Orthorexia Nervosa and Healthy Orthorexia in a Physically Active North American Population

The Teruel Orthorexia Scale (TOS) defines two related but distinct constructs: Orthorexia Nervosa (OrNe), a pathological fixation on a healthy diet, and Healthy Orthorexia (HeOr), an interest in a healthy diet independent of psychopathology. Here, we (a) assessed both types of Orthorexia in a large North American sample using the TOS and (b) explored if engaging in regular physical activity was associated with a greater risk of Orthorexia. A cohort of physically active adults (n = 927; 41% men) completed the TOS, as well as the Rapid Assessment of Physical Activity (RAPA), to broadly assess aerobic physical activity level and participation in strength and/or flexibility training. As expected, scores for HeOr and OrNe differed between participants, with lower scores for Orthorexia Nervosa in our physically active non-clinical sample. Higher HeOr scores were associated with lower BMI, and this was true for both men and women. We also found that measures of Orthorexia were associated with self-reported physical activity: active adults reporting more aerobic physical activity had higher HeOr scores, with the most active men having the highest scores. Notably, adults who reported regular strength training had higher scores for both HeOr and OrNe, with men who strength trained showing higher OrNe scores than women. Here, those who participate in regular strength training are more likely to exhibit orthorexic behaviors, and this effect was more pronounced for men than women. Prior work has validated the TOS in young, primarily female samples of non-English speakers outside the United States: present data from an age-diverse, physically active, gender balanced sample support the use of TOS for measurement of Orthorexia Nervosa and Healthy Orthorexia in English speakers and suggest that more work is needed to assess potential gender differences in these constructs.

The food and beverage cues in digital marketing model: special considerations of social media, gaming, and livestreaming environments for food marketing and eating behavior research

Digital marketing to children, teens, and adults contributes to substantial exposure to cues and persuasive messages that drive the overconsumption of energy dense foods and sugary beverages. Previous food marketing research has focused on traditional media, but less is known about how marketing techniques translate within digital platforms, such as social media, livestreaming, and gaming. Building upon previous theories and models, we propose a new model entitled food and beverage cues in digital marketing (FBCDM). The FBCDM model specifies key marking elements and marketing integration strategies that are common on digital platforms and are hypothesized to enhance the effects of advertising and incentive sensitization process. FBCDM also categorizes measurable outcomes into three domains that include brand, food, and social outcomes. Additionally, repeated marketing exposure and the resulting outcomes are hypothesized to have long term consequences related to consumer markets, consumption behavior, culture, and health. We include a discussion of what is currently known about digital marketing exposure within the outcome domains, and we highlight gaps in research including the long-term consequences of digital marketing exposure. The FBCDM model provides a conceptual framework to guide future research to examine the digital marketing of food and beverages to children and adolescents in order to inform government and industry policies that restrict the aggressive marketing of products associated with obesity and adverse diet related outcomes.

Loss of control eating in children is associated with altered cortical and subcortical brain structure

Introduction

Loss of control (LOC) eating is the perceived inability to control how much is eaten, regardless of actual amount consumed. Childhood LOC-eating is a risk factor for the development of binge-eating disorder (BED), but its neurobiological basis is poorly understood. Studies in children with BED have shown both increased gray matter volume in regions related to top-down cognitive control (e.g., dorsolateral prefrontal cortex) and reward-related decision making (e.g., orbital frontal cortex) relative to healthy controls. However, no studies have examined brain structure in children with LOC-eating. To identify potential neurobiological precursors of BED, we conducted secondary analysis of five studies that conducted T1 MPRAGE scans.

Methods

A total of 143, 7-12-year-old children (M = 8.9 years, 70 boys) were included in the study, 26% of which (n = 37) reported LOC-eating (semi-structured interview). Age, sex, and obesity status did not differ by LOC-eating. Differences between children with and without LOC were examined for gray matter volume, cortical thickness, gyrification, sulci depth, and cortical complexity after adjusting for age, sex, total intercranial volume, weight status, and study.

Results

Children with LOC, relative to those without, had greater gray matter volume in right orbital frontal cortex but lower gray matter volume in right parahippocampal gyrus, left CA4/dentate gyrus, and left cerebellar lobule VI. While there were no differences in cortical thickness or gyrification, children with LOC-eating had great sulci depth in left anterior cingulate cortex and cuneus and greater cortical complexity in right insular cortex.

Discussion

Together, this indicates that children with LOC-eating have structural differences in regions related to cognitive control, reward-related decision-making, and regulation of eating behaviors.

Food and non-alcoholic beverage marketing in children and adults: A systematic review and activation likelihood estimation meta-analysis of functional magnetic resonance imaging studies

Food marketing impacts the food behaviors of children and adults, but the underpinning neural mechanisms are poorly understood. This systematic review and meta-analysis pooled evidence from neuroimaging studies of exposure to food marketing stimuli (vs. control) on brain activations in children and adults to clarify regions associated with responding. Databases were searched for articles published to March 2022. Inclusion criteria included human functional magnetic resonance imaging (fMRI) studies employing a contrast between a food marketing stimulus and a non-food/non-exposure control, published in English in a peer-reviewed journal, reporting whole brain (not Region of Interest [ROI] only) co-ordinates. Eleven studies met inclusion criteria, of which eight were included in the quantitative synthesis (Activation Likelihood Estimation [ALE] meta-analysis). Food marketing exposures (vs. controls) produced greater activation in two clusters lying across the middle occipital gyrus, lingual gyrus, and cuneus (cluster 1), and the postcentral gyrus, precentral gyrus, and the inferior parietal lobule/supramarginal gyrus (cluster 2). Brain responses to food marketing are most consistently observed in areas relating to visual processing, attention, sensorimotor activity, and emotional processing. Subgroup analyses (e.g., adults vs. children) were not possible because of the paucity of data, and sensitivity analyses highlighted some instability in the clusters; therefore, conclusions remain tentative pending further research.

What Is Food Noise? A Conceptual Model of Food Cue Reactivity

As GLP-1 receptor agonists, like semaglutide, emerge as effective treatments for weight management, anecdotal reports from patients and clinicians alike point to a reduction in what has been colloquially termed "food noise", as patients report experiencing less rumination and obsessive preoccupation about food. In this narrative review, we discuss concepts used in studies to investigate human eating behavior that can help elucidate and define food noise, particularly food cue reactivity. We propose a conceptual model that summarizes the main factors that have been shown to determine the magnitude of the reactivity elicited by external and internal food cues and how these factors can affect short- and long-term behavioral and clinical outcomes. By integrating key research conducted in this field, the Cue-Influencer-Reactivity-Outcome (CIRO) model of food cue reactivity provides a framework that can be used in future research to design studies and interpret findings related to food noise and food cue reactivity.

Portion size affects food selection in an immersive virtual reality buffet and is related to measured intake in laboratory meals varying in portion size

A crucial step for validating the utility of an immersive virtual reality (iVR) buffet to study eating behavior is to determine whether variations in food characteristics such as portion size (PS) are relevant predictors of food selection in an iVR buffet. We tested whether manipulating PS in an iVR buffet affects the weight of food selected, and whether this response to PS is similar to participants' measured intake when PS varies at laboratory meals. In a randomized crossover design, 91 adults (18-71 y; 64 females; BMI = 25.3 ± 5.7) used their iVR remote to select lunch and dinner portions from an iVR buffet before consuming a standardized lab meal at two visits separated by one week. The PS in the iVR buffet and lab meals varied between a standard PS and a large PS. This design enabled comparisons of PS effects between iVR and lab settings, despite the scale difference in food weight between the environments. Portion size significantly affected food selection and food intake (p < 0.001). Subjects selected an additional 350 g in iVR and consumed an additional 154 g of food in the lab meals when offered the large portion compared to the small portion. The effect of PS showed a similar percentage increase in iVR (36.5%) and lab meals (39.2%). There was no significant difference in the effect of PS between iVR and lab meals after accounting for scale differences in food weight between the environments. The response to PS was not influenced by subject characteristics such as body mass index, sex, or age. These results demonstrate the utility of iVR for replicating real-world eating behaviors and enhancing our understanding of the intricate dynamics of food-related behaviors in a variety of contexts.

Associations between behavioral self-regulation and external food cue responsiveness (EFCR) in preschool-age children and evidence of modification by parenting style

Decreased behavioral regulation is hypothesized to be a risk factor for excess weight gain among children, possibly via reduced appetite-specific regulation. Little research has specifically focused on behavioral regulation and food cue responsiveness, a conditioned precursor to eating, at a young age. This study examined the association between behavioral regulation and external food cue responsiveness among preschool-age children and explored if a more structured parenting style moderated that association. Baseline data from a prospective study on media use among preschool-age children (n = 83) in Northern New England were used. Parents reported on three domains of children's behavioral regulation (attentional focusing, inhibitory control, and emotional self-regulation), the children's external food cue responsiveness (EFCR), and their parenting styles (authoritative and permissive) via validated questionnaires. Mean age among children was 4.31 (SD 0.91) years, 57% of children were male, 89% were non-Hispanic white, and 26.2% had overweight or obesity. In a series of adjusted linear regression models, lower attentional focusing (standardized β, βs = -0.35, p = 0.001), inhibitory control (βs = -0.30, p = 0.008), and emotional self-regulation (standardized beta, βs = -0.38, p < 0.001) were each significantly associated with greater EFCR. In exploratory analyses, a more structured parenting style (more authoritative or less permissive) mitigated the associations between inhibitory control and EFCR (Bonferroni-adjusted p-interaction < 0.017). Findings support that lower attentional focusing, inhibitory control, and emotional self-regulation relate to greater ECFR in preschool-age children. The association between inhibitory control and EFCR may be modified by parenting style. Further research is needed to understand if children's responsiveness to external food cues may account for reported associations between lower behavioral regulation and adiposity gain over time.

Psychometric Analysis of the Rapid Eating Assessment for Participants-Short Form to Evaluate Dietary Quality in a Pre-Surgical Bariatric Population

Dietary quality and eating behaviors are essential to evaluating bariatric surgery candidates. The Rapid Eating Assessment for Participants-Short Form (REAP-S) is a previously validated measure of dietary quality suited for use in primary care. This study aimed to evaluate the psychometric properties of the REAP-S in a pre-surgical bariatric population. This study included data from one academic medical center from August 2020 to August 2022. Variables included socio-demographics, the REAP-S, mental health, and assessments of appetitive traits. Statistical methods included Cronbach's alpha, confirmatory factor analysis (CFA), and multivariable analyses. A total of 587 adult patients were included in this analysis. The mean score for the REAP-S was 28.32 (SD: 4.02), indicative of relatively moderate dietary quality. The internal consistency of the REAP-S was moderate, with a Cronbach's alpha of 0.65. The three-factor CFA model resulted in a comparative fit index of 0.91. Race (p = 0.01), body mass index (p = 0.01), food fussiness (p < 0.0001), food responsiveness (p = 0.005), and socially desirable responses (p = 0.003) were significantly associated with the total REAP-S score. Although the REAP-S's original purpose was to assess dietary quality within a primary care population, it shows promise for application within a bariatric surgery-seeking population.

The development of an immersive mixed-reality application to improve the ecological validity of eating and sensory behavior research

Introduction

The modern eating environment has been implicated as a driving force of the obesity epidemic. Mixed reality applications may improve traditional methodological assessments of eating behavior by improving the ecological validity of the laboratory setting.

Methods

Research experts evaluated the utility and ecological validity of a mixed reality application that allowed immersion within virtual environments through utilizing the passthrough cameras of the head mounted display to view and interact with real foods. An initial evaluation was conducted that involved three virtual environments: a traditional laboratory booth, a non-textured restaurant, and a full-textured restaurant. The feedback from the initial evaluation was used to create a new virtual restaurant environment and a subsequent evaluation was conducted.

Results

Nearly all research experts suggested adding social cues such as people and background noise to create a more authentic and ecologically valid experience. The experts scored the new virtual restaurant environment to be more acceptable than eating or conducting research in a sensory booth but scored lower when compared to conducting research in a real-world restaurant setting.

Discussion

The results of this evaluation suggest that mixed reality applications may be a new methodology to assess environmental influences of eating behavior and may be a promising direction for eating behavior and sensory science research.

Corrigendum: Differential neural reward reactivity in response to food advertising medium in children

[This corrects the article DOI: 10.3389/fnins.2023.1052384.].

Differential neural reward reactivity in response to food advertising medium in children

Introduction

Food cues including food advertisements (ads) activate brain regions related to motivation and reward. These responses are known to correlate with eating behaviors and future weight gain. The objective of this study was to compare brain responses to food ads by different types of ad mediums, dynamic (video) and static (images), to better understand how medium type impacts food cue response.

Methods

Children aged 9-12 years old were recruited to complete a functional magnetic resonance imaging (fMRI) paradigm that included both food and non-food dynamic and static ads. Anatomical and functional images were preprocessed using the fMRIPrep pipeline. A whole-brain analysis and a targeted region-of-interest (ROI) analysis for reward regions (nucleus accumbens, orbitofrontal cortex, amygdala, insula, hypothalamus, ventral tegmental area, substantia nigra) were conducted. Individual neural responses to dynamic and static conditions were compared using a paired t-test. Linear mixed-effects models were then constructed to test the differential response by ad condition after controlling for age, sex, BMI-z, physical activity, and % of kcal consumed of a participant's estimated energy expenditure in the pre-load prior to the MRI scan.

Results

A total of 115 children (mean=10.9 years) completed the fMRI paradigm. From the ROI analyses, the right and left hemispheres of the amygdala and insula, and the right hemisphere of the ventral tegmental area and substantia nigra showed significantly higher responses for the dynamic food ad medium after controlling for covariates and a false discovery rate correction. From the whole-brain analysis, 21 clusters showed significant differential responses between food ad medium including the precuneus, middle temporal gyrus, superior temporal gyrus, and inferior frontal gyrus, and all regions remained significant after controlling for covariates.

Discussion

Advertising medium has unique effects on neural response to food cues. Further research is needed to understand how this differential activation by ad medium ultimately affects eating behaviors and weight outcomes.

User engagement with a popular food brand before, during and after a multi-day interactive marketing campaign on a popular live streaming platform

OBJECTIVE

To assess viewer engagement of a food advertising campaign on the live streaming platform Twitch.tv, a social media platform that allows creators to live stream content and communicate with their audience in real time.

DESIGN

Observational analysis of chat comments across the Twitch platform containing the word 'Wendy's' or 'Wendys' during a 5-day ad campaign compared with two 5-day non-campaign time periods. Comments were categorised as positive, negative or neutral in how their sentiment pertained to the brand Wendy's.

SETTING

Twitch chatrooms.

PARTICIPANTS

None.

RESULTS

There were significantly more chatroom messages related to the Wendy's brand during the campaign period. When considering all messages, the proportion of messages was statistically different (x2 = 1417·41, P < 0·001) across time periods, with a higher proportion of neutral and positive messages and a lower proportion of negative messages during the campaign compared with the comparison periods. Additionally, the proportion of negative messages following the campaign was lower than before the campaign. When considering only positive and negative messages, the proportion of messages was statistically different (x2 = 366·38, P < 0·001) across each time period with a higher proportion of positive messages and a lower proportion of negative messages during the campaign when compared with the other time periods. Additionally, there was a higher proportion of positive messages and a lower portion of negative messages following the campaign when compared with before the campaign.

CONCLUSIONS

This study demonstrates the impact and sustained impact of a fast-food brand ad campaign on brand engagement on the live streaming platform Twitch.

Associations between adolescent and young adult External Food Cue Responsiveness (EFCR) and brand recall, product craving and product purchasing in the livestreaming food marketing environment

OBJECTIVE

To evaluate the utility of three validated food responsiveness scales in measuring recall of, and responsiveness to, food marketing exposure on social media.

DESIGN

Cross-sectional survey among adolescents and adults who used the social media platform Twitch.tv (Twitch). Responsiveness to food marketing was self-reported as craving or purchasing any brands participants observed on Twitch. Participants completed three validated scales of food responsiveness: the revised 18-question Three Factor Eating Questionnaire (TFEQ), the external eating subscale of the Dutch Eating Behavior Questionnaire (DEBQ) and the External Food Cue Responsiveness (EFCR) scale. Adjusted linear regression models assessed the predictive ability of each scale on recall and responsiveness outcomes.

SETTING

Online survey.

PARTICIPANTS

Five hundred and sixty-eight Twitch users (90·1 % male, 60·6 % White, 43·7 % aged 18-24, 25·9 % under 18).

RESULTS

In separate adjusted linear regression models, scores on the TFEQ were not related to any outcome, while DEBQ scores related to product cravings (OR: 1·10, 95 % CI 1·01, 1·19, P = 0·02). In contrast, scores on the EFCR scale were significantly associated with higher brand recall (incident rate ratio: 1·42, 95 % CI 1·20, 1·68, P < 0·001), product craving (OR: 3·93, 95 % CI 2·22, 7·17, P < 0·001) and purchasing behaviour (OR: 3·97, 95 % CI 1·99, 8·26, P < 0·001). A subset of three EFCR scale items related to influencer marketing were similarly associated with each outcome with greater precision in the point estimates than the overall EFCR.

CONCLUSIONS

The EFCR scale predicted recall of and responsiveness to food marketing via Twitch, suggesting its utility in monitoring the effects of food marketing on social media.

Could dietary creatine intake modulate overweight elderly's selective attention and inhibitory function?

Aims: There is evidence that both aging and increased adiposity may impact creatine levels in the brain, and brain creatine levels are important for cognition. The aim of this study was to assess correlation between dietary creatine intake and cognition in in elderly women with overweight. Methods: Twenty seven overweight women over 60 years of age who were part of a larger study participated in an Eriksen Flanker Task (EFT) to asssess cognitive performance. Additionally, diet was assessed over 5 days via daily diary nutritional recalls and the estimate of the daily amount of creatine was calculated. Results: In the EFT when incongruente stimulus were presented there was a significant diferences between those with low and high intake of creatine (-35.3 ± 5.84; p < 0.001). Similarly, reaction time to answer incongruent stimulus (r = -0.383; p = 0.004) and the percent of correct answers (r = 0.743; p < 0.001) showed weak to strong correlations with self-reported daily creatine intake. Conclusions: In conclusion, our results suggest that in elderly women with overweight that dietary intake of creatine may influence cognitive ability. Clinical Implications: Our findings support the idea that intake of dietary creatine may be an important factor for cognition in older adults.

Use of a brief, retrospective Comprehensive Feeding Practices Questionnaire in a bariatric-surgery seeking adult population

Parental feeding practices in childhood have been shown to contribute to childhood eating habits, behaviors, and weight status. Less understood is the longitudinal impact of parental feeding practices on these variables in adulthood. Therefore, the aim of the present work was to validate a modified, brief, Comprehensive Feeding Practices Questionnaire (CFPQ) reformatted to account for retrospective recollections of parental feeding practices experienced in childhood among a sample of adults with obesity. Adults (n = 719, mean age = 44.3 years, mean BMI = 47.1 kg/m²) completed a modified, brief, retrospective CFPQ containing seven pre-defined subscales of the original CFPQ. Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) procedures were used to evaluate survey factor structure and associations with gender, BMI, and self-reported race. An EFA derived six-factor model demonstrated better model fit and reliability than the originally proposed seven-factor model. Gender and self-reported race were not correlated with subscales of the brief, retrospective, CFPQ, while BMI was positively correlated with the Food as Reward subscale. This six-factor, brief, retrospective, CFPQ can be used to provide insight into the potential origins of individual eating behaviors, and warrants use in future work attempting to clarify the relationships between parental feeding practices and eating behaviors in adulthood.

Remote iVR for Nutrition Education: From Design to Evaluation

While different crowdsourcing platforms promote remote data collection, experiments in the immersive Virtual Reality (iVR) research community are predominantly performed in person. The COVID-19 pandemic, however, has forced researchers in different disciplines, including iVR, to seriously consider remote studies. In this paper, we present a remote study using the Immersive Virtual Alimentation and Nutrition (IVAN) application, designed to educate users about food-energy density and portion size control. We report on the results of a remote experiment with 45 users using the IVAN app. In IVAN, users actively construct knowledge about energy density by manipulating virtual food items, and explore the concept of portion size control through hypothesis testing and assembling virtual meals in iVR. To explore the feasibility of conducting remote iVR studies using an interactive health-related application for nutrition education, two conditions were devised (interactive vs. passive). The results demonstrate the feasibility of conducting remote iVR studies using health-related applications. Furthermore, the results also indicate that regardless of level of interactivity learners significantly improved their knowledge about portion size control after using the IVAN (p &lt; 0.0001). Adding interactivity, however, suggests that the perceived learning experience of users could be partially affected. Learners reported significantly higher scores for immediacy of control in the interactive condition compared to those in the passive condition (p &lt; 0.05). This study demonstrates the feasibility of conducting an unsupervised remote iVR experiment using a complex and interactive health-related iVR app.

Influence of exclusive breastfeeding on hippocampal structure, satiety responsiveness, and weight status

Longer exclusive breastfeeding duration has been associated with differences in neural development, better satiety responsiveness, and decreased risk for childhood obesity. Given hippocampus sensitivity to diet and potential role in the integration of satiety signals, hippocampus may play a role in these relationships. We conducted a secondary analysis of 149, 7–11‐year‐olds (73 males) who participated in one of five studies that assessed neural responses to food cues. Hippocampal grey matter volume was extracted from structural scans using CAT12, weight status was assessed using age‐ and sex‐adjusted body mass index (%BMI_p85), and parents reported exclusive breastfeeding duration and satiety responsiveness (Children's Eating Behaviour Questionnaire). Separate path models for left and right hippocampus tested: (1) the direct effect of exclusive breastfeeding on satiety responsiveness and its indirect effect through hippocampal grey matter volume; (2) the direct effect of hippocampal grey matter volume on %BMI_p85 and its indirect effect through satiety responsiveness. %BMI_p85 was adjusted for maternal education, yearly income, and premature birth while hippocampal grey matter volume was adjusted for total intercranial volume, age, and study from which data were extracted. Longer exclusive breastfeeding duration was associated with greater bilateral hippocampal grey matter volumes. In addition, better satiety responsiveness and greater left hippocampal grey matter volume were both associated with lower %BMI_p85. However, hippocampal grey matter volumes were not associated with satiety responsiveness. Although no relationship was found between breastfeeding and child weight status, these results highlight the potential impact of exclusive breastfeeding duration on the hippocampal structure.

Longer exclusive breastfeeding was associated with greater bilateral hippocampal grey matter volume but not satiety responsiveness in children.

While exclusive breastfeeding duration was not directly associated with weight status, better satiety responsiveness and greater left hippocampal grey matter volume were both associated with lower weight status in children.

This study highlights the potential impact of exclusive breastfeeding on hippocampal structure, providing a possible mechanism in which breastfeeding may reduce the risk for excess childhood weight gain.

Future studies need to determine the relative impact that complementary periods of breastfeeding may have on regional brain development and satiety responsiveness.

Twitch user perceptions, attitudes and behaviours in relation to food and beverage marketing on Twitch compared with YouTube

Influencer marketing may be amplified on livestreaming platforms (e.g., Twitch) compared with asynchronous social media (e.g., YouTube). However, food and beverage marketing on Twitch has not been evaluated at a user level. The present study aimed to compare users' self-reported exposure to food marketing and associated attitudes, consumption and purchasing behaviours on Twitch compared with YouTube. A survey administered via social media was completed by 621 Twitch users (90 % male, 64 % white, 69 % under 25 years old). Of respondents, 72 % recalled observing at least one food or beverage advertisement on Twitch. There were significant differences in the recall of specific brands advertised on Twitch (P < 0⋅01). After observing advertised products, 14 % reported craving the product and 8 % reported purchasing one. In chat rooms, 56 % observed conversations related to food and 25 % participated in such conversations. There were significant differences in the number of users who consumed various products while watching Twitch (P < 0⋅01). Of users who frequented YouTube (n 273), 65 % reported negative emotions when encountering advertising on YouTube compared with 40 % on Twitch (P < 0⋅01). A higher proportion felt Twitch's advertising primarily supported content creators (79 v. 54 %, P < 0⋅01), while a higher proportion felt that YouTube's advertising primarily supported the platform (49 v. 66 %, P < 0⋅01). The findings support that food marketing exposures on Twitch are noticeable, less bothersome to users and influence consumption and purchasing behaviours. Future studies are needed to examine how the livestreaming environment may enhance advertising effectiveness relative to asynchronous platforms.

Differences in preferred fat level, sweetener type, and amount of added sugar in chocolate milk in a choice task relate to physical activity and orthorexia

Fluid dairy milk consumption has decreased over the last 4 decades, and this drop has accelerated with the introduction of many competing beverage alternatives, such as plant-based milks and bottled water. Conversely, flavored milk sales remain strong, but many adults avoid flavored milk because of concerns about added sugar and calories and/or excessive sweetness. Here we used two discrete choice experiments to assess interest for a dark chocolate milk drink in adults, and explored whether there might be a consumer segment who prefers a more bitter, lower sugar chocolate milk. Adults were recruited from the Mid-Atlantic region of the United States for two conjoint analysis studies. In a general population cohort (n = 735), type of sweetener was the most important attribute (24%), followed by milk fat (19%), grams of added sugar (16%), front of pack messaging (15%), package type (12%), carton size (8%), and protein content (6%). Attribute importance was relatively consistent in a second study with a younger, more physically active cohort (n = 1017). Product choices in the active cohort were related to orthorexia and physically activity scores, indicating revealed preferences in a choice task are reflective of personal lifestyle and eating behavior. In both cohorts, three consistent consumer segments were identified and characterized: the calorie conscious, the average consumer, and the natural eaters. These data can help uncover lifestyle differences between adult consumers that impact their food product choices.

Prevalence and strategies of energy drink, soda, processed snack, candy and restaurant product marketing on the online streaming platform Twitch

OBJECTIVE

To evaluate the prevalence of food and beverage marketing on Twitch.tv (Twitch), a social media platform where individuals broadcast live audiovisual material to millions of daily users.

DESIGN

Observational analysis of the prevalence of 238 food and beverage brands in five distinct categories (processed snacks; food delivery services and restaurants; candies, energy drinks/coffees/teas; and sodas and other sugar-sweetened beverages) over the course of 18 months.

SETTING

Twitch streamer profiles and stream titles between January 2018 and July 2019. Twitch chat room messages during July 2019.

PARTICIPANTS

None.

RESULTS

There was a significant increase in brand exposure on Twitch both in stream titles (sodas and candies, P < 0·05) and on streamer profiles (sodas, restaurants/food delivery services, candies, and energy drinks/coffees/teas, P < 0·05) over the 18-month study period. Energy drinks, coffees and teas had the most exposure with 1·08 billion exposure hours from profiles and 83 million exposure hours from titles. Restaurants/food delivery services and sugar-sweetened beverages were the most frequently mentioned products in chat rooms with 1·24 million messages and 1·10 million messages, respectively.

CONCLUSIONS

This study is the first to demonstrate the extent by which food and beverage brands garner millions of hours of exposure on Twitch. Future studies should evaluate the impact that this level of exposure to nutrient-poor, energy-dense products may have on behavioural and health outcomes.

"Healthy"/"Unhealthy" Food Brands Influence Health, Calorie, and Price Ratings of Food

OBJECTIVE

To assess the effect of healthy or unhealthy food brands on consumer ratings of a food's perceived healthfulness, caloric content, and estimated price.

METHODS

Using a crossover design, 35 adults aged 18-25 years scored a variety of healthy and unhealthy foods paired with "healthy" or "unhealthy" brands or with no brand present, on their healthfulness, caloric content, and estimated price. For each outcome measure, ANOVA was used to evaluate the effect of brand condition on healthy and unhealthy foods.

RESULTS

Pairing an unhealthy food with a "healthy brand" led to increased ratings of healthfulness (P < .001), decreased estimates of caloric content (P < .001), and increased price (P < .001). Pairing a healthy food with an "unhealthy brand" led to decreased ratings of healthfulness (P < .001), increased estimates of caloric content (P < .001), and decreased price (P < .001).

CONCLUSIONS AND IMPLICATIONS

These findings extend previous research showing that brands may influence perceptions of food products. Future studies are needed to understand the implications of pairing healthy foods with "unhealthy brands" on actual food intake.

Relationships Among Dietary Cognitive Restraint, Food Preferences, and Reaction Times

Objective

To assess the associations between dietary cognitive restraint, disinhibited eating, and how taste and health perceptions relate to food preference; and further, whether cognitive restraint and disinhibited eating are associated with food preference decision reaction time.

Methods

Five hundred and seventeen adults participated in the study. Dietary cognitive restraint and disinhibited eating were assessed using the shortened Three-Factor Eating Questionnaire (TFEQ-R18). Participants also completed a dietary decision-making task to examine their food-related decisions. Participants were presented with 50 food items and asked to rate them for health and for taste. Participants were then presented with a reference food item and comparison items one at a time and asked to indicate which of the two foods they would prefer to eat.

Results

Participants with higher levels of cognitive restraint were more sensitive to health perceptions whereas those with higher levels of disinhibited eating were more sensitive to taste perceptions when indicating food preference. Reaction time analysis corroborated these results. Being classified as high for cognitive restraint was associated with faster reaction times if the preferred food was rated as healthier than the referent food. Conversely, being classified as high for disinhibited eating was associated with faster reaction times if the preferred food was rated as tastier than the referent food.

Conclusion

The dietary decision-making task appears to capture distinct aspects of dietary restraint and disinhibition and may be useful in future studies to measure and/or alter levels of dietary restraint and disinhibition.

Association between regional brain volumes and BMI z-score change over one year in children

PURPOSE

Associations between brain region volume and weight status have been observed in children cross-sectionally. However, it is unclear if differences in brain region volume precede weight gain.

METHODS

Two high-quality structural brain images were obtained approximately one year apart in 53 children aged 9-12 years old. Children's height and weight were also measured at each scan. Structural images were processed using the FreeSurfer software-package providing volume measures for regions of interest including the entorhinal cortex, nucleus accumbens, and hippocampus. Age- and sex-adjusted BMI z-scores (BMIz) were calculated at both timepoints. The association between brain region volume and BMIz was examined cross-sectionally using linear regression and longitudinally using structural equation modeling. All models were adjusted by estimated cranial volume to account for individual variation in head size and were corrected for multiple comparisons (pFDR<0.05).

RESULTS

The sample of children was primarily healthy weight at baseline (79.78%). Cross-sectionally at the one-year follow-up, a positive relationship was observed between right hippocampal volume and BMIz (β = 0.43, 95% CI = (0.10, 0.77)). Longitudinally a negative relationship was observed between right entorhinal volume at baseline and BMIz at the one-year follow-up (β = -0.25, 95% CI = (-0.44, -0.07)).

CONCLUSION

These results suggest that measured volumes from certain regions of the brain that have been associated with BMI in adults are associated with both concurrent BMIz and BMIz change over one-year in a primarily healthy weight sample of children. As the entorhinal cortex integrates signals from both reward and control regions, this region may be particularly important to weight management during child development.

Time spent looking at food during a delay of gratification task is positively associated with children's consumption at ad libitum laboratory meals

Greater ability to delay gratification for an immediate food reward may protect against the development of obesity. However, it is not known if the behaviors children exhibit during a delay of gratification task are related to overeating in other contexts. The purpose of this analysis was to assess the relationship between observed child coping strategies during a delay of gratification task and laboratory intake from ad libitum test-meals. The sample consisted of 40, 7-9 year old children (40% (N = 16 with overweight/obesity). Across 5 laboratory visits, children consumed 3 identical test-meals presented after varying exposure conditions (i.e., no exposure, exposure to food commercials, exposure to toy commercials). On the first visit, children were recorded during a delay of gratification task which was coded for three behavioral themes: looking at vs. away from food, talking vs. staying silent, and fidgeting vs. sitting still. Pearson correlations and multiple regressions were run to look at the relationships between coping strategies and test-meal intake. Time spent looking away from food was negatively associated with ad libitum food consumption at the meals. Conversely, greater time spent looking at food was positively associated with ad libitum food consumption. These relationships were independent of covariates likely to influence intake (e.g., sex, age, weight status, parent income) and were more robust following food rather than toy commercial exposure. Children who spent more time looking at food and less time looking away during a delay of gratification task may be vulnerable to overeating in other contexts. Upon replication in larger samples, these behaviors could serve as modifiable targets in the development of childhood obesity prevention programs.

Measurement of external food cue responsiveness in preschool-age children: Preliminary evidence for the use of the external food cue responsiveness scale

BACKGROUND

Conditioned eating in response to external food cues may contribute to obesity risk in young children.

OBJECTIVES

To develop a brief, parent-reported scale to measure external food cue responsiveness for preschool-age children.

METHODS

Focus groups with parents of preschool-age children were conducted to create an initial pool of items reflecting children's behavioral responses to external food cues. Items were included in a nationally-distributed online survey of parents of preschool-age children (n = 456). Factor analysis was used to reduce the initial item pool, the scale's psychometric properties were assessed, and scores were correlated with reported snacking behaviors.

RESULTS

Nine items met inclusion criteria in the final scale, which had high internal consistency (alpha = 0.86). Final scores were the mean across the nine items. External food cue responsiveness was greater among children with, versus without, usual TV advertisement exposure. Furthermore, greater external food cue responsiveness mediated the relationship between children's usual TV advertisement exposure and snacking during TV viewing. Findings remained statistically significant when adjusted for food responsiveness as measured with the Child Eating Behavior Questionnaire.

CONCLUSIONS

Findings provide preliminary evidence that external food cue responsiveness is measurable by parental report in preschool-age children.

Brain reactivity to visual food stimuli after moderate-intensity exercise in children

Exercise may play a role in moderating eating behaviors. The purpose of this study was to examine the effect of an acute bout of exercise on neural responses to visual food stimuli in children ages 8-11 years. We hypothesized that acute exercise would result in reduced activity in reward areas of the brain. Using a randomized cross-over design, 26 healthy weight children completed two separate laboratory conditions (exercise; sedentary). During the exercise condition, each participant completed a 30-min bout of exercise at moderate-intensity (~ 67% HR maximum) on a motor-driven treadmill. During the sedentary session, participants sat continuously for 30 min. Neural responses to high- and low-calorie pictures of food were determined immediately following each condition using functional magnetic resonance imaging. There was a significant exercise condition*stimulus-type (high- vs. low-calorie pictures) interaction in the left hippocampus and right medial temporal lobe (p < 0.05). Main effects of exercise condition were observed in the left posterior central gyrus (reduced activation after exercise) (p < 0.05) and the right anterior insula (greater activation after exercise) (p < 0.05). The left hippocampus, right medial temporal lobe, left posterior central gyrus, and right anterior insula appear to be activated by visual food stimuli differently following an acute bout of exercise compared to a non-exercise sedentary session in 8-11 year-old children. Specifically, an acute bout of exercise results in greater activation to high-calorie and reduced activation to low-calorie pictures of food in both the left hippocampus and right medial temporal lobe. This study shows that response to external food cues can be altered by exercise and understanding this mechanism will inform the development of future interventions aimed at altering energy intake in children.

Perceived Exertion during Exercise Is Associated with Children's Energy Intake

PURPOSE

To examine the individual-level factors that predict energy intake (EI) after imposed exercise (EX) and sedentary time (SED) in children.

METHODS

Healthy-weight children ages 9-12 yr (n = 20) reported to the laboratory for one baseline and two experimental visits (EX and SED) each separated by 1 wk in a randomized crossover design. Percent body fat, weight (kg), and height (m) were used to calculate fat-mass index (FM index) and fat-free mass index (FFM index; kg·m). On the EX day, children exercised at 70% estimated V˙O2peak for 30 min on a cycle ergometer, whereas cardiovascular responses and RPE were measured. Objective EI (kcal) was measured at identical meals (breakfast, lunch, snack, and dinner) on the EX and SED days.

RESULTS

Total EI was not statistically different between the EX and SED days (t = 1.8, P = 0.09). FFM index was positively associated with EI on the EX day (r = 0.54, P < 0.05). RPE was also positively associated with EI on the EX day (r = 0.82, P < 0.001). Together, FFM index and RPE explained 77% of the variability in EX day EI (F(2,17) = 26.4, P < 0.001). For each unit increase in RPE, children consumed approximately 270 more calories on the EX day. A similar pattern of associations was observed on the SED day.

CONCLUSIONS

FFM index was positively associated with EI on the EX day. Despite experiencing the same 70% relative exercise intensity, increased perceived difficulty predicted greater EI on both the EX and SED day. These findings demonstrate a role for both FFM and RPE in explaining EI variability in children.

Changes in Behaviors and Outcomes Among School-Based Employees in a Wellness Program

OBJECTIVE

To examine the health behavior changes and mental-health and job-related outcomes of school-based employees over 2 years while participating in a worksite wellness program.

METHOD

All participants in this analysis (n = 1,873) were employees of a large public school district in the western United States and voluntarily enrolled in a comprehensive wellness program. Exercise level, fruit and vegetable consumption, restful sleep, smoking, alcohol consumption, self-rated health, mental health-related outcomes (stress, depression, life-satisfaction, and loneliness), and job-related outcomes (job performance, absenteeism, job-related satisfaction) are reported.

RESULTS

There was an increase in days and minutes/week exercised, fruit/vegetable consumption, days per week of restful sleep, and a decrease in alcohol consumption (ps < .037) over 2 years. Among those who reported smoking, the number of days smoked increased after 1 year but then dropped below baseline levels at year 2 (p < .0001). Several mental health-related outcomes improved (ps < .033); however, job performance was slightly lower (↓ 2%), and the other job-related outcomes were unchanged.

CONCLUSION

School employees may benefit from a comprehensive worksite wellness program, particularly to improve health behaviors. However, mental health and job-related outcome results were mixed over 2 years.

Impact of imposed exercise on energy intake in children at risk for overweight

Background

Exercise not only has a direct effect on energy balance through energy expenditure (EE), but also has an indirect effect through its impact on energy intake (EI). This study examined the effects of acute exercise on daily ad libitum EI in children at risk for becoming overweight due to family history.

Methods

Twenty healthy-weight children (ages 9–12 years, 12 male/8 female) with at least one overweight biological parent (body mass index ≥ 25 kg/m²) participated. Children reported to the laboratory for one baseline and two experimental visits (EX = exercise, SED = sedentary) each separated by 1 week in a randomized crossover design. Two hours into the EX day session, children exercised at 70 % estimated VO_2max for 30 min on a cycle ergometer. Objective EI (kcal) was measured at a standard breakfast (~285 kcal) and ad libitum lunch, snack and dinner. Meals were identical on the EX and SED days. Activity-related EE (kcal) was estimated with accelerometers worn on the non-dominant wrist and ankle. Relative EI (kcal) was computed as the difference between Total EI and Activity-related EE for each testing day. Paired t-tests were performed to test differences in Total EI, Activity-related EE and Relative EI between the EX and SED days.

Results

Across all meals, Total EI was not statistically different between the EX and SED days (t = 1.8, p = 0.09). Activity-related EE was greater on the EX day compared to the SED day (t = 10.1, p < 0.001). By design, this difference was predominantly driven by activity during the morning (t = 20.4, p < 0.001). Because children consumed a similar number of kcal on each day, but had greater Activity-related EE on the EX day, Relative EI was lower (t = −5.15, p < 0.001) for the EX day (1636 ± 456 kcal) relative to the SED day (1862 ± 426 kcal).

Conclusions

Imposed exercise was effective in reducing Relative EI compared to being sedentary. Morning exercise may help children at risk for becoming overweight to better regulate their energy balance within the course of a day.