Are Peripheral Biomarkers Determinants of Eating Styles in Childhood and Adolescence Obesity? A Cross-Sectional Study

Disturbances in eating behaviors have been widely related to obesity. However, little is known about the role of obesity-related biomarkers in shaping habitual patterns of eating behaviors (i.e., eating styles) in childhood. The objective of the present study was to explore the relationships between several biomarkers crucially involved in obesity (ghrelin, insulin resistance, and leptin/adiponectin ratio) and eating styles in children and adolescents with obesity. Seventy participants aged between 8 and 16 (56.2% men) fulfilled the Spanish version of the Dutch Eating Behavior Questionnaire for Children to measure external, emotional, and restrained eating styles. In addition, concentrations of ghrelin, leptin, adiponectin, insulin, and glucose were obtained through a blood test. Hierarchical multiple regression analyses controlling for age and sex were computed for each eating style. Results indicated that individuals with higher ghrelin concentration levels showed lower scores in restrained eating (β = −0.61, p < 0.001). The total model explained 32% of the variance of the restrained pattern. No other relationships between obesity-related biomarkers and eating behaviors were found. This study highlights that one of the obesity-risk factors, namely lower plasma ghrelin levels, is substantially involved in a well-known maladaptive eating style, restraint eating, in childhood obesity.

Indicated, Internet-based Prevention for Women With Anorexia Nervosa Symptoms: A Randomised Controlled Efficacy Trial (Preprint)

BACKGROUND While preventive interventions for eating disorders in general have shown promise, interventions specifically targeting individuals at risk for anorexia nervosa have not been evaluated. OBJECTIVE To determine the efficacy of a guided, indicated, Internet-based prevention program for women at risk for anorexia nervosa (AN). METHODS Randomized, controlled efficacy trial for women at risk for AN. Assessments at baseline (pre), post-intervention (10 weeks after baseline), 6-, and 12-month follow-up (FU). 168 women with low body weight (17.5≤BMI≤19) and high weight concerns, or with normal body weight 19<BMI≤25, high weight concerns and high restrained eating were recruited from three German universities as well as online, and randomized to Student Bodies-AN (SB-AN) or a waiting list control group (CG). Exclusion criteria were current DSM-IV full-syndrome AN, bulimia nervosa or binge eating disorder, serious medical or mental problems, such as current substance abuse, acute or chronic organic or schizophrenic psychosis, severe suicidal ideation or behaviour, no Internet access. Interventions: 1. Cognitive-behavioural, guided, Internet-based prevention program (SB-AN) over 10 weeks (IG); 2. Waiting list control condition (CG). Primary outcomes were clinically significant changes in attitudes and behaviours of disordered eating, and change in BMI in the underweight group of participants at 12-month follow-up. Secondary outcomes are new onset of eating disorders, symptoms of disordered eating, and associated psychopathology. RESULTS Data were available at post-intervention for N=137 women, and for N=116 women at 12-month FU. At 12-month FU, IGs participants showed larger decreases in EDE Total scores (79% vs. 57%) compared to the CG, and underweight IG participants also showed larger clinically relevant increases in BMI (49% vs. 32%) compared with underweight CG participants, but these differences were not significant. In addition, at post-intervention and 12-month follow-up, we found a significant increase in continuously measured BMI for underweight participants and significant improvements in attitudes and behaviours of disordered eating (e.g., restrained eating, weight and shape concerns). At all time points, rates of newly emerging ED onset cases were (non-significantly) lower in the IG compared with the CG and reductions in DSM-5-based ED syndromes were (non-significantly) higher in the IG compared with the CG. CONCLUSIONS SB-AN is the first preventive intervention shown to significantly reduce specific risk factors and symptoms for AN and shows promise for reducing full-syndrome AN onset. CLINICALTRIAL ISRCTN70380261

The Association of Restrained Eating and Overeating during COVID-19: A Cross-Lagged Model

Widespread overeating has been found during the 2019 coronavirus (COVID-19) pandemic. The present study investigated whether pre-pandemic restrained eating (RE) predicted overeating during the pandemic, and further explored the behavioral (mortality threat, negative affect) mechanisms underlying this association. An eight-month longitudinal survey was conducted with a large sample of 616 undergraduates from Southwest university. From September 2019 to April 2020, three measurements were conducted. RE was tested before the pandemic (T1), and data of mortality threat, negative affect, and overeating were collected at the middle (T2) and end of (T3) the COVID-19 crisis in China. The correlation results showed that baseline RE was positively associated with mortality threat, negative affect, and overeating at T2 and T3. Moreover, negative affect and mortality threat were positively correlated with overeating. Results from longitudinal mediation showed that baseline RE would positively predict T3 overeating through T2 negative affect, but not T2 mortality threat. This study supports and extends the counterregulatory eating hypothesis that RE positively predicts future overeating, especially through negative emotions. These findings further reveal the core psychological mechanism underlying this positive RE-overeating relation in the context of COVID-19, indicating that the individuals with higher RE could not cope with negative affect adequately, contributing to more overeating.

Polish Adaptation of the Dutch Eating Behaviour Questionnaire (DEBQ): The Role of Eating Style in Explaining Food Intake—A Cross-Sectional Study

Knowledge of associations between emotional, external, and restrained eating with food choices is still limited due to the inconsistent results of the previous research. The aim of the study was to adopt the Dutch Eating Behavior Questionnaire (DEBQ) and then to examine the relationship between emotional, external, and restrained eating styles and dietary patterns distinguished on the basis of intake of fruit and vegetables (fresh and processed separately), fruit and/or vegetable unsweetened juices, sweets and salty snacks, and the adequacy of fruit and vegetable intake. The cross-sectional study was conducted in 2020, in a sample of 1000 Polish adults. The questionnaire consisted of the Dutch Eating Behavior Questionnaire, questions on selected food groups intake, and metrics. DEBQ structure was tested using both exploratory and confirmatory factor analysis (EFA, CFA) and structural equation modelling (SEM), while multi-group analysis was used to test measurement invariance. Logistic regression was applied to investigate the association between eating styles and dietary patterns, identified with the use of K-means cluster analysis. EFA, CFA and SEM revealed a three-factor, 29-item tool with satisfactory psychometric parameters. Restrained eating (ResEat) and external eating (ExtEat) were found to decrease chances of low intake of both favorable (fruit, vegetables, and unsweetened juices) and unfavorable (sweets and salty snacks) foods and increased the chances of their moderate intake. ResEat increased the probability of the high intake of favorable and moderate or high intake of unfavorable foods. ResEat and ExtEat were predisposed to adequate intake of fruit and vegetables while emotional eating had the opposite effect. Gender, education, and BMI were also found to determine food intake. Our results provide evidence that both eating styles and sociodemographic characteristics should be taken into account while explaining food intake as they may favor healthy and unhealthy eating in different ways.

Exploring the role of mindful eating and self-compassion on eating behaviours and orthorexia in people following a plant-based diet

Orthorexia nervosa (ON) is a new concept that is more prevalent in vegan populations. The aim of this study was to explore problematic eating behaviours in a vegan population, and to explore whether mindful eating and self-compassion have an impact on orthorexia nervosa. Three hundred thirteen individuals following a vegan diet completed scales in Orthorexia, Self-Compassion, Mindful, Emotional, External and Restraint Eating. The results indicated that individuals with high levels of orthorexia nervosa display low levels of self-compassion, and high levels of restrained eating. Moreover, the findings indicated that self-compassion, but not mindful eating, partially mediated the relationship between restrained eating and orthorexia nervosa. The present results contribute to a better understanding of orthorexic eating behaviours in a vegan population, and identifies the mediating capacity of self-compassion. Future directions are discussed.

RESTRAINED EATING BEHAVIOR, ANOREXIA NERVOSA AND FOOD CONSUMPTION BETWEEN CHILDREN AND ADOLESCENTS: A SCOPING REVIEW

Anorexia nervosa (AN) and restrained eating behavior (REB) are characterized by reduced food intake to achieve body weight loss. This scope review aimed to describe the existing evidence on the association between anorexia nervosa, restrictive eating behavior and food consumption. Studies with children and adolescents of both sexes of all races and ethnicities were included. Experimental and observational studies, systematic reviews, meta-analysis, case reports or series, conference abstracts, dissertations and theses were also included. The search was conducted in ten electronic databases and gray literature without language restriction on November 14, 2020. Twenty-four studies met the inclusion criteria. Most studies included girls and identified lower intake of calories, fat and certain micronutrients. There was also a higher intake of caffeine, fiber, vegetables, legumes and fruits and a lower intake of low-quality snack, fast food, sweets and foods with high carbohydrate and fat contents. The need to improve the quality of the diet among study participants was also identified. Thus, it is recommended that the evaluation of food consumption be careful to develop effective prevention strategies for the development of AN/REB and minimize nutritional deficiencies in these individuals.

Restrained Eating Is Associated with Lower Cortical Thickness in the Inferior Frontal Gyrus in Adolescents

Some eating patterns, such as restrained eating and uncontrolled eating, are risk factors for eating disorders. However, it is not yet clear whether they are associated with neurocognitive differences. In the current study, we analyzed whether eating patterns can be used to classify participants into meaningful clusters, and we examined whether there are neurocognitive differences between the clusters. Adolescents (n = 108; 12 to 17 years old) and adults (n = 175, 18 to 40 years old) completed the Three Factor Eating Questionnaire, which was used to classify participants according to their eating profile using k means clustering. Participants also completed personality questionnaires and a neuropsychological examination. A subsample of participants underwent a brain MRI acquisition. In both samples, we obtained a cluster characterized by high uncontrolled eating patterns, a cluster with high scores in restrictive eating, and a cluster with low scores in problematic eating behaviors. The clusters were equivalent with regards to personality and performance in executive functions. In adolescents, the cluster with high restrictive eating showed lower cortical thickness in the inferior frontal gyrus compared to the other two clusters. We hypothesize that this difference in cortical thickness represents an adaptive neural mechanism that facilitates inhibition processes.

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 %; αCronbach = 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.

Why Dieters Succeed or Fail: The Relationship Between Reward and Punishment Sensitivity and Restrained Eating and Dieting Success

BackgroundThe current study set out to improve our understanding of the characteristics of individuals who are motivated to restrict their food intake yet who nevertheless fail to do so. We examined whether punishment sensitivity (PS) was related to restrained eating, and reward sensitivity (RS) to perceived dieting success. Additionally, it was examined whether executive control (EC) moderates the association between RS and perceived dieting success.MethodsFemale student participants (N = 290, aged 17–29, BMI between 18.5 and 38.0) completed questionnaires on restrained eating, perceived dieting success, RS and PS, and carried out a behavioral task to index EC.ResultsPS was indeed positively related to restrained eating. RS was positively related to perceived dieting success, yet, EC did not moderate this association.ConclusionThe current study adds to the evidence that PS is related to individuals’ motivation to restrict their food intake. Furthermore, it shows support for the suggestion that RS may facilitate food restriction.

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.