Dietary restraint, ambivalence toward eating, and the valence and content of spontaneous associations with eating

Methods to assess ambivalence towards food and diet: a scoping review

BACKGROUND

Ambivalence towards food and diet, which favours behavioural inertia, might be a barrier to adopting healthier eating behaviours. Measuring it can help researchers to better understand its relationship with behaviour change and design interventions aimed at resolving it. In this scoping review, we map and describe methods and tools employed in studies to assess, measure or classify the ambivalence of participants towards food- and diet-related attitude objects.

METHODS

In accordance with Joanna Briggs Institute guidance for conducting scoping reviews, we retrieved peer-reviewed studies from MEDLINE, CINAHL, PsycINFO, Web of Science, FSTA and Food Science Source and preprints from PsyArXiv and MedRxiv. Two independent reviewers screened the articles. We considered for inclusion peer-reviewed studies and preprints that assessed the ambivalence of participants of any age, sex or sociodemographic group towards food and diet.

RESULTS

We included 45 studies published between 1992 and 2022, which included participants from 17 countries. Eighteen methods were employed across the included studies to assess different types of ambivalence (felt, potential or cognitive-affective), the most frequent of which were the Griffin Index, the Subjective Ambivalence Questionnaire, the MouseTracker Paradigm and the Orientation to Chocolate Questionnaire.

CONCLUSION

This scoping review identified several methods and tools to assess different types of ambivalence towards food- and diet-related objects, providing an array of options for future studies.

Examining Nutrition Knowledge, Skills, and Eating Behaviours in People with Severe Mental Illness: A Cross-Sectional Comparison among Psychiatric Inpatients, Outpatients, and Healthy Adults

Compared to the general population, people with severe mental illness (SMI) have an increased risk of weight gain and metabolic syndrome, but also of malnutrition, in part due to unhealthy lifestyle behaviours. The aim of this cross-sectional study was to identify barriers to healthy eating, including nutrition knowledge and skills in people with SMI. For this purpose, we compared the means of anthropometric data such as body mass index, waist-to-hip ratio, and interview data on nutrition knowledge and skills, health-related variables, eating behaviours, personality, motivation, and attitudes in 65 inpatients and 67 outpatients of the Psychiatric Hospital of the University of Zurich and 64 healthy adults using ANOVA and chi-squared tests. The results showed that patients with SMI had worse nutritional status and lifestyle compared to the healthy controls, including disordered (e.g., night eating) and unhealthy (e.g., high intake of sugary foods) eating habits. However, levels of nutrition knowledge, cooking and food skills, and motivation to eat healthily were not significantly lower in the psychiatric patients than in the healthy adults and were not associated with weight change. Based on our findings, nutritional support for people with SMI is urgently needed and should include not only educational but also behavioural and long-term approaches.

Nutritional Needs in Mental Healthcare: Study Protocol of a Prospective Analytic Observational Study Assessing Nutritional Status, Eating Behavior and Barriers to Healthy Eating in Psychiatric Inpatients and Outpatients Compared to Healthy Adults

BACKGROUND

Mental disorders are often associated with unhealthy eating behaviors and metabolic comorbidities. This can result in reduced life expectancy and poorer quality of life in people with mental disorders. This study protocol describes an observational study that examines the nutritional status and eating behaviors of people with severe mental illness (SMI) and the need for psychiatric treatment who were between 18 and 65 years old. In addition, the study focuses on possible barriers for healthy eating that have not yet been examined in this population.

METHODS

A total of 192 study participants will be recruited: 64 inpatients and 64 outpatients from the Psychiatric Hospital of the University of Zurich with SMI as well as 64 healthy individuals from the general population as a control group. The participants will be interviewed regarding their nutritional status, eating behavior, nutrition knowledge, food and cooking skills, personality, attitudes and feelings toward nutrition. In addition, the severity of symptoms and several control variables (e.g., sociodemographic variables and physical activity) will be assessed. For the patient samples, data will comprise routine medical data, and, if available, routine laboratory data. Inpatients will be interviewed once at the beginning of their treatment. Outpatients will be interviewed at the beginning and after 3 months of treatment (same interview questions). Healthy adults of the control group will be interviewed once at any time during the recruitment period.

DISCUSSION

The described study will identify nutritional needs and possible barriers to healthy eating in patients with mental disorders. The results will help to define recommendations for nutritional risk screening in psychiatric patients and for planning effective nutritional interventions.

Coping styles moderate the relationship between perceived discrimination and eating behaviors during the transition to college

The transition to college is a critical developmental window during which eating behaviors are susceptible to dysregulation. Changes in exposure to discrimination contribute to alterations in eating behaviors, which may be exacerbated or attenuated by coping styles. The present longitudinal study examines whether increases in perceived discrimination predict increases in overeating and decreases in eating well during the transition to college. We expect that adaptive coping styles will buffer against, while maladaptive coping styles will exacerbate, the effects of increases in perceived discrimination on increases in overeating and decreases in eating well. First year students (n = 804) were assessed at two time points: the spring before freshman year (Time 1) and one year later during the spring semester of freshman year (Time 2). Two distinct coping styles emerged from a factor analysis: adaptive (active coping, planning, emotional support, positive reframing, acceptance, instrumental support) and maladaptive coping (denial, venting, self-blame, self-distraction). Increases in perceived discrimination, lower adaptive coping, and higher maladaptive coping had main effects for predicting more overeating at Time 2. Among students who reported increases in perceived discrimination, higher use of adaptive coping was associated with less overeating at Time 2 while higher use of maladaptive coping was associated with more overeating. While adaptive and maladaptive coping styles had main effects on eating well, change in perceived discrimination did not. Neither adaptive nor maladaptive coping styles interacted with change in perceived discrimination to predict eating well. Findings inform a gap in the literature about the relationship between discrimination and eating behaviors from a developmental perspective by demonstrating that adaptive and maladaptive coping styles influence the effects of changes in perceived discrimination on overeating during the college transition.

Lack of conflict during food choice is associated with the failure of restrained eating

Restrained eaters tend to sustain a restriction in caloric intake to lose or maintain body weight; however, only a few restrained eaters can achieve the goal of restricting their caloric intake to lose or maintain body weight. Those who are effective restrained eaters habitually adhere to their intentions to avoid eating certain palatable foods, whereas those who are ineffective restrained eaters are generally unable to translate their intentions into behavior. To restrain eating regardless of temptation, an individual must first identify potential conflicts between achieving restrained eating and temptation to eat. Regarding food selections, the association between a lack of conflict between temptation, eating enjoyment, and weight loss or maintenance goals and the failure of restriction of caloric intake remains unknown. The present study used an eye-tracking technique to assess the degree of conflict experienced by effective and ineffective restrained eaters during food choice. Participants were required to choose between pairs of high- and low-calorie foods. The results showed that choosing the low-calorie food was associated with the experience of more conflict, measured by longer response times and more gaze switches, than choosing the high-calorie food. Ineffective restrained eaters experienced less conflict, exhibiting shorter response times and fewer gaze switches, than did effective restrained eaters, which suggests that a failure to restrain eating might be associated with a lack of experience of conflict.

Moderate eating with pleasure and without effort: Toward understanding the underlying psychological mechanisms

Integrating research on elementary eating behaviors, savoring, mental imagery, mindfulness, cooking, and dinner rituals, a psychological theory of moderate eating is formulated that does not require effortful self-control and giving up on the pleasures of eating. The theory proposes that taste and pleasure can be combined with a relatively objective attitude toward food, resulting in a relatively slow, gentle, and thoughtful manner of eating that enhances satiation. The objective food attitude is thought to result from (a) the accumulation of multiple sensorimotor expectancies and perspectives and (b) a motivational mechanism underlying prosocial behavior, food sharing, and aggression-inhibiting dinner rituals.

MC4R variant rs17782313 and manifestation of obese phenotype in Pakistani females

MC4R represents a key player involved in melanocortin-mediated control of energy balance. Recently identified near MC4R variant rs17782313 (T > C) can serve as a contributing factor for obese phenotype but its association with obesity has never been sought in a sample of the Pakistani population. The role of genetic variants as causal factors varies across populations. Association studies in a specific population can help us to distinguish global from local gene–gene and gene–environment interactions. This is the first study that investigated the association of rs17782313 with obesity and various obesity-linked anthropometric, metabolic, physical, and behavioural traits in Pakistani subjects including 306 OW/OB (overweight and obese) and 300 NW (normal weight) individuals. The comparison of various aforementioned obesity-linked continuous and categorical variables between OW/OB and NW subjects revealed that almost all variables were found significantly aberrant (p < 0.05) in OW/OB subjects as compared to their age- and gender-matched NW controls indicating greater risk of developing various cardio-metabolic disorders. The genotyping of rs17782313 showed significant association of this variant with obesity and obesity-linked anthropometric traits in females suggesting the gender-specific effect of this variant in our population. The minor allele C increased the risk of obesity by 1.55 times (95% CI = 1.1–2.18, p = 0.01) whereas homozygous CC genotype increased the risk by 2.43 times (95% CI = 1.19–4.96, p = 0.015) in females. However, no association of rs17782313 was observed with any of the obesity-linked metabolic, physical, and behavioural traits except random eating timings. In conclusion, the current study significantly contributes to the knowledge of the genetic proneness to obesity in Pakistani females. This could also be helpful for forthcoming meta-analysis studies elucidating which variants are truly associated with the susceptibility to develop an obese phenotype.

The current study significantly contributes to the knowledge of the genetic proneness to obesity in Pakistani females and could also be helpful for forthcoming meta-analysis studies.

The Eating Motivation Survey: results from the USA, India and Germany

OBJECTIVE

Research has shown that there is a large variety of different motives underlying why people eat what they eat, which can be assessed with The Eating Motivation Survey (TEMS). The present study investigates the consistency and measurement invariance of the fifteen basic motives included in TEMS in countries with greatly differing eating environments.

DESIGN

The fifteen-factor structure of TEMS (brief version: forty-six items) was tested in confirmatory factor analyses.

SETTING

An online survey was conducted.

SUBJECTS

US-American, Indian and German adults (total N 749) took part.

RESULTS

Despite the complexity of the model, fit indices indicated a reasonable model fit (for the total sample: χ 2/df=4·03; standardized root-mean-squared residual (SRMR)=0·063; root-mean-square error of approximation (RMSEA)=0·064 (95 % CI 0·062, 0·066)). Only the comparative fit index (CFI) was below the recommended threshold (for the total sample: CFI=0·84). Altogether, 181 out of 184 item loadings were above the recommended threshold of 0·30. Furthermore, the factorial structure of TEMS was invariant across countries with respect to factor configuration and factor loadings (configural v. metric invariance model: ΔCFI=0·009; ΔRMSEA=0·001; ΔSRMR=0·001). Moreover, forty-three out of forty-six items showed invariant intercepts across countries.

CONCLUSIONS

The fifteen-factor structure of TEMS was, in general, confirmed across countries despite marked differences in eating environments. Moreover, latent means of fourteen out of fifteen motive factors can be compared across countries in future studies. This is a first step towards determining generalizability of the fifteen basic eating motives of TEMS across eating environments.

Distinguishing the affective and cognitive bases of implicit attitudes to improve prediction of food choices

Eating behaviors largely result from automatic processes. Yet, in existing research, automatic or implicit attitudes toward food often fail to predict eating behaviors. Applying findings in cognitive neuroscience research, we propose and find that a central reason why implicit attitudes toward food are not good predictors of eating behaviors is that implicit attitudes are driven by two distinct constructs that often have diverging evaluative consequences: the automatic affective reactions to food (e.g., tastiness; the affective basis of implicit attitudes) and the automatic cognitive reactions to food (e.g., healthiness; the cognitive basis of implicit attitudes). More importantly, we find that the affective and cognitive bases of implicit attitudes directly and uniquely influence actual food choices under different conditions. While the affective basis of implicit attitude is the main driver of food choices, it is the only driver when cognitive resources during choice are limited. The cognitive basis of implicit attitudes uniquely influences food choices when cognitive resources during choice are plentiful but only for participants low in impulsivity. Researchers interested in automatic processes in eating behaviors could thus benefit by distinguishing between the affective and cognitive bases of implicit attitudes.

The web-buffet – development and validation of an online tool to measure food choice

Objective

To date, no data exist on the agreement of food choice measured using an online tool with subsequent actual consumption. This needs to be shown before food choice, measured by means of an online tool, is used as a dependent variable to examine intake in the general population.

Design

A ‘web-buffet’ was developed to assess food choice.

Setting

Choice was measured as planned meal composition from photographic material; respondents chose preferred foods and proportions for a main meal (out of a possible 144 combinations) online and the validity was assessed by comparison of a meal composed from a web-buffet with actual food intake 24–48 h later. Furthermore, correlations of food preferences, energy needs and health interest with meals chosen from the web-buffet were analysed.

Subjects

Students: n 106 (Study I), n 32 (Study II).

Results

Meals chosen from the web-buffet (mean=2998 kJ, sd=471 kJ) agreed with actual consumption (rs=0·63, P<0·001) but were on average 367 kJ (10·5 %) lower in energy than consumed meals (mean=3480 kJ, sd=755 kJ). Preferences were highly associated with chosen amounts and health interest was negatively correlated with the energy selected (rs=−0·40, P<0·001).

Conclusions

Meal composition choice in the web-buffet agrees sufficiently well with actual intake to measure food choice as a dependent variable in online surveys. However, we found an average underestimation of subsequent consumption. High correlations of preferences with chosen amounts and an inverse association of health interest with total energy further indicate the validity of the tool. Applications in behavioural nutrition research are discussed.

A content analysis of healthy living blogs: evidence of content thematically consistent with dysfunctional eating attitudes and behaviors

OBJECTIVE

"Healthy" living blogs are a recent addition to internet media that offer advice on improving physical and mental health. Often, these sites include information on eating, exercise, and self-image. This study was a content analysis designed to evaluate the information included on these sites.

METHOD

A sample of 21 blogs was selected from a larger sample for evaluation. These blogs were chosen based on two criteria: they had won an award for healthy blogs and they had a large number of pageviews (pageviews were calculated using a web analytics website). Two raters (kappa reliability = 0.82) rated these blogs on multiple variables related to the blogger's characteristics, the content provided by the blogger, and entries posted on the blog.

RESULTS

Five of the bloggers self-identified as having had an eating disorder; seven mentioned difficulties with either menstruation or fertility; 11 referenced being on a diet; five indicated that they were using some form of dietary restraint; and 11 included some form of written negative/guilt-inducing message about food. Blog entries and About Me sections contained a variety of content indicative of problematic eating and body image information.

DISCUSSION

These findings suggest the content of healthy living blogs might be problematic for viewers who have eating or body image issues. The content does not approach the inflammatory nature of pro-eating disorder websites, yet information promoted clearly indicates that future research should further evaluate these sites.

Successful and unsuccessful restrained eating. Does dispositional self-control matter?

In a random sample (N=1078) from the general population, this study examined whether individual differences in dispositional self-control can explain restrained eaters' success in controlling their weight. A regression analysis with body mass index (BMI) as dependent variable revealed a significant negative association between dispositional self-control and BMI, and a significant positive association between dietary restraint and BMI. These effects were qualified by a significant interaction between restraint and self-control. Among restrained eaters, the association between self-control and BMI was significantly more negative than among normal eaters. Furthermore, among female restrained eaters higher dispositional self-control scores were associated with BMIs within the normal-weight range (BMI<25) and lower dispositional self-control scores were associated with BMIs within the overweight range (BMI>25). Among male restrained eaters very high scores on dispositional self-control were associated with BMIs within the normal-weight range, whereas medium or low scores on self-control were associated with BMIs within the overweight range. Results suggest that high dispositional self-control facilitates successful restrained eating.

Tempting food words activate eating simulations

This study shows that tempting food words activate simulations of eating the food, including simulations of the taste and texture of the food, simulations of eating situations, and simulations of hedonic enjoyment. In a feature listing task, participants generated features that are typically true of four tempting foods (e.g., chips) and four neutral foods (e.g., rice). The resulting features were coded as features of eating simulations if they referred to the taste, texture, and temperature of the food (e.g., "crunchy"; "sticky"), to situations of eating the food (e.g., "movie"; "good for Wok dishes"), and to the hedonic experience when eating the food (e.g., "tasty"). Based on the grounded cognition perspective, it was predicted that tempting foods are more likely to be represented in terms of actually eating them, so that participants would list more features referring to eating simulations for tempting than for neutral foods. Confirming this hypothesis, results showed that eating simulation features constituted 53% of the features for tempting food, and 26% of the features for neutral food. Visual features, in contrast, were mentioned more often for neutral foods (45%) than for tempting foods (19%). Exploratory analyses revealed that the proportion of eating simulation features for tempting foods was positively correlated with perceived attractiveness of the foods, and negatively with participants' dieting concerns, suggesting that eating simulations may depend on individuals' goals with regard to eating. These findings are discussed with regard to their implications for understanding the processes guiding eating behavior, and for interventions designed to reduce the consumption of attractive, unhealthy food.