Exploring changes in temporary abstinence in increasing and higher risk drinkers in England and Dry January participation in users of the Try Dry app in the UK between 2020 and 2021.

BACKGROUND: We looked at changes in the prevalence of increasing and higher risk drinkers reporting a reduction attempt motivated by temporary abstinence and changes in prevalence of use of the official app accompanying Dry January between 2020 vs 2021, following the onset of the COVID-19 pandemic. We also explored potential shifts in the sociodemographic composition of both groups. METHODS: We analysed data from: i) 1863 increasing and higher risk drinkers (defined as ≥ 8 on the AUDIT) responding to a nationally representative survey of adults in England in January and February 2020 and 2021, and ii) 104,598 users of the 'Try Dry' app, the official aid to those participating in Dry January 2020 and 2021 in the UK. We used logistic regression to examine shifts in the prevalence of increasing and higher risk drinkers reporting a reduction attempt motivated by temporary abstinence and explored whether there were shifts in the characteristics of this group in terms of AUDIT score, number of last year reduction attempts, smoking status, living alone, living with children, reducing alcohol consumption due to future health motives, age, sex, and occupational social grade between 2020 and 2021. We used t-tests and chi-squared tests to compare the prevalence of users of the 'Try Dry' app in 2020 and 2021 and examine whether the two groups differed in terms of age and sex. RESULTS: The proportion of increasing and higher risk drinkers reporting a reduction attempt motivated by temporary abstinence increased from 4% in 2020 to 8% in 2021 (OR = 2.07, 95% CI = 1.38-3.11, p < .001) with no changes detected in sociodemographic composition. The number of Try Dry app users in 2021 increased by 34.8% relative to 2020. App users in 2021 were two years older on average [p < .001, d = .02], with a 2% increase in the proportion of female app users [p < .001, vs. < .01]. CONCLUSIONS: Higher participation in Dry January 2021 relative to 2020 indicates increased engagement with a period of temporary abstinence following the COVID-19 related lockdowns in England and the UK, which is positive in the wider context of increasing alcohol consumption throughout the pandemic.

A smartphone based attentive eating intervention for energy intake and weight loss: results from a randomised controlled trial.

BACKGROUND: Laboratory studies suggest that eating more 'attentively' (e.g. attending to food being eaten and recalling eating episodes) can reduce food intake among participants with both healthy weight and overweight. The aim of this trial was to assess whether a smartphone application that encourages a more attentive eating style reduces energy intake and promotes weight loss. METHODS: In an open-label, single centre, parallel groups, individually randomised controlled trial, 107 adults with overweight/obesity in Merseyside, UK used an attentive eating smartphone application along with standard dietary advice (intervention group) or standard dietary advice only (control group) for 8 weeks. The primary outcomes were change in body weight at 8 weeks and energy intake at 4 and 8 weeks. Additional outcomes included self-reported eating behaviours measured at 8 weeks. Differences between groups were assessed with linear regression (adjusted) using multiple imputation for missing data. Study protocol registered prospectively at ( https://doi.org/10.17605/osf.io/btzhw ). RESULTS: There was no significant difference between the intervention and control group in weight lost at 8 weeks, or change in self-reported 24 h or objective taste-test energy intake at 4 or 8 weeks. Mean weight loss in the intervention group (n = 53) was 1.2 kg and 1.1 kg in the control group (n = 54), adjusted difference of - 0.10 (- 1.6 to 1.3) kg. Self-reported eating behaviours at 8 weeks also did not differ across groups. The intervention was largely used as intended and a per protocol analysis confined to participants in the intervention group that used the attentive eating smartphone application regularly and as intended also showed no effect on energy intake or weight loss. CONCLUSIONS: A smartphone based attentive eating intervention and standard dietary advice did not result in reduced energy intake or greater weight loss at 4 or 8 week follow-up than standard dietary advice alone. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03602001 . Registered retrospectively on 26th July 2018. Prospectively registered on the Open Science Framework on 11th August 2017.

Hypothesis awareness as a demand characteristic in laboratory-based eating behaviour research: An experimental study.

Demand characteristics are thought to undermine the validity of psychological research, but the extent to which participant awareness of study hypotheses affects laboratory-measured eating behaviour studies has received limited attention. Participants (N = 84) attended two laboratory sessions in which food intake was measured. In session 1 baseline food intake was measured. In session 2 participants were allocated to either a 'hypothesis aware' or 'hypothesis unaware' condition. Participants were led to believe in the 'hypothesis aware' condition that they were expected to increase their food intake in session 2 relative to session 1. Participants in the 'hypothesis unaware' condition were not provided with hypothesis information. Contrary to our pre-registered predictions, the experimental manipulation of hypothesis awareness did not affect session 2 food intake. However, the manipulation was less effective than anticipated as some participants did not appear to believe the hypothesis information provided. Post-hoc exploratory analyses revealed that participants who believed the study hypothesis was that their food intake would increase in session 2 ate more in session 2 than participants who did not believe this was the study hypothesis. Further confirmatory research is required to understand the causal effect that participant awareness of study hypotheses has on laboratory measured eating behaviour.

When a portion becomes a norm: Exposure to a smaller vs. larger portion of food affects later food intake.

BACKGROUND: Portion sizes in the food environment may communicate information about what constitutes a 'normal' amount of food to eat. Here we examined whether mere visual exposure to a smaller vs. larger portion size of snack food affects perceptions of how much a 'normal' sized portion is and how much people choose to eat of that food in future. METHODS: Under the guise of a study on taste preference and personality, 104 female participants were randomly allocated to be exposed to either a smaller or larger portion size of snack food. Twenty-four hours later participants freely selected a portion of the snack food to consume and reported on their perception of what constituted a normal sized portion of the snack food. RESULTS: Participants that were exposed to a smaller, as opposed to larger portion size subsequently believed that a normal portion of the snack food was smaller in size. Exposure to the smaller as opposed to the larger portion size also resulted in participants consuming less snack food the next day. CONCLUSIONS: Environmental exposure to smaller, as opposed to larger portion sizes of food may change perceptions of what constitutes a normal amount of food to eat and affect the amount of food people choose to eat in future.

The effects of exposure to appetitive cues on inhibitory control: A meta-analytic investigation.

Inhibitory control refers to the ability to stop, change or delay a response, and is often used in order to protect higher order goals. Theoretical models suggest that appetitive cues such as pictures of alcoholic drinks or food evoke strong automatic appetitive responses which lead to transient impairments in inhibitory control, and that these effects of cues may be related to individual differences (e.g. in body mass index, or alcohol consumption). In order to investigate these claims we conducted a random effects meta-analysis of 66 effect sizes (35 alcohol, 31 food) from 37 articles that tested the effect of exposure to appetitive (alcohol/food) cues on indices of inhibitory control. The overall effect of cue exposure was small, but robust (SMD = -0.12 [95% CI -0.23, -0.02]; Z = 2.34, p = .02, I2 = 84%). Exposure to alcohol-related cues significantly impaired inhibitory control (SMD = -0.21 [95% CI = -0.32, -0.11]; Z = 4.17, p < .001), however exposure to food-related cues did not lead to impairments (SMD = -0.03 [95% CI = -0.21, 0.15]; Z = 0.36, p = .720). There was no evidence that drinking or weight status significantly moderated the effects of cues on inhibitory control. Similarly, cue modality (words, pictures, or smells) did not significantly moderate the effects. Trim and Fill analysis suggested bias in the literature, which when corrected, made the overall effect of cues non-significant. Overall, these findings provide some tentative support for theoretical claims that exposure to appetitive cues prompts transient impairments in inhibitory control. Further research is required to determine the clinical significance of these observations. However, care should be taken when drawing conclusions from a potentially biased evidence base.

Alcohol consumers' attention to warning labels and brand information on alcohol packaging: Findings from cross-sectional and experimental studies.

BACKGROUND: Alcohol warning labels have a limited effect on drinking behavior, potentially because people devote minimal attention to them. We report findings from two studies in which we measured the extent to which alcohol consumers attend to warning labels on alcohol packaging, and aimed to identify if increased attention to warning labels is associated with motivation to change drinking behavior. METHODS: Study 1 (N = 60) was an exploratory cross-sectional study in which we used eye-tracking to measure visual attention to brand and health information on alcohol and soda containers. In study 2 (N = 120) we manipulated motivation to reduce drinking using an alcohol brief intervention (vs control intervention) and measured heavy drinkers' attention to branding and warning labels with the same eye-tracking paradigm as in study 1. Then, in a separate task we experimentally manipulated attention by drawing a brightly colored border around health (or brand) information before measuring participants' self-reported drinking intentions for the subsequent week. RESULTS: Study 1 showed that participants paid minimal attention to warning labels (7% of viewing time). Participants who were motivated to reduce drinking paid less attention to alcohol branding and alcohol warning labels. Results from study 2 showed that the alcohol brief intervention decreased attention to branding compared to the control condition, but it did not affect attention to warning labels. Furthermore, the experimental manipulation of attention to health or brand information did not influence drinking intentions for the subsequent week. CONCLUSIONS: Alcohol consumers allocate minimal attention to warning labels on alcohol packaging and even if their attention is directed to these warning labels, this has no impact on their drinking intentions. The lack of attention to warning labels, even among people who actively want to cut down, suggests that there is room for improvement in the content of health warnings on alcohol packaging.

Eating 'attentively' reduces later energy consumption in overweight and obese females.

Attentional and memory processes underpin appetite control, but whether encouraging overweight individuals to eat more 'attentively' can promote reductions in energy consumption is unclear. In the present study with a between-subjects design, a total of forty-eight overweight and obese females consumed a fixed lunchtime meal. Their ad libitum energy intake of high-energy snack food was observed during a second laboratory session that occurred later that day. In the focused-attention condition, participants ate their lunch while listening to audio instructions that encouraged them to pay attention to the food being eaten. In a control condition, participants ate while listening to an audio book with a neutral (non-food-related) content. To test whether focused attention influenced food intake via enhancing the memory of the earlier consumed meal, we measured the participants' memory of their lunchtime meal. Ad libitum snack intake was approximately 30 % lower for participants in the focused-attention condition than for those in the control condition, and this difference was statistically significant. There was limited evidence that attention decreased later food intake by enhancing memory representation of the earlier consumed meal. Eating attentively can lead to a substantial decrease in later energy intake in overweight and obese individuals. Behavioural strategies that encourage a more 'attentive' way of eating could promote sustained reductions in energy intake and weight loss.

I'm watching you. Awareness that food consumption is being monitored is a demand characteristic in eating-behaviour experiments.

Eating behaviour is often studied in the laboratory under controlled conditions. Yet people care about the impressions others form about them so may behave differently if they feel that their eating behaviour is being monitored. Here we examined whether participants are likely to change their eating behaviour if they feel that food intake is being monitored during a laboratory study. In Study 1 participants were provided with vignettes of typical eating behaviour experiments and were asked if, and how, they would behave differently if they felt their eating behaviour was being monitored during that experiment. Study 2 tested the effect of experimentally manipulating participants' beliefs about their eating behaviour being monitored on their food consumption in the lab. In Study 1, participants thought they would change their behaviour if they believed their eating was being monitored and, if monitored, that they would reduce their food consumption. In Study 2 participants ate significantly less food after being led to believe that their food consumption was being recorded. Together, these studies demonstrate that if participants believe that the amount of food they eat during a study is being monitored then they are likely to suppress their food intake. This may impact the conclusions that are drawn from food intake studies.

Expanding our understanding of long-term trends in alcohol abstention and consumption in England (2001-19) using two age-period-cohort approaches.

BACKGROUND AND AIMS: Alcohol consumption has decreased in England in recent decades, while alcohol-specific death rates have remained relatively stable. Age-period-cohort (APC) models offer the potential for understanding these paradoxical trends. This study aimed to use an APC model approach to measure long-term trends in alcohol abstention and consumption in England from 2001 to 2019. DESIGN, SETTING AND PARTICIPANTS: The study used grouped and proxy-variable APC models of repeat cross-sectional survey data, set in England (2001-19). Participants were residents in England aged 13 years or over who took part in the Health Survey for England. MEASUREMENTS: Outcome variables were alcohol abstention and consumption in units. We created nine age groups (13-15, 16-17, 18-24, 25-34, until 65-74 and 75+, reference 45-54 years), four periods (2001-04, 2005-09, 2010-14 to 2015-19, reference 2005-09) and 18 5-year birth cohorts (1915-19 to 2000-04, reference 1960-64). We proxied age effects (systolic and diastolic blood pressure), period effects (alcohol affordability, internet usage and household alcohol expenditure) and birth cohort effects (prevalence of smoking and prevalence of overweight). FINDINGS: The odds of abstaining were considerably larger at young ages, 13-15 years [odds ratio (OR) = 5.38; 95% confidence interval (CI) = 4.50-6.43], were lowest during the first period, 2001-04 (OR = 0.83; 95% CI = 0.79-0.86) and had a U-shaped pattern by birth cohort. For units of alcohol, the incidence rate ratio (IRR) increased until age 18-24 years (IRR = 1.41, 95% CI = 1.34-1.48) and decreased afterwards, were highest during the first period, 2001-04 (IRR = 1.07; 95% CI = 1.05-1.08) and showed an inverted J-shape by birth cohort. Our proxy variable approach revealed that using blood pressure measures, alcohol affordability and prevalence of overweight as proxies resulted in APC effects that differed from our base-case model. However, internet usage, household expenditure on alcohol and smoking prevalence resulted in APC effects similar to our base-case model. CONCLUSIONS: The discrepancy between decreasing alcohol consumption and increasing alcohol-related deaths observed in England from 2001 to 2019 may, in part, be explained by the halt in abstention trends since 2010 and a slight consumption decline since 2001.

A latent class analysis of international change and continuity in adolescent health and wellbeing: A repeat cross-sectional study.

BACKGROUND: Since the early 2000s, there have been marked trends in adolescent health and wellbeing indicators across Europe, North America and Australia. In particular, there have been substantial declines in youth drinking. We know little about how these trends are underpinned by co-occurring indicators within individuals. This paper aims to analyse change over time in how indicators cluster within individuals and differences in these patterns between five countries with different trends in youth drinking. METHODS: We analysed four waves of repeat cross-sectional survey data from 15-year-olds in England (n = 5942), Italy (n = 5234), the Netherlands (n = 5408), Hungary (n = 5274), and Finland (n = 7446), which were included in the Health Behaviours in School-aged Children (HBSC) study between 2001/02 and 2013/14. We defined clusters of individuals using multigroup latent class analyses which accounts for change over time. The class indicators included health behaviours, attitudes, wellbeing and relationships. We modelled associations between class membership, sex, and family affluence over time. RESULTS: We identified four classes in all countries: Overall unhealthy, Overall healthy, Moderately healthy and Substance abstainers with behaviour risk indicators. The proportion of adolescents in the Overall unhealthy class declined between 2001/02 and 2013/14 by between 22.8 percentage points (pp) in England and 3.2pp in Italy. The extent to which indicators of health and wellbeing changed as linked clusters differed across countries, but changes in alcohol consumption, smoking, drug use and sexual activity were typically concurrent. Adolescents with low family affluence were more likely to be in the Overall unhealthy class in all years. CONCLUSIONS: Improvements in indicators of adolescent health and well-being are due mainly to concurrent declines in drinking, smoking, sexual activity, and cannabis use, but these declines are not consistently associated with improvements in other domains. They have also not led to reductions in inequalities in indicators of health and well-being.

The effect of alcohol packaging size and strength on U.K. alcohol consumers' classification of alcohol products as containing a single or multiple drinks.

OBJECTIVE: Reductions to the size and strength of alcohol products prompt reductions in alcohol consumption, although these effects may be limited to single drinks rather than packages that contain multiple drinks. This study investigated what product characteristics predict whether a product is seen as a single drink and seeks to identify the thresholds beyond which products are considered to contain multiple drinks. METHOD: Ninety-four U.K. drinkers from the prolific participant panel categorized 250 alcohol products with varying packaging sizes and strengths into single or multiple drinks. We used multilevel logistic regression to investigate whether packaging size, strength, total alcohol content, and container type predicted the likelihood that products were classified as a single drink across five drink types (beer, cider, ready-to-drink, spirits, wine). We used receiver operating characteristics curve analysis to identify the point at which products become too large or too strong to be considered a single drink by most drinkers. RESULTS: Larger products, bottled drinks, products with higher alcohol by volume (ABV), and higher alcohol content were more likely to be classified as containing multiple drinks. We report thresholds for packaging size, ABV, and total alcohol content where products switch from being seen as a single drink to containing multiple drinks. The thresholds did not significantly differ between low-risk and increased risk drinkers. CONCLUSIONS: The reported thresholds can help researchers and policy makers encourage more accurate self-monitoring of alcohol consumption. Future research should test whether single drink classifications moderate the effect of packaging size and strength reductions on alcohol consumption. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Temporary abstinence challenges: What do we need to know?

Participation in temporary abstinence challenges (TAC) continues to increase with campaigns established in several countries. Temporarily abstaining from alcohol as part of such challenges is associated with ongoing benefits including reductions to alcohol consumption after the TAC. We identified three research priorities regarding TACs which are outlined in this paper. First, the role of temporary abstinence itself is unclear with post-TAC reductions in alcohol consumption still apparent among participants who do not remain fully abstinent throughout the challenge. It is necessary to establish to what degree temporary abstinence itself, rather than the combination of abstinence and the additional supports provided by TAC organisers (e.g., mobile applications, online support groups), contributes to changes in consumption after the TAC. Second, little is known about the psychological changes underlying these changes in alcohol consumption, with conflicting evidence as to whether increases in someone's belief in their ability to avoid drinking mediates the association between participation in a TAC and reductions in consumption afterwards. Other potential psychological and social mechanisms of change have been subjected to little, if any, scrutiny. Third, evidence of increased consumption post-TAC among a minority of participants indicates a need to establish for whom or in what circumstances participation in a TAC may result in unintended negative consequences. Focussing research in these areas would increase the confidence with which participation could be encouraged. It would also enable campaign messaging and additional supports to be prioritised and tailored to be as effective as possible in facilitating long-term change.

Print and online textual news media coverage of UK low-risk drinking guidelines from 2014 to 2017: A review and thematic analysis.

INTRODUCTION: The UK low-risk drinking guidelines were revised in 2016. Drinkers were primarily informed about the guidelines via news media, but little is known about this coverage. This study investigated the scale and content of print and online textual news media coverage of drinking guidelines in England from February 2014 to October 2017. METHODS: We searched the Nexis database and two leading broadcasters' websites (BBC and Sky) for articles mentioning the guidelines. We randomly selected 500 articles to code for reporting date, accuracy, tone, context and purpose of mentioning the guidelines, and among these, thematically analysed 200 randomly selected articles. RESULTS: Articles mentioned the guidelines regularly. Reporting peaked when the guidelines revision was announced (7.4% of articles). The most common type of mention was within health- or alcohol-related articles and neutral in tone (70.8%). The second most common was in articles discussing the guidelines' strengths and weaknesses, which were typically negative (14.8%). Critics discredited the guidelines' scientific basis by highlighting conflicting evidence and arguing that guideline developers acted politically. They also questioned the ethics of limiting personal autonomy to improve public health. Criticisms were partially facilitated by announcing the guidelines alongside a 'no safe level of drinking' message, and wider discourse misrepresenting the guidelines as rules, and highlighting apparent inconsistencies with standalone scientific papers and international guidelines. DISCUSSION AND CONCLUSIONS: News media generally covered drinking guidelines in a neutral and accurate manner, but in-depth coverage was often negative and sought to discredit the guidelines using scientific and ethical arguments.

Are animal models of addiction useful?

BACKGROUND: Pre-clinical research involving non-human animals has made important contributions to our understanding of risk factors for addiction, neuroadaptations that follow chronic drug exposure and to the development of some efficacious pharmacotherapies for addiction. Despite these contributions, we argue that animal models of addiction have impeded progress in our understanding of addiction and its treatment in humans. ARGUMENT: First, the majority of pharmacological treatments that were initially developed using animal models have failed to prove effective for the treatment of addiction in humans, resulting in a huge waste of resources. Secondly, we demonstrate that prevailing animal models that portray addiction as a disorder of compulsion and habit cannot be reconciled with observations that psychoactive drug use in humans is a goal-directed operant behaviour that remains under the control of its consequences, even in people who are addicted. Thirdly, addiction may be a uniquely human phenomenon that is dependent on language, which necessarily limits the validity of animal models. Finally, we argue that addicted brains must be understood as one component of broader networks of symptoms and environmental and social factors that are impossible to model in laboratory animals. CONCLUSIONS: A case can be made that animal models of addiction have not served us well in understanding and treating addiction in humans. It is important to reconsider some widely held beliefs about the nature of addictive behaviour in humans that have arisen from the zeal to translate observations of laboratory animals.

User Experiences of a Smartphone-Based Attentive Eating App and Their Association With Diet and Weight Loss Outcomes: Thematic and Exploratory Analyses From a Randomized Controlled Trial.

BACKGROUND: Short-term laboratory studies suggest that eating attentively can reduce food intake. However, in a recent randomized controlled trial we found no evidence that using an attentive eating smartphone app outside of the laboratory had an effect on energy intake or weight loss over 8 weeks. OBJECTIVE: This research examined trial participants' experiences of using an attentive eating smartphone app and whether app usage was associated with energy intake and weight loss outcomes over 8 weeks. METHODS: We conducted thematic analysis of semistructured interviews (N=38) among participants in the attentive eating smartphone app group of the trial who completed the 8-week assessment. Linear regression models examined the associations between energy intake and weight loss outcomes at 8 weeks and app usage. RESULTS: Participants reported several barriers and facilitators to using the smartphone app, including repetition of app content, social setting, motivation, and habitual use of the app. Participants believed that using the app had some beneficial effects on their eating behavior and diet. Exploratory analyses indicated that more frequent recording of eating episodes in the app was associated with lower body weight (B=-0.02, P=.004) and greater self-reported energy intake (B=5.98, P=.01) at 8 weeks, but not body fat percentage or taste-test energy intake. Total audio clip plays, gallery views, and percentage of food entries recorded using an image were not significantly associated with energy intake or weight. CONCLUSIONS: Frequent recording of eating episodes in a smartphone app was associated with greater weight loss. There are barriers and facilitators to frequent use of an attentive eating smartphone app that may be useful to address when designing dietary behavior change smartphone apps. TRIAL REGISTRATION: ClinicalTrials.gov NCT03602001; https://clinicaltrials.gov/ct2/show/NCT03602001; Open Science Framework DOI 10.17605/osf.io/btzhw; https://osf.io/btzhw/.

Blatant Dehumanization of People with Obesity.

OBJECTIVE: Stigmatization of obesity is common, but whether this stigma extends to people with obesity also being considered less human than individuals without obesity has not been examined. This study investigated whether people with obesity are blatantly dehumanized (i.e., explicitly considered to be less human and more animallike) and whether this predicts obesity discrimination. METHODS: In four online studies (total N = 1,506) with American, British, and Indian participants, evidence for blatant dehumanization of people with obesity was examined. Whether blatant dehumanization of people with obesity was moderated by BMI and to what extent blatant dehumanization predicted support for weight discrimination were also investigated. RESULTS: In all studies, participants believed that people with obesity were less evolved and less human than people without obesity. Although blatant dehumanization of people with obesity was most pronounced among thinner participants, the belief that people with obesity were less human was also observed among participants with class I obesity. Finally, dehumanization was predictive of support for policies that discriminate against people living with obesity. CONCLUSIONS: This study provides the first evidence that people with obesity are blatantly dehumanized. This tendency to consider people with obesity as less human reveals the level of obesity stigma and may facilitate and/or justify weight discrimination.

Portion size and meal consumption in domesticated dogs: An experimental study.

Increases in food portion sizes have been identified as a possible contributor to the increased prevalence of obesity in humans. However, little is known about the origin of behavioural tendencies to overeat from larger portion sizes or whether other non-human animals are affected by meal portion size. In the present experimental study, we examined the effect that larger portion sizes have on meal consumption among domesticated dogs (N = 32). Dogs were fed three meals that varied in size on different occasions (150%, 200% and 300% of usual portion size). A repeated measures design was used and food consumption was measured for each meal. Portion size positively affected food consumption, with dogs eating significantly more food as the portion size of meal increased. The effect of portion size on food consumption was also observed when the dogs that finished all available food were excluded from analyses, however not among dogs who did not finish any of the meals. We conclude that the influence larger portions have on food consumption observed in humans is also observed in domesticated dogs. However, it is unclear whether portion size directly biases the amount of food dogs choose to consume, as has been suggested in humans. Further research is now warranted to examine commonalities between human and non-human animal eating behaviour to understand shared behavioural tendencies and their origins.

Does perceived overweight increase risk of depressive symptoms and suicidality beyond objective weight status? A systematic review and meta-analysis.

Obesity is associated with a significant disease burden, but whether recognising as opposed to failing to recognise personal overweight is beneficial or detrimental to mental health is unclear. Here we examine the associations between perceived overweight and depressive symptoms and suicidality. A systematic search of three electronic databases yielded 10,398 unique records, from which 32 studies (110 observations) were eligible for inclusion. Pooled odds ratios (OR) and 95% confidence intervals (CI) were calculated for each outcome using random effects meta-analyses and potential publication bias was examined. Perceived overweight was associated with an increased risk of depressive symptoms (OR: 1.42, CI: 1.31, 1.54 p <.0001, N >128,585) and suicidality (OR: 1.41, CI: 1.28, 1.56, p <.0001, N = 133,576) in both cross-sectional and longitudinal studies. The association between perceived overweight and poorer mental health was observed irrespective of study origin, participant age (children vs. adults), gender, and whether or not a person was objectively overweight. The pooled statistical relationship between objective weight status and poorer mental health was attenuated to non-significance when perceived overweight was accounted for, suggesting that the detrimental effect of overweight on mental health is largely dependent on whether or not a person identifies as overweight.

Portion size and later food intake: evidence on the "normalizing" effect of reducing food portion sizes.

Background: Historical increases in the size of commercially available food products have been linked to the emergence of a worldwide obesity crisis. Although the acute effect that portion size has on food intake is well established, the effect that exposure to smaller portion sizes has on future portion size selection has not been examined. Objective: We tested whether reducing a food portion size "renormalizes" perceptions of what constitutes a normal amount of that food to eat and results in people selecting and consuming smaller portions of that food in the future. Design: Across 3 experiments, participants were served a larger or smaller portion of food. In experiments 1 and 2, participants selected and consumed a portion of that food 24 h later. In experiment 3, participants reported on their preferred ideal portion size of that food after 1 wk. Results: The consumption of a smaller, as opposed to a larger, portion size of a food resulted in participants believing a "normal"-sized portion was smaller (experiments 1-3, P ≤ 0.001), consuming less of that food 1 d later (experiments 1-2, P ≤ 0.003), and displaying a tendency toward choosing a smaller ideal portion of that food 1 wk later (experiment 3, P = 0.07), although the latter finding was not significant. Conclusion: Because consumer preferences appear to be driven by environmental influences, reducing food portion sizes may recalibrate perceptions of what constitutes a "normal" amount of food to eat and, in doing so, decrease how much consumers choose to eat. This trial was registered at www.clinicaltrials.gov as NCT03241576.