cognitive task, even though we recently reported that these same transgenic mice exhibited metabolic changes and had increased amyloid beta. Mice fed high-fat diet had higher baseline and post-stressor corticosterone, but diet did not impact cognition or pain tolerance. Sex had the biggest influence, as female mice were consistently more active and had higher corticosterone than males.

CONCLUSION

Overall, diet, genotype, and sex did not have consistent impacts on outcomes. We found little support for predicted interactions and correlations, suggesting diet impacts metabolic function and amyloid beta levels, but these outcomes do not translate to changes in behaviors measured here.

Stress, Eating Behavior and Adverse Health in Parents of Young Children with Autism Spectrum Disorder

Mothers of children with Autism Spectrum Disorder (ASD) often experience chronic stress and are at risk for adverse health. However, little is known about fathers, especially when their child is in early childhood. Parenting stress, eating behavior and physical health was evaluated in mothers (n = 48) and fathers (n = 43) of young children (3-7 years) with ASD by questionnaires and physical measurements. Mother's prevalence rates of obesity (39.1%), abdominal obesity (59.6%) and metabolic syndrome (21.6%) were higher than the norm. In fathers, the prevalence rate of clinical parenting stress (33%) was higher than the norm. Parenting stress was positively related to disinhibited eating in mothers, not in fathers. It is crucial to monitor stress and health of parents of children with ASD.

Food Insecurity and Pediatric Nonalcoholic Fatty Liver Disease Severity

OBJECTIVE

To determine the association between food insecurity and pediatric nonalcoholic fatty liver disease (NAFLD).

METHODS

Cross-sectional study of patients < 21 years of age with histologically confirmed NAFLD. The Household Food Security Survey Module was administered to determine food insecurity status. Skin lipidomics were performed to explore pathophysiologic mechanisms.

RESULTS

Seventy-three patients with histologically confirmed NAFLD completed the Household Food Security Survey Module. Of these, the majority were male (81%) and non-Hispanic (53%), with a mean age at biopsy of 13 ± 3 years. Food insecurity was seen in 42% (n = 31). Comparison of features between food insecure and food secure subgroups revealed no differences in sex, ethnicity, BMI z-score, aminotransferases, or histologic severity. However, children experiencing food insecurity presented on average 2 years before their food secure counterparts (12.3 ± 3.0 vs 14.4 ± 3.6 years, P = .015). A subset of 31 patients provided skin samples. Skin lipidomics revealed that food insecurity was associated with down-regulated features from the lipoamino acid class of lipids, previously linked to inflammation and adipocyte differentiation.

CONCLUSIONS

Food insecurity is highly prevalent in children with NAFLD and is associated with earlier presentation. Lipidomic analyses suggest a possible pathophysiologic link that warrants further exploration.

Diabetes alters neuroeconomically dissociable forms of mental accounting

Those with diabetes mellitus are at high-risk of developing psychiatric disorders, yet the link between hyperglycemia and alterations in motivated behavior has not been explored in detail. We characterized value-based decision-making behavior of a streptozocin-induced diabetic mouse model on a naturalistic neuroeconomic foraging paradigm called Restaurant Row. Mice made self-paced choices while on a limited time-budget accepting or rejecting reward offers as a function of cost (delays cued by tone-pitch) and subjective value (flavors), tested daily in a closed-economy system across months. We found streptozocin-treated mice disproportionately undervalued less-preferred flavors and inverted their meal-consumption patterns shifted toward a more costly strategy that overprioritized high-value rewards. We discovered these foraging behaviors were driven by impairments in multiple decision-making systems, including the ability to deliberate when engaged in conflict and cache the value of the passage of time in the form of sunk costs. Surprisingly, diabetes-induced changes in behavior depended not only on the type of choice being made but also the salience of reward-scarcity in the environment. These findings suggest complex relationships between glycemic regulation and dissociable valuation algorithms underlying unique cognitive heuristics and sensitivity to opportunity costs can disrupt fundamentally distinct computational processes and could give rise to psychiatric vulnerabilities.

Comparing Lifestyle and Behavior of Post-Bariatric Surgery and Participants with Obesity: A Community-Based Cross-Sectional Study

Background

There is a paucity of research dedicated to exploring behavioral change in patients following bariatric surgery. However, there is a need for comparison analysis of individuals with obesity who have received surgical treatment and those who have not opted for any surgical procedures for weight loss. This study is designed to scrutinize the lifestyle choices, behavioral patterns, psychological elements, and eating habits of individuals who have undergone bariatric surgery, in contrast to those with obesity who have not undergone such a procedure.

Methods

This study is a secondary analysis from Sharik Diet and Health National Survey (SDHNS) dataset, which is a cross-sectional investigation covering the period from 2020 to 2022. The study focused on demographic factors like age, gender, educational attainment, and monthly earnings. Furthermore, other variables such as physical activity, leisure and workplace sitting habits, smoking patterns, strategies for managing weight, and eating and consumption behaviors were also examined.

Results

Out of the initial 15,980 participants reached, 4,069 satisfied the study's inclusion criteria. Bariatric surgery was reported by 806 participants (19.8%). Upon comparing three obesity status groups - The participants who underwent bariatric surgery with or without obesity, those with obesity who did not opt for any surgical weight loss measure, the analysis found that the three obesity status groups were significantly different in 21 variables from a total of 26. Moreover, a logistic regression analysis revealed that 11 variables influenced persistent obesity in the post-surgery phase, as opposed to those who successfully lost weight. These variables included advanced age, limited education, being female, lower income, waterpipe smoking habits, and the consumption of carbonated drinks.

Conclusion

This study showed that inability to lose weight after bariatric surgery are linked to poor lifestyle choices and behavior compared to those who were able to lose weight after the surgery.

The role of psychosocial well-being and emotion-driven impulsiveness in food choices of European adolescents

BACKGROUND

It is unclear whether a hypothetical intervention targeting either psychosocial well-being or emotion-driven impulsiveness is more effective in reducing unhealthy food choices. Therefore, we aimed to compare the (separate) causal effects of psychosocial well-being and emotion-driven impulsiveness on European adolescents' sweet and fat propensity.

METHODS

We included 2,065 participants of the IDEFICS/I.Family cohort (mean age: 13.4) providing self-reported data on sweet propensity (score range: 0 to 68.4), fat propensity (range: 0 to 72.6), emotion-driven impulsiveness using the UPPS-P negative urgency subscale, and psychosocial well-being using the KINDLR Questionnaire. We estimated, separately, the average causal effects of psychosocial well-being and emotion-driven impulsiveness on sweet and fat propensity applying a semi-parametric doubly robust method (targeted maximum likelihood estimation). Further, we investigated a potential indirect effect of psychosocial well-being on sweet and fat propensity mediated via emotion-driven impulsiveness using a causal mediation analysis.

RESULTS

If all adolescents, hypothetically, had high levels of psychosocial well-being, compared to low levels, we estimated a decrease in average sweet propensity by 1.43 [95%-confidence interval: 0.25 to 2.61]. A smaller effect was estimated for fat propensity. Similarly, if all adolescents had high levels of emotion-driven impulsiveness, compared to low levels, average sweet propensity would be decreased by 2.07 [0.87 to 3.26] and average fat propensity by 1.85 [0.81 to 2.88]. The indirect effect of psychosocial well-being via emotion-driven impulsiveness was 0.61 [0.24 to 1.09] for average sweet propensity and 0.55 [0.13 to 0.86] for average fat propensity.

CONCLUSIONS

An intervention targeting emotion-driven impulsiveness, compared to psychosocial well-being, would be marginally more effective in reducing sweet and fat propensity in adolescents.

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.

Early traumatic experiences and the hypothalamus-pituitary-adrenal axis in people with eating disorders: A narrative review

Exposure to trauma during childhood is a non-specific risk factor for psychiatric disorders, including eating disorders (EDs), over the life course. Moreover, an association between stressful life events and the onset/maintenance of EDs has been documented. Therefore, the hypothalamus-pituitary-adrenal (HPA) axis, namely the main component of the endogenous stress response system, has been proposed to be implicated in the pathophysiology of EDs. In this narrative review the current knowledge concerning the effects of early trauma exposure on the HPA axis activity and their putative role in the pathophysiology of EDs will be illustrated. Research findings corroborate the idea that childhood trauma exposure has long-lasting dysregulating effects on the activity of the HPA axis, which may contribute to the biological background of the early trauma-related risk for the development of EDs across the life span. Moreover, literature data support the existence of a "maltreated ecophenotype" in EDs characterized by specific clinic and neuroendocrine features, which may have important implications in treatment programming for such a type of patients.