The Dutch Eating Behavior Questionnaire: Further psychometric validation and clinical implications of the French version in normal weight and obese persons

Bodily sensations and bariatric surgery: Links between interoceptive sensibility, intuitive and disordered eating behaviour in obesity and obesity surgery

OBJECTIVE

This study evaluated interoceptive sensibility, intuitive and disordered eating among bariatric candidates, operated individuals and individuals with obesity seeking non-surgical treatment.

METHOD

We recruited 57 individuals with obesity seeking nonsurgical weight-loss (IOB), 84 bariatric candidates (Pre) and 22 individuals post-bariatric surgery (Post) who responded to questionnaires: Multidimensional Assessment of Interoceptive Awareness, Intuitive Eating Scale-2 (IES-2), Dutch Eating Behaviour Questionnaire, Binge Eating Scale, State-Trait Anxiety Inventory, Beck's Depression Inventory.

RESULTS

Overall, the Post group manifested higher scores on 'Body-Listening' (F = 4.95, p = 0.01), 'Emotional Awareness' (F = 8.83, p < 0.001) and 'Trusting' (F = 6.71, p = 0.002) interoceptive dimensions, on the IES-2 total score (F = 5.48, p = 0.007) and 'Reliance on hunger and satiety cues' (F = 31.3, p < 0.001) when age was controlled. The IOB group presented higher scores on emotional (F = 3.23, p = 0.047) and binge eating (F = 5.99, p = 0.004). Among operated individuals, intuitive eating mediated the relationship between interoceptive sensibility dimensions and binge eating: 'Attention regulation' (54%) 'Self-regulation' (75.1%), 'Body listening' (94.09%) and 'Trusting' (84.9%).

CONCLUSIONS

Our results suggest the therapeutic potential of interoceptive sensibility and intuitive eating in obesity management in/beyond the bariatric context.

Post-exercise energy replacement might lead to reduced subsequent energy intake in women with constitutional thinness: Exploratory results from the NUTRILEAN project

While people with Constitutional Thinness (CT) declare a deep willingness to gain weight, there appetitive responses to energy balance manipulations remain unclear. The present work compares the effect of an acute exercise combined or not with an energy replacement load, on subsequent energy intake, appetite and food reward, between normal weight and women with CT. Anthropometric measurements, body composition (Dual X-ray absorptiometry-DXA) and aerobic capacity (VO2max) were assessed in 10 normal-weight (Body Mass Index-BMI): 20-25 kg/m2) and 10 C T (BMI<17.5 kg/m2) women (18-30 years). They randomly performed i) a resting session (CON); ii) an exercise session (EX); iii) an exercise session with energy replacement (EX + R). Their subsequent ad libitum intake, appetite feelings and food reward were evaluated (Leeds-Food-Preference-Questionnaire). CT showed a lower weight (p < 0,001), BMI(p < 0,001), Fat-Mass (%) (p = 0,003) and Fat-Free Mass (kg) (p < 0,001). CT showed a lower ad libitum energy intake on EX + R compared with CON (p = 0,008) and a higher Relative Energy Intake (REI) on CON compared with EX (p = 0,007) and EX + R (p < 0,001). A lower was observed during EX and EX + R compared with CON (p = 0,006,p = 0,009 respectively) in CT. No condition nor group effect was found for hunger. NW only showed a higher pre-meal fullness on EX + R compared to CON and EX (p < 0,001). Choice (p = 0,030), Explicit Liking (p = 0,016), Explicit Wanting (p = 0,004) and Implicit Wanting (p = 0,035) for taste were higher on EX + R than CON and EX. The decreased EI observed in CT when the exercise-induced energy expenditure is compensated by the ingestion of an equivalent energy load, might contribute to explain the difficulty to increase their energy balance and then induce weight gain. Further studies are needed to better understand their energy balance regulation to propose adapted weight gain strategies.

Interoceptive sensibility, intuitive eating, binge, and disordered eating behavior among individuals with obesity: A comparative study with the general population

The present study assessed the links between interoceptive sensibility, binge, disordered (emotional, restrained, and external) and intuitive eating among individuals with obesity (n = 57) and normal weight (n = 29). Individuals with obesity presented lower "attention regulation," "body-listening," and "trusting" interoceptive dimensions. When age was controlled, group differences on "trusting" remained significant. Individuals with obesity showed lower intuitive eating, higher emotional, and binge eating compared to controls. Higher "body listening," "eating for physical rather than emotional reasons," and "reliance on hunger and satiety cues" predicted lower binge eating whereas "external eating" predicted higher binge eating among individuals with obesity. Eating for physical reasons and reliance on hunger and satiety had protective mediating roles in the relationship between external and binge eating in both groups. Interoceptive sensibility and intuitive eating should conjointly serve as psychotherapeutic targets for disordered eating, obesity, and weight management.

Italian validation of a short version of the Dutch eating behavior questionnaire: Psychometric properties and relationships with self-esteem, eating self-efficacy, and snacking habits in university students

Background: The Dutch Eating Behavior Questionnaire (DEBQ) is a widely used self-report measure of eating styles, i.e., emotional, restrained, and external. A short and reliable version is useful for screening, routine assessments, and multipurpose surveys. Objective: The short version of the DEBQ by Bailly et al. (2012) was validated in the Italian context in two studies. Concurrent criterion validity was tested by considering gender, body mass index, self-esteem, eating self-efficacy, and snacking habits. Method: Data were collected via online questionnaires administered to two convenience samples of university students (n = 613, n = 856). Results: The three-factor structure of the short version of the DEBQ was supported and was invariant across genders. Correlations among the three eating styles, gender, body mass index, self-esteem, eating self-efficacy, and snacking habits followed the expected pattern. Conclusion: The short form of the DEBQ is psychometrically sound and can be used to investigate eating styles among Italian university students.

Motivations Associated with Food Choices among Adults from Urban Setting

Motivation for food choices is one of the most important determinant of eating behavior, because it comes from within the person. The aim of this study was to observe food choice motivations and estimate differences in demographic and health characteristics towards food choice motives in the adult population (n = 675; 54% women, ≥18 years) from urban setting. Food choice motivations were assessed using an online questionnaire validated by the EATMOT project. Using K-Means cluster analysis, participants were divided into two clusters of six motivational categories for food choices. Regarding the most and least important motivations, participants in cluster 1 chose food based on emotional motivations, and in cluster 2, they chose based on environmental and political motivations. In addition, younger and obese individuals had more pronounced emotional motivations. In conclusion, this study emphasizes the need to address emotional motivations for healthier food choices among overweight and young people. In addition, the prevalence of health motivations and growing awareness of sustainability indicate a willingness to take actions that benefit personal health and the environment. Apart from providing education, it is society's responsibility to create an environment that promotes the implementation of acquired knowledge and changes in dietary habits.

A randomized controlled trial to evaluate the acceptability and effectiveness of two eating disorders prevention interventions: the HEIDI BP-HW project

BACKGROUND

Eating disorders (ED) are common in Switzerland, as in other Western countries, with a prevalence of any ED of 3.5%. However, no specific prevention intervention has been evaluated in the French-speaking part of the country. In this study, we assessed the acceptability and effectiveness of two well-validated eating disorders prevention interventions: the Body Project intervention (BP), based on cognitive dissonance techniques, and the Healthy Weight intervention (HW), based on the implementation of a healthy lifestyle.

METHODS

Forty female students, aged 18-28, with body dissatisfaction, were randomized into three arms: a BP group, an HW group, and a waiting-list control group (WLCG). The primary outcome measure was body dissatisfaction. Secondary outcomes were thin-ideal internalization, dietary restraint, negative affect, and ED psychopathology. Thirty-three participants completed the assessments before and after the one-month interventions or waiting period. A follow-up measurement was conducted one month after the interventions to assess the stability of the results.

RESULTS

Both interventions, delivered via a virtual web platform, were considered acceptable. The reduction in body dissatisfaction was greater in the BP group (r = 0.7; p < 0.01) or the HW group (r = 0.6; p < 0.01) than in the WLCG, with large effect sizes. Dietary restraint and shape concern were also significantly reduced in the BP group (r = 0.6 and r = 0.7, respectively; p < 0.01) and HW group (r = 0.5 and r = 0.5, respectively; p < 0.05) compared to the WLCG, with moderate to large effect sizes. The results obtained in each intervention group were stable at the one-month follow-up.

CONCLUSIONS

This study showed encouraging results in young women with body dissatisfaction, arguing in favor of the French adaptations of the BP and HW interventions. However, the feasibility of recruitment was difficult, partly due to the pandemic situation at the time of the study, and should be further considered to improve dissemination.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT04558073, 22/09/2020 and Swiss National Clinical Trial Portal (SNCTP000003978).

A Mexican Spanish Adaptation of the Dutch Eating Behavior Questionnaire: Psychometric Properties and Influence of Sociodemographic Variables in Pregnant Women

Eating behaviors are complex phenomena, entangling physiological signals of hunger and satiety, food choices, emotional states, and social factors and expectations, as well as food availability and sensory appearance. Evaluating eating behaviors is challenging and must cover different motives. One instrument for such evaluation is the Dutch Eating Behavior Questionnaire (DEBQ), composed of three subscales for exploring emotional eating, external eating, and restrained eating. In this article, we aimed to (1) evaluate the psychometric properties of a Mexican Spanish adaptation of the DEBQ; and (2) explore the associations between the three adapted DEBQ scales and the influence of sociodemographic factors on each of the three eating behaviors in Mexican pregnant women. A sample of 514 pregnant women responded to our adapted version of the DEBQ and a questionnaire about sociodemographic information. We performed an exploratory factor analysis using a principal component analysis with varimax rotation; based on this analysis, we removed items that loaded on two factors and then performed a confirmatory factor analysis. The final version of the adapted DEBQ has 26 items, clearly divided into a three-factor structure and satisfactorily reliable (Cronbach's ⍺ = 0.903). We then performed Spearman bivariate correlations and multivariate linear regression with backward variable selection to test the associations and influence of sociodemographic factors on each of the three eating behaviors evaluated with the DEBQ. In pregnant women, emotional eating (EmoE) had a medium-high correlation with external eating (ExtE) and a low correlation with restrained eating (RestE), while ExtE and RestE showed no association. The three eating behaviors are associated with maternal sociodemographic and reproductive variables, which partly explain their variation, most notably maternal schooling. Our adapted version of the DEBQ is suitable for use with Mexican Spanish-speaking pregnant women. Maternal sociodemographic and reproductive factors have an influence on the variance of eating behaviors during pregnancy.

Development, sensitivity and reliability of a French version of the Leeds Food Preference Questionnaire (LFPQ-fr) for the evaluation of food preferences and reward

BACKGROUND

. There is a growing global interest in the evaluation of food reward, necessitating the adaptation of culturally appropriate instruments for use in empirical studies. This work presents the development and validation of a culturally adapted French version of the Leeds Food Preference Questionnaire (LFPQ-fr).

METHODS

. The LFPQ-fr was developed and validated in healthy-weight adults using the following systematic approach: i) selection and validation of appropriate food pictures; ii) linguistic translation of liking and wanting constructs in the target population (n=430; 81% female; 42.2 ± 12.7 years); iii) validation of the sensitivity and reliability of the task performed in a fasted state and in response to a standardized test meal (n=50; 50% female; 30.0 ± 8.4 years).

RESULTS

. During the first and second phases, the nutritional and perceptual validation of culturally appropriate food pictures and pertinent reward constructs, respectively, was demonstrated in a healthy-weight French sample. Findings from the third phase indicated that all food reward components were sensitive to the test meal and showed moderate to high agreement in both fasted (Lin's CCC =.72-.94) and fed (Lin's CCC = .53-.80) appetitive states between visit 1 (V1) and visit (V2). Except for explicit liking fat bias, all primary outcomes were statistically consistent in fasted and fed states between V1 and V2. Changes in fat and taste biases in response to a standardized meal for all primary outcomes were also consistent between V1 and V2 except for explicit liking fat bias (Lin's CCC = .49- .72).

CONCLUSION

. The LFPQ-fr developed and tested in this study is a reproducible and reliable method to assess food reward in both the fasted and fed states in a healthy-weight French population.

Effects of aquatic exercise on appetitive responses in adolescents with obesity: An exploratory study

Aquatic exercise has been suggested as a beneficial modality to improve weight loss, cardiorespiratory fitness and quality of life in adolescents with obesity; however, its impact on appetite control in youth remains unknown. The aim of this preliminary study was to examine the effect of an acute aquatic exercise session on energy intake (EI), appetite feelings and food reward in adolescents with obesity. Twelve adolescents with obesity (12-16 years, Tanner stage 3-5, 9 males) randomly completed two conditions: i) control (CON); ii) aquatic exercise session (AQUA). One hour before lunch, the adolescents stayed at rest outside the water in a quiet room for 45 min on CON while they performed a 45-min aquatic exercise session on AQUA. Ad libitum EI and macronutrients were assessed at lunch and dinner, subjective appetite feelings taken at regular intervals, and food reward measured before and after lunch. Paired T-test showed that EI was not different between CON and AQUA at lunch (1333 ± 484 kcal vs 1409 ± 593 kcal; p = 0.162) and dinner (528 ± 218 kcal vs 513 ± 204 kcal; p = 0.206). Total daily ad libitum EI was significantly higher on AQUA (1922 ± 649 kcal) compared with CON (1861 ± 685 kcal; p = 0.044) but accounting for the exercise-induced energy expenditure, relative energy intake did not differ (2263 ± 732 kcal vs 2117 ± 744 kcal, p = 0.304). None of the appetite feelings (hunger, fullness, prospective food consumption and desire to eat) and food reward dimensions were significantly different between conditions. These preliminary and exploratory results suggest that an acute aquatic-exercise session might not induce energy compensatory responses in adolescents with obesity.

Dietary- but not exercise-induced acute iso-energetic deficit result in short-term appetitive compensatory responses in adolescents with obesity

BACKGROUND

Producing negative energy balance rests on the creation of energy deficits that have been shown, depending on their modality, to induce potential appetitive compensatory responses. The aim of this study was to compare energy intake (EI), appetite feelings, and the hedonic responses to equivalent acute energy deficits induced by exercise versus energy restriction in adolescents with obesity.

METHODS

In a within-participants design, seventeen adolescents with obesity (12-16 years, Tanner stage 3-5, 9 males) randomly completed three conditions: i) control (CON); ii) deficit induced by diet only (Def-EI); and iii) deficit induced by exercise only (Def-EX). Lunch was calibrated to generate a 400-kcal deficit in Def-EI and remained similar in CON and Def-EX. A 400-kcal deficit was created through a cycling bout set at 65% VO_2peak in Def-EX. Ad libitum EI, macronutrient intake and relative EI (REI) were assessed at dinner, subjective appetite sensations taken at regular intervals, and food reward measured before dinner.

RESULTS

Food intake at dinner was greater in Def-EI (1112 ± 265 kcal) compared to CON (983 ± 277 kcal; p = 0.005) and Def-EX (1009 ± 281 kcal; p = 0.025). Absolute protein and lipid intake were significantly higher in Def-EI (52.4 ± 9.5 g and 36.8 ± 8.9 g respectively) compared with both CON (44.9 ± 12.6 g; p = 0.001 and 33.8 ± 10.1 g; p = 0.002 respectively) and Def-EX (47.3 ± 11.8 g, p = 0.018, 35.4 ± 10.1 g, p = 0.036 respectively). Area under the curve (AUC) for hunger, desire to eat and prospective food consumption were significantly higher in Def-EI compared with both CON (p = 0.0001) and Def-EX (p = 0.0001). AUC for fullness was significantly lower on Def-EI compared with CON and Def-EX (p = 0.0001). Implicit wanting for sweet food was significantly lower on Def-EX (p = 0.031), relative to CON.

CONCLUSION

Appetitive compensatory responses that are observed after iso-caloric energy restriction in adolescents with obesity are absent with acute exercise, which could contribute to optimize our impact on short-term energy balance.

Reliability and validity of the dutch eating behavior questionnaire in an online format for university students from low-income regions in a pandemic context: A 24 hour MESYN study

Objective

To test the reliability and validity of the Dutch Eating Behavior Questionnaire (DEBQ) in an online format in university students from low-income regions.

Methods

We applied the questionnaire to a sample of 195 and 117 university students from a low-income region (Gini index of 0.56) to study validity and reliability, respectively. The DEBQ consists of 33 items on eating behavior in three dimensions/factors: emotional eating, restrained eating and external eating. The questionnaire was administered twice at 2-week intervals. We tested the reliability via temporal stability and internal consistency and construct validity via exploratory and confirmatory factor analysis.

Results

For reliability, we identified an acceptable Spearman correlation coefficient (rho > 0.30 and p < 0.05) and Cronbach's alpha (α ≥ 0.70) for all DEBQ items. In the exploratory analysis, we identified 6 factors representing a mix of original and additional factors, with an explained variance of 69.1%. In the confirmatory analysis with structural equation modeling, we observed better global model adjustment for the 6-factor model with the Tucker-Lewis index and comparative fit index closer to one, as well as root mean square error of approximation closer to zero than the original (3-factor) model. Using generalized structural equation modeling, we also observed a better fit in latent class modeling for the 6-factor model (AIC: 16990.67; BIC. 17874.38) than for the 3-factor model (AIC: 17904.09; BIC: 18342.67).

Conclusion

The online format of the DEBQ has acceptable reliability and validity for measuring eating behavior in university students from low-income regions.

The effect of intranasal insulin on appetite and mood in women with and without obesity: an experimental medicine study

BACKGROUND/OBJECTIVES

Intranasal (IN) administration of insulin decreases appetite in humans, but the underlying mechanisms are unclear, and it is unknown whether IN insulin affects the food intake of women with obesity.

SUBJECTS/METHODS

In a double-blind, placebo-controlled, crossover design, participants (35 lean women and 17 women with obesity) were randomized to receive 160 IU/1.6 mL of IN insulin or placebo in a counterbalanced order in the post prandial state. The effects of IN insulin on cookie intake, appetite, mood, food reward, cognition and neural activity were assessed.

RESULTS

IN insulin in the post prandial state reduced cookie intake, appetite and food reward relative to placebo and these effects were more pronounced for women with obesity compared with lean women. IN insulin also improved mood in women with obesity. In both BMI groups, IN insulin increased neural activity in the insula when viewing food pictures. IN insulin did not affect cognitive function.

CONCLUSIONS

These results suggest that IN insulin decreases palatable food intake when satiated by reducing food reward and that women with obesity may be more sensitive to this effect than lean women. Further investigation of the therapeutic potential of IN insulin for weight management in women with obesity is warranted.

Suboptimal Weight Loss 13 Years After Roux-en-Y Gastric Bypass: Is Hedonic Hunger, Eating Behaviour and Food Reward to Blame?

Purpose

Suboptimal weight loss (SWL) and weight regain (WR) following bariatric surgery are common. The exact reasons for this phenomenon remain to be fully elucidated. To compare hedonic hunger, food preferences, food reward and eating behaviour traits between participants with SWL and optimal weight loss (OWL) 13 years after Roux-en-Y gastric bypass (RYGB).

Materials and Method

Cross-sectional case control study where participants experiencing SWL or OWL (< or ≥ 50% of excess weight, respectively) post-RYGB were compared to a non-surgical control group matched for pre-operative body mass index. Hedonic hunger (Power of Food Scale), implicit and explicit liking and wanting for high-fat and low-fat savoury and sweet food (Leeds Food Preference Questionnaire) and eating behaviour (Dutch Eating Behavior Questionnaire, Three-Factor Eating Questionnaire and the Food Cravings Questionnaires State and Trait-reduced) were assessed.

Results

In total, 75 participants were recruited from the bariatric surgery observation study (BAROBS). Disinhibition, hunger, emotional, external and restrained eating, frequency of cravings and hedonic hunger were lower in the OWL, compared with the SWL and/or control groups. Implicit wanting and explicit liking and wanting for high-fat savoury and high-fat sweet food were lower, and implicit wanting for low-fat savoury food higher, in the OWL, compared with the SWL and/or control groups.

Conclusion

SWL 13 years after RYGB is associated with dysfunctional eating behaviours, increased preference and reward for high-fat food and increased hedonic hunger. Future longitudinal studies are needed to establish the cause-effect relationship between these variables.

Graphical abstract

Supplementary Information

The online version contains supplementary material available at 10.1007/s11695-022-06075-z.

Considerations for health and food choice in adolescents

The aim of this review is to summarise the common barriers and motivations for healthy food choice among adolescents, with a specific focus on the Irish context where available. It will also discuss other concerns adolescents have, which may influence their food choices and eating habits. Adolescence represents a period of rapid physical, mental and social development, and many health-related habits developed during adolescence tend to persist into adulthood, making the teenage years an optimal time to encourage healthy eating and health-promoting behaviours. Adolescents are concerned about the health impact of their diet, but their understanding of health is often seen in the context of their physical appearance or body image. Body image concerns are prevalent in adolescents, and this can affect their food choices. Taste, price and convenience are commonly noted factors influencing adolescents' food choices, and as they grow, their level of independence increases and spending more time with their peers means that social desirability and social norms about food become increasingly important factors in adolescent food choice. However, their limited autonomy means their supporting food environment also plays an important role. When developing more targeted interventions in adolescent populations, information on adolescent nutrition needs, their concerns for health and body image, and the barriers and motivations for healthy eating and food choice should be considered. Such a holistic approach should help support healthy eating and the prevention of overweight and obesity in the population, whilst also supporting a healthy relationship with food and their bodies.

Eating behavior modulates the sensitivity to the central effects of GLP-1 receptor agonist treatment: a secondary analysis of a randomized trial

AIMS

We investigated if individuals with higher emotional eating scores are less sensitive to the effects of a GLP-1RA on central responses to food cues. Additionally, we investigated the associations of higher external and restraint eating scores with the sensitivity to the central effects of GLP-1RA.

METHODS

This secondary analysis of a randomized crossover study in people with obesity and type 2 diabetes, consisted of two periods of 12-week treatment with liraglutide or insulin glargine. Using functional MRI, we assessed the relation between baseline eating behavior and the effects of the GLP-1RA liraglutide compared with insulin after 10 days and 12 weeks of treatment on brain responses to food cues.

RESULTS

After 10 days, higher emotional eating scores were associated with less pronounced GLP-1RA induced reductions in brain responses to food pictures in the amygdala, insula and caudate nucleus. In addition, higher emotional eating scores tended to be associated with less pronounced GLP-1RA increases in brain responses to chocolate milk receipt in the caudate nucleus and insula. After 12 weeks, there were no significant associations between emotional eating scores and liraglutide-induced changes in brain responses to food cues. After 10 days, baseline external eating scores were associated with less pronounced GLP-1RA induced reductions in brain responses to food pictures in the insula, amygdala and orbitofrontal cortex. After 12 weeks, baseline restraint eating scores were associated with more GLP-1RA induced reductions in brain responses to food pictures in the insula and caudate nucleus, and with more GLP-1RA induced reductions in brain responses to the anticipation of chocolate milk in the caudate nucleus.

CONCLUSIONS

Our findings indicate that individuals with higher baseline emotional eating scores are less sensitive to the central effect of GLP-1RA treatment. Additionally, external eating may also decrease, whereas restraint eating may increase the sensitivity to the treatment effects of GLP-1RAs. These insights may help to optimize treatment strategies for obesity and to select patient groups with better efficacy of GLP-1RA treatment.

Effect of acute dietary- versus combined dietary and exercise-induced energy deficits on subsequent energy intake, appetite and food reward in adolescents with obesity

BACKGROUND

Acute dietary-induced energy deficits have been shown to favor compensatory appetitive responses. The aim of this study was to compare energy intake (EI), appetite sensations and the hedonic responses to equivalent energy deficits induced by dietary restriction alone and combined with exercise in adolescents with obesity.

METHODS

In a within-subjects design, seventeen adolescents with obesity (12-16 years, Tanner stage 3-5, 6 males) randomly completed three 14 h conditions: (i) control (CON); (ii) deficit induced by diet only (Def-EI) and; (iii) deficit induced by combined diet and physical exercise (Def-mixed). Breakfast and lunch were calibrated to generate a 500 kcal deficit in Def-EI and 250 kcal deficit in Def-mixed. A 250 kcal deficit was created through a cycling exercise set at 65% VO_2peak in Def-mixed. Ad libitum EI, macronutrients and relative EI (REI) were assessed at dinner, subjective appetite sensations taken at regular intervals, and food reward measured before dinner.

RESULTS

EI at dinner was significantly lower in Def-EI compared to CON (p = 0.014; Effect size (ES): -0.59 [-1.07; -0.12]), with no difference between Def-mixed and both CON and Def-EI. Total REI was lower in both deficit conditions compared with CON (Def-mixed: p < 0.001; ES: -3.80 [-4.27; -3.32], Def-EI: p < 0.001; ES: -4.90 [-5.37; -4.42] respectively), indicating incomplete compensation for the energy deficits. Absolute protein ingestion at dinner was lower in Def-EI than Def-mixed (p = 0.037; ES: -0.50 [-0.98; -0.03]) and absolute lipid ingestion was lower in Def-EI than in CON (p = 0.033; ES: -0.51 [-0.99; -0.04]). A higher proportion of protein and a lower proportion of carbohydrates was observed in Def-mixed than in Def-EI (p = 0.078; ES: -0.42 [-0.90; 0.04] and p = 0.067; ES: 0.44 [-0.03; 0.92] respectively). Total area under the curve for appetite sensations were similar between conditions. Explicit liking for sweet relative to savoury food was lower in Def-mixed compared to CON (p = 0.027; ES: -0.53 [-1.01; -0.06]) with no difference in food reward between Def-EI and CON.

CONCLUSION

Neither of the two acute isoenergetic deficits led to subsequent appetitive compensation, with the dietary deficit even inducing a lower ad libitum EI at the subsequent dinner. Further studies are needed to better understand the appetitive response to dietary and exercise energy balance manipulations in this population.

A study protocol for a preliminary randomised controlled trial assessing the acceptability and effectiveness of two eating disorders prevention interventions in Switzerland: The HEIDI BP-HW project

Because of the serious consequences of eating disorders on young women’s lives and because of the lack of specialised care facilities, assessing and implementing evidence-based prevention interventions is necessary. Switzerland, like other Western countries, has high prevalence rates of eating disorders. However, no prevention interventions have been evaluated in this country so far. This paper presents the protocol of a preliminary study with the aim to evaluate the acceptability and effectiveness of two interventions, the Body Project (BP) and the Healthy Weight Program (HW), for female students from French-speaking Switzerland. These two interventions were chosen because they have been widely evaluated and they proved to be effective in various countries. They take place in groups and include four weekly sessions over one month. Because of the pandemic situation, the group sessions will take place online on an collaborative platform. The design is a three-arm randomised controlled study. Ninety female students aged 18–25 and presenting with at least moderate body dissatisfaction will be randomised into three groups: (1) one-month BP intervention, (2) one-month HW intervention, and (3) one-month waiting-list control group followed by the BP intervention. Assessments of body dissatisfaction, thin-ideal internalisation, dietary restraint, negative affect, and eating disorder psychopathology will be conducted before and after the interventions or waiting list and after a one-month follow-up. ANCOVA and ANOVA with repeated measures will be used to assess group differences and follow-up stability. Acceptability will be assessed with a questionnaire on participants’ satisfaction with the interventions, group discussion at the end of the intervention, and with participants’ rate of attendance to the group sessions. The study results will provide additional data on these two eating disorders prevention interventions and will suggest ways for their dissemination and further evaluation in Switzerland.

Validation of the Dutch Eating Behavior Questionnaire in a Romanian Adult Population

(1) Background: Obesity, part of the triple global burden of disease, is increasingly attracting research on its preventive and curative management. Knowledge of eating behavior can be useful both at the individual level (to individualize treatment for obesity) and the population level (to implement more suitable food policies). The Dutch Eating Behavior Questionnaire (DEBQ) is a widely used international tool to assess eating behavior, i.e., emotional, external and restricted eating styles. The aim of this study was to validate the Romanian version of DEBQ, as obesity is a major concern in Romania. (2) Methods: Our study tested the psychometric properties of the Romanian version of DEBQ on an adult population and explored the associations of eating behavior with weight status (3) Results: The study showed a factor load similar to the original version of the questionnaire and a very good internal validity (Cronbach’s alpha fidelity coefficient greater than 0.8 for all scales of the questionnaire) for the Romanian version of DEBQ and showed that all of the scales positively correlated with body mass index in both men and women. (4) Conclusions: This study will enable the use of the DEBQ Romanian version on the adult population of Romania where the findings could be incorporated into developing better strategies to reduce the burden of nutrition-related diseases.

Eating styles profiles in Chilean women: A latent Profile analysis

The aims of this study were to identify profiles of women based on their levels of emotional, external and restraint eating, and to determine differences in these eating styles profiles based on nutritional status, sociodemographic characteristics, stress, social support, and satisfaction with the body image. Questionnaires were administered to 884 women aged 20 to 60 living in two Chilean cities. Questionnaires included the Dutch Eating Behavior Questionnaire (DEBQ), the Medical Outcomes Study-Social Support Survey, and the Perceived Stress Scale (PSS). Satisfaction with body image was assessed using a body-image-related single question. Nutritional status and sociodemographic characteristics were also assessed. Latent Profile Analysis (LPA) was used to identify profiles based on the three eating styles measured by the DEBQ. LPA allowed to distinguish four eating styles profiles: "women with medium emotional and external eating, high dietary restraint" (Profile 1, 36.64%); "women with low emotional, external and restraint eating" (Profile 2, 25.25%), "women with high emotional, external and restraint eating" (Profile 3, 21.85%); and "women with very low emotional and external eating, low dietary restraint" (Profile 4, 16.26%). Profile 1 had a greater proportion of women moderately satisfied with their body image. Profiles 2 and 4 scored higher in perceived social support and had greater proportions of women satisfied with their body image. Profile 4 had a higher proportion of married or cohabiting women. Profile 3 scored higher in the PSS and had higher proportion of obese and unsatisfied with their body image women. These results suggest that interventions to reduce emotional, external and restraint eating should not only involve the women, but also their family members.

Eating behaviour styles in Irish teens: a cross-sectional study

OBJECTIVES

To describe the eating behaviour styles of Irish teens and to explore the relationships between demographic factors, BMI and dietary intake and these eating behaviour styles.

DESIGN

Cross-sectional data from the Irish National Teens' Food Survey (2005-2006). The Dutch Eating Behaviour Questionnaire assessed three eating behaviour styles in teens: restrained, emotional and external eating. Data were stratified by sex and age groups.

SETTING

The Republic of Ireland.

PARTICIPANTS

Nationally representative sample of teens aged 13-17 years (n 441).

RESULTS

The highest scoring eating behaviour style was external eating (2·83 external v. 1·79 restraint and 1·84 emotional). Girls scored higher than boys on all three scales (Restraint: 2·04 v. 1·56, P < 0·001, Emotional: 2·15 v. 1·55, P < 0·001 and External: 2·91 v. 2·76, P = 0·03), and older teens scored higher than younger teens on the Emotional (1·97 v. 1·67, P < 0·001) and External scales (2·91 v. 2·72, P = 0·01). Teens classified as overweight/obese scored higher than those classified as normal weight on the Restraint scale (2·15 v. 1·71, P < 0·001) and lower on the External scale (2·67 v. 2·87, P < 0·03). Daily energy intake was negatively correlated with the Restraint (r -0·343, P < 0·001) and Emotional scales (r -0·137, P = 0·004) and positively correlated with the External scale (r 0·110, P = 0·02).

CONCLUSIONS

External eating is the predominant eating behaviour style among Irish teens, but sex, age, BMI and dietary differences exist for each eating behaviour style. Including measures of eating behaviour styles into future dietary research could help understand both how and why as well as what people eat.

A bifactor analysis of the Weight Bias Internalization Scale: What are we really measuring?

Internalized weight stigma (IWS) has been linked with disordered eating behavior, both directly, and as a mediator of the relationship between experienced weight stigma and maladaptive coping. However, the construct of IWS is highly correlated with the related constructs of body image and global self-esteem, and the three constructs may better be represented by underlying trait self-judgment. This overlap is not generally accounted for in existing studies. The present study investigated the shared variance between self-esteem, body image, and IWS in an international sample of higher-weight individuals. Bifactor analysis confirmed that the intermediary role of IWS in the relationship between experienced stigma and self-reported eating behavior was largely accounted for by aspects of body image and global self-esteem. Greater conceptual clarity in the study of IWS is needed to understand the mechanisms via which societal weight stigma impacts on individuals' self-directed judgments and downstream health-related behaviors.

Resting-State Brain Connectivity Predicts Weight Loss and Cognitive Control of Eating Behavior After Vertical Sleeve Gastrectomy

OBJECTIVE

The effects of sleeve gastrectomy (SG) on functional connectivity (FC) and associations with weight loss and eating-related cognitive control were investigated.

METHODS

In a longitudinal study, 14 SG patients (13 female; 42.1 presurgery BMI) completed study visits 1 month pre surgery and 12 months post surgery. Patients completed the Dutch Eating Behavior Questionnaire and resting-state functional magnetic resonance imaging scanning to measure FC. Data were analyzed using a seed-to-voxel approach in the CONN Toolbox to investigate pre-/postsurgery changes (n = 12) and to conduct predictive analysis (n = 14).

RESULTS

Seed-to-voxel analysis revealed changes in magnitude (decreases) and directionality (positively correlated to anticorrelated) of FC pre to post surgery within and between default mode network, salience network, and frontoparietal network nodes [Family-Wise Error (FWE) corrected at P < 0.05]. Baseline FC of the nucleus accumbens (with insula) and hypothalamus (with precentral gyrus) predicted 12-month post-SG % total weight loss (FWE-P < 0.05). Baseline FC of the hippocampus, frontoparietal network, and default mode network nodes predicted improvement in cognitive control of eating behavior 12 months after SG (FWE-P < 0.05).

CONCLUSIONS

Our findings demonstrate changes in FC magnitude and directionality post versus pre surgery within and between resting-state networks and frontal, paralimbic, and visual areas in SG patients. Baseline FC predicted weight loss and changes in cognitive control of food intake behavior at 12 months. These could serve as predictive biomarkers for bariatric surgery.

Consumption of a High Quantity and a Wide Variety of Vegetables Are Predicted by Different Food Choice Motives in Older Adults from France, Italy and the UK

BACKGROUND

Consumption of a high quantity and wide variety of vegetables is currently recommended for health. Dietary variety can be low, however, particularly for older adults. This study investigated the affective factors associated with the quantity and variety of vegetables consumed by older adults in France, Italy and the UK.

METHODS

Adults aged 65 years plus completed questionnaires on self-reported vegetable intake (quantity and variety), liking for vegetables, attitudes towards intake, and demographic variables.

RESULTS

In 497 older adults (France, n = 187, Italy, n = 152, UK, n = 158), higher quantities of vegetables consumed were associated with a higher age, affluence score and liking for vegetables, and a lower importance in consumption of familiarity (smallest β = 0.11, p = 0.03). Greater variety was associated with a higher liking and importance of health benefits, and a lower importance of familiarity (smallest β = -0.11, p < 0.01). Higher quantity and variety combined (quantity × variety) was associated with a higher age, liking and importance of health benefits, and a lower importance of familiarity (smallest β = 0.14, p = 0.02). Country-specific effects were also found (smallest β = 0.20, p < 0.01).

CONCLUSIONS

These findings demonstrate a role for liking and a lower concern for eating familiar foods in vegetable consumption, and a particular role for concern for health benefits in the consumption of a greater variety of vegetables.

The German Version of the Dutch Eating Behavior Questionnaire: Psychometric Properties, Measurement Invariance, and Population-Based Norms

The Dutch Eating Behavior Questionnaire is an internationally widely used instrument assessing different eating styles that may contribute to weight gain and overweight: emotional eating, external eating, and restraint. This study aimed to evaluate the psychometric properties of the 30-item German version of the DEBQ including its measurement invariance across gender, age, and BMI-status in a representative German population sample. Furthermore, we examined the distribution of eating styles in the general population and provide population-based norms for DEBQ scales. A representative sample of the German general population (N = 2513, age ≥ 14 years) was assessed with the German version of the DEBQ along with information on sociodemographic characteristics and body weight and height. The German version of the DEQB demonstrates good item characteristics and reliability (restraint: α = .92, emotional eating: α = .94, external eating: α = .89). The 3-factor structure of the DEBQ could be replicated in exploratory and confirmatory factor analyses and results of multi-group confirmatory factor analyses supported its metric and scalar measurement invariance across gender, age, and BMI-status. External eating was the most prevalent eating style in the German general population. Women scored higher on emotional and restrained eating scales than men, and overweight individuals scored higher in all three eating styles compared to normal weight individuals. Small differences across age were found for external eating. Norms were provided according to gender, age, and BMI-status. Our findings suggest that the German version of the DEBQ has good reliability and construct validity, and is suitable to reliably measure eating styles across age, gender, and BMI-status. Furthermore, the results demonstrate a considerable variation of eating styles across gender and BMI-status.