Unintentional eating. What determines goal-incongruent chocolate consumption?

Disentangling inhibition toward food and non-food stimuli across two hunger levels: An fNIRS study

While individuals tend to display poorer inhibitory control toward food-related than neutral stimuli, it is unclear whether this challenge is specific to food or extends to other pleasant stimuli. Uncertainty also remains regarding the general impact of hunger on inhibition. To address these questions, we used a within-subjects design whereby 44 healthy adults completed two go/no-go tasks including no-go images of highly palatable foods and no-go images of animals matched for valence and physical properties. Both tasks were completed one week apart in either a fed or a fasted state. Prefrontal cortex activity was measured using functional near-infrared spectroscopy. Poorer behavioral inhibition was observed when participants needed to withhold their response to images of food compared to animals, regardless of hunger state. In addition, more commission errors were made in the fasted compared to the fed condition, regardless of the type of image to avoid responding to. Responses to go trials were slower when these trials were interspersed with food compared to animal no-go trials. However, hunger did not influence go response time. Greater activation was observed in the dorsolateral prefrontal cortex during blocks of trials with (vs. without) no-go images, but brain activity did not differ according to the type of no-go image. The effect of hunger on prefrontal brain activity was also not significant. Exploratory correlations showed that food-related inhibition deficits were positively related to self-reported impulsivity, but unrelated to body mass index. This study suggests that even among healthy adults, food-related inhibitory control may have a unique behavioral signature beyond general inhibition toward pleasant stimuli. Hunger also exerts an independent influence on general inhibitory capabilities, highlighting the importance of carefully controlling hunger levels in inhibition studies.

Reactive control in suicide ideators and attempters: An examination of the congruency sequence effect in cognitive and emotional Simon tasks

Reactive control is the cognitive ability to adjust thoughts and behaviors when encountering conflict. We investigated how this ability to manage conflict and stress distinguishes suicidal from nonsuicidal individuals. The hypothesis was that suicidal individuals would show poorer reactive control when faced with conflict generated by emotional than neutral stimuli. Hence, individuals with a lifetime history of suicide ideation or attempt and nonsuicidal controls were tested in cognitive and emotional Simon tasks. We examined the congruency sequence effect (CSE) in the Simon tasks as an indication of the efficiency of reactive control in resolving conflict. Whereas controls demonstrated significant CSEs in both tasks, suicide attempters showed a significant CSE in the cognitive task but not in the emotional task. Suicide ideators, on the other hand, displayed marginally significant CSEs in both tasks. Comparing groups with pairwise comparison demonstrated that the difference in CSE was significant only in the emotional task between attempters and controls. Our findings of attempters' inefficiency in adjusting reactive control during the emotional task reflect cognitive inflexibility in coping with conflicting situations during which suicidal individuals become vulnerable to suicide attempts in states of negative emotion.

Utility of temporal self‐regulation theory in health and social behaviours: A meta‐analysis

PURPOSE

Temporal self-regulation theory was developed to address an observed intention-behaviour gap across behaviours. However, a synthesis of studies has not yet been conducted to investigate the theory's utility to explain behaviour and bridge the intention-behaviour gap. This review aimed to evaluate the predictive ability of temporal self-regulation theory to understanding behaviour and pre-registered at PROSPERO (ID: CRD42021253174).

METHOD

Forward citation searches on the original theory publication through Google Scholar until May 2021 identified 37 eligible articles, including, 12,555 participants assessing at least two of the three theory constructs. Random-effects meta-analyses assessed the strength of associations between theory constructs on behaviour and random effects meta-regressions assessed moderators of behaviour.

RESULTS

Findings provide support for temporal self-regulation theory to explain behaviour with very weak (self-regulatory capacity r = .039, CI = .00, -.07) to moderate (intention r = .331, CI = .26, .40; behavioural pre-potency r = .379, CI = .32, .44) effect sizes. Further, the strength of associations varied across behaviour types and contexts. However, there was high heterogeneity across studies and some moderating effects could not be assessed due to insufficient numbers of studies assessing interactions.

CONCLUSIONS

We urge researchers to assess and report interactions for better understanding of the drivers of behaviour to develop effective interventions for positive behaviour change.

Neurobiological regulation of eating behavior: Evidence based on non-invasive brain stimulation

The prefrontal cortex is appreciated as a key neurobiological player in human eating behavior. A special focus is herein dedicated to the dorsolateral prefrontal cortex (DLPFC), which is critically involved in executive function such as cognitive control over eating. Persons with obesity display hypoactivity in this brain area, which is linked to overconsumption and food craving. Contrary to that, higher activity in the DLPFC is associated with successful weight-loss and weight-maintenance. Transcranial direct current stimulation (tDCS) is a non-invasive neurostimulation tool used to enhance self-control and inhibitory control. The number of studies using tDCS to influence eating behavior rapidly increased in the last years. However, the effectiveness of tDCS is still unclear, as studies show mixed results and individual differences were shown to be an important factor in the effectiveness of non-invasive brain stimulation. Here, we describe the current state of research of human studies using tDCS to influence food intake, food craving, subjective feeling of hunger and body weight. Excitatory stimulation of the right DLPFC seems most promising to reduce food cravings to highly palatable food, while other studies provide evidence that stimulating the left DLPFC shows promising effects on weight loss and weight maintenance, especially in multisession approaches. Overall, the reported findings are heterogeneous pointing to large interindividual differences in tDCS responsiveness.

Choices of (in)action in obesity: Implications for research on treatment and prevention

The obesity epidemic has crossed social-demographic barriers and is a matter of significant concern. Why do individuals fail to restrain from eating high-calorie foods and fail to follow treatment routines that reduce the risk of health complications? These questions have been addressed through behavioral and brain imaging studies on prefrontal cortex inhibitory mechanisms. Failure to inhibit undesirable behaviors has become a hallmark of obesity. In many life situations, obesity risk is increased by inaction (e.g., not taking blood pressure medication, not following a healthy diet). Risk by inaction has been defined as passive risk-taking, and it is correlated with traits such as procrastination, future time perspective, and cognitive avoidance. To the present, passive tendencies, specifically in the context of risk-taking behaviors, have not been addressed in the obesity literature. We introduce a framework in which active and passive risk-taking behaviors are integrated within the scope of bidirectional models of obesity that describe the brain as both the cause and the consequence of obesity vulnerability. The present perspective aims to foster new research on treatment and prevention, and also on the neurobiology of passive behaviors in obesity and other metabolic conditions.

Impact of increasing the availability of healthier vs. less-healthy food on food selection: a randomised laboratory experiment

Background

Environmental cues shape behaviour, but few studies compare the impact of targeting healthier vs. less-healthy cues. One online study suggested greater impact on selection from increasing the number of less-healthy (vs. healthier) snacks. The current study aimed to: (1) extend the previous study by using physically-present snacks for immediate consumption; (2) explore responsiveness by socio-economic position; (3) investigate possible mediators (response inhibition, food appeal) of any socio-economic differences in selection.

Methods

In a between-subjects laboratory experiment UK adults (n = 417) were randomised according to their ID number (without blinding) to one of three ranges of options: Two healthier, two less-healthy [“Equal”] (n = 136); Six healthier, two less-healthy [“Increased Healthier”] (n = 143); Two healthier, six less-healthy [“Increased Less-Healthy”] (n = 138). Participants completed measures of response inhibition and food appeal, and selected a snack for immediate consumption from their allocated range. The primary outcome was selection of a healthier (over less-healthy) snack.

Results

The odds of selecting a less-healthy snack were 2.9 times higher (95%CIs:1.7,5.1) in the Increased Less-Healthy condition compared to the Equal condition. The odds of selecting a healthier snack were 2.5 times higher (95%CIs:1.5,4.1) in the Increased Healthier (vs. Equal) condition. There was no significant difference in the size of these effects (− 0.2; 95%CIs:-1.1,0.7). Findings were inconclusive with regard to interactions by education, but the direction of effects was consistent with potentially larger impact of the Increased Healthier condition on selection for higher-educated participants, and potentially larger impact of the Increased Less-Healthy condition for less-educated participants.

Conclusions

A greater impact from increasing the number of less-healthy (over healthier) foods was not replicated when selecting snacks for immediate consumption: both increased selections of the targeted foods with no evidence of a difference in effectiveness. The observed pattern of results suggested possible differential impact by education, albeit not statistically significant. If replicated in larger studies, this could suggest that removing less-healthy options has the potential to reduce health inequalities due to unhealthier diets. Conversely, adding healthier options could have the potential to increase these inequalities.

Trial registration

ISRCTN: ISRCTN34626166; 11/06/2018; Retrospectively registered.

ImpulsePal: The systematic development of a smartphone app to manage food temptations using intervention mapping

BACKGROUND

Impulsive processes driving eating behaviour can often undermine peoples' attempts to change their behaviour, lose weight and maintain weight loss.

AIM

To develop an impulse management intervention to support weight loss in adults.

METHODS

Intervention Mapping (IM) was used to systematically develop the "ImpulsePal" intervention. The development involved: (1) a needs assessment including a qualitative study, Patient and Public advisory group and expert group consultations, and a systematic review of impulse management techniques; (2) specification of performance objectives, determinants, and change objectives; (3) selection of intervention strategies (mapping of change techniques to the determinants of change); (4) creation of programme materials; (5) specification of adoption and implementation plans; (6) devising an evaluation plan.

RESULTS

Application of the IM Protocol resulted in a smartphone app that could support reductions in unhealthy (energy dense) food consumption, overeating, and alcoholic and sugary drink consumption. ImpulsePal includes inhibition training, mindfulness techniques, implementation intentions (if-then planning), visuospatial loading, use of physical activity for craving management, and context-specific reminders. An "Emergency Button" was also included to provide access to in-the-moment support when temptation is strong.

CONCLUSIONS

ImpulsePal is a novel, theory- and evidence-informed, person-centred app that aims to support impulse management for healthier eating. Intervention Mapping facilitated the incorporation of app components that are practical operationalisations of change techniques targeting our specific change objectives and their associated theoretical determinants. Using IM enabled transparency and provided a clear framework for evaluation, and enhances replicability and the potential of the intervention to accomplish the desired outcome of facilitating weight loss through dietary change.

Chronic versus recent expressive suppression burdens are differentially associated with cognitive performance among older adults

Introduction: Expressive suppression (ES; suppression of affective behavior) has been shown to have a deleterious impact on subsequently administered tests of executive functions (EF), threatening validity, and reliability of EF assessment. Past research has shown that recent ES (i.e., across 24 hours prior to testing) and chronic ES (i.e., across 2 weeks prior to testing) have differential impact on test performance. The present study compared the association of chronic vs. recent ES with speed vs. accuracy of performance on tests of EF and tests of lower-order processes.

METHOD

Participants were 255 community-dwelling older adults aged 60 and older. Participants completed timed subtests of the Delis-Kaplan Executive Function System and the Burden of State Emotion Regulation Questionnaire.

RESULTS

Hierarchical linear regressions examined the contributions of chronic vs. recent ES to test performance. Recent ES was related to scores of both speed and accuracy on EF tests. The association between recent ES and EF errors held beyond covariates (i.e., chronic ES, demographics, depression, and general cognitive status). In contrast, the association between recent ES and EF speed was fully explained by EF error scores. Chronic ES was associated only with speed of performance and only on lower-order tasks, but this relationship did not survive correction for cognitive, psychiatric, and demographic factors.

CONCLUSIONS

Recent ES appears to be a risk factor for EF lapses. Chronic ES, while related to performance speed, seems to also relate to several other cognitive, psychiatric, and demographic factors, which themselves explain slower information processing.

Automatic and Controlled Processing: Implications for Eating Behavior

It is a widely held view that humans have control over their food choices and consumption. However, research also suggests that eating behavior is often triggered by contextual cues and guided by automaticities and habits. Interestingly, the dichotomy between automatic and controlled processing has recently been challenged, suggesting that they may be intertwined. In a large female sample (n = 567), we investigated the hypothesis that task-based and self-reported measures of automatic and controlled processing would interact and impact self-reported eating behavior. Results analyzed via structural equation modeling suggest that automatic, but not controlled processing, during a modified flanker task, including a context-specific proportion congruent (CSPC) manipulation, was inversely associated with self-reported self-control. The influence of self-control on unhealthy eating behavior (i.e., uncontrolled and emotional eating, heightened consumption of fat and sugar) was only indirect via habitual behavior, which itself had a strong direct impact. Unhealthy eating was further associated with real-life outcomes (e.g., body mass index (BMI)). Our findings suggest that eating behavior may indeed be guided primarily by automaticities and habits, whereas self-control might facilitate this association. Having self-control over eating might therefore be most effective by avoiding contextual cues eliciting undesired automatic behavior and establishing habits that serve long-term goals.

A Randomised Experiment Evaluating the Mindful Raisin Practice as a Method of Reducing Chocolate Consumption During and After a Mindless Activity

The present study investigated the impact of the mindful raisin exercise on overeating during and after the experiment while controlling for wellbeing. One-hundred and twenty-eight participants were recruited and completed a questionnaire on wellbeing (i.e. depression, anxiety and stress) and state mindfulness. Participants were randomly allocated to either the mindful raisin exercise or a newspaper reading control condition. The State Mindfulness Scale was then completed again, and participants watched a neutral video while exposed to chocolate for 10 min. For those 10 min, results showed that the mindfulness condition translated into lower food consumption during the mindless activity when compared to the control condition. Post experiment, participants were asked to wait for 5 min, and any extra chocolate consumption during this time was recorded. Post-consumption was non-significantly different between the two groups, with those in the mindfulness condition consuming 1.3 g less than those in the control group. Controlling for wellbeing did not alter the impact of the mindfulness intervention on consumption. Implications for future work and practical applications for weight regulation are discussed.

Altering the availability of healthier vs. less healthy items in UK hospital vending machines: a multiple treatment reversal design

BACKGROUND

Altering the availability of healthier or less-healthy products may increase healthier purchases, but evidence is currently limited. The current study aimed to investigate the impact of altering the absolute-and-relative availability of healthier and less-healthy products - i.e. simultaneously altering the number of options available and the proportion of healthier options - in hospital vending machines.

METHODS

An adapted multiple treatment reversal design was used, altering products available in ten vending machines serving snack foods and/or cold drinks in one English hospital. Machines were randomised to one of two sequences for the seven 4-week study periods: ABCADEA or ADEABCA. In Condition A (study periods 1, 4 and 7) the proportions of healthier products were standardised across all machines, so that 25% of all snack slots and 75% of drink slots were healthier. In Condition B, 20% of vending machine slots were emptied by removing less-healthy products. In Condition C, the empty slots created in Condition B were filled with healthier products. Conditions D and E were operationalised in the same way as B and C, except healthier products were removed in D, and then less-healthy products added in E. Sales data were obtained from machine restocking records. Separate linear mixed models were conducted to examine the impact of altering availability on energy purchased (kcal) from (i) snacks or (ii) drinks each week, with random effects for vending machine.

RESULTS

The energy purchased from drinks was reduced when the number of slots containing less-healthy drinks was decreased, compared to standardised levels (- 52.6%; 95%CI: - 69.3,-26.9). Findings were inconclusive for energy purchased from snacks when less-healthy snack slots were reduced (- 17.2%; 95%CI: - 47.4,30.5). Results for altering the number of slots for healthier drinks or snacks were similarly inconclusive, with no statistically significant impact on energy purchased.

CONCLUSIONS

Reducing the availability of less-healthy drinks could reduce the energy purchased from drinks in vending machines. Further studies are needed to establish whether any effects might be smaller for snacks, or found with higher baseline proportions of healthier options.

Food Addiction: Implications for the Diagnosis and Treatment of Overeating

With the obesity epidemic being largely attributed to overeating, much research has been aimed at understanding the psychological causes of overeating and using this knowledge to develop targeted interventions. Here, we review this literature under a model of food addiction and present evidence according to the fifth edition of the Diagnostic and Statistical Manual (DSM-5) criteria for substance use disorders. We review several innovative treatments related to a food addiction model ranging from cognitive intervention tasks to neuromodulation techniques. We conclude that there is evidence to suggest that, for some individuals, food can induce addictive-type behaviours similar to those seen with other addictive substances. However, with several DSM-5 criteria having limited application to overeating, the term 'food addiction' is likely to apply only in a minority of cases. Nevertheless, research investigating the underlying psychological causes of overeating within the context of food addiction has led to some novel and potentially effective interventions. Understanding the similarities and differences between the addictive characteristics of food and illicit substances should prove fruitful in further developing these interventions.

Food craving predicts the consumption of highly palatable food but not bland food

The impact of obesity on physical and psychological health is well recognized in the literature with, among others, evidence of alterations in cognition. Indeed, obese populations are characterized by lower executive functions as well as an enhanced food craving. However, the relationship between executive functions and food craving remains unexplored. Moreover, these two variables have also been shown to predict food intake, but studies in the context of obesity are lacking. Thus, this study had two objectives: (1) determining if executive functions and food craving are linked, and (2) examining the predictors of highly palatable food intake and bland food intake. First, it was hypothesized that executive functions would be negatively associated with food craving. Second, it was expected that food craving would predict positively highly palatable food intake but not bland food intake. Third, it was predicted that executive functions would predict negatively highly palatable food intake and positively bland food intake. 48 participants (34 females) with BMIs ranging from 17.9 to 46.4 took part in two experimental sessions. First, executive functions were assessed using the delayed discounting task (impulsivity towards food and money) and the color-word interference test (CWIT; inhibition/flexibility). Second, a cue-induced food craving protocol, with images as well as real food, was administered followed by an ad libitum food intake protocol including both highly palatable and bland food. The inhibition/flexibility condition of the CWIT was significantly and negatively correlated with food craving following induction. Highly palatable food intake was significantly predicted by food craving following induction, but bland food intake was not. This study reveals an association between lower inhibition/flexibility and susceptibility to food craving induction that is of great importance in obesogenic environments. Moreover, this study confirmed the link between food craving and food intake, and showed for the first time a specific contribution of food craving to highly palatable food intake but not to bland food intake, highlighting its potential influence in obesity. This work leads to future research questions regarding the possible benefits of cognitive remediation interventions, as well as interventions aiming at reducing food craving, in weight loss programs. LEVEL OF EVIDENCE: Level IV, quasi-experimental study.

Does executive function moderate the relation between momentary affective and physical states and subsequent dietary lapse? An EMA investigation

The study explored whether baseline individual differences in executive function (EF) affect the relation between elevations in internal states and subsequent likelihood of lapsing from a dietary prescription. Participants were 189 adults with overweight/obesity in a behavioral weight loss treatment who completed a neuropsychological EF task at intake and a 2-week EMA protocol measuring internal states and dietary lapses at start of treatment. Generalized estimating equations found relations between momentary elevations in tiredness (b = .06, p = .01) and deprivation (b = .06, p = .047) and subsequent likelihood of lapsing were more robust for participants with lower EF, whereas the relation between momentary elevations in boredom and subsequent likelihood of lapsing (b = .04, p = .03) was more robust for participants with higher EF. Results provide support for EF impacting the relation between elevations in internal states and likelihood of dietary lapse, informing the development of personalized behavioral weight loss treatments.

Availability of healthier vs. less healthy food and food choice: an online experiment

BACKGROUND

Our environments shape our behaviour, but little research has addressed whether healthier cues have a similar impact to less healthy ones. This online study examined the impact on food choices of the number of (i) healthier and (ii) less healthy snack foods available, and possible moderation by cognitive load and socioeconomic status.

METHODS

UK adults (n = 1509) were randomly allocated to one of six groups (two cognitive load x three availability conditions). Participants memorised a 7-digit number (7777777: low cognitive load; 8529713: high cognitive load). While remembering this number, participants chose the food they would most like to eat from: (a) two healthier and two less healthy foods, (b) six healthier and two less healthy foods, or (c) two healthier and six less healthy foods.

RESULTS

Compared to being offered two healthier and two less healthy options, the odds of choosing a healthier option were twice as high (Odds Ratio (OR): 2.0, 95%CI: 1.6, 2.6) with four additional healthier options, while the odds of choosing a less healthy option were four times higher (OR: 4.3, 95%CI: 3.1, 6.0) with four additional less healthy options. There were no significant main effects or interactions with cognitive load or socioeconomic status.

CONCLUSIONS

This study provides a novel test of the impact of healthier vs. less healthy food cues on food choice, suggesting that less healthy food cues have a larger effect than healthier ones. Consequently, removing less healthy as opposed to adding healthier food options could have greater impact on healthier choices. Studies are now needed in which choices are made between physically-present foods.

Reported Self-control is not Meaningfully Associated with Inhibition-related Executive Function: A Bayesian Analysis

Self-control is assessed using a remarkable array of measures. In a series of five data-sets (overall N = 2,641) and a mini meta-analysis, we explored the association between canonical operationalisations of self-control: The Self-Control Scale and two measures of inhibition-related executive functioning (the Stroop and Flanker paradigms). Overall, Bayesian correlational analyses suggested little-to-no relationship between self-reported self-control and performance on the Stroop and Flanker tasks. The Bayesian meta-analytical summary of all five data-sets further favoured a null relationship between both types of measurement. These results suggest that the field’s most widely used measure of self-reported self-control is uncorrelated with two of the most widely adopted executive functioning measures of self-control. Consequently, theoretical and practical conclusions drawn using one measure (e.g., the Self-Control Scale) cannot be generalised to findings using the other (e.g., the Stroop task). The lack of empirical correlation between measures of self-control do not invalidate either measure, but instead suggest that treatments of the construct of self-control need to pay greater attention to convergent validity among the many measures used to operationalize self-control.

Group cognitive remediation therapy for adults with obesity prior to behavioural weight loss treatment: study protocol for a randomised controlled superiority study (CRT study)

INTRODUCTION

Individuals with obesity show deficits in executive functioning which have been implicated in decreased weight loss outcome. Preliminary evidence suggests that cognitive remediation therapy (CRT) improves executive functioning and weight loss in obesity. However, confirmatory support, especially for pre-weight loss use, is lacking. The CRT study aims at determining the efficacy of CRT versus no treatment control in patients with obesity before entering behavioural weight loss (BWL) treatment. It is hypothesised that individuals who receive CRT will show better weight loss outcome, improved executive functioning, greater weight loss-related behavioural changes and higher attendance of BWL treatment, 6 and 12 months after cessation of CRT.

METHODS AND ANALYSIS

In a single-centre, assessor-blinded, randomised, two-armed parallel-group superiority trial, 260 adults with body mass index ≥35.0 kg/m2 are centrally randomised to 8-week group-based CRT versus no treatment, before entering BWL treatment. Primary outcome is the amount of weight loss (%) at 6-month follow-up, compared with pre-treatment, derived from measured body weight. Secondary outcomes include improvement in executive functioning post-treatment and in weight loss-related behaviour, mental and physical health, and attendance to BWL treatment at 6-month and 12-month follow-up. Maintenance of weight loss at 12-month follow-up will be determined. Mixed model analyses based on intent-to-treat will be used to compare the CRT and control groups with respect to differences in weight change between pre-treatment and 6-month follow-up. Similar models will be used for analysing 12-month follow-up data and secondary outcomes. Further analyses will include additional covariates to identify predictors of treatment outcome.

ETHICS AND DISSEMINATION

The study was approved by the Ethical Committee of the University of Leipzig (256-15-13072015, version 'Final 1.0 from 28 May 2015). The study results will be disseminated through peer-reviewed publications.

TRIAL REGISTRATION NUMBER

DRKS00009333; Pre-results.

Cognitive effects of a 30-min aerobic exercise bout on adults with overweight/obesity and type 2 diabetes

BACKGROUND

Several studies document reliable brain health benefits of acute exercise bouts. However, no prior studies have explored such effects among those living with co-morbid overweight/obesity and type 2 diabetes (T2DM), both of which are conditions associated with cognitive performance decrements.

PURPOSE

To examine the impact of a 30-min bout of moderate-intensity aerobic exercise on executive function among adults with overweight/obesity and T2DM, employing a widely used experimental paradigm.

METHODS

Thirty adults with overweight/obesity and T2DM were randomly assigned to moderate (30% maximal heart rate reserve) and minimal (r.p.m. 30-50; work load 5) intensity aerobic exercise. Pre-exercise to post-exercise changes in Stroop interference and Go/No-Go scores were compared across conditions.

RESULTS

Primary analyses revealed no overall effect of exercise condition on changes in Stroop or Go/No-Go performance. Post-hoc moderation analyses indicated that Stroop interference scores were reduced, following moderate exercise among female participants and among those who were more physically active.

CONCLUSION

The current study revealed no reliable benefit of acute aerobic exercise for overweight and obese individuals living with T2DM overall. There may be limited benefits for women and more and active subgroups, but the precise nature of such benefits remains unclear.

Personal and situational predictors of everyday snacking: An application of temporal self-regulation theory

OBJECTIVES

This study aims at testing predictions derived from temporal self-regulation theory (TST) in relation to discretionary food choices (snacks). TST combines a motivational sphere of influence (cognitions and temporal valuations resulting in intentions) with a momentary sphere (encompassing social and physical environmental cues). This dual approach differs from current health behaviour theories, but can potentially improve our understanding of the interplay of personal and environmental factors in health behaviour self-regulation.

DESIGN

A mixed event-based and time-based (Ecological Momentary Assessment) study in 61 adults aged between 18 and 64, with a BMI range between 18.34 and 39.78 (M = 25.66, SD = 4.82) over two weeks.

METHODS

Participants recorded their food and drink intake for two weeks in real time using electronic diaries. Participants also responded to non-consumption assessments at random intervals throughout each day. Momentary cues (individual, situational, and environmental factors) were assessed both during food logs and non-consumption assessments. Motivational factors, past behaviour, and trait self-regulation were assessed during baseline.

RESULTS

Multilevel logistic regression analyses showed that across all snack types, environmental cues and negative affect were associated with an increased likelihood of snacking. Perceiving a cost of healthy eating to occur before eating was associated with an increased likelihood of snacking, whereas intentions and self-regulation were not.

CONCLUSIONS

Discretionary food intake is largely guided by momentary cues, and motivational-level factors, such as intention and self-regulation, are less important in the initiation of discretionary food intake. Statement of contribution What is already known on this subject? Overweight and obesity are a result of prolonged periods of energy imbalance between energy intake and expenditure (Hill & Peters, ). One of the key behavioural determinants of energy imbalances results from food intake, specifically from discretionary food choices (snacking). Temporal self-regulation theory (Hall & Fong, ) takes into account both deliberate and momentary influences on health behaviour, which is especially relevant to exploring the drivers of snacking. What does this study add? Offers new insight into the application of TST in explaining momentary eating behaviours. Snacking initiation is guided by momentary cues, not person-level factors. Dietary interventions should acknowledge the momentary cues that are associated with snacking.

Executive function fails to predict smoking outcomes in a clinical trial to motivate smokers to quit

BACKGROUND

Executive function (EF) is considered an important mediator of health outcomes. It is hypothesized that those with better EF are more likely to succeed in turning their intentions into actual health behaviors. Prior studies indicate EF is associated with smoking cessation. Experimental and longitudinal studies, however, have yielded mixed results. Few studies have examined whether EF predicts post-treatment smoking behavior. Fewer still have done so prospectively in a large trial. We sought to determine if EF predicts quit attempts and cessation among community smokers in a large randomized trial evaluating the efficacy of motivational interventions for encouraging cessation.

METHODS

Participants (N=255) completed a baseline assessment that included a cognitive battery to assess EF (Oral Trail Making Test B, Stroop, Controlled Oral Word Association Test). Participants were then randomized to 4 sessions of Motivational Interviewing or Health Education or one session of Brief Advice to quit. Quit attempts and cessation were assessed at weeks 12 and 26.

RESULTS

In regression analyses, none of the EF measures were statistically significant predictors of quit attempts or cessation (all ps>0.20).

CONCLUSIONS

Our data did not support models of health behavior that emphasize EF as a mediator of health outcomes. Methodological shortcomings weaken the existing support for an association between EF and smoking behavior. We suggest methodological improvements that could help move this potentially important area of research forward.

Is decision-making ability related to food choice and facets of eating behaviour in adolescents?

PURPOSE

To test the prediction that poor decision-making would predict poor eating-related behaviours, which in turn would relate to elevated body mass index (BMI) percentile.

METHODS

Associations among decision-making ability, eating behaviours, and BMI percentile were examined in a sample of 311 healthy male and female adolescents, aged 14-18 years. Structural equation modelling was used to test the proposed relationships.

RESULTS

The predicted model was a good fit to the data and all paths between latent and indicator variables were significant. Impulsive responding significantly predicted poor food choice and overeating. No significant relationships emerged between eating-related variables and BMI percentile.

CONCLUSIONS

Findings from this study extend the existing research in adults and offer a more comprehensive understanding of factors that may contribute to eating behaviours and weight status in teenagers.

A Bidirectional Relationship between Executive Function and Health Behavior: Evidence, Implications, and Future Directions

Physically active lifestyles and other health-enhancing behaviors play an important role in preserving executive function into old age. Conversely, emerging research suggests that executive functions facilitate participation in a broad range of healthy behaviors including physical activity and reduced fatty food, tobacco, and alcohol consumption. They do this by supporting the volition, planning, performance monitoring, and inhibition necessary to enact intentions and override urges to engage in health damaging behavior. Here, we focus firstly on evidence suggesting that health-enhancing behaviors can induce improvements in executive function. We then switch our focus to findings linking executive function to the consistent performance of health-promoting behaviors and the avoidance of health risk behaviors. We suggest that executive function, health behavior, and disease processes are interdependent. In particular, we argue that a positive feedback loop may exist whereby health behavior-induced changes in executive function foster subsequent health-enhancing behaviors, which in turn help sustain efficient executive functions and good health. We conclude by outlining the implications of this reciprocal relationship for intervention strategies, the design of research studies, and the study of healthy aging.

A Serious Game to Increase Healthy Food Consumption in Overweight or Obese Adults: Randomized Controlled Trial

BACKGROUND

Obesity is a growing global issue that is linked to cognitive and psychological deficits.

OBJECTIVE

This preliminary study investigated the efficacy of training to improve inhibitory control (IC), a process linked to overeating, on consumption and cognitive control factors.

METHODS

This study utilized a multisession mobile phone-based intervention to train IC in an overweight and obese population using a randomized waitlist-control design. A combination of self-assessment questionnaires and psychophysiological measures was used to assess the efficacy of the intervention in terms of improved general IC and modified food consumption after training. Attitudes toward food were also assessed to determine their mediating role in food choices. A total of 58 participants (47 female) completed 2 assessment sessions 3 weeks apart, with 2 weeks of intervention training for the training group during this time. The groups did not differ in baseline demographics including age, body mass index, and inhibitory control.

RESULTS

Inhibitory control ability improved across the training sessions, with increases in P3 amplitude implying increased cognitive control over responses. Inhibitory control training was associated with increased healthy and reduced unhealthy food consumption in a taste test and in the week following training, as measured by the Healthy Eating Quiz and the food consumption test. Cognitive restraint was enhanced after training for the training but not the waitlist condition in the Three-Factor Eating Questionnaire, implying that attempts to avoid unhealthy foods in the future will be easier for the training group participants.

CONCLUSIONS

Inhibitory control training delivered via a purpose-designed mobile phone app is easy to complete, is convenient, and can increase cognitive restraint and reduce unhealthy food consumption.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12616000263493; http://www.ANZCTR.org.au/ACTRN12616000263493.aspx (Archived by WebCite at http://www.webcitation.org/6ioHjGING).

"You Can't Always Get What You Want": A Novel Research Paradigm to Explore the Relationship between Multiple Intentions and Behaviours

Objective

Research investigating cognitive moderators of the intention–behaviour relationship and psychological consequences of failure to enact intentions is usually conducted in a single‐behaviour paradigm. A multiple‐behaviour paradigm is introduced which overcomes bias inherent to single‐behaviour designs and allows testing of novel hypotheses. Two exploratory studies illustrate the utility of this new paradigm by investigating the role of cognitive predictors and psychological correlates of intention–behaviour relationships.

Method

The proposed method involves measuring multiple intentions across common areas of life activity at baseline and corresponding behaviours at follow‐up. In two studies, 51 intentions and behaviours were assessed (49 by self‐report, 2 objectively). In Study 1, participants (n = 126) also completed self‐reported measures of everyday cognitive failures and dysexecutive behaviours, crystallised intelligence (Mill Hill Vocabulary Scale) at baseline and Quality of Life (QoL; follow‐up). In Study 2, objective executive function measures (Stroop, Go/NoGo task and Word Fluency test) were completed by N = 30 participants.

Results

The total number of intentions, cognitive, and QoL measures were unrelated to the percentage of intentions enacted. Crystallised intelligence was related to successful intention implementation and problems with emotion regulation were associated with forming fewer intentions and with fewer failed intentions. QoL was strongly related with more intentions, regardless of whether or not these were implemented. Study 2 showed that cognitive flexibility (word fluency) and task errors, rather than Stroop effect and Go/No‐Go performance were related, to intention–behaviour congruence.

Conclusion

Intention–behaviour relationships might be better understood when considering the multiple intentions and behaviours that people are engaged in at once at any one point in time. A multiple‐behaviour paradigm suggests novel hypotheses. Preliminary findings reported here require replication. Anticipated applications of the paradigm are outlined and discussed.

Defying Food - How Distance Determines Monkeys' Ability to Inhibit Reaching for Food

Objects, such as food, in the environment automatically activate and facilitate affordances, the possibilities for motoric movements in interaction with the objects. Previous research has shown that affordance activation is contingent upon the distance of the object with only proximal objects activating potential movements. However, the effect of affordance-activating proximal objects on the ability to inhibit movements has been unaddressed. The current study addressed this question with two experiments on long-tailed macaques. In both experiments monkeys were situated behind a Plexiglass screen that prevented direct access to food placed right behind the screen. The food could only be reached via a detour through one of two holes on the sides of the screen. It was assessed whether monkeys’ ability to inhibit the unsuccessful immediate reaching movement forward toward the food depended on the distance at which the food was presented. Results of both Experiments revealed that monkeys reached for the proximally positioned food significantly more than for the distally positioned food, despite this Plexiglass screen preventing successful obtainment of the food. The findings reveal the effect of proximal, affordance-activating objects on the ability to resist movements involved in interacting with the objects. Implications for humans, living in environments in which proximal, or accessible food is constantly available are discussed. The findings can contribute to an understanding of why resisting accessible food in the environment is often unsuccessful.

A Computational Analysis of Aberrant Delay Discounting in Psychiatric Disorders

Impatience for reward is a facet of many psychiatric disorders. We draw attention to a growing literature finding greater discounting of delayed reward, an important aspect of impatience, across a range of psychiatric disorders. We propose these findings are best understood by considering the goals and motivation for discounting future reward. We characterize these as arising from either the opportunity costs of waiting or the uncertainty associated with delayed reward. We link specific instances of higher discounting in psychiatric disorder to heightened subjective estimates of either of these factors. We propose these costs are learned and represented based either on a flexible cognitive model of the world, an accumulation of previous experience, or through evolutionary specification. Any of these can be considered suboptimal for the individual if the resulting behavior results in impairments in personal and social functioning and/or in distress. By considering the neurochemical and neuroanatomical implementation of these processes, we illustrate how this approach can in principle unite social, psychological and biological conceptions of impulsive choice.

Psychological predictors of opportunistic snacking in the absence of hunger

Increased frequency of eating in the absence of homeostatic need, notably through snacking, is an important contributor to overconsumption and may be facilitated by increased availability of palatable food in the obesogenic environment. Opportunistic initiation of snacking is likely to be subject to individual differences, although these are infrequently studied in laboratory-based research paradigms. This study examined psychological factors associated with opportunistic initiation of snacking, and predictors of intake in the absence of homeostatic need. Fifty adults (mean age 34.5years, mean BMI 23.9kg/m(2), 56% female) participated in a snack taste test in which they ate a chocolate snack to satiation, after which they were offered an unanticipated opportunity to initiate a second eating episode. Trait and behavioural measures of self control, sensitivity to reward, dietary restraint and disinhibited eating were taken. Results showed that, contrary to expectations, those who initiated snacking were better at inhibitory control compared with those who did not initiate. However, amongst participants who initiated snacking, intake (kcal) was predicted by higher food reward sensitivity, impulsivity and BMI. These findings suggest that snacking initiation in the absence of hunger is an important contributor to overconsumption. Consideration of the individual differences promoting initiation of eating may aid in reducing elevated eating frequency in at-risk individuals.

Temporal self-regulation theory: a neurobiologically informed model for physical activity behavior

Dominant explanatory models for physical activity behavior are limited by the exclusion of several important components, including temporal dynamics, ecological forces, and neurobiological factors. The latter may be a critical omission, given the relevance of several aspects of cognitive function for the self-regulatory processes that are likely required for consistent implementation of physical activity behavior in everyday life. This narrative review introduces temporal self-regulation theory (TST; Hall and Fong, 2007, 2013) as a new explanatory model for physical activity behavior. Important features of the model include consideration of the default status of the physical activity behavior, as well as the disproportionate influence of temporally proximal behavioral contingencies. Most importantly, the TST model proposes positive feedback loops linking executive function (EF) and the performance of physical activity behavior. Specifically, those with relatively stronger executive control (and optimized brain structures supporting it, such as the dorsolateral prefrontal cortex (PFC)) are able to implement physical activity with more consistency than others, which in turn serves to strengthen the executive control network itself. The TST model has the potential to explain everyday variants of incidental physical activity, sport-related excellence via capacity for deliberate practice, and variability in the propensity to schedule and implement exercise routines.

A bidirectional relationship between physical activity and executive function in older adults

Physically active lifestyles contribute to better executive function. However, it is unclear whether high levels of executive function lead people to be more active. This study uses a large sample and multi-wave data to identify whether a reciprocal association exists between physical activity and executive function. Participants were 4555 older adults tracked across four waves of the English Longitudinal Study of Aging. In each wave executive function was assessed using a verbal fluency test and a letter cancelation task and participants reported their physical activity levels. Fixed effects regressions showed that changes in executive function corresponded with changes in physical activity. In longitudinal multilevel models low levels of physical activity led to subsequent declines in executive function. Importantly, poor executive function predicted reductions in physical activity over time. This association was found to be over 50% larger in magnitude than the contribution of physical activity to changes in executive function. This is the first study to identify evidence for a robust bidirectional link between executive function and physical activity in a large sample of older adults tracked over time.

Executive function in the context of chronic disease prevention: theory, research and practice

OBJECTIVE

To provide an overview of the nature, organization and measurement of executive function, and describe its significance for preventive medicine theory, research and practice.

METHOD

A conceptual and narrative review linking the operation of executive control systems to health behavior performance and health outcomes, within the context of chronic illness prevention.

RESULTS

Stronger executive function is linked with more consistent performance of a variety of health protective behaviors, less performance of health risk behaviors, and greater longevity in the existing observational research literature. These effects are not fully explained by demographic factors such as education, income and socioeconomic status, but may in some cases interact with them, or mediate their effects on other outcomes. Experimental manipulations of executive control suggest that the effect of executive function is causal, particularly in relation to the modulation of appetitive craving responses that may compete with healthy behaviors (or facilitate unhealthy behaviors).

CONCLUSION

Executive function is a potentially important variable in explanatory frameworks for health behavior and health outcomes. The size of effect and its endurance remain uncertain, though the causal status of its influence on some behaviors is becoming increasingly clear. Additional understanding of the relation between executive control and demand imposed by ecological context is an important frontier for research on changing behavior to prevent disease, and may be an explanatory factor in social patterning of these same conditions.

The SNAPSHOT study protocol: SNAcking, Physical activity, Self-regulation, and Heart rate Over Time

Background

The cognitive processes responsible for effortful behavioural regulation are known as the executive functions, and are implicated in several factors associated with behaviour control, including focussing on tasks, resisting temptations, planning future actions, and inhibiting prepotent responses. Similar to muscles, the executive functions become fatigued following intensive use (e.g. stressful situations, when tired or busy, and when regulating behaviour such as quitting smoking). Therefore, an individual may be more susceptible to engaging in unhealthy behaviours when their executive functions are depleted. In the present study we investigate associations between the executive functions, snack food consumption, and sedentary behaviour in real time. We hypothesise that individuals may be more susceptible to unhealthy snacking and sedentary behaviours during periods when their executive functions are depleted. We test this hypothesis using real-time objective within-person measurements.

Methods/Design

A sample of approximately 50 Scottish adults from varied socio-economic, working, and cultural backgrounds will participate in the three phases of the SNAcking, Physical activity, Self-regulation, and Heart rate Over Time (SNAPSHOT) study. Phase one will require participants to complete home-based questionnaires concerned with diet, eating behaviour, and physical activity (≈1.5 hours to complete). Phase two will constitute a 2-3 hour psychological laboratory testing session during which trait-level executive function, general intelligence, and diet and physical activity intentions, past behaviour, and automaticity will be measured. The final phase will involve a 7-day ambulatory protocol during which objective repeated assessments of executive function, snacking behaviour, physical activity, mood, heart rate, perceived energy level, current context and location will be measured during participants’ daily routines. Multi-level regression analysis, accounting for observations nested within participants, will be used to investigate associations between fluctuations in the executive functions and health behaviours.

Discussion

Data from the SNAPSHOT study will provide ecologically valid information to help better understand the temporal associations between self-regulatory resources (executive functions) and deleterious health behaviours such as snacking and sedentary behaviour. If we can identify particular periods of the day or locations where self-regulatory resources become depleted and produce suboptimal health behaviour, then interventions can be designed and targeted accordingly.

Does temporal discounting explain unhealthy behavior? A systematic review and reinforcement learning perspective

The tendency to make unhealthy choices is hypothesized to be related to an individual's temporal discount rate, the theoretical rate at which they devalue delayed rewards. Furthermore, a particular form of temporal discounting, hyperbolic discounting, has been proposed to explain why unhealthy behavior can occur despite healthy intentions. We examine these two hypotheses in turn. We first systematically review studies which investigate whether discount rates can predict unhealthy behavior. These studies reveal that high discount rates for money (and in some instances food or drug rewards) are associated with several unhealthy behaviors and markers of health status, establishing discounting as a promising predictive measure. We secondly examine whether intention-incongruent unhealthy actions are consistent with hyperbolic discounting. We conclude that intention-incongruent actions are often triggered by environmental cues or changes in motivational state, whose effects are not parameterized by hyperbolic discounting. We propose a framework for understanding these state-based effects in terms of the interplay of two distinct reinforcement learning mechanisms: a “model-based” (or goal-directed) system and a “model-free” (or habitual) system. Under this framework, while discounting of delayed health may contribute to the initiation of unhealthy behavior, with repetition, many unhealthy behaviors become habitual; if health goals then change, habitual behavior can still arise in response to environmental cues. We propose that the burgeoning development of computational models of these processes will permit further identification of health decision-making phenotypes.

Moral responsibility for (un)healthy behaviour

Combatting chronic, lifestyle-related disease has become a healthcare priority in the developed world. The role personal responsibility should play in healthcare provision has growing pertinence given the growing significance of individual lifestyle choices for health. Media reporting focussing on the 'bad behaviour' of individuals suffering lifestyle-related disease, and policies aimed at encouraging 'responsibilisation' in healthcare highlight the importance of understanding the scope of responsibility ascriptions in this context. Research into the social determinants of health and psychological mechanisms of health behaviour could undermine some commonly held and tacit assumptions about the moral responsibility of agents for the sorts of lifestyles they adopt. I use Philip Petit's conception of freedom as 'fitness to be held responsible' to consider the significance of some of this evidence for assessing the moral responsibility of agents. I propose that, in some cases, factors outside the agent's control may influence behaviour in such a way as to undermine her freedom along the three dimensions described by Pettit: freedom of action; a sense of identification with one's actions; and whether one's social position renders one vulnerable to pressure from more powerful others.

Cognitive and personality factors in the prediction of health behaviors: an examination of total, direct and indirect effects

Conscientiousness reliably predicts health behavioral patterns, and the same is true of executive function. However, few investigations have examined their relative predictive power, or probed for possible indirect effects and age-moderated effects. In the current study, we examined the predictive validity of all Big Five personality traits, executive function and IQ in relation to an index of health behaviors in an age-stratified community sample. Results indicated that conscientiousness, neuroticism and executive function were significant predictors of health behavior in age-corrected regression analyses. Using bootstrapping methods, we found that executive function partially explains the relationship between both personality dimensions and health behavior. Moderational analyses revealed that effects of personality traits on health behavior were uniformly modest across the age span, whereas the predictive power of executive function became more amplified with increasing age. Both conscientiousness and neuroticism predict health behavior patterns, though their magnitude of association is significantly weaker than executive function and some of their effects are explained by executive function.

Dieting and the self-control of eating in everyday environments: an experience sampling study

OBJECTIVE

The literature on dieting has sparked several debates over how restrained eaters differ from unrestrained eaters in their self-regulation of healthy and unhealthy food desires and what distinguishes successful from unsuccessful dieters. We addressed these debates using a four-component model of self-control that was tested using ecological momentary assessment, long-term weight change, and a laboratory measure of inhibitory control.

DESIGN

A large sample of adults varying in dietary restraint and inhibitory control (as measured by a Stroop task) were equipped with smartphones for a week. They were beeped on random occasions and provided information on their experience and control of healthy and unhealthy food desires in everyday environments.

MAIN OUTCOME MEASURES

The main outcome measures were desire strength, experienced conflict, resistance, enactment of desire, and weight change after a 4-month follow-up.

RESULTS AND CONCLUSIONS

Dietary restraint was unrelated to desire frequency and strength, but associated with higher conflict experiences and motivation to use self-control with regard to food desires. Most importantly, relationships between dietary restraint and resistance, enactment of desire, and long-term weight change were moderated by inhibitory control: Compared with dieters low in response inhibition, dieters high in response inhibition were more likely to attempt to resist food desires, not consume desired food (especially unhealthy food), and objectively lost more weight over the ensuing 4 months. These results highlight the combinatory effects of aspects of the self-control process in dieters and highlight the value in linking theoretical process frameworks, experience sampling, and laboratory-based assessment in health science.

STATEMENT OF CONTRIBUTION

What is already known on this subject? Dieting is a multifaceted process that can be viewed from the lens of self-control. Dietary restraint measures can be used to capture dieting status, but it is relatively unclear what differentiates successful from unsuccessful dieters (e.g., differences in desire frequency, desire strength, motivation, executive functions). What does this study add? A novel four-step conceptual model of self-control is applied to eating behaviour in everyday life. This model allows a fine-grained look at the self-control process in restrained eaters (dieters) as compared to non-dieters. Dieters and non-dieters do not differ in desire frequency and strength (they are not simply more tempted). Dieters high (as compared to low) in inhibitory control are more likely to engage in self-control. Dieters high (as compared to low) in inhibitory control are more likely to resist unhealthy food desires. Dieters high (as compared to low) in inhibitory control are more likely to loose weight over a 4-month period. Together, the study shows clear differences among successful and unsuccessful dieters that can be linked to differences in executive functioning (inhibitory control). The present article is one of the first studies combining a conceptual model with smartphone experience sampling to study weight control and thus paradigmatic from a methodological perspective.

Neurobehavioural correlates of body mass index and eating behaviours in adults: a systematic review

The worldwide increase in obesity has spurred numerous efforts to understand the regulation of eating behaviours and underlying brain mechanisms. These mechanisms can affordably be studied via neurobehavioural measures. Here, we systematically review these efforts, evaluating neurocognitive tests and personality questionnaires based on: (a) consistent relationship with obesity and eating behaviour, and (b) reliability. We also considered the measures' potential to shed light on the brain mechanisms underlying these individual differences. Sixty-six neurocognitive tasks were examined. Less than 11%, mainly measures of executive functions and food motivation, yielded both replicated and reliable effects. Several different personality questionnaires were consistently related to BMI. However, further analysis found that many of these questionnaires relate closely to Conscientiousness, Extraversion and Neuroticism within the Five-Factor Model of personality. Both neurocognitive tests and personality questionnaires suggest that the critical neural systems related to individual differences in obesity are lateral prefrontal structures underpinning self-control and striatal regions implicated in food motivation. This review can guide selection of the highest yield neurobehavioural measures for future studies.

Using the temporal self-regulation theory to examine the influence of environmental cues on maintaining a healthy lifestyle

OBJECTIVES

The aim of the current study is to explore the predictive utility of the temporal self-regulation theory (TST) for maintaining a healthy lifestyle (Hall & Fong, 2007, Health Psychology Review, 1, 6). According to TST, the influence of intention, self-regulation, and behavioural prepotency differs depending on the environmental context in which the behaviour is performed. This study examined the influence of perceptions about the supportiveness of the environmental context on TST-related factors.

DESIGN

Temporal self-regulation theory was tested using a prospective design with a 1-week follow-up.

METHODS

One hundred and fifty-two undergraduates were administered three executive functioning tasks and an online questionnaire regarding their intentions to maintain a healthy lifestyle, environmental responsiveness, and previous behaviour. One week later, they completed a follow-up questionnaire.

RESULTS

Participants who were supported by the environment were significantly more likely to maintain a healthy lifestyle than those distracted by the environment. Behavioural prepotency was significantly predictive of behaviour performance for 'supported' participants. Behavioural prepotency, planning, and response inhibition were significantly predictive of 'unsupported' participants' behaviour.

CONCLUSIONS

These findings provided preliminary support for the use of TST for the prediction of healthy lifestyle behaviour. Importantly, this study provided support for the contention that the influence of TST-related factors would vary according to the perceived supportiveness of the environment. These findings suggest that environmental responsiveness may be an important determinant to close the intention-behaviour gap for maintaining a healthy lifestyle.

Association of symptoms of attention-deficit/hyperactivity disorder with physical activity, media time, and food intake in children and adolescents

Introduction

The aim of the study was to assess the association between attention deficit/hyperactivity disorder (ADHD) symptoms and potentially obesogenic behaviors.

Methods

Data of 11,676 German children and adolescents (6–17 years) were analyzed. Television/video exposure, physical activity, food frequency and portion size were assessed using questionnaires. A dietary quality index, energy density and volumes of consumed food, and total energy intake were calculated. The parent-rated hyperactivity/inattention subscale of the Strengths and Difficulties Questionnaire (SDQ-HI) was used as a continuous measure of ADHD symptoms. Associations were analyzed with general linear models adjusting for sex, age, socioeconomic status, migrant status, parental BMI, and parental smoking.

Results

SDQ-HI scores correlated positively with physical activity, average energy density of food, volume of beverages, total energy intake, and television exposure and negatively with the nutritional quality score (HuSKY) even after adjustment for parental variables (BMI, smoking, socioeconomic status, migrant status), age, sex, as well as the other SDQ subscales. The adjusted association of the SDQ-HI scores with the nutritional quality score was stronger in girls and the associations with food volume, food energy, and total energy intake was significant only in girls.

Conclusions

Poor nutritional quality, high energy intake and television exposure appear to be independently associated with ADHD symptoms. The relationship between food energy intake and ADHD symptoms was especially pronounced in girls and this may help to explain the reported association of ADHD symptoms with overweight in adolescent girls.