Understanding factors that affect wellbeing in trans people "later" in transition: a qualitative study.

PURPOSE: Although cross-sectional studies have demonstrated that trans people present with lower quality of life and wellbeing than the general population, few studies have explored the factors associated with this, particularly in those who have medically transitioned some time ago. This paper aims to fill the gap in the literature on what factors are associated with wellbeing in trans people who initiated medical transition some time ago. METHODS: This study used semi-structured one-to-one interviews with 23 participants to investigate the factors that impact upon the wellbeing of trans people who had initiated Gender Affirming Medical Treatment five or more years ago. The content of the interviews were analysed with an inductive, grounded theory approach to identify common themes within them. RESULTS: The four themes identified include some consistencies with cisgender populations (while being viewed through the lens of trans experience), as well as those more specific to the trans experience. Together these themes were: Interactions with healthcare services; Seeking societal acceptance; Quality of social support; The 'double-edged sword' of media and social media. Each of the themes identifies a factor that participants highlighted as impacting, either positively or negatively, on their wellbeing. CONCLUSIONS: The results highlight the importance of social support, protective legislations, awareness of trans issues in the general public, and the need of improving the knowledge held by non-specialist healthcare providers.

Portions selected to stave off hunger are reduced when food is presented in an 'unusual' food-to-mealtime context: An implication for implicit satiety drivers.

Research suggests that the role of expected satiety in influencing portion-size selection is reduced when food is presented in unusual food-to-mealtime contexts; however, the underlying mechanism has not been explored. Other research has revealed that different implicit satiety drivers (e.g., to stop momentary hunger or obtain complete fullness) are associated with different perceived levels of stomach fullness, portion-size selections and can change on instruction. The current study explored whether changes in expected satiety and ideal portions in congruous vs incongruous contexts can be explained by changes in implicit satiety drivers. Another aim was to investigate a previous exploratory finding suggesting that portions selected to stave off hunger are reduced when foods are presented in unusual food-to-mealtime contexts. At two trials (breakfast/lunch), participants (n = 40) selected a portion of typical lunch (pasta) and breakfast (porridge) foods via a psychophysical computer-based method 1) to stave off hunger for 5 h, and 2) as an ideal portion. Participants also indicated their perceived level of stomach fullness associated with 1) each portion, and 2) five implicit satiety drivers. Results revealed that a smaller average portion was selected to stave off hunger in incongruous (vs congruous) food-to-mealtime contexts (531 ± 229 vs 575 ± 236 kcal) (p = 0.008). This suggests that expected satiety is influenced by momentary context; foods are perceived to be more satiating when consumed in unusual (vs usual) contexts. Results also showed that implicit satiety drivers are malleable in regard to the portion size associated with a perceived level of stomach fullness and that this can vary contextually. These findings provide initial evidence to explain the psychological mechanism underlying the contextual differences observed in portion-size selections. Future work should explore longer-term impacts of consuming foods in unusual contexts.

Current appetite influences relative differences in the expected satiety of foods for momentary, but not hypothetical, expected satiety assessments.

Research has shown that expected satiety is highly associated with portion-size selection and can vary (kcal-for-kcal) significantly between foods. However, research has not adequately investigated whether current appetite influences relative differences in the expected satiety of foods. This is important to explore to better understand how current motivational state influences food choice and portion selection. This study used 'hypothetical' and 'momentary' expected-satiety assessments to understand whether methods requiring a reflection on current motivational state [momentary] versus more hypothetical considerations when assessing expected satiety can influence the interpretation of results. It was hypothesised that current appetite would only influence relative differences in expected satiety between foods for momentary, but not hypothetical, expected satiety assessments. Participants (n = 54) were shown images of twelve foods, once when hungry and once when full. In each case, they selected a portion for each food to 1) match the expected satiety of a fixed-portion 'standard' food [hypothetical], and 2) stave off hunger until their next meal [momentary]. Results showed that the relative between-food comparison of expected satiety was stable for hypothetical (p=.73) but not momentary assessments (p<.001) suggesting that while current motivational state may influence food choice and portion selection in the moment, more generalised comparisons of the satiating abilities of foods (learned over a longer period) remain stable. This is important 1) for methods in future studies, as immediate dietary intake does not appear to influence hypothetical expected satiety, thus dietary control is not necessary before participants undertake these assessments, and 2) as it confirms that difficulties associated with dietary regulation may not be due to inaccurate hypothetical judgements about foods, but instead appear to be influenced by contextual nuances that occur in the moment.

The influence of expected satiety on portion size selection is reduced when food is presented in an 'unusual' meal context.

Research shows that expected satiety is highly correlated with ideal portion size, however this correspondence has not been explored when a food is presented in an 'unusual' (incongruous) meal context. This study's aim was to explore whether expected satiety influences portion selection to the same extent in both congruous and incongruous meal contexts. Forty participants completed two trials (one at breakfast and one at lunch) on separate days in a randomised counterbalanced order. They completed measures of expected satiety and ideal portion size for four typical breakfast foods and four typical lunch foods, using a bespoke computer program. Our results showed a significant difference between expected satiety and ideal portion size for lunch foods presented at breakfast time (an incongruous meal context; t(39) = 2.95, p = 0.02). There was no significant difference between expected satiety and ideal portion size in the other incongruous meal context (breakfast foods at lunch; t(39) = 2.10, p = 0.17) or in congruous meal contexts (breakfast foods at breakfast time, lunch foods at lunch time; both t(39) ≤ -0.15, p > 0.999). These results suggest that expected satiety does not have as strong an influence on portion selection when food is presented in an unusual context. Furthermore, in such contexts, smaller portions were selected 1) to stave off hunger until the next meal and 2) as ideal portions compared to in more usual meal contexts. Research is warranted to explore this finding further to understand its implications for weight management.

Eating rate and food intake are reduced when a food is presented in an 'unusual' meal context.

Research has shown that 1) the slower a food is eaten the less food is consumed overall, and 2) context affects portion selection. This study aimed to explore whether eating rate and food intake are influenced by consuming food in 'usual' vs 'unusual' mealtime contexts. Furthermore, this study aimed to identify whether mealtime-specific appropriateness and previous consumption frequency corresponded with differences in eating rate and food intake between contexts. Seventy-eight participants were served either cheese and tomato pasta (a typical lunch food) or porridge with milk and honey (a typical breakfast food) ad libitum at both breakfast and lunch on separate days. Results showed that eating rate was slower (60.7 vs 71.2 g/min, p < 0.001) and less food was consumed (404.1 vs 543.2 g, p < 0.001) when participants ate cheese and tomato pasta at breakfast compared to at lunch. However, no significant differences in eating rate (54.6 vs 56.4 g/min, p = 0.75) or food intake (423.7 vs 437.7 g, p = 0.88) were found between mealtimes for porridge with milk and honey. Furthermore, differences in eating rate and food intake between contexts were not associated with differences in mealtime-specific appropriateness or previous consumption frequency. These results suggest that eating rate and ad libitum food intake are influenced by the congruency of the food-to-mealtime context; however, this effect is not associated with mealtime-specific appropriateness or previous consumption of the food. Further research should explore the implications of introducing foods at unusual mealtimes in relation to strategies for weight management.