What is restrained eating and how do we identify it?

Investigating motivations to eat: Refining and validating a framework of Eating Behaviour Traits in dieters and the general population

Due to relationships between diet and health including obesity, there is a need to examine the explanatory power of factors that motivate people to (over or under) eat. In a previous investigation, a four-factor subscale-based model of eating behaviour traits (EBTs) was developed which identified individual differences in psychological factors influencing motivations to eat and some residual uncertainties. The current study used a data-driven and theory-driven approach, including individual items to refine and extend previous EBT models. The aim was to examine and validate the domain structure of a framework for EBTs. The analysis used two samples including a representative sample of the UK population (n = 2010, 51% female, 49% male, 18-88 years), and members of a weight management program (n = 2317, 96.6% female, 2.8% male, 21-84 years), who completed 5 questionnaires including 10 EBTs. The results found some support for a 6-factor model, encompassing reactive eating, negative emotional eating, positive emotional eating, restricted eating, homeostatic eating, and body-food choice congruence (data-driven model) or eating for health (theory-driven model). There were differences between the data-driven model and the theory-driven model regarding the 6th factor. Additionally, the data-driven model did not distinguish between eating for pleasure and reactive eating. The models demonstrated that the eating behaviour factors were significantly associated with BMI category. Overall, this research contributes to a more structured understanding of the dimensions of motivation underlying EBTs, emphasising the utility of this framework for identifying at-risk individuals and tailoring interventions to meet specific individual needs.

Anxiety and restrained eating in everyday life: An ecological momentary assessment study

BACKGROUND

Restrained eating has been related to psychological distress like anxiety and eating disorder symptomatology, but little is known about this relationship in daily life in non-clinical populations. We aimed to understand concurrent and temporal associations between momentary anxiety and restrained eating in everyday life within and across persons in a non-clinical sample, and examined whether this association remains after controlling for eating disorder symptomatology.

METHODS

We used a 10-day ecological momentary assessment (EMA) protocol. Participants (n = 123) completed a baseline survey with demographics and eating disorder symptomatology questions, and three EMA surveys per day reporting anxiety and restrained eating intentions. We applied mixed-effects and random intercept cross-lagged models to analyze the data.

RESULTS

Momentary anxiety and restrained eating were concurrently significantly positively associated within and between persons. When participants had more anxiety than was typical for them, they were more likely to intend to restrain eating, and people with overall higher anxiety symptoms tended to report greater restrained eating over the study period. These associations remained significant after adjusting for eating disorder symptomatology. There were no significant temporal cross-lagged effects. Anxiety-restrained eating association did not spill over into the next assessment window.

LIMITATIONS

The time window between prompts may have been too long to capture potential temporal effects, and we did not examine actual behavioral food restrictions.

CONCLUSION

Daily-life anxiety may be related to concurrent restrained eating intentions, above and beyond baseline eating disorder symptomatology. Research is needed exploring daily-life anxiety as a potential intervention target to address restrained eating.

Self-reported food liking and wanting: A factor analytic study of ratings across 49 consecutive days

Reward responses to food are thought to play an important role in highly palatable food overconsumption. In animal models, food reward responses can be decoupled into unique "liking" (in the moment enjoyment) and "wanting" (motivation/craving) components. However, research on liking and wanting has been hampered by uncertainty regarding whether liking and wanting can be reliably separated in humans. We used factor analysis to test whether ratings of liking and wanting could be empirically separated in women assessed across 49 consecutive days. Female participants (N = 688; ages 15-30) from the Michigan State University Twin Registry reported liking and wanting of foods consumed that day, and wanting of foods not consumed that day, separately for sweets (e.g., cookies), fast food (e.g., French fries), carbohydrates (e.g., bread), and whole foods (fruit, plain chicken) each evening for 49 consecutive days. We examined both average levels and daily levels of liking/wanting across the 49-day period that captured individual differences in liking/wanting over time. Across both types of analyses, liking and wanting for foods that were eaten formed a single factor rather than separate, dissociable factors, while wanting of foods not eaten formed an independent factor. At the daily level, a liking/wanting factor emerged for each individual food category (e.g., liking/wanting sweets), whereas in average analyses, a single factor emerged that collapsed across all food types (i.e., liking/wanting of all foods). Results suggest individuals have difficulty distinguishing between liking and wanting of foods they have eaten on that day but may be able to more reliably separate wanting of foods they have not consumed.

Eating behaviors and dietary intake 2 to 4 years following sleeve gastrectomy: Are there any associations?

OBJECTIVES

A lack of research exists on associations between eating behaviors and dietary intake among patients undergoing bariatric surgery. This study aimed to ascertain the association between eating behaviors and dietary quantity and quality at mid-term postsleeve gastrectomy (SG).

METHODS

This cross-sectional study included 146 adults within 2 to 4 years post-SG. Dietary intake and eating behaviors were assessed using a food frequency questionnaire and the Dutch Eating Behavior Questionnaire, respectively. Energy and the proportion of macronutrients were determined. Carbohydrate quality index (CQI), fat quality index (FQI), healthy plate protein quality index (HPPQI), macronutrient quality index (MQI), and Healthy Eating Index (HEI)-2015 were computed to evaluate diet quality. Participants were categorized into high and low groups based on median scores for each eating behavior scale. Least-squared (geometric) means and 95% confidence intervals were determined for each group using the analysis of covariance, adjusted for age and sex.

RESULTS

The mean time since surgery for participants was 30.8 ± 6.5 months, and 77.4% were female. Participants with high emotional eating had higher energy and HPPQI. Individuals with high external eating had higher energy and percentages of fat and lower FQI and HEI scores. Individuals with high restrained eating scores demonstrated lower energy intake but a higher percentage of protein intake and higher CQI, FQI, MQI, and HEI scores.

CONCLUSIONS

External eating showed the most unfavorable associations, while restrained eating showed the most favorable associations with quantity and quality of diet 2 to 4 years after SG. Emotional eating was minimally related to dietary characteristics.

Youth's energy intake during a laboratory-based loss-of-control eating paradigm: Associations with reported current dieting

Dieting is theorized as a risk factor for loss-of-control (LOC)-eating (i.e., feeling a sense of lack of control while eating). Support for this association has largely relied on retrospective self-report data, which does not always correlate with objectively assessed eating behavior in youth. We hypothesized that during a laboratory-based LOC-eating paradigm, children and adolescents who reported current (at the time of the visit) dieting would consume meals consistent with LOC-eating (greater caloric intake, and intake of carbohydrates and fats, but less intake of protein). Participants were presented with a buffet-style meal and instructed to "Let yourself go and eat as much as you want." Current dieting (i.e., any deliberate change to the amount or type of food eaten to influence shape or weight, regardless of how effective the changes are) was assessed via interview. General linear models were adjusted for fat mass (%), lean mass (kg), height, sex, protocol, race and ethnicity, pre-meal hunger and minutes since consumption of a breakfast shake. Of 337 participants (Mage 12.8 ± 2.7y; 62.3 % female; 45.7 % non- Hispanic White and 26.1 % non-Hispanic Black; MBMIz 0.78 ± 1.11), only 33 (9.8 %) reported current dieting. Current dieting was not significantly associated with total energy intake (F = 1.63, p = .20, ηp2 = 0.005), or intake from carbohydrates (F = 2.45, p = .12, ηp2 = 0.007), fat (F = 2.65, p = .10, ηp2 = 0.008), or protein (F = 0.39, p = .53, ηp2 = 0.001). Contrary to theories that dieting promotes LOC-eating, current dieting was not associated with youth's eating behavior in a laboratory setting. Experimental approaches for investigating dieting are needed to test theories that implicate dieting in pediatric LOC-eating.

Feeling well surrounded: Perceived societal support fosters healthy eating

Societal resources (e.g. recreational facilities, free online information, healthy food retail) are consistently found to be important facilitators for healthy eating. In the current research, we propose that healthy eating is not only facilitated by the actual available support in society, but equally well by individuals' subjective perception on how helpful the provided support truly is. We refer to the latter as "perceived societal support" and examine how this influences healthy eating. Across two experimental studies, we observe that perceived societal support positively affects healthy eating: People who perceive the available support as helpful are more likely to choose healthy food over unhealthy food (study 1) and consume less from an unhealthy food product (study 2) compared to people who perceive the available support as less helpful. These findings do not only contribute to existing literature on societal support and healthy eating behavior, but also provide important policy implications.

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.

Associations among eating behaviors, food security status, and dietary intake during pregnancy

Dietary intake of certain food groups and/or nutrients during pregnancy has been associated with maternal and infant pregnancy-related outcomes. Few studies have examined how behavioral and environmental factors interact to influence prenatal diet. We examined associations between eating behaviors (dietary restraint, emotional eating, external eating) and food security status regarding dietary intake of selected nutrients/food groups during pregnancy. Participants (N = 299; 29% Non-Hispanic Black; 16% ≤ high school education; 21% food insecure) completed validated questionnaires to assess estimated daily intake of food groups/nutrients during pregnancy [e.g., added sugars from sugar-sweetened beverages (SSBs), % of energy from fat, fruit and vegetable (FV) intake] via National Cancer Institute Dietary Screener Questionnaires); eating behaviors (Dutch Eating Behavior Questionnaire); and food security status (6-item USDA Food security Module). Separate hierarchical multiple regressions for each dietary outcome were conducted controlling for maternal age, education, income-to-needs, race/ethnicity, pre-pregnancy BMI, and gestational diabetes. A significant interaction was found between dietary restraint and food security status on added sugar intake from SSBs (β = -0.15, p = 0.02). The negative association between restraint and added sugar from SSBs was stronger among food insecure participants (β = -0.47, p < 0.001 vs. β = -0.15, p = 0.03). Higher external eating (β = 0.21, p < 0.01) and lower restraint (β = -0.13, p = 0.03) were associated with higher % of energy from fat and living in a food insecure household (β = -0.15, p = 0.01) was associated with lower FV intake. Understanding dietary intake during pregnancy requires consideration of the broader context in which eating behaviors occur.

Exploring the association between self-compassion, mindfulness and mindful eating with eating behaviours amongst patients with obesity

Background: People who have obesity often experience problematic eating behaviours, contributing towards their excessive weight gain. Aims: Understanding problematic eating behaviours and their association to self-compassion, mindfulness and mindful eating is important for the development of future interventions that improve weight-loss and weight-regulation. Methods: One hundred and one participants attending their first session of a 6-session dietetic programme within a Tier 3 medical weight management service in the West Midlands, UK were recruited to complete questionnaires on self-compassion, mindfulness, mindful eating and eating behaviours, such as, emotional, restrained, external, fat and sugar consumption and grazing. Results: The findings suggested all three constructs, self-compassion, mindfulness and mindful eating were significantly and negatively associated with grazing and emotional eating, but mindful eating was the only construct that also displayed a significant and negative association with other eating behaviours that are often barriers to successful weight regulation, such as external eating and fat consumption. Further investigation suggested mindful eating had an indirect effect on fat consumption and grazing via external eating. Conclusion: Whilst, self-compassion, mindfulness and mindful eating displayed a negative relationship with grazing and emotional eating, mindful eating also displayed a negative relationship with fat consumption and external eating. Possible explanations and directions for future work are discussed with an emphasis on the need for more empirical work.

Psychometric properties and factor structure of the Revised Beliefs About Emotions Questionnaire

OBJECTIVE

Given that there is an increasing exploration of the role of beliefs about emotions in emotion regulation and psychotherapy, there is a need for a range of valid and reliable measures of beliefs about emotions. The Beliefs About Emotions Questionnaire (BAEQ) has been shown to be a promising measure of beliefs about emotions. However, to date, no study has attempted to replicate the original factor structure of the BAEQ in an English-speaking country. The present study examined the psychometric properties of the BAEQ in a nonclinical sample.

METHOD

Archival data of 1807 adult participants residing in Australia was divided into three equal groups of participants. A confirmatory factor analysis (CFA) was conducted on the first sub-sample, an exploratory factor analysis (EFA) was performed on the second sub-sample, and a second CFA was performed on the third sub-sample. Divergent validity was tested using the heterotrait-monotrait ratio and the concurrent validity was tested through correlations with the subscales of the Three-Factor Eating Questionnaire (TFEQ-R18).

RESULTS

The first CFA failed to replicate the original factor structure of the BAEQ. An EFA supported five of the original six factors. A five-factor structure, including 30 out of the original 43 items, was confirmed in a second CFA. The final subscales (Shameful and Irrational, Overwhelming and Uncontrollable, Invalid and Meaningless, Useless and Damaging) demonstrated good construct validity, good internal consistency, and good concurrent and divergent validity.

CONCLUSION

The results from this study support a briefer five-factor, 30-item version of the BAEQ (BAEQ-R) as a reliable and valid measure of beliefs about emotions that can be utilised in future research.

Temporal dynamics of mental imagery, craving and consumption of craved foods: an experience sampling study

Objective: According to the elaborated intrusion theory of desire, an initial thought about a wanted substance is elaborated with mental imagery, which increases craving and the probability of consuming the substance. We used an app-assisted experience sampling approach to test this theory in the context of food craving and eating.Design: Overall, 221 females (mean age = 21 years; mean body mass index = 22) reported craving, mental imagery, and food consumption six times per day (2 h intervals) for seven consecutive days. Additionally, two traits (general food craving and imagery ability) were assessed.Main outcome measures: craving intensity, food consumption.Results: The probability of eating a craved food increased if the vividness of the mental food image and craving intensity increased two hours before - independent of trait food craving and trait imagery ability. We also found evidence of controlled eating behavior, with participants consuming the food they craved in only 38% of the cases.Conclusion: Mental imagery vividness and craving intensity predict consumption of craved food. The association between craving and eating might be stronger in individuals who struggle with controlling their eating behavior. Therefore, future studies should examine these relationships in overweight/obese samples or patients with eating disorders.

Retrospective Reports of Parental Feeding Practices and Current Eating Styles in Polish Adults

The role of childhood food experiences (CFEs) in determining future eating behaviors remains unclear. The aim of the study was to examine the link between CFEs and selected eating styles (ESs), i.e., intuitive (IE), restrained (ResEat) and external (ExtEat) eating, among 708 Polish adults aged 18-65 (477 women and 231 men). CFEs were measured with the Adults' Memories of Feeding in Childhood questionnaire. Polish versions of the Intuitive Eating Scale-2 and Dutch Eating Behavior Questionnaire were used to assess ESs. Mann-Whitney U test was used to compare ESs scores between those with lower and higher CFEs. In the total sample, "Restrictions" and "Pressure and Food Reward" parental feeding practices favored lower IE, while "Healthy Eating Guidance" and "Monitoring" practices predisposed higher levels of IE in adulthood. "Restrictions" were found to correlate with greater chances of ResEat, whereas "Healthy Eating Guidance" was linked with lower probability of ResEat. "Pressure and Food Reward" and "Monitoring" were associated with higher score for ExtEat. "Restrictions", "Child Control", "Monitoring" and "Healthy Eating Guidance" practices were differently linked to ESs in women and men. The findings suggest that education programs for parents should focus on the long-term consequences of feeding practices.

Patients' Pre and Post-Bariatric Surgery Experience of Dieting Behaviours: Implications for Early Intervention

PURPOSE

Bariatric surgery works, in part, by surgically changing signals of hunger and satiety to achieve weight loss. Not all patients experience optimal outcomes. One potential explanation is that post-surgery dieting may subvert the ability to identify physiological cues of hunger and fullness. Dieting behaviours (e.g. restriction/cognitive restraint) are correlated with disordered eating, and disordered eating implicated in poor outcomes. This study examines the experience of dieting after bariatric surgery.

METHOD

Seventeen adult participants who had undertaken bariatric surgery and residing in Australia participated in semi-structured interviews. Surgeries occurred in 2021 (n = 8), 2020 (n = 4), 2019 (n = 2), and one participant each had surgery in 2014, 2009, and 2004. Thematic analysis elicited themes related to post-operative dieting.

RESULTS

All participants reported chronic pre-surgery dieting. Lifestyle change was the overarching post-surgical theme comprising (i) flexibility (e.g. allowing food, intuitive eating), and (ii) control, comprising surgery control (e.g. set portions, surgery instilled control) and dieting control (e.g. discipline, restriction/restraint). Descriptions of lifestyle change often mirrored pre-surgery descriptions of dieting.

CONCLUSION

Post-surgery lifestyle change appears to encompass a tension between flexible/adaptive approaches to eating and the need to maintain control. Control may emerge as practices that mirror pre-surgery dieting with the potential to interfere with adaptive eating behaviours or promote disordered eating. Dieting behaviours may be a precursor to the development of disordered eating. Health care practitioners should regularly assess dieting behaviour post-surgery to enable early intervention where warranted. Future research should consider how post-surgery re-emerging dieting may be identified and measured to aid in intervention.

On Skinner's pendulum: A framework for assessing s-frame hope

Unsatisfied with the effects of behavioral economics' i-frame, "technology of behavior," Chater & Loewenstein call for a pendulum swing back to the s-frame, suggesting that such an approach offers a more hopeful path toward societal well-being. In this commentary, I offer a framework to think about this pendulum swing, as well as the scope - and limits - of this hope.

When Eating Intuitively Is Not Always a Positive Response: Using Machine Learning to Better Unravel Eaters Profiles

BACKGROUND

The aim of the present study was to identify eaters profiles using the latest advantages of Machine Learning approach to cluster analysis.

METHODS

A total of 317 participants completed an online-based survey including self-reported measures of body image dissatisfaction, bulimia, restraint, and intuitive eating. Analyses were conducted in two steps: (a) identifying an optimal number of clusters, and (b) validating the clustering model of eaters profile using a procedure inspired by the Causal Reasoning approach.

RESULTS

This study reveals a 7-cluster model of eaters profiles. The characteristics, needs, and strengths of each eater profile are discussed along with the presentation of a continuum of eaters profiles.

CONCLUSIONS

This conceptualization of eaters profiles could guide the direction of health education and treatment interventions targeting perceptual and eating dimensions.

Stability and longitudinal association between Body Mass Index and maladaptive eating behaviors in older adults: Results from the NutriAct Family Study (NFS)

PURPOSE

Due to the increasing prevalence of overweight and obesity with age and associated health risks, older adults are an important target group to promote healthy weight. Evidence indicates that maladaptive eating behaviors are associated with higher BMI. However, older adults are often neglected in this research field. This prospective study aims to clarify the temporal relationship between BMI and maladaptive eating behaviors among older adults.

METHODS

In total, 964 participants of the NutriAct Family Study (Mage = 63.34 years) completed web-based questionnaires two times (M = 3.33 years apart). BMI was assessed via self-reported height and weight, and maladaptive eating behaviors with the Dutch Eating Behavior Questionnaire (DEBQ). The stability and longitudinal associations were analyzed using cross-lagged models.

RESULTS

Cross-sectional analysis showed positive correlations between BMI and emotional (r = 0.218), external (r = 0.101), as well as restrictive eating (r = 0.160). All maladaptive eating behaviors (β > 0.684) and BMI (β > 0.922) were longitudinally stable. No significant bidirectional relationships were found between BMI and maladaptive eating behaviors over time, except for BMI predicting restrictive eating (β = 0.133).

CONCLUSION

The observed cross-sectional, but not longitudinal associations between BMI and maladaptive eating behaviors underline the need for prospective study designs to deepen the understanding of the role of maladaptive eating behaviors in weight management among the general population. Maladaptive eating behaviors among older adults may have already consolidated and play a smaller role in explaining weight course, compared to early life like childhood.

Food addiction and dietary restraint in postpartum women: The role of childhood trauma exposure and postpartum depression

The early postpartum period is a sensitive time for understanding women's high-risk eating (i.e., eating behavior associated with negative health outcomes) given potential long-term eating behavior implications for infants. Food addiction and dietary restraint are two high-risk eating phenotypes associated with long-term negative health outcomes that have been theoretically linked. Yet, no research has considered how much these constructs overlap during the early postpartum period. The present study sought to characterize these two high-risk eating phenotypes in postpartum women to examine whether these are distinct constructs with specific etiologies and to inform future targets of intervention. Women (N = 277) in the early postpartum period reported on high-risk eating, childhood trauma exposure, depression symptoms, and pre-pregnancy weight. Women's height was measured and pre-pregnancy BMI was calculated. We conducted bivariate correlations and path analysis to characterize the relationship between food addiction and dietary restraint, controlling for pre-pregnancy BMI. Results showed that food addiction and dietary restraint were not significantly associated and that women's childhood trauma exposure and postpartum depression were associated with food addiction but not dietary restraint. Sequential mediation revealed that higher levels of childhood trauma exposure were associated with worse postpartum depression and, in turn, greater food addiction during the early postpartum period. Findings suggest that food addiction and dietary restraint have distinct psychosocial predictors and etiological pathways, which suggests important construct validity differences between the two high-risk eating phenotypes. Interventions seeking to address food addiction in postpartum women and mitigate the impact of this high-risk eating phenotype on the next generation may benefit from treating postpartum depression, especially in women with histories of childhood trauma exposure.

Evaluating Bidirectional Predictive Pathways between Dietary Restraint and Food Addiction in Adolescents

The relationship between food addiction, an important emerging construct of excessive eating pathology, and dietary restraint has yet to be fully understood. Eating disorder models commonly posit that dietary restraint exacerbates loss of control eating (e.g., binge episodes) and may also play a causal role in the development of food addiction. However, dietary restraint as a reaction to consequences of food addiction (e.g., uncontrollable eating or weight gain) represents another plausible pathway. Existing studies indicate that the association between food addiction and dietary restraint may be more significant during adolescence than adulthood, but are limited by cross-sectional study designs. A longitudinal study using an adolescent sample is ideal for investigating potential pathways underlying links between food addiction and dietary restraint. This study examined temporal pathways between food addiction and dietary restraint in a sample of one hundred twenty-seven adolescents (M = 14.8, SD = 1.1) at three timepoints spanning two years. This is the first study to examine longitudinal cross-lagged panel associations between food addiction and dietary restraint. In this adolescent sample, food addiction significantly predicted future dietary restraint (b = 0.25, SE = 0.06, p < 0.001), but dietary restraint did not significantly predict future food addiction (b = 0.06, SE = 0.05, p > 0.05). These findings support the theory that dietary restraint may be a reaction to deleterious effects of food addiction during adolescence.

Too healthy for their own good: orthorexia nervosa and compulsive exercise in the community

BACKGROUND

The similarities and differences between orthorexia nervosa symptoms (ONs) and the symptoms and correlates of eating disorders listed in the DSM-5 need to be elucidated. ONs were examined in a volunteer community sample in conjunction with compulsive exercise, disordered eating, as well as emotional and behavioral correlates of eating disorders.

METHODS

Participants were 561 adult volunteers (93 men, 17.09%) aged 19-72 (M = 32.7 ± 11), recruited via social media networks. Participants self-reported on the following measures online: Düsseldorf Orthorexia Scale, Compulsive Exercise Test, Retrospective Child Feeding Questionnaire, Experiences in Close Relationships, Difficulties in Emotional Regulation Scale, Toronto Alexithymia Scale, and Eating Disorder Examination Questionnaire 13. Data were downloaded and analyzed in SPSS26 and Amos26.

RESULTS

A theoretical model of the connections between the study variables was tested via SEM and confirmed. The profiles of participants with high, average and low levels of ONs were compared. Participants with the highest levels also scored highest for compulsive exercise, insecure attachment, alexithymia, emotion regulation difficulties, weight and shape concerns, body dissatisfaction, restriction, bingeing, purging and parental feeding practices of concern about child's weight and restricting and monitoring the child's intake of calorie-rich foods.

DISCUSSION

High levels of ONs are related to disordered eating attitudes and behaviors, as well as to emotional and behavioral correlates of eating disorders. It is unclear to what extent these ONs are distinguishable from symptoms of other eating disorders listed in the DSM-5. Longitudinal studies may help to elucidate distinct trajectories and risk factors for ON.

LEVEL OF EVIDENCE

Level III, case-control analytic study.

To Eat or Not to Eat-A Qualitative Exploration and Typology of Restrictive Dietary Practices among Middle-Aged and Older Adults

Favorable diets often include restrictive practices that have proven health benefits, even if initiated later in life. The aim of this qualitative study is to gain a comprehensive understanding of Restrictive Dietary Practices (RDPs) among a sample of middle-aged and older German adults (aged 59-78 years). We conducted 24 narrative in-depth interviews and analyzed the data using qualitative content analysis (Kuckartz). Following an inductive thematic approach, a typology was reconstructed comprising four typical RDP characteristics: I. The Holistically Restraining Type, II. The Dissonant-savoring Restraining Type, III. The Reactively Restraining Type, and IV. The Unintentionally Restraining Type. These types differed regarding the practical implementation of, e.g., restrictive food choice into everyday routines, barriers to do so, as well as with respect to attitudes and motives underlying RDPs. The major motives for adopting a RDP involved health, well-being, ethical, and ecological concerns. The most prominent barriers to a 'successful' adoption of RDPs were the enjoyment of food and the desire for spontaneity and freedom of (food) choice. Our study offers an in-depth understanding of the aspects that shape the widespread practice of dietary restriction among middle-aged and older adults. Lifeworld-related changes in RDPs and possible 'type shiftings' are discussed as well as the meaning and chances of RDPs for public health promotion.

Childhood Food Experiences and Selected Eating Styles as Determinants of Diet Quality in Adulthood-A Cross-Sectional Study

Available studies suggest that childhood food experiences (CFE) may be linked with eating behaviors in adulthood, as well as eating style (ES); thus, both CFE and ES can determine dietary intake. Little is known about the role of both of these factors in explaining the diet quality (DQ) of adults. The aim was to investigate to what extent selected ESs, i.e., intuitive (IE), restrained (ResEat), and external (ExtEat) eating, and CFE related to parental feeding practices (PFPs) will predict the DQ of women and men. Data from 708 Polish adults (477 women and 231 men) aged 18-65 were collected via the Internet from October 2022 to January 2023. Mann-Whitney's U Test was used to compare ES and CFE levels among women and men, while DQ determinants were tested with the multiple linear regression (MLR). In the total study sample, "Healthy Eating Guidance" (CFE), "Child Control" (CFE), "Body-Food Choice Congruence" (IE), and ResEat favored higher DQ scores, while "Unconditional Permission to Eat" (IE), "Eating for Physical Rather Than Emotional Reasons" (IE), and ExtEat predisposed to lower DQ scores. After the MLR was conducted separately in women and men, differences were noted in the role of "Healthy Eating Guidance" (CFE), "Pressure and Food Reward" (CFE), "Unconditional Permission to Eat" (IE), "Eating for Physical Rather Than Emotional Reasons" (IE), ExtEat, and ResEat in predicting DQ indices. Our findings suggest that childhood food experiences and selected eating styles may differently determine the DQ of women and men. Future studies conducted within representative samples are needed to confirm these results.

Eating behavior dimensions and 9-year weight loss maintenance: a sub-study of the Finnish Diabetes prevention study

BACKGROUND

Behavioral processes through which lifestyle interventions influence risk factors for type 2 diabetes (T2DM), e.g., body weight, are not well-understood. We examined whether changes in psychological dimensions of eating behavior during the first year of lifestyle intervention would mediate the effects of intervention on body weight during a 9-year period.

METHODS

Middle-aged participants (38 men, 60 women) with overweight and impaired glucose tolerance (IGT) were randomized to an intensive, individualized lifestyle intervention group (n = 51) or a control group (n = 47). At baseline and annually thereafter until nine years body weight was measured and the Three Factor Eating Questionnaire assessing cognitive restraint of eating with flexible and rigid components, disinhibition and susceptibility to hunger was completed. This was a sub-study of the Finnish Diabetes Prevention Study, conducted in Kuopio research center.

RESULTS

During the first year of the intervention total cognitive (4.6 vs. 1.7 scores; p < 0.001), flexible (1.7 vs. 0.9; p = 0.018) and rigid (1.6 vs. 0.5; p = 0.001) restraint of eating increased, and body weight decreased (-5.2 vs. -1.2 kg; p < 0.001) more in the intervention group compared with the control group. The difference between the groups remained significant up to nine years regarding total (2.6 vs. 0.1 scores; p = 0.002) and rigid restraint (1.0 vs. 0.4; p = 0.004), and weight loss (-3.0 vs. 0.1 kg; p = 0.046). The first-year increases in total, flexible and rigid restraint statistically mediated the impact of intervention on weight loss during the 9-year study period.

CONCLUSIONS

Lifestyle intervention with intensive and individually tailored, professional counselling had long-lasting effects on cognitive restraint of eating and body weight in middle-aged participants with overweight and IGT. The mediation analyses suggest that early phase increase in cognitive restraint could have a role in long-term weight loss maintenance. This is important because long-term weight loss maintenance has various health benefits, including reduced risk of T2DM.

A study of intentional inhibition of food stimuli among female restricted eaters

Restrictive eating is the propensity to restrict food consumption to control body weight. Most previous studies have focused on reactive inhibition induced by external cessation signals. Individuals usually engage in intentional inhibition, an internal form of inhibitory control that arises spontaneously in the absence of an explicit external inhibitory signal. However, there has been no clear research on intentional inhibition in restricted eaters. Therefore, the Go/No-Go/Choose experimental paradigm was used in this study to investigate the performance of intentional inhibition among restrained and unrestrained eaters under general stimuli, food stimuli, and food context conditions. The findings showed that only when food stimuli were present did the intentional inhibition of restricted and non-restricted eaters differ. In contrast to non-restricted eaters, restricted eaters significantly inhibit high-calorie foods in favor of low-calorie ones. There was no difference in intentional inhibition responses between the two groups in the non-food-related or food-context conditions, indicating that the intentional inhibition process was specific to restricted/non-restricted eaters.

Associations of maternal food addiction, dietary restraint, and pre-pregnancy BMI with infant eating behaviors and risk for overweight

Maternal food addiction, dietary restraint, and pre-pregnancy body mass index (BMI) are associated with high-risk eating behaviors and weight characteristics in children and adolescents. However, little is known about how these maternal factors are associated with individual differences in eating behaviors and risk for overweight in infancy. In a sample of 204 infant-mother dyads, maternal food addiction, dietary restraint and pre-pregnancy BMI were assessed using maternal self-report measures. Infant eating behaviors (as measured by maternal report), objectively measured hedonic response to sucrose, and anthropometry were measured at 4 months of age. Separate linear regression analyses were used to test for associations between maternal risk factors and infant eating behaviors and risk for overweight. Maternal food addiction was associated with increased risk for infant overweight based on World Health Organization criteria. Maternal dietary restraint was negatively associated with maternal report of infant appetite, but positively associated with objectively measured infant hedonic response to sucrose. Maternal pre-pregnancy BMI was positively associated with maternal report of infant appetite. Maternal food addiction, dietary restraint, and pre-pregnancy BMI are each associated with distinct eating behaviors and risk for overweight in early infancy. Additional research is needed to identify the mechanistic pathways driving these distinct associations between maternal factors and infant eating behaviors and risk for overweight. Further, it will be important to investigate whether these infant characteristics predict the development of future high-risk eating behaviors or excessive weight gain later in life.

Effectiveness of acceptance and commitment therapy on weight, eating behaviours and psychological outcomes: a systematic review and meta-analysis

PURPOSE

To examine the effectiveness of ACT on weight (body mass index and body mass), eating behaviours (binge eating, emotional eating, external eating and restraint eating), and psychological outcomes (quality of life [QoL], depression, psychological flexibility, and weight stigma) among adults with overweight and obesity.

METHODS

Seven electronic databases (CINAHL, EMBASE, PubMed, PsycInfo Scopus, The Cochrane Library, and Web of Science) were searched from inception through 17 June 2022. 13 studies and 48 unique effect sizes were analyzed using random-effects models. Pooled effect estimates were calculated using weighted mean differences (WMD) and standardized mean differences expressed in Hedges' g (g). Heterogeneity was assessed using Q-statistics and interpreted using I².

RESULTS

ACT was found to be effective in improving weight loss in terms of BMI (k = 6, WMD = - .50, 95% CI = - .90; - .11, t = - 3.25, p = .20, I² = .0%), psychological flexibility and weight-related stigma. However, non-significant changes were found for body mass (k = 4, WMD = - 0.33 95% CI = - 1.53; 0.87, t = - .88, p = .44, I² = .0%), binge eating (k = 4, g = - .34, 95% CI = - 1.31; 0.62, t = - 1.13, p = .34, I² = 71.1%), emotional eating (k = 6, g = - .20, 95% CI = - 0.54; 0.15, t = - 1.47, p = .20, I² = 45.0%), external eating (k = 5, g = - .40, 95% CI = 0.96; 0.16, t = - 1.99, p = .12, I² = 81.8%), restraint eating (k = 3, g = .22 95% CI = - 0.57; 1.01, t = 1.19, p = .36, I² = 69.1%), QoL (k = 3, g = .01, 95% CI = - 1.51; 1.52, t = .02, p = .99, I² = 90.2%) and depression (k = 3, g = - .55, 95% CI = - 1.78; 0.67, t = - 1.94, p = .19, I² = 79.9%).

CONCLUSION

ACT could be effective in improving weight loss but more studies are needed to ascertain its effectiveness and the underlying mechanism by which the various components influence weight-related outcomes.

LEVEL OF EVIDENCE

Evidence obtained from a systematic review and meta-analysis of existing empirical studies.

Food word processing in Chinese reading: A study of restrained eaters

Food-related attentional bias refers that individuals typically prioritize rewarding food-related cues (e.g. food words and food images) compared with non-food stimuli; however, the findings are inconsistent for restrained eaters. Traditional paradigms used to test food-related attentional bias, such as visual probe tasks and visual search tasks, may not directly and accurately enough to reflect individuals' food-word processing at different cognitive stages. In this study, we introduced the boundary paradigm to investigate food-word attentional bias for both restrained and unrestrained eaters. Eye movements were recorded when they performed a naturalistic sentence-reading task. The results of later-stage analyses showed that food words were fixated on for less time than non-food words, which indicated a superiority of foveal food-word processing for both restrained and unrestrained eaters. The results of early-stage analyses showed that restrained eaters spent more time on pre-target regions in the food-word valid preview conditions, which indicated a parafoveal food-word processing superiority for restrained eaters (i.e. the parafoveal-on-foveal effect). The superiority of foveal food-word processing provides new insights into explaining food-related attentional bias in general groups. Additionally, the enhanced food-word attentional bias in parafoveal processing for restrained eaters illustrates the importance of individual characteristics in studying word recognition.

Disconnect between sympathetically-induced hunger suppression and consumption among highly restrained eaters following stress

Despite emphasis on findings suggesting restrained eaters increase food consumption under stress, unrestrained eaters' reduction in intake is more robust. Early proposals asserted unrestrained eaters significantly reduced intake after certain threats due to the hunger-inhibiting effects of autonomic influences, presuming unrestrained eaters are more responsive to these effects and restrained eaters rely less on physiological cues for eating. However, scant empirical evidence has substantiated these claims. This study examined whether a sequence exists whereby stress elicits autonomic activation, autonomic activation impacts hunger, and hunger then impacts eating, with dietary restraint altering the hunger-intake link. It was hypothesized that sympathetic nervous system activation would be greatest when ongoing safety from stress was uncertain, sympathetic activation would be linked to reduced hunger, and lower hunger would be associated with attenuated intake. Restraint, conceptualized via Hagan et al.'s (2017) latent restraint factors, was hypothesized to reduce the association between hunger and intake. Female participants (n = 147) were randomized to a stress + certain safety, stress + uncertain safety, or control condition. Sympathetic nervous system activity was recorded prior to a bogus taste test, which quantified ad libitum consumption of highly-palatable snack foods post-stress. Only the stress + uncertain safety condition exhibited greater sympathetic nervous system activity than the control condition. A significant index of moderated serial mediation emerged for Preoccupation with Dieting and Weight-Focused Restraint in the stress + uncertain safety condition. Though sympathetic activation decreased hunger similarly regardless of dietary restraint, only less restrained individuals significantly decreased intake. More restrained individuals ate more despite experiencing lower hunger. The disconnect between hunger and intake in more restrained eaters suggests that focus on enhancing attunement to hunger may yield greater benefit than enhancing restraint. 281 words.

A survey of eating styles in eight countries: Examining restrained, emotional, intuitive eating and their correlates

INTRODUCTION

Restrained, emotional and intuitive eating were examined in relation to each other and as correlates of participants' weight status, body image and self-esteem. In some past research, restrained and emotional eating have been associated with higher weight status and poorer mental health, while intuitive eating is more frequently linked to lower weight status and more positive well-being. However, these eating styles have rarely been examined together and never in a large cross-country sample.

METHOD

Six-thousand two-hundred and seventy-two (6272) emerging adults (M age = 21.54 years, SD = 3.13) completed scales from the Three-Factor Eating Questionnaire, the Eating Disorders Examination Questionnaire, the Intuitive Eating Scale-2, the Multidimensional Body Self Relations Questionnaire, the Rosenberg Self-Esteem Scale, and provided weight and height information that was used to calculate body mass index (BMI). Participants resided in Australia, Belgium, Canada, China, Italy, Japan, Spain and the United States and provided information using an online survey.

RESULTS

Path analyses for the entire sample revealed significant pathways between higher intuitive eating and higher body satisfaction and self-esteem, and lower BMIs among participants. Higher levels of restrained and emotional eating were associated with lower body satisfaction and self-esteem, and higher BMIs among participants. Minor cross-country differences were evident in these patterns of relations, but intuitive eating emerged as a consistent predictor across countries.

CONCLUSION

Overall, findings suggest that efforts should be made to increase intuitive eating among emerging adults and to support individual and macrolevel interventions to decrease restrained and emotional eating behaviours.

Effect of food cues on time perception: influence of calories and diet control

The aim of this study was to investigate the influence on individuals' time perception of observing a range of foods differing in calorific content. In a first experiment, 92 adult participants performed a temporal bisection task with stimulus durations presented in the form of high- or low-calorie food pictures as well as matched non-food control pictures. In a second experiment, 102 participants performed a strict replication of Experiment 1, without the low-calorie pictures condition as it showed less pronounced effects. Across the two experiments, the data revealed common results. An overestimation of time was observed in relation to high-calorie food pictures when compared with non-food pictures (Experiment 2), and the effect was a function of participants' diet control (Experiments 1 & 2). Contrary to our hypothesis, the more the participants reported controlling their diet, the less they overestimated the time when presented with food stimuli. The participants who controlled their diet reported being less aroused by the high-calorie food pictures, allowing the assumption that the modulation in time overestimation relies on the arousal response generated by high-calorie food pictures.

Enriching sociocultural perspectives on the effects of idealized body norms: Integrating shame, positive body image, and self-compassion

Body image is an integral aspect of the psychology of the self. Idealized body images are ubiquitous in both traditional media forms (e.g., magazines, television) and social media (e.g., Facebook, Instagram). The classic sociocultural model of body image (i.e., the Tripartite Influence Model) emphasizes pathways between idealized body norms, appearance comparisons, internalization of body ideals, and body dissatisfaction and its outcomes. We summarize the model and identify some issues to be addressed in future work, particularly in light of the immense popularity of social media. We review three topics that are not included in the sociocultural model but that provide a more complete picture of the influence of societal body norms on body image: (1) body shame, (2) positive body image, and (3) self-compassion. Research on the nature, assessment, and relevance of these constructs is reviewed in detail. In terms of clinical applications of these areas of research for individuals at risk of body dissatisfaction, we suggest assessing for and targeting body shame, cultivating facets of positive body image, and teaching strategies for developing self-compassion.

Examining socio-cognitive factors and beliefs about mindful eating in healthy adults with differing practice experience: a cross-sectional study

Background

Mindful eating (ME), defined as a “non-judgmental awareness of bodily and emotional sensations regarding food consumption”, may be a promising strategy to promote healthy eating behaviors. However, little is known about the psychosocial factors and underlying beliefs that explain ME adoption.

Methods

Participants (N = 282; M_age = 43.2) responded to an online questionnaire based on the I-Change Model. Groups with different frequencies of prior engagement in ME, i.e., low (n = 82; LME), medium (n = 96), and high (n = 104), were compared via (M)ANOVAs on factors and individual beliefs regarding predisposing (i.e., habits, experience with mindfulness, emotional eating, facets of ME), pre-motivational (i.e., knowledge, behavioral cognizance, risk perception, cues to action), and motivational factors (i.e., attitudes, self-efficacy, social influence) as well as their intentions and action planning. Bivariate correlations and a forward-stepwise regression with ICM constructs were conducted to examine model fit.

Results

LME had a greater habit of mindless eating and significantly lower internal awareness, cognizance, cues, and less favorable attitudes, self-efficacy, engagement and support by their social environment, intention, and action plans about engaging in ME than the other two groups. Less habitual mindless eating, and greater experience, internal awareness, cognizance, susceptibility, support, and intention explained 54% of the variance in ME.

Discussion and conclusion

Results indicate that individuals need to be treated differently when promoting ME with respect to their psychosocial characteristics, rather than as a single group with homogenous baseline beliefs, abilities, support, and motivation. Future longitudinal research should examine which determinants are predictors of ME to better tailor program contents.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40359-022-00977-4.

Exploring the role of mindful eating and self-compassion on eating behaviours and orthorexia in people following a vegan diet

Orthorexia nervosa (ON) is a new concept that is more prevalent in vegan populations. ON is characterised by obsessive focus on healthy eating, following restrictive dietary practices and dietary restrictions escalating over time. The aim of this study was to explore problematic eating behaviours in a vegan population, and to explore whether mindful eating and self-compassion have an impact on ON. Two hundred and eighty-seven females and twenty-eight males who followed a vegan diet completed scales in Orthorexia, Self-Compassion, Mindful, Emotional, External and Restraint Eating. The results indicated that individuals with high levels of ON display low levels of self-compassion, and high levels of restrained eating. Moreover, the findings indicated that self-compassion, but not mindful eating, partially mediated the relationship between restrained eating and orthorexia nervosa. The present results contribute to a better understanding of orthorexic eating behaviours in a vegan population, and identifies the mediating capacity of self-compassion. Further implications and future directions are discussed.Level of evidence: Level V, cross-sectional descriptive study.

"Neurotic people tend to eat less when disinhibited": The mediating role of food-related cognitive flexibility in restrained eaters

OBJECTIVES

This study aims to reveal the individual differences in Neuroticism and cognitive flexibility among successful restrained eaters (SREs), unsuccessful restrained eaters (UREs), and non-restrained eaters (NREs). Moreover, this study is dedicated to investigating whether certain personality traits and cognitive flexibility could concurrently influence disinhibited eating behaviors among restrained eaters and reveal the pathways through which they interact.

METHODS

Female participants aged 17 and 24 years (NREs = 23; SREs = 24; UREs = 23) were assessed with body mass index (BMI) and appetite state measurement, the Dutch Eating Behavior Questionnaire (DEBQ), the NEO Five-Factor Inventory (NEO-FFI), and the Positive and Negative Affect Schedule. To measure behavioral and neural responses related to cognitive flexibility, participants were required to complete a food-related switching task, and their brain activities were recorded through the technique of electroencephalography (EEG). Here we analyzed two widely investigated components-the N2 and P3 components that separately relate to conflict monitoring and response inhibition.

RESULTS

The behavioral performance of food-related task switching did not show significant between-group differences. However, in comparison to NREs and SREs, UREs elicited larger N2 and lower P3 amplitudes during task switching. In addition, UREs exhibited a lower level of Neuroticism than SREs and NREs. Furthermore, food-related task switching induced N2 amplitude fully mediated the association between Neuroticism and disinhibited eating behavior in restrained eaters controlled for BMI and negative affect. Importantly, when a parallel mediation model with N2 and P3 was built concurrently, N2 was still able to fully mediate the association.

CONCLUSION

According to behavioral and neural evidence, increased N2 amplitude induced by food-related task switching totally mediated the negative association between Neuroticism and disinhibited eating in restrained eaters.

Eating and body image characteristics of those who aspire to the slim-thick, thin, or fit ideal and their impact on state body image

The slim-thick ideal is characterized by a small waist and flat stomach, but large hips, thighs, and butt. Little research to date has examined the impact of this body-ideal on women's body image. The purpose of the current study was to investigate: 1) the impact of slim-thick, thin-, and fit-ideal imagery on women's body image, 2) the body ideals women most aspire to, and 3) eating and body image characteristics of women who aspire to each ideal. Participants were 123 female undergraduate students. Results revealed that experimental exposure to slim-thick- and fit-ideal imagery resulted in lower body satisfaction. Participants reported aspiring more to the fit and slim-thick-ideal than to the thin-ideal, and rated the slim-thick-ideal as the most attractive and desirable. Women who aspired to the thin- or slim-thick-ideal reported the greatest overall disordered eating. Women who aspired to the slim-thick-ideal reported greater dietary restraint, eating, shape and weight concerns, appearance ideal internalization, body image investment, and physical appearance perfectionism than those who aspired to the fit-ideal. Findings show that beauty ideals are shifting away from the thin-ideal toward a slim-thick-ideal. Slim-thick internalization may be harmful to women's well-being and should be addressed in body image and eating disorders interventions.

Cyberbullying victimization and disordered eating behaviors: The mediating roles of self-compassion and self-objectification

Previous studies have demonstrated the correlations between cyberbullying victimization and disordered eating behaviors in adolescents, however, limited attention has been paid to the long-term effects and underlying mechanisms, and studies focused on young adults are scarce. This study explored the association between cyberbullying victimization and disordered eating behaviors and the underlying mechanisms in a sample of young adults using a longitudinal design. A total of 955 Chinese young adults completed the Cyber Victim Subscale of the Cyber Victim and Bullying Scale, the Self-surveillance Subscale of the Objectified Body Consciousness Scale, the Self-compassion Scale-Short Form, and the Dutch Eating Behaviors Questionnaire three times with a 3-months interval. The results indicated that cyberbullying victimization was positively correlated with emotional eating and external eating after six months, but not with restrained eating. Moreover, self-compassion and self-objectification mediated the associations between cyberbullying victimization and the three kinds of disordered eating behaviors, however, in different ways. In the associations of cyberbullying victimization with restrained eating and external eating, the independent mediating effect of self-objectification and the serial mediating effect were significant, while in the association between cyberbullying victimization and emotional eating, only the independent mediating effect of self-compassion was significant. The findings indicated that the relations between cyberbullying with different kinds of disordered eating behaviors might have different mediation mechanisms, which sheds light on the prevention and intervention for disordered eating behaviors associated with cyberbullying in the future.

The dynamic network associations of food craving, restrained eating, hunger and negative emotions

OBJECTIVE

Food craving, restrained eating, hunger, and negative emotions may predict and reinforce one another. However, less is known about how they interact together as a complex system in daily life. Therefore, we used a dynamic network approach to examine the associations between food craving, restrained eating, hunger and negative emotions in daily life.

METHODS

Food craving, restrained eating, hunger and negative emotions were measured using ecological momentary assessment three times a day over ten days in a community sample in Israel (n = 123). A two-step multilevel vector auto-regression network analysis was used to estimate temporal, contemporaneous and between-persons networks.

RESULTS

In the temporal network, restrained eating was the most central predictor of eating behaviors and negative emotions, predicting food craving and hunger as well as sadness and loneliness. Food craving was also predicted by hunger and stress, and hunger predicted loneliness. In the contemporaneous network, food craving was associated with hunger and feeling bored, and higher anger was associated with lower restrained eating. Stress and sadness were central negative emotions in the models.

DISCUSSION

This study suggests possible temporal and contemporaneous relationships between food craving, restrained eating, hunger and negative emotions, emphasizing their complex interactions in daily life. Restrained eating and stress should be investigated as potential targets for interventions addressing food craving and overeating.

Orthorexia nervosa and eating disorder behaviors: A systematic review of the literature

BACKGROUND

Orthorexia nervosa (ON) involves obsessive thoughts about healthy eating and distress related to this obsession. There is still dispute over whether ON should be considered on the obsessive-compulsive spectrum, the eating disorder (ED) spectrum, or as its own disorder. Based on current research, orthorexic behaviors seem to be closely related to eating disorder behaviors. However, given the range of instruments used to measure ED and ON, and the lack of consistency in the specific ED domains explored, a review of the current literature is warranted.

OBJECTIVE

The objective of this study was to review the literature relating ON and ED symptoms in an effort to understand the nature of their relationship, and to identify ED symptom domains most closely related to ON.

METHODS

A search was conducted on PubMed, Science Direct, and Web of Science using the term "orthorexia" and at least one of the following: "anorexia nervosa," "bulimia nervosa," "eating disorder," "arfid," "restrictive," "body image," "weight concern," "shape concern." After exclusion criteria were applied, 42 articles were included in the review.

RESULTS

The results indicated that ON is consistently related to both trait and disordered restrictive eating symptoms of anorexia nervosa, and weight control motivations for food choice. However, ON was less consistently related to binge-spectrum eating disorder symptoms, emotional eating, uncontrolled eating, or body dissatisfaction/shape and weight concerns.

CONCLUSION

The finding that ON symptoms are related to restraint and weight loss efforts, but not to body dissatisfaction or dysregulated eating suggests that ON may represent a distinct ED.

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.

Correlation between Eating Behavior and Use of Social Media with Energy-Dense Food Intake Based on Gender among Students in Semarang, Indonesia

BACKGROUND: Eating behavior and the use of social media are believed to affect the intake of energy-dense foods. This study aimed to determine the relationship between eating behavior and use of social media with energy-dense food intake in students by gender. METHODS: This study used a cross-sectional method. The subjects were 123 peoples from one of university in Semarang, Indonesia aged 18-24 years, taken using the consecutive sampling method. Energy-dense food intake was taken using the Semi-Quantitative Food Frequency Questionnaire, eating behavior was using the Dutch Eating Behavior Questionnaire and social media use was using the Scale of Effects of Social Media on Eating Behavior and self-identity questionnaire. Data were analyzed using Pearson's test, Spearman's rank test, and multiple linear regression. RESULTS: The intake of energy-dense foods was higher in men than women. This study showed that there was a relationship between emotional eating (p = 0.001; r = 0.408), external eating (p = 0.008; r = 0.338), and eating behavior due to social media (p = 0.001; r = 0.415) and energy-dense food intake. in women, and duration of social media use (p = 0.003; r = 0.377) with energy-dense food intake in men. Gender and eating behavior due to social media had an effect of 24.9% on energy-dense food intake. CONCLUSION: In women, emotional eating, external eating, and eating behavior due to social media were related to the intake of energy-dense foods. In men, the duration of social media use was related to the intake of energy-dense foods. Gender and eating behavior due to social media were the most influential variables on energy-dense food intake.

Gender Differences in the Relationships between Perceived Stress, Eating Behaviors, Sleep, Dietary Risk, and Body Mass Index

BACKGROUND

Obesity is a growing epidemic among university students, and the high levels of stress reported by this population could contribute to this issue. Singular relationships between perceived stress; engagement in restrained, uncontrolled, and emotional eating; sleep; dietary risk; and body mass index (BMI) have been reported in the current body of literature; however, these constructs interact with each other, and the complex relationships among them are infrequently examined. Therefore, the aim of the present study was to explore the complex relationships between these constructs using mediation and moderation analyses stratified by gender.

METHODS

A cross-sectional study, enrolling university students from the United States (U.S.), the Netherlands, South Korea, Malaysia, Ireland, Ghana, and China, was conducted between October 2020 and January 2021 during the COVID-19 pandemic. Perceived stress; maladaptive eating behaviors including restrained, uncontrolled, and emotional eating; sleep duration and quality; dietary risk; and BMI were assessed using validated questionnaires, which were distributed through an online platform.

RESULTS

A total of 1392 students completed the online survey (379 male, 973 female, and 40 who self-identified as "other"). Uncontrolled and emotional eating mediated the relationship between perceived stress and dietary risk for both males and females; higher sleep quality weakened this relationship among female students but not males. Emotional eating mediated the relationship between perceived stress and BMI for both males and females, but higher sleep quality weakened this relationship only among females.

CONCLUSIONS

Our findings suggest that students in higher education are likely to benefit from interventions to reduce uncontrolled and emotional eating. Programs that improve sleep quality, especially during highly stressful periods, may be helpful.

Are Peripheral Biomarkers Determinants of Eating Styles in Childhood and Adolescence Obesity? A Cross-Sectional Study

Disturbances in eating behaviors have been widely related to obesity. However, little is known about the role of obesity-related biomarkers in shaping habitual patterns of eating behaviors (i.e., eating styles) in childhood. The objective of the present study was to explore the relationships between several biomarkers crucially involved in obesity (ghrelin, insulin resistance, and leptin/adiponectin ratio) and eating styles in children and adolescents with obesity. Seventy participants aged between 8 and 16 (56.2% men) fulfilled the Spanish version of the Dutch Eating Behavior Questionnaire for Children to measure external, emotional, and restrained eating styles. In addition, concentrations of ghrelin, leptin, adiponectin, insulin, and glucose were obtained through a blood test. Hierarchical multiple regression analyses controlling for age and sex were computed for each eating style. Results indicated that individuals with higher ghrelin concentration levels showed lower scores in restrained eating (β = -0.61, p < 0.001). The total model explained 32% of the variance of the restrained pattern. No other relationships between obesity-related biomarkers and eating behaviors were found. This study highlights that one of the obesity-risk factors, namely lower plasma ghrelin levels, is substantially involved in a well-known maladaptive eating style, restraint eating, in childhood obesity.

The Effects of the COVID-19 Pandemic Lockdown on Eating, Body Image, and Social Media Habits Among Women With and Without Symptoms of Orthorexia Nervosa

The COVID-19 pandemic is negatively impacting people's mental health worldwide. The current study examined the effects of COVID-19 lockdown on adult women's eating, body image, and social media habits. Furthermore, we compared individuals with and without signs of orthorexia nervosa, a proposed eating disorder. Participants were 143 women, aged 17-73 years (M = 25.85, SD = 8.12), recruited during a COVID-19 lockdown in Canada from May-June 2020. Participants completed self-report questionnaires on their eating, body image, and social media habits during the pandemic. The Eating Habits Questionnaire (EHQ) assessed symptoms of orthorexia nervosa. Compared to the period prior to lockdown, women with higher total orthorexia nervosa scores reported eating a lot more than usual, feeling greater pressure to diet and lose weight, thinking about food more often than usual, experiencing greater weight gain, and perceiving more pressure from social media specifically to lose weight and to exercise, compared to their healthy counterparts. We examined associations between individual EHQ subscales and perceived changes to eating and weight. Women who scored high on EHQ-Problems reported seeing more weight loss content on their social media than those who reported fewer orthorexia nervosa symptoms. Conversely, those who scored low on EHQ-Feelings reported feeling a lot less pressure to lose weight, somewhat less or a lot less pressure to lose weight or to exercise from social media specifically, and trended toward less laxative use during lockdown, compared to those who scored higher on orthorexia nervosa. And those who scored low on EHQ-Knowledge reported feeling somewhat less or a lot less pressure to lose weight than those who reported more orthorexia nervosa symptoms. Together, the findings suggest that women with symptoms of orthorexia nervosa are experiencing an exacerbation of disordered eating thoughts and behaviors during COVID-19, and that social media may be a contributing factor.

Polish Adaptation of the Dutch Eating Behaviour Questionnaire (DEBQ): The Role of Eating Style in Explaining Food Intake-A Cross-Sectional Study

Knowledge of associations between emotional, external, and restrained eating with food choices is still limited due to the inconsistent results of the previous research. The aim of the study was to adopt the Dutch Eating Behavior Questionnaire (DEBQ) and then to examine the relationship between emotional, external, and restrained eating styles and dietary patterns distinguished on the basis of intake of fruit and vegetables (fresh and processed separately), fruit and/or vegetable unsweetened juices, sweets and salty snacks, and the adequacy of fruit and vegetable intake. The cross-sectional study was conducted in 2020, in a sample of 1000 Polish adults. The questionnaire consisted of the Dutch Eating Behavior Questionnaire, questions on selected food groups intake, and metrics. DEBQ structure was tested using both exploratory and confirmatory factor analysis (EFA, CFA) and structural equation modelling (SEM), while multi-group analysis was used to test measurement invariance. Logistic regression was applied to investigate the association between eating styles and dietary patterns, identified with the use of K-means cluster analysis. EFA, CFA and SEM revealed a three-factor, 29-item tool with satisfactory psychometric parameters. Restrained eating (ResEat) and external eating (ExtEat) were found to decrease chances of low intake of both favorable (fruit, vegetables, and unsweetened juices) and unfavorable (sweets and salty snacks) foods and increased the chances of their moderate intake. ResEat increased the probability of the high intake of favorable and moderate or high intake of unfavorable foods. ResEat and ExtEat were predisposed to adequate intake of fruit and vegetables while emotional eating had the opposite effect. Gender, education, and BMI were also found to determine food intake. Our results provide evidence that both eating styles and sociodemographic characteristics should be taken into account while explaining food intake as they may favor healthy and unhealthy eating in different ways.

The food restriction wars: Proposed resolution of a primary battle

Research regarding the definition and consequences of dieting has generated controversy for years. This controversy has spilled over into the public domain, especially as eating disorders and obesity have become more prevalent. One of the earliest and longest-lasting controversies involves the restrained eating framework, which was originally developed by Herman and Polivy and also strongly influenced the development of the cognitive-behavioral model of bulimia nervosa. An alternative framework for understanding the role of dieting in nonclinical and clinical groups, called the Three-Factor Model of Dieting, took a sharply different approach to defining, and understanding the impact of, dieting. This paper provides a brief historical review of the development of these divergent perspectives and updates the Three Factor Model's critical distinction between restraining eating to prevent over-consumption and dieting to lose weight. We suggest that three historical trends impacted the development of Restraint Theory in ways that unfairly impugned dieting for weight control: the emergence of the new eating disorders of bulimia nervosa and binge eating disorder, a population-based increase in loss of control eating and a population-based increase in obesity. This update is aimed in part at encouraging new research to reconcile ongoing, unresolved issues between Herman and Polivy's restrained eating model and the Three-Factor model of Dieting model. Such research might also contribute to the public's understanding of the pros and cons of dieting and to new approaches to treating eating disorders and obesity.

Differences in the Factor Structure of the Eating Attitude Test-26 (EAT-26) in Different Cultures in Israel: Jews, Muslims, and Christians

BACKGROUND

In recent years, there has been a shift in the clinical presentation and, hence, diagnostic definitions of eating disorders (EDs), reflected in a dramatic change in the diagnostic criteria of EDs in the DSM-5. The Eating Attitudes Test-26 (EAT-26) is currently considered an accepted instrument for community studies of EDs, although it features an inconsistent factorial structure in different cultures. Therefore, it is essential to investigate whether the EAT-26 can still be considered an adequate instrument for identifying the risk of developing EDs in different cultures. The aim of the present study was to examine the construct validity and internal consistency of the EAT-26.

METHOD

The study used exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) among different cultural populations in Israel.

RESULTS

Findings indicated different factors in different ethnic groups, most of which do not correspond with the original EAT-26 three-factor structure.

RESULTS

The analysis yielded two main factors among Israeli Jews, four main factors among Israeli Muslim Arabs, and three main factors among Israeli Christian Arabs.

CONCLUSION

These findings shed light on cultural factors affecting perceptions of the EAT-26 items. This calls for a reconsideration of the generalization of the original three-factor structure of the questionnaire in different cultures.