Choice is relative: Reinforcing value of food and activity in obesity treatment

A psychobioecological model to understand the income-food insecurity-obesity relationship

Food insecurity, defined by unpredictable access to food that may not meet a person's nutritional needs, is associated with higher BMI (kg/m2) and obesity. People with food insecurity often have less access to food, miss meals and go hungry, which can lead to psychological and metabolic changes that favor energy conservation and weight gain. We describe a conceptual model that includes psychological (food reinforcement and delay discounting) and physiological (thermic effect of food and substrate oxidation) factors to understand how resource scarcity associated with food insecurity evolves into the food insecurity-obesity paradox. We present both animal and human translational research to describe how behavioral and metabolic adaptations to resource scarcity based on behavioral ecology theory may occur for people with food insecurity. We conclude with ideas for interventions to prevent or modify the behaviors and underlying physiology that characterize the income-food insecurity-obesity relationship.

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

INTRODUCTION

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

METHOD

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

RESULTS

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

DISCUSSION

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

Effects of Episodic Memory Recall on Reinforcing Value of Physical Activity

OBJECTIVE

Many people prefer a sedentary versus an active lifestyle and have difficulty completing sufficient physical activity to improve health. While exercise can be a powerful reinforcer for some people, many prefer to be sedentary. The relative reinforcing value of physical activity (RRVPA) is influenced by a person's learning history with positive experiences strengthening the motivation to be active. Episodic memories may be critical to determining RRVPA, or RRV of different types of positive behaviors.

METHOD

As a potential way to increase RRVPA we examined if recalling a positive episodic memory would affect RRVPA. One hundred and thirty seven adult participants completed measures of reinforcement history and memory functions and then recalled a single positive episode of either a physical activity or of a cognitively enriching activity, rated subjective memory qualities, and completed tasks to measure the RRV of both types of activity.

RESULTS

Recalling a positive episodic memory increased RRV for the respective activity, and changes in RRVPA were moderated by how much the memory satisfies a basic psychological need.

CONCLUSIONS

This research demonstrates the impact of episodic memory on RRVPA, which could be leveraged to aid behavior change efforts.

Reasons individuals stop eating questionnaire (RISE-Q) among adults in the United Arab Emirates

The relationship between obesity and satiation is complex and bidirectional. Understanding differences in reasons for meal termination may enhance our understanding of overeating risks and susceptibility to overconsumption. This study aimed to investigate the reasons why individuals in the UAE stop eating. A cross-sectional web-based study was conducted among adults ≥18 years in the UAE (n = 1482). Using a self-administered online questionnaire, we collected information on sociodemographic characteristics, lifestyle habits, and eating behavior using the Reasons Individuals Stop Eating-Questionnaire (RISE-Q-15) used twice for breakfast/main meal. The items were categorized into five scales; decreased food appeal (DFA), physical satisfaction (PS), planned amount (PA), self-consciousness (SC), and decreased priority of eating (DPE). All items were scored from 1 to 7 ranging between 3 to 21 on each scale. A paired t-test was used to evaluate the difference between the RISE-Q scores on each scale concerning the two meals. The main reason why participants stopped eating breakfast was under the PS scale (14.91 ± 3.72), followed by the PA scale (14.58 ± 3.00). The main reason why participants stopped eating main meals was under the PS scale (14.78 ± 3.56), followed by the PA scale (14.77 ± 43.81). The mean score of the DPE scale was significantly higher for breakfast than the main meal (p = 0.038). More than half of the participants reported an average eating rate (58.7%). Pearson's chi-square analysis revealed that the eating rate was dependent on BMI (p<0.001). Considering individual mealtimes and addressing factors related to PS and PA of food is crucial when designing nutrition interventions aiming to promote healthy eating habits among adults in the UAE.

Obesity in Childhood and Adolescence: The Role of Motivation for Physical Activity, Self-Esteem, Implicit and Explicit Attitudes toward Obesity and Physical Activity

The purpose of the present study was to compare attitudes toward body weight and physical activity in both regular-weight and overweight/obese children and adolescents, and assessing relations between attitudes and self-esteem, motivation for physical activity, life satisfaction and level of physical activity. A total of 126 children (Mage = 12.2, SD = 3.4), divided into two subsamples (i.e., overweight/obese, N = 44, and regular-weight), voluntarily participated in the study. A series of univariate analyses of variance was conducted to examine the differences in the study variables across the subsamples. Correlational analyses were conducted to examine the relationships among the variables. The results indicated that obese/overweight participants expressed a more positive implicit attitude toward the thin category than regular-weight participants. Furthermore, among overweight/obese participants, implicit attitude toward physical activity was significantly negatively correlated with explicit attitude toward physical activity and general self-esteem. Significant differences between obese/overweight and regular-weight participants indicated that the status in terms of weight played a key role in attitudes toward the explored constructs.

Parents' recalled experiences of the child centred health dialogue in children with overweight: a qualitative study

BACKGROUND

Because overweight and obesity are still increasing and prevention of childhood obesity is more likely to be effective when initiated in preschool children, the Child Health Service in the south of Sweden developed a structured child-centred health dialogue model targeting all 4-year-old children and their families. The aim of this study was to describe parents' recalled experiences of this health dialogue in children with overweight.

METHODS

A qualitative inductive approach with purposeful sampling was used. Thirteen individual interviews with parents (including 11 mothers and 3 fathers) were conducted and analysed with qualitative content analysis.

RESULTS

The analysis resulted in two categories: 'A valuable visit with a subtle individual impact' that described parents' recalled experiences of the health dialogue and 'There is a complex interaction between weight and lifestyle' that reflected the parents' perceptions of the relationship between their children's weight and lifestyle.

CONCLUSIONS

Parents recalled the child-centred health dialogue as important and described discussing a healthy lifestyle as one of the obligations of the Child Health Service. Parents wanted confirmation that their family lifestyle was healthy; however, they did not want to discuss the relationship between their family lifestyle and their children's weight. Parents expressed that when their child followed the child's growth curve, then this indicated healthy growth. This study supports using the child-centred health dialogue as a model to provide structure for discussing a healthy lifestyle and growth but highlights the difficulties of discussing body mass index and overweight, especially in the presence of children.

A value accumulation account of unhealthy food choices: testing the influence of outcome salience under varying time constraints

People often engage in unhealthy eating despite having an explicit goal to follow a healthy diet, especially under certain conditions such as a lack of time. A promising explanation from the value accumulation account is that food choices are based on the sequential consideration of the values of multiple outcomes, such as health and taste outcomes. Unhealthy choices may result if taste is considered before health. We examined whether making a health outcome more salient could alter this order, thereby leading to more healthy choices even under time pressure. Two studies examined the time-dependent effect of outcome values and salience on food choices. Participants first completed priming trials on which they rated food items on healthiness (health condition), tastiness (taste condition), or both healthiness and tastiness (control condition). They then completed blocks of binary choice trials between healthy and tasty items. The available response time was manipulated continuously in Study 1 (N = 161) and categorically in Study 2 (N = 318). As predicted, results showed that the values of health and taste outcomes influenced choices and that priming led to more choices in line with the primed outcomes even when time was scarce. We did not obtain support for the prediction that the priming effect is time-dependent in the sense that primed outcomes are considered before non-primed outcomes. Together, these findings suggest that increasing the value and salience of a health outcome may be effective ways to increase healthy choices, even under poor conditions such as time pressure.

Reducing relative food reinforcement of infants using a music enrichment program: a randomized, controlled trial

BACKGROUND

Food reinforcement or one's motivation to eat may be established early in life; it might not be the food reinforcement per se that drives weight gain, but rather the imbalance between food and nonfood reinforcement.

OBJECTIVES

We implemented a 2-y randomized, controlled trial to assess the effects of a music enrichment program (music, n = 45) compared with an active play date control (control, n = 45) in 9- to 15-mo-old healthy infants who were strongly motivated to eat.

METHODS

The 12-mo intensive intervention phase included 4 semesters of Music Together® or a play date program (Winter, Spring, Summer, and Fall), comprised of once per week group meetings, followed by a 12-mo maintenance phase with monthly meetings. Parents were encouraged to listen to the Music Together® program CD or play with the play date group's toy with their infants at home, respectively. We performed a modified intention-to-treat analysis using all randomly assigned, non-excluded subjects for the outcome measures [relative reinforcing value of food (RRVfood), food reinforcement, music reinforcement, and weight-for-length z-score (WLZ)].

RESULTS

There were significant differential group changes across time for RRVfood (group × month; P = 0.016; Cohen's f2 = 0.034). The music group had significantly greater RRVfood decreases than the control group from baseline to the end of the intensive intervention phase (music change = -0.211; control change = -0.015; P = 0.002; Cohen's D = 0.379). However, these differences were not maintained during months 12-24 (music change = -0.187; control change = -0.143; P = 0.448; D = 0.087). We observed an overall moderation effect by sex for food reinforcement and WLZ. Boys in the music group had a significant attenuation in food reinforcement and WLZ compared with boys in the control group.

CONCLUSIONS

This study extends our knowledge in infant eating behavior by providing insight into the role of nonfood alternatives in altering one's motivation to eat. There may be sex differences in altering one's motivation to eat.This trial was registered at clinicaltrials.gov as NCT02936284.

The role of dietary fibers in regulating appetite, an overview of mechanisms and weight consequences

Dietary fibers prevent obesity through reduction of hunger and prolongation of satiety. A number of mechanical and endocrine signals from gastrointestinal tract are stimulated by fibers and their fermentation products, reach regions of brain involved in the regulation of appetite, and ultimately reduce food intake. Gastric distention, delayed gastric emptying, prevention of hypoglycemic, increased amounts of unabsorbed nutrients reaching to the ileum, and stimulation of enteroendocrine cells for secretion of cholecystokinin, glucagon-like peptide-1 (GLP-1), and peptide YY are among mechanisms of fibers in decreasing hunger and prolongation of satiety. Fermentation of fibers produces short-chain fatty acids that also stimulates enteroendocrine cells to secrete GLP-1 and PYY. Randomized controlled trials have shown reductions in energy intake and body weight along with increased satiation and reduced hunger following consumption of fibers. Prospective cohort studies have confirmed these results but the extent of weight loss in some studies has been small. Controversies exist between studies particularly for the effect of fibers on the gastrointestinal hormones, subsequent food intake, and the resultant weight loss. More studies are needed before a clear conclusion can be drawn especially for the effect of fibers on appetite-related hormones and weight loss.

Feasibility of a Theory-Based, Online Tailored Message Program to Motivate Healthier Behaviors in College Women

We aimed to test the feasibility of an online survey and tailored message program in young women. Recruited from college campuses, women (n = 189) completed an online survey assessing preference for and behaviors toward diet and physical activity as well as theory-based influencers of these behaviors (knowledge/information, motivation, and confidence). Health messages were tailored to the participant’s survey responses and learning style to address misconceptions and motivate or reinforce healthy physical activity and dietary behaviors. Most women reported the survey as relevant (92%) and useful for reflecting on their health (83%), with survey responses variable in level of nutrition and physical activity knowledge, motivation, and confidence. Each woman received four tailored messages—most reported the messages as relevant (80%) and learning new information (60%). Across all messages, nearly half of the participants (~48%) reported willingness to try or maintain healthier behaviors and confidence in their ability. Body size discrepancy and dietary restraint had small effects message responses of information learned, and the motivation and confidence in trying healthier behaviors. In summary, these data support the feasibility of this online tailored message program. The college women found the tailored message program acceptable and useful to motivate healthier behaviors. The findings provide direction for behaviorally focused interventions to improve dietary and physical activity behaviors.

Thirty Obesity Myths, Misunderstandings, and/or Oversimplifications: An Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) 2022

Background

This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) is intended to provide clinicians an overview of 30 common obesity myths, misunderstandings, and/or oversimplifications.

Methods

The scientific support for this CPS is based upon published citations, clinical perspectives of OMA authors, and peer review by the Obesity Medicine Association leadership.

Results

This CPS discusses 30 common obesity myths, misunderstandings, and/or oversimplifications, utilizing referenced scientific publications such as the integrative use of other published OMA CPSs to help explain the applicable physiology/pathophysiology.

Conclusions

This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) on 30 common obesity myths, misunderstandings, and/or oversimplifications is one of a series of OMA CPSs designed to assist clinicians in the care of patients with the disease of obesity. Knowledge of the underlying science may assist the obesity medicine clinician improve the care of patients with obesity.

Valuing the Diversity of Research Methods to Advance Nutrition Science

The ASN Board of Directors appointed the Nutrition Research Task Force to develop a report on scientific methods used in nutrition science to advance discovery, interpretation, and application of knowledge in the field. The genesis of this report was growing concern about the tone of discourse among nutrition professionals and the implications of acrimony on the productive study and translation of nutrition science. Too often, honest differences of opinion are cast as conflicts instead of areas of needed collaboration. Recognition of the value (and limitations) of contributions from well-executed nutrition science derived from the various approaches used in the discipline, as well as appreciation of how their layering will yield the strongest evidence base, will provide a basis for greater productivity and impact. Greater collaborative efforts within the field of nutrition science will require an understanding that each method or approach has a place and function that should be valued and used together to create the nutrition evidence base. Precision nutrition was identified as an important emerging nutrition topic by the preponderance of task force members, and this theme was adopted for the report because it lent itself to integration of many approaches in nutrition science. Although the primary audience for this report is nutrition researchers and other nutrition professionals, a secondary aim is to develop a document useful for the various audiences that translate nutrition research, including journalists, clinicians, and policymakers. The intent is to promote accurate, transparent, verifiable evidence-based communication about nutrition science. This will facilitate reasoned interpretation and application of emerging findings and, thereby, improve understanding and trust in nutrition science and appropriate characterization, development, and adoption of recommendations.

Effects of the HEARTY exercise randomized controlled trial on eating behaviors in adolescents with obesity

Background

There are well-recognized benefits of behavioral interventions that include exercise for children and adolescents with obesity. However, such behavioral weight management programs may precipitate unintended consequences. It is unclear if different exercise modalities impact eating behaviors differently in youth with obesity.

Objectives

The purpose of this study was to examine the effects of aerobic, resistance, and combined aerobic and resistance exercise training on eating attitudes and behaviors (uncontrolled eating, restrained eating, emotional eating, external eating and food craving) among adolescents with overweight and obesity.

Methods

N = 304 (70% female) adolescents with overweight and obesity participated in the 6-month Healthy Eating Aerobic and Resistance Training in Youth (HEARTY) randomized controlled trial. All participants were inactive post-pubertal adolescents (15.6 ± 1.4 years) with a mean BMI = 34.6 ± 4.5 kg/m². The Food Craving Inventory (food cravings), Dutch Eating Behavior Questionnaire (restrained eating, emotional eating, external eating), and the Three-Factor Eating Questionnaire (uncontrolled eating) were used to assess eating attitudes and behaviors.

Results

All exercise groups showed within-group decreases in external eating and food cravings. Participants randomized to the Combined training group and were more adherent showed the greatest improvements in eating behaviors and cravings.

Conclusions

A 6-month exercise intervention produced improvements in disordered eating behaviors and food cravings, but effects may be gender and modality-specific. Findings highlight the need to tailor exercise intervention to participant characteristics for the promotion of healthier eating and weight management outcomes in youth with obesity.

Clinical Trial Registration # and Date: ClinicalTrials.Gov NCT00195858, September 12, 2005.

Family‐based interventions for preventing overweight or obesity among preschoolers from racial/ethnic minority groups: A scoping review

Objective

This scoping review aimed to synthesize the published literature on family‐based childhood obesity prevention interventions from 2015 to 2021 that focused on children 2–5 years of age from racial and/or ethnic minority households.

Methods

A PICOS (population, intervention, comparison, outcome, and setting) framework was used to guide the development of the research question, search strategy, and inclusion/exclusion criteria. To be included, the study must have been a randomized controlled trial or quasi‐experimental trial that enrolled participants 2–5 years of age and their caregivers who identified as being from a racial and/or ethnic minority group in the United States. The study must have also examined a family‐based intervention that incorporated components to prevent childhood obesity (i.e., fruits and vegetable intake, parental responsive feeding, physical activity), be conducted in a remote (i.e., online, text, mail), home, community, primary care setting, or early childhood education institution setting, and report on body mass index (BMI, kg/m²), BMI z‐score, anthropometric measures (weight, waist circumference, fat mass, etc.), changes in health behaviors, or increase in nutritional knowledge.

Results

Fourteen individual studies were identified. Most interventions used multiple components for promoting nutritional knowledge and behavioral changes among families. Eight interventions included culturally tailored components targeting four aspects: (1) language barriers, (2) food choices, (3) relationships between family members, and (4) rapport building.

Conclusions

There is limited research in this field focusing on children from racial and/or ethnic minority groups. Future efforts should invest in developing culturally appropriate interventions for these groups.

The impact of yoga on components of energy balance in adults with overweight or obesity: A systematic review

Background

Yoga may reduce body weight in individuals with overweight or obesity, but whether this occurs through decreased energy intake (EI) or increased energy expenditure (EE)/physical activity (PA) is unclear.

Methods

A systematic search of PubMed, Web of Science, Embase, and PsychINFO was conducted from inception until April 26, 2021. Eligible studies included randomized controlled trials or single‐arm pre‐post studies with any type and duration of yoga intervention in adults with overweight or obesity. Studies with measures related to EI , EE, or PA were eligible. The review initially identified 1,373 articles.

Results

Of the 10 included studies, one used indirect calorimeter measures of resting EE, while nine used self‐reported measures of EI and PA. Of the seven studies measuring parameters related to EI, only one found greater decreases in EI relative to the control group, although three other investigations reported trends toward improved dietary intake. Of the eight studies measuring PA, two reported greater increases in resting EE or PA in the yoga group relative to the control group. Two reported significant within‐group increases in PA from pre‐post intervention, and four studies reported a trend for increased PA with no p‐values reported.

Conclusions

Limited evidence suggests yoga may reduce EI and increase PA in adults with overweight or obesity. Additional studies that investigate the effects of yoga interventions on energy balance parameters using objective techniques are warranted.

A child-centered health dialogue for the prevention of obesity in child health services in Sweden - A randomized controlled trial including an economic evaluation

BACKGROUND

Prevention of child obesity is an international public health priority and believed to be effective when started in early childhood. Caregivers often ask for an early and structured response from health professionals when their child is identified with overweight, yet cost-effective interventions for children aged 2-6 years and their caregivers in Child Health Services are lacking.

OBJECTIVES

To evaluate the effects and cost-effectiveness of a child-centered health dialogue in the Child Health Services in Sweden on 4-year-old children with normal weight and overweight.

METHODS

Thirty-seven Child Health Centers were randomly assigned to deliver intervention or usual care. The primary outcome was zBMI-change.

RESULTS

A total of 4598 children with normal weight (zBMI: 0.1 [SD = 0.6] and 490 children with overweight (zBMI: 1.6 [SD = 0.3]) (mean age: 4.1 years [SD = 0.1]; 49% females) were included. At follow-up, at a mean age of 5.1 years [SD = 0.1], there was no intervention effect on zBMI-change for children with normal weight. Children with overweight in the control group increased zBMI by 0.01 ± 0.50, while children in the intervention group decreased zBMI by 0.08 ± 0.52. The intervention effect on zBMI-change for children with overweight was -0.11, with a 95% confidence interval of -0.24 to 0.01 (p = 0.07). The estimated additional costs of the Child-Centered Health Dialogue for children with overweight were 167 euros per child with overweight and the incremental cost-effectiveness ratio was 183 euros per 0.1 zBMI unit prevented.

CONCLUSIONS

This low-intensive multicomponent child-centered intervention for the primary prevention of child obesity did not show statistical significant effects on zBMI, but is suggested to be cost-effective with the potential to be implemented universally in the Child Health Services. Future studies should investigate the impact of socio-economic factors in universally implemented obesity prevention programs.

Food reinforcement and habituation to food are processes related to initiation and cessation of eating

An individual bout of eating involves cues to start eating, as well as cues to terminate eating. One process that determines initiation of eating is food reinforcement. Foods with high reinforcing value are also likely to be consumed in greater quantities. Research suggests both cross-sectional and prospective relationships between food reinforcement and obesity, food reinforcement is positively related to energy intake, and energy intake mediates the relationship between food reinforcement and obesity. A process related to cessation of eating is habituation. Habituation is a general behavioral process that describes a reduction in physiological or affective response to a stimulus, or a reduction in the behavioral responding to obtain a stimulus. Repeated exposure to the same food during a meal can result in habituation to that food and a reduction in consumption. Habituation is also cross-sectionally and prospectively related to body weight, as people who habituate slower consume more in a meal and are more overweight. Research from our laboratory has shown that these two processes independently influence eating, as they can account for almost 60% of the variance in ad libitum intake. In addition, habituation phenotypes show reliable relationships with reinforcing value, such that people who habituate faster also find food less reinforcing. Developing a better understanding of cues to start and stop eating is fundamental to understanding how to modify eating behavior. An overview of research on food reinforcement, habituation and food intake for people with a range of weight status and without eating disorders is provided, and ideas about integrating these two processes that are related to initiation and termination of a bout of eating are discussed.

A novel model of obesity prediction: Neurobehaviors as targets for treatment

Obesity is a worldwide epidemic that is on the rise, with approximately 30% of the world population classified as either overweight or obese. The United States has some of the highest rates of obesity, and in most countries in the world, obesity now poses more of a serious health concern than malnutrition. Obesity is a chronic, relapsing disorder that is both preventable and treatable; however, traditional interventions that target eating less and exercising more have low success rates, especially in the long term. Therefore, identifying the neurobehaviors that predict obesity is important to help identify targets to decrease BMI and improve obesity outcomes. Using the Competing Neurobehavioral Decisions System (CNDS) Theory, we hypothesized that individuals with obesity compared to individuals without obesity would display neurobehaviors marked by a hyperactive impulsive system and a hypoactive executive system. To test this hypothesis, we collected data from a battery of self-reported measures and neurocognitive assessments through Amazon Mechanical Turk from n = 178 obese (BMI ≥ 30) and n = 198 nonobese controls who were weight stable for the past 3 months. We found that compared to the nonobese control group, individuals with obesity showed heightened delay discounting (a marker of CNDS imbalance), impaired motivation, poor self-image, decreased affective state, and impaired executive function. Using a Bayesian network approach, we established a neurobehavioral model that predicts obesity with 64.4% accuracy and indicates an imbalance between impulsive and executive neural systems. Results from our study suggest that interventions targeting neurobehaviors may be integral to help improve obesity outcomes. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The Relative Reinforcing Value of Cookies Is Higher Among Head Start Preschoolers With Obesity

The relative reinforcing value (RRV) of food measures how hard someone will work for a high-energy-dense (HED) food when an alternative reward is concurrently available. Higher RRV for HED food has been linked to obesity, yet this association has not been examined in low-income preschool-age children. Further, the development of individual differences in the RRV of food in early childhood is poorly understood. This cross-sectional study tested the hypothesis that the RRV of HED (cookies) to low-energy-dense (LED; fruit) food would be greater in children with obesity compared to children without obesity in a sample of 130 low-income 3- to 5-year-olds enrolled in Head Start classrooms in Central Pennsylvania. In addition, we examined individual differences in the RRV of food by child characteristics (i.e., age, sex, and reward sensitivity) and food security status. The RRV of food was measured on concurrent progressive-ratio schedules of reinforcement. RRV outcomes included the last schedule reached (breakpoint) for cookies (cookie Pmax) and fruit (fruit Pmax), the breakpoint for cookies in proportion to the total breakpoint for cookies and fruit combined (RRV cookie), and response rates (responses per minute). Parents completed the 18-item food security module to assess household food security status and the Behavioral Activation System scale to assess reward sensitivity. Pearson's correlations and mixed models assessed associations between continuous and discrete child characteristics with RRV outcomes, respectively. Two-way mixed effects interaction models examined age and sex as moderators of the association between RRV and Body Mass Index z-scores (BMIZ). Statistical significance was defined as p < 0.05. Children with obesity (17%) had a greater cookie Pmax [F (1, 121) = 4.95, p = 0.03], higher RRV cookie [F (1, 121) = 4.28, p = 0.04], and responded at a faster rate for cookies [F (1, 121) = 17.27, p < 0.001] compared to children without obesity. Children with higher cookie response rates had higher BMIZ (r = 0.26, p < 0.01); and RRV cookie was positively associated with BMIZ for older children (5-year-olds: t = 2.40, p = 0.02) and boys (t = 2.55, p = 0.01), but not younger children or girls. The RRV of food did not differ by household food security status. Low-income children with obesity showed greater motivation to work for cookies than fruit compared to their peers without obesity. The RRV of HED food may be an important contributor to increased weight status in boys and future research is needed to better understand developmental trajectories of the RRV of food across childhood.

The Satiation Framework: Exploring processes that contribute to satiation

Satiation has been described as a process that leads to the termination of eating and controls meal size. However, studies have shown that the termination of eating can be influenced by multiple behavioral and biological processes over the course of a meal as well as those related to the context in which the meal is consumed. To expand understanding of how individuals experience satiation during a meal, we recently developed the Reasons Individuals Stop Eating Questionnaire (RISE-Q). The development of the RISE-Q revealed five distinct factors reported to contribute to meal termination: Planned Amount, Self-Consciousness, Decreased Food Appeal, Physical Satisfaction, and Decreased Priority of Eating. Thus, we define satiation as a series of dynamic processes that emerge over the course of a meal to promote meal termination. We suggest that each of the factors identified by the RISE-Q represents a distinct process, and illustrate the contribution of each process to meal termination in the Satiation Framework. Within this framework the prominence of each process as a reason to stop eating likely depends on meal context in addition to individual variability. Therefore, we discuss contexts in which different processes may be salient as determinants of meal termination. Expanding the definition of satiation to include several dynamic processes as illustrated in the Satiation Framework will help to stimulate investigation and understanding of the complex nature of meal termination.

Identifying Patterns of Alcohol Use and Obesity-Related Factors Among Emerging Adults: A Behavioral Economic Analysis

BACKGROUND

Although heavy alcohol consumption and maladaptive eating behaviors have been shown to co-occur among college students, less is known about the co-occurrence of these behaviors in a more diverse community-dwelling, emerging adult sample. The purpose of this study was to: (i) identify classes of emerging adults by their reported alcohol consumption patterns, food addiction symptoms, and body mass index; and (ii) determine whether these classes differed on indices of behavioral economic reinforcer pathology (e.g., environmental reward deprivation, impulsivity, alcohol demand).

METHOD

Emerging adult participants were recruited as part of a study on risky alcohol use (n = 602; 47% white, 41.5% Black; mean age = 22.63, SD = 1.03). Participants completed questionnaires on alcohol and food-related risk factors and underwent anthropometric assessment.

RESULTS

Latent profile analysis suggested a four-profile solution: a moderate alcohol severity, overweight profile (Profile 1; n = 424, 70.4%), a moderate alcohol severity, moderate food addiction + obese profile (Profile 2; n = 93, 15.4%), a high alcohol severity, high food addiction + obese profile (Profile 3; n = 44, 7.3%), and a high alcohol severity, overweight profile (Profile 4; n = 41, 6.8%). Individuals in Profile 1 reported significantly lower levels of environmental reward deprivation than either Profile 2 or 3, and participants in Profile 3 reported significantly higher environmental reward deprivation than those in Profile 4 (p < 0.001). Profile 4 demonstrated significantly higher alcohol demand intensity and Omax and lower demand elasticity than Profile 1, Profile 2, or Profile 3. Profile 4 also demonstrated significantly greater proportionate substance-related reinforcement than Profile 1 (p < 0.001) and Profile 2 (p = 0.004).

CONCLUSION

Maladaptive eating patterns and alcohol consumption may share common risk factors for reinforcer pathology including environmental reward deprivation, impulsivity, and elevated alcohol demand.

Stress coping strategies and stress reactivity in adolescents with overweight/obesity

This study explored the associations between the frequency and effectiveness of habitual stress coping strategies on physiological and psychological stress responses to an acute laboratory stressor in adolescents with overweight/obesity (51 adolescents; 47% female; ages 14-19 years). Coping strategies were assessed using the Schoolager's Coping Strategies Inventory. Acute physiological stress responses were measured as salivary cortisol and α-amylase output during the Trier Social Stress Test and during a control condition. Acute psychological stress was measured using a Likert-type scale, and systolic blood pressure (SBP) and heart rate were measured at baseline. Results revealed that higher coping effectiveness was associated with lower log-based α-amylase during the stress (β = -0.025, p = 0.018) and control (β = -0.030, p = 0.005) conditions, but not with cortisol across either condition (all ps > 0.05). SBP moderated the association between coping effectiveness and α-amylase during the stress condition, with higher coping effectiveness associated with lower α-amylase only among individuals with lower SBP (β = 0.002, p = 0.027). Coping frequency was not associated with cortisol responses, neither was habitual stress coping strategies associated with psychological stress (all ps > 0.05). These findings provide preliminary evidence that effective use of stress coping strategies may provide a dampening effect on sympathetic activity in an at-risk adolescent population.

Evaluation of a Pilot Healthy Eating and Exercise Program for Young Adults with Autism Spectrum Disorder and Intellectual Disabilities

OBJECTIVES

The aims of this pilot study were to examine program structure, implementation, and outcomes of a healthy eating and exercise program for young adults with Autism Spectrum Disorder (ASD) and intellectual disabilities (IDs).

METHODS

Seventeen young adults with ASD and IDs, six parents, and 10 staff participated. Programming was delivered for over a year and featured healthy eating and exercise lessons. Also, group-based motivational interviewing was used to develop weekly health goals for participants. During COVID-19, lessons were delivered online. The program was modified using lectures with visual material, when participants returned to classrooms. Lessons focused on MyPlate, portion sizes, the food pyramid, vitamins and minerals in foods, and learning to eat "less" of unhealthy food groups. Exercise lessons featured information about importance of exercise, introduction to different types of exercise, and knowledge about how exercise benefits the body. Staff completed implementation logs. Height and weight of participants were examined at regular intervals. Parents completed surveys and participants completed group interviews to assess program impact.

RESULTS

Two participants lost a significant amount of weight and others maintained their weight during COVID-19. Participants and parents were satisfied with the program and reported knowledge and behavior change.

CONCLUSIONS

Results indicated participating in the intervention resulted in improved knowledge and health behaviors. Findings are preliminary, and research using control groups and assessing change in weight and behaviors over time are needed. Observation of meals and physical activity levels will provide more objective data in future studies.