Eating behaviors, mental health, and food intake are associated with obesity in older congregate meal participants

Mediating role of weight concerns in the relationship between seasonality and eating behavior among community-dwelling older adults: A path analysis

BACKGROUND

Weight concerns are common among older adults, and it is unclear how they may impact the relationship between seasonality and eating behaviors, which can contribute to various health-related issues.

AIM

This study investigated the mediating role of weight concerns in the relationship between seasonality and eating behavior among community-dwelling older adults.

METHOD

A descriptive correlational analytical design was used on 200 randomly chosen participants who completed the Personal Inventory for Depression and Seasonal Affective Disorder Self-Assessment Version, the Adult Eating Behavior Questionnaire, and the Weight Concern Subscale. A path analysis was conducted to test the hypothesized model.

RESULTS

The study findings indicated that most older adults reported moderate-to-severe seasonal variations, moderate enjoyment of food, emotional overeating, emotional undereating, and food fussiness. Weight concern partially mediated the relationship between seasonality and eating behavior.

CONCLUSION

By understanding the complex interplay between these factors, weight concerns may play an essential role in mediating the effects of seasonal changes on eating behavior, while seasonal winter symptoms may directly impact eating behavior. These results have potential implications for nurses' efforts to develop interventions to promote healthy eating behaviors and manage weight concerns during seasonal variations, especially in the winter.

Association of Patient Anthropometric Measurements and Dental Implant Treatment

Background

Dental implants are currently one of the most preferred treatment modalities for replacing missing teeth, as they are the most comparable to natural teeth. Even so, satisfaction with such treatment may differ depending on patient nature. The aim of this article was to examine the relationships between different anthropometric measurements on dental implant patient's satisfaction.

Methods and Material

Self-administered questionnaire (structured questions) were given to patients who had dental implant treatment to evaluate their satisfaction level with dental-implant treatment. Different anthropometric measurements were taken: body height; weight; body mass index (BMI); body composition; waist/hip ratio; and circumferences at the waist, hip, and neck.

Results

The overall BMI was 28.9±4.7 kg/m², there was a highly-significant difference in patient satisfaction among the different BMI groups (P< 0.000). The significant difference in most of those groups was between the obese group and the other groups. For neck circumference and waist/hip ratio, a significance difference between the normal weight and obese groups (P< 0.000) was found, while for percentage of muscle, the differences were between the overweight and obese groups (P< 0.000). According to BMI groups a highly significant difference in many patient satisfaction domains were found (P< 0.000). These significant differences were between the obese group and non-obese groups for most aspects of patient satisfaction. For patient satisfaction with final appearance, the normal BMI group differed significantly from the overweight BMI group (P=0.013). Additionally, for patient satisfaction with dentist performance and communication, the overweight BMI group showed significantly higher satisfaction than the normal BMI group (P=0.019). Body measurements were correlated negatively with overall patient satisfaction, and positively with satisfaction with prosthesis.

Conclusion

The obese group patients had the lowest rate of patient satisfaction. BMI and other body measurements can be used to predict patient satisfaction with the outcome of dental implant treatment.

The moderating role of eating behaviour traits in the association between exposure to hot food takeaway outlets and body fatness

BACKGROUND

Previous studies demonstrated a relation between takeaway outlet exposure and health outcomes. Individual characteristics, such as eating behaviour traits, could make some people more susceptible to the influence of the food environment. Few studies have investigated this topic. We aimed to investigate the moderating role of eating behaviour traits (cognitive restraint, uncontrolled eating and emotional eating) in the association between neighbourhood exposure to hot food takeaway outlets (hereafter referred to as takeaway outlets), and takeaway food consumption and adiposity.

METHODS

We used cross-sectional data from a cohort in Cambridgeshire, UK (The Fenland study). Takeaway outlet exposure was derived using participants' residential address and data from local authorities and divided into quarters. The Three Factor Eating questionnaire (TFEQ-R18) was used to measure eating behaviour traits. Primary outcomes were consumption of takeaway-like foods (derived from food frequency questionnaire), and body fat percentage (measured using dual-energy X-ray absorptiometry).

RESULTS

Mean age of participants (n = 4791) was 51.0 (SD = 7.2) and 53.9% were female. Higher exposure to takeaway outlets in the neighbourhood and higher eating behaviour trait scores were independently associated with greater takeaway consumption and body fat percentage. Uncontrolled eating did not moderate the associations between takeaway outlet exposure and takeaway consumption or body fat percentage. The association between takeaway outlet exposure and takeaway consumption was slightly stronger in those with higher cognitive restraint scores, and the association between takeaway outlet exposure and body fat percentage was slightly stronger in those with lower emotional eating scores.

CONCLUSION

Eating behaviour traits and exposure to takeaway outlets were associated with greater takeaway consumption and body fat, but evidence that individuals with certain traits are more susceptible to takeaway outlets was weak. The findings indicate that interventions at both the individual and environmental levels are needed to comprehensively address unhealthy diets.

TRIAL REGISTRY

ISRCTN72077169.

Identification of several eating habits that mediate the association between eating behaviors and the risk of obesity

Objective

Eating behaviors play important roles in the development of obesity. A better knowledge of the psychological aspects of eating behaviors in individuals with and without obesity and their consequences on daily eating and lifestyle habits would be informative. The Three-Factor Eating Questionnaire (TFEQ)-R21 assesses the psychometrics of eating behavior. The objectives of the study were to establish which eating habits were or were not associated with TFEQ eating behaviors, and to quantify the extent to which those eating habits mediated the association between TFEQ eating behaviors and obesity risk.

Methods

Data were obtained from the Gene and Environment Case-Control Obesity Study from northern France. It included 2237 individuals with obesity and 403 individuals without obesity. Eating behaviors were assessed according to the TFEQ-R21. Two activity levels (physical activity and television watching) and six eating habits (e.g., plate size, having one serving or at least two servings of the main meal, …) were evaluated. Regression and mediation analyses were performed.

Results

Higher cognitive restraint, higher uncontrolled eating (UE) and higher emotional eating (EE) were associated with a higher risk of obesity, independently of each other and of age, sex, socio-economic status and physical activity. Cognitive restraint was negatively associated with having at least two servings, while UE and EE were associated with several obesogenic habits such as eating in front of the television or eating at night. Each of these obesogenic habits mediated between 3% and 20% of the association between UE or EE and obesity.

Conclusions

Psychological eating behaviors were associated with several lifestyle and eating habits in both individuals with and without obesity. Moreover, some eating habits partially mediated (between 3% and 20%) the association between TFEQ eating behaviors and obesity risk. For clinicians, this study shows that simple, easy-to-ask questions on specific daily eating habits can provide essential information to better understand and manage patients with obesity.

Psychosocial factors influencing the eating behaviours of older adults: A systematic review

Our understanding of how eating behaviours change in later life have been dominated by the studies of physiological and biological influences on malnutrition. Insights from these studies were consequently used to develop interventions, which are predominantly aimed at rectifying nutritional deficiencies, as opposed to interventions that may enable older adults to eat well and enjoy their food-related life well into older age. The objective of the present review is to summarise the existing knowledge base on psychosocial influences on eating behaviours in later life. Following comprehensive searches, review, and appraisal, 53 articles were included (22 qualitative and 31 quantitative) to provide a greater understanding of the mechanisms underpinning the psychosocial factors influencing eating behaviours. Our analysis identified eight underpinning psychosocial factors that influences eating behaviours in later life; (1) health awareness & attitudes, (2) food decision making, (3) perceived dietary control, (4) mental health & mood, (5) food emotions & enjoyment, (6) eating arrangements, (7) social facilitation, and (8) social support. The importance and lasting influence of early food experiences were also identified as contributing to eating behaviours in later life. The review concludes with the call for further investigation into specific psychosocial factors that influence eating behaviour, calls for improvements in methodologies, and a summary of psychosocial barriers and enablers to eating well in later life.

Examination of three-factor eating questionnaire subscale scores on weight loss and weight loss maintenance in a clinical intervention

Background

The purpose of this study is to examine three-factor eating questionnaire (TFEQ) scores at baseline and post-intervention (6 months) on successful weight loss and weight maintenance in an 18-month behavioral weight management intervention for adults with overweight and obesity.

Methods

TFEQ and weight were assessed at baseline, 6, and 18 months. Logistic regression models were used to examine scores at baseline on disinhibition, restraint, and perceived hunger factors in the TFEQ on 5% body weight loss at 6 months and 6-month scores to predict 5% weight maintenance at 18 months while controlling for age, sex, and baseline weight.

Results

Participants (n = 287; age = 43.8 ± 10.36 years; female = 64.1%; weight = 222.5 ± 39.02 pounds; BMI = 34.73 ± 4.56) were included for analysis. Dietary restraint at baseline was the only significant predictor of 5% weight loss at 6 months. None of the TFEQ subscale scores at 6 months predicted 5% weight maintenance at 18 months. The model examining weight loss at 6 months accounted for 7% of the variance of the outcome and 11% of the variance of weight maintenance at 18 months.

Conclusion

Dietary restraint is a unique eating behavior associated with weight loss at 6 months beyond other eating behaviors measured by the TFEQ in an adult sample enrolled in a weight loss intervention. No other subscale scores were significant at 6 months or at 18 months. Future research should consider how to promote flexible control and discourage adoption of rigid restraint behaviors since the latter is associated with disordered eating patterns.

Emotional Eating Mediates the Relationship Between Food Insecurity and Obesity in Latina Women

OBJECTIVE

To examine the mediating role of emotional eating (EE) in the association between food insecurity (FI) and obesity in Latina women.

DESIGN

A secondary analysis of a cross-sectional study.

PARTICIPANTS

Women (n = 297) were recruited from a community health center in Lawrence, MA.

VARIABLES MEASURED

The 6-item US Department of Agriculture Household Food Security Scale was used to measure FI. The Three-Factor Eating Questionnaire Revised 18-item, version 2 was used to measure EE. Measured height and weight were used to calculate body mass index. Covariates included: age, education, marital status, number of children in the house, physical activity, and country of birth.

ANALYSIS

Multivariable logistic and linear regressions. Mediation was tested and the mediated proportion was calculated.

RESULTS

Overall, 36.7% of women experienced FI. In adjusted regression models, FI was positively associated with obesity (odds ratio [OR] = 1.79; 95% confidence interval [CI], 1.08-2.97; P = 0.02) and EE (β = 0.22; 95% CI, 0.001-0.44; P = 0.05), and EE was positively associated with obesity (OR = 1.82; 95% CI, 1.37-2.42; P < 0.01). When EE was included in the main effects model, FI was not significantly associated with obesity (OR = 1.64; 95% CI, 0.97-2.76; P = 0.06) and EE explained 21% of the association.

CONCLUSIONS AND IMPLICATIONS

Longitudinal studies are needed to confirm the findings. If the findings are confirmed, future studies can explore interventions to ameliorate EE among Latina women experiencing FI, and providers can screen for EE in Latinas experiencing FI.

Psychosocial Functioning, BMI, and Nutritional Behaviors in Women at Cardiovascular Risk

Psychosocial factors such as depression, anxiety, and stress are associated with increased cardiovascular risk. Health behaviors may play a role in this relationship, as individuals experiencing elevated levels of anxiety, stress, and/or depression may be less likely to engage in risk-reducing behaviors such as diet and exercise. Some evidence suggests that this relationship is particularly relevant for women. This study explored the relationship between levels of anxiety, depression, stress, and specific nutritional behaviors in a sample of 187 women at cardiovascular risk. BMI was explored as a possible moderator of these relationships. Higher levels of depression in patients with high BMI was associated with increased fruit consumption, whereas this was not seen in highly depressed patients with normal BMI. The reverse pattern was seen for consumption of sweet drinks. Anxiety was found to have a complex relationship with consumption of sweetened drinks and white bread, with higher consumption at moderately elevated levels of anxiety and reduced consumption at the highest levels. Possible interpretations of these findings, as well as their implications for lifestyle interventions with this population are discussed. These findings suggest a number of questions for further research.

Understanding and effectively addressing disparities in obesity: A systematic review of the psychological determinants of emotional eating behaviours among Black women

Emotional eating may be a particularly important contributor to differences in body weight and weight loss response to behavioural interventions among non-Hispanic Black women. We performed a systematic review on the impact of psychological factors (stress, anxiety, depression, and discrimination) upon emotional eating and weight among non-Hispanic Black women, applying the Preferred Reporting Items for Systematic Reviews and Meta-analysis for relevant studies. The initial search yielded 4593 articles with 15 accepted for review. Based on this review, there is a suggestion that negative emotions, in particular, perceived stress, may be predictive of emotional eating among non-Hispanic Black women. Results from the only two longitudinal studies identified by the review indicate that stress influences emotional eating, and emotional eating predicts weight gain over time. Findings from this review highlight the need for more studies that examine various negative emotions that may lead to emotional eating and weight gain among non-Hispanic Black women. Findings from this review also highlight the need for more rigorous studies to differentiate the effects of emotional eating from that of the physiologic (ie, activation of the hypothalamic-pituitary axis) responses to stress and its impact on high-risk groups.

"Bad Enough to Cook for Two, Worse for One" - Mixed Method Evaluation of Eating Behavior among Community Dwelling Older Adults

Food insecurity, life events, and emotional eating can influence dietary patterns. However, their interaction among older adults requires further investigation. This mixed-method, interdisciplinary project included 7 focus groups and a cross-sectional survey (n = 55) to evaluate these factors among older adults (60-102 years of age) living in rural Ohio communities. Qualitative data highlighted critical life events, emotions and personal relationships, food insecurity, and learning how to do more with less, and resilience in dietary patterns. The majority of the participants were overweight or obese. Food insecurity, frequency of congregate meals, and age were associated with emotional eating. Attributes of diet quality correlated with emotional eating and food insecurity. Future work should address the unique needs of older adults by expanding food assistance programs, while including the older adult's perspectives with regard to life experiences, the value of social support, personal relationships, and honoring food preferences, particularly nutrient-dense foods.

Obesity and Eating Disturbance: the Role of TFEQ Restraint and Disinhibition

PURPOSE OF REVIEW

Literature from the past five years exploring roles of Three-Factor Eating Questionnaire (TFEQ) Restraint and Disinhibition in relation to adult obesity and eating disturbance (ED) was reviewed.

RECENT FINDINGS

Restraint has a mixed impact on weight regulation, diet quality, and vulnerability to ED, where it is related detrimentally to weight regulation, diet, and psychopathology, yet can serve as a protective factor. The impact of Disinhibition is potently related to increased obesity, poorer diet, hedonically driven food choices, and a higher susceptibility to ED. Restraint and Disinhibition have distinct influences on obesity and ED and should be targeted differently in interventions. Further work is required to elucidate the mechanisms underlying TFEQ eating behavior traits.

Association between emotional eating, energy-dense foods and overeating in Latinos

BACKGROUND

Latinos experience disparities in obesity. Although causes of obesity are multifactorial, overeating is a major contributor. Emotional eating (EE) is associated with obesity and with intake of energy-dense foods. However, the relationship between EE and overeating, and the mediating role of energy-dense foods on this relationship, has not been studied.

OBJECTIVE

This study examined the association between EE and overeating among Latinos and the potential mediating role of energy-dense food consumption on this relationship.

METHODS

This study had a cross-sectional design. Participants were recruited from a community health center. EE was assessed with the Three Factor Eating Behavior Questionnaire R18-V2. Overeating was calculated from the Mifflin-St Jeor equation. Energy-dense food intake was assessed with a Food Frequency Questionnaire. Mediation was tested with bootstrapping.

RESULTS

Participants (n = 200) were 53.5% female and 78% were overweight or obese. Approximately 60% of the sample reported EE and 45.5% engaged in overeating. Percentage of calories from energy-dense foods was 23%. EE was significantly associated with overeating (OR total effect = 1.23; 95%CI = 1.03, 1.45) and this relationship was partly mediated by intake of energy-dense foods (OR indirect effect = 1.06; 95%CI = 1.02, 1.15; mediated proportion = 31.5%).

CONCLUSION

In this Latino sample, EE was positively associated with overeating and intake of energy-dense foods partially mediated this association. Examination of longitudinal associations between EE, energy-dense foods, overeating and obesity is warranted. Understanding these associations may provide information to develop effective interventions to prevent and manage obesity among Latinos.

Congregate Meals: Opportunities to Help Vulnerable Older Adults Achieve Diet and Physical Activity Recommendations

BACKGROUND

Through diet and exercise interventions, community centers offer an opportunity to address health-related issues for some of the oldest, most vulnerable members of our society.

OBJECTIVES

The purpose of this investigation is to draw upon nationwide data to better characterize the population served by the congregate meals program and to gather more detailed information on a local level to identify opportunities for service enhancement to improve the health and well-being of older adults.

DESIGN

We examined community center data from two sources: 2015 National Survey of Older Americans Act and surveys from two New York City community centers. To assess nationwide service delivery, we analyzed participant demographics, functional status defined by activities of daily living, and perceptions of services received.

MEASUREMENTS

Participants from the two New York City community centers completed a four-day food record. Functional measures included the short physical performance battery, self-reported physical function, grip strength, and the Montreal Cognitive Assessment.

RESULTS

Nationwide (n=901), most participants rated the meal quality as good to excellent (91.7%), and would recommend the congregate meals program to a friend (96.0%). Local level data (n=22) were collected for an in-depth understanding of diet, physical activity patterns, body weight, and objective functional status measures. Diets of this small, local convenience sample were higher in fat, cholesterol, and sodium, and lower in calcium, magnesium, and fiber than recommended by current United States Dietary Guidelines. Average time engaged in moderate physical activity was 254 minutes per week (SD=227), exceeding the recommended 150 minutes per week, but just 41% (n=9) and 50% (n=11) of participants engaged in strength or balance exercises, respectively.

CONCLUSION

Research is warranted to test whether improvements in the nutritional quality of food served and access/supports for engaging in strength training within community centers could help older adults achieve diet and physical activity recommendations.

Health Indicators of US Older Adults Who Received or Did Not Receive Meals Funded by the Older Americans Act

BACKGROUND

The Older Americans Act (OAA) requires that nutrition programs provide meals and related nutrition services that promote health and help manage chronic diseases. The purpose of this study was to compare health status, food security, functional limitations, and chronic diseases of older adults who received or did not receive OAA meals using data from a representative sample of US adults.

METHODS

Data were from the National Health and Nutrition Surveys 2011-2014 for 2,392 older adults ≥ 65 years of age, including 187 Mexican Americans, 212 other Hispanics, 521 non-Hispanic Blacks, 219 non-Hispanic Asians, and 1253 non-Hispanic Whites.

RESULTS

Those receiving OAA meals had higher percent of food insecurity and functional disabilities. Adjusting for potential confounders, adults who received OAA meals had higher odds of emphysema (OR = 2.02; 1.05, 3.89) and lower odds of good-to-excellent health (OR = 0.52; 0.36, 0.77). Women and minorities had poorer health status compared to non-Hispanic Whites.

CONCLUSION

A higher proportion of older adults who received nutritional services reported poorer health as compared to older adults who do not participate in these services. Future studies should assess nutritional adequacy for older adults who participate in nutritional programs comparing sex and race/ethnicity.

Evaluation of Handgrip Strength and Nutritional Risk of Congregate Nutrition Program Participants in Florida

The aim of this study was to determine if handgrip strength (HGS) is a predictor of nutritional risk in community-dwelling older adults. A cross-sectional study was carried out to determine the relationship between HGS and nutritional risk using SCREEN 1. The setting was Congregate Nutrition program meal sites (n = 10) in North Central Florida and included community-dwelling older adults participating in the Congregate Nutrition program. Older adults (n = 136; 77.1 ± 8.9 y; 45 M, 91 F) participated in the study. Nutritional risk was identified in 68% of participants, with 10% exhibiting clinically relevant weakness (men, HGS < 26 kg; women, HGS < 16 kg), suggesting a vulnerable population. HGS was weakly associated with nutritional risk as assessed by SCREEN 1 (AUC = 0.59), but alternate cutpoints, 33 kg for men (mean of both hands) and 22 kg for women (highest of either hand), provided the best comparison to nutritional risk. In community-dwelling older adults, HGS was weakly associated with nutritional risk assessed using traditional screening. However, as existing research supports the inclusion of HGS in malnutrition screening in acute care, further research into the usefulness of HGS and possibly other measures of functional status in nutrition risk screening of community-dwelling older adults may be warranted.

Association of Dysfunctional Eating Patterns and Metabolic Risk Factors for Cardiovascular Disease among Latinos

BACKGROUND

Latinos are at high risk for cardiovascular disease (CVD). Identifying behavioral factors associated with CVD risk in this population may provide novel targets for further research to reduce chronic disease disparities. Dysfunctional eating patterns (emotional eating [EE], uncontrolled eating [UE], and cognitive restraint of eating [CR]) may be associated with CVD risk but little is known about this relationship in Latinos.

OBJECTIVE

The aim of this study was to examine associations between dysfunctional eating patterns and metabolic risk factors for CVD in Latinos.

DESIGN

The study used a cross-sectional design.

PARTICIPANTS/SETTING

Latino individuals (n=602), aged 21 to 84 years, were enrolled in the study from September 2011 to May 2013 from a community health center that serves 80% to 85% of the Latino population in Lawrence, MA. Individuals with complete data were included in this analysis (n=578).

MEASURES

Dysfunctional eating patterns were measured with the Three Factor Eating Questionnaire-R18V2. CVD risk factors examined included obesity assessed by body mass index and waist circumference and diagnoses of type 2 diabetes, hypertension, and hyperlipidemia abstracted from electronic health records.

STATISTICAL ANALYSIS

Multivariable logistic and Poisson regressions adjusting for age, sex, perceived income, employment, education, physical activity, and perceived stress were performed. The no dysfunctional eating category (ie, no EE, no UE, or no CR) was used as the reference category in all analyses.

RESULTS

High EE was associated with greater odds of obesity (odds ratio [OR] 2.19, 95% CI 1.38 to 3.45) and central obesity (OR 2.97, 95% CI 1.81 to 4.87), and diagnosis of type 2 diabetes (OR 1.99, 95% CI 1.13 to 3.48) and hypertension (OR 2.01, 95% CI 1.16 to 3.48). High UE was associated with obesity (OR 1.96, 95% CI 1.20 to 3.21) and central obesity (OR 2.33, 95% CI 1.38 to 3.94). Low and high CR were associated with obesity (OR 2.26, 95% CI 1.43 to 3.56 and OR 2.77, 95% CI 1.75 to 4.37, respectively) and central obesity (OR 2.04, 95% CI 1.25 to 3.32 and 2.51, 95% CI 1.54 to 4.08, respectively) and diagnosis of type 2 diabetes (OR 1.83, 95% CI 1.05 to 3.16 and OR 2.73, 95% CI 1.58 to 4.70, respectively) and hyperlipidemia (OR 1.94, 95% CI 1.16 to 3.24 and OR 2.14, 95% CI 1.28 to 3.55, respectively). Lastly, high EE and low and high CR were associated with increased odds of having a greater number of metabolic CVD risk factors (incidence-rate ratio [IRR] 1.33, 95% CI 1.13 to 1.58; IRR 1.34, 95% CI 1.13 to 1.58; and IRR 1.44, 95% CI 1.22 to 1.71, respectively).

CONCLUSIONS

Dysfunctional eating patterns were positively associated with metabolic CVD risk factors in this Latino sample, with dose-response relationships for some associations. Future studies are needed to determine whether dysfunctional eating patterns influence CVD risk factors among Latinos.

Challenges in the Management of Geriatric Obesity in High Risk Populations

The global prevalence of obesity in the older adult population is growing, an increasing concern in both the developed and developing countries of the world. The study of geriatric obesity and its management is a relatively new area of research, especially pertaining to those with elevated health risks. This review characterizes the state of science for this “fat and frail” population and identifies the many gaps in knowledge where future study is urgently needed. In community dwelling older adults, opportunities to improve both body weight and nutritional status are hampered by inadequate programs to identify and treat obesity, but where support programs exist, there are proven benefits. Nutritional status of the hospitalized older adult should be optimized to overcome the stressors of chronic disease, acute illness, and/or surgery. The least restrictive diets tailored to individual preferences while meeting each patient’s nutritional needs will facilitate the energy required for mobility, respiratory sufficiency, immunocompentence, and wound healing. Complications of care due to obesity in the nursing home setting, especially in those with advanced physical and mental disabilities, are becoming more ubiquitous; in almost all of these situations, weight stability is advocated, as some evidence links weight loss with increased mortality. High quality interdisciplinary studies in a variety of settings are needed to identify standards of care and effective treatments for the most vulnerable obese older adults.

Food Insecurity and Eating Behavior Relationships Among Congregate Meal Participants in Georgia

This study explored relationships of food insecurity with cognitive restraint, uncontrolled eating, and emotional eating behaviors among congregate meal participants in northeast Georgia [n = 118 years, age 60 years and older, mean (SD) age = 75 ( 8 ) years, 75% female, 43% Black, 53% obese (Body Mass Index ≥ 30)]. Food insecurity was assessed with a 6-item questionnaire. Scores ranged from 0 to 6 and were defined as high or marginal food security, FS, 0-1 (70%); low food security, LFS, 2-4 (20%); very low food security, VLFS, 5-6 (10%); and low and very low food security, LVLFS, 2-6 (30%). Eating behavior was assessed with an 18-item Three-Factor Eating Questionnaire R-18. In bivariate analyses food insecurity was consistently associated with cognitive restraint scores above the median split and to a lesser extent with uncontrolled eating scores (p ≤ 0.05). No association was found between emotional eating and food insecurity. In multivariate linear and logistic regression analyses, food insecurity was consistently associated with cognitive restraint (p ≤ 0.05) even when controlled for potential confounders (demographics, Body Mass Index, and chronic diseases). Food insecurity was also associated with uncontrolled eating (p ≤ 0.05), but the relationship was attenuated when controlled for potential confounding variables. Although cognitive restraint is defined as the conscious restriction of food intake to control body weight or promote weight loss, these findings suggest there may be other dimensions of cognitive restraint to consider in nutritional assessment and interventions among food-insecure older adults.

Nutritional Vulnerability in Older Adults: A Continuum of Concerns

A nutritionally vulnerable older adult has a reduced physical reserve that limits the ability to mount a vigorous recovery in the face of an acute health threat or stressor. Often this vulnerability contributes to more medical complications, longer hospital stays, and increased likelihood of nursing home admission. We have characterized in this review the etiology of nutritional vulnerability across the continuum of the community, hospital, and long term care settings. Frail older adults may become less vulnerable with strong, consistent, and individualized nutritional care. Interventions for the vulnerable older adult must take their nutritional needs into account to optimize resiliency in the face of the acute and/or chronic health challenges they will surely face in their life course.