Gender differences in food craving among overweight and obese patients attending low energy diet therapy: a matched case-control study

Sex- and Gender-Related Differences in Obesity: From Pathophysiological Mechanisms to Clinical Implications

Obesity, primarily characterized by excessive fat accumulation, is a multifactorial chronic disease with an increasing global prevalence. Despite the well-documented epidemiology and significant advances in understanding its pathophysiology and clinical implications, the impact of sex is typically overlooked in obesity research. Worldwide, women have a higher likelihood to become obese compared to men. Although women are offered weight loss interventions more often and at earlier stages than men, they are more vulnerable to psychopathology. Men, on the other hand, are less likely to pursue weight loss intervention and are more susceptible to the metabolic implications of obesity. In this narrative review, we comprehensively explored sex- and gender-specific differences in the development of obesity, focusing on a variety of biological variables, such as body composition, fat distribution and energy partitioning, the impact of sex steroid hormones and gut microbiota diversity, chromosomal and genetic variables, and behavioural and sociocultural variables influencing obesity development in men and women. Sex differences in obesity-related comorbidities and varying effectiveness of different weight loss interventions are also extensively discussed.

Socio-Demographic Factors Associated with Rural Residents' Dietary Diversity and Dietary Pattern: A Cross-Sectional Study in Pingnan, China

There is limited evidence regarding the factors correlated with dietary diversity (DD) and dietary pattern (DP) in rural residents of China. This study aims to identify the DD and DP of rural residents and their association with socio-demographic factors. A cross-sectional survey was conducted in Pingnan, China. The Food Frequency Questionnaire (FFQ) was applied to evaluate dietary intake. Latent class analysis (LCA) was used to identify patterns of six food varieties, including vegetables-fruits, red meat, aquatic products, eggs, milk, and beans-nuts. Generalized linear models and multiple logistic regression models were used to determine factors associated with the DD and DP. Three DPs were detected by LCA, namely "healthy" DP (47.94%), "traditional" DP (33.94%), and "meat/animal protein" DP (18.11%). Females exhibited lower DD (β = -0.23, p = 0.003) and were more likely to adhere to "traditional" DP (OR = 1.46, p = 0.039) and "meat/animal protein" DP (OR = 2.02, p < 0.001). Higher educational levels and annual household income (AHI) were positively associated with higher DD (p < 0.05) and less likely to have "traditional" DP and "meat/animal protein" DP (p < 0.05). Non-obese people exhibited higher DD (β = 0.15, p = 0.020) and were less likely to have "meat/animal protein" DP (OR = 0.59, p = 0.001). Our study reveals that females, those with lower educational levels and AHI, and obese people are more likely to have a lower DD and are more likely to adhere to "traditional" DP and "meat/animal protein" DP. The local, regional, and even national performance of specific diet-related health promotion measures and interventions must target these vulnerable populations to improve a healthier DD and DP.

The relationship between food and cooking skills, and eating behaviors in people with overweight or obesity

BACKGROUND

In the present study, the authors aimed to determine food skills and cooking skills, and eating behaviors, and to evaluate the relationship between food skills and cooking skills, and eating behaviors in people with overweight or obesity.

METHODS

This cross-sectional study was conducted with 185 people with overweight or obesity. The researchers collected the study data using the face-to-face interview method through a questionnaire including the Descriptive Information Form, Cooking Skills and Food Skills Scale, and Three-Factor Eating Questionnaire-R21. Numbers, percentages, arithmetic mean, standard deviation, Student's t-test, Pearson Chi-Square test, and multiple linear regression analysis were used in the analysis of the data.

RESULTS

The mean scores of the individuals obtained from the overall Cooking Skills and Food Skills Scale, and cooking skills, food skills, uncontrolled eating, cognitive restraint, and emotional eating sub-dimensions were 148.17 ± 52.20, 70.45 ± 27.48, 77.84 ± 28.90, 43.90 ± 22.74, 36.95 ± 23.93, and 38.94 ± 29.17 respectively. Multiple linear regression was fitted to determine the association between food skills and cooking skills and eating behaviors while adjusting for sociodemographic and health-related characteristics. Food skills and cooking skills were positively associated with uncontrolled eating (β = 0.213, p = 0.030), cognitive restraint (β = 0.245, p = 0.009), and emotional eating behaviors (β = 0.338, p = 0.001).

CONCLUSION

In people with overweight or obesity, cognitive restraint and emotional eating behaviors improve as their food preparation and cooking skills improve. Therefore, education and public health practices on eating awareness, food skills, and cooking skills can play an important role in bringing healthy behavior change into practice in society.

The PACAP Paradox: Dynamic and Surprisingly Pleiotropic Actions in the Central Regulation of Energy Homeostasis

Pituitary Adenylate Cyclase-Activating Polypeptide (PACAP), a pleiotropic neuropeptide, is widely distributed throughout the body. The abundance of PACAP expression in the central and peripheral nervous systems, and years of accompanying experimental evidence, indicates that PACAP plays crucial roles in diverse biological processes ranging from autonomic regulation to neuroprotection. In addition, PACAP is also abundantly expressed in the hypothalamic areas like the ventromedial and arcuate nuclei (VMN and ARC, respectively), as well as other brain regions such as the nucleus accumbens (NAc), bed nucleus of stria terminalis (BNST), and ventral tegmental area (VTA) - suggesting that PACAP is capable of regulating energy homeostasis via both the homeostatic and hedonic energy balance circuitries. The evidence gathered over the years has increased our appreciation for its function in controlling energy balance. Therefore, this review aims to further probe how the pleiotropic actions of PACAP in regulating energy homeostasis is influenced by sex and dynamic changes in energy status. We start with a general overview of energy homeostasis, and then introduce the integral components of the homeostatic and hedonic energy balance circuitries. Next, we discuss sex differences inherent to the regulation of energy homeostasis via these two circuitries, as well as the activational effects of sex steroid hormones that bring about these intrinsic disparities between males and females. Finally, we explore the multifaceted role of PACAP in regulating homeostatic and hedonic feeding through its actions in regions like the NAc, BNST, and in particular the ARC, VMN and VTA that occur in sex- and energy status-dependent ways.

The prevalence and independent influencing factors of obesity and underweight in patients with schizophrenia: a multicentre cross-sectional study

BACKGROUND

Few studies have investigated the weight of patients with schizophrenia in China.

OBJECTIVE

The aim of this study was to analyse the prevalence, clinical characteristics and influencing factors of obesity and underweight in patients with chronic schizophrenia in China.

METHODS

A total of 325 patients with schizophrenia and 172 sex- and age-matched healthy controls from the community were recruited. Socio-demographic data and laboratory measurements were collected for all subjects. Using the Positive and Negative Syndrome Scale (PANSS), we evaluated the psychiatric symptoms of patients with schizophrenia. According to the body mass index (BMI) criteria in China, BMI ≥ 28 kg/m² indicates obesity, and BMI < 18.5 kg/m² indicates underweight.

RESULTS

Of the patients with schizophrenia, 16.3% were obese, and 6.8% were underweight; 11.0% of the healthy controls were obese, and 3.5% were underweight. There was no difference between the two groups in the prevalence of obesity and underweight. After controlling for relevant variables, the obesity rate remained non significant, but the underweight rate appeared to be different. The multinomial regression analysis revealed that among the patients with schizophrenia, female sex, triglyceride level and LDL level were independent risk factors for obesity and that HDL level was an independent protective factor against obesity. In contrast, male sex and HDL level were independent risk factors for underweight.

CONCLUSION

We found that the patients with schizophrenia had an increased rate of underweight and some factors related to weight.

LEVEL OF EVIDENCE

Level V, descriptive study.

Considering Sex as a Biological Variable in Basic and Clinical Studies: An Endocrine Society Scientific Statement

In May 2014, the National Institutes of Health (NIH) stated its intent to "require applicants to consider sex as a biological variable (SABV) in the design and analysis of NIH-funded research involving animals and cells." Since then, proposed research plans that include animals routinely state that both sexes/genders will be used; however, in many instances, researchers and reviewers are at a loss about the issue of sex differences. Moreover, the terms sex and gender are used interchangeably by many researchers, further complicating the issue. In addition, the sex or gender of the researcher might influence study outcomes, especially those concerning behavioral studies, in both animals and humans. The act of observation may change the outcome (the "observer effect") and any experimental manipulation, no matter how well-controlled, is subject to it. This is nowhere more applicable than in physiology and behavior. The sex of established cultured cell lines is another issue, in addition to aneuploidy; chromosomal numbers can change as cells are passaged. Additionally, culture medium contains steroids, growth hormone, and insulin that might influence expression of various genes. These issues often are not taken into account, determined, or even considered. Issues pertaining to the "sex" of cultured cells are beyond the scope of this Statement. However, we will discuss the factors that influence sex and gender in both basic research (that using animal models) and clinical research (that involving human subjects), as well as in some areas of science where sex differences are routinely studied. Sex differences in baseline physiology and associated mechanisms form the foundation for understanding sex differences in diseases pathology, treatments, and outcomes. The purpose of this Statement is to highlight lessons learned, caveats, and what to consider when evaluating data pertaining to sex differences, using 3 areas of research as examples; it is not intended to serve as a guideline for research design.

Twenty Years of the Food Cravings Questionnaires: a Comprehensive Review

Purpose of Review

The Food Cravings Questionnaires (FCQs; Cepeda-Benito, Gleaves, Williams, & Erath, 2000) are among the most widely used instruments for measuring food cravings. In addition to the Food Cravings Questionnaire–Trait (FCQ–T) and the Food Cravings Questionnaire–State (FCQ–S), several modified versions have been developed as well. For their 20th anniversary, this article provides a comprehensive description of the FCQs and reviews studies on their psychometric properties and correlates.

Recent Findings

The FCQs and their modified versions have excellent internal reliability. Expectedly, the FCQ–T (and its derivatives) has higher retest-reliability than the FCQ–S as the FCQ–S is sensitive to situational changes such as food deprivation and food intake. However, while the FCQ–T is largely unaffected by such momentary states, it is also sensitive to change during weight-loss treatments and other interventions. Factor structure of the FCQ–T and FCQ–S has only partially been replicated. Construct validity of the FCQs is supported by experimental and longitudinal studies that measured food craving and food consumption in the laboratory and with ecological momentary assessment.

Summary

Numerous studies support reliability and validity of the FCQs and their modified versions, yet findings about their factor structures are inconsistent. Thus, using total scores or the short versions of the FCQs may be preferable.

Association of food cravings with weight gain, overweight, and obesity in patients after liver transplantation

OBJECTIVE

After liver transplantation (LTx), patients often gain weight and many become overweight or obese; however, the association between LTx and food craving (FC) is unknown. The aim of this study was to describe FC among patients after LTx and verify its association with weight gain and obesity.

METHODS

This was a cross-sectional study that assessed 301 patients who underwent LTx (55.1 ± 12.7 y of age; time since LTx 6.6 ± 4.4 y; 64.1% men). Pregnant or nursing women were excluded. Patients were interviewed once either in the outpatient clinic or by completing the online questionnaire, from August 2016 to February 2017.

RESULTS

The median weight variation after Ltx was 8 kg (ranging from -16 to +41 kg). At evaluation, 62.5% (n = 188) of the patients presented excessive weight and 22.3% (n = 67) presented with obesity. The average score on the Food Craving Questionnaire-State (FCQ-S) was 33.4 ± 9 and for the Food Craving Questionnaire-Trait (FCQ-T) the median score was 68 (39-163). The FCQ-T dimensions of lack of control, preoccupation, emotion, environmental triggers/stimuli, and guilt correlated positively with weight gain (P < 0.05). The desire dimension on the FCQ-S was significantly associated with overweight in post-LTx patients (P < 0.05) and the FCQ-T dimensions [negative reinforcement (P = 0.013), lack of control (P = 0.016), emotion (P = 0.009), environmental triggers/stimuli (P = 0.029), and guilt (P = 0.007)] were associated with obesity.

CONCLUSION

Lack of control, preoccupation, emotion, trigger, and guilt were positively correlated with weight gain. Desire was significantly associated with overweight. Negative reinforcement, lack of control, emotion, environmental triggers/stimuli, and guilt were associated with obesity.

Testing virtual reality-based cue-exposure software: Which cue-elicited responses best discriminate between patients with eating disorders and healthy controls?

PURPOSE

Virtual reality (VR) technologies have been proposed as a new tool able to improve on in vivo exposure in patients with eating disorders. This study assessed the validity of a VR-based software for cue exposure therapy (CET) in people with bulimia nervosa (BN) and binge eating disorder (BED).

METHODS

Fifty eight outpatients (33 BN and 25 BED) and 135 healthy participants were exposed to 10 craved virtual foods and a neutral cue in four experimental virtual environments (kitchen, dining room, bedroom, and cafeteria). After exposure to each VR scenario, food craving and anxiety were assessed. The frequency/severity of episodes of uncontrollable overeating was also assessed and body mass index was measured prior to the exposure.

RESULTS

In both groups, craving and anxiety responses when exposed to the food-related virtual environments were significantly higher than in the neutral-cue virtual environment. However, craving and anxiety levels were higher in the clinical group. Furthermore, cue-elicited anxiety was better at discriminating between clinical and healthy groups than cue-elicited craving.

CONCLUSIONS

This study provides evidence of the ability of food-related VR environments to provoke food craving and anxiety responses in BN and BED patients and highlights the need to consider both responses during treatment. The results support the use of VR-CET in the treatment of eating disorder patients characterized by binge-eating and people with high bulimic symptoms.

Sweet cognition: The differential effects of glucose consumption on attentional food bias in individuals of lean and obese status

In general, glucose consumption improves cognitive performance; however, it is unknown whether glucose specifically alters attentional food bias, and how this process may vary by BMI status. We hypothesized that glucose consumption would increase attentional food bias among individuals of obese BMI status more so than among individuals of lean BMI status. Participants (N = 35) completed the n-back, a working memory task modified to assess attentional food bias (ATT-Food), under fasting and glucose challenge conditions. We computed pre-post changes in ATT-Food, blood glucose and insulin (∆BG & ∆BI), and perceived task-stress (∆stress). After the second cognitive test and blood draw, participants ate lunch and completed a "taste test" of highly palatable foods, and we recorded food consumption. Pre-post changes in ATT-Food were greater among participants of obese (relative to lean) BMI status (F(1,33) = 5.108, p = .031). Greater ∆ATT-Food was significantly associated with greater ∆BG (r = .462, p = .007) and reduced ∆stress (r =-.422, p = .011), and marginally associated with greater taste-test eating (r =.325, p = .057), but was not associated with ∆BI. Our findings suggest that individuals of obese BMI status may exhibit "sweet cognition," as indexed by greater attentional food bias following glucose ingestion, relative to individuals of lean BMI status. Among individuals of obese BMI status, sweet cognition may arise from difficulty broadening attention toward non-food cues after consuming a high glucose load, thereby potentially perpetuating sugar consumption. If confirmed by further research, measures of sweet cognition may help identify individuals with a phenotype of risk for obesity and greater sugar consumption, who may benefit from tailored interventions.

Eating Behaviours and Food Cravings; Influence of Age, Sex, BMI and FTO Genotype

Previous studies indicate that eating behaviours and food cravings are associated with increased BMI and obesity. However, the interaction between these behaviours and other variables such as age, sex, BMI and genetics is complex. This study aimed to investigate the relationships between eating behaviours and food cravings, and to examine the influence of age, sex, body mass index (BMI) and fat mass and obesity-associated (FTO) genotype on these relationships. A total of 475 participants (252 female, 223 male, BMI: 25.82 ± 6.14 kg/m², age: 30.65 ± 14.20 years) completed the revised 18-question version of the Three Factor Eating Questionnaire (TFEQ-R18) to assess cognitive restraint, uncontrolled eating and emotional eating, and the Food Cravings Inventory (FCI) to assess cravings for fatty food, sweet food, carbohydrates and fast food. DNA samples were genotyped for the rs9939609 polymorphism in the obesity-linked gene FTO. Questionnaire data was analysed for associations between the TFEQ-R18 and FCI subscales for the whole study group, and the group divided by sex, genotype and age (≤25 years versus >25 years). Finally, mediation analysis was used to explore the relationships between BMI, cognitive restraint and food cravings. FTO AA + AT genotype was associated with increased BMI, but not with differences in eating behavior scores or food craving scores; age was associated with increased BMI and decreases in food craving scores in which this effect was stronger in women compared to men. Increased cognitive restraint was associated with decreased food craving scores in the ≤25 years group. Mediation analysis demonstrated that in this group the association between BMI and reduced food cravings was mediated by cognitive restraint indicating that in this age group individuals use cognitive restraint to control their food cravings. The positive correlation between age and BMI confirms previous results but the findings of this study show that age, sex, FTO genotype and BMI have an influence on the relationships between eating behaviours and food cravings and that these variables interact.

Reliability and Validity of the Korean Version of the General-Food Craving Questionnaire-Trait for Children

OBJECTIVE

The General-Food Craving Questionnaire-Trait (G-FCQ-T) is a validated, assessment scale for food craving. The aim of this study was to measure its reliability and validity for Korean children.

METHODS

A total of 172 children (94 boys and 78 girls) were selected to fill out a set of questionnaires, including the G-FCQ-T, the Children's version of the Dutch Eating Behavior Questionnaire (DEBQ-C), and the Three-Factor Eating Questionnaire (TFEQ) in the Korean language.

RESULTS

The internal consistency (Cronbach's alpha=0.933) and test-retest reliability (r=0.653) were satisfactory. The G-FCQ-T showed a significantly positive correlation with the DEBQ-C (r=0.560) and the TFEQ (r=0.397). The optimum cutoff score of the G-FCQ-T set by Receiver Operating Characteristics analysis was 51, with sensitivity and specificity of 0.833 and 0.825, respectively, for children.

CONCLUSION

The G-FCQ-T showed good reliability and validity for assessing food craving for children and could become a practial instrument in clinical and research settings.

The role of tryptophan metabolism and food craving in the relationship between obesity and bipolar disorder

BACKGROUND & AIMS

Individuals with bipolar disorder (BD) have a significantly increased risk of obesity-related conditions. The imbalance between food intake and energy expenditure is assumed to be a major risk factor for obesity in BD. This study analyzed food craving in relation to anthropometric, metabolic, and neurobiological parameters in a well-characterized cohort of euthymic individuals with BD.

METHODS

One-hundred-thirty-five patients completed the Food-Craving Inventory assessing four categories of food craving (fat, fast-food, sweets and carbohydrate craving). Additionally, clinical, metabolic and anthropometric parameters were assessed.

RESULTS

Higher levels of fat craving were observed in males, versus females, with BD. High levels of carbohydrate craving positively correlated with kynurenine and the kynurenine-to-tryptophan ratio. Higher serum nitrite and neopterin levels were related to fat craving. Parameters of fat metabolism (triglycerides, high-density lipoprotein) were associated with fat and fast-food craving. Anthropometric measures of obesity (e.g. body mass index, waist-to-hip-ratio) were not related to food craving.

CONCLUSIONS

Overweight/obese individuals with BD show an increased driving of tryptophan down the kynurenine pathways, as indicated by an increase in the serum kynurenine-to-tryptophan ratio. The driving of tryptophan down the kynurenine pathway is mediated by immune-inflammatory activity and stress. The correlation of increased kynurenine with food craving, especially carbohydrate craving, probably indicates a regulatory deficit in the maintenance of chronic inflammatory processes in obesity and BD. Food craving seems to be of clinical importance in the treatment of metabolic disturbances in BD, although not associated with anthropometric measures of obesity. Rather, food craving correlates with blood metabolic parameters and an increased activation of the kynurenine pathway, both of which are linked to higher affective symptomatology and the development of cardiovascular diseases.

Food cravings, binge eating, and eating disorder psychopathology: Exploring the moderating roles of gender and race

OBJECTIVE

To examine the moderating effects of gender and race on the relationships among food cravings, binge eating, and eating disorder psychopathology in a community sample.

METHODS

Data were collected from a convenience sample of 320 adults (53% male; mean age 28.5±8.2years; mean BMI 27.1±5.2kg/m(2); mean education 15.1±2.2years; 64% white, 24% black, and 13% other race) participating in a cross-sectional study examining the interactions between stress, self-control and addiction. Participants completed a comprehensive assessment panel including a demographic questionnaire, the Food Craving Inventory, and Eating Disorder Examination Questionnaire. Data were analyzed using multiple logistic regression for binge eating behavior and multiple linear regression for eating disorder psychopathology.

RESULTS

Overall, food cravings demonstrated significant main effects for binge eating behavior (adjusted OR=2.65, p<.001) and global eating disorder psychopathology (B=.47±.09, p<.001). Females had a stronger relationship between food cravings and eating disorder psychopathology than males; there were no statistically significant differences by race.

CONCLUSION

These findings, based on a diverse sample recruited from the community, suggest that food cravings are associated with binge eating and eating disorder psychopathology and may represent an important target for interventions.

Psychometric properties of the Italian Food Cravings Questionnaire-Trait-reduced (FCQ-T-r)

PURPOSE

The aim of the present study was to investigate dimensionality and psychometric properties of the Italian Food Cravings Questionnaire-Trait-reduced (FCQ-T-r) in a sample of obese and overweight patients seeking weight loss treatment.

METHODS

Participants were 504 (416 women and 88 men) overweight and obese patients (BMI ≥ 25 kg/m(2)), and 289 (215 women and 74 men) Italian adults not currently seeking weight loss treatment. All participants were administered the Food Cravings Questionnaire-Trait (FCQ-T) and the Binge Eating Scale.

RESULTS

The fifteen items included in the FCQ-T-r explained 93% of the variance of the 39-item FCQ-T total score (R(2) = 0.93). A principal axis factoring analysis indicated a one-factor solution, explaining 55.6% of the variance of the data. The FCQ-T-r had high internal consistency and was also able to differentiate between individuals with various severities of binge eating behavior.

CONCLUSIONS

The FCQ-T-r may be considered a useful instrument for measuring trait food craving, when time constraints impede the use of the 39-item FCQ-T.

Ecological momentary assessment of urban adolescents' technology use and cravings for unhealthy snacks and drinks: differences by ethnicity and sex

BACKGROUND

Adolescents' technology use is generally associated with food cravings, but it is not clear whether specific types of technology elicit particular types of cravings or whether personal characteristics play a role in these associations.

OBJECTIVE

We examined whether momentary associations between four technology types (ie, television, video games, computer messaging, and phone messaging) and cravings for unhealthy snack foods and sweetened drinks were moderated by youths' sex, ethnicity, body mass index, and age.

METHODS

Urban adolescents (N=158) aged 14 to 17 years provided momentary information about their technology use and food cravings during the course of 1 week and completed survey reports of their personal characteristics. We used multilevel modeling to determine momentary associations and interactions.

RESULTS

Non-Hispanic adolescents showed stronger associations between television exposure and cravings for sweet snacks, salty snacks, and sweetened drinks. Being Hispanic was associated with stronger associations between phone messaging and cravings for sweet snacks, salty snacks, and sweetened drinks. Males showed stronger associations between video game use and salty snack cravings.

CONCLUSIONS

As the public health field continues to monitor the effects of technology use on adolescents' eating and overall health, it will be important to determine the extent to which these groups are differentially affected by different forms of technology.

Exploring the factor structure of the Food Cravings Questionnaire-Trait in Cuban adults

Food cravings refer to an intense desire to eat specific foods. The Food Cravings Questionnaire-Trait (FCQ-T) is the most commonly used instrument to assess food cravings as a multidimensional construct. Its 39 items have an underlying nine-factor structure for both the original English and Spanish version; but subsequent studies yielded fewer factors. As a result, a 15-item version of the FCQ-T with one-factor structure has been proposed (FCQ-T-reduced; see this Research Topic). The current study aimed to explore the factor structure of the Spanish version for both the FCQ-T and FCQ-T-reduced in a sample of 1241 Cuban adults. Results showed a four-factor structure for the FCQ-T, which explained 55% of the variance. Factors were highly correlated. Using the items of the FCQ-T-reduced only showed a one-factor structure, which explained 52% of the variance. Both versions of the FCQ-T were positively correlated with body mass index (BMI), scores on the Food Thoughts Suppression Inventory and weight cycling. In addition, women had higher scores than men and restrained eaters had higher scores than unrestrained eaters. To summarize, results showed that (1) the FCQ-T factor structure was significantly reduced in Cuban adults and (2) the FCQ-T-reduced may represent a good alternative to efficiently assess food craving on a trait level.