Depression, emotional eating and long-term weight changes: a population-based prospective study

Proof-of-concept testing of a brief virtual ACT workshop for emotional eating

BACKGROUND

Emotional eating, or eating in response to negative emotions, is a commonly reported short-term emotion regulation strategy but has been shown to be ineffective in the long term. Most emotional eating interventions based on Acceptance and Commitment Therapy (ACT) have been delivered in the context of weight loss trials, highlighting a need for ACT-based emotional eating interventions in weight-neutral contexts.

AIMS

This proof-of-concept study aimed to test the acceptability and efficacy potential of a brief virtual ACT workshop for emotional eating in a small sample of adults identifying as emotional eaters.

METHODS

Twenty-six adult emotional eaters completed an ACT workshop delivered in two 1.5-h sessions over two weeks. The workshop targeted awareness and acceptance of emotions and eating urges, and valued actions around eating.

RESULTS

The acceptability of the workshop was demonstrated by high participant satisfaction. Significant improvements on all outcome measures were found and maintained up to 3 months follow-up.

CONCLUSIONS

These proof-of-concept findings suggest that a brief virtual ACT workshop may improve emotional eating and associated ACT processes. Results from this study can inform a future randomized controlled trial to test the efficacy of the workshop and the role of theoretical processes of change.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT04457804.

LEVEL OF EVIDENCE

Level IV, evidence obtained from multiple time series with the intervention.

Orthorectic behavior among students and motivation for physical activity, dietary habits, and restrictive eating

Introduction

Orthorexia lacks official recognition as an eating disorder; however, orthorexic behaviors, associated with a stringent selection of food, may serve as a predisposing factor to the development of eating disorders. It is characterized by an obsessive preoccupation with healthy eating and strict dietary standards, often prevalent in high-risk groups such as athletes and individuals concerned with their physical appearance. The objective of this study was to evaluate the incidence of orthorexia among students exhibiting varying lifestyles (including dietary habits and levels of physical activity, along with their respective motivational factors). The research involved 600 participants equally distributed between health-related (HRF) and non-health-related (NRF) academic categories, with the majority of participants in the HRF category being women.

Methods

Assessments included BMI calculations, dietary evaluation based on Polish standards, categorization of physical activity levels, the EMI-2 questionnaire on motivation to exercise, the DOS test for orthorexia propensity, and the TFEQ-13 questionnaire for eating behavior.

Results and discussion

Results showed that primary motivators for physical activity included disease prevention, health maintenance, strength/endurance, and physical appearance. Orthorexia tendencies were prevalent, particularly in the HRF group, linked to lower BMI, better diet quality, higher physical activity levels, and a higher prevalence of restrictive eating. In conclusion, students in health-related fields, driven by a strong health consciousness, are at risk of orthorexia. This emphasizes the need for balanced health education and support.

Conclusion

Orthorexic tendencies are associated with distorted perceptions of food portions and calories, underscoring the importance of awareness and intervention.

Sex differences in the combined influence of inflammation and nutrition status on depressive symptoms: insights from NHANES

Background

Both nutrition and inflammation are associated with depression, but previous studies have focused on individual factors. Here, we assessed the association between composite indices of nutrition and inflammation and depression.

Methods

Adult participants selected from the National Health and Nutrition Examination Survey (NHANES) between 2005 and 2018 were chosen. The exposure variable was the Advanced Lung Cancer Inflammation Index (ALI) integrating nutrition and inflammation, categorized into low, medium, and high groups. The outcome variable was depression assessed using the Patient Health Questionnaire-9 (PHQ-9). A multivariable logistic regression model was employed to evaluate the relationship between ALI and the risk of depression.

Results

After extensive adjustment for covariates, in the overall population, participants with moderate and high levels of ALI had a decreased prevalence of depression compared to those with low ALI levels, with reductions of 17% (OR, 0.83; 95% CI: 0.72-0.97) and 23% (OR, 0.77; 95% CI: 0.66-0.91), respectively. Among females, participants with moderate and high ALI levels had a decreased prevalence of depression by 27% (OR, 0.73; 95% CI: 0.60-0.88) and 21% (OR, 0.79; 95% CI: 0.64-0.98), respectively, compared to those with low ALI levels, whereas no significant association was observed among males. Subgroup analyses based on females and males yielded consistent results.

Conclusion

In this study, we observed a negative correlation between moderate to high levels of ALI and the prevalence of depression, along with gender differences. Specifically, in females, greater attention should be given to the nutritional and inflammatory status.

Depressive disorder subtypes, depressive symptom clusters, and risk of obesity and diabetes: A systematic review

BACKGROUND

Overlapping but divided literatures suggest certain depression facets may pose greater obesity and diabetes risk than others. Our objectives were to integrate the major depressive disorder (MDD) subtype and depressive symptom cluster literatures and to clarify which facets are associated with the greatest cardiometabolic disease risk.

METHODS

We conducted a systematic review of published studies examining associations of ≥2 MDD subtypes or symptom clusters with obesity or diabetes risk outcomes. We report which facets the literature is "in favor" of (i.e., having the strongest or most consistent results).

RESULTS

Forty-five articles were included. Of the MDD subtype-obesity risk studies, 14 were in favor of atypical MDD, and 8 showed similar or null associations across subtypes. Of the symptom cluster-obesity risk studies, 5 were in favor of the somatic cluster, 1 was in favor of other clusters, and 5 were similar or null. Of the MDD subtype-diabetes risk studies, 7 were in favor of atypical MDD, 3 were in favor of other subtypes, and 5 were similar or null. Of the symptom cluster-diabetes risk studies, 7 were in favor of the somatic cluster, and 5 were similar or null.

LIMITATIONS

Limitations in study design, sample selection, variable measurement, and analytic approach in these literatures apply to this review.

CONCLUSIONS

Atypical MDD and the somatic cluster are most consistently associated with obesity and diabetes risk. Future research is needed to establish directionality and causality. Identifying the depression facets conferring the greatest risk could improve cardiometabolic disease risk stratification and prevention programs.

Determinants of Weight Status and Body, Health and Life Satisfaction in Young Adults

Health behaviors include behavioral patterns and habits that relate to health maintenance, restoration and improvement. They do not only affect the physical condition; they are also associated with life satisfaction. In our study, we focused on young adulthood, a specific lifespan period for establishing long-term health behavior patterns. The aim of the present study was to investigate depressive symptoms, lifestyle and eating behaviors and delineate their associations with overweight/obesity and body, health and life satisfaction in young adults in Poland. We enrolled 800 students (81.4% females and 18.6% males). Diet, physical activity, depressive symptoms, eating behaviors and body, health and life satisfaction were assessed. Multivariate logistic regression models were employed. Almost half of the participants in our study had at least mild symptoms of depression. Symptoms of depression significantly reduced the odds of satisfaction with body, health and life, whereas physical activity increased them. Overweight/obesity significantly reduced the odds of body and health satisfaction. In women, a history of depression and emotional eating increased the odds of being overweight/obese. The results of our study may contribute to the development of educational programs and intervention strategies for young adults.

The Beneficial Effects of Nordic Walking Training Combined with Time-Restricted Eating 14/24 in Women with Abnormal Body Composition Depend on the Application Period

The aim of the study was to assess the impact of two lengths of Nordic walking (NW) training interventions combined with time-restricted eating (TRE) on improving body-composition parameters, lipid profiles, and levels of selected adipokines in women with elevated body mass. Overweight and obese women (n = 55, age: 21-85) were recruited. Four groups were selected: 6 weeks (SG6, n = 13) and 12 weeks intervention (SG12, n = 13); and two control groups: CON6 (n = 13) and CON12 (n = 13). The training sessions took place three times a week (60 min each) and were conducted outdoors under the supervision of a professional coach. The training intensity was determined individually. The extended NW program combined with TRE induced a significant weight reduction in SG12 by 1.96 kg (p = 0.010) and fat tissue by 1.64 kg (p = 0.05). The proposed interventions did not affect LBM, TBW [kg], VFA, and lipid profile. The LDL/HDL ratio changed with a small size effect. The leptin concentration differed between groups (p = 0.006), but not over time. For resistin, the differentiating factor was time (p = 0.019), with lower results observed after the intervention. The change in leptin concentration was negatively correlated with its baseline concentration (p = 0.025). Extended to 12 weeks, this intervention allows for an improvement in body composition. Neither 6 nor 12 weeks of training and fasting affected the lipoprotein profile. It is, therefore, indicated to recommend prolonged training protocols and to inform patients that beneficial effects will be seen only after prolonged use of training and time-restricted eating.

Lifestyle, meal times, and sleep patterns changes in higher education professors during COVID-19: Association with non-communicable chronic diseases

BACKGROUND

In response to the COVID-19 pandemic, educational institutions had to swiftly adapt and transition to remote teaching in order to maintain academic activities. However, these changes presented a number of challenges for professors, which could have negative effects on their health.

OBJECTIVE

To analyze the association between changes in dietary and sleep habits, physical activity level, and sedentary behavior with the development of non-communicable diseases (NCDs) among Brazilian higher education professors during the pandemic period.

METHODS

This is a cross-sectional and retrospective study conducted using an online form. Generalized linear models, adjusted for age, sex, and body mass index, were used to verify the difference between pre-pandemic and pandemic periods. Logistic regression models were used to predict the odds ratio (OR) for the development of NCDs according to physical activity time, sedentary behavior time, dietary and sleep patterns.

RESULTS

A total of 936 professors residing across Brazil participated in the survey. The duration of sedentary behavior increased, sleep duration slightly decreased, and meal times shifted to earlier during the pandemic. A total of 22.9%of the participants reported the diagnosis of some NCDs during this period. Physical activity practice was associated with a lower risk of diseases during the pandemic, regardless of the intensity performed. On the other hand, late eating habits and excessive food consumption during the pandemic were associated with a higher risk.

CONCLUSION

The results provide data that can help in the development of public policies that promote health actions to minimize the consequences associated with the pandemic period.

Increased regional body fat is associated with depressive symptoms: a cross-sectional analysis of NHANES data obtained during 2011-2018

AIMS

The findings from previous epidemiological studies of the association between regional body fat and depressive symptoms have been unclear. We aimed to determine the association between the body fat in different regions and depressive symptoms based on data from the National Health and Nutrition Examination Survey (NHANES).

METHODS

This study included 3393 participants aged ≥ 20 years from the NHANES performed during 2011-2018. Depressive symptoms were assessed using the Patient Health Questionnaire-9. The fat mass (FM) was measured in different regions using dual-energy X-ray absorptiometry to determine the total FM, trunk FM, arm FM, and leg FM. The FM index (FMI) was obtained by dividing the FM in kilograms by the square of the body height in meters. Weighted data were calculated in accordance with analytical guidelines. Linear logistic regression models were used to quantify the association between regional FMI and depressive symptoms. Univariate and stratified analyses were also performed.

RESULTS

The participants in this study comprised 2066 males and 1327 females. There were 404 (11.91%) participants with depressive symptoms, who were aged 40.89 ± 11.74 years and had a body mass index of 30.07 ± 7.82 kg/m². A significant association was found between total FMI and depressive symptoms. In the fully adjusted multivariate regression model, a higher total FMI (odds ratio = 2.18, 95% confidence interval [CI] = 1.08-4.39) was related to a higher risk of depressive symptoms, while increased total FMI (β = 1.55, 95% CI = 0.65-2.44, p = 0.001), trunk FMI (β = 0.57, 95% CI = 0.04-1.10, p = 0.036), and arm FMI (β = 0.96, 95% CI = 0.33-1.59, p = 0.004) were significantly associated with PHQ-9 (Patient Health Questionnaire-9) scores, whereas the leg FMI was not (p = 0.102). The weighted association between total FMI and depressive symptoms did not differ significantly between most of the subpopulations (all p values for interaction > 0.05). The risk of having depression was higher in individuals who were non-Hispanic Whites, smokers, drinkers, obese, and had diabetes and thyroid problems (p < 0.05).

CONCLUSION

These findings suggest that the population with a higher regional FMI is more likely to have depressive symptoms, especially in those who also have an increased total FMI. The association is more pronounced in individuals who are smokers, drinkers, obese, and have diabetes and thyroid problems.

Association of dietary overall antioxidant intake with all-cause and cause-specific mortality among adults with depression: evidence from NHANES 2005-2018

Higher intakes of individual antioxidants such as vitamins A, C, and E have been linked to mortality in the general population, but the association of overall antioxidant intake with mortality especially in depressed adults remains unclear. We aimed to investigate whether the dietary overall antioxidant intake is associated with all-cause and cause-specific mortality among depressed adults. This study included 3051 US adults with depression, who participated in the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2018. Patient Health Questionnaire-9 (PHQ-9) was used to define depression and evaluate depression severity. The dietary antioxidant quality score (DAQS) and dietary antioxidant index (DAI) were calculated based on the intakes of vitamins A, C, and E, zinc, selenium, and magnesium. A higher DAQS and DAI were significantly associated with lower depression scores (PHQ-9) (all P-trend < 0.05). For individual antioxidants, significant negative associations of vitamins A and E with all-cause mortality were observed. For overall antioxidant intake, the DAQS and DAI were inversely associated with all-cause and cancer mortality. Compared with participants in the lowest categories of DAQS and DAI, the corresponding HRs (95% CIs) in the highest categories were 0.63 (0.42-0.93) and 0.70 (0.49-0.98) for all-cause mortality and 0.39 (0.17-0.87) and 0.43 (0.21-0.88) for cancer mortality, respectively. The overall dietary antioxidant intake was beneficially associated with all-cause and cancer mortality in depressed adults. These findings suggest that comprehensive dietary antioxidant intake may improve depressive symptoms and lower mortality risk among adults with depression.

The Role of Anxiety and Depression in the Relationship Among Emotional Eating, Sleep Quality, and Impulsivity

ABSTRACT

The aim of this study was to investigate the relationship among sleep quality, impulsivity, anxiety, and depression in individuals with emotional eating behavior. The study was designed as a cross-sectional study. The study included 92 individuals (age 31.29 ± 9.17; female, 67.4% [n = 62]; male, 32.6% [n = 30]) with symptoms of emotional eating but no previous psychiatric diagnosis or treatment. Participants were administered a Structured Clinical Interview for DSM-5 Disorders interview form, a sociodemographic data form, the Emotional Eating Scale, the Beck Depression Scale, the Barratt Impulsivity Scale, the Beck Anxiety Scale, and the Pittsburgh Sleep Quality Index Scale. Emotional eating is positively correlated with anxiety (r = 0.377, p = 0.001), depression (r = 0.375, p = 0.001), impulsivity (r = 0.250, p = 0.016), and poor sleep quality (r = 0.478, p = 0.001). Obese individuals (defined as having a body mass index of 30 or higher) showed higher emotional eating (z = -2.552, p = 0.016) and poorer sleep quality (z = -2.089, p = 0.044) than nonobese individuals, and women showed higher emotional eating (t = 2116, p = 0.037) and poorer sleep quality (z = -2537, p = 0.010) than men. Poor sleep quality was associated with emotional eating. In this relationship, poor sleep quality influenced emotional eating through all mediators, including anxiety and depression (B = 3.491; standardized effect, 0.485; p = 0.001). Poor sleep quality directly influenced emotional eating (B = 2.806; standardized effect, 0.390; p = 0.001). The findings of the study suggest that emotional eating is associated with higher levels of anxiety, depression, impulsivity, and sleep problems, especially in women. It suggests that the interrelationships of psychological factors associated with emotional eating should be investigated.

Mediation of the association between depression and coronary heart disease by metabolic syndrome components

BACKGROUND

Depression is associated with incident coronary heart disease (CHD) via a pathway that may be causal, but the mechanisms underlying this association are unclear. We assessed the extent to which metabolic syndrome (MetS) and its components (i.e., elevated waist circumference, low high-density lipoprotein [HDL] cholesterol, elevated triglycerides, elevated blood pressure, and elevated fasting plasma glucose) may mediate this association.

METHODS

Data were Framingham Heart Study Research Materials obtained from the National Heart, Lung, and Blood Institute (NHLBI) Biologic Specimen and Data Repository Information Coordinating Center. We used Cox proportional hazards regression to estimate adjusted hazard ratios (aHR) representing the total effect (aHRTE) of probable depression, measured via the Centers for Epidemiological Studies - Depression scale, on incident CHD over approximately 18 years. Using inverse odds ratio weighting, we decomposed this estimate into natural direct effects (aHRNDE) and natural indirect effects (aHRNIE) through potential mediators (measured approximately three years after depression).

RESULTS

Probable depression was associated with incident CHD (aHRTE=1.45, 95% confidence interval [CI]: 0.93, 2.25), and elevated waist circumference partially mediated this association (aHRNDE=1.34, 95% CI: 0.76-2.32; aHRNIE=1.08, 95% CI: 0.63-1.91). We did not find evidence of additional mediation by additional MetS components.

CONCLUSIONS

Elevated waist circumference appears to play a role in the association between depression and CHD.

Eating disorders and obesity: bridging clinical, neurobiological, and therapeutic perspectives

Eating disorders (EDs) and obesity are complex health conditions sharing various risk and maintenance factors, intensified in cases of comorbidity. This review explores the similarities and connections between these conditions, examining different facets from a multidisciplinary perspective, among them comorbidities, metabolic and psychological factors, neurobiological aspects, and management and therapy implications. We aim to investigate the common characteristics and complexities of weight and EDs and explore their interrelationships in individuals who experience both. The rising prevalence of EDs in people with obesity necessitates integrated approaches to study this comorbidity and to identify and analyze both common and distinct features of these conditions. This review may offer new opportunities for simultaneous prevention and management approaches, as well as future lines of research.

The relationship between psychological distress and weight maintenance in weight cycling: mediating role of eating behavior

BACKGROUND

Obesity is a global public health concern. The goal of this study was to see if eating habits could mediate the relationship between psychological distress and weight maintenance in a population with a history of weight cycling.

METHODS

A 3-month outpatient intervention consisting of a diet and exercise program was provided to 153 participants. Psychological distress, appetite, and behavior were assessed at the beginning and end of the study. Anthropometric measurements were taken at baseline and six months.

RESULTS

After the structural equation model was developed, it was discovered that the psychological status of people with obesity and weight cycling histories correlated with the weight loss outcome effect (three and six months). This effect was mediated by factors related to eating behavior. Associative psychological factors had a direct effect on eating behavior (three months: β = 0.181, 95% CI: 0.055-0.310; six months: β = 0.182, 95% CI: 0.039-0.332) and appetite had a direct effect on eating behavior (three months: β = 0.600, 95% CI: 0.514-0.717; six months: β = 0.581, 95% CI: 0.457-0.713), both of which were significant (p < 0.01). At three months, psychological distress has a more substantial positive impact on weight change, with eating behavior acting as a partial mediator. At six months, there was no support for appetite's moderating role in eating behavior.

CONCLUSIONS

The findings suggest that psychological interventions should be strengthened to improve weight loss effectiveness, particularly in participants with a history of weight cycling, making weight loss more complicated and prone to rebound.

CLINICAL TRIAL REGISTRATION

The study has been registered in Clinical Trials (NCT05311462).

Predispose, precipitate, perpetuate, and protect: how diet and the gut influence mental health in emerging adulthood

Medicine often employs the 4Ps of predisposing, precipitating, perpetuating, and protective factors to identify salient influences on illness states, and to help guide patient care. Mental illness is a significant cause of morbidity and mortality worldwide. Mental health is a complex combination of biological, psychological, environmental, and social factors. There is growing interest in the gut-brain-microbiome (GBM) axis and its impact on mental health. We use the medical model of the 4Ps to explore factors involving the connection between nutrition and the GBM axis and their associated risks with mental health problems in emerging adults (EAs), a life stage when mental illness onset is the most common. We review the impact of current dietary trends on the GBM and on mental health, and the role that gut microbiome-based interventions can have in modulating the GBM axis of EAs. We discuss the implications of gut health on the GBM and areas for clinical intervention.

Effects of Shared Decision Making Model-Based Guided Self-Help Program on Emotional Eating and Uncontrolled Eating Behavior in Individuals with a Severe Mental Disorder: A Randomized Controlled Trial

PURPOSE

The study was aimed at determining the effectiveness of the Shared Decision Making Model-based Guided Self-Help Program (SDM-GSH) on emotional eating behavior and uncontrolled eating behavior in individuals with a severe mental disorder.

METHOD

This randomized controlled experimental study was conducted in the Community Mental Health Center of a university hospital between September 2020 and November 2022. The sample of the study consisted of 64 participants. Of them, 33 were in the Experimental Group and 31 were in the control group. To collect the study data, the Patient Information Form, Emotional Eater Questionnaire, and Three-Factor Eating Questionnaire were administered. The participants in the Experimental Group took part in the SDM-GSH. The study data were collected from the participants in the Experimental and Control Groups before, right after and 6 months after the intervention.

RESULTS

The comparison of the BMI values of the participants with a severe mental disorder who took part in the SDM-GSH demonstrated that their pre-intervention BMI values significantly decreased at the measurements preformed right after and 6 months after the intervention (p < 0.05). The mean emotional eating (λ = 0.189, η2 = 0.811) and uncontrolled eating (λ = 0.218, η2 = 0.782) scores obtained by the participants in the Experimental Group before the intervention significantly decreased at the measurements preformed right after and 6 months after the intervention (p < 0.05).

CONCLUSION

Based on the results of our study, it is concluded that the SDM-GSH positively affected the BMI values, emotional eating behaviors and uncontrolled eating behaviors of the participants with a severe mental disorder.

The role of lifestyle and mental health in the weight change of higher vocational college students in Fuzhou, China during COVID-19

Objectives

This study is aimed to explore the influence of higher vocational college students' lifestyle and mental health on weight change in Fuzhou during COVID-19.

Methods

This study adopted the cross-sectional study method and a total of 1426 students (1111 women and 315 men) were recruited from higher vocational college in Fuzhou. The questionnaire mainly included six dimensions: demographic characteristics, anthropometric measurements, dietary habits, physical activity, sleep quality and psychological status.

Results

According to the weight changes, the group was divided into weight loss group, constant weight group and weight gain group. More people in the weight gain group had increased their intake of various foods compared to the other groups (P < 0.001), in addition, the number of physical activity decreased and basically unchanged was more, and the number of sedentary time increased and basically unchanged was more in the three groups(P < 0.001). The incidence of poor sleep quality (60.3 %, 46.9 %, 57.5 %, P < 0.001), depressive symptoms (58.9 %, 47.5 %, 62.0 %, P < 0.001) and anxiety symptoms (42.5 %, 35.8 %, 45.3 %, P = 0.005) in the weight loss group and the weight gain group were significantly higher than those in the constant weight group. After adjusting for the potential confounders (including age, sex, grade, smoking, drinking, diet, etc.), decreased physical activity, depressive symptoms and anxiety symptoms were independent risk factors for weight gain compared with the constant weight group(OR = 1.643, P = 0.046; OR = 1.695, P < 0.001; OR = 1.389, P = 0.020).

Conclusions

The increased food intake, decreased physical activity, depressive symptoms and anxiety symptoms were positively correlated with weight gain.

Understanding of and clinical approach to cardiometabolic transition at the menopause

Cardiovascular disease (CVD) represents the leading cause of death and accounts for almost 50% of all deaths in women worldwide. The menopausal transition is associated with central body fat accumulation, a decrease in energy expenditure, weight gain, insulin resistance and a pro-atherogenic lipid profile. Moreover, menopause is independently associated with an adverse effect on functional and structural indices of subclinical atherosclerosis. Women with premature ovarian insufficiency have heightened CVD risk compared to women of natural age at menopause. Furthermore, women with severe menopausal symptoms may have a more adverse cardiometabolic profile than those without symptoms. We reviewed the latest evidence on the cardiovascular management of perimenopausal or postmenopausal women. Clinicians should aim for cardiovascular risk stratification, followed by dietary and lifestyle advice as required based on individual needs. The medical management of cardiometabolic risk factors at midlife should always be individualized, focusing on hypertension, diabetes and dyslipidemia. Menopausal hormone therapy, when prescribed for the management of bothersome menopausal symptoms or for the prevention of osteoporosis, has also a beneficial effect on cardiometabolic risk factors. This narrative review aims to summarize the cardiometabolic alternations occurring during the menopausal transition and to outline the appropriate prevention strategies to prevent future cardiovascular adverse outcomes.

The relationship of within-individual and between-individual variation in mental health with bodyweight: An exploratory longitudinal study

BACKGROUND

Poor mental health is associated with obesity, but existing studies are either cross-sectional or have long time periods between measurements of mental health and weight. It is, therefore, unclear how small fluctuations in mental wellbeing within individuals predict bodyweight over short time periods, e.g. within the next month. Studying this could identify modifiable determinants of weight changes and highlight opportunities for early intervention.

METHODS

2,133 UK adults from a population-based cohort completed monthly mental health and weight measurements using a mobile app over a period of 6-9 months. We used random intercept regression models to examine longitudinal associations of depressive symptoms, anxiety symptoms and stress with subsequent weight. In sub-group analyses, we included interaction terms of mental health variables with baseline characteristics. Mental health variables were split into "between-individual" measurements (= the participant's median score across all timepoints) and "within-individual" measurements (at each timepoint, the difference between the participant's current score and their median).

RESULTS

Within-individual variation in depressive symptoms predicted subsequent weight (0.045kg per unit of depressive symptom severity, 95% CI 0.021-0.069). We found evidence of a moderation effect of baseline BMI on the association between within-individual fluctuation in depressive symptoms and subsequent weight: The association was only apparent in those with overweight/obesity, and it was stronger in those with obesity than those with overweight (BMI<25kg/m2: 0.011kg per unit of depressive symptom severity [95% CI -0.017 to 0.039]; BMI 25-29.9kg/m2: 0.052kg per unit of depressive symptom severity [95%CI 0.010-0.094kg]; BMI≥30kg/m2: 0.071kg per unit of depressive symptom severity [95%CI 0.013-0.129kg]). We found no evidence for other interactions, associations of stress and anxiety with weight, or for a reverse direction of association.

CONCLUSION

In this exploratory study, individuals with overweight or obesity were more vulnerable to weight gain following higher-than-usual (for that individual) depressive symptoms than individuals with a BMI<25kg/m2.

Beat the Clock: Assessment of Night Eating Syndrome and Circadian Rhythm in a Sample of Greek Adults

The night eating syndrome (NES) is characterized by excessive food intake during the evening and night hours, with 25% of the daily intake being consumed post-dinner, paired with ep-isodes of nocturnal food intake, at a frequency of more than twice weekly. The NES has been associated with a misaligned circadian rhythm related to a delay in overall food intake, increased energy and fat consumption. The present cross-sectional study aimed to assess NES in a Greek population and evaluate possible links between NES and chronotype. NES was assessed using the Night Eating Questionnaire (NEQ), and circadian rhythm, sleep and mood were evaluated with the Sleep, Circadian Rhythms, and Mood (SCRAM) questionnaire. A total of 533 adults participated in the study. A relatively high prevalence of NES was revealed, with more than 8.1% (NEQ ≥ 30) of the participants reporting experiencing NES symptoms, depending on the NEQ threshold used. Most participants had the intermediate chronotype. NEQ score was positively associated with the morning chronotype, and SCRAM was negatively related to "Good Sleep". Each point increment in the depression score was associated with 6% higher odds of NES. The early identification of NES gains importance in clinical practice, in a collective effort aiming to reduce NES symptomatology and its detrimental health effects.

The Relationship between Occupational Fatigue and Well-Being: The Moderating Effect of Unhealthy Eating Behaviour

Tech giants are large, well-known internet and technology companies. Employees of such companies are generally expected to work fast and for long periods of time, causing them to experience high occupational fatigue. The relationship between occupational fatigue and well-being is complex. Furthermore, in the context of the workplace, unhealthy eating behaviour may be used as a mechanism to cope with fatigue and stress. This study explored the relationship between occupational fatigue, well-being and unhealthy eating behaviour within this specific professional population. Study 1 used qualitative research methods, in which in-depth interviews were conducted with staff working at 13 tech giants in Shenzhen, China (N = 50). The findings revealed that work-related stress and occupational fatigue are common among employees working for tech giants. Additionally, factors such as unhealthy eating behaviour, workload, working hours and workplace interpersonal relationships were found to influence occupational well-being. Study 2 involved a cross-sessional survey of 237 employees of tech giants. The results indicated that occupational fatigue negatively impacts occupational well-being and that unhealthy eating behaviours play a moderating role between occupational fatigue and occupational well-being. These findings highlight the significance of adopting appropriate measures to improve the situation and cope with the effects of occupational fatigue by managing unhealthy eating behaviours.

Perceived Stress and Depressive Symptoms Are Associated With Emotional Eating but Not Nutritional Intake During Pregnancy: A Prospective Cohort Study

INTRODUCTION

Pregnancy is a major life event during which women may experience increased psychological distress and changes in eating behaviors. However, few studies have investigated the influence of psychological distress on pregnant women's eating behaviors. The primary objective of this prospective study was to examine the associations of changes in perceived stress and depressive symptoms with emotional eating and nutritional intake during pregnancy. In addition, we examined the direct and moderating effects of perceived social support.

METHODS

Participants were racially diverse pregnant women (14-42 years) from 4 clinical sites in Detroit, MI, and Nashville, TN (N = 678). We used multiple linear and logistic regression models to determine if changes in stress and depressive symptoms across pregnancy were associated with changes in emotional eating and nutritional intake. We examined residualized change in stress and depressive symptoms from second to third trimester of pregnancy; positive residualized change scores indicated increased stress and depressive symptoms.

RESULTS

Participants showed significant improvement in emotional eating and nutritional intake from second to third trimester of pregnancy (P < .001 for both). At second trimester, higher depressive symptoms were associated with a greater likelihood of emotional eating (P < .001) and worse nutritional intake (P = .044) at third trimester. Increased stress and depressive symptoms during pregnancy were both associated with increased risk, whereas increased perceived social support reduced risk of emotional eating at third trimester (stress: adjusted odds ratio [AOR], 1.17; 95% CI, 1.08-1.26; depressive symptoms: AOR, 1.05; 95% CI, 1.01-1.08; social support: AOR, 0.93; 95% CI, 0.88-0.99). None were associated with changes in nutritional intake. Perceived social support did not show any moderating effects.

DISCUSSION

Increased psychological distress during pregnancy may increase emotional eating. Efforts to promote healthy eating behaviors among pregnant women should consider and address mental health.

Inter-relationships of obesity-related eating behavior with depression and anxiety among adults during the COVID-19 pandemic: A network analysis

The COVID-19 pandemic has significantly impacted individuals' mental health, resulting in a higher incidence of depression, anxiety, and changes in eating behaviors. The objective of this study is to examine the inter-relationships among obesity-related eating behavior, depression, and anxiety in adults during the COVID-19 pandemic, utilizing a network analysis method. We conducted a cross-sectional survey among a representative sample of 9091 adults between July 10 and September 15, 2021. Participants completed self-report measures to assess obesity-related eating behavior and symptoms of depression and anxiety. Network analysis was employed to investigate the inter-relationships among these variables. The network analysis revealed that item 2 (i.e., Do not feel satisfied unless I eat until full) exhibited the highest node strength within the network, followed by item 5 (i.e., Like oily foods). In addition, positive correlations were found between the severity of depression and anxiety and most of the obesity-related eating behavior items. These findings offer valuable insights into the interplay between obesity-related eating behavior, depression, and anxiety during the COVID-19 pandemic, underscoring the significance of considering these factors in comprehending and addressing mental health and well-being in adults. Further research is warranted to explore potential interventions and treatment approaches that specifically target the identified relationships.

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

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

The relationship between coronavirus anxiety level and emotional eating in individuals with metabolic syndrome

This study used a descriptive, cross-sectional and relational screening model. The full sampling method was used in this study. The study was completed with 105 individuals with MetS attending the outpatient nutrition clinic and 109 non-MetS individuals without MetS diagnosis, who also attended the outpatient nutrition clinic. The data included anthropometric measurements, biochemical findings, blood pressure, a survey form, the Coronavirus Anxiety Scale (CAS), and the Emotional Eating Scale (EES). The coronavirus anxiety scale scores of individuals with MetS were found to be statistically significantly higher than those of the non-MetS group (p <0.05). The difference in the emotional eating scale scores between the MetS and non-MetS groups was not significant (p <0.05). Individuals with MetS had higher coronavirus anxiety levels than those without MetS; however, there was no difference between participants with and without MetS in terms of emotional eating behavior.

The New Zealand eating behavior questionnaire - Validation study for a novel assessment tool to describe actionable eating behavior traits

Individualised management of obesity remains challenging and, to date, most treatment is based on clinical judgement. This study aimed to develop and validate a novel questionnaire-based tool to identify three pre-defined eating behavior (EB) traits, emotional eating, reduced satiety (constant hunger) and reduced satiation (feasters) that may predict selective medication response given their targeted actions. We recruited 977 individuals from a tertiary academic diabetes clinic to participate in this two-phase validation study. Participants self-reported weight management activities and were asked to self-assess their EB characteristics. The initial questionnaire included 42 visual analogue scale questions. In Phase I, 729 participants completed the questionnaire, including Māori (11.8%) and Pacific peoples (19.3%). After random division of the study sample, Exploratory Factor Analysis (EFA) confirmed a three-factor model as the best fit. Stepwise removal of items with inadequate factor loading retained 27 of 42 items, which accounted for 96% of the variance. Confirmatory Factor Analysis (CFA), performed on the second half of the sample, demonstrated good model fit with the final 27-item questionnaire. Internal consistency was high for factor (α = 0.82-0.95) and demographic subgroups, and similar to those obtained in the EFA. Test-retest reliability in a subset of 399 participants who repeated the questionnaire after a four-week interval (Phase II) showed moderate to good reliability. Participants classified into one of three EB types based on the highest median score among the factors. Test-retest reliability was robust for emotional eaters (71.25%) and constant hunger (68.9%). The correlation between aggregate EB score (sum of three EB scores) and BMI was significant (Spearman rho = 0.314, P = .0005). The questionnaire reliably identified three distinct EB traits, which may be informative for precision medicine applications for obesity management.

Assessing how bariatric surgery, emotional eating, and depression could affect each other: A cross-sectional study

Emotional eating (EE) has been found to be associated with depression, anxiety, excessive weight, obesity, and unhealthy eating habits. EE could also be associated with recurrent weight gain. To date, the factors predicting success following bariatric surgery remain uncertain. In addition, there is a paucity of data regarding the associations between EE, percent of total weight loss (TWL), and depression after bariatric surgery. The aims of this study were to evaluate the relationship between EE behavior, depression, and TWL, and to identify other factors, such as the type of bariatric surgery, that may have an impact on EE, depression and TWL after bariatric surgery. A self-report questionnaire was administered to 253 patients who underwent bariatric surgery between 2014 and 2021 at the Department of General Surgery, Faculty of Medicine, Gazi University. In total, 115 patients agreed to participate and completed the questionnaire. The administered scales consisted of the Sociodemographic Data Form, Emotional Eating Scale (EES), and Beck Depression Inventory (BDI). The participants were divided into the Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) groups. The RYGB and SG groups included 79 (68.8%) and 36 (31.3%) patients, respectively. A significant difference was found in terms of age (P = .002) and gender (P = .033). The BDI scores (P = .499) and TWL (P = .068) did not differ significantly. The EES score was higher in the SG group (P = .020). Between the groups with and without EE, age (P = .004) and BDI scores (P = .004) were significantly different. In correlation analyses, EES score was related to BDI score(ρ = 0.402, P < .001) and age(ρ = -0.348, P = .002) in the RYGB group. In regression analyses, TWL was associated with age (β = -0.366, P < .001) and surgery type (β = -6.740, P < .001), EES score was associated with BDI score (β = 0.149, P = .009) and age (β = -0.154, P = .006), and BDI score was associated with EES score (β = 0.419, P = .009) and age (β = -195, P = .041). In patients with moderate-to-severe depression, TWL was higher than in those without depression (P = .025). The effect of emotional eating and depression on TWL was not detected. Emotional eating and depression trigger each other in the individuals who underwent bariatric surgery. Young individuals who undergo bariatric surgery are more vulnerable to emotional eating and depression than older patients.

Association of health behaviors, dietary habits, and oral health with weight gain after 20 years of age in community-dwelling Japanese individuals aged 40 years and older: a cross-sectional study

OBJECTIVES

This cross-sectional study investigated the factors associated with weight gain ≥ 10 kg after 20 years of age in the general Japanese population, with a focus on the number of teeth.

MATERIALS AND METHODS

We included individuals aged ≥ 40 years from Yamagata prefecture, Japan from 2017-2021. A postal survey was conducted using a self-administered questionnaire; 5,940 participants were included in the final analysis. The questionnaire included items on lifestyle factors, medical history, physical and mental conditions, oral health, and dietary intake. A multivariate logistic regression analysis was used to identify independent associations between weight gain ≥ 10 kg after 20 years of age and various parameters; adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated.

RESULTS

Less than 20 teeth, male sex, drinking habit frequency, eating very fast or fast, and a higher frequency of eating-away-from-home were significant factors associated with weight gain ≥ 10 kg after 20 years of age; individuals with < 20 versus > 20 teeth exhibited a 1.35-fold higher OR (95% CI 1.15-1.59; p < 0.01).

CONCLUSIONS

Our results suggest that having < 20 teeth may affect weight gain ≥ 10 kg after 20 years of age. However, owing to the cross-sectional study design, causality could not be determined. Therefore, maintaining healthy lifestyle behaviors to avoid tooth loss may also affect weight gain ≥ 10 kg after 20 years of age.

CLINICAL RELEVANCE

Having < 20 teeth has the potential to affect long-term weight gain after 20 years of age.

Association between anxiety and depression and all-cause mortality: a 50-year follow-up of the Population Study of Women in Gothenburg, Sweden

OBJECTIVES

This study aimed to examine the association between anxiety disorders and/or major depression disorder (ADs/MDD) and all-cause mortality in a 50-year perspective and to examine specific risk and health factors that may influence such an association.

DESIGN

Observational population study, 1968-2019.

SETTING

The Population Study of Women in Gothenburg, Sweden (PSWG).

PARTICIPANTS

In 1968-1969, 899 (out of 1462) women from PSWG were selected according to date of birth for a psychiatric investigation, including diagnostic evaluation. Eight hundred (89%) were accepted. Twenty-two women were excluded. Of the 778 included, 135 participants (17.4 %) had solely ADs, 32 (4.1%) had solely MDD and 25 (3.2%) had comorbid AD/MDD.

PRIMARY AND SECONDARY OUTCOME MEASURES

Associations between ADs, MDD, comorbid AD/MDD and all-cause mortality with adjustments for potential confounding factors. Differences between the groups concerning health and risk factors and their association with mortality.

RESULTS

In a fully adjusted model, ADs were non-significantly associated with all-cause mortality (HR 1.17, 95% CI 0.98 to 1.41). When examining age during risk time as separate intervals, a significant association between mortality and AD was seen in the group of participants who died at the age of 65-80 years (HR 1.70, 95% CI 1.26 to 2.29). In the younger or older age interval, the association did not reach significance at the 95% level of confidence. Among confounding factors, smoking and physical activity were the strongest contributors. The association between smoking and mortality tended to be further increased in the group with ADs versus the group without such disorders (HR 2.10, 95% CI 1.60 to 2.75 and HR 1.82, 95% CI 1.56 to 2.12, respectively).

CONCLUSIONS

This study suggests potential links between ADs, age and mortality among women with 50 years of follow-up, but does not provide definitive conclusions due to the borderline significance of the results.

Measuring the relationship between body mass index and depression among Saudi adult population: A nationwide cross-sectional study

BACKGROUND

The prevalence of obesity and depression shows an accelerating trend with increased risk of morbidity and disability. The exact underlying relationship between them is unclear. We aimed to evaluate the prevalence of body mass index (BMI) and depression and their associations in a large sample of Saudi adults.

METHODS

We administered a nationwide cross-sectional web-based survey using a snowball sampling method among Saudi adults aged 18-60 years. We used a validated Arabic version of Beck's Depression Inventory-II (BDI-II) for depression assessment. We classified BMI into underweight, normal weight, overweight, and obesity. We used logistic regression analysis to determine the factors associated with depression.

RESULTS

Among 4,683 Saudi adults, different grades of depression were present in 43.3%, most (25.2%) with a mild condition. Overweight and obesity were present in 26.4% and 21%, respectively. We found a positive association between BMI and BDI-II score (ρ = 0.14, p = 0.006). BMI was significantly higher among those who were older, males, married, living in the Eastern region of Saudi Arabia, educated at a pre-university level, employed, at high family-income levels, smokers, and people with chronic diseases. Depression score was significantly higher among married, non-employees, non-smokers, people with chronic diseases, and those with BMI ≥ 25 kg/m2. Non-smoking, presence of chronic diseases, and being overweight or obese were significantly associated with depression.

CONCLUSIONS

Saudi adults were suffering from different grades of depression, overweight, and obesity. A positive association between BMI and BDI-II score was observed. Depression score did not differ by age, sex, geographical region, educational level, or family income. Non-smoking, presence of chronic diseases, and being overweight or obese were significantly associated with depression. Further longitudinal research is required to understand the factors underpinning causal relationships between BMI and depression, the subgroups' variation, and mediating strategies.

Abdominal obesity mediates the causal relationship between depression and the risk of gallstone disease: retrospective cohort study and Mendelian randomization analyses

OBJECTIVE

Our study aimed to explore the causal effect of depression on the risk of gallstone disease, and the mediation effects of metabolic traits.

METHODS

A retrospective cohort study on Chinese elderly from the Dongfeng-Tongji cohort (including 18,141 individuals) was conducted to estimate the adverse effect of probable depression on the risk of gallstone disease. Two-sample Mendelian randomization was performed in European and East-Asian ancestries, to verify the causal relationship between major depression and gallstone disease. We further applied two-step Mendelian randomization to explore the mediation effects of metabolic traits.

RESULTS

In the cohort study, probable depression was associated with an increased risk of gallstone disease within 5 years, with RR (95% CI) of 1.33 (1.12, 1.58) in multivariable regression, and 1.34 (1.11, 1.61) following propensity score weighting. Bidirectional Mendelian randomization in European ancestry revealed a positive causal effect (OR: 1.21; 95% CI: 1.07 to 1.37) of genetically predicted major depression liability on gallstone disease, based on the inverse variance weighted method. Little evidence was presented from other complementary approaches, and the analysis in East-Asian ancestry (IVW estimated OR: 1.03; 95% CI: 0.92 to 1.15). The indirect effect via waist circumference and HDL-C were 1.06 (95% CI: 1.02 to 1.10) and 1.01 (95% CI: 1.00 to 1.01) respectively, which mediated 25.8% and 3.78% of the causal relationship.

CONCLUSIONS

Our study suggested a higher risk of gallstone disease in the population with probable depression, while the two-sample Mendelian randomization provided weak evidence for the causal relationship, which was moderately mediated by abdominal obesity.

Hybrid visualization-based framework for depressive state detection and characterization of atypical patients

INTRODUCTION

Depression is a global concern, with a significant number of people affected worldwide, particularly in low- and middle-income countries. The rising prevalence of depression emphasizes the importance of early detection and understanding the origins of such conditions.

OBJECTIVE

This paper proposes a framework for detecting depression using a hybrid visualization approach that combines local and global interpretation. This approach aims to assist in model adaptation, provide insights into patient characteristics, and evaluate prediction model suitability in a different environment.

METHODS

This study utilizes R programming language with the Caret, ggplot2, Plotly, and Dalex libraries for model training, visualization, and interpretation. Data from the NHANES repository was used for secondary data analysis. The NHANES repository is a comprehensive source for examining health and nutrition of individuals in the United States, and covers demographic, dietary, medication use, lifestyle choices, reproductive and mental health data. Penalized logistic regression models were built using NHANES 2015-2018 data, while NHANES 2019-March 2020 data was used for evaluation at the global-specific and local level interpretation.

RESULTS

The prediction model that supports this framework achieved an average AUC score of 0.748 (95% CI: 0.743-0.752), with minimal variability in sensitivity and specificity.

CONCLUSION

The built-in prediction model highlights chest pain, the ratio of family income to poverty, and smoking status as crucial features for predicting depressive states in both the original and local environments.

Emotional eating among adults with healthy weight, overweight and obesity: a systematic review and meta-analysis

BACKGROUND

Emotional eating (EE) is a disordered eating behaviour which may lead to overeating. It is not clear whether EE presents to an equal degree among adults, regardless of their body mass index (BMI) status. The aim of this study was to assess whether there is a difference in degree of EE between adults with healthy weight, overweight and obesity.

METHODS

MEDLINE and APA PsycINFO databases were searched from inception up to January 2022 for studies that reported EE scores from validated questionnaires. The quality of all included studies was assessed using the AXIS tool. Meta-analysis used random effects and standardised mean difference (SMD). Heterogeneity was investigated using I2 statistics and sensitivity analyses.

RESULTS

A total of 11 studies with 7207 participants were included in the meta-analysis. Degree of EE was greater in adults with a BMI above the healthy range, compared to adults with a healthy BMI (SMD 0.31, 95% CI 0.17 to 0.45; I2  = 85%). However, subgroup analysis found that degree of EE was greater only in adults with obesity (SMD 0.61, 95% CI 0.41 to 0.81; I2  = 62%), and there was no difference in degree of EE between adults with overweight and those with a healthy BMI.

CONCLUSIONS

Degree of EE is greater among adults living with obesity, compared to adults with a healthy BMI, indicating a need for behavioural support to support EE among people living with obesity seeking weight management. Future research should examine the long-term effectiveness of interventions for EE.

Applying psycho-behavioural phenotyping in obesity characterization

Individual differences in obesity, beyond being explained by metabolic and medical complications, are understood by alterations in eating behaviour which underlie psychological processes. From this psychological perspective, studies have identified several potential characteristic features at the psycho-behavioural level that could additionally explain the maintenance of chronic excess weight or the unsuccessful results of current treatments. To date, despite the growing evidence, the heterogeneity of the psychological evidence associated with obesity has made it challenging to generate consensus on whether these psycho-behavioural phenotypes can be a complement to improve outcomes of existing interventions. For this reason, this narrative review is an overview focused on summarizing studies describing the psycho-behavioural phenotypes associated with obesity. Based on the literature, three psychological constructs have emerged: reward dependence, cognitive control, and mood and emotion. We discuss the clinical implications of stratifying and identifying these psycho-behavioural profiles as potential target for interventions which may ensure a better response to treatment in individuals with obesity. Our conclusions pointed out a considerable overlap between these psycho-behavioural phenotypes suggesting bidirectional interactions between them. These findings endorse the complexity of the psycho-behavioural features associated with obesity and reinforce the need to consider them in order to improve treatment outcomes.

Stress during the COVID-19 Pandemic and Emotional Eating Scale Adapted for Children and Adolescents (EES-C) Results in Girls: Polish Adolescents' COVID-19 Experience (PLACE-19) Study

Stress related to the outbreak of the COVID-19 pandemic may have caused substantial changes in eating behaviors, and may have been associated with emotional eating, especially in female individuals. The aim of the present study was to analyze the association between stress perceived during the COVID-19 pandemic and emotional eating in girls, within the third phase of the Polish Adolescents' COVID-19 Experience (PLACE-19) Study. A nationwide sample of 818 Polish female adolescents, aged 15-20, was gathered. The adolescents were recruited to the study based on a random quota sampling procedure. Using a computer-assisted web interview (CAWI) survey, participants filled out the Emotional Eating Scale Adapted for Children and Adolescents (EES-C) to assess the urge to cope with negative emotions by eating, and the Adolescent Stress Questionnaire (ASQ) to assess perceived stress. Additionally, the data concerning body mass, height, as well as body mass change during the COVID-19 pandemic were verified. The groups most susceptible to emotional eating were excessive body mass female adolescents, those who gained weight during the COVID-19 pandemic and those experiencing high stress levels while facing negative emotions. In order to plan effective therapeutic interventions dealing with the issue of emotional eating, both psychological therapy and dietary strategy tailored to the individual should be considered for the indicated susceptible groups.

Emotional Overeating during the COVID-19 Pandemic: Polish Adolescents' COVID-19 Experience (PLACE-19) Study

Emotional overeating is the most frequently noted type of emotional eating, being commonly associated with increased consumption of energy-dense products, as well as excessive body mass, and weight gain. Even though a number of studies assessed emotional overeating during the COVID-19 pandemic in adult populations, studies of children and adolescents are scarce. The aim of the present study was to assess emotional overeating background, including consumption in response to six emotions (anxiety, sadness, loneliness, tiredness, anger, and happiness), in the population of Polish adolescents within the PLACE-19 Study during the COVID-19 pandemic. The PLACE-19 Study is a national Polish population-based study of adolescents gathered upon recruitment based on a random quota sampling of secondary schools, conducted in a population of 1126 students (818 females and 308 males, a median of age 17.0 and 16.5 years, respectively). Emotional overeating was assessed while using the Emotional Overeating Questionnaire (EOQ), and as additional factors, the following were assessed: gender, body mass, body mass change during the COVID-19 pandemic, and declared tempting food products. Female participants declared a higher frequency of overeating in response to feelings of anxiety, sadness, loneliness, and happiness, and were characterized by a higher total score than male participants, while p ≤ 0.05 was interpreted as a statistical significance. Obese participants declared a higher frequency of overeating in response to feelings of sadness, and loneliness than normal weight participants. Participants gaining weight declared a higher frequency of overeating in response to feelings of anxiety, sadness, loneliness, tiredness, and anger, and were characterized by a higher total score than participants losing weight or maintaining a stable weight, while participants gaining weight declared a higher frequency of overeating in response to feelings of happiness than participants losing weight. Participants declaring both sweet and salty products as tempting declared a higher frequency of overeating in response to feelings of anxiety, and sadness than participants declaring no tempting products; participants declaring both sweet and salty products declared a higher frequency of overeating in response to feelings of tiredness than participants declaring only salty products and those declaring no tempting products, as well as declared a higher frequency of overeating in response to feelings of happiness than participants declaring only sweet products, and those declaring no tempting products; participants declaring sweet products declared a higher frequency of overeating in response to feelings of anger than participants declaring no tempting products, while participants declaring both sweet and salty products declared a higher frequency of overeating in response to feelings of loneliness, and were characterized by a higher total score than all other respondents. The sub-groups with the highest frequency of emotional overeating were the female respondents, obese participants, those gaining weight, and those declaring both sweet and salty products as tempting, while among the emotions most often causing emotional overeating, there were sadness and loneliness.

Associations of timing of food intake with energy intake, eating behaviour traits and psychosocial factors in adults with overweight and obesity

Introduction

Whether a late distribution of food intake impacts obesity through increased energy intake remains uncertain and the behavioural characterization of late eating needs to be further investigated. The first objective of this study was to assess the associations between late eating and body mass index (BMI) and total energy intake (TEI), and whether TEI mediates the association between late eating and BMI. The second objective was to assess the associations between late eating and eating behaviour traits or psychosocial factors and whether eating behaviour traits mediate the association between late eating and TEI.

Methods

Baseline data from 301 individuals (56% women, age = 38.7 ± 8.5 years; BMI = 33.2 ± 3.4 kg/m²), who participated in four weight loss studies were used in this cross-sectional study. Total energy intake was assessed using a three-day food record from which the percentage of TEI after 17:00 and after 20:00 was calculated. Eating behaviour traits and psychosocial factors were assessed with questionnaires. Pearson correlations and mediation analyses adjusted for age, sex, underreporting of energy intake, sleep duration and bedtime were performed.

Results

Percent TEI after 17:00 and after 20:00 were associated with TEI (r = 0.13, p = 0.03 for both), and TEI mediated the association between percent TEI after 17:00 and BMI (β = 0.01 ± 0.01, 95% CI: 0.001, 0.02). Percent TEI after 17:00 was associated with disinhibition (r = 0.13, p = 0.03) and percent TEI after 20:00 was associated with susceptibility to hunger (r = 0.13, p = 0.03), stress (r = 0.24, p = 0.002) and anxiety (r = 0.28, p = 0.0004). In women, disinhibition mediated the association between percent TEI after 17:00 and TEI (β = 3.41 ± 1.43, 95% CI: 0.92, 6.47). Susceptibility to hunger mediated the association between percent TEI after 20:00 and TEI (β = 0.96 ± 0.59, 95% CI: 0.02, 2.34) in men and women.

Conclusion

Late eating is associated with TEI and suboptimal eating behaviours which could contribute to explaining the association between timing of food intake and obesity.

Secreted Protein Acidic and Rich in Cysteine (SPARC) to Manage Coronavirus Disease-2019 (COVID-19) Pandemic and the Post-COVID-19 Health Crisis

Coronavirus disease-2019 (COVID-19) has had and will have impacts on public health and health system expenses. Indeed, not only it has led to high numbers of confirmed COVID-19 cases and hospitalizations, but its consequences will remain even after the end of the COVID-19 crisis. Therefore, therapeutic options are required to both tackle the COVID-19 crisis and manage its consequences during the post COVID-19 era. Secreted protein acidic and rich in cysteine (SPARC) is a biomolecule that is associated with various properties and functions that situate it as a candidate which may be used to prevent, treat and manage COVID-19 as well as the post-COVID-19-era health problems. This paper highlights how SPARC could be of such therapeutic use.

Are Emotional Eating and Other Eating Behaviors the Missing Link in the Relationship between Inadequate Sleep and Obesity? A Systematic Review

Evidence is emerging to explain that the relationship between inadequate sleep and obesity could be influenced by emotional eating and other eating behaviors such as disinhibition. Therefore, our aim was to conduct a systematic review to analyze the potential role of emotional eating and other eating behaviors in the relationship between inadequate sleep and obesity. We conducted a comprehensive search on 2 databases (Medline and Scopus) looking for records from 1 January 2011 until 31 December 2022 without language restrictions. Cross-sectional, longitudinal, and interventional studies were included if they assessed the association between sleep and emotional eating, as well as the role of emotional eating on the relationship between inadequate sleep and obesity. Secondary outcomes included studies analyzing the link between sleep and other eating behaviors as well as their role in the sleep-obesity relationship. Our results showed that emotional eating and disinhibition play a significant role in the relationship between inadequate sleep and obesity, especially in women. Furthermore, we provide evidence of other eating behaviors (e.g., external eating, eating competence, and hunger), which are also associated with poor sleep outcomes. However, these behaviors do not seem to be determinants of the association between sleep and obesity. In conclusion, our results suggest that individuals with inadequate sleep who are prone to emotional eating and/or disinhibition may require tailored approaches for obesity prevention and treatment.

Different carbohydrate exposures and weight gain-results from a pooled analysis of three population-based studies

BACKGROUND

The role of carbohydrate quantity and quality in weight gain remains unsolved, and research on carbohydrate subcategories is scarce. We examined total carbohydrates, dietary fiber, total sugar, and sucrose intake in relation to the risk of weight gain in Finnish adults.

METHODS

Our data comprised 8327 adults aged 25-70 years in three population-based prospective cohorts. Diet was assessed by a validated food frequency questionnaire and nutrient intakes were calculated utilizing the Finnish Food Composition Database. Anthropometric measurements were collected according to standard protocols. Two-staged pooling was applied to derive relative risks across cohorts for weight gain of at least 5% by exposure variable intake quintiles in a 7-year follow-up. Linear trends were examined based on a Wald test.

RESULTS

No association was observed between intakes of total carbohydrate, dietary fiber, total sugar or sucrose and the risk of weight gain of at least 5%. Yet, total sugar intake had a borderline protective association with the risk of weight gain in participants with obesity (RR 0.63; 95% CI 0.40-1.00 for highest vs. lowest quintile) and sucrose intake in participants with ≥10% decrease in carbohydrate intake during the follow-up (RR 0.78; 95% CI 0.61-1.00) after adjustments for sex, age, baseline weight, education, smoking, physical activity, and energy intake. Further adjustment for fruit consumption strengthened the associations.

CONCLUSIONS

Our findings do not support an association between carbohydrate intake and weight gain. However, the results suggested that concurrent changes in carbohydrate intake might be an important determinant of weight change and should be further examined in future studies.

Eating when depressed, anxious, bored, or happy: An examination in treatment-seeking adults with overweight/obesity

Emotions that differ in valence are uniquely associated with eating. In our previous study with an online sample of adults with overweight/obesity, eating in response to depression was the type of emotional eating most closely associated with negative psychosocial correlates (Braden et al., 2018). The current study extended this research by examining associations between emotional eating types (eating in response to depression, anxiety, boredom, happiness) and psychological correlates among treatment-seeking adults. The present study was a secondary analysis of adults (N = 63; 96.8% female) with overweight/obesity and self-identified emotional eating who completed a baseline assessment for a behavioral weight loss intervention. Emotional eating in response to depression (EE-depression), anxiety/anger (EE-anxiety/anger), and boredom (EE-boredom) were assessed with the revised Emotional Eating Scale (EES-R), and positive emotional eating (EE-positive) was assessed with the positive emotions subscale of the Emotional Appetite Questionnaire (EMAQ). The Eating Disorder Examination Questionnaire (EDE-Q), Binge Eating Scale (BES), Difficulties in Emotion Regulation Scale (DERS), and Patient Health Questionnaire-9 (PHQ-9; depressive symptoms) were also administered. Frequencies showed the most endorsed emotional eating type was EE-depression (44.4%; n = 28). Four multiple regression analyses examined associations between emotional eating (EE-depression, EE-anxiety/anger, EE-boredom, and EE-positive) and dependent variables (EDE-Q, BES, DERS, and PHQ-9). Results showed that depression was the emotional eating type most closely related to disordered eating, binge eating, and depressive symptoms. Eating in response to anxiety was closely related to emotion regulation difficulties. Positive emotional eating was related to less depressive symptoms. Exploratory analyses showed that lower levels of positive emotional eating were related to higher depressive symptoms among adults with greater emotion regulation difficulties. Researchers and clinicians may consider tailoring weight loss treatment based on unique emotions that trigger eating.

Evening types as determined by subjective and objective measures are more emotional eaters

OBJECTIVE

This study aimed to determine the association between being an evening type (ET; defined subjectively by the Morning-Evening Questionnaire or objectively by the dim-light melatonin onset [DLMO] timing) and reporting emotional eating (EE) behaviors.

METHODS

Cross-sectional analyses were conducted in 3964 participants (four international cohorts: ONTIME and ONTIME-MT [both Spain], SHIFT [the US], and DICACEM [Mexico]), in which chronotype (Morning-Evening Questionnaire), EE behaviors (Emotional Eating Questionnaire), and dietary habits (dietary records or food-frequency questionnaire) were assessed. Among 162 participants (ONTIME-MT subsample), additional measures of DLMO (physiological gold standard of circadian phase) were available.

RESULTS

In three populations, ETs presented with a higher EE score than morning types (p < 0.02); and they made up a higher proportion of emotional eaters (p < 0.01). ETs presented with higher scores on disinhibition/overeating as well as food craving factors and experienced these behaviors more frequently than morning types (p < 0.05). Furthermore, a meta-analysis showed that being an ET was associated with a higher EE score by 1.52 points of a total of 30 points (95% CI: 0.89-2.14). The timing of DLMO in the early, intermediate, and late objective chronotypes occurred at 21:02 h, 22:12 h, and 23:37 h, with late types showing a higher EE score (p = 0.043).

CONCLUSIONS

Eveningness associated with EE in populations with different cultural, environmental, and genetic backgrounds. Individuals with late DLMO also showed more EE.

Connecting Dots between Mitochondrial Dysfunction and Depression

Mitochondria are the prime source of cellular energy, and are also responsible for important processes such as oxidative stress, apoptosis and Ca2+ homeostasis. Depression is a psychiatric disease characterized by alteration in the metabolism, neurotransmission and neuroplasticity. In this manuscript, we summarize the recent evidence linking mitochondrial dysfunction to the pathophysiology of depression. Impaired expression of mitochondria-related genes, damage to mitochondrial membrane proteins and lipids, disruption of the electron transport chain, higher oxidative stress, neuroinflammation and apoptosis are all observed in preclinical models of depression and most of these parameters can be altered in the brain of patients with depression. A deeper knowledge of the depression pathophysiology and the identification of phenotypes and biomarkers with respect to mitochondrial dysfunction are needed to help early diagnosis and the development of new treatment strategies for this devastating disorder.

The role of self-compassion in the relationship between rejection and unhealthy eating: An ecological momentary assessment study

Available studies suggest that experiencing interpersonal rejection heightens negative affect and, in turn, triggers unhealthy eating behaviors. Elucidating individual differences that attenuate the negative consequences of rejection could inform interventions targeting unhealthy eating. This study examined the buffering role of self-compassion in the relationship between rejection experiences and unhealthy eating behaviors, defined as snacking on junk food and overeating. Two-hundred undergraduate students (50% women) completed ecological momentary assessments measuring rejection experiences, emotions, and unhealthy eating seven times a day for 10 consecutive days. Self-compassion was measured after the 10-day assessment period. Reports of rejection were low (2.6%) in our university sample. Multilevel mediation analyses examined whether the relationship between experiencing rejection and subsequent unhealthy eating was mediated by negative affect. Multilevel moderated mediation analyses further considered whether relationships between rejection and negative affect and between negative affect and unhealthy eating were moderated by self-compassion. Experiencing rejection predicted more unhealthy eating behaviors at the next time point, and this relationship was fully explained by increases in negative affect. Participants with high levels of self-compassion experienced less intense negative affect after rejection and reported less unhealthy eating behaviors when feeling negative emotions, compared to their counterparts with lower levels of self-compassion. The indirect effect of rejection on unhealthy eating was moderated by self-compassion, and there was no statistically significant relationship between rejection and unhealthy eating behaviors among highly self-compassionate participants. Findings suggest that cultivating self-compassion may help attenuate the negative impact of rejection experiences on emotions and unhealthy eating behaviors.

Emotional Eating among Ghanaian University Students: Associations with Physical and Mental Health Measures

Eating behaviors are a set of cognitive processes that influence dietary decision making and, thus, overall health. Some of the most studied eating behaviors are those characterized by the Three Factor Eating Questionnaire-18 (TFEQ). The TFEQ examines three eating behaviors: emotional eating (EE), uncontrolled eating (UE), and restrained eating (RE). While frequently used, there is little information characterizing these eating behaviors in the Ghanaian population. This cross-sectional study describes EE, UE, and RE behaviors in a university student population (n = 129) in Ghana. Of the three behaviors, EE was the only one associated with any of the health outcomes in this study: BMI for males (r = 0.388, p = 0.002) and anxiety (r = 0.471, p < 0.001, higher score is less desirable), and sleep quality (r = 0.464, p < 0.001, higher score is less desirable) for females. Overweight and obese females reported significantly higher EE scores compared to healthy weight females (35.7 ± 23.7 vs. 11.9 ± 15.6, p = 0.002). No such observation was observed among overweight and obese males (p > 0.05). EE, UE, and RE scores did not differ between males and females. While this study provides important information about the eating behaviors of Ghanaian university students and allows for comparison to students from other cultures, future work must develop culturally relevant tools for the Ghanaian population.

Stress-induced eating and drinking and their associations with weight among women and men during 30-year follow-up

BACKGROUND

Stress is associated with obesity through several mechanisms, including coping methods used in stressful situations. However, long-term prospective studies investigating stress-induced eating and drinking in parallel and their relationships with weight are scarce.

PURPOSE

We examined the prevalence of stress-induced eating and drinking and their associations with body mass index (BMI) among women and men during a 30-year follow-up, as well as BMI trajectories from early adulthood to middle age.

METHODS

Participants of a Finnish cohort study were followed by questionnaires at the ages of 22 (N = 1656), 32 (N = 1471), 42 (N = 1334), and 52 (N = 1160). Their coping methods were evaluated by asking how common it was for them to act in certain ways when they encountered stressful situations. We used linear regression analysis to examine the associations between coping methods and BMI, and latent growth models to analyze the BMI trajectories.

RESULTS

The prevalence of stress-induced eating was higher among women than men throughout the follow-up, whereas stress-induced drinking was more common among men at 22 and 32 years of age. Stress-induced eating was associated with higher BMI at all ages among women, and from the age of 32 among men. Eating as a persistent coping method over the life course was associated with a higher and faster growth rate of BMI trajectories. Stress-induced drinking was associated with higher BMI in middle age, and with a faster growth of BMI among men.

CONCLUSIONS

Effective, appropriate stress management may be one essential factor in preventing weight gain in the adult population.

The Association of Emotional Eating with Overweight/Obesity, Depression, Anxiety/Stress, and Dietary Patterns: A Review of the Current Clinical Evidence

(1) Background: Emotional eating is considered as the propensity to eat in response to emotions. It is considered as a critical risk factor for recurrent weight gain. Such overeating is able to affect general health due to excess energy intake and mental health. So far, there is still considerable controversy on the effect of the emotional eating concept. The objective of this study is to summarize and evaluate the interconnections among emotional eating and overweight/obesity, depression, anxiety/stress, and dietary patterns; (2) Methods: This is a thorough review of the reported associations among emotional eating and overweight/obesity, depression, anxiety/stress, and dietary patterns. We compressively searched the most precise scientific online databases, e.g., PubMed, Scopus, Web of Science and Google Scholar to obtain the most up-to-date data from clinical studies in humans from the last ten years (2013-2023) using critical and representative keywords. Several inclusion and exclusion criteria were applied for scrutinizing only longitudinal, cross-sectional, descriptive, and prospective clinical studies in Caucasian populations; (3) Results: The currently available findings suggest that overeating/obesity and unhealthy eating behaviors (e.g., fast food consumption) are associated with emotional eating. Moreover, the increase in depressive symptoms seems to be related with more emotional eating. Psychological distress is also related with a greater risk for emotional eating. However, the most common limitations are the small sample size and their lack of diversity. In addition, a cross-sectional study was performed in the majority of them; (4) Conclusions: Finding coping mechanisms for the negative emotions and nutrition education can prevent the prevalence of emotional eating. Future studies should further explain the underlying mechanisms of the interconnections among emotional eating and overweight/obesity, depression, anxiety/stress, and dietary patterns.

Emotions and Food Consumption: Emotional Eating Behavior in a European Population

Emotion can reflect in the perception of food consumption. An increase in food intake during emotional and psychological conditions may have a negative impact on human health. The aim of this cross-sectional study was to determine the associations between food consumption, emotional eating behavior, and emotional conditions such as stress, depression, loneliness, boredom eating, maintaining vigilance and alertness, and emotional food consolation. We used a Motivations for Food Choices Questionnaire (Eating Motivations, EATMOT) to determine the emotional aspects of food consumption in 9052 respondents living in 12 European countries between October 2017 and March 2018. Ordinal linear regression was used to identify the associations between the emotional eating behavior and emotional conditions such as stress, depression, loneliness, emotional consolation, and reasons to improve physical and psychological conditions. The regression models confirmed the associations between food consumption, emotional conditions, and emotional eating behavior. Associations were found between the emotional eating behavior and stress (odds ratio (OR) = 1.30, 95% confidence interval (CI) = 1.07-1.60, p = 0.010), depressive mood (OR = 1.41, 95% CI = 1.40-1.43, p < 0.001), loneliness (OR = 1.60, 95% CI = 1.58-1.62, p < 0.001), boredom (OR = 1.37, 95% CI = 1.36-1.39, p < 0.001), and emotional consolation (OR = 1.55, 95% CI = 1.54-1.57, p < 0.001). Emotional eating was associated with an effort to improve physical and psychological conditions, such as controlling body weight (OR = 1.11, 95% CI = 1.10-1.12, p < 0.001), keeping awake and alert (OR = 1.19, 95% CI = 1.19-1.20, p < 0.001) and consumption to feel good (OR = 1.22, 95% CI = 1.21-1.22, p < 0.001). In conclusion, emotions might provoke emotional eating behavior. The appropriate way to handle stress, depression, or other emotional states is important in conditions of being emotionally overwhelmed. The public should be educated on how to handle different emotional states. The focus should be moved somehow from emotional eating and the consumption of unhealthy food to healthy lifestyle practices, including regular exercise and healthy eating habits. Thus, it is necessary to halt these negative health effects on human health through public health programs.

Does obesity related eating behaviors only affect chronic diseases? A nationwide study of university students in China

The primary aims of this study are to examine associations between obesity-related eating behaviors (OEB) and chronic and infectious diseases, and mental disorders. A representative nationwide survey was used to collect information among 11,659 medical students from 31 universities in China. Multiple variable logistic regression analysis was conducted to examine the associations between OEB and the diseases. The multiple variable logistic regression model found that OEB was significantly associated with chronic disease (OR (Odds Ratio): 1.74 < 95 % C.I (Confidence Interval): 1.45, 2.65 > ), infectious disease (OR: 3.37 < 95 % C.I: 1.04, 1.81 > ), and mental disorder (OR: 1.87(<95 % C.I: 1.55, 2.25 > ). These findings underscore the importance of addressing OEB in programs and policies to promote health and prevent disease among university students.

Link between emotional and external eating behaviors, peripheral neuropeptide Y, and β-hydroxybutyrate in participants with obesity on 12-week ketogenic diet

Objective: Understanding the impact of stress on emotional and external eating behaviors and the psychological and the associated metabolic factors can help in designing subsequent interventions to protect health. In particular, psychological trait-like construct related to eating has been shown to be an important target for intervention. Methods and measures: This study aimed to investigate the biochemical variables associated with a decrease in emotional and external eating behaviors due to 12-week ketogenic diet (12KD) in 35 adult participants (12 males) with obesity. Results: Absolute changes in emotional and external eating were independent of changes in body mass, nutritional intake, and Δ cortisol, but were predicted with increases in serum β-hydroxybutyrate (BHB) and decreases in serum peripheral neuropeptide Y (pNPY) (all p's < 0.050). Decrease in pNPY was also associated with an increase in BHB but was independent of anthropometrical changes, Δ fasting glucose, and Δ insulin. Conclusion: The reductions in emotional and external eating behaviors in participants with obesity were uniquely predicted by an increase in BHB and a decrease in pNPY after 12KD. In ketosis, emotional and external eating dropped independently of body mass change. Change in pNPY predicted changes in emotional and external eating. The role of BHB in modulating eating behavior should be further explored.

Impact of weight loss on sexual and psychological functions and quality of life in females with sexual dysfunction: A forgotten avenue

Objectives

This study aimed to evaluate the impact of weight loss on sexual and psychological health as well as quality of life in females with sexual dysfunction.

Materials and methods

The study was done at Delta University for Science and Technology in Gamasa, Egypt, on 40 obese married females having sexual dysfunction. Their age ranged from 20 to 40 years old, with a mean of 28.98 ± 4.96 years. They followed a weight loss program in the form of diet regimen and physical training for 6 months. Anthropometric measures, Arabic Female Sexual Function Index (FSFI), Arabic version of Hospital Anxiety and Depression Scale (HADS), and Arabic version of Short-Form 36 Health Survey (SF-36) were evaluated prior to starting the study, after 3 and 6 months of the study.

Results

Statistical analysis revealed significant reductions in anthropometric measures, as well as significant improvements in HADS and SF-36 scores after both 3 and 6 months of weight loss intervention compared to the baseline measurements, while there were significant improvements in sexual arousal, lubrication, patient satisfaction as well as the total score of FSFI after 3 months and contrarily there were no statistically significant changes in any of the FSFI's domains or overall score after 6 months of the weight loss program compared to baseline.

Conclusion

Weight loss improves females' anthropometric measures, psychological function and quality of life; however, it has no direct effect on female sexual dysfunction (FSD) after 6 months compared to baseline, so increased awareness of FSD is necessary as this issue suffers from inadequate identification and management.