The Italian food environment may confer protection from hyper-palatable foods: evidence and comparison with the United States.

Background: Multi-national food corporations may saturate country-level food systems with hyper-palatable foods. However, the degree to which global food corporations have been integrated into country-level food systems may vary. Italy has largely retained local food production and may have low hyper-palatable food (HPF) availability in the food supply. The study quantified the prevalence of HPF in the Italian food system and compared the hyper-palatability of similar foods across Italy and the United States, which has wide HPF saturation. Methods: A national food system dataset was used to characterize HPF availability in Italy. A representative sample of foods commonly consumed in both Italy and the US were collected and compared. Foods represented six categories: cookies/biscotti, cakes/merendine, salty snacks, industrial bread, frozen pizza and protein/cereal bars. A standardized definition from Fazzino et al. identified HPF. Results: Less than one third (28.8%) of foods in the Italian food system were hyper-palatable. US HPF items had significantly higher fat, sugar, and/or sodium across most food categories (p values = 0.001 to 0.0001). Italian HPF items had higher fiber and/or protein relative to US HPF from the same category (p values = 0.01 to 0.0001). Conclusion: The Italian food system may confer protection from HPF exposure. HPF products in Italy had lower palatability-related nutrients and higher satiety-promoting nutrients.

Giving fruits and vegetables a tax break: lessons from a Dutch attempt.

OBJECTIVE: Food taxation can improve diets by making unhealthy foods more expensive and by making healthy foods cheaper. In the Netherlands, a political window of opportunity arose in December 2021 to reduce the value-added tax (VAT) on fruits and vegetables to zero percent. The policy is now facing institutional friction along several fronts, however, delaying and potentially averting its implementation. We analysed this institutional friction to inform future food tax policies. DESIGN: We qualitatively analysed open-access fiscal and health experts' position papers about benefits and downsides of the zero-rate that were discussed with members of parliament in June 2023. SETTING: The Netherlands. PARTICIPANTS: Not applicable. RESULTS: Health and fiscal experts expressed noticeably different viewpoints towards the utility of the zero-rate. One important argument fiscal experts based their negative advice upon pertained to the legal restrictions for distinguishing between healthier and unhealthier forms of fruits and vegetables (i.e. the principle of neutrality). A zero-rate VAT on unhealthier forms of fruits and vegetables, e.g. processed cucumber, mixed with salt and sugar, would be undesirable, but differentiating between raw and processed cucumber would offend the neutrality principle. CONCLUSIONS: The Dutch attempt to give fruits and vegetables a tax break highlights the need for crystal-clear food classifications when designing food tax policies. Public health nutritionists should combine classifications based on caloric density, palatability, degree of processing and nutrient content to provide a database for evidence-informed tax differentiation according to food item healthfulness.

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.

Ultraprocessed, hyper-palatable, and high energy density foods: Prevalence and distinction across 30 years in the United States.

OBJECTIVE: Ultraprocessed foods (UPF), hyper-palatable foods (HPF), and high energy density (HED) foods may contribute to obesity risk. All have distinct definitions; however, it is unknown the degree to which they may identify overlapping or distinct foods. This study examined the availability of UPF, HPF, and HED foods in the US food system from 1988 to 2018 and the degree of distinction across definitions. METHODS: Four data sets representing the US food system (1988, 2001, 2006, 2018) from the US Department of Agriculture were analyzed. UPF were identified based on the extent of industrialized processing. HPF were identified using the standardized definition that specifies palatability-inducing nutrient combinations. HED was characterized as >2.0 kcal/g. RESULTS: Across years, 58% to 65% of foods were classified as UPF, 55% to 69% as HPF, and 37% to 47% as HED. Prevalence of UPF, HPF, and HED foods was higher in 2018 versus 1988 (p values < 0.001); HPF evidenced the largest increase (14%) and UPF evidenced the smallest (4%) over time. There was moderate to high overlap in foods (40%-70%) across definitions. CONCLUSIONS: Together, UPF, HPF, and HED foods comprise most foods in the US food supply. Changes in availability varied across definitions, with substantial increases in HPF and HED and relative stability of UPF.

Engagement in types of activities and frequency of alcohol use in a national sample of United States adolescents.

OBJECTIVE: Adolescents with fewer sources of environmental reinforcement may be at risk for alcohol use. Behavioral economic theories posit that engagement in some activities may facilitate alcohol use, whereas other activities may be incompatible with use and reduce likelihood of alcohol use. It is unclear which types of activities may facilitate or may be incompatible with alcohol use in adolescence. Using a national sample of adolescents, the current study examined differences in engagement with types of activities that may be incompatible with alcohol use, compared among adolescents who endorsed alcohol use, and adolescents who did not. METHOD: Data from the 2019 Monitoring the Future (MTF) study (N = 4626) were analyzed. Potentially incompatible and facilitating activities, and alcohol-involved activities were identified from pre-existing survey measures. Confirmatory factor analysis, measurement invariance, and structural equation modeling were used to examine patterns in activity engagement among those who endorsed alcohol use and those who did not. RESULTS: Participants who did not endorse alcohol use reported higher engagement in activities that may be incompatible with alcohol use, including enjoyment from school and going to the mall (p < .001). Participants who endorsed alcohol use reported higher engagement in activities that may facilitate alcohol use (p < .001), such as spending time with friends and attending parties. Facilitating activities (ß = 0.15, p < .001) and alcohol-involved activities (ß = 0.70, p < .001) were positively associated with alcohol use frequency. Observed effect sizes were small in magnitude for all findings. CONCLUSIONS: The findings support the premise of behavioral economic theory, suggesting some activities may serve as protective factors against alcohol use frequency while other activities may facilitate alcohol use among adolescents. National surveys may consider adding specific measure of activity engagement to identify activities that may be incompatible with alcohol use among adolescents.

Motives and food craving: Associations with frequency of hyper-palatable food intake among college students.

BACKGROUND: College food environments provide wide access to hyper-palatable foods (HPF). Palatable eating motives and craving are individual factors that may impact HPF intake. Nevertheless, no study to date has examined the relationship between these factors and frequency of HPF intake in a dormitory all-you-can-eat-style cafeteria meal, a typical college food setting. METHODS: College students (N = 218) self-reported frequency of HPF intake at a college cafeteria meal and their frequency of HPF intake in the overall diet. Quasipoisson and logistic regression models tested whether palatable eating motives (assessed via the Palatable Eating Motives Scale) and craving (assessed via the Food Craving Inventory) were associated with the rate of HPF intake during the cafeteria meal and excess frequency of HPF intake in the overall diet. RESULTS: Craving was associated with a 19% higher rate of HPF intake during the cafeteria meal (RR = 1.19; p = .015) and a >2-fold higher likelihood of excess frequency of HPF intake the overall diet (OR = 2.69; p < .001). Coping motive was associated with an 87% higher likelihood of excess frequency of HPF intake in the overall diet (OR = 1.87; p = .002), but not in the cafeteria meal. Reward enhancement, social and conformity motives were not significantly associated with the frequency of HPF intake in either setting. CONCLUSIONS: Results highlight the role of craving and coping motive in the frequency of HPF intake among college students. Prevention efforts may consider targeting craving and eating to cope to potentially address frequency of HPF intake among college students.

Early exposure to added sugars via infant formula may explain high intakes of added sugars during complementary feeding beyond maternal modeling.

Background: Research has shown that early exposure to added sugars from table food is related to increased intake of added sugars in later childhood. The earliest window of exposure to added sugars may be in infancy via infant formula. However, beyond the well-established factors of maternal lifestyle and modeling, there is a lack of research examining how exposure to added sugars from infant formula influences infant/toddler added sugar intakes from table foods and sugar sweetened beverages (SSB). Objective: While accounting factors previously associated with infant/toddler added sugar intakes and maternal SSB consumption (proximal measure of maternal modeling), this study aims to examine if there is an association between added sugars in infant formula and added sugar intakes from table foods and SSB during the complementary feeding period. Methods: This is a secondary, cross-sectional analysis using three-day caregiver-reported 24-h dietary recalls in a cohort of infant/toddlers (n = 95), ages 9- < 16 mos., enrolled in a music intervention trial. Hierarchical stepwise regression was used to estimate the association between exposure to added sugars from infant formula and (1) intake of added sugars from table food and (2) SSB consumption. Infant/toddler SSB consumption was transformed to account for distributional properties. We performed incremental F-tests to determine whether the addition of each step improved model fit (R2). Results: Early exposure to added sugars via infant formula was associated with infant/toddler SSB (ΔR2 = 0.044, Finc (1, 87) =6.009, p = 0.016) beyond sociodemographic and maternal SSB consumption, but not with infant/toddler added sugar intakes from table foods (ΔR2 = 0.02, Finc (1, 87) =3.308, p = 0.072). Conclusion: While past studies have identified circumstantial (i.e., sociodemographic), or indirect (i.e., maternal lifestyle and modeling), mechanisms contributing to higher infant/toddler added sugar intakes, this study identifies exposure to added sugars from infant formula as a possible direct mechanism explaining why some infants/toddlers consume more added sugars.

Discounting of Hyper-Palatable Food and Money: Associations with Food Addiction Symptoms.

INTRODUCTION: Delay discounting (DD), the tendency to prefer small, immediate rewards over larger, delayed rewards, is associated with health-risk behaviors. The study examined associations between DD for money and hyper-palatable foods (HPF) with food addiction (FA) symptoms among a general population sample. METHODS: Participants (N = 296) completed an adjusting DD task that consisted of a single-commodity condition with HPF as the reward (HPF now vs. HPF later) and cross-commodity conditions comparing money and HPF (money now vs. HPF later; HPF now vs. money later). The Yale Food Addiction Scale 2.0 was used to assess FA symptoms. Zero-inflated negative binomial regression models tested whether discounting of HPF and money was associated with FA symptoms. RESULTS: Findings indicated there were no significant associations between DD and FA symptoms in the single-commodity HPF condition (logit: OR = 1.02, p-value = 0.650; count: IRR = 1.04, p-value = 0.515). There were no significant associations among cross-commodity conditions comparing money now vs. HPF later (logit: OR = 0.96, p-value = 0.330; count: IRR = 1.02, p-value = 0.729) or conditions comparing HPF now vs. money later (logit: OR = 1.02, p-value = 0.682; count: IRR = 0.92, p-value = 0.128) and FA symptoms. CONCLUSIONS: Discounting HPF may not be a key behavioral feature among individuals who endorse FA symptoms.

Engagement with Activity Monitoring During a Behavioral Activation Intervention: A Randomized Test of Monitoring Format and Qualitative Evaluation of Participant Experiences.

Behavioural activation (BA) is an efficacious treatment approach. Activity monitoring is a key component of brief BA treatments; however, no studies have examined the most efficacious format for monitoring. The present pilot study tested brief versus intensive activity monitoring approaches during a BA intervention administered in a college orientation course. Outcomes characterised (1) engagement with the treatment protocol via activity monitoring and (2) participant qualitative experiences with monitoring and the intervention as reported during focus group interviews. Four course sections were randomly assigned to receive monitoring forms that were brief (assessed activities three times daily) or intensive (assessed activities hourly). Forms were provided electronically to students via a web-based platform which tracked completion. There were no significant differences in monitoring frequency (38.0 vs. 23.0 days; p = .154) or the duration of monitoring engagement (62.0 vs. 36.0 days; p = .054) between the brief and intensive conditions. Qualitative findings suggested that participants in both conditions found utility in activity monitoring, particularly during the first month as they transitioned to college. Overall, findings indicated that participants may find utility in monitoring during the first month of a BA intervention using either brief or intensive monitoring forms.

Delay discounting and substance use treatment outcomes: A systematic review focused on treatment outcomes and discounting methodology.

INTRODUCTION: Delay discounting-the tendency to choose small, immediate rewards over larger, delayed rewards-is robustly associated with substance use. Delay discounting may present challenges in treatment for substance use disorders, as individuals with elevated discounting may struggle to wait for the long-term rewards that come from abstinence, which may yield poorer treatment outcomes. However, evidence on the role of discounting in treatment outcomes has been inconsistent. The study conducted a systematic review of the literature to characterize the prospective effects of delay discounting measured pre-treatment on substance use treatment outcomes, with a focus on characterizing findings across: 1) type of treatment outcome and 2) methodology used to assess and characterize discounting. METHOD: A systematic literature search identified N = 17 studies that examined the association between delay discounting at treatment entry (pre-treatment) and substance use treatment outcomes. Findings were reported across the following substance use treatment outcomes: abstinence, relapse, use frequency and related problems, and treatment adherence. Findings regarding discounting methodology were reported by type of discounting measure (adjusting choice task, fixed choice task, or experiential task) and parameter used to characterize discounting (k, log transformed k (lnk), and area under the curve). RESULTS: Delay discounting at treatment entry was not consistently associated with substance use treatment outcomes when examined across all studies overall (47 %) or by treatment outcome (0-40 % for most outcomes). The majority of studies (64 %) that used an adjusting choice, computer-based task reported a significant association between discounting and treatment outcomes, whereas few studies that used a fixed choice or experiential task reported significant associations with treatment outcomes (0-25 %). Most studies (71 %) that used the lnk parameter to characterize discounting reported significant associations between discounting and a range of treatment outcomes. In contrast, few studies that used k or AUC (25-33 %) reported significant associations between discounting and treatment outcomes. CONCLUSION: When examined overall and by treatment outcome, evidence did not consistently indicate that delay discounting was prospectively associated with substance use treatment outcomes. However, delay discounting at treatment entry was more commonly associated with a variety of poorer treatment outcomes when researchers used more fine-grained methods to characterize discounting.

Ad libitum meal energy intake is positively influenced by energy density, eating rate and hyper-palatable food across four dietary patterns.

Diets for the prevention and treatment of obesity are often informed by theories about food characteristics believed to support spontaneous reductions in ad libitum energy intake without inducing hunger. Here we estimated how energy density, hyper-palatability, protein content and eating rate affected ad libitum energy intake of 2,733 meals from four dietary patterns. Energy density, eating rate and hyper-palatable foods were consistently positively related to meal energy intake across all diets. Protein content was positively related to meal energy intake during ultraprocessed and unprocessed diets but was not significantly related to energy intake of minimally processed low-fat or low-carbohydrate meals.

Associations between Alcohol-Free Sources of Reinforcement and the Frequency of Alcohol and Cannabis Co-Use among College Freshmen.

Co-use of alcohol and cannabis is common among young adults in the United States. A behavioral economics framework indicates that greater engagement in substance-free sources of reinforcement may be protective against co-use frequency. The current study tested the association between proportionate alcohol-free reinforcement and the frequency of co-use among college freshmen. Participants (N = 86) were freshmen who enrolled in a freshman orientation course and completed surveys at the beginning of the semester. Past month alcohol use, cannabis use, and reinforcement from alcohol-free and alcohol-involved activities were assessed. A zero-inflated Poisson regression was used to test the association between proportionate alcohol-free reinforcement and days of co-use. The results indicated that proportionate alcohol-free reinforcement was negatively associated with co-use days in the count model when controlling for alcohol use days and gender as covariates (ß: -3.28, p = 0.016). Proportionate alcohol-free reinforcement did not significantly differentiate individuals who did not engage in co-use in the zero-inflated model (ß: -1.68, p = 0.497). The study suggested that greater proportionate alcohol-free reinforcement may be associated with lower engagement in the co-use of alcohol and cannabis among young adults. Increasing engagement in alcohol-free sources of reinforcement may be considered a target for co-use prevention or harm reduction efforts.

Hyper-palatable foods in elementary school lunches: Availability and contributing factors in a national sample of US public schools.

BACKGROUND: School cafeterias are a major point of influence for child nutrition. United States federal legislation requires the presence of important nutrients in school meals. However, legislation overlooks the potential presence of hyper-palatable foods in school lunches, a hypothesized factor that may influence children's eating behavior and obesity risk. The study sought to 1) quantify the prevalence of hyper-palatable foods (HPF) served in US elementary school lunches; and 2) determine whether food hyper-palatability varied based on school geographic region (East/Central/West), urbanicity (urban/micropolitan/rural), or meal item (entrée/side/fruit or vegetable). METHODS: Lunch menu data (N = 18 menus; N = 1160 total foods) were collected from a sample of six states that represented geographic regions of the United States (Eastern/Central/Western; Northern/Southern) and that had variability in urbanicity (urban, micropolitan, and rural) within each state. A standardized definition from Fazzino et al (2019) was used to identify HPF in lunch menus. RESULTS: HPF comprised almost half of foods in school lunches (M = 47%; SD = 5%). Compared to fruit/vegetable items, entrées were >23 times more likely to be hyper-palatable and side dishes were >13 times more likely to be hyper-palatable (p values < .001). Geographic region and urbanicity were not significantly associated with food item hyper-palatability (p values >.05). The majority of entrée and side items contained meat/meat alternatives and/or grains and likely aligned with the US federal reimbursable meal components of meat/meat alternatives and/or grains. CONCLUSIONS AND IMPLICATIONS: HPF comprised almost half of foods offered in elementary school lunches. Entrées and side items were most likely to be hyper-palatable. US school lunches may be a key point of regular exposure to HPF among young children, a risk factor that may elevate child obesity risk. Public policy regulating HPF in school meals may be needed to protect children's health.

Hyperpalatable Foods Consumption in a Representative Sample of the General Population in Brazil: Differences of Binge and Non-Binge Eating Meals.

The availability of hyper-palatable foods (HPF) increased over the past three decades worldwide, a period when eating disorders (ED) and obesity have become global public health concerns. The present study aimed to assess HPF consumption during binge and non-binge meals in a representative sample of adults with and without ED from a metropolitan city in Brazil. A total of 2297 individuals were interviewed in their homes by trained lay interviewers to assess the presence of binge eating disorder (BED), bulimia nervosa (BN), and recurrent binge eating (RBE). Information on their food consumption in objective and subjective binge eating episodes (OBE and SBE, respectively), as well as in the 24 h food recall were obtained. Individuals from the general population consumed 56% of their total calories from HPF. In non-binge meals, people with BN consumed substantially fewer calories from HPF than BED (63% vs. 48%) and RBE (63% vs. 48%) groups. During OBE, participants consumed an average of 70% of the calories from HPF, with no between-group differences. During SBE, subjects with BN consumed substantially fewer calories from HPF than those with BED (76% vs. 50%). In conclusion, HPF were highly consumed by the Brazilian population. However, there was a greater impact on BED and RBE subjects and during binge eating episodes.

Change in hyper-palatable food availability in the US food system over 30 years: 1988-2018.

OBJECTIVE: To quantify the change in availability of hyper-palatable foods (HPF) in the US foods system over 30 years (1988-2018). DESIGN: Three datasets considered representative of the US food system were used in analyses to represent years 1988, 2001 and 2018. A standardised definition from Fazzino et al. (2019) that specifies combinations of nutrients was used to identify HPF. SETTING: Analysis of food-item level data was conducted. Differences in the prevalence of HPF were characterised by Cochran's Q and McNemar's tests. Generalised linear mixed models with a fixed effect for time and random intercept for food item estimated change in the likelihood that a food was classified as hyper-palatable over time. PARTICIPANTS: No participant data were used. RESULTS: The prevalence of HPF increased 20 % from 1988 to 2018 (from 49 % to 69 %; P < 0·0001). The most prominent difference was in the availability of HPF high in fat and Na, which evidenced a 17 % higher prevalence in 2018 compared with 1988 (P < 0·0001). Compared with 1988, the same food items were >2 times more likely to be hyper-palatable in 2001, and the same food items were >4 times more likely to be classified as hyper-palatable in 2018 compared with 1988 (P values < 0·0001). CONCLUSIONS: The availability of HPF in the US food system increased substantially over 30 years. Existing food products in the food system may have been reformulated over time to enhance their palatability.

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).

Reward sensitivity, eating behavior, and obesity-related outcomes: A systematic review.

INTRODUCTION: Previous research has identified reward sensitivity as an important factor that may contribute to the engagement in eating behavior (e.g., binge eating, emotional eating, etc.) and increase obesity risk. In the current study, we conducted a systematic review of the literature to determine the relationships between reward sensitivity, eating behavior, and obesity-related outcomes. The study focused on two commonly used measures of reward sensitivity in the literature: the Sensitivity to Punishment and Sensitivity to Reward Questionnaire (SPSRQ) and the Behavioral Inhibition Scale/Behavioral Activation Scale (BIS/BAS Scale). METHOD: We conducted a systematic search to identify studies that analyzed reward sensitivity as a predictor of eating behavior or obesity-related outcomes, and measured reward sensitivity using the SPSRQ or BIS/BAS Scale. The search yielded N=19 total publications included in the review. RESULTS: Findings indicated that reward sensitivity, primarily measured by summary scores on the SPSRQ or BIS/BAS Scale, were positively associated with a variety of eating behaviors and obesity-related outcomes with small to moderate effect sizes. Findings were most consistent across studies that examined the association between reward sensitivity and eating behavior outcomes (e.g., binge eating, emotional eating) (r values= .08 to .41; p values < .001 to p < .05) and food consumption outcomes (e.g., palatable food intake) (r values = .21 to .40; p < .001 to p values < .05). Findings were less consistent for food craving and BMI outcomes, and revealed these relationships may depend on individual-level factors and/or environment-related factors, (e.g., food cues). A quality evaluation using the Critical Appraisal Tool for Cross-Sectional Studies (AXIS tool) indicated that most studies were rated as moderate to strong quality (84%). CONCLUSION: Findings indicate that elevated reward sensitivity may be a risk factor for engagement in eating behaviors that may increase obesity risk.

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.

Bridging gaps by including culture: Development and empirical test of the culturally informed theory for disordered eating among Black women.

BACKGROUND: Leading eating disorder (ED) theories were informed primarily by samples of White females. Therefore, ED theories lack consideration of sociocultural factors that may impact ED symptom development among Black women. The current study proposed the first culturally informed theory for disordered eating among Black women, positing that ethnic discrimination, strong black woman (SBW) ideology (cultural and societal expectations of strength), and culturally informed appearance satisfaction may significantly impact stress. Stress may be associated with coping-motivated eating behaviors, which may lead to maladaptive weight control behaviors. METHODS: Black women (N = 208) completed surveys assessing socio-cultural factors, stress, commensal and binge eating, and maladaptive weight control behaviors. Path analysis was used to test the proposed theory. RESULTS: The final model had a good fit for the data. Findings overall supported the hypothesized model. Specifically, higher ethnic discrimination (ß = 0.044, p = .003), greater endorsement of SBW ideology (ß = 0.074, p =< .001), and lower culturally informed appearance satisfaction (ß = -0.032, p = .025) were associated with greater stress. Stress was positively associated with binge eating (ß = 0.457, p = .046), and binge eating was significantly associated with excessive exercise (=0.152, p = .008) and purging (ß = 0.273, p = <.001). In contrast, commensal eating was not associated with stress or weight control behaviors (p values = .697 to .749). CONCLUSIONS: The current study found that stress, as influenced by sociocultural factors, may play a role in binge eating, and subsequently, weight control behaviors among Black women. This theory is a starting point for future research on the specialized conceptualization of eating and maladaptive weight control behaviors among Black women.