Eating Frequency is Associated With Energy Intake but Not Obesity in Midlife Women

Midlife women tend to gain weight with age, thus increasing risk of chronic disease. The purpose of this study was to examine associations between overweight/obesity and behavioral factors, including eating frequency, in a cross‐sectional national sample of midlife women (n = 1,099) (mean age = 49.7 years, and BMI = 27.7 kg/m²). Eating behaviors and food and nutrient intakes were based on a mailed 1‐day food record. BMI was calculated from self‐reported height and weight, and level of physical activity was assessed by self‐reported questionnaire. After exclusion of low‐energy reporters (32% of sample), eating frequency was not associated with overweight/obesity (P > 0.05) and was not different between BMI groups (normal, 5.21 ± 1.79; overweight, 5.16 ± 1.74; obese, 5.12 ± 1.68, P = 0.769). Adjusted logistic regression showed that eating frequency, snacking frequency, breakfast consumption, eating after 10 pm and consuming meals with children or other adults were not significantly associated with overweight/obesity. Total energy intake increased as eating frequency increased in all BMI groups, however, obese women had greater energy intake compared to normal weight women who consumed the same number of meals and snacks. Intake of fruit and vegetables, whole grains, dietary fiber, dairy, and added sugars also increased as eating frequency increased. While eating frequency was not associated with overweight/obesity, it was associated with energy intake. Thus, addressing total energy intake rather than eating frequency may be more appropriate to prevent weight gain among midlife women.     

Internal and External Cues of Meal Cessation: The French Paradox Redux?

Objective: Our objective was to investigate whether people who use internal cues of satiation when eating a meal are likely to weigh less than people who instead rely on external cues. In addition to exploring the role that internal and external cues play in meal cessation, this study raises an overlooked explanation of the French paradox. Research Methods and Procedures: A demographically‐matched student sample of 133 Parisians and 145 Chicagoans completed a brief survey on meal cessation that asked the extent to which they agreed with statements associated with internal cessation cues and statements with external cessation cues. Their answers to these were compared across BMI levels and across countries. Results: Normal‐weight people indicated that they were more likely to be influenced by internal cues of meal cessation (p = 0.043), while overweight people indicated that they were more influenced by external cues (p = 0.005). Similarly, while the French were influenced by internal cues of meal cessation (p < 0.001), Americans were more influenced by external cues (p < 0.001). Discussion: This research revisits Schachter's externality hypothesis and suggests that one's over‐reliance on external cues may prove useful in offering a partial explanation of why BMI might vary across people and potentially across cultures. Relying on internal cues for meal cessation, rather than on external cues, may improve eating patterns over the long term.     

Mechanisms behind the portion size effect: visibility and bite size

Increases in portion size lead to increases in energy intake, yet the mechanisms behind this "portion size effect" are unclear. This study tested possible mechanisms of the portion size effect, i.e., bite size and visual cues. A 2 × 2 repeated measures, within-subject design was used to test the effects of portion size (410 g vs. 820 g of a pasta dish) and visual cues (blindfolded vs. visible) on energy intake in 30 individuals (15 men, 15 women). At each meal participants were exposed to one of four experimental conditions (small portion/visible; small portion/blindfold; large portion/visible; large portion/blindfold). Participant characteristics, food intake, number of bites, meal duration, palatability measures and hunger and fullness were assessed. In response to a doubling of the portion presented, entrée energy intake increased 26% (220 kcal; P < 0.001) and mean bite size increased 2.4 g/bite (P < 0.05). Overweight (OW) individuals consumed 40% (334 kcal) more of the entrée in response to the large portion condition (P < 0.05), while lean individuals' intakes did not differ (P < 0.56). A 12% (122 kcal) decrease in entrée intake was observed in the blindfolded condition (P < 0.01), but no portion by visual cue interaction was found; indicating that blindfolding did not significantly attenuate the portion size effect. These data suggest that the portion size effect is not impacted by removing the visual cue of food and that this effect occurs via changes in bite size in adults.     

Cognitive Change in Obese Adolescents Losing Weight

Objectives: To investigate how obese adolescents think about themselves in terms of exercise, eating, and appearance and whether these cognitions change over the course of a residential weight loss camp. Research Methods and Procedures: Obese adolescents [N = 61; age, 14.1 (±0.2) years; BMI, 33.9 (±0.7) kg/m²] completed assessments of body weight and height and self‐esteem and a sentence‐completion test eliciting thoughts and beliefs about exercise, eating, and appearance at the start and end of the camp (mean stay, 26 days). They were compared with a single assessment of 20 normal‐weight adolescents [age, 15.4 (±0.2) years; BMI, 21.8 (±0.5) kg/m²]. Results: The obese adolescents lost 5.7 kg and reduced their BMI SD score by 0.25. Camp residence was associated with a significant reduction in the number of negative automatic thoughts and an increase in positive thoughts, especially related to exercise and appearance. There was no change in conditional beliefs, either functional or dysfunctional. Including BMI SD score change as a covariate took away all the main and interaction effects of time, showing that cognitive change was largely accounted for by the reduction in weight. Despite this improvement, campers remained cognitively more negative and dysfunctional than the normal‐weight comparison adolescents. Discussion: Obese adolescents not only lost weight, but they improved their self‐representation, specifically in terms of automatic thoughts about exercise and appearance. Although these are short‐term cognitive changes, they reflect positively on the camp experience and show the value of psychological improvement in assessing obesity‐treatment outcomes.     

The Influence of Weekday Eating Patterns on Energy Intake and BMI Among Female Elementary School Personnel

Many health practitioners recommend eating small, frequent meals for weight loss, yet the relationship of eating patterns, such as eating occasion frequency (EOF), to energy intake and body weight is controversial. Broad‐based efforts to promote worksite wellness programs increase the importance of this issue, as many work environments inherently restrict eating patterns. The eating patterns of school personnel are understudied, but are of particular interest, not only because they have limited eating opportunities during the day but also because their diet and weight outcomes are likely to influence behaviors of a much larger population. We examined relationships between weekday EOF and energy intake and BMI among female elementary school personnel in 22 schools in a suburban county of southeastern Louisiana. Two 24‐h dietary recalls were administered to randomly‐selected employees (n = 329) on nonconsecutive days by registered dietitians. Measured heights and weights were used to calculate BMI (weight/height²). On average, employees consumed 2.2 of their total 5.9 meals and snacks during the school day, accounting for 37% of daily energy. In multiple regression models controlling for demographic and health variables, EOF as well as separate counts of meal and snack frequency were each positively and significantly associated with energy intake. However, neither the number of meals, snacks, nor overall EOF was associated with BMI. The proportion of energy consumed during the school day and the positive association of weekday EOF with energy intake suggest an important role for worksite wellness programs that target the dietary improvement of elementary school personnel.     

Accuracy of self-reported weight among bariatric surgery candidates: the influence of race and weight cycling

Objective: Research on the accuracy of self‐reported weight has indicated that the degree of misreporting (underestimating) weight is associated with increasing weight but is variable across patient groups. We examined the degree of discrepancy between actual and self‐reported BMI in severely obese bariatric surgery candidates, and whether the degree of accuracy varied by race and by eating‐related and psychological factors. Research Methods and Procedures: Participants were 179 obese female gastric bypass surgery candidates (31 black, 22 Hispanic, 126 white) who were asked to self‐report height and weight as part of a larger assessment battery. Actual height and weight were then measured and a discrepancy score was generated (actual BMI ? reported BMI). Results: In this group of severely obese patients, degree of misreporting was unrelated to BMI. The race groups did not differ in actual or self‐reported BMI but differed significantly in the degree of misestimation between self‐reported and actual BMI. Post hoc tests indicated that black women underestimated their BMI significantly more than white women; Hispanic women did not differ from the other race groups. No eating‐related or psychological variables assessed predicted percentage discrepancy; however, the accuracy in self‐reported weight was related to history of weight cycling. Discussion: Overall, obese bariatric surgery candidates were accurate in self‐report of weight, although the degree of accuracy differed by race and weight cycling history.     

Episodic Memory and Appetite Regulation in Humans

Psychological and neurobiological evidence implicates hippocampal-dependent memory processes in the control of hunger and food intake. In humans, these have been revealed in the hyperphagia that is associated with amnesia. However, it remains unclear whether ‘memory for recent eating’ plays a significant role in neurologically intact humans. In this study we isolated the extent to which memory for a recently consumed meal influences hunger and fullness over a three-hour period. Before lunch, half of our volunteers were shown 300 ml of soup and half were shown 500 ml. Orthogonal to this, half consumed 300 ml and half consumed 500 ml. This process yielded four separate groups (25 volunteers in each). Independent manipulation of the ‘actual’ and ‘perceived’ soup portion was achieved using a computer-controlled peristaltic pump. This was designed to either refill or draw soup from a soup bowl in a covert manner. Immediately after lunch, self-reported hunger was influenced by the actual and not the perceived amount of soup consumed. However, two and three hours after meal termination this pattern was reversed - hunger was predicted by the perceived amount and not the actual amount. Participants who thought they had consumed the larger 500-ml portion reported significantly less hunger. This was also associated with an increase in the ‘expected satiation’ of the soup 24-hours later. For the first time, this manipulation exposes the independent and important contribution of memory processes to satiety. Opportunities exist to capitalise on this finding to reduce energy intake in humans.     

Package Unit Size and Amount of Food: Do Both Influence Intake?

Objective: Large portions increase intake and are hypothesized to contribute to the obesity epidemic. However, it is unclear if portion size affects intake through changes in the unit size of available food or the overall amount of food available for consumption. Thus, this study examined the independent effects of package unit size and amount of food on intake. It was hypothesized that both variables would influence intake. Research Methods and Procedures: Non‐obese (BMI <30 kg/m²), non‐smoking, unrestrained, college‐aged men (n = 12) and women (n = 16) who regularly consumed (≥3 times/wk) snack foods were randomly assigned to one of four groups crossing package unit size (small vs. large) and amount of food (small vs. large). Participants were given a box with 4 snack foods (potato chips, cheese crackers, cookies, and candy) packaged according to their assigned group to take home and eat over 3 days. Dependent variables were energy and gram intake of provided snack foods. Results: An effect of amount of food was found (p < 0.01). A 100% increase in the amount of food provided produced an 81% increase in energy consumed from the snack foods [small amount, 21,037.6 ± 10,852 kJ (5028 ± 2596 kcal) vs. large amount, 11,640.7 ± 4914.1 kJ (2782 ± 1174 kcal)]. No effect of package unit size was found. Discussion: These results suggest that the amount of food available to eat strongly influences intake.     

Intentional Weight Loss in Young Adults: Sex‐Specific Genetic and Environmental Effects

Objective: To explore eating styles associated with intentional weight loss (IWL) and to determine whether the genetic liability in IWL is entirely shared with genetic liability affecting BMI. Research Methods and Procedures: As part of a longitudinal assessment of various health‐related behaviors in a large population‐based sample of twins, eating styles, BMI, and the number of times the study participants had intentionally lost ≥5 kg were assessed by questionnaire from 4667 male and female twins (22 to 27 years of age). Associations of eating styles and IWL were explored using polytomous logistic regression models adjusted for BMI. Sex‐specific bivariate structural equation modeling was used to explore genetic and environmental correlations of BMI and IWL. Results: Individuals who had engaged in IWL exhibited markedly more restricting, overeating, and alternating restricting/overeating than those in the no‐IWL group. Snacking and eating in the evening were characteristic of women with at least two IWL attempts. Eating in response to visual and emotional cues was very pronounced in women who had engaged in IWL but much less so in men. IWL was estimated to have a heritability of 38% [95% confidence interval (CI), 19% to 55%] in men and 66% (95% CI, 55% to 75%) in women. The genetic covariance of BMI and IWL was 0.38 (95% CI, 0.28 to 0.47) for men and 0.45 (95% CI, 0.41 to 0.52) for women. Discussion: Distinct sex differences exist in eating styles associated with IWL and in the heritability of IWL. Most genetic factors affecting BMI are different from those affecting IWL.     

Effects of age on children's intake of large and self-selected food portions

Objective: Whether developmental periods exist in which children become particularly sensitive to environmental influences on eating is unclear. This research evaluated the effects of age on intake of large and self‐selected portions among children 2 to 9 years of age. Research Methods and Procedures: Seventy‐five non‐Hispanic white children 2 to 3, 5 to 6, and 8 to 9 years of age were seen at a dinner meal in reference, large, and self‐selected portion size conditions in which the size of an entrée was age‐appropriate, doubled, and determined by the child, respectively. Weighed food intake data were collected. Entrée bite size and bite frequency were assessed. Height and weight measurements were obtained. Results: The effect of age on children's intake of the large portion was not significant. Entrée consumption was 29% greater (p < 0.001) and meal energy intake was 13% greater (p < 0.01) in the large portion condition than in the reference condition. Increases in entrée consumption were attributable to increases in average bite size (p < 0.001). Neither child weight nor maternal weight predicted children's intake of large portions. Self‐selection resulted in decreased entrée (p < 0.05) and meal energy (p < 0.01) only among those children who ate more when served the large portion. Discussion: The results of this research confirm that serving large entrée portions promotes increased intake at meals among 2‐ to 9‐year‐old children. These findings suggest that any age‐related differences in children's response to large portions are likely to be smaller than previously suspected.     

Water and Food Consumption Patterns of U.S. Adults from 1999 to 2001

Objective: High water consumption has been proposed as an aid to weight control and as a means of reducing the energy density of the diet. This study examines the relationship between water consumption and other drinking and eating patterns. Research Methods and Procedures: The National Health and Nutrition Examination Survey 1999 to 2001, with responses from 4755 individuals ≥18 years of age, provides the data for this cross‐sectional analysis. A cluster analysis was performed using z‐scores of specific food and beverage consumption to examine patterns. A multinomial logit analysis was used to examine sociodemographic characteristics of each dietary pattern and to examine the effects of water consumption on the likelihood of consuming a non–dairy caloric beverage. All results were weighted to be nationally representative and controlled for design effects. Results: Within the sample, 87% consumed water, with an average daily consumption of 51.9 oz (1.53 liters) per consumer. Water consumers drank fewer soft/fruit drinks and consumed 194 fewer calories per day. Water consumers (potentially a self‐selected sample) consumed more fruits, vegetables, and low‐ and medium‐fat dairy products. Four distinct unhealthy dietary patterns were found that included little or no water consumption. Older and more educated persons used healthier food patterns. Mexican dietary patterns were much healthier than dietary patterns of blacks. Discussion: Water consumption potentially is a dietary component to be promoted, but much more must be understood about its role in a healthy diet. Because high water consumption is linked with healthier eating patterns—patterns more likely to be followed by higher‐educated, older adults—the target of water promotion and healthy diet options should focus on younger and less educated adults.     

Association of eating frequency with body fatness in pre- and postmenopausal women

Objective: To examine associations between eating frequency (EF) and body fatness in pre‐ and postmenopausal women, after excluding potential low‐energy reporters. Research Methods and Procedures: In this cross‐sectional study of 220 free‐living women, 64 pre‐ and 50 postmenopausal non‐low‐energy‐reporting women were further analyzed (age, 24 to 74 years; BMI, 18.5 to 38.6 kg/m²). Anthropometric and body composition measurements (DXA) were performed in all study participants. EF, energy, and macronutrient intake were assessed by 3‐day food record. Physical activity level and energy expenditure were assessed by self‐reported questionnaire. Results: No association between EF and adiposity indices was detected in premenopausal women. In contrast, EF was positively correlated with percentage body fat in postmenopausal women (r = 0.30, p = 0.03). EF was positively correlated with total energy intake in both groups and with total energy expenditure in premenopausal women only (r = 0.34, p = 0.02). Multivariate analysis revealed that, in postmenopausal women, EF was a significant predictor of body fatness (standardized β = 0.41, p = 0.01). Discussion: Frequent eating was not found to be related to adiposity in premenopausal women, but it was associated with increased body fat in postmenopausal women. Possible explanations could be that the frequent eating is not associated with a physically active lifestyle in postmenopausal women or that frequent eating predisposes women after menopause to a higher energy intake by increasing food stimuli and rendering it more difficult for them to control energy balance.     

Gender Differences in Shame in Patients with Binge‐Eating Disorder

Objective: To examine the relationship between shame and the behavioral and attitudinal features of eating disorders in men and women diagnosed with binge‐eating disorder (BED). Research Methods and Procedures: Participants were 188 consecutively evaluated adults (38 men and 150 women) who met Diagnostic and Statistical Manual of Mental Disorders, 4th edition, criteria for BED. Participants were interviewed and completed a battery of measures assessing shame, behavioral and attitudinal features of eating disorders, and general psychological functioning. Results: Shame did not differ significantly by gender and was not associated with BMI or binge‐eating frequency. Shame was significantly associated with the attitudinal features of eating disorders, even after controlling for levels of depression and self‐esteem. When considered separately by gender and controlling for depression and self‐esteem, shame was associated with body dissatisfaction in men and with weight concern in women. Discussion: Men and women with BED, who presented for treatment, reported similar levels of shame. Overall, while shame was related to attitudinal features, the specific associations differed by gender. For men, shame was related to how dissatisfied they felt with their bodies, whereas for women, shame was associated with concerns about weight. Interestingly, shame was not related to BMI or binge‐eating frequency in men or women. These results provide preliminary support for self‐conscious emotions playing different roles in men and women with BED.     

Influence of parents' eating behaviors and child feeding practices on children's weight status

Objective : To investigate the effects of mothers’ and fathers’ eating behaviors, child feeding practices, and BMI on percentage body fat and BMI in their children. Research Methods and Procedures : Four hundred fifty‐eight parents (239 mothers, 219 fathers) were asked to complete two questionnaires: the Three‐Factor Eating Questionnaire and the Child Feeding Questionnaire, which measure dimensions of parent eating behavior and child feeding practices, respectively. Parent BMI was calculated from self‐reported height and weight; children's measures included BMI and percentage fat assessed by DXA. Regression analyses were used to analyze relationships between parents’ BMI and questionnaire scores and children's weight status. Results : One hundred forty‐three mothers and 68 fathers returned questionnaires, representing parents of 148 children 3 to 5 years old (78 boys). Children's weight was related to mothers’ BMI, but not fathers’. Girls had a greater BMI if either parent reported being overweight as a child, and both girls and boys were likely to be overweight if their mothers believed they had risky eating habits (fussiness, eating too much, etc.). Girls with fathers who were more controlling had a higher percentage fat; these fathers were also more concerned about their daughters’ future health. Discussion : Mothers exert a strong influence over their children's weight and seem to be more concerned about their children's eating behaviors; however, fathers play a role in imposing child feeding practices. Gender bias may be present in child feeding, as suggested by dissimilar effects of parent practices on the weight status of girls vs. boys. Fathers should be included in future studies analyzing parent feeding practices and children's weight outcome.     

Loss of control is central to psychological disturbance associated with binge eating disorder

Objective: Binge eating disorder (BED) is positively associated with obesity and psychological distress, yet the behavioral features of BED that drive these associations are largely unexplored. The primary aim of this study was to investigate which core behavioral features of binge eating are most strongly related to psychological disturbance. Methods and Procedures: A cross‐sectional study involved 180 bariatric surgery candidates, 93 members of a non‐surgical weight loss support group, and 158 general community respondents (81 men/350 women, mean age 45.8 ± 13.3, mean BMI 34.8 ± 10.8, BMI range 17.7–66.7). Validated questionnaires assessed BED and binge eating, symptoms of depression, appearance dissatisfaction (AD), quality of life (QoL) and eating‐related behaviors. Features of binge eating were confirmed by interview. BMI was determined by clinical assessment and self‐report. Results: The loss of control (LOC) over eating, that is, being unable to stop eating or control what or how much was consumed was most closely related to psychological markers of distress common in BED. In particular, those who experienced severe emotional disturbance due to feelings of LOC reported higher symptoms of depression (P < 0.001), AD (P = 0.009), and poorer mental health–related QoL (P = 0.027). Discussion: Persons who report subjective binge episodes or do not meet BED frequency criteria for objective binge episodes may still be at elevated risk of psychological disturbance and benefit from clinical intervention. Feelings of LOC could drive binge eaters to seek bariatric surgery in an attempt to gain control over body weight and psychologically disturbing eating behavior.     

The Influence of Higher Protein Intake and Greater Eating Frequency on Appetite Control in Overweight and Obese Men

The purpose of this study was to determine the effects of dietary protein intake and eating frequency on perceived appetite, satiety, and hormonal responses in overweight/obese men. Thirteen men (age 51 ± 4 years; BMI 31.3 ± 0.8 kg/m²) consumed eucaloric diets containing normal protein (79 ± 2 g protein/day; 14% of energy intake as protein) or higher protein (138 ± 3 g protein/day; 25% of energy intake as protein) equally divided among three eating occasions (3‐EO; every 4 h) or six eating occasions (6‐EO; every 2 h) on four separate days in randomized order. Hunger, fullness, plasma glucose, and hormonal responses were assessed throughout 11 h. No protein × eating frequency interactions were observed for any of the outcomes. Independent of eating frequency, higher protein led to greater daily fullness (P < 0.05) and peptide YY (PYY) concentrations (P < 0.05). In contrast, higher protein led to greater daily ghrelin concentrations (P < 0.05) vs. normal protein. Protein quantity did not influence daily hunger, glucose, or insulin concentrations. Independent of dietary protein, 6‐EO led to lower daily fullness (P < 0.05) and PYY concentrations (P < 0.05). The 6‐EO also led to lower glucose (P < 0.05) and insulin concentrations (P < 0.05) vs. 3‐EO. Although the hunger‐related perceived sensations and hormonal responses were conflicting, the fullness‐related responses were consistently greater with higher protein intake but lower with increased eating frequency. Collectively, these data suggest that higher protein intake promotes satiety and challenge the concept that increasing the number of eating occasions enhances satiety in overweight and obese men.     

Ethnic differences in lifestyle and overweight in the Netherlands

Objective: To study the effects of lifestyle variables and socioeconomic status on overweight among native Dutch and immigrants in The Netherlands. Research Methods and Procedures: Data were used from a survey sample (N = 2551) of native Dutch and immigrant respondents (Surinamese/Antilleans, Turks, and Moroccans). BMI was calculated using self‐reported weight and height. Lifestyle variables such as modern food habits (take‐out food and eating out) and participating in sports were included, as well as socioeconomic and demographic background variables. Bivariate and ordinary least squares analyses were performed to study BMI and the determinants of overweight among the different groups. Results: All immigrant groups had a higher prevalence of overweight than the Dutch, except Moroccans. Men were overweight more frequently than women. Take‐out food, eating out, and fresh vegetables were related to a decrease in BMI, whereas convenience foods were related to an increase in BMI. For ready‐to‐eat meals, the results were mixed. In all groups, age was associated with a higher BMI, and a higher level of education was associated with a lower BMI. Immigrants participated in sports less frequently than native Dutch people. Discussion: One percent to 5% of the total public health costs can be attributed to costs for overweight‐related diseases. Public health policies should aim at stimulating healthy lifestyles and discouraging bad food habits through higher taxes on high‐calorie foods. In particular, Dutch immigrants should be encouraged to lose weight, because they have a higher risk for overweight‐related diseases.     

Treatment of Morbid Obesity in Low‐income Adolescents: Effects of Parental Self‐monitoring

Objective: This study examined the extent to which consistency of self‐monitoring by participants and their parents was related to weight control over an initial period of 3 months within the context of a treatment program for morbidly obese low‐income minority adolescents. Research Methods and Procedures: Eighty‐three obese adolescents (mean age, 13.0 years; 51% boys; 92% African American; mean BMI, 43.0 kg/m²; mean BMI z‐score, 6.0) and at least one parent participated in a long‐term treatment program that included a very‐low‐fat dietary focus, weekly group cognitive‐behavior therapy, monthly nutrition education classes, a 12‐week physical therapy class, and medical monitoring. Results: Participants who self‐monitored on the majority of days compared with those who did not self‐monitor at all or who self‐monitored infrequently attended more sessions and generally lost more weight over the first 3 months. Although parents signed behavioral contracts committing to self‐monitor their own eating and exercising over the first month, only 12% did so. Nonetheless, participants whose parents self‐monitored were much more likely to self‐monitor consistently and lose weight during the first 3 months. Discussion: These results indicate that self‐monitoring is a cornerstone of successful weight control even for morbidly obese low‐income minority adolescents; targeting consistency of self‐monitoring among these high‐risk weight controllers and their parents should be just as important as it is for more affluent and less overweight adolescents.