How multiple threats to safety affects quality of life for picky eating adults: A new explanatory model

Picky eating describes a pattern of eating characterised by a narrow dietary range with rejection of both novel and familiar foods. Research has suggested that picky eating in adulthood is associated with several negative psychosocial outcomes including impaired quality of life. This research aimed to build and test a model explaining the relationship between picky eating and quality of life. 230 participants were recruited via online support forums for picky eating, and an undergraduate research participation scheme. Participants completed self-report measures of picky eating, sensory sensitivity, disgust, anxiety, fear of negative evaluation and eating related quality of life. Regression analysis indicated that picky eating, disgust sensitivity, anxiety, and fear of negative evaluation were all associated with impaired eating-related quality of life. A theoretical model was then devised which aimed to explain the interactions between these factors, and Path Analysis indicated that this model was a good fit for the data. This Safety in Picky Eating and Quality of life (SPEQ) model suggests that threat perception and the drive for safety underlies the relationship between picky eating and impaired quality of life. The SPEQ model provides a preliminary basis for understanding how picky eating impacts quality of life in adulthood.

Food Restriction in Anorexia Nervosa in the Light of Modern Learning Theory: A Narrative Review

Improvements in the clinical management of anorexia nervosa (AN) are urgently needed. To do so, the search for innovative approaches continues at laboratory and clinical levels to translate new findings into more effective treatments. In this sense, modern learning theory provides a unifying framework that connects concepts, methodologies and data from preclinical and clinical research to inspire novel interventions in the field of psychopathology in general, and of disordered eating in particular. Indeed, learning is thought to be a crucial factor in the development/regulation of normal and pathological eating behaviour. Thus, the present review not only tries to provide a comprehensive overview of modern learning research in the field of AN, but also follows a transdiagnostic perspective to offer testable explanations for the origin and maintenance of pathological food rejection. This narrative review was informed by a systematic search of research papers in the electronic databases PsycInfo, Scopus and Web of Science following PRISMA methodology. By considering the number and type of associations (Pavlovian, goal-directed or habitual) and the affective nature of conditioning processes (appetitive versus aversive), this approach can explain many features of AN, including why some patients restrict food intake to the point of life-threatening starvation and others restrict calorie intake to lose weight and binge on a regular basis. Nonetheless, it is striking how little impact modern learning theory has had on the current AN research agenda and practice.

A Current Learning Theory Approach to the Etiology and Course of Anxiety and Related Disorders

The authors describe how contemporary learning theory and research provide the basis for models of the etiology and maintenance of anxiety and related disorders. They argue that contemporary learning theory accounts for much of the complexity associated with individual differences in the development and course of these disorders. These insights from modern research on learning overcome the limitations of earlier behavioral approaches, which were overly simplistic and have been justifiably criticized. The authors show how considerations of early learning histories and temperamental vulnerabilities affect the short- and long-term likelihood that experiences with stressful events will lead to the development of anxiety disorders. They also discuss how contextual variables during and after stressful learning experiences influence the maintenance of anxiety disorder symptoms. Thus, contemporary learning models provide a rich and nuanced understanding of the etiology and course of anxiety and related disorders. Expected final online publication date for the Annual Review of Clinical Psychology, Volume 18 is May 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

An implicit priming intervention alters brain and behavioral responses to high-calorie foods: a randomized controlled study

BACKGROUND

Conditioned food cues (e.g., smell, sight) can affect intake of foods associated with those cues, regardless of homeostatic need. As such, altering automatic associations with food cues could support weight loss or maintenance efforts by affecting the salience of those cues and the effort required to resist consumption.

OBJECTIVES

This study investigated neuronal and behavioral effects of an implicit priming (IP) intervention, in which negatively valenced images were paired with high-calorie foods and positively valenced images with low-calorie foods. Priming images were presented immediately before food images, but below conscious perception (20 ms). We hypothesized that this evaluative conditioning approach could alter food cue responses by modifying affective associations.

METHODS

The final sample included 41 adults with BMI ≥25 kg/m2 (n = 22, active IP; n = 19, control IP). In control IP, food images were primed with neutral, scrambled images. Participants completed a visual food cue task during fMRI, both before and after IP. To determine the replicability of prior behavioral findings, food image ratings were completed before and after IP as a secondary outcome.

RESULTS

In a whole-brain analysis, reduced dorsolateral prefrontal cortex (dlPFC) response to high-calorie foods was observed after active compared with control IP (t = 4.93, P = 0.033). With a region of interest analysis, reduced response to high-calorie foods in active compared with control IP was also observed in the striatum (t = 2.40, P = 0.009) and insula (t = 2.38, P = 0.010). Active compared with control IP was associated with reduced high-calorie food ratings (F = 4.70, P = 0.038).

CONCLUSIONS

Reduced insula and striatum response to high-calorie foods after active compared with control IP suggests effectiveness of IP in altering food cue salience. Reduced dlPFC response to high-calorie foods after active compared with control IP may reflect fewer attentional resources being directed to those images and reduced engagement of inhibitory processes.This trial was registered at clinicaltrials.gov as NCT02347527.

The multidimensional nature of food neophobia

People vary in their willingness to try new foods. This variation, which is most frequently measured using the Food Neophobia Scale (FNS; Pliner & Hobden, 1992), has been interpreted as unidimensional. In four studies (N's = 210, 306, 160, and 161), we 1) demonstrate that food neophobia varies across meat and plant dimensions, 2) explore the validity of a measure of meat and plant neophobia, and 3) test whether these food neophobia dimensions predict decisions to eat a novel food item (i.e., a snack bar that contains insects). Mixed-effects model across the four studies indicated that the two dimensions differentially relate to a number of variables, including disgust sensitivity, animal empathy, and masculinity. Women scored higher on meat neophobia than men, but the sexes did not differ on plant neophobia. Only meat neophobia uniquely predicted eating a novel insect-based snack bar. Overall, these results extend knowledge regarding orientations toward novel foods.

Are Maternal Feeding Practices and Mealtime Emotions Associated with Toddlers' Food Neophobia? A Follow-Up to the DIT-Coombe Hospital Birth Cohort in Ireland

This study was conducted to explore the associations between maternal feeding practices, mealtime emotions, as well as maternal food neophobia and toddlers’ food neophobia in Ireland. A follow-up to the Technological University Dublin (DIT)-Coombe Hospital birth cohort was conducted. Mothers in the original cohort were invited to the present study by telephone calls. Postal questionnaires with stamped addressed envelopes were distributed to those who agreed to participate in the study. Toddler food neophobia was assessed by the modified version of the Child Food Neophobia Scale (CFNS). There were 205 participants included in this study, with a median score of child food neophobia of 12. A higher degree of child food neophobia (score > 12) was positively associated with the maternal practice of coaxing the children to eat at refusal (OR (Odds Ratio) = 2.279, 95% CI: 1.048–4.955), unpleasant emotions at mealtime (e.g., stressful or hectic for mothers, or tearful for children) (OR ranged between 1.618 and 1.952), and mothers’ own degree of food neophobia (OR = 1.036, 95% CI: 1.001–1.072). Mothers who were not worried when confronted with child’s food refusal was negatively associated with toddlers’ food neophobia (OR = 0.251, 95% CI: 0.114–0.556). This study suggests the maternal practices of responsive feeding, being calm and patient with the toddlers, and creating a positive atmosphere at mealtime.

The relationship between caregivers' feeding practices and children's eating behaviours among preschool children in Ethiopia

Preschool age is a time when distinct eating behaviours are formed. Eating behaviours have been associated with underweight and poor growth as well as with overweight. However, the relationship between caregivers' feeding practices and children's eating behaviours remains poorly understood in developing countries. This study aims to evaluate the association between caregivers' feeding practices and eating behaviours among preschool children in Ethiopia. We conducted a school-based cross-sectional study among 542 caregivers of children aged between three and six years old. We used the Children Eating Behaviour Questionnaire and the Child Feeding Questionnaire to measure eating behaviour and caregivers' feeding practices respectively. A multiple linear regression was fitted to determine the association between caregivers' feeding practices and the multiple scales of children's eating behaviour while adjusting for potential confounders. Children whose caregivers practice food restriction tended to be more food responsive (β = .23, p < .001), tend to emotionally overeat (β = .09, p < .01), enjoy food more (β = 0.23, p < .001) and have more desire to drink (β = .24, p < .001). Meanwhile, children whose caregivers practiced pressure to eat were fussier about food (β = .09, p < .001), were more satiety responsive (β = .13, p < .001) and tended to eat slower (β = .10, p < .01). In Ethiopia, where under- and over-nutrition coexist among pre-school children, the results from this study underscore the importance of investigating eating behaviours at an early age, as these eating styles may contribute to children's poor nutritional status. It is also essential to include appropriate child eating behaviour and specific feeding practices components, together with responsive feeding in national nutritional programmes to improve the nutritional status of children aged 24-59 months.

The factors associated with food fussiness in Irish school-aged children

Objective

To establish the factors that determine food fussiness, to explore if child age determines the extent to which these factors influence food fussiness and to identify whether parental neophobia is an independent determinant of food fussiness.

Design

Cross-sectional data from the National Children’s Food Survey (2003–2004). The Children’s Eating Behaviour Questionnaire (CEBQ) assessed eating behaviours in children. The Food Neophobia Scale (FNS) assessed parental food neophobia. Young children were classified as 5–8 years old with older children classified as 9–12 years old.

Setting

Republic of Ireland.

Participants

Nationally representative sample of Irish children aged 5–12 years (n 594).

Results

Parents identifying child’s food preferences as a barrier to providing their child with a healthy diet was significantly associated with increased food fussiness in younger (P<0·001) and older children (P<0·001). Higher levels of parental neophobia were significantly associated with an increase in food fussiness in younger (P<0·05) and older (P<0·001) children. Food advertising as a barrier to providing a healthy diet was inversely associated with food fussiness in younger children (P<0·05). In older children, there was a significant inverse association between child’s BMI and food fussiness (P<0·05), but not to the extent that a difference in weight status was noted. Family mealtimes in older children were associated with significantly lower levels of food fussiness (P<0·05).

Conclusions

Findings from the present study identify that a child’s age does determine the extent to which certain factors influence food fussiness and that parental neophobia is an independent determinant of food fussiness.

Bidirectional association between parental child-feeding practices and body mass index at 4 and 7 y of age

BACKGROUND

Evidence of the association between parental child-feeding practices and the child's body mass index (BMI) is controversial, and bidirectional effects have been poorly studied.

OBJECTIVE

We aimed to examine bidirectional associations between parental child-feeding practices and BMI at 4 and 7 y of age.

DESIGN

This study included 3708 singleton children from the Generation XXI birth cohort with data on parental child-feeding practices and BMI at 4 and 7 y old. Feeding practices were assessed through a self-administered questionnaire by combining the Child Feeding Questionnaire and the Overt/Covert Control scale and then adapting it to Portuguese preschool children. Weight and height were measured according to standardized procedures, and age- and sex-specific BMI z scores were computed based on the WHO Growth References. Linear regression models were used to estimate the bidirectional associations between each practice and BMI z score. Crosslagged analyses were performed to compare the directions of those associations (the mean score of each practice and BMI z score at both ages were standardized to enable effect size comparisons).

RESULTS

After adjustments, pressure to eat and overt control at 4 y of age were associated with a lower BMI z score 3 y later (β: -0.05; 95% CI: -0.08, -0.03 and β: -0.05; 95% CI: -0.09, -0.01, respectively). Regarding the opposite direction of association, a higher BMI z score at 4 y of age was significantly associated with higher levels of restriction and covert control at 7 y of age (β: 0.06; 95% CI: 0.03, 0.08 and β: 0.06; 95% CI: 0.04, 0.08, respectively) and with lower levels of pressure to eat (β: -0.17; 95% CI: -0.20, -0.15). The only bidirectional practice, pressure to eat, was more strongly influenced by the BMI z score than the reverse (βstandardized: -0.17 compared with βstandardized: -0.04; likelihood ratio test: P < 0.001).

CONCLUSIONS

We found that parents both respond to and influence the child's weight; thus, this child-parent interaction should be considered in future research.

Harnessing the power of disgust: a randomized trial to reduce high-calorie food appeal through implicit priming

BACKGROUND

In our increasingly obesogenic environment, in which high-calorie convenience foods are readily available, food choices can drastically affect weight and overall health. Learned food preferences, which are developed through repeated pairings with positively and negatively valenced stimuli, can contribute to obesity susceptibility if positive attitudes toward high-calorie foods are developed. Thus, the modification of automatic associations with food may be a viable strategy to promote healthier eating behaviors.

OBJECTIVE

In this study, we investigated the ability of an implicit priming (IP) intervention to alter responses to visual food cues by using an evaluative conditioning approach. The main objective was to implicitly (i.e., below conscious perception) associate disgust with high-calorie foods with the aim of reducing liking of these foods.

DESIGN

Participants were randomly assigned to active or control IP. In active IP (n = 22), high-calorie food images were implicitly primed with negatively valenced images, and low-calorie food images were implicitly primed with positively valenced images. In control IP (n = 20), all food images were primed with neutral images of fixation crosses. Food images were rated on the desire to eat immediately before and after IP.

RESULTS

A significant main effect of calorie (high compared with low; P < 0.001) and a significant calorie-by-group (active compared with control) interaction (P = 0.025) were observed. Post hoc tests identified a significantly greater high-calorie rating decline after active IP than after control IP (P = 0.036). Furthermore, there was significantly greater change in high-calorie ratings than in low-calorie ratings in the active group (P = 0.001). Active IP effects extended to high-calorie foods not specifically included in the intervention, which suggested an effect generalization. Moreover, a greater change in high-calorie ratings than in low-calorie ratings persisted 3-5 d after active IP (P < 0.007), which suggested lasting effects.

CONCLUSION

This study provides initial evidence that IP can be used to alter high-calorie food preferences, which could promote healthier eating habits.

Parental feeding practices and socioeconomic status are associated with child adiposity in a multi-ethnic sample of children

Parental feeding practices have been associated with children's weight status, but results have been inconsistent across populations. Research is needed to elucidate the relationship between parental feeding practices and adiposity in diverse populations. The present study tested if: (1) parental feeding practices differed by race/ethnicity, (2) parental pressure to eat and parental restriction were associated with adiposity levels, and (3) to investigate the relationship between parental feeding practices and/or child adiposity with socioeconomic status (SES). Structural equations modeling was conducted to test the model in 267 children aged 7-12 years self-identified as African American (AA), European American (EA), or Hispanic American (HA) from economically diverse backgrounds. Dual energy X-ray absorptiometry and computed tomography scanning were used to determine body composition and abdominal fat distribution, respectively. Parental restriction was a significant predictor of child adiposity while parental pressure to eat had an inverse relationship with child adiposity. HA parents reported significantly higher levels of restriction and pressure to eat, whereas EA parents reported the lowest. SES was positively associated with child adiposity and inversely related to parental restriction and pressure to eat. Thus, parental feeding practices differ across racial/ethnic groups and SES and may contribute to population differences in child adiposity.

Disgust sensitivity and anorexia nervosa

BACKGROUND

Previous studies found inconsistent differences in disgust sensitivity between patients with a variety of eating disorders and normal controls.

AIM

The objective of this study was to compare disgust sensitivity between a larger and more specific sample of anorexia nervosa (AN) patients and control subjects.

METHOD

We compared the scores on the 'disgust sensitivity scale' of AN patients (N = 62) and control subjects (N = 62) using a multivariate analysis of variance. All subjects were women.

RESULTS

AN patients scored consistently higher on all domains of disgust sensitivity. This difference was significant for six of eight disgust domains. The largest significant difference between the groups was on the domains food and magical thinking.

CONCLUSION

Our findings elaborate on previous findings and are in line with recent neurological findings suggesting that disgust and insular impairments are associated with AN. Clinical implications of our findings are discussed.

Maternal feeding practices predict fruit and vegetable consumption in young children. Results of a 12-month longitudinal study

This study aimed to explore the prospective relationship between maternal feeding practices and young children's frequency of consumption of fruits, vegetables and sweets, and also child weight-for-height z-scores. Participants were 60 mothers who completed questionnaires when their children were 1 year old and again when their children were 2 years old. Regression analyses were performed. After controlling for availability and prior child consumption of the target food, maternal use of pressure to eat at 1 year predicted lower child frequency of fruit consumption at 2 years and approached significance for lower vegetable consumption. Maternal modelling of healthy eating at 1 year predicted higher child frequency of vegetable consumption at 2 years. Restriction did not significantly predict child frequency of consumption of fruits, vegetables or sweets over time. Child weight-for-height scores at 2 years were predicted by weight-for-height at 1 year but not by feeding practices. The findings suggest that maternal feeding practices can influence child eating at a very young age. Interventions should focus on encouraging parents to model healthy eating to promote healthy eating in children.

Maternal feeding practices, child eating behaviour and body mass index in preschool-aged children: a prospective analysis

Background

Previous research has found associations between parental feeding practices and children's eating behaviour and weight status. Prospective research is needed to elucidate these relationships.

Methods

One hundred and fifty-six mothers of 2- to 4-year-old children completed questionnaires including measures of maternal feeding practices (pressure to eat, restriction, monitoring and modelling of healthy eating), child eating behaviour (food responsiveness, food fussiness and interest in food), and mother reported child height and weight. The questionnaire was repeated 12 months later. Regression analyses were used to find longitudinal associations between maternal feeding practices, child eating behaviour and child body mass index (BMI).

Results

Modelling of healthy eating predicted lower child food fussiness and higher interest in food one year later, and pressure to eat predicted lower child interest in food. Restriction did not predict changes in child eating behaviour. Maternal feeding practices did not prospectively predict child food responsiveness or child BMI.

Conclusion

Maternal feeding practices appear to influence young children's eating behaviour but not weight status in the short term.

Gender differences in factors affecting rejection of food in healthy young Swedish adults

With the objectives to better understand gender-related differences in variables of importance for food intake, and interrelations between these variables, 100 healthy, young women and 100 healthy, young men responded to self-administrated questionnaires about general food rejection, learned illness-associated food aversions, disgust (the Disgust Scale), food neophobia (the Food Neophobia Scale), nausea and appetite. The results show that food rejection and aversions were more common in women (69 and 38%, respectively) than in men (47 and 18%), and that women are more disgust sensitive than men. However, no differences between women and men were observed regarding reasons for rejecting food (predominantly sensory attributes), prevalence of gastrointestinal illness as an associated aversion symptom (95 vs 89%), type of aversive food due to associated illness (predominantly high protein items), or food neophobia. Based on path analyses, a model is proposed of interrelations between disgust, food neophobia, learned food aversions, nausea, appetite, and general food rejection in healthy young adults.

"You will eat all of that!": a retrospective analysis of forced consumption episodes

The present research was initiated to examine the prevalence of forced consumption and its role in subsequent food rejection. A forced consumption episode was defined as a situation where Person(s) A forced or demanded Person B to consume a specific substance against Person B's will. An initial survey of 407 college students revealed that over 69% of them had experienced at least one forced consumption episode. One hundred forty individuals completed a follow-up questionnaire exploring various characteristics of their most memorable forced consumption scenario. Specifically, the most common type of forced consumption (76%) involved an authority figure (e.g. parent, teacher) forcing a child to consume a novel, disliked, or aversive food. In this authority figure scenario, respondents recalled the episode as involving interpersonal conflict and negative affect, and identified the most aversive aspects of this scenario as lack of control and feelings of helplessness. Furthermore, most respondents (72%) reported that they would not willingly eat the target food today. In sum, the forced consumption episode appears to be a unique situation in which distasteful food combines with interpersonal conflict to result in long-lasting food rejection.