Everyday discrimination is a stronger predictor of eating competence than food insecurity or perceived stress in college students amidst COVID-19.

Stress is a common experience of college students, which has been exacerbated by COVID-19. Perceived stress may help predict students' eating behaviors. Eating competence is an adaptive model of eating characterized as being flexible, comfortable, and positive with food and eating, and reliable about getting enough nourishing and enjoyable food to eat. Eating competence is associated with numerous health benefits and may be developing and/or disrupted as young adults transition to college. No prior research has explored the associations of everyday discrimination and food insecurity with eating competence, and there is limited research on the eating competence of trans and gender nonconforming (TGNC) college students. This cross-sectional study sought to examine the associations of everyday discrimination, food insecurity, and perceived stress with eating competence in a sample of 1996 undergraduate students. Participants completed an online survey comprised of validated tools assessing socio-demographics, eating competence, everyday discrimination, food insecurity, and perceived stress and stress management. After accounting for covariates (gender, stress management), multivariate regression analyses were conducted, and the coefficients of partial determination revealed that everyday discrimination was the strongest predictor of eating competence. Results demonstrated that lower experience of everyday discrimination, less stress, and being food secure were associated with greater likelihood of being eating competent (EC). Men were more likely to be EC than women or TGNC identities. Since the experience of everyday discrimination was the strongest, inverse predictor of eating competence, addressing discrimination must be considered in future efforts to improve eating competence.

Association of the Healthy, Hunger-Free Kids Act With Dietary Quality Among Children in the US National School Lunch Program.

Importance: The Healthy, Hunger-Free Kids Act of 2010, implemented nationwide in 2012, was intended to improve the nutritional quality of meals served in the National School Lunch Program (NSLP). Objective: To assess whether there was an association between the Healthy, Hunger-Free Kids Act of 2010 and dietary quality of lunch for students participating in the NSLP, stratified by income. Design, Setting, Participants: Serial cross-sectional study design, using National Health and Nutrition Examination Survey (NHANES) data from 2007-2008, 2009-2010, 2013-2014, and 2015-2016, of students who were surveyed in the NHANES and were attending schools participating in the NSLP. Individuals who were aged 5 to 18 years, in kindergarten through 12th grade, enrolled in a school that served school lunch, and had a reliable weekday dietary recall were included. Exposures: The Healthy, Hunger-Free Kids Act of 2010 (prepolicy period: 2007-2010; postpolicy period: 2013-2016), with participation in the NSLP estimated based on an algorithm. Main Outcomes and Measures: The primary outcome was dietary quality of intake for lunch, measured by the Healthy Eating Index-2010 (HEI-2010) score (range, 0-100; 0 indicates a diet with no adherence to the 2010 Dietary Guidelines for Americans and 100 indicates a diet with complete adherence to the guidelines). Results: Among 6389 students included in the surveys (mean age, 11.7 [95% CI, 11.6-11.9] years; 3145 [50%] female students; 1880 [56%] were non-Hispanic white), 32% were low-income, 12% were low-middle-income, and 56% were middle-high-income students. A total of 2472 (39%) were participants in the NSLP. Among low-income students, the adjusted mean prepolicy HEI-2010 score was 42.7 and the postpolicy score was 54.6 among NSLP participants and the adjusted mean prepolicy score was 34.8 and postpolicy score was 34.1 among NSLP nonparticipants (difference in differences, 12.6 [95% CI, 8.9-16.3]). Among low-middle-income students, the adjusted mean prepolicy HEI-2010 score was 40.4 and postpolicy score was 54.8 among NSLP participants and the adjusted mean prepolicy score was 34.2 and postpolicy score was 36.1 among NSLP nonparticipants (difference in differences, 12.4 [95% CI, 4.9-19.9]). Among middle-high-income students, the adjusted mean HEI-2010 prepolicy score was 42.7 and postpolicy score 55.5 for NSLP participants and the adjusted mean prepolicy score was 38.9 and prepolicy score was 43.6 for NSLP nonparticipants (difference in differences, 8.1 [95% CI, 4.2-12.0]). Conclusions and Relevance: In a serial cross-sectional study of students, the Healthy, Hunger-Free Kids Act of 2010 was associated with better changes in dietary quality for lunch among presumed low-income, low-middle-income, and middle-high-income participants in the NSLP compared with nonparticipants.

Eating competence is related to executive function skills in college students.

PURPOSE: This study aimed to determine the relationship between eating competence (EC) and executive function (EF) skills in college students. METHODS: This cross-sectional study was part of a larger study in which an online survey was administered during autumn quarter 2020 to undergraduate students at a northwestern U.S. public university. Sociodemographic data were collected, along with measures of EC (16-item Satter Eating Competence Inventory, ecSI-2.0™) and EF skills (27-item Executive Function Index, EFI). Multiple linear regression was used to examine the ecSI-2.0™ total score and its four domain scores with each of the five EF skills. RESULTS: Of the 1996 respondents included in the final analyses, 40.2 % were eating competent (total ecSI-2.0™ ≥32). The mean ecSI-2.0™ score among participants was 28.7. Gender distribution was 72.0 % women, 23.3 % men, and 4.7 % trans-and-gender non-conforming (TGNC) or preferred not to answer. EFI scores were higher among women (70.9) than among men (68.2) and TGNC (64.9). Both total ecSI-2.0™ score and the contextual skills domain were significantly associated with four of the EFI subscales. Internal regulation was related to impulse control and motivational drive. Further significant associations were found with other domains of ecSI-2.0™ and specific EFI subscales. CONCLUSION: EF skills are associated with EC in college students, particularly skills related to food management and internal regulation. Since both EF and EC can be developed, this study offers promise for future research in an increasingly gender-diverse and neurodiverse college population during a time of increasing independence and autonomy.

Weight-Inclusive Approaches to Nutrition and Dietetics: A Needed Paradigm Shift.

This Perspective article encourages the field of nutrition and dietetics to move away from a weight-centric paradigm that emphasizes weight loss and weight management as primary health outcomes. This approach can perpetuate weight stigma, which is associated with poorer health behaviors, poorer mental health, disordered eating, and even increased mortality risk. We propose an alternative approach-adopting a weight-inclusive paradigm-that focuses on providing care across the weight spectrum by centering health behaviors rather than weight. This approach allows individuals of all sizes to have equitable access to high-quality nutrition and dietetics care.

Weight-Inclusive Podcasts Improved Intuitive Eating, Body Appreciation, and Anti-Fat Attitudes Among Nutrition Students.

OBJECTIVE: Assess the impact of a weight-inclusive podcast (WIP) intervention on body appreciation, intuitive eating (IE), anti-fat attitudes, and weight and health attitudes in university students enrolled in an upper-division nutrition course. METHODS: Quasi-experimental design: Intervention participants listened to 8 weekly WIP episodes (n = 16); the comparison group listened to 8 weekly general nutrition podcasts (n = 29). Intuitive eating, body appreciation, anti-fat attitudes, and general weight and health attitudes were measured preintervention and postintervention. RESULTS: Two-way, repeated measures analysis of variance revealed significant interaction effects of time × group, with participants in the WIP group experiencing significantly greater improvements in body appreciation (P = 0.03) and IE (P = 0.02) and greater reductions in anti-fat attitude scores (P = 0.006) than the comparison group. CONCLUSIONS AND IMPLICATIONS: Podcasts may be a cost-effective tool to improve body appreciation and IE and reduce anti-fat attitudes in future nutrition professionals. Future research would benefit from recruiting prehealth professionals across different majors.

Disordered eating and eating competence in members of online irritable bowel syndrome support groups.

BACKGROUND: This study seeks to evaluate eating competence and disordered eating likelihood among members of online support groups for irritable bowel syndrome (IBS) and determine whether eating competence and disordered eating likelihood varies according to IBS symptom severity and subtype. METHODS: This cross-sectional study is based on an anonymous survey conducted from August to September 2021. Adults with IBS (N = 225) were recruited from online and social media IBS support forums. IBS symptom severity was assessed using the validated IBS Severity Scoring System (IBS-SSS), likelihood of disordered eating was assessed using the validated Eating Attitudes Test (EAT-26), and eating competence was assessed using the validated Satter Eating Competence Inventory (ecSI 2.0™). Multiple linear regression was used to predict EAT-26 total score from IBS-SSS score, age, and IBS subtype. ANOVAs were used to examine the relationships between IBS severity level, IBS subtype, and ecSI 2.0™ total score. KEY RESULTS: Eating competence among the sample was low at 17% while 27% was classified as likely or very likely disordered eating. IBS severity was positively associated with EAT-26 score (p = 0.011) and ecSI 2.0™ score was significantly lower in the severe IBS group compared to the moderate IBS group (p = 0.016). No relationship was detected between IBS subtype and EAT-26 or ecSI 2.0™ scores. CONCLUSIONS & INFERENCES: IBS severity was positively associated with disordered eating likelihood and negatively associated with eating competence. This sheds light on the importance of assessing eating competence and screening for disordered eating prior to selecting therapies for patients with IBS, particularly in females with severe symptoms.

Gender differences in factors related to eating competence in college students: Weight-and-body shame and guilt, weight satisfaction, weight loss effort, and eating disorder risk.

PURPOSE: This study aimed to determine which weight-and-body-related attitudes and behaviors were most predictive of Eating Competence (EC) in college students amidst COVID-19, according to gender. METHODS: This cross-sectional study was part of a larger study in which an online survey was administered during autumn quarter 2020 to undergraduate students at a northwestern U.S. public university. Measures included EC (ecSI 2.0™), weight-and-body shame and/or guilt (WEBSG), weight satisfaction, current weight loss effort, and eating disorder risk. RESULTS: Of the 1996 respondents included in the final analyses, 40.2 % were eating competent (ecSI 2.0™ ≥32). Gender distribution was 71.6 % women, 23.1 % men, and 4.6 % trans-and-gender non-conforming (TGNC). WEBSG and WEB-S were higher in women and TGNC than in men. Weight satisfaction was lower in women and TGNC students than men, and 47.3 % of the sample was trying to lose weight at the time of the study. Eating disorder (ED) risk was prevalent with nearly 34 % scoring ≥2 on SCOFF and 33 % reporting they saw themselves as having an ED now or in the past. Significant factors of EC varied for each gender, although WEB-S was a shared model factor for all genders. CONCLUSION: EC may be protective, as this was related to less WEB-S in all genders; less WEB-G and greater weight satisfaction in men and women; and lower likelihood of ED risk and trying to lose weight among women. Further research is needed to elucidate whether these maladaptive weight-and-body attitudes and behaviors in college students can be improved to increase EC. LEVEL OF EVIDENCE: Level V, descriptive cross-sectional study.

Baby-led weaning and the family diet. A pilot study.

Baby-led weaning (BLW) is a style of solid food introduction that emphasizes self-feeding rather than spoon-feeding. The purpose of this cross-sectional study was to determine whether parents using BLW change their dietary intake during weaning, and if their babies are offered family foods. Participants kept diet diaries at baseline and three months later, post-BLW implementation. Wilcoxon tests revealed no significant changes in dietary intake during the first three months of weaning, however, parents offered their children 57% of the same foods they were consuming. Results suggest that BLW does not lead to dietary changes among parents during the weaning process.

Food Acquisition Strategies of Homeless Youth in the Greater Seattle Area: A Cross- Sectional Study.

OBJECTIVES: The aims of this study were to describe how homeless youths access food in the Seattle area, and to describe the nutritional adequacy and quality of food obtained. METHODS: This cross-sectional study was conducted between February 2018 and May 2019. Data collection took place at seven organizations in the greater Seattle area at which homeless youths typically access food. Trained research assistants verbally administered an ∼50-item survey to homeless youths aged 14 to 24 years on their general demographic characteristics, current housing situation, ability to access food, and quantity and quality of foods acquired. Each participant was given $10 at the completion of the survey. RESULTS: Participants were 122 homeless youths with an average age of 21.6±1.94 years. During the previous week, 79.3% obtained meals from drop-in centers and 69.8% from a shelter. Most (75.2%) had not utilized a food bank during the previous month. The majority (73.6%) reported having enough food to eat, but not always the kind they wanted, and 75.4% rated the overall nutritional quality of their diet as average or below. Not having enough food or money for food contributed to skipping meals (50.4%), eating less than desired (47.1%), being hungry (45.5%), and losing weight (20.5%). CONCLUSIONS: Information from this study can be used to identify barriers that homeless youths experience in acquiring adequate nutrition; to make suggestions for future research and program development; and to help social service organizations improve the network of nutrition services and the quality of food available to this vulnerable population through policy, community partnership, and public health action.

The impact of dietary restraint and moderate-intensity exercise on post-exercise energy intake in sedentary males.

Exercise is often used for successful weight management, particularly by males. However, exercise may have the potential to promote counter-regulatory eating, because of certain cognitive and psychological factors. The purpose of this study was to investigate the unknown role of dietary restraint, BMI, and dieting status on acute and 12-hour post-exercise energy intake (PE-EI) in sedentary males following moderate-intensity exercise. The study consisted of two experimental conditions, exercise and rest, in a counterbalanced-crossover design on two days. Exercise consisted of walking on a treadmill for 60 min. Acute and 12-hour PE-EI were compared on exercise and rest days. Eighty males, mean age 30+/-8 years, participated in the study and were categorized by dietary restraint level, BMI, and dieting status. The main effects of condition and group, and the interaction were not significant for acute or 12-hour PE-EI, suggesting that a single bout of moderate-intensity exercise did not influence PE-EI in sedentary males in reference to dietary restraint, BMI, and dieting status. Therefore, moderate-intensity exercise as a prescription for weight loss does not appear to promote counter-regulatory eating in sedentary males.

Psychosocial risk factors for eating disorders in Hispanic females of diverse ethnic background and non-Hispanic females.

This study investigated differences in psychosocial risk factors for eating disorders among university females (n=406) of diverse Hispanic background (Puerto Rican, Cuban, Central American/Mexican, Dominican, Venezuelan) and among White non-Hispanic (n=102) female students. Risk factors were assessed using the Psychosocial Risk Factor Questionnaire (PRFQ) which includes four subscales: Social Pressure for Thinness, Media Pressure for Thinness, Concern for Physical Appearance, and Perception of Physical Appearance. There were significant differences among the groups in total PRFQ score, F(7,499)=2.76, P<.008, and the subscale score for Concern, F(7,499)=2.99, P<.004, with Dominicans, Venezuelans and Columbians having higher scores than White non-Hispanics and Central Americans/Mexicans. In addition, there was a significant difference in BMI, F(7,499)=2.70, P<.009. Both Puerto Ricans (24.27+0.81) and Venezuelans (24.66+1.00) had higher BMIs than White non-Hispanics (21.87+0.37), Cubans (21.99+0.24) and Brazilians (21.46+0.96). There was also a significant, F(7,498)=2.70, P<.009, difference among the groups in Ideal Body Image score. Puerto Ricans had the highest score and Brazilians the lowest. Acknowledging that differences in psychosocial risk factors exist among Hispanic females of diverse background can assist us in creating more targeted approaches for the prevention of potential eating disorders in this population.

CDE and non-CDE dietitians' knowledge of exercise and content of exercise programs for older adults with type 2 diabetes.

OBJECTIVE: To study differences between non-certified diabetes educator registered dietitians (non-CDE-RDs) and certified diabetes educator registered dietitians (CDE-RDs) in the design and content of programs to promote physical activity in older adults with type 2 diabetes. DESIGN: The Exercise Teaching Questionnaire was used to assess knowledge of and promotion of physical activity. SETTING AND PARTICIPANTS: Surveys were sent to CDE-RDs and non-CDE-RDs in Florida, California, and Texas. Ninety-four CDE-RDs and 73 non-CDE-RDs completed the study. MAIN OUTCOME MEASURES: The independent variable was CDE status. The dependent variables were knowledge, design, content, and total exercise scores. ANALYSIS: Two-way ANOVA's tested for Knowledge, Design, and Content scores by RD status and one of the following: years practicing in diabetes education, state, and practice setting. RESULTS: The exercise Knowledge, Design and Content scores were significantly (P < .001) higher in the CDE-RDs compared to those of the non-CDE-RDs. CONCLUSIONS AND IMPLICATIONS: The results of this study indicate that education and experience play a key role in the design and content of programs to promote physical activity in older adults. Therefore, the results raise the question of the role the dietitian and nutrition educator should play in the promotion of physical activity in older adults.

A pilot study to evaluate nutritional influences on gastrointestinal symptoms and behavior patterns in children with Autism Spectrum Disorder.

BACKGROUND: One in 110 children in the US have autism spectrum disorder (ASD), a debilitating and life-long disorder that affects the health, relationships, and learning of affected children. Existing research on the etiology, contributing factors, and treatment for ASD is limited and controversial. Studies suggest that GI symptoms are related to behavior issues in children with ASD, which may be improved by a gluten-free, casein-free (GFCF) diet. OBJECTIVES: To evaluate the relationship between a GFCF diet and gastrointestinal symptoms and behavior patterns in children with ASD. DESIGN AND SETTING: Cross-sectional design in which parents completed an online survey regarding general health, diet (adapted food-frequency questionnaire (FFQ)), gastrointestinal symptoms, and behavior patterns of their children with ASD. MAIN OUTCOME MEASURES: Scores on the Gastrointestinal Symptoms Rating Scale (GSRS) and Childhood Autism Rating Scale (CARS). RESULTS: Seven of thirteen children (median age 9years) were on a GFCF diet, consuming significantly fewer gluten- and casein-containing foods than those not on a GFCF diet. GSRS and CARS scores did not differ significantly according to diet. Parents of all the children on a GFCF diet reported improved GI symptoms and behavior patterns. CONCLUSIONS: This study provides evidence that the adapted FFQ is an effective tool for evaluating adherence to a GFCF diet. Continued well-controlled research is necessary to elucidate the gut-brain relationship in ASD.

Dietary restraint influences accuracies in estimating energy expenditure and energy intake among physically inactive males.

Inaccurate estimations of energy intake (EI) and energy expenditure (EE) may ultimately affect body weight. The purpose of this study was to evaluate accuracy of estimated EI and EE among males in reference to exercise and rest using a counterbalanced, crossover, repeated-measures design. Participants (N = 80) were recruited from a large, urban university in South Florida. Exercise consisted of walking on a treadmill for 60 min at 65% age-predicted maximum heart rate. Food intake was evaluated immediately following exercise and rest. Participants underestimated EI (kcal) on both the exercise (M = 435, SEM = 69) and rest days (M = 439, SEM = 54), overestimated EE (kcal) for exercise (M = 129, SEM = 44), and underestimated EE for rest (M = 54, SEM = 10). Greater accuracy in estimating EE for exercise was significantly (p < .05) associated with higher dietary restraint. The findings suggest that among sedentary males, there is an inability to accurately estimate calories, which has the potential to influence behaviors that affect weight management.