Power of Food Scale in association with weight outcomes and dieting in a nationally representative cohort of U.S. young adults

The burden of overweight/obesity and weight-related behaviors attributable to food addiction in emerging adults

While food addiction has been positively associated with excess weight and disordered eating behaviors, this has not been examined in representative samples of emerging adults, who are at elevated risk for these outcomes. This study investigated relationships of food addiction with weight outcomes, weight perception, and weight-control behaviors in emerging adults and estimated the population attributable fraction to food addiction. Data from an observational cohort study were collected in seven annual waves from 2010 to 2016. A nationally representative sample of 2785 10th grade students was recruited from schools within each U.S. census region (73% participation) (mean ± SD baseline age = 16.3 ± 0.5years). Wave 7 retention was 81% (n = 2323, 60% female, mean ± SD = 22.6 ± 0.5 years). Outcomes included current BMI, BMI change from baseline - wave 7, increased weight status in wave 7 (increased weight status from baseline-wave 7), perceived overweight, dieting, any weight-control behavior, and extreme weight-control behaviors. Food addiction was measured in wave 7 using the modified Yale Food Addiction Scale. Relative risk of the outcomes associated with food addiction, and population attributable fraction, were estimated using adjusted log-binomial or robust Poisson regression analyses accounting for the complex survey design. Food addiction prevalence was 4.7%. Participants with food addiction were primarily females (91%); food addiction was uncorrelated with other sociodemographics. Food addiction was associated with 48%-167% increased RR for all outcomes, but these were attenuated after adjustment for confounders (31%-64%). The population attributable fraction for food addiction ranged from 2% (high wave 7 BMI) - 5% (extreme weight-control behaviors). Although the population attributable fraction estimates indicate that the public health burden of these outcomes attributable to food addiction may be relatively minor, food addiction may signal the presence of several adverse mental health symptoms.

Cross-sectional association study of hedonic hunger, self-control, cognitive distortion, and well-being with adiposity measures among a sample of urban Malaysian adults

BACKGROUND

We assessed the association of hedonic hunger, self-control (impulsivity and restraint), cognitive distortion (CD), and well-being with adiposity measures such as waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), body mass index (BMI), total body fat (TBF), subcutaneous fat (SF), visceral fat level (VFL), skeletal muscle percentage (SM), and resting metabolism (RM), among a sample of urban Malaysian adults at Sunway University and Sunway College, Selangor, Malaysia.

METHODS

Among 186 participants (M/F = 51/135; aged 22.1 ± 5.0), psychometrics were assessed using Power of Food Scale (PFS), Brief Self-Control Scale, CD Questionnaire (CD-Quest), and WHO-5 Well-being Index. Blood pressures, anthropometrics and body compositions were also measured using standard methods and bioimpedance.

RESULTS

Men had significantly higher well-being, but lower overall self-control, impulsivity and Food Available hedonic hunger. Those with moderate/severe CD had higher odds ratio (OR) of having high central adiposity, compared with those with absent/slight CD (OR: 2.52;95% CI: 1.14, 5.61; p = 0.023 for WC and OR: 2.50; 95% CI: 1.19, 5.23; p = 0.015 for WHR). Higher CD and PFS scores were strongly significantly correlated with higher systolic blood pressure (SBP), WC, WHR, WHtR, BMI, TBF, SF, VFL and RM. Lower self-control was weakly correlated with higher WC, while lower impulsivity and restraint were weakly correlated with higher VFL. Those who were overweight, obese, and in high TBF class had significantly higher PFS Aggregate Factor scores. Food Available and Food Present scores, but not Food Tasted, were also significantly higher among overweight participants.

CONCLUSIONS

Higher hedonic hunger and CD were associated with higher SBP and all adiposity measures. Overweight participants had higher hedonic hunger in the context of ready availability and physical presence of highly palatable foods. Lower self-control was weakly correlated with higher central adiposity; lower impulsivity and restraint were weakly correlated with higher visceral adiposity. These findings have provided some insights into the cognitive factors underlying adiposity.

The relationship among disordered eating behavior, power of food scale and sensitization of the reinforcing value of food

INTRODUCTION

Disordered eating behaviors are a current public health concern since their progression can lead to the development of a full criteria eating disorder. Sensitization to repeated intake of high energy density (HED) foods is associated with excess weight gain over time, but less is known about relationships with assessments of disordered eating. Thus, this study aims to understand how disordered eating behaviors refunlate to the influence of the food environment and sensitization.

METHOD

163 adolescents - 50 % female and 13.2 mean age - were followed for 24 months. Sensitization was assessed by comparing the relative reinforcing value (RRV) of HED food at baseline and after two weeks of daily intake; sensitization was defined as RRV of food after repeated intake. Study participants also completed the EDE-Q, and Power of Food Scale (PFS). We conducted multivariate general linear models to examine these associations.

RESULTS

Sensitization status and PFS scores at baseline were positively associated with EDE-Q subscale scores cross-sectionally, but not longitudinally, at baseline and 24 months. We found that sensitization to HED food and higher susceptibility to food cues relates to increased disordered eating behaviors and both at baseline and at 24-months.

DISCUSSION

These findings suggest that sensitization to repeated HED food intake and the food environment might be a risk factor for later engagement in disordered eating behaviors. Future studies should address the temporal relationships among these factors and the role that social norms around body weight and weight stigma may play in the development of these behaviors.

The Psychological Impact of the Widespread Availability of Palatable Foods Predicts Uncontrolled and Emotional Eating in Adults

This study aimed to investigate the role of the psychological impact of environments rich in palatable foods on three aspects of eating behavior: cognitive restraint (CR), uncontrolled eating (UE), and emotional eating (EE). The hypotheses were as follows: (a) The psychological impact (i.e., motivation to eat) of an environment rich in palatable foods will positively predict CR, UE, and EE; (b) dieting will predict CR, UE, and EE; and (c) CR, UE, and EE will positively predict body mass index (BMI). This study had a cross-sectional design in which data were collected online from 413 subjects. The psychological impact of food-rich environments (food available, food present, and food tasted) was assessed using the Power of Food Scale (PFS), and CR, UE, and EE were assessed using the Three-Factor Eating Questionnaire (TFEQ-R18). Both instruments were tested for confirmatory factor analysis. The relationship between constructs was measured using partial least-square structural equation modeling (PLS-SEM). "Food available" positively predicted all TFEQ-R18 factors (p < 0.01). "Food present" positively predicted UE (p < 0.001) and EE (p = 0.01). People currently on a diet showed higher levels of CR (p < 0.001) and EE (p = 0.02). UE and EE positively predicted BMI. Thus, CR, UE, and EE were positively predicted by the motivation to consume palatable foods in varying proximity, suggesting that the presence of food and, more importantly, its general availability may be important determinants of eating behavior, particularly UE and EE. Health strategies should consider the influence of the food environment to prevent and better manage impairments in eating behavior. Sex differences suggest that special attention should be paid to women. Furthermore, dieting was associated with higher levels of EE, which in turn was associated with higher BMI. Weight loss interventions should consider this vulnerability.

Relationship of perceived depression, stress, anxiety levels and hedonic hunger

BACKGROUND

This study was designed to explore relationship of perceived depression, anxiety and stress (DAS) levels and hedonic hunger in adults.

METHODS

A cross-sectional survey included questions about some socio-demographic characteristics, Power of Food Scale (PFS-Tr) and Depression Anxiety Stress Scales (DASS-21) was sent via an online platform. Self-reported weight and height were also questioned. A total of 4112 adult volunteers between the ages of 18-65 years participated in this study. 72.3% of them were female.

RESULTS

The prevalence of moderate to extremely severe depression, anxiety, and stress was reported as 31%, 34% and 13% respectively. Hedonic hunger and perceived DAS levels were higher in females (p < 0.001). Hedonic hunger was positively correlated with perceived DAS (p < 0.001). While body mass index (BMI) was positively associated with PFS-Tr total score, food available and food present; negatively associated with food tasted. Body mass index was negatively correlated with perceived DAS. Hedonic hunger and perceived DAS levels decreased with increasing age. Females were more prone to both hedonic hunger and perceived DAS. About one in three participants reported moderate to extremely severe levels of depression and anxiety. Greater perceived DAS levels are associated with hedonic hunger. Underweight individuals had higher levels of perceived DAS.

CONCLUSION

To our knowledge, this is the first study to examine the prevalence and predictors of perceived DAS levels and hedonic hunger in the Turkish adult population. The findings of the study suggest that the predictors such as age, sex and BMI are a part of psychological well-being and hedonic hunger.

Relationship between hedonic hunger and subjectively assessed sleep quality and perceived stress among university students: A cross-sectional study

Purpose

This study examined the relationship between hedonic hunger (HH), sleep quality, and stress levels among university students in the United Arab Emirates and the Kingdom of Bahrain.

Methods

We used a cross-sectional design with participants (N = 565) recruited via convenience sampling. Data were collected with a self-administered, standardized, and validated online questionnaire. HH was assessed with the Palatable Eating Motives Scale (PEMS) and Power of Food Scale (PFS), sleep quality and sleep components were assessed with the Pittsburgh Sleep Quality Index (PSQI), stress was evaluated with the Perceived Stress Scale (PSS), and physical activity was examined with the International Physical Activity Questionnaire. Descriptive and analytical statistics were used to assess the relationship between HH and sleep quality and perceived stress.

Results

There were positive associations between total PSQI scores and total PEMS (β = 0.14, 95% confidence interval [CI]: 0.06-0.25, P = 0.001) and PFS (β = 0.21, 95% CI: 0.45-1.04, P < 0.001). The likelihood of poor sleep quality increased by 8% (odds ratio [OR] = 1.08, P = 0.020) and 43% (OR = 1.43, P < 0.001) for each one-unit increase in PEMS and PFS scores, respectively. We also found positive associations between PSS scores and total PEMS (β = 0.19, 95% CI: 0.26-0.63, P < 0.001) and PFS (β = 0.23, 95% CI: 1.04-2.22, P < 0.001) scores.

Conclusion

Reducing HH and stress levels may help to enhance sleep quality among university students. Conversely, improving sleep quality and reducing stress levels could improve HH in this population.

Assessing hedonic hunger among Chinese adults using the Power of Food Scale: Psychometric properties and cross-cultural invariance between China and the US

Hedonic hunger refers to food consumption for pleasure without biological energy deficits. The Power of Food Scale (PFS) is a well-developed self-report instrument assessing hedonic hunger. The present study aimed to translate and validate the PFS into simplified Chinese (C-PFS) and examine its psychometric properties among Chinese adults. A total of 773 participants (51.1 % men, M age = 24.98 years, SD = 6.10) were recruited in the present study from college and community populations. Consistent with the previous studies, confirmatory factor analysis showed that the C-PFS had three factors: food present, food available, and food tasted. In addition, a Cronbach's alpha of 0.92 and an ICC of 0.86 suggested that the C-PFS has good internal consistency and test-retest reliability. In terms of convergent validity, the scores of C-PFS correlated significantly with disordered eating symptomatology and loss of control over eating. Measurement invariance tests showed that the C-PFS was invariant across gender and sample source groups in the Chinese sample. In addition, a U.S. sample of 490 college students (26.6 % men, M age = 21.41 years, SD = 5.45) was used to test the measurement invariance across countries, and results suggested a partial invariance across college students from China and those from the U.S. In conclusion, the C-PFS can be a useful tool for measuring hedonic hunger among adults in China, and there may be cultural differences in the measurement of the PFS in college students across China and the U.S.

Motivation to consume palatable foods as a predictor of body image dissatisfaction: Using the Power of Food Scale in a Brazilian sample

The Power of Food Scale (PFS) is a questionnaire for self-assessing the motivation to consume palatable foods, especially in environments where food is abundant and constantly available. This study aimed to a) assess the factorial structure of the PFS in a Brazilian sample and b) examine the relationship between the power of food and body image dissatisfaction and BMI. The PFS and Body Shape Questionnaire (BSQ) were applied to a sample of 300 adults. Data were analysed using confirmatory factor analysis. Composite reliability (CR) was used to verify factor reliability. A partial least squares structural equation model was used to verify the effect of the PFS score on body image dissatisfaction. The PFS had an adequate factorial structure in this Brazilian sample, showing three well-defined factors: food available (CR = 0.91), food tasted (CR = 0.84), and food present (CR = 0.87). The BSQ showed one reliable factor (CR = 0.97). The power of the food aggregate factor significantly predicted body mass index (β = 0.16; p = .01) and body image dissatisfaction (β = 0.46; p < .001). The effect size was small for body mass index (f² = 0.02) and medium for body image dissatisfaction (f² = 0.26). The food present factor also had a slightly higher average among the three PFS factors. Women had higher PFS scores than men. Understanding the role that this motivation plays in physical and psychological outcomes such as body dissatisfaction can contribute to developing treatment strategies and support health professionals' performance in clinical settings.

[Scale of Eating Behavior Phenotypes (EFCA), confirmatory factor analysis and psychometric properties]

INTRODUCTION

Weight gain depends on multiple modifiable mediating factors, including ingestive behavior phenotype. The Eating Behavior Phenotypes Scale (EFCA) is a self-administered questionnaire designed as a tool for clinical use to characterize different sub-phenotypes of ingestive behavior: hedonic, compulsive, emotional grazing, disorganized and hyperphagic.

OBJECTIVES

The aim of this study is to validate the psychometric properties of the Eating Behavior Phenotypes Scale (EFCA), to analyze the stability of the construct and its external validity.

MATERIALS AND METHODS

three hundred adult participants completed a self-administered survey developed to identify eating behavior phenotypes (EFCA). A confirmatory factor analysis was performed, internal consistency was evaluated using Cronbach's alpha coefficient, and concurrent validity was assessed using Pearson's correlation method between EFCA and BMI.

RESULTS

The EFCA scale and the subscales showed an acceptable internal consistency (α > 0.70). The confirmatory factor analysis showed a good adjustment of the data to the proposed structure (SBχ922 = 155, p < 0.05; CFI = 0.97; TLI = 0.96; RMSEA = 0.05; SRMR = 0.04). A positive and statistically significant correlation was found between BMI and both each subscale and total scale scores.

CONCLUSIONS

EFCA and its subscales are a valid instrument to assess eating phenotypes in adults. The five-component structure shows high stability and consistent results in relation to a previous study carried out with a sample of obese patients.

Contribution of Hedonic Hunger and Binge Eating to Childhood Obesity

Background: Studies examining the association between hedonic hunger, that is, having frequent thoughts about food in the absence of an energy deficit, and obesity in youth show mixed results. This may be due to the confounding effect of binge eating, which has been associated with both hedonic hunger and obesity. The purpose of this study was to determine the extent to which hedonic hunger is associated with obesity independent of binge eating in youth. Methods: Data for this cross-sectional study were collected from youth enrolled in a larger study of cardiovascular disease and obesity. Linear regression models were used to assess the association between hedonic hunger measured by Power of Food Scale (PFS) and binge eating measured by Eating Disorder Examination-Questionnaire, on percent of the 95th BMI percentile (BMIp95). Results: Among 269 participants (mean age 12.8 years), 16.4% endorsed binge eating. PFS was positively associated with BMIp95 with a difference in percent of BMIp95 of 5.9% [95% confidence interval (1.5-10.3), p = 0.009]. However, when binge eating was added to the model, the relationship between PFS and BMIp95 was no longer significant. Conclusion: Hedonic hunger, above and beyond binge eating, may not be associated with BMI. Future research should examine whether screening for and targeting binge eating rather than hedonic hunger in weight management care may have more impact on obesity outcomes. Clinical Trial Registration number: NCT01508598.

Validation of the Turkish version of the power of food scale in adult population

PURPOSE

The Power of Food Scale (PFS) is a tool for measuring the hedonic impact of food environments rich in palatable foods. The purpose of this study was to validate the Turkish version of PFS (PFS-Tr) in a large adult population.

METHODS

Data were obtained from 505 Turkish adults aged between 19 and 64 years. The PFS-Tr and Dutch Eating Behavior Questionnaire (DEBQ) were completed by all participants.

RESULTS

PFS-Tr compared with the original English version of PFS, items 5 and 13, which showed the highest error covariance under the food available factor. To provide general criteria, items 5 and 13 were removed. After these two items were removed, the Cronbach's alpha coefficient was 0.922 for PFS-Tr and Cronbach's alpha values for "food available", "food present", and "food taste" were found to be 0.849, 0.797, and 0.82, respectively. Besides, the Cronbach's alpha coefficient was 0.93 for DEBQ. In addition, a linear association was found between BMI and mean score of PFS-Tr with a model fit (R² = 0.02) and PFS-Tr was positively correlated with DEBQ (r 0.497 p < 0.001).

CONCLUSION

This is the first study that validates and reports the Turkish version of PFS and the results of our study show that PFS-Tr is a valid and reliable tool for determining the tendency for the hedonic hunger in Turkish adult population.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Hedonic Hunger Is Associated with Intake of Certain High-Fat Food Types and BMI in 20- to 40-Year-Old Adults

BACKGROUND

Hedonic hunger occurs in response to a desire to consume food for pleasure. The μ-opioid system regulates the hedonic impact of food and the opioid receptor mu 1 gene (OPRM1) polymorphism has been associated with fat intake.

OBJECTIVES

The aim of this study was to determine whether the intake of high-fat food is associated with hedonic hunger and the OPRM1 polymorphism and whether these variables are related to BMI.

METHODS

Participants were 20- to 40-y-old women and men enrolled in Poznań, Poland in 2016-2018. The frequency of consumption of high-fat food was measured using a validated application for mobile devices. Hedonic hunger was assessed with the use of the Power of Food Scale (PFS). PFS1, PFS2, and PFS3 scores were generated for food available, food present, and food tasted, respectively. Genotyping of rs1799971 in the OPRM1 gene was performed using TaqMan probes. The associations were analyzed using linear regression or logistic regression, as appropriate.

RESULTS

Hedonic hunger scores were not associated with total high-fat food intake. Total PFS was associated with snack intake (β: 0.16, P = 0.0066). PFS1 was positively associated with healthy high-fat food intake (β: 0.27, P = 0.0001) and PFS2 with sweet high-fat food and fast-food intake (β: 0.27, P = 0.0030). OPRM1 genotype and hedonic hunger interacted on fast-food intake (β: -0.17; P < 0.0154). Total PFS and PFS2 increased the chance of having a BMI ≥ 25 kg/m2 (OR: 1.43; 95% CI: 1.03, 2.01; P = 0.0335 and OR: 1.89; 95% CI: 1.37, 2.61; P = 0.0001, respectively), whereas PFS3 decreased it (OR: 0.61; 95% CI: 0.41, 0.87; P = 0.0082).

CONCLUSIONS

Hedonic hunger is associated with the intake of selected types of high-fat food, but not with its total intake, in people aged 20-40 y. Associations between hedonic hunger and fast-food intake can be modified by OPRM1 genotype. Hedonic hunger is associated with BMI.

Reward-related eating, self-regulation, and weight change in pregnancy and postpartum: the Pregnancy Eating Attributes Study (PEAS)

Background/Objectives.

Reward-related eating is hypothesized to underlie risk for weight gain in obesogenic environments, but its role is unknown during pregnancy and postpartum when weight change is normative, but excess weight gain and weight retention are common. This study examined associations of self-reported reward-related eating, self-regulation, and the home food environment with excessive gestational weight gain (GWG) and postpartum weight change.

Subjects/Methods.

Participants in the Pregnancy Eating Attributes Study observational cohort were enrolled at ≤12 weeks pregnancy and followed through one-year postpartum (458 recruited; 367 retained through delivery). Participants completed four measures of reward-related eating – Modified Yale Food Addiction Scale, Power of Food Scale, Multiple Choice Procedure, and a Reinforcing Value of Food Questionnaire; two measures of self-regulation – Barratt Impulsiveness Scale and Delay of Gratification Inventory; and a Home Food Inventory. Measured weight and skinfolds were obtained. Multinomial logistic and multiple linear regression analyses estimated associations of reward-related eating, self-regulation, and home food environment with excessive GWG, gestational fat gain, postpartum weight change, and percent of GWG retained.

Results.

Excessive GWG was associated with food reinforcement intensity, but not with any other measure of reward-related eating, self-regulation, or home food environment. Greater gestational fat gain was associated only with higher Multiple Choice Procedure. Postpartum weight change and percent of GWG retained were associated with greater Delay of Gratification and obesogenic home food environment, but not with any measure of reward-related eating or with impulsivity.

Conclusions.

Findings do not support the hypothesis that self-reported reward-related eating is associated with weight outcomes in pregnancy and postpartum but indicate a relation of Delay of Gratification with postpartum weight retention. Further research using both surveys and objective measures of reward-related eating is needed to advance our understanding of the relation of reward-related eating with weight changes during this critical period of a woman’s life.

Psychological and weight history variables as predictors of short-term weight and body fat mass loss

OBJECTIVE

Identifying predictors of early weight loss may have value in predicting longer-term success in weight loss programmes. This study examined if weight history variables (ie, weight cycling history [WCH], age of onset of obesity [AOO]), and preintervention Three-Factor Eating Questionnaire (TFEQ) and Power of Food Scale (PFS) scores predicted weight loss (WL) and fat mass loss (FML) following a 3-week calorie restriction intervention.

METHODS

Thirty-two participants (19-60 y; body mass index [BMI] 30-39.9 kg/m2) participated in a 3-week calorie restriction intervention (1120 kcal/d) as part of a larger clinical trial with 28 completers included in the current analyses. Preintervention WCH, AOO, TFEQ, and PFS subscale scores were collected, and WL and FML were measured. Multiple linear regression analyses were performed to predict WL and FML for relevant covariates in this study.

RESULTS

WCH, AOO, preintervention TFEQ subscale scores, and PFS subscale scores did not predict WL (all Ps > .08) or FML (Ps > .06) except, PFS-food tasted scores significantly predicted WL (r = -0.40, P = .03).

CONCLUSION

Although these variables were not robust predictors, results for at least the PFS suggest there may be value in further exploring this measure using larger sample sizes.

Psychometric evaluation of the power of food scale in a diverse college sample: Measurement invariance across gender, ethnicity, and weight status

The Power of Food Scale (PFS) is an instrument designed to examine individual differences in the drive to eat for pleasure (as opposed to in response to physiological hunger) and the effect of living in an obesogenic environment. Previous research supports the validity and reliability of the PFS, however, it had yet to be validated in an ethnically diverse college sample. The purpose of the current study was to test the factor structure and measurement invariance of the PFS across gender, ethnicity, and weight status. A sample of 432 college students completed the PFS (males=113, females = 319; non-Hispanic white=181, Hispanic=251; non-overweight=302, overweight=130). Confirmatory factor analysis was used to test a second-order, 3-factor (food available, food present, food tasted) structure of the PFS in each group separately (males, females, Hispanic, non-Hispanic white, non-overweight, and overweight) and tests of measurement invariance were conducted to test the equivalency of the measure across gender, ethnicity, and weight status. Results supported the measure's original factor structure (second-order, 3-factor model) and indicated that the measure is equivalent across each of these groups, respectively. Although the small, unbalanced groups may impact the stability of the findings, the results nonetheless suggest that the PFS is a psychometrically valid measure in a diverse college sample, and that mean comparisons on this measure are meaningful across gender, ethnicity, and weight status. Given the measurement invariance of the PFS, there is support for use of the PFS among diverse college students in future work.

Lack of prospective relationships of the Power of Food Scale with Body Mass Index and dieting over 2 years in U.S. emerging adults

BACKGROUND

This study investigated prospective relationships of the Power of Food Scale (PFS), a self-report measure of hedonic hunger, with weight outcomes and dieting in U.S. young adults.

METHODS

PFS (PFS-aggregate and subscales: PFS-available, PFS-present, PFS-tasted) was assessed in waves (W, years) 5 and 6 of a nationally representative cohort of 10th graders assessed annually (baseline n = 2785, 83% retention at W7). Internal consistency (Cronbach's α), 1-year stability (intraclass correlation coefficient, ICC) and confirmatory factor analysis (CFA) were examined. Analyses accounting for the complex survey design examined cross-sectional associations of W6 PFS with W6 BMI and dieting, and prospective relationships of PFS in each wave with BMI, 1-year BMI change (BMIΔ, W6-W5 and W7-W6), overweight/obesity onset (OWOB, moving to a higher risk weight category) and dieting in the following wave. Multiple imputations addressed missing data.

RESULTS

Baseline participant mean ± SE age was 20.3 ± 0.02 years. Mean BMI increased by approximately 0.6 kg/m² from W5 through W7; OWOB occurred in 7.4% of participants between W5-W6; 9.0% between W6-W7. Approximately half the sample reported dieting in each wave. W6 weight outcomes were not associated with W6 PFS, but W6 dieting frequency was positively associated with W6 PFS-available, PFS-present, and PFS-aggregate (but not PFS-tasted) in multivariable models. PFS was not prospectively associated with weight outcomes. Positive prospective associations of PFS with dieting frequency were inconsistent across waves and with respect to inclusion of covariates.

CONCLUSIONS

Greater PFS is associated with dieting cross-sectionally but was not a reliable indicator of susceptibility to future weight outcomes or dieting in young adults.

Impact of expanded diagnostic criteria for avoidant/restrictive food intake disorder on clinical comparisons with anorexia nervosa

OBJECTIVE

Avoidant/restrictive food intake disorder (ARFID) and anorexia nervosa (AN) are restrictive eating disorders. There is a proposal before the American Psychiatric Association to broaden the current DSM-5 criteria for ARFID, which currently require dietary intake that is inadequate to support energy or nutritional needs. We compared the clinical presentations of ARFID and AN in an outpatient sample to determine how a more inclusive definition of ARFID, heterogeneous for age and weight status, is distinct from AN.

METHODS

As part of standard care, 138 individuals with AN or ARFID completed an online assessment battery and agreed to include their responses in research.

RESULTS

Individuals with ARFID were younger, reported earlier age of onset, and had higher percent median BMI (%mBMI) than those with AN (all ps < .001). Individuals with ARFID scored lower on measures of eating pathology, depression, anxiety, and clinical impairment (all ps < .05), but did not differ from those with AN on restrictive eating (p = .52), and scored higher on food neophobia (p < .001).

DISCUSSION

Allowing psychosocial impairment to be sufficient for an ARFID diagnosis resulted in a clinical picture of ARFID such that %mBMI was higher (and in the normal range) compared with AN. Differences in gender distribution, age, and age of onset remained consistent with previous research. Both groups reported similar levels of dietary restriction, although ARFID can be distinguished by relatively higher levels of food neophobia. Currently available measures of eating pathology may capture certain ARFID symptoms, but highlight the need for measures of impairment relative to ARFID.

Uncontrolled eating: a unifying heritable trait linked with obesity, overeating, personality and the brain

Many eating-related psychological constructs have been proposed to explain obesity and overeating. However, these constructs, including food addiction, disinhibition, hedonic hunger, emotional eating, binge eating and the like all have similar definitions, emphasizing loss of control over intake. As questionnaires measuring the constructs correlate strongly (r > 0.5) with each other, we propose that these constructs should be reconsidered to be part of a single broad phenotype: uncontrolled eating. Such an approach enables reviewing and meta-analysing evidence obtained with each individual questionnaire. Here, we describe robust associations between uncontrolled eating, body mass index (BMI), food intake, personality traits and brain systems. Reviewing cross-sectional and longitudinal data, we show that uncontrolled eating is phenotypically and genetically intertwined with BMI and food intake. We also review evidence on how three psychological constructs are linked with uncontrolled eating: lower cognitive control, higher negative affect and a curvilinear association with reward sensitivity. Uncontrolled eating mediates all three constructs' associations with BMI and food intake. Finally, we review and meta-analyse brain systems possibly subserving uncontrolled eating: namely, (i) the dopamine mesolimbic circuit associated with reward sensitivity, (ii) frontal cognitive networks sustaining dietary self-control and (iii) the hypothalamus-pituitary-adrenal axis, amygdala and hippocampus supporting stress reactivity. While there are limits to the explanatory and predictive power of the uncontrolled eating phenotype, we conclude that treating different eating-related constructs as a single concept, uncontrolled eating, enables drawing robust conclusions on the relationship between food intake and BMI, psychological variables and brain structure and function.

Validation of the German Version of the Power of Food Scale in a General Population Sample

OBJECTIVE

The Power of Food Scale (PFS) is a self-report instrument for assessing appetitive motivation in the absence of caloric needs. The study aim was to validate the German PFS version in a large population sample.

METHODS

Complete information on all PFS items was available from 2,421 respondents (age ≥14) of a nationally representative sample of the German population. We examined the psychometric properties of the German PFS version and provided population-based normative data.

RESULTS

The 3-factor structure of the original scale was replicated in confirmatory factor analysis. The German PFS version demonstrated good internal consistency (α = 0.92 for the total scale). It was well accepted by the respondents, as indicated by a low proportion of missing item values (≤0.56%). While no significant differences were observed in the PFS mean scores between men and women, the scores increased across BMI categories. PFS was positively correlated with a measure of global eating disorder psychopathology (Eating Disorder Examination-Questionnaire 8) and the ultra-brief Patient Health Questionnaire for depression and anxiety.

CONCLUSIONS

Our findings suggest that the German PFS version has adequate psychometric properties and good reliability for measuring hedonic hunger in the general population. The provided population-based norms can be used for individual assessment.

Patterns of weight loss and their determinants in a sample of adults with overweight and obesity intending to lose weight

AIM

Weight loss success is highly variable among individuals. Cluster analysis contributes to future intervention development by recognising this individual variability and identifying different weight loss patterns. Identifying determinants that differentiate between these patterns would explain the source of variability. Thus, we aimed to identify weight loss patterns and their determinants in adults with overweight and obesity.

METHODS

The present study is a secondary analysis of data from the PortionControl@HOME study. The weight of 175 adults was measured at 0, 3 and 12 months and potential determinants were self-reported using validated questionnaires at 0 and 3 months. Weight loss patterns were identified based on percent weight change during Phase 1 (0-3 months) and Phase 2 (3-12 months) using cluster analysis. Determinants were assessed using multinomial logistic regression.

RESULTS

We identified three weight loss patterns: (i) low success, demonstrating low weight loss achievement, (ii) moderate success, demonstrating successful weight loss in Phase 1 followed by partial regain in Phase 2 and (iii) high success, demonstrating weight loss in Phase 1 followed by continued weight loss in Phase 2. Compared to the moderate success pattern, the low success pattern was negatively associated with power of food at baseline (i.e. the appetitive drive to consume highly palatable food) (odds ratio, OR = 0.42, 95% CI = 0.21-0.86) and change in portion control behaviour (i.e. the use of behavioural strategies to control the amount of food consumed) (OR = 0.28, 95% CI = 0.10-0.78).

CONCLUSIONS

Three weight loss patterns were identified in adults with overweight and obesity. Adults with greater power of food and increased portion control behaviour were less likely to exhibit an unsuccessful weight loss pattern.

A narrative review of the construct of hedonic hunger and its measurement by the Power of Food Scale

INTRODUCTION

The term 'hedonic hunger' refers to one's preoccupation with and desire to consume foods for the purposes of pleasure and in the absence of physical hunger. The Power of Food Scale (PFS) was developed as a quantitative measure of this construct in 2009. Since then, over 50 published studies have used the PFS to predict appetite-related outcomes including neural, cognitive, behavioural, anthropometric and clinical measures.

OBJECTIVE

This narrative review evaluates how closely the PFS captures the construct it was originally presumed to assess and to more clearly define hedonic hunger itself.

METHODS

The measure's relationship to four domains is reviewed and summarized: motivation to consume palatable foods; level of actual consumption of such foods; body mass; and subjective loss-of-control over one's eating behaviour. Findings are synthesized to generate a more accurate understanding of what the PFS measures and how it may relate to the broader definition of hedonic hunger.

RESULTS

Results suggest that the PFS is closely related to motivation to consume palatable foods and, in extreme cases, occurrence of loss-of-control eating episodes. PFS scores are not consistently predictive of amount of food consumed or body mass.

CONCLUSIONS

Implications of these findings are discussed in the context of behavioural health, and avenues for further inquiry are identified.

Association between hedonic hunger and body-mass index versus obesity status

Obesity-associated differences in hedonic hunger, while consistently reported, have not been adequately quantified, with most studies failing to demonstrate strong correlations between Body Mass Index (BMI) and hedonic hunger indicators. Here, we quantified and assessed the nature of the relationship between hedonic hunger and BMI, in a cross-sectional study using the Portuguese version of the PFS (P-PFS) to measure hedonic hunger. Data were collected from 1266 participants belonging to non-clinical, clinical (candidates for weight-loss surgery) and population samples. Across samples, significant but weak positive associations were found between P-PFS scores and BMI, in adjusted linear regression models. However, in logistic regression models of data from the clinical and non-clinical samples, the P-PFS Food Available domain score was significantly and robustly associated with belonging to the clinical sample (OR = 1.8, 95%CI: 1.2–2.8; p = 0.008), while in the population sample it was associated to being obese (OR = 2.1, 95%CI: 1.6–2.7; p < 0.001). Thus, hedonic hunger levels are associated with obesity status with the odds of being obese approximately doubling for each unit increase in the P-PFS Food Available score.

Greater Food Reward Sensitivity Is Associated with More Frequent Intake of Discretionary Foods in a Nationally Representative Sample of Young Adults

Food reward sensitivity may influence individual susceptibility to an environment replete with highly palatable foods of minimal nutritional value. These foods contain combinations of added sugar, fat, and/or salt that may enhance their motivational salience. This study examined associations of food reward sensitivity with eating behaviors in the NEXT Generation Health Study, a nationally representative sample of U.S. young adults. Participants (n = 2202) completed self-report measures including the Power of Food Scale, assessing food reward sensitivity, and intake frequency of 14 food groups. Multiple linear regressions estimated associations of food reward sensitivity with each of the eating behaviors adjusting for covariates. Higher food reward sensitivity was associated with more frequent intake of fast food (b ± linearized SE = 0.24 ± 0.05, p < 0.001), sweet and salty snacks (0.21 ± 0.05, p < 0.001), foods made with cheese (0.14 ± 0.06, p = 0.03), soda (0.12 ± 0.04, p = 0.009), processed meats (0.12 ± 0.05, p = 0.045), and fish (0.08 ± 0.03, p = 0.03) but was not associated with intake frequency of fruit or juice, green or orange vegetables, beans, whole grains, nuts/seeds, or dairy products. Food reward sensitivity was associated with greater intake of discretionary foods but was not associated with intake of most health-promoting foods, suggesting food reward sensitivity may lead to preferential intake of unhealthful foods.