Cultural Reflections on Restrained Eating

Adapting the Dietary Fat and Free Sugar Short Questionnaire: A Comprehensive Polish Modification for Enhanced Precision in Nutritional Assessments

BACKGROUND

This study aimed to investigate whether The Dietary Fat and Free Sugar-Short Questionnaire (DFS) is a reliable and valid measure that can be used in Polish conditions. It involved 291 participants, aged 14 to 70 (M = 25.9, SD = 10.1), the majority of whom were women (75%).

METHODS

The questionnaire consisted of, among others, Polish DFS version, FFQ-6, TFEQ, and SCOFF. Test-retest reliability was established on the group of 26 students with a 2-week interval. Participants' percentage of energy intake from both free sugars and saturated fats based on FFQ was correlated with DFS total and subscales scores. To investigate convergent and divergent validity, DFS scores with TFEQ correlations were performed. Diagnostic validity was established based on difference analysis between groups with the risk of eating disorders and those without the risk of those based on SCOFF.

RESULTS

Test-retest reliability (rtr = 0.856) and internal consistency (α = 0.797) indicated excellent reliability. DFS correlated significantly with FFQ for both total scores (r = 0.82) and each subscale: sugar (0.79), fat (0.75), and fat-sugar (0.59). The correlations of DFS and TFEQ were statistically significant for cognitive restraint (r = 0.32) and uncontrolled eating (r = 0.19). There also have been found significant differences based on SCOFF regarding DFS.

CONCLUSIONS

The results suggest good reliability and validity of the Polish version of DFS.

Practice makes perfect: Restrained eaters' heightened control for food images

OBJECTIVE

Restrained eaters (RE) show behaviourally unregulated food intake, which is often explained by a deficit in inhibitory control. Despite evidence for general inhibitory deficits in RE, it remains unclear how the variety of (food) cues in our environment can influence cognitive control.

METHOD

In this re-analysis, we explored the inhibitory capacity of RE and unrestrained eaters (URE) on a stop-signal task with modal (pictures) and amodal (word) food and non-food stimuli.

RESULTS

Although we did not find the expected inhibitory deficits in RE compared to URE, we found a significant Group × Modality × Stimulus Type interaction. This indicated that RE have relatively good inhibitory control for food, compared to non-food modal cues, and that this relationship is reversed for amodal cues.

CONCLUSIONS

Hence, we showed differential processing of information based on food-specificity and presentation format in RE. The format of food cues is thus an important new avenue to understand how the food environment impedes those struggling with regulating their eating behaviour.

Psychometric properties of an Arabic translation of the Inflexible Eating Questionnaire (IEQ) in a non-clinical sample of adults

BACKGROUND

The Inflexible Eating Questionnaire (IEQ) is an 11-item instrument designed to evaluate the behavioural and psychological components of inflexible eating. However, the psychometric properties of the instrument have been infrequently examined, and no previous work has examined its utility in the context of the Middle East.

METHODS

A total of 826 Lebanese citizens and residents completed a novel Arabic translation of the IEQ, as well as previously validated measures of body appreciation, functionality appreciation, and disordered eating.

RESULTS

The unidimensional factor structure of the IEQ was upheld through both exploratory and confirmatory factor analyses, with all 11 items retained. We obtained evidence of scalar invariance across gender and found that there were no significant differences in observed IEQ scores between men and women. IEQ scores were also found to have adequate composite reliability and adequate patterns of concurrent validity.

CONCLUSION

The present findings provide support for the psychometric properties of the Arabic version of the IEQ in examining inflexible eating in Arabic-speaking adults in Lebanon. Inflexible or rigid dietary restraint reflects an all-or-none approach that encompasses feeling compelled to obey a set of self-imposed dieting rules (e.g., avoiding high-calorie food, calorie counting, fasting to lose weight and/or skipping meals), having a sense of self-control and feeling empowered when adhering to these rules, and not respecting or following internal/external cues of hunger, satiety, and appetite. Therefore, the inflexible eating construct is composed of two dimensions, the first one is behavioural (i.e., obeying restrictive dietary rules) and the second one is psychological (i.e., the belief that following these rules is a consistent must). Until recently, the measures designed to assess inflexible eating focused on the behavioral dimension, while omitting to account for the psychological processes underlying the construct. To bridge this gap, the Inflexible Eating Questionnaire (IEQ), an 11-item self-report measure, was developed to assess both the behavioural and psychological components of dietary restraint. To date, the IEQ is not yet validated in Arabic. Through the present study, we aimed to examine the psychometric properties of an Arabic translation of the IEQ, which would in turn facilitate improved research and clinical practices related to dietary restraint in Arabic-speaking nations. Overall, findings provided support for the good psychometric qualities of the Arabic version of the IEQ, which suggests its utility for detecting inflexible eating in Arabic-speaking adults.

Body Dissatisfaction, Eating Styles, Weight-Related Behaviors, and Health among Young Women in the United States

Body dissatisfaction is a common condition that poses health behavior risks, such as the use of maladaptive eating styles instead of adaptive eating styles. Few studies have simultaneously examined both adaptive and maladaptive eating styles and their association with body dissatisfaction in a comprehensive manner. To address this gap, this study examined how body dissatisfaction is related to an array of adaptive and maladaptive eating styles, weight-related behaviors, and health status as well as the associations of health status, BMI, and weight-related behaviors with body dissatisfaction in 261 young adult women. Maladaptive eating styles, such as emotional eating, tended to rise in tandem with body dissatisfaction, differing significantly among body-dissatisfaction levels with medium to large effect sizes. For adaptive eating styles, as body dissatisfaction increased, compensatory restraint increased, intuitive eating declined, and mindful eating did not differ. Weight-related dietary, physical activity, and sleep behaviors did not differ by body dissatisfaction level. BMI increased and health status decreased as body dissatisfaction increased. Binary logistic regression revealed those who were body-dissatisfied had significantly lower health status, higher BMIs, and did not differ on weight-related behaviors. Study findings suggest strategies to improve health-promotion interventions aiming to increase body satisfaction.

Negative Affect and Maladaptive Eating Behavior as a Regulation Strategy in Normal-Weight Individuals: A Narrative Review

Emotions have a powerful influence on eating behavior, and eating behavior can have a powerful effect on emotions. The objective of the present narrative review was to evaluate the relationship between negative affect and maladaptive eating behavior as a regulation strategy in normal-weight individuals. A search of the literature within PubMed®, MEDLINE® and PsycINFO was conducted using a combination of the following terms: “affect”, “negative affect”, “affect regulation” and “maladaptive eating behavior”. A total of 106 papers were identified for full text review and were included in the final set of literature. The manuscript presents an overview of the literature on negative affect and maladaptive eating behavior. It offers a brief overview of restrained, uncontrolled and emotional eating in normal-weight individuals and looks at maladaptive eating behavior used to regulate their affect. Based on the previous research findings, we argue that using more adaptive strategies for emotion regulation (cognitive reappraisal) might result in downregulating integral negative affect to food and in improving eating behavior.

Body Dissatisfaction, Weight-Related Behaviours, and Health Behaviours: A Comparison Between Australian and Malaysian in Female Emerging Adults

The presence of body dissatisfaction (BD) in non-Western countries is an important area of empirical enquiry. The results reflect collectivistic and individualistic cultures of Malaysians and Australians, respectively, whereby social approval, social acceptance, and cultural values are of high importance to Malaysians compared with the more liberal attitudes of Australians with respect to health behaviours. This study sought to compare: (1) Australian and Malaysian women on BD, thin ideal internalisation, sociocultural influences, problematic weight-related behaviours, and health behaviours; and (2) the degree to which BD is associated with health behaviours (smoking, alcohol consumption, drug use, and sexual behaviours) across the two cultures. Participants were 428 Australian females and 402 Malaysian females aged 18–25 years old. Australians had higher BD, thin ideal internalisation, family and media influences, restrained eating, and poorer health behaviours, while Malaysians had higher peer influence. There was no difference for bulimic behaviours across the two countries. BD was found to have an association with use of drugs, smoking, and sexual behaviours among Malaysian women, but not for Australian participants. The permeation of Western standards of the thin ideal due to increased industrialisation, Westernisation, and modernisation has brought about bulimic behaviours in Malaysian women, similar to that of Australian women.

Restrained eating in Lebanese adolescents: scale validation and correlates

BACKGROUND

Restrained eating disorder is prevalent worldwide across both ethnic and different cultural groups, and most importantly within the adolescent population. Additionally, comorbidities of restrained eating present a large burden on both physical and mental health of individuals. Moreover, literature is relatively scarce in Arab countries regarding eating disorders, let alone restrained eating, and among adolescent populations; hence, the aim of this study was to (1) validate the Dutch Restrained Eating Scale in a sample of Lebanese adolescents and (2) assess factors correlated with restrained eating (RE), while taking body dissatisfaction as a moderator between body mass index (BMI) and RE.

METHODS

This cross-sectional study, conducted between May and June 2020 during the lockdown period imposed by the Lebanese government, included 614 adolescents aged between 15 and 18 years from all Lebanese governorates (mean age of 16.66 ± 1.01 years). The scales used were: Dutch Restrained Eating Scale, body dissatisfaction subscale of the Eating Disorder Inventory-Second version, Rosenberg Self-Esteem Scale, Beirut Distress Scale (for psychological distress), Hamilton Anxiety Rating Scale and Patient Health Questionnaire (for depression).

RESULTS

The factor analysis yielded a one-factor solution with Eigen values > 1 (variance explained = 59.65 %; α_Cronbach = 0.924). Female gender (B = 0.19), higher BMI (B = 0.49), higher physical activity index (B = 0.17), following a diet to lose weight (B = 0.26), starving oneself to lose weight (B = 0.13), more body dissatisfaction (B = 1.09), and higher stress (B = 0.18) were significantly associated with more RE, whereas taking medications to lose weight (B=-0.10) was significantly associated with less RE. The interaction body mass index (BMI) by body dissatisfaction was significantly associated with RE; in the group with low BMI, higher body dissatisfaction was significantly associated with more RE.

CONCLUSIONS

Our study showed that the Dutch Restrained Eating scale is an adapted and validated tool to be used among Lebanese adolescents and revealed factors associated with restrained eating in this population. Since restrained eating has been associated with many clinically-diagnosed eating disorders, the results of this study might serve as a first step towards the development of prevention strategies targeted towards promoting a healthy lifestyle in Lebanese adolescents.

Differences in the Associations between Body Dissatisfaction and Eating Outcomes by Gender? A Lebanese Population Study

BACKGROUND

The objective of this study was to evaluate the impact of the interaction between body dissatisfaction and gender on eating disorders (restrained eating, binge eating, orthorexia nervosa, and emotional eating) among a sample of Lebanese adults.

METHODS

This cross-sectional study, conducted between January and May 2018, enrolled 811 participants selected randomly from all Lebanese Mohafazat. The mean age of the participants was 27.6±11.8 years. The majority were females (66.5%), had a high level of education (73.2%), and low income (77.9%). This study used the following scales: body dissatisfaction subscale of the Eating Disorder Inventory-second version, binge eating scale, Dutch restrained eating scale, orthorexia nervosa scale (ORTHO-15 scale), emotional eating scale, perceived stress scale, Hamilton Anxiety Rating Scale, and Hamilton Depression Rating Scale.

RESULTS

Body dissatisfaction was positively correlated to restrained eating (r=0.293, P<0.001), emotional eating (r=0.073, P=0.042) and binge eating (r=0.250, P<0.001). The interaction between body dissatisfaction and gender was significantly associated with more restrained eating (Beta=0.01, P<0.001) and orthorexia nervosa (Beta=-0.09, P<0.001), but not with emotional (Beta=-0.43, P=0.103) and binge eating (Beta=-0.08, P=0.358). When stratifying the analysis by gender, the results revealed that higher body dissatisfaction was significantly associated with more restrained eating in both genders, but particularly among women. Body dissatisfaction was significantly associated with higher emotional eating in men only and with higher orthorexia nervosa tendencies and behaviors in females only.

CONCLUSION

The interaction between body dissatisfaction and gender was significantly associated with orthorexia nervosa and restrained eating but not with binge or emotional eating. Higher body dissatisfaction was significantly associated with higher restrained eating, more pronounced in women, while it was significantly associated with higher orthorexia tendencies (lower ORTO-15 scores) in women only. Body dissatisfaction was associated with emotional eating in men only.

Bidirectional Associations between Restrained Eating and Body Mass Index in Middle Childhood

The nature of the association between dietary restraint and weight has been examined in adult samples, but much less is known about this relationship among children. The current study examined the transactional associations among restrained eating behavior and weight among boys and girls during middle childhood. Data for this study came from 263 children participating in the Families and Schools for Health Project (FiSH), a longitudinal study of the psychosocial correlates of childhood obesity. Participants were interviewed by trained researchers in their third- and fourth-grade year when they completed questionnaires and anthropometric assessments. Dietary restraint was assessed using the restrained eating subscale of the Dutch Eating Behavior Questionnaire (DEBQ), and weight was assessed using Body Mass Index z-scores (BMIz). Bidirectional associations between variables were examined using cross-lagged models controlling for children's sex, ethnicity, and weight in first grade. Results indicated that weight in grade 3 was related to greater dietary restraint in grade 4 (B = 0.20, p = 0.001), but dietary restraint in grade 3 was not associated with weight in grade 4 (B = 0.01, p = 0.64). Neither child sex nor race/ethnicity were associated with BMIz or dietary restraint at either time point. Findings from this study advance the existing limited understanding of eating behavior development among children and show that weight predicts increases in children's dietary restraint in middle childhood.

Understanding eating and drinking behaviours in Pakistani university students: A conceptual model through qualitative enquiry

Excess weight in Pakistan's university students is on the rise and is driven by their maladaptive eating behaviours. Practitioners in Pakistan have adopted Western conceptual models to understand obesogenic eating behaviours. However, these models provide incomplete explanations as they miss important culturally specific determinants for such eating behaviours. The goals of this study were two-fold: first, to explore Pakistani university students' perception of their obesity-related eating behaviours and attitudes; second, to develop a culturally sensitive model of obesogenic eating behaviours in university students from Pakistan. Semi-structured interviews were used with twenty-four Pakistani university students who were categorised as obese using the Body Mass Index according to Asia-Specific cut-offs. Interviews were transcribed, translated, and then analysed through a Grounded Theory methodology. Six major categories emerged from interviews: (1) Obesogenic Eating Habits (Social Eating, Emotional Eating, and Eating Whatever and Whenever You Want); (2) Beliefs about Food in the Culture; (3) Neither Too Fat nor Too Thin body belief (4) Student Life Attitudes; (5) Student Stressors; (6) Inconsistent Weight-Control Strategies. A model was developed with cultural beliefs about food, attitudes towards student-life, and stressors as important determinants of students' obesogenic eating habits, while inconsistent weight-control strategies contributed to further weight gain. The findings highlight the importance of identifying culturally specific determinants of eating behaviours among university students in Pakistan. This emerging model can be used to guide the development of future quantitative and also longitudinal studies aimed at identifying targets for therapeutic interventions to manage obesogenic eating behaviours in Pakistani university students.

The Relationship between Sense of Coherence, Stress, Body Image Satisfaction and Eating Behavior in Japanese and Austrian Students

Background: Restrained, emotional, and external eating are related to obesity and eating disorders. A salutogenic model has confirmed sense of coherence (SOC) as a health resource that moderates stress and helps limit the occurrence of overweightness and eating disorders. This study aimed to examine the relationship between SOC, social support, stress, body image satisfaction (BIS) and eating behaviors in different cultural environments. Methods: A total of 371 Austrian (161 men, 210 women) and 398 Japanese (226 men, 172 women) university students participated. The SOC-13 scale, Multidimensional Scale of Perceived Social Support, Dutch Eating Behavior Questionnaire, BMI-Based Silhouette Matching Test and an analogue single-stress item were used as measurements. Results: SOC negatively affected all three types of eating in Austrian students (men: β = −0.227 to −0.215; women: β = −0.262 to −0.214). In Japanese students, SOC negatively affected external eating in both sexes (men: β = −0.150; women: β = −0.198) and emotional eating (β = −0.187) in men. BIS indicated that the desire to become slim predicted restrained eating, women’s emotional eating, and men’s and Austrian women’s external eating. Stress was only predictive of emotional eating in Japanese men. Conclusions: This study found that SOC, BIS and stress might be valuable factors regulating eating behavior in a cultural context. However, the relationship between SOC, BIS, stress and eating behavior differs between cultures.

Weight Fluctuation and Diet Concern Negatively Affect Food-Related Life Satisfaction in Chilean Male and Female Adolescents

Problematic eating behaviors and obesity are frequent problems encountered during adolescence that may potentially result in psychological, social and physical consequences that may interfere with adolescent development and well-being. The present study evaluates the relationship between satisfaction with food-related life and satisfaction with family life, and their relationship with life satisfaction in male and female adolescents. We explored the relationships between both subscales of the Revised Restraint Scale (RRS), Diet Concern (DC) and Weight Fluctuation (WF) and adolescent life satisfaction as well as satisfaction with food-related life and family life. We also explored the moderating role of socioeconomic status (SES). A questionnaire was applied to a non-probabilistic sample of 470 adolescents (mean age 13.2 years, 52.3% female) in Chile, including the RRS, Satisfaction with Life Scale (SWLS), Satisfaction with Food-related Life (SWL-Food) scale and Satisfaction with Family Life (SWL-Family) scale. Using structural equation modeling, we found that adolescent life satisfaction was related to satisfaction with family life and food-related life in both genders. In male adolescents, a negative relationship was identified between WF and food-related life satisfaction. In contrast, a negative relationship was identified in female adolescents between DC and food-related life satisfaction. DC and WF were not directly related to life satisfaction or to satisfaction with family life in either gender. SES was found to moderate the relationship between food-related life satisfaction and life satisfaction and the relationship between WF and food-related life satisfaction in female adolescents. These findings suggest that reducing DC in female adolescents and reducing WF in male adolescents and female adolescents from higher SES may improve their food-related life satisfaction.