US tobacco companies selectively disseminated hyper-palatable foods into the US food system: Empirical evidence and current implications

BACKGROUND AND AIMS

US tobacco companies owned leading US food companies from 1980 to 2001. We measured whether hyper-palatable foods (HPF) were disproportionately developed in tobacco-owned food companies, resulting in substantial tobacco-related influence on the US food system.

DESIGN

The study involved a review of primary industry documents to identify food brands that were tobacco company-owned. Data sets from the US Department of Agriculture were integrated to facilitate longitudinal analyses estimating the degree to which foods were formulated to be hyper-palatable, based on tobacco ownership.

SETTING AND CASES

United States Department of Agriculture data sets were used to identify HPF foods that were (n = 105) and were not (n = 587) owned by US tobacco companies from 1988 to 2001.

MEASUREMENTS

A standardized definition from Fazzino et al. (2019) was used to identify HPF. HPF items were identified overall and by HPF group: fat and sodium HPF, fat and sugar HPF and carbohydrates and sodium HPF.

FINDINGS

Tobacco-owned foods were 29% more likely to be classified as fat and sodium HPF and 80% more likely to be classified as carbohydrate and sodium HPF than foods that were not tobacco-owned between 1988 and 2001 (P-values = 0.005-0.009). The availability of fat and sodium HPF (> 57%) and carbohydrate and sodium HPF (> 17%) was high in 2018 regardless of prior tobacco-ownership status, suggesting widespread saturation into the food system.

CONCLUSIONS

Tobacco companies appear to have selectively disseminated hyper-palatable foods into the US food system between 1988 and 2001.

Eating-disorder psychopathology in female athletes and non-athletes: A meta-analysis

OBJECTIVE

There is ongoing discussion about whether sports participation is a risk or protective factor for eating disorders (EDs). Research is mixed, with some studies suggesting that athletes have higher mean levels of ED psychopathology compared to nonathletes, while other studies suggest the opposite effect or no differences. The purpose of the current meta-analysis was to identify whether female athletes reported higher mean levels of ED psychopathology compared to nonathletes.

METHOD

Following PRISMA guidelines, we identified 56 studies that reported ED psychopathology for female athletes and nonathletes. A three-level random-effects model of between- and within-study variance was completed for the following outcome variables: overall ED psychopathology, body dissatisfaction, drive for thinness, restricting, and loss-of-control eating.

RESULTS

Athletes reported lower levels of body dissatisfaction compared to nonathletes (g = -.21, p < .0001). Athletes and nonathletes reported similar levels of overall ED psychopathology, drive for thinness, restricting, and loss-of-control eating on average. Sport type significantly moderated standardized mean difference effect sizes of ED psychopathology in athletes versus nonathletes. Effect sizes comparing levels of drive for thinness, restricting, and loss-of-control eating in athletes versus nonathletes were larger for studies with athletes participating in aesthetic/lean sports compared to nonaesthetic/nonlean sports.

DISCUSSION

Findings from this meta-analysis could inform future ED prevention and treatment in female athletes by providing further evidence that athletes in aesthetic/lean sports may report higher levels of ED psychopathology. Participating in nonaesthetic/nonlean sports may be a protective factor for experiencing less body dissatisfaction.

PUBLIC SIGNIFICANCE STATEMENT

The current meta-analysis summarized findings from 56 studies that assessed levels of disordered eating, body dissatisfaction, dietary restricting, and loss-of-control eating in female athletes and nonathletes. Athletes reported lower levels of body dissatisfaction compared to nonathletes, highlighting that participation in sport could have some protective factors. Athletes participating in sports that require weight categories (e.g., judo) and sports that emphasize thinness/leanness (e.g., gymnastics and distance running) had higher levels of disordered eating relative to athletes participating in other types of sports that do not emphasize thinness/leanness (e.g., volleyball and basketball).

Choices between money and hyper-palatable food: Choice impulsivity and eating behavior

OBJECTIVE

Choice impulsivity may influence eating behavior. The study tested whether choice impulsivity, termed delay discounting, may be related to food generally, or may be specific to hyper-palatable foods (HPF). The study also determined whether a discounting task with choices between money and food may have utility in predicting obesity-related outcomes.

METHOD

Participants (N = 284) completed a task that assessed choices between smaller reward available immediately and larger reward available later. Single commodity conditions presented choices between amounts of HPF, non-HPF, or money (e.g., HPF now vs. HPF later). Cross-commodity conditions presented choices between money and food commodities (e.g., money now vs. HPF later; money now vs. non-HPF later).

RESULTS

There were no significant differences in discounting of HPF and non-HPF in single commodity conditions (Mean ln[k] difference = .40, p = .058). In the cross-commodity conditions holding money constant as the immediate reward, individuals discounted HPF significantly less than non-HPF (Mean ln[k] difference = .92; p = .0001). In regression analyses, individuals with excess HPF intake, greater HPF craving, and higher BMIs were more likely to choose HPF immediately, when money was the delayed reward (p values = .003 to .008).

CONCLUSIONS

Choice impulsivity may be specific to foods that are hyper-palatable. Results suggest that individuals with excess HPF intake, higher HPF craving, and higher BMIs may exhibit a general tendency toward impulsive decision making that may be exacerbated in an obesogenic environment that provides wide access to HPF. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Hyper-palatable food consumption during binge-eating episodes: A comparison of intake during binge eating and restricting

OBJECTIVE

The study aim was to elucidate the degree to which hyper-palatable foods (HPF) are consumed during binge episodes compared to restricting episodes, and to test the association between HPF intake during each episode and respective episode frequency.

METHOD

This study was a secondary analysis of data from a larger study on eating disorders. The present sample included adults (N = 147, 83% women) diagnosed with sub-threshold (41%) or full-threshold (59%) bulimia nervosa (BN). Foods consumed during binge and restricting episodes were assessed using the Eating Pathology Symptoms Inventory-Clinician Rated Version. A standardized definition of HPF developed previously was applied to foods consumed during binge and restricting episodes. A Wilcoxon matched-pairs signed-rank test was used to test the difference between total caloric intake from HPF (KcalHPF) and percentage of caloric intake from HPF (PercHPF) during binge episodes relative to restricting episodes. Four linear regression models tested HPF intake (KcalHPF and PercHPF) during both episode types (binge and restricting) as predictors of respective episode frequency.

RESULTS

There was a significant difference between median KcalHPF (1846.6 vs. 279.6; Z = -13.38, p < .001) and PercHPF during binge compared to restricting episodes (95% vs. 61%; Z = -7.35, p < .001). Regression analyses demonstrated that KcalHPF during binge episodes was significantly associated with binge episode frequency (B = 0.002; p < .001), but not PercHPF (p = .287).

DISCUSSION

Results suggest that HPF may be primarily consumed during binge episodes among individuals with BN, and may be associated with greater binge-eating frequency.

PUBLIC SIGNIFICANCE

Findings from the current study support an underlying assumption of theoretical models of binge eating, suggesting that highly rewarding, hyper-palatable foods (HPF), may constitute the vast majority of energy intake during binge-eating episodes. Additionally, a substantial amount of energy intake from HPF may occur during restricting episodes among people with bulimia nervosa. Greater HPF intake during binge eating may also be associated with binge-eating severity.

Food insecurity associated with elevated eating disorder symptoms, impairment, and eating disorder diagnoses in an American University student sample before and during the beginning of the COVID-19 pandemic

OBJECTIVE

This study tested the association between food insecurity and eating disorder (ED) pathology, including probable ED diagnosis, among two cohorts of university students before and during the beginning of the COVID-19 pandemic.

METHOD

Students (n = 579) from a large Midwestern American university completed self-report questionnaires assessing frequency of ED behaviors, ED-related impairment, and individual food insecurity as measured by the Eating Disorder Diagnostic Scale 5, Clinical Impairment Assessment, and Radimer/Cornell, respectively. Chi-square tests and MANOVA with post-hoc corrections were conducted to compare demographic characteristics, ED pathology, and probable ED diagnosis prevalence between students with and without individual food insecurity.

RESULTS

Partially supporting hypotheses, MANOVA indicated significantly greater frequency of objective binge eating, compensatory fasting, and ED-related impairment for students with food insecurity compared with individuals without food insecurity. Chi-squared tests showed higher prevalence of ED diagnoses among individuals with food insecurity compared with those without food security (47.6 vs. 31.1%, respectively, p < .01, NNT = 6.06), specifically bulimia nervosa and other specified feeding and eating disorder. There were no differences in food insecurity before or during the beginning of the COVID-19 pandemic.

DISCUSSION

Consistent with prior literature, food insecurity was associated with elevated ED psychopathology in this sample. Findings emphasize the importance of proper ED screening for college students vulnerable to food insecurity and EDs.

Impulsivity as a risk factor for weight gain and body roundness change among college freshmen

BACKGROUND

The college setting is considered an obesogenic environment due to high availability of palatable foods. However, only a minority of freshmen gain weight. Individual-level risk factors, such as impulsivity, may hold utility in predicting weight and adiposity changes. Individuals with an impulsive decision-making style may favor immediately rewarding foods at the expense of long-term health. Individuals who seek rewarding foods during strong emotions may also be at risk. The study tested decisional (delay-discounting; DD) and emotion-driven impulsivity (urgency) as risk factors for 1) weight and 2) body roundness change during freshman year.

METHODS

Freshmen (N = 103) completed questionnaires assessing DD, positive urgency (PU), and negative urgency (NU). Weight and body roundness index (BRI) were collected at the beginning and end of the academic year. Four repeated measures regression models examined impulsivity factors predicting change in 1) weight and 2) BRI. Models included baseline weight and height or BRI, respectively. Covariates included average daily caloric intake, energy expenditure from walking, and sex.

RESULTS

In models examining weight, neither DD nor NU were significantly associated with weight at follow-up (b = 0.008, p = .977; b = 0.280, p = .075) when holding covariates constant. In contrast, PU was significantly associated with weight at follow-up (b = 0.303, p = .033). In models examining BRI, DD (b = -0.039, p = .511) and PU (b = 0.049, p = .072) were not associated with BRI at follow-up. In contrast, NU was significantly associated with BRI at follow-up (b = 0.068, p = .017).

CONCLUSIONS

Emotion-driven impulsivity may be a risk factor for weight gain or change in body roundness during freshman year.

Comparing integrative cognitive-affective therapy and guided self-help cognitive-behavioral therapy to treat binge-eating disorder using standard and naturalistic momentary outcome measures: A randomized controlled trial

OBJECTIVE

Innovative treatments and outcome measures are needed for binge-eating disorder (BED). This randomized controlled trial compared Integrative Cognitive-Affective Therapy (ICAT-BED), an individual psychotherapy targeting momentary behavioral and emotional precipitants of binge eating, with an established cognitive-behavioral guided self-help (CBTgsh) treatment using standard and ecological momentary assessment (EMA) outcome measures.

METHOD

A total of 112 participants were randomized to 17 weeks of treatment (21 sessions for ICAT-BED and 10 sessions for CBTgsh). Binge-eating frequency was assessed with the Eating Disorder Examination (EDE) as well as EMA using cell phone-based real-time, naturalistic assessment at end of treatment (EOT) and 6-month follow-up. Hypothesized maintenance mechanisms were assessed using self-report questionnaires.

RESULTS

Binge-eating frequency as measured by the EDE and real-time assessment showed significant reductions at EOT and follow-up, with no significant differences between treatments. Hypothesized maintenance mechanisms, including emotion regulation, cognitive self-discrepancy, self-directed style, as well as measures of associated eating disorder psychopathology, depression, anxiety, impulsivity, and negative affect, showed similar improvement at EOT and follow-up with no differences between treatments. Abstinence rates at EOT (ICAT-BED: 57.1%; CBTgsh: 42.9%) and 6-month follow-up (ICAT-BED: 46.4%; CBTgsh: 42.9%) were not significantly different. Treatment retention was significantly higher for ICAT-BED (87.5%) than CBTgsh (71.4%).

DISCUSSION

These findings suggest that ICAT-BED and CBTgsh were associated with similar improvements in binge eating, psychopathology, and putative maintenance mechanisms as measured by traditional self-report and momentary, naturalistic assessments and that these changes were generally sustained at 6-month follow-up.

Self-discrepancy theory as a transdiagnostic framework: A meta-analysis of self-discrepancy and psychopathology

Self-discrepancy theory (SDT) is a model of the relations between the self and affect which has been applied to the study of different types of psychopathology including depression, anxiety, and eating disorders. Although the theory itself is compatible with a transdiagnostic perspective on psychopathology, to date no systematic review of the literature has examined that possibility. We conducted a meta-analysis that synthesized the literature on self-discrepancy and psychopathology across a heterogeneous range of 70 studies. Results showed a small-to-medium association between self-discrepancy and psychopathology that was highly robust and similar in magnitude across domains. Furthermore, self-discrepancy was related to higher levels of a range of negative emotions and lower levels of a range of positive emotions. Meta-regression models showed that the effects were greater for actual:ideal discrepancy compared with actual:ought discrepancy for both depression and anxiety, which was contrary to the tenets of SDT which suggests specific associations between actual:ideal discrepancy and depression and actual:ought discrepancy and anxiety. Measurement type (i.e., idiographic vs. nomothetic) was a significant predictor of the effects for depression and anxiety, such that nomothetic measures evidenced greater associations compared with idiographic measures. Our findings could suggest that self-discrepancy represents a contributory factor related to a number of psychiatric disorders. However, the tenet of SDT suggesting unique associations between actual:ideal and actual:ought discrepancy and anxiety and depression respectively was not supported. Implications are discussed for future research on self-discrepancy and psychopathology including the study of mechanistic frameworks. (PsycINFO Database Record (c) 2019 APA, all rights reserved).