Association of body mass with dietary restraint and disinhibition

Towards Novel Nutritional Strategies in Gestational Diabetes: Eating Behaviour and Obesity in Women with Gestational Diabetes Compared with Non-Pregnant Adults

BACKGROUND

Gestational diabetes is associated with increased risk of obesity, type 2 diabetes and cardiovascular disease. Effective nutritional strategies are needed to reduce BMI and improve long-term maternal cardiometabolic health, but the relative contribution of maternal eating behaviour, a potential barrier to dietary change, has not been explored. We compared eating behaviour in women with gestational diabetes with that of men and non-pregnant women with comparable risk factors, and tested associations between eating behaviour traits and BMI in women with gestational diabetes. We hypothesized that eating behaviour would be unfavourable in gestational diabetes and would be associated with BMI.

METHODS

Participants (n = 417) including 53 men, 164 non-pregnant women and 200 women with gestational diabetes (singleton pregnancy; 29 weeks' gestation) were recruited into three prospective studies assessing weight loss interventions, with similar entry criteria. The three-factor eating questionnaire (TFEQ-R18) assessed uncontrolled eating, emotional eating and cognitive restraint at study enrolment. Associations between BMI at study enrolment and TFEQ-R18 (% maximum score) were assessed using linear regression.

RESULTS

Women with gestational diabetes had significantly lower uncontrolled eating scores vs. men (53% vs. 65%; p < 0.001) and non-pregnant women (53% vs. 66%; p < 0.001), lower emotional eating scores vs. non-pregnant women (60% vs. 71%; p < 0.001) and higher cognitive restraint (p < 0.001 vs. men and non-pregnant women). In women with gestational diabetes, emotional eating scores were positively associated with BMI at study enrolment (beta coefficient 7.8 (95% CI 3.9 to 11.7), p < 0.001).

CONCLUSIONS

Women with gestational diabetes have favourable eating behaviour compared with other population groups. Because BMI at study enrolment was associated with emotional eating, nutritional strategies which reduce emotional eating may provide new opportunities to improve long-term maternal health after gestational diabetes.

Evening types as determined by subjective and objective measures are more emotional eaters

OBJECTIVE

This study aimed to determine the association between being an evening type (ET; defined subjectively by the Morning-Evening Questionnaire or objectively by the dim-light melatonin onset [DLMO] timing) and reporting emotional eating (EE) behaviors.

METHODS

Cross-sectional analyses were conducted in 3964 participants (four international cohorts: ONTIME and ONTIME-MT [both Spain], SHIFT [the US], and DICACEM [Mexico]), in which chronotype (Morning-Evening Questionnaire), EE behaviors (Emotional Eating Questionnaire), and dietary habits (dietary records or food-frequency questionnaire) were assessed. Among 162 participants (ONTIME-MT subsample), additional measures of DLMO (physiological gold standard of circadian phase) were available.

RESULTS

In three populations, ETs presented with a higher EE score than morning types (p < 0.02); and they made up a higher proportion of emotional eaters (p < 0.01). ETs presented with higher scores on disinhibition/overeating as well as food craving factors and experienced these behaviors more frequently than morning types (p < 0.05). Furthermore, a meta-analysis showed that being an ET was associated with a higher EE score by 1.52 points of a total of 30 points (95% CI: 0.89-2.14). The timing of DLMO in the early, intermediate, and late objective chronotypes occurred at 21:02 h, 22:12 h, and 23:37 h, with late types showing a higher EE score (p = 0.043).

CONCLUSIONS

Eveningness associated with EE in populations with different cultural, environmental, and genetic backgrounds. Individuals with late DLMO also showed more EE.

Emotional Eating as a Mediator in the Relationship between Dietary Restraint and Body Weight

This study aimed to assess the relationships between routine and compensatory restraints and body mass index (BMI), as well as to explore the mediating role of emotional and external eating in the relationships between routine and compensatory restraints and BMI. Chinese adults aged ≥18 years with different weight statuses were invited to fill out an online questionnaire. Routine and compensatory restraints and emotional and external eating were assessed using the validated 13-item Chinese version of the Weight-Related Eating Questionnaire. Mediation analyses tested the mediation effects of emotional and external eating on the relationship between routine and compensatory restraints and BMI. In total, 949 participants (26.4% male) responded to the survey (mean age = 33 years, standard deviation (SD) = 14, mean BMI = 22.0 kg/m², SD = 3.8). The mean routine restraint score was higher in the overweight/obese group (mean ± SD = 2.13 ± 0.76, p < 0.001) than in the normal weight (2.08 ± 0.89) and underweight (1.72 ± 0.94) groups. However, the normal weight group scored higher in compensatory restraint (2.88 ± 1.03, p = 0.021) than the overweight/obese (2.75 ± 0.93) and underweight (2.62 ± 1.04) groups. Routine restraint was related to higher BMI both directly (β = 0.07, p = 0.02) and indirectly through emotional eating (β = 0.04, 95% confidence interval (CI) = 0.03, 0.07). Compensatory restraint was only indirectly related to higher BMI through emotional eating (β = 0.04, 95% CI = 0.03, 0.07).

Does eating behaviour among adolescents and young adults seeking obesity treatment differ depending on sex, body composition, and parental country of birth?

BACKGROUND

Adolescents and young adults around the world experience high rates of weight gain. The underlying eating behaviours that may lead to overconsumption of energy are complex and can depend on a number of factors. The aim of this study was to explore if eating behaviour among adolescents and young adults referred to specialized obesity treatment differed depending on sex, body composition, and parental country of birth.

METHODS

Adolescents and young adults aged 16-25 years, referred for obesity treatment in 2018-2021 were included in the study. Eating behaviour was assessed using the Three Factor Eating Questionnaire, comprising domains of uncontrolled-, emotional- and cognitive restraint eating. Student's t-test was used to compare differences in eating behaviour scores between males and females, and between those having at least one parent born in a Nordic country and those with both parents born outside the Nordic countries. Associations between BMI, waist circumference, and body fat percentage, and eating behaviour as the dependent variable, were examined using linear regression.

RESULTS

A total of 463 participants, mean age 21 years and mean BMI 41.3 kg/m², were included in the analysis. Females scored statistically significantly higher than males on emotional eating (45.8 vs. 35.4, p = 0.002) and cognitive restraint eating (45.4 vs. 39.2, p = 0.009). Participants with at least one parent born in a Nordic country reported a statistically significantly lower score of uncontrolled eating (45.7 vs. 51.3, p = 0.02) compared to participants with both parents born outside the Nordic countries. Further, there were statistically significant inverse associations between cognitive restraint eating scores and BMI (β=-0.64, 95%CI: -0.97 to -0.31), waist circumference (β=-0.44, 95%CI: -0.61 to -0.27) and body fat percentage (β=-0.57, 95%CI: -1.01 to -0.14) in models adjusted for age, sex, smoking, and civil status.

CONCLUSION

Our findings suggest that sex and parental country of birth may influence eating behaviours among adolescents and young adults referred for specialist obesity treatment. We also found that cognitive restraint eating decreased with increasing BMI, waist circumference, and body fat percentage. This indicates that there may be an inverse association between the ability to restrain oneself from eating and gaining weight, however, the direction of the association must be investigated further. Increased knowledge about eating behaviours may be valuable in the clinical setting.

Validation of the Flexible and Rigid Cognitive Restraint Scales in a General French Population

Distinguishing between flexible and rigid cognitive restraint (CR) may be useful for understanding the role of CR in dietary behavior and weight status. This study aimed to translate and adapt the flexible and rigid CR scales to the French context and test their psychometric properties. Construct validity, internal consistency, and test-retest reliability were examined in a sample of 620 individuals. Confirmatory factor analysis of the scales found a two-factor structure (flexible CR: 12 items; rigid CR: 15 items) that provided a good fit and supported the initial solution (χ² = 584.7, df = 322, CFI = 0.96, RMSEA = 0.052 [0.045, 0.059], TLI = 0.95). Higher flexible and rigid CR were associated with higher CR overall, emotional eating (TFEQ-R21) and eating disorders (SCOFF), and lower intuitive eating (IES-2). In addition, higher flexible CR was associated with lower impulsivity (BIS-11) while higher rigid CR was associated with higher uncontrolled eating (TFEQ-R21) and lower self-esteem (RSES), satisfaction with life (SWLS), and optimism (LOT-R). Flexible and rigid CR internal consistency was satisfactory (McDonald ω = 0.77 and 0.74, respectively) and test-retest reliability was good (ICC = 0.81 and 0.79, respectively). This study validated a flexible and rigid CR tool in a French population and confirmed that these two types of CR represent distinct eating behaviors.

The moderating role of self-compassion on the relationship between emotion-focused impulsivity and dietary restraint in a diverse undergraduate sample

OBJECTIVE

High levels of emotion-focused impulsivity (e.g., negative urgency) are significantly related to disordered eating behaviors, including dietary restraint. The objective of the current study was to understand the moderating role of self-compassion between emotion-focused impulsivity and dietary restraint in a diverse undergraduate sample. We hypothesized that high levels of self-compassion would protect individuals with high levels of emotion-focused impulsivity from engaging in high levels of dietary restraint.

METHOD

Participants (n = 607, M_age = 18.8, 63 % female, 45.3 % White) completed the UPPS-P, Eating Disorder Examination Questionnaire, and the Self-Compassion Questionnaire as part of a larger study examining eating behaviors in college students.

RESULTS

Negative urgency, but not positive urgency, was related to dietary restraint. Self-compassion moderated the relationship between both forms of impulsivity and dietary restraint, such that individuals with high emotion-focused impulsivity and high self-compassion had lower dietary restraint than individuals who had high emotion-focused impulsivity and low self-compassion.

DISCUSSION

Emotion-focused urgency is a risk factor for dietary restraint; both factors are highly correlated with more severe eating pathology, such as binging and purging behaviors. Self-compassion may buffer against the risk of emotion-focused impulsivity on engaging in dietary restraint behaviors in a community sample, which may inform our understanding of preventative interventions against eating pathology. These results should be replicated in clinical populations and across eating disorder diagnoses.

Hypnosis reduces food impulsivity in patients with obesity and high levels of disinhibition: HYPNODIET randomized controlled clinical trial

BACKGROUND

The obesogenic environment of Western countries raises questions about its current management. Some clinical studies have explored hypnosis, although the current state of knowledge does not lead to definitive conclusions about its efficacy.

OBJECTIVES

We assessed the impact of Ericksonian hypnosis and self-hypnosis on disinhibition of eating in adults with obesity and high food impulsivity levels, compared with standard nutritional education.

METHODS

From September 2014 to July 2015, adults with BMI (in kg/m2) of 30-40 and a high disinhibition score [>8 on the Three Factor Eating Questionnaire (TFEQ-51)] were included in a randomized controlled trial. The control and hypnosis groups received the same standard nutrition education in 8 workshops. In the hypnosis group, subjects had 8 sessions of hypnosis combined with training in self-hypnosis. Disinhibition (primary outcome) and other scores from the TFEQ-51 as well as anthropometric, food intake, cardiometabolic, and physical activity variables were collected at inclusion and at 8 mo.

RESULTS

Of 82 randomly assigned adults, 70 participated in all sessions; 80 participated in ≥1 session and were included in the main analysis (hypnosis group, n = 41; control group, n = 39). After 8 mo of follow-up, disinhibition scores adjusted for baseline values were lower in the hypnosis group, with a mean between-group difference of 4.2 (95% CI: 2.8, 5.5; P < 0.001); 67.7% of adults in the hypnosis group had normalized their disinhibition (compared with 11.1% in control; P < 0.0001). Differences for weight (1.8 kg; 95% CI: -0.1, 3.7 kg; P = 0.052), BMI (0.8; 95% CI: 0.1, 1.4; P = 0.028), susceptibility to hunger score (2.2; 95% CI: 1.0, 3.3; P < 0.001), and its 2 subscales also favored the hypnosis group.

CONCLUSIONS

In the management of adults with obesity and a high disinhibition score, hypnosis and self-hypnosis can significantly improve the deep mechanisms of eating behaviors and seem to have a beneficial effect on weight loss.This trial was registered at clinicaltrials.gov as NCT02292108.

Resting state differences between successful and unsuccessful restrained eaters

Restrained eating is a popular weight loss strategy for young women that tends to have limited effectiveness over extended periods of time. Although previous studies have explored and identified possible personality and behavior differences between successful and unsuccessful restrained eaters (REs), there has been a paucity of research on neurophysiological differences.Towards addressing this gap, we assessed brain resting state (Rs) differences in groups of unsuccessful REs (N = 39) and successful REs (N = 31). In line with hypotheses, unsuccessful REs displayed reduced regional homogeneity in brain regions involved in cognitive control (inferior parietal lobe) compared to successful REs. Regions involved in conflict monitoring (anterior cingulate cortex) were also observed to be comparatively less active in the unsuccessful RE group. Finally, based on analyses of independent components and seed-based functional connectivity, regions involved in conflict monitoring and cognitive control, especially those localized within the frontoparietal network, showed weaker connectivities among unsuccessful REs compared to their successful counterparts.These results underscore specific brain Rs differences between successful REs and unsuccessful REs in regions implicated in cognitive control and conflict monitoring.

Too stressed to self-regulate? Associations between stress, self-reported executive function, disinhibited eating, and BMI in women

Stress is associated with obesity. Executive Function (EF), a set of behavioral regulation capacities, may play a mediating role in this relation if lower EF increases disinhibited eating. Participants were 249 women who completed an online survey. We measured stress using Cohen's Perceived Stress Scale, EF using the Behavior Rating Inventory of Executive Function (BRIEF), disinhibited eating using the Three Factor Eating Questionnaire, and self-reported BMI. We used path analysis on this cross-sectional sample of women to test our hypothesis that higher stress is associated with reduced EF, greater disinhibited eating, and higher BMI and tested the indirect effects from stress to disinhibited eating and from stress to BMI. Stress was related to lower EF (β = 0.53 p < .001), lower EF was related to greater disinhibited eating (β = 0.34, p < .001), and disinhibited eating was related to higher BMI (β = 0.37, p < .001). There was an indirect effect of stress on disinhibited eating through EF (β = 0.18, SE = 0.04, p < .001) and an indirect effect of stress on BMI through EF and disinhibited eating (β = 0.07, SE = 0.02, p < .001). Women with higher stress may have higher BMI, in part due to reduced EF and disinhibited eating, suggesting that interventions designed to improve stress management and EF may also improve success with weight control, at least in this population of women.

Predicting Weight Loss Using Psychological and Behavioral Factors: The POUNDS LOST Trial

CONTEXT

Eating habits and food craving are strongly correlated with weight status. It is currently not well understood how psychological and behavioral factors influence both weight loss and weight regain.

OBJECTIVE

To examine the associations between psychological and behavioral predictors with weight changes and energy intake in a randomized controlled trial on weight loss.

DESIGN AND SETTING

The Prevention of Obesity Using Novel Dietary Strategies is a dietary intervention trial that examined the efficacy of 4 diets on weight loss over 2 years. Participants were 811 overweight (body mass index, 25-40.9 kg/m2; age, 30-70 years) otherwise healthy adults.

RESULTS

Every 1-point increase in craving score for high-fat foods at baseline was associated with greater weight loss (-1.62 kg, P = .0004) and a decrease in energy intake (r = -0.10, P = .01) and fat intake (r = -0.16, P < .0001) during the weight loss period. In contrast, craving for carbohydrates/starches was associated with both less weight loss (P < .0001) and more weight regain (P = .04). Greater cognitive restraint of eating at baseline was associated with both less weight loss (0.23 kg, P < .0001) and more weight regain (0.14 kg, P = .0027), whereas greater disinhibition of eating was only associated with more weight regain (0.12 kg, P = .01).

CONCLUSIONS

Craving for high-fat foods is predictive of greater weight loss, whereas craving for carbohydrates is predictive of less weight loss. Cognitive restraint is predictive of less weight loss and more weight regain. Interventions targeting different psychological and behavioral factors can lead to greater success in weight loss.

Appetite-Related Responses to Overfeeding and Longitudinal Weight Change in Obesity-Prone and Obesity-Resistant Adults

OBJECTIVE

Appetite responses to 3 days of overfeeding (OF) were examined as correlates of longitudinal weight change in adults classified as obesity prone (OP) or obesity resistant (OR).

METHODS

OP (n = 22) and OR (n = 30) adults consumed a controlled eucaloric and OF diet (140% of energy needs) for 3 days, followed by 3 days of ad libitum feeding. Hunger and satiety were evaluated by visual analog scales. Ghrelin and peptide YY (PYY) levels were measured during a 24-hour inpatient visit on day 3. Body weight and composition were measured annually for 4.0 ± 1.3 years.

RESULTS

Dietary restraint and disinhibition were greater in OP than OR (mean difference: 3.5 ± 1.2 and 3.3 ± 0.9, respectively; P < 0.01) participants, and disinhibition was associated with longitudinal weight change (n = 48; r = 0.35; P = 0.02). Compared with the eucaloric diet, energy intake fell significantly in OR participants following OF (P = 0.03) but not in OP (P = 0.33) participants. Twenty-four-hour PYY area under the curve values increased with OF in OR (P = 0.02) but not in OP (P = 0.17) participants. Furthermore, changes in PYY levels with OF correlated with measured energy intake (r = -0.36; P = 0.01).

CONCLUSIONS

Baseline disinhibition and PYY responses to OF differed between OP and OR adults. Dietary disinhibition was associated with 5-year longitudinal weight gain. Differences in appetite regulation may underlie differences in propensity for weight gain.

Associations between eating behaviors, diet quality and body mass index among adolescents

OBJECTIVE

Some eating behaviors are associated with negative nutrition-related outcomes in adults, but research is lacking in adolescent samples. The current study examined whether dietary restraint moderates the relationship between disinhibition and weight outcomes and overall diet quality in a community sample of 16-year old adolescents.

METHODS

Participants were recruited from a longitudinal study examining self-regulation and cardiometabolic risk. Data for this cross-sectional study were collected from questionnaires and laboratory visits when participants were approximately 16 years old (n = 178). Disinhibition and restraint were assessed using two subscales of the Three-Factor Eating Questionnaire. Diet quality was determined using Healthy Eating Index-2010 (HEI-2010) scores that were calculated using dietary data from 24-h dietary recalls. Two separate hierarchical linear regression analyses tested whether restraint moderated the associations of disinhibition with BMI-for-age percentile and HEI-2010 scores.

RESULTS

After adjusting for covariates, restraint moderated the association between disinhibition and HEI-2010 scores (β = -0.21, p = 0.03). There was a main effect for disinhibition on BMI-for-age percentiles (β = 0.58, p = 0.02), but this relationship was not moderated by the level of restraint.

CONCLUSIONS

The relationship between disinhibition and overall diet quality differed among adolescents according to level of dietary restraint. Although disinhibition independently predicted weight status, the level of restraint had no influence on this association. Future studies should examine restraint in relation to energy intake and weight concerns to better understand how it influences weight and dietary outcomes in this population.

Different and Unequal: A Qualitative Evaluation of Salient Factors Influencing Energy Intake in Adults with Overweight and Obesity

Environmental factors such as food availability and variety can function as cues for overeating in individuals susceptible to overweight or obesity, but relatively little is known about other types of environmental factors that may also be important. This qualitative study compared and contrasted categories of internal and external cues through focus groups and key informant interviews with 24 adults (26 to 77 years old) in the United States who had a body mass index within the healthy range (21.6 ± 2.5 kg/m²) or had overweight or obesity (29.1 ± 3.6 kg/m²). Five domains of external factors influencing food intake were identified: (a) Environmental cues including food availability and variety; (b) normative expectations for dietary intake; (c) food palatability; (d) overt social pressures to overeat; and (e) perceived social expectations around eating. All external domains were noted by participants with overweight or obesity to be challenging, and solutions to avoid overeating were lacking; however, overt social pressures and perceived social expectations appeared to be especially problematic. By explicitly defining different domains of external factors that challenge healthy weight regulation, this study identifies specific targets to address in interventions for healthy weight management.

Uncontrolled Eating during Pregnancy Predicts Fetal Growth: The Healthy Mom Zone Trial

Excess maternal weight gain during pregnancy elevates infants' risk for macrosomia and early-onset obesity. Eating behavior is also related to weight gain, but the relationship to fetal growth is unclear. We examined whether Healthy Mom Zone, an individually tailored, adaptive gestational weight gain intervention, and maternal eating behaviors affected fetal growth in pregnant women (n = 27) with a BMI > 24. At study enrollment (6-13 weeks gestation) and monthly thereafter, the Three-Factor Eating Questionnaire was completed. Ultrasounds were obtained monthly from 14-34 weeks gestation. Data were analyzed using multilevel modeling. Higher baseline levels of uncontrolled eating predicted faster rates of fetal growth in late gestation. Cognitive restraint was not associated with fetal growth, but moderated the effect of uncontrolled eating on fetal growth. Emotional eating was not associated with fetal growth. Among women with higher baseline levels of uncontrolled eating, fetuses of women in the control group grew faster and were larger in later gestation than those in the intervention group (study group × baseline uncontrolled eating × gestational week interaction, p = 0.03). This is one of the first intervention studies to use an individually tailored, adaptive design to manage weight gain in pregnancy to demonstrate potential effects on fetal growth. Results also suggest that it may be important to develop intervention content and strategies specific to pregnant women with high vs. low levels of disinhibited eating.

Epidemic obesity in children and adolescents: risk factors and prevention

The prevalence of obesity among children and adolescents (aged 2-18 years) has increased rapidly, with more than 100 million affected in 2015. Moreover, the epidemic of obesity in this population has been an important public health problem in developed and developing countries for the following reasons. Childhood and adolescent obesity tracks adulthood obesity and has been implicated in many chronic diseases, including type 2 diabetes, hypertension, and cardiovascular disease. Furthermore, childhood and adolescent obesity is linked to adulthood mortality and premature death. Although an imbalance between caloric intake and physical activity is a principal cause of childhood and adolescent obesity, environmental factors are exclusively important for development of obesity among children and adolescents. In addition to genetic and biological factors, socioenvironmental factors, including family, school, community, and national policies, can play a crucial role. The complexity of risk factors for developing obesity among children and adolescents leads to difficulty in treatment for this population. Many interventional trials for childhood and adolescent obesity have been proven ineffective. Therefore, early identification and prevention is the key to control the global epidemic of obesity. Given that the proportion of overweight children and adolescents is far greater than that of obesity, an effective prevention strategy is to focus on overweight youth, who are at high risk for developing obesity. Multifaceted, comprehensive strategies involving behavioral, psychological, and environmental risk factors must also be developed to prevent obesity among children and adolescents.

Features and Trajectories of Eating Behavior in Weight-Loss Maintenance: Results from the German Weight Control Registry

OBJECTIVE

Eating behaviors such as dietary restraint and disinhibition caused by emotional and external cues play a relevant role in weight-loss maintenance.

METHODS

Four hundred forty individuals with successful weight-loss maintenance included in the prospective German Weight Control Registry completed the Dutch Eating Behavior Questionnaire. Participants were categorized into the following two weight groups: stable weight trajectory (WS) (n = 280) and unstable weight trajectory (WUS) (n = 160) over the 2-year assessment period.

RESULTS

Those with successful weight-loss maintenance had significantly higher scores on the restrained and emotional eating subscales compared with a general population (GP) sample. At baseline, the WS individuals had lower restrained, emotional, and external eating scores compared with the WUS individuals. Over the 2-year follow-up period, the trajectories of the restraint scores decreased in both groups but stayed elevated compared with the GP sample. Scores of the emotional and external eating subscales remained stable in the WS group but increased in the WUS group.

CONCLUSIONS

A certain degree of restraint seems to be necessary for successful weight-loss maintenance; however, high emotional and external eating may counteract this effect, resulting in weight regain in the long run.

Flexible Eating Behavior Predicts Greater Weight Loss Following a Diet and Exercise Intervention in Older Women

Eating behaviors (cognitive restraint, flexible and rigid restraint, disinhibition, hunger) have been associated with obesity and weight loss success in middle-aged individuals, but little is known about these relationships in older adults. This study examined relationships between eating behaviors and weight loss in overweight/obese older women (n = 61; 69 ± 3.6 years; body mass index = 31.1 ± 5.0 kg/m²) completed a 6-month behavioral weight loss intervention. Baseline, postintervention, and change measures of eating behaviors (51-items Three-Factor Eating Questionnaire) were assessed for relationships with weight loss. In the final regression model, an increase in flexible restraint accompanied by a decrease in rigid restraint predicted greater weight loss (adjusted R² = 0.21, Model F (4, 56) = 4.97, P < 0.01). No associations were found with disinhibition or hunger and degree of weight loss (all P > 0.05). Results suggest encouraging a flexible approach to eating behavior and discouraging rigid adherence to a diet may lead to better intentional weight loss for overweight and obese older women.

Study Time after School and Habitual Eating Are Associated with Risk for Obesity among Overweight Korean Children: A Prospective Study

OBJECTIVE

To investigate behavioral factors that contribute to the development of obesity among overweight children.

METHODS

Among a community sample of 884 children aged 9-13 years, 833 children completed a baseline and 1-year follow-up examination that included anthropometrics, physical fitness, and behavioral factors.

RESULTS

During the follow-up period, BMI for most children with normal weight or obesity did not change. However, among overweight children (n = 100), about one-third developed obesity (n = 26), while the others were categorized as normal weight (n = 32) or overweight (n = 42) after 1 year. Characteristics of overweight children at baseline and follow-up were analyzed. Those who developed obesity showed a notable increase in blood pressure as well as in BMI, waist circumference, and body fat over 1 year. At baseline, this group spent more time studying after school compared to overweight children who did not develop obesity, while there were no differences in time spent viewing television or engaging in vigorous physical activity. Eating outside the home, fast food consumption, and habitual eating in the absence of hunger were more common at baseline in those who did versus those who did not develop obesity. After adjusting for age, sex, and BMI, spending more time studying after school and habitual eating without hunger were associated with the development of obesity.

CONCLUSION

Among Korean overweight children, study time after school and habitual eating without hunger were associated with an increased risk for development of obesity.

Dietary disinhibition mediates the relationship between poor sleep quality and body weight

BACKGROUND

Inadequate sleep independently influences eating habits and weight status. However, the relationship between these three factors has not been well quantified. The objective of this study was to examine if eating behavior (i.e. dietary restraint, disinhibition and hunger) mediates the relationship between sleep and body mass index (BMI) in a large sample of American adults.

METHOD

Cross-sectional data from the Nathan Kline Institute Rockland sample were assessed (n = 602; 38.9 ± 14.5 years). Self-reported sleep and eating behavior were measured using the Pittsburgh Sleep Quality Index and Three Factor Eating Questionnaire, respectively. Path analysis was used to examine relationships amongst the construct, with mediation tested via bootstrapped confidence intervals.

RESULTS

Poorer sleep quality was associated with both greater hunger (P = 0.03) and higher disinhibited eating (overeating in the presence of palatable foods or other disinhibiting stimuli like emotional stress; P < 0.001) behaviors. Higher disinhibited eating behavior was also associated with higher BMI (P < 0.001). There was a significant indirect relationship between sleep quality and BMI via disinhibition (b [95% CI] = 0.13 [0.06, 0.21], P = 0.001). No significant effects were found when total sleep time or time in bed were replaced as predictors in the mediation model.

CONCLUSION

Disinhibited eating behavior mediated the relationship between sleep quality and weight status in both males and females. This mediation was due to aspects of sleep quality other than duration. These results suggest that improving sleep quality may benefit weight loss by helping to reduce an individuals' susceptibility to overeating.

Contextual factors associated with eating in the absence of hunger among adults with obesity

Eating in the absence of hunger (EAH) is under-explored in adults with obesity. In this study, 50 adults with obesity recorded eating episodes and theoretically-relevant environmental, perceptual, and emotional correlates in the natural environment for 2weeks via ecological momentary assessment (EMA). Generalized linear models and mixed models were used to characterize correlates and consequences of EAH vs. non-EAH episodes/tendencies (within-subjects and between-subjects effects, respectively), time of day, and time of day×EAH interactions. Approximately 21% of EMA-recorded eating episodes involved EAH, and 70% of participants reported at least 1 EAH episode. At the within-person level, participants' EAH episodes were associated with greater self-labeled overeating than their non-EAH episodes. At the between-person level, participants who tended to engage in more EAH reported less self-labeled overeating than those who engaged in less EAH. Across EAH and non-EAH episodes, eating in the evening was associated with overeating, expecting eating to be more rewarding, greater alcoholic beverage consumption, eating alone, eating because others are eating, and eating while watching television. Significant EAH×time of day interactions were also observed but the pattern of findings was not consistent. Findings suggest that EAH may be a relevant target for reducing food intake in individuals with obesity given its high prevalence and association with perceptions of overeating, although results should be extended using objective measures of food intake. Associations between evening eating episodes and perceptual and environmental factors should be further explored.

Hunger and disinhibition but not cognitive restraint are associated with central norepinephrine transporter availability

The relationship between food-intake related behaviours measured by the Three-Factor Eating Questionnaire (TFEQ) and in vivo norepinephrine transporter (NET) availability has not been explored yet. We investigated ten obese individuals (body mass index (BMI) 42.4 ± 3.7 kg/m²) and ten normal-weight healthy controls (HC, BMI 23.9 ± 2.5 kg/m²) with (S,S)-[¹¹C]-O-methylreboxetine ([¹¹C]MRB) positron emission tomography (PET). All participants completed the TFEQ, which measures cognitive restraint, disinhibition and hunger. Image analysis required magnetic resonance imaging data sets onto which volumes-of-interests were drawn. Tissue time activity curves (TACs) were obtained from the dynamic PET data followed by kinetic modeling of these regional brain TACs applying the multilinear reference tissue model (2 parameters) with the occipital cortex as reference region. Obese individuals scored significantly higher on the hunger subscale of the TFEQ. Correlative data analysis showed that a higher degree of hunger correlated negatively with the NET availability of the insular cortex in both obese individuals and HC; however, this finding was more pronounced in obesity. Further, for obese individuals, a negative correlation between disinhibition and NET BP_ND of the locus coeruleus was detected. In conclusion, these initial data provide in vivo imaging support for the involvement of the central NE system in maladaptive eating behaviors such as susceptibility to hunger.

Are overeating and food addiction related to distress tolerance? An examination of residents with obesity from a U.S. metropolitan area

OBJECTIVE

Low distress tolerance (DT) is an inability to handle negative emotions. There is strong support for the connection between low DT and substance addiction, which suggests that the former might be related to food addiction (FA). Previous work found that low DT was related to overeating in a college sample. The current study had two primary aims: (1) to determine whether low DT is associated with overeating in a sample of participants with diverse races and incomes, and (2) to investigate the relationships among DT and body mass index (BMI) as well as DT and FA symptoms. DT as a moderator of the association between general overeating and FA was also explored.

METHODS

One hundred and ninety residents of Metropolitan Detroit communities (mean age: 41.71; 45.8% male; 34.7% non-White race; 47.4% with obesity) completed the DT Scale, Dutch Eating Behavior Questionnaire, Three Factor Eating Questionnaire, and Yale FA Scale. BMI was based on measured weight and height.

RESULTS

After adjusting for covariates, linear regression models found significant negative relationships between DT and emotional eating (P<0.001), external eating (P<0.001), disinhibition (P<0.001), FA (P<0.001), and BMI (P<0.01). DT was determined to be a moderator, such that among individuals who endorsed high levels of overeating, those with low DT reported more FA symptoms than those with high DT.

CONCLUSION

These findings suggest interventions targeting low DT should be considered to reduce overeating, which is a precursor and maintenance factor of obesity and FA.

Social appearance anxiety and dietary restraint as mediators between perfectionism and binge eating: A six month three wave longitudinal study

Binge eating is related to perfectionism and restrained eating. However, the mechanisms underlying these relationships are not well understood. It is possible that social anxiety, specifically social appearance anxiety (i.e., the fear of overall appearance evaluation), influences the relationship between binge eating, perfectionism, and dietary restraint. In the current study (N = 300 women), we tested the relationship between dietary restraint, social appearance anxiety, concern over mistakes (a component of perfectionism), and binge eating in prospective data (three time points: at baseline, at two month, and at six month follow up). We found that social appearance anxiety, dietary restraint, and concern over mistakes each predicted binge eating at baseline. Only social appearance anxiety prospectively predicted binge eating when accounting for all variables. Further, in the tested model, social appearance anxiety mediated the relationship between concern over mistakes and binge eating across six months. On the contrary, dietary restraint did not mediate the relationship between concern over mistakes and binge eating in the tested model. The finding that social appearance anxiety served as a mediator between concern over mistakes and binge eating, but that dietary restraint did not, implies that social appearance anxiety may be a more salient prospective predictor of binge eating than dietary restraint. Intervening on social appearance anxiety may be important in the treatment and prevention of binge eating.

Exploring the Relationship between Body Composition and Eating Behavior Using the Three Factor Eating Questionnaire (TFEQ) in Young New Zealand Women

Obesity is a leading cause of morbidity and mortality, yet is preventable. This study aimed to investigate associations between body mass index, body fat percentage and obesity-related eating behaviors. Women (n = 116; 18–44 years) were measured for height, weight and body fat using air displacement plethysmography (BodPod). Women completed the validated Three Factor Eating Questionnaire to assess their eating behaviors using Restraint, Disinhibition and Hunger eating factor categories and sub-categories. The eating behavior data were analyzed for associations with body mass index and body fat percentage, and comparisons across body mass index and body fat percentage categories (< vs. ≥25 kg/m²; < vs. ≥30%, respectively). Women had a mean (standard deviation) body mass index of 23.4 (3.5) kg/m², and body fat percentage of 30.5 (7.6)%. Disinhibition was positively associated with both body mass index (p < 0.001) and body fat percentage (p < 0.001). Emotional Disinhibition was positively associated with body fat percentage (p < 0.028). Women with low Restraint and high Disinhibition had significantly higher body mass index and body fat percentage than women with high Restraint and low Disinhibition. Disinhibition seems likely to be an important contributor to obesity. Tailored intervention strategies focused on counteracting Disinhibition should be a key target area for managing weight/fat gain.

Associations between Restrained Eating and the Size and Frequency of Overall Intake, Meal, Snack and Drink Occasions in the UK Adult National Diet and Nutrition Survey

Obesity is a global public health priority. Restrained eating is related to obesity and total energy intake but associations with the eating patterns are unclear. We examined the associations of restrained eating with the size and frequency of intake occasions among 1213 British adult (19-64 y) participants in a cross-sectional analysis of the UK National Diet and Nutrition Survey 2000. The Dutch Eating Behaviour Questionnaire assessed restrained eating. Overall intake occasions were all energy consumed in a 60 min period. A food-based classification separated intake occasions into meals, snacks, or drinks from seven-day weighed food diaries. Average daily frequency and size (kcal) of overall intake, meal, snack and drink occasions were calculated and associations with restrained eating were modelled using multiple linear regression including under-reporting of energy intake, age, gender, BMI, emotional eating, external eating and physical activity as covariates. Restrained eating was very weakly positively correlated with overall intake (r = 0.08, p<0.05) and meal frequency (r = 0.10, p<0.05) but not snack or drink frequency (r = 0.02 and -0.02 respectively). Adjusted regressions showed a one-point change in restrained eating was associated with 0.07 (95% CI 0.03, 0.11) more meal occasions/day and 0.13 (95% CI 0.01, 0.25) extra overall intake occasions/day. Overall intake occasion size was weakly negatively correlated with restrained eating regardless of type (r = -0.16 to -0.20, all p<0.0001). Adjusted regressions showed each one-point increase in restrained eating was associated with lower-energy meals (-15 kcal 95% CI -5.9, -24.2) and drinks (-4 kcal 95%CI -0.1, -8), but not snacks or overall intake occasions. Among a national sample of UK adults, greater restrained eating was associated with smaller and slightly more frequent eating, suggesting that restrained eaters restrict their energy intake by reducing meal/drink size rather than skipping snacks.

Greater hunger and less restraint predict weight loss success with phentermine treatment

OBJECTIVE

Phentermine is thought to cause weight loss through a reduction in hunger. It was hypothesized that higher hunger ratings would predict greater weight loss with phentermine.

METHODS

This is an observational pilot study in which all subjects were treated with phentermine for 8 weeks and appetite and eating behaviors were measured at baseline and week 8. Outcomes were compared in subjects with ≥5% vs. <5% weight loss, and linear regression was used to identify predictors of percent weight loss.

RESULTS

Twenty-seven subjects (37 ± 4.5 years, 93.8 ± 12.1 kg, BMI 33.8 ± 3.1 kg m(-2) ) completed the study, with mean weight loss of -5.4 ± 3.3 kg (-5.7% ± 3.2%). Subjects with ≥5% weight loss had higher baseline pre-breakfast hunger (P = 0.017), desire to eat (P =0.003), and prospective food consumption (0.006) and lower baseline cognitive restraint (P = 0.01). In addition, higher baseline home prospective food consumption (P = 0.002) and lower baseline cognitive restraint (P < 0.001) were found to be predictors of weight loss.

CONCLUSIONS

These results suggest that individuals reporting greater hunger and less restraint are more likely to achieve significant weight loss with phentermine. This information can be used clinically to determine who might benefit most from phentermine treatment.

Temperament Dispositions, Problematic Eating Behaviours and Overweight in Adolescents

Obesity, a common health condition in adolescence leading to severe medical complications, is assumed to be influenced by temperament factors. This paper investigates associations between reactive and regulative temperament, problematic eating behaviours and excess weight. Several self-report instruments were completed by 130 adolescents (mean age 14.13 ± 0.61 years), including 27 overweight and obese individuals (20.8%). Bootstrap analysis revealed a mediating effect of restrained eating on the relation between reactive temperament and body mass index percentile, which differed according to gender: Restrained eating, which predicted weight gain, was more present in girls having a higher sensitivity to reward and in boys showing a higher sensitivity to punishment. No effect of regulative temperament was found. These results have important implications for weight management programmes, as they suggest that reducing restrained eating by working on temperament may help to control weight.

Quantifying consumer portion control practices. A cross-sectional study

The use of portion control practices has rarely been quantified. The present study aimed to: (1) explore which portion control practices are actually used by the general population and their association with cognitive restraint, demographic background and general health interest (GHI), and (2) examine how the usage of portion control practices predicts the estimated consumption of an energy dense food (i.e. pizza). Twenty-two portion control practices were rated in terms of their frequency of use from 'never' to 'very often' by a representative sample of 1012 consumers from the island of Ireland. Three factors were extracted and named: measurement-strategy scale, eating-strategy scale, and purchasing-strategy scale. The eating-strategy scale score was the highest, while the measurement-strategy scale carried the lowest frequency score. For each strategy scale score, the strongest predictor was GHI, followed by gender. Having higher GHI and being female were independently associated with more frequent portion control. Both the eating-strategy scale score and the purchasing-strategy scale score were negatively associated with pizza portion size consumption estimates. In conclusion, while this study demonstrates that the reported use of portion control practices is low, the findings provide preliminary evidence for their validity. Further studies are needed to explore how portion control practices are used in different kinds of portion size decisions and what their contribution is to the intake of food over an extended period of time.

Eating behavior and obesity in bipolar disorder

OBJECTIVES

Individuals with bipolar disorder are more frequently overweight or obese than the general population, but the reasons for this association are unknown. The aim of this study is to further understand the etiology of overweight and obesity in bipolar disorder.

METHODS

We invited patients in a specialty outpatient bipolar clinic to complete the Eating Inventory. Patients provided self-reported restraint, disinhibition, and perceived hunger as well as general perceptions of dietary intake.

RESULTS

Sixty-two individuals (37 female) between the ages of 18 and 67 (M = 41.5, SD = 13.38) and with an average body mass index (BMI) of 27.18 (SD = 5.71) completed the survey. Disinhibition and perceived hunger were positively correlated with BMI and self-reported difficulty eating healthy foods. Restraint was positively correlated with healthy eating (ps < .05). Stepwise linear regressions revealed that hunger was the most significant predictor of BMI (F(1) = 8.134, p = .006). Those participants with bipolar I or II disorder reported greater hunger scores (p < .01) and difficulty eating healthily (p < .05) than those without a full diagnosis.

CONCLUSIONS

These results suggest that disinhibition and perception of hunger may be linked to the disproportionately high rate of obesity in bipolar disorder.

The influence of BMI and predictors of disordered eating and life satisfaction on postmenopausal women

This study aims to compare eating behaviors, body satisfaction, exercise, and life satisfaction between normal-weight and overweight postmenopausal women and to examine the predictors of disordered eating and life satisfaction among postmenopausal women (n = 294). The overweight group had more eating disordered behavior, more body dissatisfaction, and lower physical quality of life. The increase of age predicted less disordered eating. Higher BMI, the perception of an ideal weight lower than the current one, lower body satisfaction, and physical quality of life predicted disordered eating. Higher body satisfaction, less psychosocial discomfort, and a greater degree of sexual symptom discomfort predicted life satisfaction.

The effects of Young Adults Eating and Active for Health (YEAH): a theory-based Web-delivered intervention

OBJECTIVE

To assess the effectiveness of a tailored theory-based, Web-delivered intervention (Young Adults Eating and Active for Health) developed using community-based participatory research process.

DESIGN

A 15-month (10-week intensive intervention with a 12-month follow-up) randomized, controlled trial delivered via Internet and e-mail.

SETTING

Thirteen college campuses.

PARTICIPANTS

A total of 1,639 college students.

INTERVENTION

Twenty-one mini-educational lessons and e-mail messages (called nudges) developed with the non-diet approach and focusing on eating behavior, physical activity, stress management, and healthy weight management. Nudges were short, frequent, entertaining, and stage-tailored to each behavior, and reinforced lesson content.

MAIN OUTCOME MEASURE

All participants were assessed at baseline, postintervention (3 months from baseline), and follow-up (15 months from baseline) for primary outcomes of weight, body mass index (BMI), fruit and vegetable intake (FVI), physical activity (PA), and perceived stress; and secondary outcomes of waist circumference, percent dietary fat, energy from sugar-sweetened beverages, servings of whole grains, self-instruction and regulation for mealtime behavior, hours of sleep, and stage of readiness for change for consuming 5 cups of FVI, completing 150 minutes of PA/wk, and managing stress on most days of the week. Demographics were collected at baseline.

ANALYSIS

Chi-square analysis and mixed-models repeated measures analysis were performed to determine differences between experimental and control outcomes.

RESULTS

There were no differences between experimental and control participants in BMI, weight, and waist circumference. There were small improvements in FVI (P = .001), vigorous PA in females (P = .05), fat intake (P = .002), self-instruction (P = .001), and regulation (P = .004) for mealtime behavior, and hours of sleep (P = .05) at postintervention, but improvements were not maintained at follow-up. At postintervention, a greater proportion of experimental participants were in the action/maintenance stages for FVI (P = .019) and PA (P = .002) than control.

CONCLUSIONS AND IMPLICATIONS

Young Adults Eating and Active for Health is one of the first studies to use the community-based participatory research process of PRECEDE-PROCEED to develop a non-diet approach intervention. Although there were no differences between experimental and control participants in weight change or BMI, the intervention supported positive change in behaviors that may mediate excessive weight gain, such as increasing FVI and more healthful self-regulation mealtime behaviors immediately postintervention. Additional strategies to maintain the behavior changes need to be explored.

Body weight status, eating behavior, sensitivity to reward/punishment, and gender: relationships and interdependencies

Behavioral and personality characteristics are factors that may jointly regulate body weight. This study explored the relationship between body mass index (BMI) and self-reported behavioral and personality measures. These measures included eating behavior (based on the Three-Factor Eating Questionnaire; Stunkard and Messick, 1985), sensitivity to reward and punishment (based on the Behavioral Inhibition System/Behavioral Activation System (BIS/BAS) scales) (Carver and White, 1994) and self-reported impulsivity (based on the Barratt Impulsiveness Scale-11; Patton et al., 1995). We found an inverted U-shaped relationship between restrained eating and BMI. This relationship was moderated by the level of disinhibited eating. Independent of eating behavior, BIS and BAS responsiveness were associated with BMI in a gender-specific manner with negative relationships for men and positive relationships for women. Together, eating behavior and BIS/BAS responsiveness accounted for a substantial proportion of BMI variance (men: ∼25%, women: ∼32%). A direct relationship between self-reported impulsivity and BMI was not observed. In summary, our results demonstrate a system of linear and non-linear relationships between the investigated factors and BMI. Moreover, body weight status was not only associated with eating behavior (cognitive restraint and disinhibition), but also with personality factors not inherently related to an eating context (BIS/BAS). Importantly, these relationships differ between men and women.

Psychological characteristics, eating behavior, and quality of life assessment of obese patients undergoing weight loss interventions

BACKGROUND AND AIMS

Bariatric surgery is the most effective treatment for obesity. However, not all patients have similar weight loss following surgery and many researchers have attributed this to different pre-operative psychological, eating behavior, or quality-of-life factors. The aim of this study was to determine whether there are any differences in these factors between patients electing to have bariatric surgery compared to less invasive non-surgical weight loss treatments, between patients choosing a particular bariatric surgery procedure, and to identify whether these factors predict weight loss after bariatric surgery.

MATERIAL AND METHODS

This was a prospective study of 90 patients undergoing gastric bypass, vertical sleeve gastrectomy, or adjustable gastric banding and 36 patients undergoing pharmacotherapy or lifestyle interventions. All patients completed seven multi-factorial psychological, eating behavior, and quality-of-life questionnaires prior to choosing their weight loss treatment. Questionnaire scores, baseline body mass index, and percent weight loss at 1 year after surgical interventions were recorded.

RESULTS AND CONCLUSIONS

Surgical patients were younger, had a higher body mass index, and obesity had a higher impact on their quality of life than on non-surgical patients, but they did not differ in the majority of eating behavior and psychological parameters studied. Patients opting for adjustable gastric banding surgery were more anxious, depressed, and had more problems with energy levels than those choosing vertical sleeve gastrectomy, and more work problems compared to those undergoing gastric bypass. Weight loss after bariatric surgery was predicted by pre-operative scores of dietary restraint, disinhibition, and pre-surgery energy levels. The results of this study generate a number of hypotheses that can be explored in future studies and accelerate the development of personalized weight loss treatments.

Development of Young Adults Eating and Active for Health (YEAH) internet-based intervention via a community-based participatory research model

OBJECTIVE

To develop a tailored, theory-based, Web-delivered intervention to prevent excessive weight gain in young adults using a Community-Based Participatory Research model.

DESIGN

Investigators from 14 universities developed the intervention and supporting administrative portal using the 4 phases of the PRECEDE model. Steering committees were composed of the target audience (aged 19-24 years) and key health/wellness personnel were formed at each institution and provided information during each phase that was used to guide development of the intervention, Project YEAH (Young Adults Eating and Active for Health). Piloting results were used to refine the curriculum and identify and avoid barriers to delivery.

RESULTS

Qualitative and quantitative data collected at each phase informed Project YEAH development. In Phase 1, factors of highest priority to young adults were identified. In Phase 2, environmental supports for healthful lifestyles were elucidated. In Phase 3, behavior and environmental changes considered important and changeable were identified. In Phase 4, the 10-week, theory-based, stage-tailored, interactive-learning intervention with a 10-month reinforcement period was developed.

CONCLUSIONS AND IMPLICATIONS

Applying the PRECEDE model with fidelity during development of Project YEAH resulted in an intervention that pilot participants found relevant and useful, gained attention, instilled confidence in the ability to apply the information, and provided a sense of satisfaction.

Restrained eating and self-esteem in premenopausal and postmenopausal women

BACKGROUND

There has been limited research about disordered eating in middle-aged women, and to date, few data exist about restrained eating behavior in postmenopausal women. Therefore, the aim of this study was to examine eating behavior with a specific focus on menopause as an associated factor in restrained eating. Beyond this, we were interested in how postmenopausal status and self-esteem would interact to determine eating patterns in women in middle age.

METHODS

We conducted an online survey in women aged between 40 and 66. Eating behavior was assessed with the Eating Disorder Examination-Questionnaire (EDE-Q) in premenopausal (N = 318) and postmenopausal women (N = 250). All participants rated their self-esteem using the Rosenberg Self-Esteem Scale (RSE) and reported their weight, height, waist circumference, and hip circumference.

RESULTS

15.7% of all participants showed clinically meaningful scores on restrained eating. Postmenopausal women showed significantly higher scores on the EDE-Q subscale of restrained eating as compared to premenopausal women, but when controlling for body mass index, however, this finding was no longer significant. Further exploratory analyses suggest that particularly low or high self-esteem levels are associated with restrained eating. Self-esteem might serve as a mediator between menopausal status and restrained eating, however results of these additional analyses were inconsistent.

CONCLUSIONS

Restrained eating may appear in middle-aged women. Particularly in postmenopausal women, restrained eating might be associated with lower and higher self-esteem.

Characteristics of individuals who report present and past weight loss behaviours: results from a Canadian university community

PURPOSE

To characterise individuals who reported present and past weight loss behaviours on psycho-behavioural factors known to influence body weight, e.g. overeating, dietary restriction.

METHODS

An online questionnaire was distributed to a university community. Questions pertaining to present weight loss, previous weight loss, eating behaviour tendencies, perceived stress and sleep quality were answered by 3,069 individuals. Body weight and height were self-reported.

RESULTS

Present and past weight loss behaviours were prevalent in the sample, with 33.3 % of the participants who reported trying to lose weight, 33.1 % who reported having previously lost weight (>10 lbs), and 18.8 % who reported repeated weight loss behaviour (i.e. present and past weight loss behaviours). Trying to lose weight and previous weight loss were both independently associated with increased risk for psycho-behavioural characteristics known to be associated with obesity, e.g. overeating tendencies, perceived stress, short sleep duration. This risk was particularly elevated among the underweight/normal-weight individuals who reported repeated weight loss behaviours. Indeed, adjusted odds ratios for reporting restrictive and overeating tendencies, perceived stress and short sleep for these individuals were significantly higher compared to their underweight/normal-weight peers who did not report repeated weight loss behaviours (adjusted odds ratios 4.7, 2.7, 1.8, and 1.8, respectively, p < 0.01 to <0.0001).

CONCLUSIONS

Normal-weight individuals reporting weight loss behaviours are characterised by a psycho-behaviour profile which may further increase their risk of weight gain.

Questionnaire and laboratory measures of eating behavior. Associations with energy intake and BMI in a community sample of working adults

PURPOSE

The present research compared a self-report measure of usual eating behaviors with two laboratory-based behavioral measures of food reward and food preference.

METHODS

Eating behaviors were measured among 233 working adults. A self-report measure was the Three Factor Eating Questionnaire (TFEQ) Restraint, Disinhibition and Hunger subscales. Laboratory measures were the (RVF) and Explicit Liking (EL) and Implicit Wanting (IW) for high fat food. Outcome measures were body mass index (BMI), and energy intake measured using three 24-h dietary recalls.

RESULTS

Significant bivariate associations were observed between each of the eating behavior measures and energy intake, but only Disinhibition and Hunger were associated with BMI. Multiple regression results showed RVF and EL and IW predicted energy intake independent of the TFEQ scales but did not predict BMI.

CONCLUSION

Laboratory and self-report measures capture unique aspects of individual differences in eating behaviors that are associated with energy intake.

Body image and cognitive restraint are risk factors for obesity in French adolescents

The present study explored the links between cognitive restraint and body image in obese adolescents when compared with normal-weight adolescents according to sex. Body image was measured on the Body Esteem Scale and cognitive restraint by means of the Three-Factor Eating Questionnaire Revised 18-item version (TFEQ-R18). Although the results did not reveal any significant correlation between overall scores on these two measures, subscale scores showed that the obese adolescents used cognitive restraint more than the normal-weight adolescents did as a strategy for regulating their diet and were less satisfied with their body image. The normal-weight adolescents' use of cognitive restraint was correlated with body-weight dissatisfaction. Despite these differences, the two populations shared several characteristics. All the adolescents were dissatisfied with the way they thought that others saw them. The loss of control was one of their major concerns, although in the obese adolescents, it went hand in hand with major emotional investment. The results suggest that these are the variables responsible for adolescents' eating habits, regardless of their weight. The most discriminating variable when crossed with weight was sex, with girls being less satisfied with their body image, especially when they were obese.

The relationships among psychiatric medications, eating behaviors, and weight

To help address gaps in information about the links that exist between psychiatric medications and weight changes, an investigation of relationships among select psychotropic agents (i.e., mood stabilizers, antidepressants, and second-generation antipsychotics {SGAs}), eating behaviors, and weight was conducted. Data from a cross-sectional study of food habits in 97 individuals with mood disorders was used. Variables measured included use of psychotropic agents, measures of cognitive dietary restraint and disinhibition from the Three Factor Eating Behavior Questionnaire (TFEQ), psychiatric functioning, reported weight gain and measured BMI. The TFEQ measures were compared to population norms. Bivariate and multivariate analyses examined the relationships among the psychotropic agents, eating behaviors, and weight. Indicators of cognitive dietary restraint and disinhibition were higher than population norms (p's<0.05 to 0.0001). Depression was associated with restraint (rho=0.21, p<0.05). BMI was associated with disinhibition (p<0.05); antidepressant use appeared to moderate weight for those taking SGAs and mood stabilizers (p<0.05). Exploration of the interacting mechanisms of psychotropic agents and attention to eating attitudes and behaviors of individuals taking psychiatric medications might lessen pharmaceutical-induced weight gain. Prospective research on large samples that can make comparisons to those who are untreated is needed.

Eating-related behaviors and appetite during energy imbalance in obese-prone and obese-resistant individuals

While the majority of Americans are now overweight, some individuals maintain their weight with minimal effort. This study investigated behavioral differences between 58 individuals recruited as either obese-resistant (OR) or obese-prone (OP) based on self-identification, BMI, and personal/family weight history. Subjects were studied during Eucaloric (EU), Overfed (OF), and Underfed (UF) phases which included a run-in diet, 1 day intervention diet, and a study day. At baseline, subjects completed the Three Factor Eating Questionnaire (TFEQ) and Power of Food Scale (PFS). On the study day, ratings of appetite, food appeal and desire, and food cravings were performed in response to a breakfast shake. OF resulted in reduced hunger and food desire while UF resulted in increased hunger and food appeal and desire. While hunger did not differ between groups, OP had higher scores for TFEQ measures (hunger, restraint and disinhibition), higher "hedonic hunger" as measured by the PFS, and greater food cravings and ratings of food appeal and desire. These results suggest that subjective hunger and desire for food change significantly after only one day of over- or underfeeding. Additionally, we found several behavioral differences between groups that are likely to promote weight gain over time in the OP.

LIBER8 design and methods: an integrative intervention for loss of control eating among African American and White adolescent girls

Loss of control (LOC) eating affects a significant number of adolescents of all racial and ethnic backgrounds and is associated with numerous psychosocial problems, including depression, anxiety, low self-esteem, body dissatisfaction, and weight concerns. However, empirically validated, culturally sensitive treatments for adolescents with these disordered eating behaviors are not available. This pilot project involved designing a developmentally and culturally appropriate treatment for LOC eating for adolescent girls. We intend to conduct multiple focus groups with adolescent girls who engage in LOC eating, and their primary caregivers. Data from these groups will inform the subsequent creation of a manualized treatment protocol. We will then evaluate the efficacy of this intervention (LIBER8-Linking Individuals Being Emotionally Real) to reduce LOC eating. This intervention will integrate components of dialectical behavior therapy, such as mindfulness and distress tolerance skills training, and cognitive-behavioral therapy. We will also integrate text-messaging, a key adolescent communication strategy, as a means of self-monitoring. Participants meeting study criteria will be offered participation in this 12-week randomized controlled trial comparing LIBER8 to a weight management control condition (2BFit). We hypothesize that this intervention will serve to reduce LOC eating, as well as improve psychosocial functioning as evidenced by decreased depression, anxiety, eating disorder cognitions, emotional eating, impulsivity, and improved quality of life. The feasibility and acceptability of this intervention will be extensively evaluated with the explicit intent of informing a subsequent larger randomized controlled trial.

Adiposity in Middle-aged Women is Associated with Genetic Taste Blindness to 6-n-Propylthiouracil

OBJECTIVE

Taste blindness to the bitterness of 6-n-propylthiouracil (PROP) may be a genetic marker for food preferences and dietary choices that ultimately influence body weight. A previous study in middle-aged women showed that those who were taste blind to PROP (i.e., nontasters) had higher BMIs than those with the greatest sensitivity to PROP (i.e., supertasters). This study tested the hypothesis that the nontaster phenotype was associated with greater adiposity in middle-aged women.

RESEARCH METHODS AND PROCEDURES

Forty women with a mean BMI of 26.6+/-1.3 kg/m2 and a mean age of 41.8+/-1.8 years were recruited from the local community. They were classified as nontasters (n=8), medium tasters (n=18), or supertasters (n=14) of PROP using a filter paper screening procedure. Anthropometric measures included height, weight, body fatness, triceps skinfold thickness, and waist circumference. Dietary restraint and disinhibition were also measured to assess cognitions associated with body weight.

RESULTS

BMI was 6.2 units higher in nontaster women compared with supertaster women (29.7+/-0.9 vs. 23.5+/-0.9, respectively; p<0.05). Body fatness (p<0.01) and triceps skinfold thickness (p<0.05) were also higher in these women. Waist circumference showed a trend in the appropriate direction. Although disinhibition was associated with greater adiposity, the relation between PROP status and adiposity was not altered after controlling for disinhibition.

DISCUSSION

The PROP nontaster phenotype was strongly associated with several measures of adiposity in middle-aged women. These data confirm our previous findings and suggest that the PROP polymorphism may be a reliable indicator of weight gain susceptibility.