Life-long dietary restrictions have negligible or damaging effects on late-life cognitive performance: A key role for genetics in outcomes.

Several studies report that caloric restriction (CR) or intermittent fasting (IF) can improve cognition, while others report limited or no cognitive benefits. Here, we compare the effects of 20% CR, 40% CR, 1-day IF, and 2-day IF feeding paradigms to ad libitum controls on Y-maze working memory (WM) and contextual fear memory (CFM) in a large population of Diversity Outbred mice that model the genetic diversity of humans. While CR and IF interventions improve lifespan, we observed no enhancement of working memory or CFM in mice on these feeding paradigms, and report 40% CR to be damaging to recall of CFM. Using Quantitative Trait Loci mapping, we identified the gene Slc16a7 to be associated with CFM outcomes in aged mice on lifespan promoting feeding paradigms. Limited utility of dieting and fasting on memory in mice that recapitulate genetic diversity in the human population highlights the need for anti-aging therapeutics that promote cognitive function, with the neuronal monocarboxylate transporter MCT2 encoded by Slc16a7 highlighted as novel target.

The Influence of Response Inhibition Training on Food Consumption and Implicit Attitudes toward Food among Female Restrained Eaters.

Restrained eaters display difficulties engaging in self-control in the presence of food. Undergoing cognitive training to form associations between palatable food and response inhibition was found to improve self-control and influence eating behaviors. The present study assessed the impact of two such response inhibition trainings on food consumption, food-related anxiety, and implicit attitudes toward food among female restrained eaters (Dutch Eating Behavior Questionnaire-restrained eating subscale ≥ 2.5). In Experiment 1, 64 restrained eaters completed either one of two training procedures in which they were asked to classify food vs. non-food images: a food-response training, in which stop cues were always associated with non-food images, or a balanced food-response/inhibition training, in which participants inhibited motor actions to food and non-food stimuli equally. The results revealed reduced snack consumption following the food-response/inhibition training compared to the food-response training. The food-response training was associated with increased levels of food-related anxiety. In Experiment 2, the same training procedures were administered to 47 restrained eaters, and implicit attitudes toward palatable foods were assessed. The results revealed an increase in positive implicit attitudes toward palatable foods in the food-response/inhibition group but not in the food-response training group. The results suggest that balancing response inhibition and execution across food and non-food stimuli may reduce overeating while retaining positive attitudes toward food among female restrained eaters.

Association between the Potential Influence of a Lifestyle Intervention in Older Individuals with Excess Weight and Metabolic Syndrome on Untreated Household Cohabitants and Their Family Support: The PREDIMED-Plus Study.

This cross-sectional study aims to evaluate the association between the PREDIMED-Plus study lifestyle intervention and (i) adherence to the Mediterranean diet (MedDiet) and (ii) physical activity of cohabiting study participants, and to define the related social characteristics of the household members. Participants were a subsample of 541 cohabitants of the PREDIMED-Plus study. Adherence to the MedDiet, physical activity, anthropometric measurements, family function, and social support were assessed. Multiple linear regressions were applied to the data. Partners of the PREDIMED-Plus participants had higher adherence to the MedDiet compared to their sons/daughters (9.0 vs. 6.9 points). In comparison to partners with low adherence to the MedDiet, partners with high adherence were older, practiced more physical activity, ate more frequently with the PREDIMED-Plus participants, and had better family function (adaptability item). Compared to physically active partners, very active ones were older, more likely to be women, and had lower BMI and higher adherence to the MedDiet. In addition, they ate more frequently with the PREDIMED-Plus participants and had better family function. Using multiple lineal regressions, an increase in the adherence to the MedDiet of the PREDIMED-Plus participant, and better family function, were positively associated with their partner's adherence to the MedDiet. The PREDIMED-Plus intervention showed a positive association with adherence to the MedDiet of the study participants' partners. In addition, this association was influenced by the social characteristics of the household members.

Beyond the thin ideal: Development and validation of the Fit Ideal Internalization Test (FIIT) for women.

[Correction Notice: An Erratum for this article was reported in Vol 32(2) of Psychological Assessment (see record 2020-04120-001). In the article, there are two errors in the Method section for Study 2. First, in the "Body dissatisfaction" subsection, the range of total scores for the Body-Image Ideals Questionnaire was incorrectly listed as being "between 0 and 99." The correct range is from - 3 to 9. Second, in the "Dieting and bulimia" subsection, the reference for the Eating Attitudes Test (EAT-26) was incorrectly cited as "Garner et al., 1983." Garner, D. M., Olmsted, M. P., Bohr, Y., & Garfinkel, P. E. (1982). The Eating Attitudes Test: Psychometric features and clinical correlates. Psychological Medicine, 12, 871-878. http://dx.doi .org/10.1017/s0033291700049163.] Females are at risk for body image and eating disturbance when they internalize societally prescribed standards of Western beauty. With respect to messages to be thin or muscular, numerous scales are available that measure internalization. However, many women are now receiving messages about the desirability of being both thin and toned, yet no self-report measure of internalization of a fit female body ideal exists. Our aim was to develop a multidimensional tool (i.e., the Fit Ideal Internalization Test; FIIT) useful for assessing women's internalization of the fit ideal (i.e., a lean and toned body ideal). Three studies were conducted, recruiting independent groups of women attending university to complete surveys. In Study 1 (N = 300, age 16-51), women completed the FIIT items, and a 3-factor structure of fit idealization (8 items), fit overvaluation (8 items), and fit behavioral drive (4 items) was established through exploratory factor analysis. Also, items loading highly on each of the factors had good interitem correlations. In Study 2 (N = 354, age 16-63), women completed the 20-item FIIT and validation measures. The 3-factor structure of the FIIT was confirmed, and findings supported convergent, discriminant, and incremental validity of the FIIT subscale scores (and a total score). In Study 3 (N = 67, age 17-50), the 2-week test-retest reliability of the FIIT scores was high. Overall, the 3 FIIT subscales are related but also distinct domains of fit ideal internalization that conform to theory and may be used as individual subscales or potentially as a composite score. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Adherence to Mediterranean Diet or Physical Activity After Bariatric Surgery and Its Effects on Weight Loss, Quality of Life, and Food Tolerance.

OBJECTIVE: To assess whether a healthy dietary pattern or physical activity after bariatric surgery mediates the effects of surgery on weight loss, the quality of life, or food tolerance. METHODS: A prospective observational study conducted in the context of a randomized controlled trial. We assessed the extent to which increasing or decreasing adherence to the Mediterranean diet (MedDiet)-assessed by MEDAS (Mediterranean Diet Adherence Screener)-and of increasing or decreasing physical activity (PA)-assessed with the Short Questionnaire of International PA (IPAQ-Short Q)-after bariatric surgery affected changes in weight, body mass index (BMI), quality of life (Moorehead-Arlet Questionnaire), and food tolerance (Suter test). Assessments were recorded at baseline and quarterly up to 12 months of surgery. RESULTS: Seventy-eight morbidly obese participants undergoing bariatric surgery were assessed up to 1 year after surgery. Those individuals who increased adherence to MedDiet showed a significantly higher mean of total weight loss percentage than those who decreased or maintained their adherence during follow-up: 37.6% (35.5-39.8) versus 34.1% (31.8-36.5) (p = 0.036). No significant differences were observed in changes in weight or BMI comparing individuals who increased their PA versus those who maintained or decreased PA, nor in quality of life or food tolerance between those individuals who increased versus those who decreased adherence to MedDiet or PA during the follow-up. CONCLUSIONS: After bariatric surgery, morbidly obese subjects present greater weight loss if they adhere to the MedDiet. PA after surgery is not associated with the magnitude of weight loss nor the quality of life and tolerance to diet.

Healthiness or calories? Side biases in food perception and preference.

The visual perception of a product and the ability to categorize it play a central role in food choice. People's opinion of the healthiness and caloric content of a food is influenced substantially by its appearance. Despite that, few studies have analyzed i) which one of the two dimensions of caloric content and healthiness is preferred to categorize food, ii) if these dimensions are mapped on the individuals' horizontal space, and iii) if such biases could influence food preferences. Therefore, through 4 experiments, we investigated which dimension, healthiness or caloric content, is more often used to categorize foods. We also evaluated whether a healthiness/caloric content side bias could be able to influence food preferences. We found that foods were mainly categorized as "Healthy" or "High-calorie" and the latter label was used more often when presented on the right of a foodstuff. Also, foods were categorized as healthier when the "Healthy" label was anchored to the left and the "Unhealthy" one to the right side of a visual analogue scale. Then, we found a more positive evaluation of transformed food when the key assigned to the "Pleasant" choice was on the right compared to the left. Lastly, we found that when presented on the left side, low-calorie was preferred compared to high-calorie food. Our findings shed light on both the fields of food categorization and side biases in food perception and preferences, suggesting the possibility to use these biases to promote a healthy diet and emphasizing the importance of considering this potential confounder in experimental setups.

Change in self-efficacy, eating behaviors and food cravings during two years of calorie restriction in humans without obesity.

Calorie restriction (CR) enhances longevity in humans who are normal weight, overweight and obese. While dietary regimens can change self-efficacy, eating behaviors, and food cravings in individuals with obesity, the responses of these measures to prolonged CR in individuals who are exclusively not obese is unknown. The aim of this analysis was to test the effects of a two-year CR intervention on self-efficacy and eating attitudes and behaviors in humans without obesity by analyzing data from the Comprehensive Assessment of Long-term Effects of Reducing Intake of Energy Phase 2 (CALERIE 2) study. Participants (n = 218, BMI range = 21.3-29.0 kg/m2) were randomized to a 25% CR group or an ad libitum (AL) group. Eating attitudes and behaviors and self-efficacy were assessed using validated questionnaires at baseline, month 12, and month 24. Dietary restraint and self-efficacy increased in the CR compared to the AL group (ES ≥ 0.32). Increased self-efficacy was negatively related to weight change (ρ < -0.24). In the CR group, males showed a reduction in cravings for carbohydrates and fats at month 24, whereas females did not. The CR group showed elevations in state hunger, which were transient, and disinhibited eating (ES ≥ 0.37). In individuals without obesity, dietary restraint and self-efficacy could be important in promoting long-term CR for individuals looking to use CR as a tool to improve longevity.

Lack of conflict during food choice is associated with the failure of restrained eating.

Restrained eaters tend to sustain a restriction in caloric intake to lose or maintain body weight; however, only a few restrained eaters can achieve the goal of restricting their caloric intake to lose or maintain body weight. Those who are effective restrained eaters habitually adhere to their intentions to avoid eating certain palatable foods, whereas those who are ineffective restrained eaters are generally unable to translate their intentions into behavior. To restrain eating regardless of temptation, an individual must first identify potential conflicts between achieving restrained eating and temptation to eat. Regarding food selections, the association between a lack of conflict between temptation, eating enjoyment, and weight loss or maintenance goals and the failure of restriction of caloric intake remains unknown. The present study used an eye-tracking technique to assess the degree of conflict experienced by effective and ineffective restrained eaters during food choice. Participants were required to choose between pairs of high- and low-calorie foods. The results showed that choosing the low-calorie food was associated with the experience of more conflict, measured by longer response times and more gaze switches, than choosing the high-calorie food. Ineffective restrained eaters experienced less conflict, exhibiting shorter response times and fewer gaze switches, than did effective restrained eaters, which suggests that a failure to restrain eating might be associated with a lack of experience of conflict.

Cognitive aids and food choice: Real-time calorie counters reduce calories ordered and correct biases in calorie estimates.

Studies of the effect of calorie information on food choices in food-away-from-home settings have identified minor to insignificant changes in calories ordered. An element of the choice process that may play an important role in influencing the total caloric content of a meal has received little attention: how individuals track the total number of calories selected when choosing multiple items. We study the effects of automating this potentially costly cognitive process using technology. We compare the number of calories ordered in a sequential food choice task in two conditions: one in which participants have access to calorie information for all options available and a second in which they are also exposed to automatically updating information about the number of calories they have ordered. Participants with access to calorie summation ordered significantly fewer calories than those without access to calorie summation. Participants without access to calorie summation significantly underestimated the number of calories they had ordered, while those in the calorie summation condition did not. The calorie summation seems to work in part through adjustment of sequential choices: calories ordered in the first choice category were very similar in the two conditions but diverged increasingly in later categories. Technologies that help individuals keep track of the nutritional consequences of cumulative choices may help promote healthier diets.

Cognitive Effects of Adding Caloric Restriction to Aerobic Exercise Training in Older Adults with Obesity.

OBJECTIVE: This study examined the short- and long-term effects of adding caloric restriction to 5 months of aerobic exercise training on executive function in sedentary older adults with obesity. METHODS: Sedentary adults with obesity aged 65 to 79 years completed a randomized trial investigating the cardiorespiratory benefits of adding moderate (~ 250 kcal) or high (~ 600 kcal) caloric restriction to a 20-week aerobic exercise program. Approximately half (n = 88) completed a cognitive assessment battery at baseline, post intervention, and 18 to 24 months after intervention completion. The primary outcome was an executive function composite score. RESULTS: In the overall sample, the executive function composite increased 0.114 from baseline to postintervention (P = 0.01). Randomization to caloric restriction did not significantly alter executive function over aerobic exercise alone, nor were there between-group differences on any individual executive function test following the intervention or at long-term follow-up. Adding caloric restriction to exercise was associated with a modest increase in Mini-Mental State Examination score (P = 0.04). In the overall sample, increases from baseline at long-term follow-up were noted in digit symbol and word list recall performance as well. CONCLUSIONS: Adding caloric restriction to a 20-week aerobic exercise program does not worsen or improve executive function more than exercise alone assessed up to 24 months post randomization.

Moderate differences in common feeding diets change lipid composition in the hippocampal dentate gyrus and affect spatial cognitive flexibility in male rats.

There is growing evidence that lipids play a fundamental role in neuronal plasticity and learning and memory. Effects of nutrition on brain lipid composition and neuronal functioning are known, but the feeding interventions are often severe and may not reflect nutritional effects below clinical relevance. Therefore, we tested two commercially available rat feeding diets with only moderate differences in the food compositions, a standard diet (gross energy metabolizable 12.8 MJ/kg) and a energy reduced diet (gross energy metabolizable 8.9 MJ/kg) on possible effects upon dentate gyrus lipid composition, spatial learning and memory in a water maze and corticosterone release (blood serum concentrations) in adult male rats. Rats were fed with the standard diet up to an age of 8 weeks. One group was further fed with the standard and another with the energy reduced diet until an age of 5 months. We did not found differences in serum corticosterone levels. We found group differences in a variety of lipids in the hippocampal dentate gyrus.. Most of the lipid levels were lower in energy reduced diets, namely glycerophosphoethanolamines, sphingomyelins and hexosyceramides, whereas some ceramides (Cer18:0 and Cer24:1) and glycerophosphocholines (PC34:3 and PC36:2) were upregulated compared to the standard diet group. The performance in a common reference memory water maze task was not different between groups, however during reversal learning (platform in a different position) after the initial training, the standard diet fed rats learned better and spatial memory was improved compared to the energy reduced diet group. Thus, moderate differences in feeding diets have effects specifically upon spatial cognitive flexibility. Possible relations between differences in lipid composition and cognitive flexibility are discussed.

Two days of calorie deprivation impairs high level cognitive processes, mood, and self-reported exertion during aerobic exercise: A randomized double-blind, placebo-controlled study.

Military personnel and emergency responders perform cognitively-demanding tasks during periods of sustained physical exertion and limited caloric intake. Cognitive function is preserved during short-term caloric restriction, but it is unclear if preservation extends to combined caloric restriction and physical exertion. According to the "reticular-activating hypofrontality" model, vigorous exertion impairs prefrontal cortex activity and associated functions. This double-blind, placebo-controlled, crossover study examined cognitive function during sustained exertion while volunteers were calorically-deprived. Twenty-three volunteers were calorie-depleted for two days on one occasion and fully-fed on another. They completed intermittent bouts of exercise at 40-65% VO2peak while prefrontal cortex-dependent tasks of cognitive control, mood, and perceived exertion were assessed. Calorie deprivation impaired accuracy on the task-switching task of set-shifting (p < .01) and decreased sensitivity on the go/no-go task of response inhibition (p < .05). Calorie deprivation did not affect risk taking on the Rogers risk task. During exercise, calorie deprivation, particularly on day 2, increased perceived exertion (p < .05) and impaired mood states of tension, depression, anger, vigor, fatigue, and confusion (all p < .01). Physical exertion during severe calorie deprivation impairs cognitive control, mood, and self-rated exertion. Reallocation of cerebral metabolic resources from the prefrontal cortex to structures supporting movement may explain these deficits.

Associations of Brain Reactivity to Food Cues with Weight Loss, Protein Intake and Dietary Restraint during the PREVIEW Intervention.

The objective was to assess the effects of a weight loss and subsequent weight maintenance period comprising two diets differing in protein intake, on brain reward reactivity to visual food cues. Brain reward reactivity was assessed with functional magnetic resonance imaging in 27 overweight/obese individuals with impaired fasting glucose and/or impaired glucose tolerance (HOMA-IR: 3.7 ± 1.7; BMI: 31.8 ± 3.2 kg/m²; fasting glucose: 6.4 ± 0.6 mmol/L) before and after an 8-week low energy diet followed by a 2-year weight maintenance period, with either high protein (HP) or medium protein (MP) dietary guidelines. Brain reactivity and possible relationships with protein intake, anthropometrics, insulin resistance and eating behaviour were assessed. Brain reactivity, BMI, HOMA-IR and protein intake did not change differently between the groups during the intervention. In the whole group, protein intake during weight maintenance was negatively related to changes in high calorie images>low calorie images (H > L) brain activation in the superior/middle frontal gyrus and the inferior temporal gyrus (p < 0.005, corrected for multiple comparisons). H > L brain activation was positively associated with changes in body weight and body-fat percentage and inversely associated with changes in dietary restraint in multiple reward, gustatory and processing regions (p < 0.005, corrected for multiple comparisons). In conclusion, changes in food reward-related brain activation were inversely associated with protein intake and dietary restraint during weight maintenance after weight loss and positively associated with changes in body weight and body-fat percentage.

Effect of A Very Low-Calorie Ketogenic Diet on Food and Alcohol Cravings, Physical and Sexual Activity, Sleep Disturbances, and Quality of Life in Obese Patients.

Psychological well-being and hunger and food control are two relevant factors involved in the success of weight-loss therapy in treating obesity. Thus, this study aims to evaluate food and alcohol cravings, physical and sexual activity, sleep, and life quality (QoL) in obese patients following a very low-calorie ketogenic (VLCK) diet, as well as the role of weight lost and ketosis on these parameters. A battery of psychological test was performed in twenty obese patients (12 females, 47.2 ± 10.2 year and BMI of 35.5 ± 4.4) through the course of a 4-month VLCK diet on four subsequent visits: baseline, maximum ketosis, reduced ketosis, and endpoint. Each subject acted as their own control. Relevantly, the dietary-induced changes in body composition (7.7 units of BMI lost, 18 kg of fat mass (1.2 kg of visceral fat mass)) were associated with a statistically significant improvement in food craving scores, physical activity, sleepiness, and female sexual function. Overall, these results also translated in a notable enhancement in QoL of the treated obese patients. Therefore, the rapid and sustained weight and fat mass (FM) loss induced by the VLCK diet is associated with good food control and improvements in the psychological well-being parameters in obese subjects, which could contribute to the long-term success of this therapy.

Naïve models of dietary splurges: Beliefs about caloric compensation and weight change following non-habitual overconsumption.

The mechanisms that lead to overeating and the consumption of tempting, unhealthy foods have been studied extensively, but the compensatory actions taken afterwards have not. Here we describe the naïve models individuals hold around dietary splurges (single bouts of overeating) and associated weight changes. Across six online experiments, we found that, following a hypothetical dietary splurge, participants did not plan to adequately adjust calorie consumption to account for the additional calories consumed (Studies 1 and 2), and this pattern was worse following hypothetical splurges characterized by a large amount of food consumed in a single bout (Study 3). Participants expected weight changes to happen faster than they do in reality (Study 4) and they expected that weight gained from a dietary splurge would disappear on its own without explicit compensation attempts through diet or exercise (Study 5). Similarly, participants expected that when compensation attempts were made through calorie restriction, the rate of weight loss would be faster following a dietary splurge compared to normal eating (Study 6). This research contributes novel data demonstrating an important mechanism that likely contributes to weight gain and failed weight loss attempts.

Examination of the relationships between dietary restraint, alcohol, and adverse problems among women.

OBJECTIVE: Women who report greater chronic dieting consume more alcohol, drink more frequently, and experience greater problems than women who report less chronic dieting. Alcohol may also temporarily disrupt a woman's dietary rules, leading to increased caloric intake and subsequent restriction. This study examined whether alcohol use mediated the relationship between dietary restraint and alcohol problems in a woman's daily life. PARTICIPANTS: Women (N = 59) completed the study by the fall of 2013. METHODS: Participants completed up to six assessments for 10 days, including intended dietary restraint, alcohol use, and problems. RESULTS: Drinking quantity partially mediated the relationship between dietary restraint and alcohol problems. For each drink consumed, there was a 1.4 times greater likelihood of eating after drinking, which was associated with greater intention to subsequently restrict calories. CONCLUSIONS: The types of drinks consumed and reasons for restricting one's caloric intake may inform the relationship between these behaviors.

Calorie Labels on the Restaurant Menu: Is the Use of Weight-Control Behaviors Related to Ordering Decisions?

BACKGROUND: There is emerging evidence that calorie information on restaurant menus does not similarly influence the ordering decisions of all population groups and may have unintended consequences for individuals who struggle with disordered eating or other weight-related concerns. OBJECTIVE: This study describes demographic patterns in the use of calorie information on restaurant menus and investigates relationships between using this information to limit calorie intake and measures of restaurant visit frequency and weight-related concerns and behavior. DESIGN/PARTICIPANTS: There were 788 men and 1042 women (mean age=31.0±1.6 years) who participated in the fourth wave of the Project EAT study. Participants were initially recruited from Minneapolis-St Paul, MN, schools and completed EAT-IV surveys online or by mail from 2015 to 2016. MAIN OUTCOME MEASURES: Participants self-reported weight-related concerns, restaurant eating, intuitive eating, dieting, healthy (eg, exercise) and unhealthy (eg, use of laxatives) weight-control behaviors, and binge eating. STATISTICAL ANALYSES PERFORMED: Descriptive statistics and linear and logistic regression models accounting for demographics and weight status. RESULTS: Approximately half of participants (52.7%) reported they had noticed calorie information while purchasing a meal or snack in a restaurant within the previous month. Among individuals who noticed calorie information, 38.2% reported they did not use it in deciding what to order. The most common use of calorie information was to avoid high-calorie menu items (50.1%) or to decide on a smaller portion (20.2%). Using menu labels to limit calories was related to binge eating among women and was associated with more weight-related concerns, dieting, and unhealthy weight-control behaviors among both women and men. CONCLUSIONS: Nutrition educators and other health care professionals should talk with clients who struggle with disordered eating or weight-related concerns to learn about their use of calorie information at restaurants, address any potential unintended consequences, and promote healthy uses of calorie information.

Personal relative deprivation increases self-selected portion sizes and food intake.

Cues and experiences of the deprivation of financial/material resources have been associated with increased caloric intake and risk for overweight/obesity. Given that social comparisons may serve as a powerful reference for the adequacy of one's standing and resources, the present research tested whether subjective feelings of personal relative deprivation (PRD) or "losing out" to others stimulates calorie selection and intake. Study 1 demonstrated that self-reported chronic experiences of PRD positively predicted calories selected for a portion and consumed during an ad-libitum meal. Study 2 revealed that experimentally-induced PRD resulted in an increase in the amount of calories selected on a portion selection task and a stronger desire to consume the foods. Consequently, these findings demonstrate that chronic and acute subjective deprivation of non-food resources may contribute to socioeconomic gradients in obesity, and that perceived social inequality may have inherently obesogenic properties that promote excess calorie intake.

Do Food Preferences Change After Bariatric Surgery?

PURPOSE OF REVIEW: Insights into physiological mechanisms responsible for weight loss after bariatric surgery (BS) have challenged the traditional view that mechanical restriction and caloric malabsorption are major drivers of weight loss and health benefits after BS. Altered diet selection with an increased postoperative preference for low-sugar and low-fat food has also been implicated as a potential mechanism beyond mere reduction of calorie intake. However, the empirical support for this phenomenon is not uniform and evidence is largely based on indirect measurements, such as self-reported food intake data, which are prone to inaccuracy due to their subjective character. RECENT FINDINGS: Most studies indicate that patients not only reduce their caloric intake after BS, but also show a reduced preference of food with high sugar and high fat content. So far, standard behavioral tests to directly measure changes in food intake behavior after BS have been mainly used in animal models. It remains unclear whether there are fundamental shifts in the palatability of high-fat and sugary foods after BS or simply a decrease in the appetitive drive to ingest them. Studies of appetitive behavior in humans after BS have produced equivocal results. Learning processes may play a role as changes in diet selection seem to progress with time after surgery. So far, direct measures of altered food selection in humans after BS are rare and the durability of altered food selection as well as the role of learning remains elusive.

'I'd rather die happy': residents' experiences with food regulations, risk and food choice in residential aged care. A qualitative study.

BACKGROUND: Food regulations exist to protect older people in residential aged care, leading to the restriction of potentially hazardous foods. The impacts of malnutrition, resident centred care and the importance of maintaining individual autonomy for older people are well documented. By contrast, there is scant literature describing residents' perceptions of food regulations and food risks in the residential aged care setting. AIMS: The aim of this study is to explore resident perceptions of food choice and food restrictions in residential aged care. METHODS: Using a qualitative, hermeneutic phenomenological design, semi-structured interviews were conducted with six participants recruited from two residential aged care facilities. Interviews were audio-taped, transcribed verbatim and thematically analysed. RESULTS: The following key themes emerged in this study: participants were largely unaware of food regulations and risks, yet expressed the desire to make their own choices. Participants provided contradictory accounts of their experiences with food in residential aged care, which emphasises the ongoing challenge of meeting individual preferences. CONCLUSION: These themes warrant further investigation, particularly in relation to the impact of food regulations on food choice and the meaning of risk to older people in residential aged care. This research provides new insight into the perceptions of residents regarding their individual autonomy and independence against legislated risk minimization strategies. Impact statement This article raises the issue of risk taking and food choices from the perspective of residents in a residential aged care facility.