Food insecurity among graduate students: prevalence and association with depression, anxiety and stress.

OBJECTIVE: The impact of food insecurity on mental health has not yet been examined in graduate students, a population widely considered at elevated risk for financial strain and negative mental health outcomes. This study aimed to derive initial prevalence estimates of food insecurity in a sample of current graduate students at a large state university and to elucidate the relationship between food insecurity and depression, anxiety and stress in this sample. DESIGN: Cross-sectional online survey including the US Household Food Security Survey Module: Six-Item Short Form and the Depression, Anxiety, and Stress Scales (DASS-21). SETTING: University in the northeastern region of the USA. PARTICIPANTS: Two hundred sixty-three graduate students. RESULTS: In the present sample, 59·7 % of participants reported high/marginal food security, 18·5 % reported low food security and 21·8 % reported very low food security. Graduate students with very low food security reported significantly greater depression (η2 = 0·09), anxiety (η2 = 0·10) and stress (η2 = 0·10), compared with those with low food security and high food security (all P's < 0·001). CONCLUSIONS: Food insecurity occurred in nearly half of the graduate students surveyed, and very low food security was associated with elevated levels of depression, anxiety and stress. Findings highlight the need to address food insecurity and associated elevated mental health problems present among graduate students.

Nudging while online grocery shopping: A randomized feasibility trial to enhance nutrition in individuals with food insecurity.

Food insecurity, the inability to acquire adequate food due to insufficient resources for food, is associated with an increased risk for obesity and associated health problems. This study assessed the feasibility and initial efficacy of a prefilled online grocery shopping cart (i.e., default option) in promoting healthier grocery purchases in individuals with food insecurity. Fifty participants recruited from food pantries in New York in 2018 were randomized to review nutrition information before purchasing groceries online (n = 23) or modify a prefilled, nutritionally balanced online shopping cart (n = 27) based on a budget corresponding to Supplemental Nutrition Assistance Program benefits. Compared to nutrition education, the default shopping cart resulted in the purchase of significantly more ounces of whole grains (Mean Difference [Mdiff] = -4.05; 95% Confidence Interval [CI] = -6.14, -1.96; p < .001), cups of fruits (Mdiff = -1.51; 95% CI = -2.51, -0.59; p = .002) and vegetables (Mdiff = -2.21; 95% CI = -4.01, -0.41; p = .02), foods higher in fiber (mg; Mdiff = -15.65; 95% CI = -27.43, -3.87; p = .01), and lower in sodium (mg; Mdiff = 1642.66; 95% CI = 660.85, 2624.48; p = .002), cholesterol (mg; Mdiff = 463.86; 95% CI = 198.76, 728.96; p = .001), and grams of fat (Mdiff = 75.42; 95% CI = 42.81, 108.03; p < .001) and saturated fat (Mdiff = 26.20; 95% CI = 14.07, 38.34; p < .001). The use of a default online shopping cart appears to improve nutritional quality of food purchases in individuals facing financial constraints.

What does the ORTO-15 measure? Assessing the construct validity of a common orthorexia nervosa questionnaire in a meat avoiding sample.

Orthorexia nervosa (ON) is a proposed diagnostic category that captures a pathological need to eat healthfully. The ORTO-15 is a self-report measure ostensibly designed to assess ON, but its suitability for capturing symptoms of pathology has been questioned. Vegans differ from omnivores in their focus on health and present with similar or lowered endorsement of eating behaviors symptoms, making them an ideal group to assess the construct validity of the ORTO-15. We tested the hypothesis that the ORTO-15 captures normative, rather than pathological, health focus. In total, 106 omnivores, 34 meat reducers, 50 lacto-ovo-vegetarians, and 191 vegans completed the ORTO-15 to quantify the presence and severity of ON and the Eating Disorder Examination Questionnaire (EDE-Q) as an established measure of eating pathology. More than 75% of respondents met criteria for a diagnosis of ON per established ORTO-15 cutoffs. Respondents above the 2.50 EDEQ cutoff (suggesting the likely presence of an eating disorder) did not differ in ORTO-15 scores from those scoring below the cutoff. There was a univariate main effect of meat avoidance type on the EDE-Q global scale (p < .01), with vegans endorsing fewer symptoms on the EDE-Q than semi-vegetarians (post-hoc p < .05). Vegans were more likely to meet the clinical ON cutoff of 40 on the ORTO-15 compared to omnivores (omnibus p < .01; post-hoc p = .01). Based on the ORTO-15, vegans' scores should be indicative of pathological eating behavior, but EDE-Q scores instead indicate the lowest levels in this group. The ORTO-15 is able to differentiate between types of meat avoiders, but given the difference in health focus between groups, the scale may be tapping into a construct other than pathological eating beliefs and behaviors.

Household food insecurity is associated with binge-eating disorder and obesity.

BACKGROUND: Food insecurity stems from limited financial resources. Yet, paradoxically, food insecurity is associated with overeating and excess weight. One subcategory of overeating is binge eating, which includes eating an unusually large amount of food while feeling a concurrent sense of loss of control. Associations between binge-eating disorder and food insecurity are not known, yet this is important to examine because binge eating is associated with more severe mental and physical health problems than overeating or obesity alone. METHOD: Survey respondents (N = 1,250) were recruited online. Participants were categorized into study groups: healthy weight (HW), binge-eating disorder (BED), and obesity (OB). Using HW as a reference group, hierarchical logistic regressions evaluated the extent to which low and very low food security were associated with BED and OB. RESULTS: Low food security and very low food security were both associated with increased likelihood of BED and OB group membership. CONCLUSIONS: Results highlight the need to devote resources towards policy revisions, preventative interventions, and psychiatric treatments aimed at decreasing the overall association of food insecurity with BED and obesity among low-income Americans.

Eating and health behaviors in vegans compared to omnivores: Dispelling common myths.

Studies comparing eating behaviors in individuals avoiding meat and other animal products to omnivores have produced largely inconclusive findings, in part due to a failure to obtain sufficiently large samples of vegan participants to make meaningful comparisons. This study examined eating and health behaviors in a large community sample of dietary vegans ("vegans"), compared to omnivores. Participants (n = 578, 80.4% female) completed an online questionnaire assessing a range of eating- and other health-related attitudes and behaviors. Vegans (62.0%, n = 358) and omnivores (38.1%, n = 220) were comparable in terms of demographics. Vegans scored significantly lower than omnivores the Eating Disorder Examination - Questionnaire (multivariate p < 0.001), a measure of pathological eating behavior. They also were more likely to consider themselves "healthy" (p < 0.001) and to prepare food at home (p < 0.001). Vegans more frequently consumed fruits, vegetables, nuts, beans and grains (all p < 0.001), and less frequently consumed caffeinated soft drinks (p < 0.001). There were no significant differences between vegans and omnivores on measures of eating styles, body mass index, smoking or exercise behaviors, or problems related to alcohol consumption. Effect sizes for comparisons on eating-related measures were generally small, with ηp2 ranging from <0.01 to 0.05; the size of effects for comparisons on measures of other health behaviors ranged from small to medium (Φ = 0.09 to 0.33 and ηp2 < 0.01 to 0.42). Taken together, findings suggest that ultimately, vegans do not differ much from omnivores in their eating attitudes and behaviors, and when they do, differences indicate slightly healthier attitudes and behaviors towards food. Similarly, vegans closely resembled omnivores in non-eating related health behaviors.

Stigmatization of binge eating disorder in men: Implicit associations with weight status and femininity.

BACKGROUND: Eating disorders are highly stigmatized, but stigma against binge eating disorder (BED) specifically is relatively understudied, especially in men. We compared perceptions of a male target with BED to one with alcohol use disorder (AUD), which shares the key characteristic of subjective loss of control over consumption. We also investigated how participants' eating and alcohol use behaviors and attitudes towards psychotherapy influence perceptions of these disorders. METHODS: Participants (n = 402) viewed vignettes describing a male target engaged in excess alcohol use or binge eating and rated the target on various attributes and as being responsible for or in control of their behavior and suffering from an addiction warranting treatment. Participants completed the Alcohol Use Disorders Identification Test, Binge Eating Scale, and questions about attitudes towards and experience with psychological treatment. RESULTS: The BED target was rated as significantly less "thin," more "overweight" and "obese", and higher on several positive attributes and traits traditionally associated with femininity; the AUD target was thought more likely to be suffering from an addiction and in need of psychological treatment (all p < .05), with no differences between targets in ratings of responsibility for or control over the problematic behavior. Ratings were unrelated to participants' attitudes towards or experience with psychological treatment and personal alcohol consumption or binge eating behaviors. CONCLUSIONS: BED in men appears less stigmatized than AUD but is implicitly associated with weight status and femininity, which may increase reluctance to seek treatment. Both AUD and BED were generally recognized as pathological and warranting intervention.

Ethnic and racial comparisons of weight-loss treatment utilization history and outcomes in patients with obesity and binge-eating disorder.

BACKGROUND: This study examined ethnic/racial differences in reported utilization of weight-loss methods/treatments and weight loss among adults with binge-eating disorder (BED) with co-existing obesity. METHODS: Participants were 400 adults (non-Hispanic Black: n = 99, Hispanic: n = 38, non-Hispanic White: n = 263) seeking treatment for BED in Connecticut from 2007 to 2012. Participants were asked about prior weight-loss methods/treatments and resulting weight losses. RESULTS: Overall, self-help diets were utilized most; mental-health services were utilized least. While non-significant differences for most methods/treatments were observed by ethnicity/race, significant differences emerged for self-help diets and supervised programs with non-Hispanic Whites, in general, utilizing these diets more frequently and losing more weight on these types of diets. CONCLUSIONS: Among treatment-seeking patients with BED and obesity, non-Hispanic White patients reported histories of greater weight-loss treatment utilization and weight loss than non-White patients for supervised and self-help diets. Findings highlight the need for greater understanding of treatment utilization and outcomes among minority patients with obesity and BED.

Strategies to manage weight during the holiday season among US adults: A descriptive study from the National Weight Control Registry.

BACKGROUND: Holidays are challenging for weight control and are consistently associated with weight gain. Managing holiday weight gain may be especially difficult for individuals with higher body weight or a history of overweight/obesity. The current study evaluated how individuals with a history of successful weight loss plan for the holiday season and how the use of weight control strategies was associated with weight change. METHODS: A subgroup of participants in the National Weight Control Registry (NWCR) were asked to complete a survey before (November) and after the holidays (January). At pre-holiday, participants reported height, weight, and weight goals for the holiday season (lose, maintain, minimize gains, or gain), and selected the top three weight control strategies they planned to use (from a list of 18). Post-holiday, participants reported weight and how often (frequently, infrequently, or not at all) they used each of the 18 strategies throughout the holidays. RESULTS: Individuals who completed both surveys were included in the analysis (n = 683; 69% female, 93% white, 54.6 years [SD: 13.2], 26.9 kg/m2 [SD: 5.5]). Pre-holiday, 64% of participants were currently trying to lose weight. Only 35% of the sample wanted to continue losing weight during the holiday season. The most common strategies individuals planned to use during the holiday season were evidence based (maintaining exercise, monitoring portions, tracking foods, and self-weighing). Participants gained 0.66 kg (SD: 1.85) from pre- to post-holiday and reported using an average of 12/18 strategies. A greater number of strategies were associated with less weight gain (F[1, 670] = 4.28, p = 0.04). Daily self-weighing (p = 0.03) and prioritizing food choices (p = 0.02) were individually associated with less weight gain. DISCUSSION: Participants in the NWCR entered the holiday season with a variety of goals for their weight and used many different strategies to control their weight. Having a wider range of strategies may be helpful to navigate the challenges to weight control during the holidays.

A Default Option to Improve Nutrition for Adults With Low Income Using a Prefilled Online Grocery Shopping Cart.

OBJECTIVE: To determine whether a prefilled online grocery shopping (default) cart improves the nutritional quality of groceries purchased compared with receiving nutrition education (NE). DESIGN: Longitudinal study. SETTING: Three food pantries in the US. PARTICIPANTS: Thirty-eight adults with low income. INTERVENTION: Groceries were purchased online for 5 consecutive weeks. After a baseline shopping trip, participants were randomized to receive NE or a nutritionally balanced prefilled online grocery shopping cart (ie, default cart) before shopping (from week 1 [T1] to week 4 [T4]). MAIN OUTCOME MEASURES: Diet quality (Healthy Eating Index [HEI-2015] scores), energy, and energy density of each online cart (ie, grocery purchases). ANALYSIS: Piecewise linear mixed-effects models. RESULTS: From baseline to T1, HEI-2015 scores in the default condition significantly increased (95% confidence interval [CI], 9.79-23.39), whereas total calories (95% CI, -10,942 to -1,663) and energy density (95% CI, -0.70 to -0.45) significantly decreased compared with NE. Improved HEI-2015 scores were maintained through T4. Calories and energy density increased from T1 to T4 in the default condition, but values remained lower (ie, more healthful) than the NE condition. In the NE condition, outcomes did not significantly change during the intervention. CONCLUSIONS AND IMPLICATIONS: Providing an online default cart may improve the nutritional quality of grocery purchases. However, future research is warranted to assess whether adding a second nudge later in the intervention or combining the NE and default cart further promotes healthy purchasing behavior.

Examining the Relationship between Youth-Targeted Food Marketing Expenditures and the Demographics of Social Media Followers.

: Background: To determine how many adolescents follow food/beverage brands on Instagram and Twitter, and examine associations between brands' youth-targeted marketing practices and percentages of adolescent followers. METHODS: We purchased data from Demographics Pro to characterize the demographics of Twitter and Instagram users who followed 27 of the most highly advertised fast food, snack, and drink brands in 2019. We used one-sample t-tests to compare percentages of adolescent followers of the selected brands' accounts versus all social media accounts, independent samples t-tests to compare followers of sugary versus low-calorie drink brands, and linear regression to examine associations between youth-targeted marketing practices and the percentages of adolescent followers. RESULTS: An estimated 6.2 million adolescents followed the selected brands. A higher percentage of adolescents followed the selected brands' accounts (9.2%) compared to any account on Twitter (1.2%) (p < 0.001), but not Instagram. A higher percentage of adolescents followed sugary (7.9%) versus low-calorie drink brands (4.3%) on Instagram (p = 0.02), but we observed the opposite pattern for adults on Twitter and Instagram. Television advertising expenditures were positively associated with percentages of adolescent followers of the selected brands on Twitter (p = 0.03), but not Instagram. CONCLUSIONS: Food and sugary drink brands maintain millions of adolescent followers on social media.

Rates of Help-Seeking in US Adults With Lifetime DSM-5 Eating Disorders: Prevalence Across Diagnoses and Differences by Sex and Ethnicity/Race.

OBJECTIVE: To investigate, in a nationally representative sample of US adults, the prevalence of help-seeking in individuals with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) eating disorders (EDs) and to examine sex and ethnic/racial differences. PATIENTS AND METHODS: The 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (N=36,309) included respondents who met the criteria for specific lifetime DSM-5 EDs and answered questions regarding help-seeking for their ED symptoms (anorexia nervosa [AN]: n=275; bulimia nervosa [BN]: n=91; and binge-eating disorder [BED]: n=256). RESULTS: The prevalence (standard error) estimates of ever seeking any help for AN, BN, and BED were 34.5% (2.80%), 62.6% (5.36%), and 49.0% (3.74%), respectively. Adjusting for sociodemographic characteristics, men and ethnic/racial minorities (non-Hispanic blacks and Hispanics) were statistically significantly less likely to ever seek help for BED than were women or non-Hispanic whites, respectively. Hispanics also were significantly less likely to seek help for AN relative to non-Hispanic whites. CONCLUSION: This was the first study in a nationally representative sample of US adults to examine rates of help-seeking, including by sex and ethnic/racial differences, across DSM-5-defined EDs. These findings emphasize the need to develop strategies to encourage help-seeking among individuals with EDs, particularly among men and ethnic/racial minorities.

The Significance of Overvaluation of Shape or Weight in Binge-Eating Disorder: Results from a National Sample of U.S. Adults.

OBJECTIVE: This study aimed to examine the prevalence of overvaluation of shape or weight in a nationally representative sample of U.S. adults with binge-eating disorder (BED) and to compare functioning correlates using a group of adults with bulimia nervosa (BN). METHODS: Participants included 207 respondents from the National Epidemiologic Survey on Alcohol and Related Conditions who met Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) diagnoses of BED (n = 163) or BN (n = 44). Sociodemographic characteristics and functioning were compared in BED with overvaluation (BED+OV), BED without overvaluation (BED), and BN. RESULTS: Approximately 50% of BED respondents reported overvaluation. Mean age was lower in BN than BED. Mean BMI was lower in BED+OV than BED and higher than BN. A greater proportion of BED+OV reported functional impairment than BED. BN was more likely to report "serious problems doing daily tasks" than BED and less likely to report "impairment in normal activities" than BED+OV. BN reported significantly lower mental functioning than BED. CONCLUSIONS: Findings based on this nationally representative sample are that overvaluation was associated with greater functional impairment within BED, and BED+OV reported greater impairment than BN in interference with normal activities but less impairment related to mental health. The increased impairment associated with BED+OV provides support for overvaluation as a diagnostic specifier for BED.

A Default Option to Enhance Nutrition Within Financial Constraints: A Randomized, Controlled Proof-of-Principle Trial.

OBJECTIVE: This study aimed to examine the feasibility and initial efficacy of a novel default option intervention targeting nutritional quality of online grocery purchases within the financial constraints of food insecurity. METHODS: Female undergraduates (n = 59) without eating disorder symptoms or dietary restrictions selected foods online with a budget corresponding to maximum Supplemental Nutrition Assistance Program benefits. Before completing the task again, participants were randomly assigned to receive a $10 incentive for selecting nutritious groceries (n = 17), education about nutrition (n = 24), or a default online shopping cart containing a nutritionally balanced selection of groceries (n = 18) to which they could make changes. Nutritional quality was quantified by using the Thrifty Food Plan Calculator. RESULTS: Compared with the education condition, participants in the default condition selected significantly more whole grains and fruits and foods lower in cholesterol, saturated fats, sodium, and overall calories. There were no statistically significant differences in nutritional outcomes between the incentive condition and the other two groups. CONCLUSIONS: Findings provide initial support for the efficacy of a default option in facilitating healthier food choice behaviors within financial constraints.

Targeting acceptance in the management of food craving: The mediating roles of eating styles and thought suppression.

Food craving is now widely considered to be a cognitively motivated state. Acceptance-based treatments are effective in reducing the adverse impact of food cravings on consumption, via a hypothesized decrease in experiential avoidance. The mechanisms that drive the success of acceptance-based management of craving remain to be empirically tested. This study examined the role of eating styles and thought suppression as mediators in the relationship between experiential avoidance and craving. Participants (n = 298, 51.5% female) completed the Food Craving Acceptance and Awareness Questionnaire (FAAQ), the Dutch Eating Behavior Questionnaire (DEBQ), the White Bear Suppression Inventory (WBSI; a measure of thought suppression), and the reduced version of the Food Craving Questionnaire- Trait (FCQ-T-r). Scores on the FAAQ were inversely associated with scores on the FCQ-T-r, DEBQ, and WBSI; FCQ-T-r scores were positively correlated with scores on the DEBQ and WBSI (all p < 0.001). The total indirect effect of acceptance on craving through the hypothesized mediators was significantly different from zero. Controlling for eating styles and thought suppression, acceptance remained a significant predictor of craving. Results thus provide initial evidence that eating styles and thought suppression mediate the relationship between food-specific experiential avoidance and food craving. Findings lay the foundation for future study of the proximal antecedents of food cravings and lend preliminary support for targeting thought suppression and eating styles in acceptance-based approaches to the management of craving.

Dietary Restraint Partially Mediates the Relationship between Impulsivity and Binge Eating Only in Lean Individuals: The Importance of Accounting for Body Mass in Studies of Restraint.

Binge eating is characteristic of eating and weight-related disorders such as binge eating disorder, bulimia nervosa, and obesity. In light of data suggest impulsivity is associated with overeating specifically in restrained eaters, this study sought to elucidate the exact nature of the associations between these variables, hypothesizing that the relationship between impulsivity and binge eating is mediated by restrained eating. We further hypothesized that the role of dietary restraint as a mediator would be moderated by body mass index (BMI). Study participants (n = 506, 50.6% female) were categorized based on self-reported BMI as under- and normal-weight (BMI < 25, 65.8%, n = 333) or overweight and obese (BMI ≥ 25, 34.2%, n = 173) and completed the "restrained eating" subscale of the Dutch Eating Behavior Questionnaire, the "impulse control difficulties" subscale of the Difficulties with Emotion Regulation Scale, and the Binge Eating Scale. Findings provide initial evidence for the hypothesized moderated mediation model, with dietary restraint partially mediating the relationship between impulsivity and binge eating severity only in lean respondents. In respondents with overweight or obesity, impulsivity was significantly correlated with binge eating severity, but not with dietary restraint. Findings inform our conceptualization of dietary restraint as a possible risk factor for binge eating and highlight the importance of accounting for body mass in research on the impact of dietary restraint on eating behaviors.