Eating behaviour in treatment-seeking obese subjects - Influence of sex and BMI classes

Emotional Eating and Uncontrolled Eating as Risk Predictors for Disordered Eating Attitudes in Candidates for Bariatric Surgery Treated at a Public Hospital in the Amazon

This study analyzes the eating behavior and factors associated with the presence of disordered eating attitudes in patients undergoing bariatric surgery. It is a cross-sectional, descriptive, and analytical study conducted at a hospital in the Amazon region of Brazil. The Disordered Eating Attitude Scale reduced version (DEAS-s) was used to assess the risk of eating disorders and the Three-Factor Eating Questionnaire (TFEQ-R21) was used to characterize eating behavior. A total of 205 patients participated, with a mean age of 37.5 ± 8.6 years. The majority of participants were female (93.7%; p < 0.001), and the mean BMI was 45.3 ± 6.7 kg/m2. It was found that cognitive restraint had the highest mean (52.6 ± 19.9; p < 0.001). As for the DEAS-s, the question with the highest mean response was "spending one or more days without eating or consuming only liquids to lose weight" (2.80 ± 1.99). Female participants had a higher score for emotional eating (p = 0.016). Disordered eating attitudes showed a correlation with emotional eating and uncontrolled eating. These results suggest that candidates for bariatric surgery may have susceptibility to eating disorders. The importance of a multidisciplinary team conducting monitoring during the preoperative period is highlighted.

Conventional weight loss therapy in morbid obesity during COVID-19 pandemic: degree of burdens at baseline and treatment efficacy

Introduction

COVID-19 affected global physical and psychological health. The purpose of this study was to explore the pandemics impact on health-related quality of life (HRQoL), mental health (anxiety, depression, and perceived stress) and eating behavior in people with severe obesity participating in a multimodal conservative behavioral weight loss (BWL) program conducted via videoconferencing. Additionally, the efficacy of the six-month BWL program in a virtual video-based setting during the pandemic was examined.

Methods

297 participants of a face-to-face multimodal behavioral weight loss program prior to the pandemic (PrePAN, May 2014-September 2019) and 146 participants of the in terms of content same intervention in a videoconference-based setting during the pandemic (PAN, July 2020-April 2022) were questioned and compared using standardized questionnaires for HRQoL, symptoms of depressive and anxiety disorders, perceived stress, and eating behavior at baseline and at the end of treatment.

Results

Symptoms for anxiety, depression and perceived stress were similar between PrePAN and PAN at baseline. In addition, PAN tended to show lower disinhibition of eating behavior and feelings of hunger than PrePAN. During the pandemic, the BWL intervention resulted in body weight loss (67%) or stabilization (16%) in most of the participants. It also contributed by improving physical HRQoL, lower worries, and improved eating behaviors compared to baseline.

Conclusion

During the COVID-19 pandemic, baseline mental health of people with morbid obesity was not worse than before the pandemic. Additionally, the BWL intervention in the virtual video-based setting stabilized and improved physical and mental health during the COVID-19 pandemic.

The 'Behavioral Balance Model': A new perspective on the aetiology and therapy of obesity

Obesity is a debilitating disease of global proportions that necessitates refined, concept-driven therapeutic approaches. Policy makers, the public and even health care professionals, but also individuals with obesity harbour many misconceptions regarding this disease, which leads to prejudice, negative attitudes, stigmatization, discrimination, self-blame, and failure to provide and finance adequate medical care. Decades of intensive, successful scientific research on obesity have only had a very limited effect on this predicament. We propose a science-based, easy-to-understand conceptual model that synthesizes the complex pathogenesis of obesity including biological, psychological, social, economic and environmental aspects with the aim to explain and communicate better the nature of obesity and currently available therapeutic modalities. According to our integrative 'Behavioral Balance Model', 'top-down cognitive control' strategies are implemented (often with limited success) to counterbalance the increased 'bottom-up drive' to gain weight, which is triggered by biological, psycho-social and environmental mechanisms in people with obesity. Besides offering a deeper understanding of obesity, the model also highlights why there is a strong need for multimodal therapeutic approaches that may not only increase top-down control but also reduce a pathologically increased bottom-up drive.

Sex Differences in Effects of Mood, Eating-Related Behaviors, and BMI on Food Appeal and Desire to Eat: A Cross-Sectional Survey Study

Although sex differences in food intake have been observed consistently, contributing factors are not well understood. Using a cross-sectional online survey (n = 306; 151 men, 155 women), this study aimed to assess how sex impacts relationships between food ratings (appeal/desire to eat for high-calorie (HC) and low-calorie (LC) food images) and eating-related attitudes/behaviors, body mass index (BMI), and mood. Across participants, increased state- and trait-based hunger, disinhibition, and cravings were associated with both increased HC appeal and desire (p < 0.001). Increased state-based hunger and cravings were associated with greater LC desire (p < 0.001). Greater satiety was associated with decreased desire for both HC and LC (p < 0.001), while greater anxiety was associated with increased desire for both HC and LC (p < 0.001). Significant associations between BMI and food ratings were not observed. Women reported greater dietary restraint, trait-based hunger, disinhibition, eating disorder-related behaviors, depression, and stress compared to men, in addition to greater appeal and familiarity with LC foods (all p < 0.05). Significant effects of sex on the associations between food ratings and eating-related attitudes/behaviors, BMI, and mood were not observed, however. Findings support the importance of considering mood and eating-related attitudes/behaviors in investigations of food cue responsivity.

The Effect of Chronotype on Addictive Eating Behavior and BMI among University Students: A Cross-Sectional Study

The aim of this study was to examine the effect of chronotype on addictive eating behavior and BMI in university students. A questionnaire on their sociodemographic characteristics and eating habits, as well as the three-factor eating questionnaire (TFEQ) and the morningness-eveningness questionnaire (MEQ), were given to students at Üsküdar University. Data were analyzed with IBM SPSS 26.0. This study included a total of 850 students, 46.8% of whom were male and 53.2% were female. The mean BMI was 22.94 ± 3.30 kg/m2. As the BMI values of students increased, there was a decrease of 25.6% in the TFEQ scores, regardless of gender (s = −0.256; p < 0.001), and an increase of 10.6% in their chronotype scores, meaning that the students tended to be morning types (s = 0.106; p < 0.01). A significantly negative, very weak correlation was found between the students’ TFEQ and MEQ scores (s = −0.123; p < 0.001). The students’ BMI (p < 0.01) and TFEQ scores (p < 0.001) were affected by their MEQ scores in a statistically significant way. It was found that each 1-point increase in the MEQ score led to a 4.0% increase in the BMI score and a 15.8% decrease in the TFEQ score. It was observed that the morning-type students tended to be obese in terms of their BMI, and these students demonstrated fewer addictive eating behaviors.

Examination of three-factor eating questionnaire subscale scores on weight loss and weight loss maintenance in a clinical intervention

Background

The purpose of this study is to examine three-factor eating questionnaire (TFEQ) scores at baseline and post-intervention (6 months) on successful weight loss and weight maintenance in an 18-month behavioral weight management intervention for adults with overweight and obesity.

Methods

TFEQ and weight were assessed at baseline, 6, and 18 months. Logistic regression models were used to examine scores at baseline on disinhibition, restraint, and perceived hunger factors in the TFEQ on 5% body weight loss at 6 months and 6-month scores to predict 5% weight maintenance at 18 months while controlling for age, sex, and baseline weight.

Results

Participants (n = 287; age = 43.8 ± 10.36 years; female = 64.1%; weight = 222.5 ± 39.02 pounds; BMI = 34.73 ± 4.56) were included for analysis. Dietary restraint at baseline was the only significant predictor of 5% weight loss at 6 months. None of the TFEQ subscale scores at 6 months predicted 5% weight maintenance at 18 months. The model examining weight loss at 6 months accounted for 7% of the variance of the outcome and 11% of the variance of weight maintenance at 18 months.

Conclusion

Dietary restraint is a unique eating behavior associated with weight loss at 6 months beyond other eating behaviors measured by the TFEQ in an adult sample enrolled in a weight loss intervention. No other subscale scores were significant at 6 months or at 18 months. Future research should consider how to promote flexible control and discourage adoption of rigid restraint behaviors since the latter is associated with disordered eating patterns.

The association of obesity with eating disorders risk: online survey of a large cohort of Russian-speaking individuals seeking medical weight correction assistance

BACKGROUND

Eating Disorders pose a serious health risk to individuals. Often, eating disorder symptoms are overlooked when assessing obesity risk. The current cross-sectional study was focused on the search of association between disordered eating behaviors evaluated by Eating Attitudes Test 26 (EAT-26) and obesity in a large cohort of Russian-speaking adults seeking online assistance with medical weight correction.

METHODS

The web-based cross-sectional study evaluated the data of online Eating Attitudes Test 26 (EAT-26) completed by 13,341 registered adult visitors of weight loss clinic website. The EAT-26 provides an overall score for potential eating disorders risk, as well as scores for three subscales: Bulimia, dieting, and oral control. Additional self-reported information about sex, weight, height, and age of respondents was used for analysis. The nonparametric analysis of variance and binominal logistic regression modeling were applied to search for an association between obesity and EAT-26 total score and subscales scores. The critical level of the significance was considered as α = 0.05.

RESULTS

Women (94%) had lower BMI values but higher EAT-26 total score than men, which was indicated as statistically significant by a Wilcoxon Signed-Ranks Test (Z = - 11.80, p < 0.0001). Logistic regression for the whole cohort revealed that Bulimia subscale score was associated with higher risk of obesity (OR = 1.03, 95% CI 1.02-1.05) whereas higher score of EAT-26 oral control subscale was associated with decreased risk of obesity (OR = 0.93, 95% CI 0.91-0.95). Separate analysis for men and women showed that in men higher obesity risk was associated with higher oral control subscale scores (OR = 1.08, 95% CI 1.06-1.11); while in women both dieting and bulimia subscales scores were associated with higher obesity risk (OR = 1.02, 95% CI 1.01-1.03 and OR = 1.03, 95% CI 1.02-1.05, respectively). Older age was associated with obesity risk for both women and men.

CONCLUSIONS

In a large cohort of individuals seeking medical weight correction assistance, the risk of obesity was associated with the higher EAT-26 scores, age, and sex. Moreover, different eating disorder risk profiles were associated with obesity in men and women. Higher oral control subscale score was associated with decreased risk of obesity in women, but with higher risk in men. Older age was a shared obesity risk factor for both sexes. Therefore, the use of EAT-26 would facilitate individual diagnostic assessment for specific eating disorders in different sub-cohorts. Further assessment of separate EAT-26 subscales may be important to predict sex-/age-specific risks of obesity that implies their study in the future. Obesity is a significant health problem. Different factors (e.g. social, biological, and behavioral) are important for their successful treatment. Abnormal eating behaviors may be one of the most likely predictors of increased body weight. This study aims to determine whether there is a significant association between obesity and scores on the eating behavior questionnaire-Eating Attitudes Test-26 (EAT-26)-in a large cohort of adults seeking medical weight correction assistance at a private weight loss clinic web-site. According to the study results, the association was shown for the male sex, older age, and higher Bulimia scores as measured on the EAT-26. Moreover, different EAT-26 scales were associated with obesity risks in women and men subgroups, while older age was a shared risk factor for obesity in both sexes. The findings may suggest sex-/age-specific diagnostic approach and treatment strategies for individuals with obesity.

Food Involvement, Eating Restrictions and Dietary Patterns in Polish Adults: Expected Effects of Their Relationships (LifeStyle Study)

Understanding the factors that coexist with healthy and unhealthy eating behaviors is prevalent and important for public health. The aim of this study was to investigate the associations between food involvement, eating restrictions, and dietary patterns in a representative sample of Polish adults. The study was conducted among a group of 1007 adults. Questions with the answers yes or no were used to obtain the data regarding eating restrictions. Data relating to food involvement were obtained with the Food Involvement Scale (FIS). Questions from the Beliefs and Eating Habits questionnaire were used to measure the frequency of consumption of different food groups. Five dietary patterns (DPs) were derived using principal component analysis (PCA), i.e., 'Fruit and vegetables', 'Wholemeal food', 'Fast foods and sweets', 'Fruit and vegetable juices' and "Meat and meat products'. In each of the DPs, three groups of participants were identified based on tertile distribution with the upper tertile denoting the most frequent consumption. Nearly two-thirds of the study sample declared some restrictions in food consumption. The probability of implementing restrictions in consumption of foods high in sugar, fat and high-fat foods increased in the upper tertile of 'Fruit and vegetables' and 'Wholemeal' DPs. Moreover, the probability of implementing restrictions in consumption of meat and high-starch products increased in 'Wholemeal' DP. The probability of using eating restrictions decreased in the upper tertile of 'Fast foods and sweets' and Meat and meat products' DPs. In conclusion, individuals characterized by high food involvement were more inclined to use eating restrictions than individuals with lower food involvement. Their DPs were also healthier compared to those of individuals manifesting low food involvement. Therefore, promoting personal commitment to learning about and experiencing food may be an effective way of inducing a change of eating habits, and therefore a healthier diet.

Obesity and Eating Disturbance: the Role of TFEQ Restraint and Disinhibition

PURPOSE OF REVIEW

Literature from the past five years exploring roles of Three-Factor Eating Questionnaire (TFEQ) Restraint and Disinhibition in relation to adult obesity and eating disturbance (ED) was reviewed.

RECENT FINDINGS

Restraint has a mixed impact on weight regulation, diet quality, and vulnerability to ED, where it is related detrimentally to weight regulation, diet, and psychopathology, yet can serve as a protective factor. The impact of Disinhibition is potently related to increased obesity, poorer diet, hedonically driven food choices, and a higher susceptibility to ED. Restraint and Disinhibition have distinct influences on obesity and ED and should be targeted differently in interventions. Further work is required to elucidate the mechanisms underlying TFEQ eating behavior traits.

Cognitive dietary restraint, disinhibition, and hunger are associated with 24-h energy expenditure

Background:

Higher energy expenditure (EE) is associated with greater food intake, possibly because the human body senses EE and modifies eating behaviors to regulate food intake and ultimately achieve energy balance. As eating behaviors are also influenced by social and cultural factors, any association between EE and eating behavior may differ between ethnicities and sexes.

Objective:

To assess relationships between EE and eating behavior constructs of the Three-Factor Eating Questionnaire (TFEQ).

Subjects/Methods:

307 healthy adults (201M/106F, 160 Native Americans) completed the TFEQ and had measures of 24-h EE in a whole-room calorimeter during energy balance. Body composition was assessed by DXA.

Results:

On average, adjusted 24-h EE was lower (β=−229 kcal/day, CI: −309-−148, p<0.001) but cognitive restraint (Δ=+1.5; CI: 0.5–2.5, p=0.003) and disinhibition (Δ=+2.1, CI: 1.3–2.8, p<0.001) scores were higher in women compared to men. In Native Americans, adjusted 24-h EE (β=+94 kcal/day, CI: 48–139, p<0.001) and disinhibition scores (Δ=+1.0, CI: 0.1–2.0, p=0.003) were higher compared to other ethnicities. Higher 24-h EE associated with lower cognitive restraint in women (ρ=−0.20, p=0.04), but not men (p=0.71; interaction term p=0.01) with no ethnic differences. Greater 24-h EE associated with higher disinhibition (ρ=0.20, p=0.001) and hunger cues (ρ=0.16, p=0.004) with no gender differences. These associations were primarily present in non-Native Americans (ρ=0.23, p=0.006 and ρ=0.25, p=0.003) but not observed in Native Americans (both p>0.40).

Conclusions:

Higher EE is associated with psychological constructs of eating behaviors that favors overeating including lower cognitive restraint, higher dietary disinhibition, and greater susceptibility to hungers cues, supporting the existence of energy-sensing mechanisms influencing human eating behavior. These associations were observed in ethnicities other than Native Americans, possibly explaining the contradictory relationships reported between EE and weight change in different ethnic groups. We propose that increased EE may alter eating behaviors, potentially leading to uncontrolled overeating and weight gain.

Greater Reward-Related Neuronal Response to Hedonic Foods in Women Compared with Men

OBJECTIVE

The current study aimed to identify how sex influences neurobiological responses to food cues, particularly those related to hedonic eating, and how this relates to obesity propensity, using functional magnetic resonance imaging (fMRI).

METHODS

Adult men and women who were either obesity resistant (OR) or obesity prone (OP) underwent fMRI while viewing visual food cues (hedonic foods, neutral foods, and nonfood objects) in both fasted and fed states.

RESULTS

When fasted, a significant sex effect on the response to hedonic vs. neutral foods was observed, with greater responses in women than men in the nucleus accumbens (P = 0.0002) and insula (P = 0.010). Sex-based differences were not observed in the fed state. No significant group effects (OP vs. OR) or group-by-sex interactions were observed in fasted or fed states.

CONCLUSIONS

Greater fasted responses to hedonic food cues in reward-related brain regions were observed in women compared with men, suggesting that women may be more sensitive to the reward value of hedonic foods than men when fasted. This may indicate sex-dependent neurophysiology underlying eating behaviors.

Association between Eating Behavior and Academic Performance in University Students

OBJECTIVE

To determine the association between academic performance and eating behavior in university students in Chile.

METHODS

A total of 680 college students, 409 (60%) women and 271 (40%) men, were randomly recruited and the mean age of the entire sample was 26. The Three-Factor Eating Questionnaire (TFEQ), which evaluates 3 dimensions of eating behavior-cognitive restriction (limiting own intake), uncontrolled eating (inclination to eat), and emotional eating (control of food intake in the context of negative emotions)-was used. Academic performance was measured by the grade point average (GPA) and was associated with eating behavior.

RESULTS

Women had significantly higher scores in the "emotional eating" dimension than men (p = 0.002). The eating behavior analysis showed that female students with higher GPAs (above 5.5) had statistically significantly lower uncontrolled eating scores (p = 0.03) and higher cognitive restriction scores (p = 0.05) than women with lower academic performance (below 5.5). There were no significant associations between eating behavior and academic performance in men.

CONCLUSIONS

A positive association between eating behavior and academic performance was observed in female university students in Chile. Further studies are needed to explore the causes of this association and determine how to improve the nutritional habits of this population.

Effect of plate size on meal energy intake in normal weight women

BACKGROUND/OBJECTIVES

Use of smaller plates to control food intake is a commonly recommended strategy for restricting energy intake, despite conflicting results. Therefore, the aim of this study was to examine whether or not three different sizes of plates influence energy intake during a multi-itemed buffet meal in normal weight women.

SUBJECTS/METHODS

This was a cross-over study conducted on 37 female participants aged 19-25 years with normal BMI levels. Participants were recruited from Hacettepe University and the surrounding community. On experimental days, participants ate a standard breakfast and were then randomly assigned to eat lunch using a small (19 cm), medium (23 cm), or large (28 cm) diameter plate. Visual analogue scale (VAS) scores on sensory and satiety outcomes were measured for all meals. Energy and macronutrient intakes during lunch were recorded.

RESULTS

There was no evidence that use of a smaller plate size reduced energy or specific macronutrient intake during the free choice lunch meal. Multiple visits to the serving table were not associated with energy or macronutrient intake. Plate size did not affect VAS scores during the test days.

CONCLUSIONS

Plate size did not influence energy intake, meal composition, or palatability in normal weight women during a multi-itemed open buffet lunch. Studies in natural settings at the population level are needed to clarify current outcomes.

Obesity in Women: The Clinical Impact on Gastrointestinal and Reproductive Health and Disease Management

Approximately 36% of adult women in the United States are obese. Although obesity affects women similarly to men in terms of prevalence, there seem to be gender-specific differences in the pathophysiology, clinical manifestations, and treatment of obesity. Obesity is linked to comorbid diseases involving multiple organ systems, including the gastrointestinal tract, like gastroesophageal reflux disease, fatty liver disease, and gallstones. This article focuses on obesity in women, specifically the impact of obesity on gastrointestinal diseases and reproductive health, as well as the treatment of obesity in women.