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Moraes CHDC, Alvarenga MDS, Moraes JMM, Cyrillo DC. Exploring Psychosocial Determinants of Eating Behavior: Fruit and Vegetable Intake Among Brazilian Adolescents. Front Nutr 2021; 8:796894. [PMID: 34977132 PMCID: PMC8716615 DOI: 10.3389/fnut.2021.796894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 11/17/2021] [Indexed: 11/13/2022] Open
Abstract
In most Western countries, children and adolescents do not eat the recommended amount of fruits and vegetables (FVs). Theoretical frameworks on social psychology of eating, such as the Reason Action Approach, Social Cognitive Theory, and Theory of Normal Conduct have been applied to understand how psychosocial variables can explain FV intake. However, considering those predictors is still rare on the understanding of FV intake among adolescents (particularly in Brazil) despite its importance within eating behavior. Therefore, this study explored important psychosocial determinants of weekly frequency of FV intake among Brazilian adolescents in a model testing socioeconomic status (SES) and body mass index (BMI). A cross-sectional design was performed with 429 students (58% female), mean age 14.45 (SD 1.86). Key variables of theoretical framework on social psychology of food were investigated by structural equation modeling. The model included self-efficacy, attitudes, and social norms (with its subcomponents descriptive and injunctive) as psychosocial predictors of weekly frequency of FV intake along with SES and BMI. An instrument developed for Brazilian Portuguese was used to collect psychosocial variables as well as to verify FV reported intake. The total model explained 45.5% of weekly frequency of FV intake, and self-efficacy was the only significant psychosocial determinant (λ = 0.51, p = 0.001). SES also showed an important effect on the model (λ = 0.21, p = 0.001), while for BMI no significance was observed. In conclusion, the model was adequate to understand psychosocial determinants of weekly frequency of FV intake for Brazilian adolescents, with self-efficacy and SES as the major determinants of this eating behavior.
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Affiliation(s)
- César Henrique de Carvalho Moraes
- Graduate Program in Nutrition in Public Health, School of Public Health, University of São Paulo, São Paulo, Brazil
- Department of Economics, School of Economics, Business and Accounting, University of São Paulo, São Paulo, Brazil
| | - Marle dos Santos Alvarenga
- Graduate Program in Nutrition in Public Health, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Jéssica Maria Muniz Moraes
- Graduate Program in Nutrition in Public Health, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Denise Cavallini Cyrillo
- Department of Economics, School of Economics, Business and Accounting, University of São Paulo, São Paulo, Brazil
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2
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Kuk JL, Dehlehhosseinzadeh M, Kamran E, Wharton S. An analysis of weight loss efforts and expectations in a Canadian Cohort: A retrospective medical chart review. Clin Obes 2021; 11:e12449. [PMID: 33745235 DOI: 10.1111/cob.12449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 02/17/2021] [Accepted: 03/03/2021] [Indexed: 11/30/2022]
Abstract
The weight loss history and weight loss goals were examined in 4108 patients referred to a publicly funded evidence-based clinical weight management program using a retrospective chart review. The majority of patients were white females, aged of 50.1 ± 13.7 years and a BMI of 39.0 ± 7.5 kg/m2 . Pregnancy was the most common reason for weight gain in women (17.7%) and while the reasons in men are more varied (injury, stress and medication: all ~5%). Over 50% of patients cited no specific reason for their weight gain. Self-directed diet and exercise were the most commonly used self-reported weight loss methods. Women were more likely to report using medication and bariatric surgical weight loss methods than men (P < .05), and only 5% of women and 12.8% men report never having tried to lose weight in the past. Patients had an ideal weight loss goal of 28.9% to 34.4%, which was similar to the patient's lowest reported adult weight. Approximately 70% of patients enrolling at the clinic had previously lost at least 4.5 kg (10 lb) one or more times and 16.7% lost weight at least 5 times in their life, but patient weight at enrolment was similar to their highest adult reported weight. Thus, most patients referred to this clinical weight management program have previously attempted self-directed diet and exercise weight loss. Patients were close to their highest adult weight and had very large weight loss goals, similar to what is typically achieved only by surgical intervention, despite having already had several bouts of weight loss.
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Affiliation(s)
- Jennifer L Kuk
- School of Kinesiology and Health Science, York University, Toronto, Canada
| | | | - Elham Kamran
- Weight Management Clinic, The Wharton Medical Clinic, Hamilton, Canada
| | - Sean Wharton
- School of Kinesiology and Health Science, York University, Toronto, Canada
- Weight Management Clinic, The Wharton Medical Clinic, Hamilton, Canada
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3
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Cassin SE, Buchman DZ, Leung SE, Kantarovich K, Hawa A, Carter A, Sockalingam S. Ethical, Stigma, and Policy Implications of Food Addiction: A Scoping Review. Nutrients 2019; 11:E710. [PMID: 30934743 PMCID: PMC6521112 DOI: 10.3390/nu11040710] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 03/08/2019] [Accepted: 03/20/2019] [Indexed: 12/12/2022] Open
Abstract
The concept of food addiction has generated much controversy. In comparison to research examining the construct of food addiction and its validity, relatively little research has examined the broader implications of food addiction. The purpose of the current scoping review was to examine the potential ethical, stigma, and health policy implications of food addiction. Major themes were identified in the literature, and extensive overlap was identified between several of the themes. Ethics sub-themes related primarily to individual responsibility and included: (i) personal control, will power, and choice; and (ii) blame and weight bias. Stigma sub-themes included: (i) the impact on self-stigma and stigma from others, (ii) the differential impact of substance use disorder versus behavioral addiction on stigma, and (iii) the additive stigma of addiction plus obesity and/or eating disorder. Policy implications were broadly derived from comparisons to the tobacco industry and focused on addictive foods as opposed to food addiction. This scoping review underscored the need for increased awareness of food addiction and the role of the food industry, empirical research to identify specific hyperpalatable food substances, and policy interventions that are not simply extrapolated from tobacco.
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Affiliation(s)
- Stephanie E Cassin
- Department of Psychology, Ryerson University, 350 Victoria St., Toronto, ON M5B 2K3, Canada.
- Centre for Mental Health, University Health Network, Network - Toronto General Hospital, 200 Elizabeth Street, 8th Floor, Toronto, ON M5G 2C4, Canada.
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON M5T 1R8, Canada.
| | - Daniel Z Buchman
- University of Toronto Joint Centre of Bioethics, 155 College Street, Suite 754, Toronto, ON M5T 1P8, Canada.
- Bioethics Program and Krembil Brain Institute, Toronto Western Hospital, University Health Network, 399 Bathurst Street, Toronto, ON M5T 1P8, Canada.
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th Floor, Toronto, ON M5T 1R8, Canada.
| | - Samantha E Leung
- Centre for Mental Health, University Health Network, Network - Toronto General Hospital, 200 Elizabeth Street, 8th Floor, Toronto, ON M5G 2C4, Canada.
- Bariatric Surgery Program, University Health Network - Toronto Western Hospital, 399 Bathurst Street, East Wing ⁻ 4th Floor, Toronto, ON M5T 2S8, Canada.
| | - Karin Kantarovich
- Centre for Mental Health, University Health Network, Network - Toronto General Hospital, 200 Elizabeth Street, 8th Floor, Toronto, ON M5G 2C4, Canada.
- Bariatric Surgery Program, University Health Network - Toronto Western Hospital, 399 Bathurst Street, East Wing ⁻ 4th Floor, Toronto, ON M5T 2S8, Canada.
| | - Aceel Hawa
- Department of Education, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON M5S 2S1, Canada.
| | - Adrian Carter
- School of Psychological Sciences, Monash University, Melbourne, VIC 3181, Australia.
- UQ Centre for Clinical Research, University of Queensland, Herston, QLD 4029, Australia.
| | - Sanjeev Sockalingam
- Centre for Mental Health, University Health Network, Network - Toronto General Hospital, 200 Elizabeth Street, 8th Floor, Toronto, ON M5G 2C4, Canada.
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON M5T 1R8, Canada.
- Bariatric Surgery Program, University Health Network - Toronto Western Hospital, 399 Bathurst Street, East Wing ⁻ 4th Floor, Toronto, ON M5T 2S8, Canada.
- Department of Education, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON M5S 2S1, Canada.
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Appelhans BM, French SA, Olinger T, Bogucki M, Janssen I, Avery-Mamer EF, Powell LM. Leveraging delay discounting for health: Can time delays influence food choice? Appetite 2018; 126:16-25. [PMID: 29551401 DOI: 10.1016/j.appet.2018.03.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 03/05/2018] [Accepted: 03/14/2018] [Indexed: 11/28/2022]
Abstract
Delay discounting, the tendency to choose smaller immediate rewards over larger delayed rewards, is theorized to promote consumption of immediately rewarding but unhealthy foods at the expense of long-term weight maintenance and nutritional health. An untested implication of delay discounting models of decision-making is that selectively delaying access to less healthy foods may promote selection of healthier (immediately available) alternatives, even if they may be less desirable. The current study tested this hypothesis by measuring healthy versus regular vending machine snack purchasing before and during the implementation of a 25-s time delay on the delivery of regular snacks. Purchasing was also examined under a $0.25 discount on healthy snacks, a $0.25 tax on regular snacks, and the combination of both pricing interventions with the 25-s time delay. Across 32,019 vending sales from three separate vending locations, the 25-s time delay increased healthy snack purchasing from 40.1% to 42.5%, which was comparable to the impact of a $0.25 discount (43.0%). Combining the delay and the discount had a roughly additive effect (46.0%). However, the strongest effects were seen under the $0.25 tax on regular snacks (53.7%) and the combination of the delay and the tax (50.2%). Intervention effects varied substantially between vending locations. Importantly, time delays did not harm overall vending sales or revenue, which is relevant to the real-world feasibility of this intervention. More investigation is needed to better understand how the impact of time delays on food choice varies across populations, evaluate the effects of time delays on beverage vending choices, and extend this approach to food choices in contexts other than vending machines. TRIAL REGISTRATION ClinicalTrials.gov, NCT02359916.
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Affiliation(s)
- Bradley M Appelhans
- Department of Preventive Medicine, Rush University Medical Center, 1700 W. Van Buren St., Suite 470, Chicago, IL, 60612, USA; Department of Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson Blvd., Suite 400, Chicago, IL, 60612, USA.
| | - Simone A French
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 S 2nd Street, Suite 300, Minneapolis, MN, 55454, USA
| | - Tamara Olinger
- Department of Preventive Medicine, Rush University Medical Center, 1700 W. Van Buren St., Suite 470, Chicago, IL, 60612, USA
| | | | - Imke Janssen
- Department of Preventive Medicine, Rush University Medical Center, 1700 W. Van Buren St., Suite 470, Chicago, IL, 60612, USA
| | - Elizabeth F Avery-Mamer
- Department of Preventive Medicine, Rush University Medical Center, 1700 W. Van Buren St., Suite 470, Chicago, IL, 60612, USA
| | - Lisa M Powell
- Health Policy and Administration, School of Public Health, University of Illinois at Chicago, MC 923, 1603 W Taylor St, Chicago, IL, 60612, USA
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Fitzpatrick SL, Wischenka D, Appelhans BM, Pbert L, Wang M, Wilson DK, Pagoto SL. An Evidence-based Guide for Obesity Treatment in Primary Care. Am J Med 2016; 129:115.e1-7. [PMID: 26239092 PMCID: PMC5988348 DOI: 10.1016/j.amjmed.2015.07.015] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 07/09/2015] [Accepted: 07/10/2015] [Indexed: 12/31/2022]
Abstract
On behalf of the Society of Behavioral Medicine, we present a model of obesity management in primary care based on the 5As counseling framework (Assess, Advise, Agree, Assist, and Arrange). Primary care physicians can use the 5As framework to build and coordinate a multidisciplinary team that: 1) addresses patients' psychosocial issues and medical and psychiatric comorbidities associated with obesity treatment failure; 2) delivers intensive counseling that consists of goal setting, self-monitoring, and problem solving; and 3) connects patients with community resources to assist them in making healthy lifestyle changes. This paper outlines reimbursement guidelines and weight-management counseling strategies, and provides a framework for building a multidisciplinary team to maximize the patient's success at weight management.
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Affiliation(s)
| | | | - Bradley M Appelhans
- Department of Preventive Medicine, Rush University Medical Center, Chicago, Ill
| | - Lori Pbert
- Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester
| | - Monica Wang
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Mass
| | - Dawn K Wilson
- Department of Psychology, University of South Carolina, Columbia
| | - Sherry L Pagoto
- Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester.
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Lifestyle Therapy as Medicine for the Treatment of Obesity. LIFESTYLE MEDICINE 2016. [DOI: 10.1007/978-3-319-24687-1_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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7
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Abstract
Among the key characteristics of the Western obesogenic food environment is a highly palatable and varied food supply. Laboratory investigations of eating behavior in both humans and animals established key roles for palatability and variety in stimulating appetite, delaying satiety, and promoting excessive energy intake. There is a robust effect of food palatability and variety on short-term food intake, and increased variety and palatability also cause weight gain in animal models. However, laboratory paradigms do not replicate the complexities of eating in a natural setting, and there is a shortage of evidence to estimate the magnitude of effects on weight in humans. There are substantial individual differences in susceptibility to the palatability effect and this may be a key determinant in individual vulnerability to weight gain. The understanding of pathways through which palatability and variety can affect eating is advancing, and epidemiologic and intervention studies are needed to translate laboratory findings into applications in public health or clinical domains, and to establish whether there is a role for greater regulation of the food environment in tackling increases in obesity.
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Affiliation(s)
- Fiona Johnson
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Jane Wardle
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
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8
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Struben J, Chan D, Dubé L. Policy insights from the nutritional food market transformation model: the case of obesity prevention. Ann N Y Acad Sci 2014; 1331:57-75. [DOI: 10.1111/nyas.12381] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Jeroen Struben
- Desautels Faculty of Management; McGill University; Montréal Québec Canada
| | - Derek Chan
- Desautels Faculty of Management; McGill University; Montréal Québec Canada
| | - Laurette Dubé
- Desautels Faculty of Management; McGill University; Montréal Québec Canada
- McGill Centre for the Convergence of Health and Economics (MMCHE); McGill University; Montréal Québec Canada
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9
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Vartanian LR, Smyth JM. Primum non nocere: obesity stigma and public health. JOURNAL OF BIOETHICAL INQUIRY 2013; 10:49-57. [PMID: 23288439 DOI: 10.1007/s11673-012-9412-9] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 11/25/2012] [Indexed: 06/01/2023]
Abstract
Several recent anti-obesity campaigns appear to embrace stigmatization of obese individuals as a public health strategy. These approaches seem to be based on the fundamental assumptions that (1) obesity is largely under an individual's control and (2) stigmatizing obese individuals will motivate them to change their behavior and will also result in successful behavior change. The empirical evidence does not support these assumptions: Although body weight is, to some degree, under individuals' personal control, there are a range of biopsychosocial barriers that make weight regulation difficult. Furthermore, there is accumulating evidence that stigmatizing obese individuals decreases their motivation to diet, exercise, and lose weight. Public health campaigns should focus on facilitating behavioral change, rather than stigmatizing obese people, and should be grounded in the available empirical evidence. Fundamentally, these campaigns should, first, do no harm.
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Affiliation(s)
- Lenny R Vartanian
- School of Psychology, The University of New South Wales, Sydney, NSW 2052, Australia.
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