Association between Emotional Eating and Frequency of Unhealthy Food Consumption among Taiwanese Adolescents.

Emotional eating is one factor that increases the consumption of unhealthy food. This study aimed to investigate the association between emotional eating and frequencies of consuming fast food, high-fat snacks, processed meat products, dessert foods, and sugar-sweetened beverages (SSBs) in adolescents. The baseline survey data (2015) from the Taiwan Adolescent to Adult Longitudinal Study (TAALS) were fitted into multivariate logistic regression models adjusted for sex, school type, Body Mass Index (BMI), eating while doing something, nutrition label reading, skipping breakfast, smoking, binge drinking, sedentary lifestyle, physical activity, peer and school support, and parental education level. Among the 18,461 participants (48.5% male and 51.5% female), those exhibiting emotional eating were more likely to consume fast food (Odds ratio (OR) = 2.40, 95% Confidence interval (CI): 2.18-2.64), high-fat snacks (OR = 2.30, 95% CI: 2.12-2.49), processed meat products (OR = 1.92, 95% CI: 1.78-2.08), dessert foods (OR = 2.49, 95% CI: 2.31-2.69), and sugar-sweetened beverages (OR = 1.83, 95% CI: 1.70-1.98). Factors that were positively associated with unhealthy food consumption included eating while doing other activities, binge drinking, smoking, and sedentary lifestyle. Among all the covariates, nutrition label reading was the only factor that was inversely associated with frequent unhealthy food consumption. Sex and school type may moderate the effect of emotional eating on the frequent consumption of specific unhealthy food groups. In conclusion, adolescents with high emotional eating were more likely to report frequent consumption of unhealthy foods in Taiwan. Our findings showed that male participants appeared to consume fast foods, high-fat snacks, processed meat, and SSBs more often and dessert foods less often than females. Future longitudinal studies are recommended for understanding the causal relationship between emotional eating and unhealthy food consumption.

Image-and-text health warning labels on alcohol and food: potential effectiveness and acceptability.

BACKGROUND: Health warning labels (HWLs) using images and text to depict the negative health consequences of tobacco consumption are effective and acceptable for changing smoking-related outcomes. There is currently limited evidence concerning their potential use for reducing consumption of alcoholic drinks and energy-dense foods. The aim of this research was to describe the potential effectiveness and acceptability of image-and-text (also known as pictorial or graphic) HWLs applied to: i. alcoholic drinks and ii. energy-dense snack foods. METHODS: Two online studies were conducted using between-subjects designs with general population samples. Participants rated one of 21 image-and-text HWLs on alcoholic drinks (n = 5528), or one of 18 image-and-text HWLs on energy-dense snacks (n = 4618). HWLs comprised a graphic image with explanatory text, depicting, respectively, seven diseases linked to excess alcohol consumption, and six diseases linked to excess energy intake. Diseases included heart disease and various cancers. Outcomes were negative emotional arousal, desire to consume the labelled product, and acceptability of the label. Free-text comments relating to HWLs were content analysed. RESULTS: For both alcoholic drinks and energy-dense snacks, HWLs depicting bowel cancer generated the highest levels of negative emotional arousal and lowest desire to consume the product, but were the least acceptable. Acceptability was generally low for HWLs applied to alcohol, with 3 of 21 rated as acceptable, and was generally high for snacks, with 13 of 18 rated as acceptable. The majority of free-text comments expressed negative reactions to HWLs on alcohol or energy-dense snacks. CONCLUSIONS: Image-and-text health warning labels depicting bowel cancer showed greatest potential for reducing selection and consumption of alcoholic drinks and energy-dense snacks, although they were the least acceptable. Laboratory and field studies are needed to assess their impact on selection and consumption.

Sweet satiation: Acute effects of consumption of sweet drinks on appetite for and intake of sweet and non-sweet foods.

Sensory-specific satiety (SSS) describes a reduction in the pleasantness of the taste of (momentary liking) and desire to consume a food that occurs with eating, compared with the relative preservation of liking and desire for uneaten foods. We conducted three studies in healthy female and male participants to test whether SSS generalises from sweet drinks to sweet foods. Studies 1 (n = 40) and 2 (n = 64) used a two-condition cross-over design. Participants consumed non-carbonated, fruit squash drinks sweetened with low-calorie sweeteners (LCS) versus water and evaluated various food and drink samples (stimuli). Generalisation of SSS was evident across all sweet stimuli, without having an effect on non-sweet (savoury) stimuli. These SSS effects were present when measured shortly after consumption of the sweet drink, but not 2 h later. There was no evidence of a 'rebound' increase above baseline in liking or desire to consume sweet foods 2 h after the sweet drink versus water. In study 3, 51 participants consumed labelled and branded 500 ml cola and water drinks (4 conditions, cross-over design) immediately before and during ad libitum consumption of sweet and non-sweet snack foods. Compared with still water, 'diet' (LCS-sweetened) cola reduced sweet food intake, but not total ad libitum intake. Carbonated water decreased hunger and increased fullness compared with still water, without differentially affecting thirst. Energy compensation from the ad libitum snacks for consumption of sugar-containing cola averaged only 20%. Together, these results demonstrate that consumption of LCS drinks acutely decreases desire for sweet foods, which supports their use in place of sugar-sweetened drinks. Further studies on the effects of carbonation of appetite are warranted.

Do perceived norms of social media users' eating habits and preferences predict our own food consumption and BMI?

In laboratory studies, exposure to social norm messages conveying the typical eating behaviour of others has influenced participants' own consumption of food. Given the widespread use of social media, it is plausible that we are implicitly exposed to norms in our wider social circles, and that these influence our eating behaviour, and potentially, Body Mass Index (BMI). This study examined whether four perceived norms (perceived descriptive, injunctive, liking and frequency norms) about Facebook users' eating habits and preferences predicted participants' own food consumption and BMI. In a cross-sectional survey, men and women university students (n = 369; mean age = 22.1 years; mean BMI = 23.7) were asked to report their perceptions of Facebook users' consumption of, and preferences for, fruit, vegetables, energy-dense snacks and sugar sweetened beverages (SSBs), their own consumption of and preferences for these foods, and their BMI. Multiple linear regression revealed that perceived descriptive norms and perceived frequency norms about Facebook users' fruit and vegetable consumption were significant positive predictors of participants' own fruit and vegetable consumption (both ps < .01). Conversely, perceived injunctive norms about Facebook users' energy-dense snack and SSB consumption were significant positive predictors of participants' own snack and SSB consumption (both ps < .05). However, perceived norms did not significantly predict BMI (all ps > .05). These findings suggest that perceived norms concerning actual consumption (descriptive and frequency) and norms related to approval (injunctive) may guide consumption of low and high energy-dense foods and beverages differently. Further work is required to establish whether these perceived norms also affect dietary behaviour over time.

Reducing screen-time and unhealthy snacking in 9-11 year old children: the Kids FIRST pilot randomised controlled trial.

BACKGROUND: Many young people form unhealthy behavioural habits, such as low intake of fruit and vegetables, high intake of energy-dense snack foods, and excessive sedentary screen-based behaviours. However, there is a shortage of parent-and home-focused interventions to change multiple health behaviours in children. METHODS: Kids FIRST was a 12-week, home- and school-based pilot randomised controlled trial to reduce screen-time and unhealthy snacking with assessments at pre- (baseline) and post-intervention. Four UK schools were randomised to control or one of three interventions targeting reductions in (1) screen-time and unhealthy snacking (ST + Sn), (2) screen-time (ST only), (3) unhealthy snacking (Sn only), and parents with children aged 9-11 years were recruited via schools. Intervention group parents received four online 'sessions' and four packages of resources tailored to each group. Children received four 30-min lessons during school time. Children and parents reported their own screen-time behaviours, children reported their own snacking behaviours. Descriptive analyses were undertaken using principles of intention to treat. RESULTS: Initial feasibility was shown in that this study successfully recruited schools and families into all four study arms and retained them over a period of 13 weeks (retention rate ≥ 74%). Seventy-five children and 64 parents provided full baseline questionnaire data. Reductions in children's school day and weekend day TV/DVD viewing and computer game use were found in the ST + Sn and ST groups, while self-reported smartphone use increased in these groups. Similar results were found for parents' TV/DVD, computer and smartphone use in these groups. Little to no changes were found in reports of the dietary variables assessed in any intervention group for children or parents. CONCLUSIONS: These preliminary findings show some promise for the Kids FIRST intervention. Based on these findings, a future full trial should recruit a more diverse sample of families and optimise the intervention and intervention resources to more fully engage parents with the dietary-based components of the intervention programme, where fewer changes were seen. Although most parents reporting receiving the intervention resources, further development work is required to achieve higher levels of engagement. This might include greater parent and child engagement work early in the development of the project. TRIAL REGISTRATION: Retrospectively registered in June 21st 2019 with ClinicalTrials.gov (number NCT03993652).

Interactive effects of impulsivity and dietary restraint over snack intake in children.

Impulsivity and dietary restraint have been found to interact to affect dietary intake in adults. Few studies have explored this effect in children. The current study therefore aimed to investigate the interactive effects of behavioural impulsivity and dietary restraint on intake. Fifty 7-11-year-olds participated in this laboratory-based study. Impulsivity was assessed through behavioural tasks measuring a number of impulsivity facets. Children self-reported dietary restraint. Children visited the lab and had access to a range of snack foods; intake was recorded. Hunger at arrival was assessed. A series of 2 x 2 between-subjects ANCOVAs indicated that motor impulsivity and dietary restraint interacted to affect intake. Reward sensitivity, delay of gratification and inhibitory control did not interact with dietary restraint. Post-hoc analyses indicated that children high in motor impulsivity and restraint ate significantly more snacks than restrained children low in motor impulsivity. Furthermore, children low in motor impulsivity but high in dietary restraint were better at inhibiting their intake than children low in impulsivity and dietary restraint. The results indicate that high levels of impulsivity or dietary restraint in isolation do not affect children's dietary intake but that their combination may lead to overeating in food rich environments.

Sensory Profiling and Consumer Acceptance of Pasta, Bread, and Granola Bar Fortified with Dried Olive Pomace (Pâté): A Byproduct from Virgin Olive Oil Production.

An olive pomace (pâté) obtained from virgin olive oil production, was used for the fortification of pasta, bread, and granola bar. For each food, a control (without pâté) and a fortified sample (with pâté, 7% in pasta and 5% in bread and granola bar) were manufactured. Descriptive analysis showed that pâté strongly affected the appearance of pasta and bread and increased the bitterness of bread and granola bar but not pasta. Granola bar was less affected in general, likely because of its higher ingredient complexity. In a central location test with 175 Californian consumers, both the control and the fortified samples of all three foods were well accepted overall, with only the mean liking of the appearance of the fortified pasta falling below the "neither like nor dislike" mark. Approximately 30% of consumers preferred the fortified sample over the control for each food and 50% were willing to pay more for the fortified products. The percentage of phenols from pâté recovered in the prepared samples was such that 63 g of pasta, 18 g of bread, and 12 g of granola bar would be sufficient to meet the EFSA health claim for olive oil phenols. This study demonstrates that pâté can be used for fortification of foods for human consumption, thus adding potential economic value to the virgin olive oil production chain and allowing for a higher daily intake of phenols from Olea europaea L., whose beneficial health properties are well recognized. PRACTICAL APPLICATION: The dried olive oil pomace (pâté) that we developed and tested in this research can be used to fortify pasta, bread, and granola bars with health-beneficial phenols with only slight alterations of their sensory profiles and slight reduction in consumer acceptance. Virgin olive oil producers can use this byproduct and gain further economic value from olive oil production.

The effect of snack consumption on physical activity: A test of the Compensatory Health Beliefs Model.

The Compensatory Health Beliefs Model proposes that individuals may believe that an unhealthy behaviour can be compensated for by subsequent engagement in a healthy behaviour. The present study aimed to test this proposition, specifically by examining the influence of snack consumption (healthy, unhealthy) on type of activity selected (physical, sedentary). A sample of 100 female undergraduate students (Mage = 20.41 years) were randomly assigned to consume either healthy or unhealthy snacks of comparable nutritional value. To assess potential compensatory behaviour, participants were then given the choice to engage in either a physical activity (exercise on a treadmill) or a sedentary activity (a game on an iPad). Results showed that a significantly higher proportion of participants who consumed the unhealthy snacks selected the physical activity as opposed to the sedentary activity. Perceived healthiness of the snacks, but not perceived caloric intake, mediated the relationship between snack type and activity selection. The findings provide empirical evidence for compensation proposed by the Compensatory Health Beliefs Model, whereby an unhealthy behaviour (unhealthy snack consumption) led to subsequent engagement in a healthy behaviour (physical activity).

Re-evaluating the self-report habit index: the cases of physical activity and snacking habits.

Objectives: The Self-Report Habit Index (SRHI) was originally reported as one-dimensional; however, habit has been described as characterised by several features. Moreover, one-dimensional models for the SRHI have demonstrated poor fit. Therefore, we aimed to compare multidimensional models with a one-dimensional model in both snacking and physical activity habits, besides examining further instrument characteristics. Design: A cross-sectional study was conducted with high school and university students (n = 555). Main outcome measure: The SRHI adapted for physical activity and for snaking habits was applied at one time point. Results: Nested models with one factor, two factors and three factors were compared. Next, a hierarchical second-order model was tested, and further validity issues, as well as invariance between habits, were examined. Three-dimensional models represented a better fit for both habits. However, fit was still inadequate in the snacking version. In addition, discriminant validity concerns emerged for the physical activity SRHI. Moreover, invariance between the snacking and the physical activity versions was not confirmed. Conclusions: Considering the SRHI as composed by the dimensions of 'lack of awareness', 'lack of control' and 'history of behavioural repetition' seems to be more accurate. Nevertheless, our findings suggest that further research is needed.

Influence of impending healthy food consumption on snacking: Nudging vs. compensatory behaviour.

The use of nudging, prompts or primes in the environment aligned with desired goals, as a strategy to promote healthy behaviour has gained increasing attention. Yet, the adoption of healthy behaviours may ironically be frustrated by licensing of competing goals for indulgence, producing compensatory unhealthy behaviours. However, little is known of these unintended compensatory effects of "health" nudging, and the conditions in which engagement of healthy behaviours may continue to activate health goals versus compensatory goals for indulgence. Over two studies, we examined both behavioural phenomena by investigating the influence of impending healthy food consumption on snack intake. We predicted that anticipated engagement of healthy eating will prime healthier eating behaviour (decreased snack intake), unless consumption of an anticipated healthy meal is expected to lead to an energy deficit (a "low calorie" meal), which may instead activate compensatory indulgence (increased snack intake). Study 1 demonstrated that the increase in the saliency of "healthiness" (unrelated to calorie content) from an anticipated meal resulted in lower snack intake (potato crisp consumption). Study 2 revealed that the anticipated consumption of a healthy meal described as low in caloric content promoted compensatory eating behaviour. This maladaptive behaviour was also observed to be associated with the endorsement of weight-regulation-related compensatory health beliefs. Furthermore, the findings also suggest that more restrained eaters (who experience competing goals for health and indulgence) may be especially likely to engage in healthier eating behaviour when anticipating healthy meals that were not portrayed to be low in calories. Taken together, our findings suggest that nudging by increasing the salience of healthy options without implying resulting negative energy balance is an effective strategy in promoting healthy eating behaviour and may be less prone to maladaptive compensatory behaviour, especially for individuals actively regulating their dietary behaviour.

Continuous access to snacks from weaning onwards in female rats causes weight gain, insulin insensitivity, and sustained leptin resistance in adulthood.

A large part of the daily intake of children in the U.S. consists of snacks, with the average child consuming three snacks per day. Despite this, little research has been conducted to determine the metabolic and behavioral effects of snacking. Using a developing female rat model, our studies aimed to determine the effects of snacking during development before the protective effects of estrogen on weight gain would be relevant. Additionally, to determine if snack composition is important, we created one healthy and one unhealthy snacking group provided with chow and three snacks each in addition to a chow-only group. We found that both snacking groups experienced increased weight gain, elevated abdominal fat pad mass, prolonged leptin resistance into adulthood, and insulin insensitivity that was not observed in their non-snacking counterparts. These physiological differences were measured despite both snacking groups having a similar caloric intake as the chow-only group throughout the study. In addition to physiological changes, both snacking groups showed a preference for snacks over chow and ate more often during the inactive light phase than typical for rats, with the unhealthy snacking group presenting this behavioral change earlier than the healthy snacking group. Our results suggest that constant access to palatable snacks, which is often the case for children in western countries, alters feeding behaviors in relation to food choice and time of day when eating occurs. Snacking during development seemed to promote signs of metabolic syndrome in adulthood even when excess caloric intake was not observed. Our work further suggests that development is a vulnerable time for palatable snack presentation when prepubertal females lack the protective effects of estrogen and exhibit reduced leptin feedback on food intake. Thus snacking from weaning onward could be a contributor to the current childhood obesity crisis.

Exploring the underpinning mechanisms of the proximity effect within a competitive food environment.

OBJECTIVE: One method of influencing an individual's food consumption involves placing unhealthy snacks further away from individuals, known as the "proximity effect". However, only one laboratory study has explored the effect while both an unhealthy and a healthy option are presented simultaneously. Further, little is known about the potential underpinning mechanisms of the effect. The current study aims to replicate the proximity effect in a competitive environment, and to explore the role of visual salience and effort in the proximity effect. METHOD: Fifty-six participants were asked to complete a two-part questionnaire under the cover story of a relaxation study. Two bowls were presented to participants, each containing either 250 g chocolate M&M's or 250 g mixed fruit pieces. Each bowl was positioned either 20 cm or 70 cm from the participant, creating four proximity conditions. Consumption of each snack was compared between proximity conditions. RESULTS: No main effects were found. A significant interaction between snack type and chocolate position was found (p = .010, ȵ2 = 0.159), with fruit consumption being significantly higher when chocolate was at located at 20 cm compared to 70 cm (53.35 g vs 22.35 g, p = .042). Higher visual salience of each snack type correlated to more of the snack being consumed, ps < .017. Results were similar when calories consumed were analysed. CONCLUSIONS: We found an unconventional proximity effect where the consumption of a snack did not depend on its position, but rather the relative position of another snack. Implications of the study could inform café and supermarket layouts to exploit the interaction between moving healthy items closer in addition to moving unhealthy items further away, in order to maximise choice of healthy items.

The psychosocial experience of feeling overweight promotes increased snack food consumption in women but not men.

Self-identification of being overweight has been associated with overeating and weight gain in observational studies, irrespective of whether the individual in question is objectively overweight. The aims of the present studies were to examine whether experimentally manipulating the psychosocial experience of feeling overweight impacted on snack food consumption and to identify mechanisms explaining this effect. In Study 1, to manipulate the psychosocial experience of feeling overweight, 120 women wore an obese body suit or control clothing in public or private settings, before consuming snack foods. Wearing the obese body suit resulted in an increase in snack food consumption and this effect was not moderated by whether participants wore the obese body suit in public or in private. In Study 2, we aimed to replicate the effect of the obese body suit on snack food consumption and also examined whether the effect of the body suit on eating behaviour was moderated by participant sex (n = 150; 80 women). Women who wore the obese body suit ate significantly more than women who wore the control clothing, but this effect was not observed in men. Across both studies we examined a number of potential mechanisms that could explain the effect that wearing the obese body suit had on snack food consumption, but did not find supporting evidence. The psychosocial experience of feeling overweight may lead to increased snack food consumption in women, but the psychological mechanism explaining this effect is unclear.

Impulsivity and vitamin D in bariatric surgery candidates.

BACKGROUND: Obesity is recognized as a major health problem. Vitamin D is involved in maintaining energy metabolism by regulation of glucose transporters, uncoupling proteins, and normal brain function. We aimed to explore a relationship between impulsivity, eating behaviors, and 25-hydroxyvitamin D concentration in a sample of 322 bariatric surgery candidates. METHODS: Participants completed a questionnaire on their health, eating habits and The Eating Disorders Examination-Questionnaire (EDE-Q). Impulsivity was evaluated with the Barratt Impulsiveness Scale (BIS-11). Blood samples were obtained to measure levels of 25(OH)D, lipids (cholesterol, triglyceride, HDL-cholesterol, LDL-cholesterol), and glucose. RESULTS: Overall scores on the BIS-11, along with scores on the Attentional Subscale of the BIS were significantly higher in participants with higher frequency of snack food consumption. Scores on the Attentional Subscale of the BIS were higher in participants who self-reported eating in response to emotions. Participants who reported eating at night or declared intense emotions associated with a desire-to-eat had the highest global, attentional, and non-planning impulsivity levels. Scores on the Non-planning Subscale of the BIS-11 were elevated in participants with 25-hydroxyvitamin D concentrations lower than 10ng/ml. CONCLUSIONS: The results suggest that the higher level of impulsivity among the patients with obesity is associated with eating habits, and support the hypothesis that vitamin D deficiency may contribute to impulsiveness.

Physical activity-equivalent label reduces consumption of discretionary snack foods.

OBJECTIVE: The present research aimed to investigate the impact of the physical activity calorie equivalent (PACE) front-of-pack label on consumption, prospective consumption and liking of familiar and unfamiliar discretionary snack foods. DESIGN: In a within-subject randomised design, participants tasted and rated liking (9-point hedonic scale) and prospective consumption (9-point category scale) of four different snack foods with four different labels (i.e. blank, fake, PACE, PACE doubled) and four control snack foods. The twenty snack foods were presented during two 45 min sessions (i.e. ten snack foods per session) which were separated by one week. The amount participants sampled of each snack food was measured. SETTING: The study was conducted in the Centre for Advanced Sensory Sciences laboratory at Deakin University, Australia. SUBJECTS: The participants were 153 university students (126 females, twenty-seven males, mean age 24·3 (sd 4·9) years) currently enrolled in an undergraduate nutrition degree at Deakin University. RESULTS: When the PACE label was present on familiar snack foods, participants sampled 9·9 % (22·8 (sem 1·4) v. 25·3 (sem 1·5) g, P=0·03) less than when such label was not present. This was in line with a decreased prospective snack food consumption of 9·1 % (3·0 (sem 0·2) v. 3·3 (sem 0·2) servings, P=0·03). Such pattern was not seen in unfamiliar snacks. CONCLUSIONS: The PACE label appears to be a promising way to decrease familiar discretionary snack food consumption in young, health-minded participants.

Emotion-driven impulsiveness and snack food consumption of European adolescents: Results from the I.Family study.

We aimed to investigate the association between emotion-driven impulsiveness and snack food consumption in 1039 European adolescents aged 12-18 years. During the cross-sectional examination in 2013/2014, complete information was collected on: emotion-driven impulsiveness (using the negative urgency subscale from the Urgency, Premeditation, Perseverance, Sensation seeking, and Positive urgency (UPPS-P) Impulsive Behaviour Scale) and snacking behaviour operationalised as 1) consumption frequency of daily snacks, 2) consumption frequency of energy-dense snacks (both measured using Food Frequency Questionnaire) and 3) usual energy intake of food consumed per snacking occasion in calories. The latter was measured using online self-administered 24-h dietary recalls and was estimated based on the National Cancer Institute (NCI) Method. Anthropometric variables were measured and BMI z-score (zBMI) calculated. Age, sex, highest education level of the family and country of residence were assessed using a questionnaire. Mixed-effect regression analyses were separately conducted for each snacking behaviour outcome with emotion-driven impulsiveness as the exposure. After controlling for zBMI, age, sex, country and socioeconomic status, emotion-driven impulsiveness was positively associated with daily consumption frequency of snacks (ß = 0.07, 95% Confidence Interval (CI) [0.02, 0.12]) and consumption frequency of energy-dense snacks (ß = 0.25, 95% CI [0.19, 0.31]), but not with usual energy intake of food per snacking (ß = 2.52, 95% CI [-0.55, 5.59]). Adolescents with a stronger emotion-driven impulsiveness tendency reported a higher snacking frequency and specifically more energy-dense snacks, whereas the energy intake of snack food seemed less important. These findings have implications for obesity prevention and treatment as they indicate the importance of targeting emotion-driven impulsiveness as a strategy to avoid excessive snacking.

Effect of snack-food proximity on intake in general population samples with higher and lower cognitive resource.

OBJECTIVE: Placing snack-food further away from people consistently decreases its consumption ("proximity effect"). However, given diet-related health inequalities, it is important to know whether interventions that alter food proximity have potential to change behaviour regardless of cognitive resource (capacity for self-control). This is often lower in those in lower socio-economic positions, who also tend to have less healthy diet-related behaviours. Study 1 aims to replicate the proximity effect in a general population sample and estimate whether trait-level cognitive resource moderates the effect. In a stronger test, Study 2 investigates whether the effect is similar regardless of manipulated state-level cognitive resource. METHOD: Participants were recruited into two laboratory studies (Study 1: n = 159; Study 2: n = 246). A bowl of an unhealthy snack was positioned near (20 cm) or far (70 cm) from the participant, as randomised. In Study 2, participants were further randomised to a cognitive load intervention. The pre-specified primary outcome was the proportion of participants taking any of the snack. RESULTS: Significantly fewer participants took the snack when far compared with near in Study 2 (57.7% vs 70.7%, ß = -1.63, p = 0.020), but not in Study 1 (53.8% vs 63.3%, X2 = 1.12, p = 0.289). Removing participants who moved the bowl (i.e. who did not adhere to protocol), increased the effect-sizes: Study 1: 39.3% vs 63.9%, X2 = 6.43, p = 0.011; Study 2: 56.0% vs 73.9%, ß = -2.46, p = 0.003. Effects were not moderated by cognitive resource. CONCLUSIONS: These studies provide the most robust evidence to date that placing food further away reduces likelihood of consumption in general population samples, an effect unlikely to be moderated by cognitive resource. This indicates potential for interventions altering food proximity to contribute to addressing health inequalities, but requires testing in real-world settings. TRIAL REGISTRATION: Both studies were registered with ISRCTN (Study 1 reference no.: ISRCTN46995850, Study 2 reference no.: ISRCTN14239872).

Is an Iranian Health Promoting School status associated with improving school food environment and snacking behaviors in adolescents?

The Iranian Health Promoting Schools (IHPS) program was first piloted and then formally established in Iran in 2011 as a framework to promote healthy environment and behaviors such as proper dietary practice among adolescents. This study examined the role of IHPS in improving the school food environment and snacking behaviors among adolescents. In this cross-sectional study, 1320 eighth grade students from 40 middle schools with IHPS and non-IHPS program were selected using a proportional stratified random sampling method. A modified 55-item qualitative Food Frequency Questionnaire was used to assess the frequency of consumption of healthy and unhealthy snacks in the studied adolescents. Mixed effect negative binomial regression models were used to analyze the data. The association was also adjusted for individual variables, including gender, socio-economic status, pocket money, family structure and nutritional knowledge level. No significant difference was observed between the average of healthy and unhealthy snack items in IHPS and non-IHPS schools (p > 0.05). On the basis of adjusted analysis, being from/in IHPS was not associated with weekly frequency consumption of unhealthy [prevalence rate ratio (PRR) = 0.99; 95% CI: 0.85-1.16] and healthy (PRR = 1.08; 95% CI: 0.96-1.2) snacks among the adolescents. There was no difference regarding school food environment and snacking behaviors in IHPS and non-IHPS schools. This might indicate that there has been a weakness in institutionalizing the comprehensive concepts of the HPS approach in the studied schools. Addressing the proper understanding of HPS approach and the need for development of HPS through matching and adaptability with health promotion actions to reach defined standards, is necessary.

Feeding styles, parenting styles and snacking behaviour in children attending primary schools in multiethnic neighbourhoods: a cross-sectional study.

OBJECTIVE: The aim of the present study was to investigate whether feeding styles and parenting styles are associated with children's unhealthy snacking behaviour and whether the associations differ according to children's ethnic background. METHOD: Cross-sectional data from the population-based 'Water Campaign' study were used. Parents (n=644) of primary school children (6-13 years) completed a questionnaire covering sociodemographic characteristics, feeding style dimensions ('control over eating', 'emotional feeding', 'encouragement to eat' and 'instrumental feeding'), parenting style dimensions ('involvement' and 'strictness') and children's unhealthy snacking behaviour. Logistic regression analyses were performed to determine whether feeding styles and parenting styles were associated with children's unhealthy snacking behaviour. RESULT: Overall, children whose parents had a higher extent of 'control over eating' had a lower odds of eating unhealthy snacks more than once per day (OR, 0.57; 95% CI 0.42 to 0.76). Further stratified analysis showed that 'control over eating' was associated with less unhealthy snacking behaviour only in children with a Dutch (OR, 0.37; 95% CI 0.20 to 0.68) or a Moroccan/Turkish (OR, 0.44; 95% CI 0.25 to 0.77) ethnic background. 'Encouragement to eat' was associated with a lower odds of eating unhealthy snacks every day in children with a Dutch ethnic background only (OR, 0.48; 95% CI 0.25 to 0.90). 'Instrumental feeding' was associated with a higher odds of eating unhealthy snacks more than once a day in children with a Moroccan/Turkish ethnic background only (OR, 1.43; 95% CI 1.01 to 2.04). CONCLUSION: Our results suggest that 'control over eating' may be associated with less unhealthy snack consumption in children. The associations of feeding styles and parenting styles with children's unhealthy snacking behaviour differed between children with different ethnic backgrounds.

Clustering and correlates of screen-time and eating behaviours among young adolescents.

BACKGROUND: Screen-time and eating behaviours are associated in adolescents, but few studies have examined the clustering of these health behaviours in this age group. The identification of clustered health behaviours, and influences on adolescents' clustered health behaviours, at the time when they are most likely to become habitual, is important for intervention design. The purpose of this study was to assess the prevalence and clustering of health behaviours in adolescents, and examine the sociodemographic, individual, behavioural, and home social and physical environmental correlates of clustered health behaviours. METHODS: Adolescents aged 11-12 years (n = 527, 48% boys) completed a questionnaire during class-time which assessed screen-time (ST), fruit and vegetable (FV), and energy-dense (ED) snack consumption using a Food Frequency Questionnaire. Health behaviours were categorised into high and low frequencies based on recommendations for FV and ST and median splits for ED snacks. Adolescents reported on their habits, self-efficacy, eating at the television (TV), eating and watching TV together with parents, restrictive parenting practices, and the availability and accessibility of foods within the home. Behavioural clustering was assessed using an observed over expected ratio (O/E). Correlates of clustered behaviours were examined using multivariate multinomial logistic regression. RESULTS: Approximately 70% reported having two or three health risk behaviours. Overall, O/E ratios were close to 1, which indicates clustering. The three risk behaviour combination of low FV, high ED, and high ST occurred more frequently than expected (O/E ratio = 1.06 95% CI 1.01, 1.15. Individual, behavioural, and social and physical home environmental correlates were differentially associated with behavioural clusters. Correlates consistently associated with clusters included eating ED snacks while watching TV, eating at the TV with parents, and the availability and accessibility of ED snack foods within the home. CONCLUSIONS: There is a high prevalence of screen time and unhealthy eating, and screen time is coupled with unhealthy dietary behaviours. Strategies and policies are required that simultaneously address reductions in screen time and changes to habitual dietary patterns, such as TV snacking and snack availability and accessibility. These may require a combination of individual, social and environmental changes alongside conscious and more automatic (nudging) strategies.