Search

This study aimed to assess the relationships between routine and compensatory restraints and body mass index (BMI), as well as to explore the mediating role of emotional and external eating in the relationships between routine and compensatory restraints and BMI. Chinese adults aged ≥18 years with different weight statuses were invited to fill out an online questionnaire. Routine and compensatory restraints and emotional and external eating were assessed using the validated 13-item Chinese version of the Weight-Related Eating Questionnaire. Mediation analyses tested the mediation effects of emotional and external eating on the relationship between routine and compensatory restraints and BMI. In total, 949 participants (26.4% male) responded to the survey (mean age = 33 years, standard deviation (SD) = 14, mean BMI = 22.0 kg/m2, SD = 3.8). The mean routine restraint score was higher in the overweight/obese group (mean ± SD = 2.13 ± 0.76, p < 0.001) than in the normal weight (2.08 ± 0.89) and underweight (1.72 ± 0.94) groups. However, the normal weight group scored higher in compensatory restraint (2.88 ± 1.03, p = 0.021) than the overweight/obese (2.75 ± 0.93) and underweight (2.62 ± 1.04) groups. Routine restraint was related to higher BMI both directly (β = 0.07, p = 0.02) and indirectly through emotional eating (β = 0.04, 95% confidence interval (CI) = 0.03, 0.07). Compensatory restraint was only indirectly related to higher BMI through emotional eating (β = 0.04, 95% CI = 0.03, 0.07).

Objective:To identify dietary self-monitoring implementation strategies in behavioural weight loss interventions.Design:We conducted a systematic review of eight databases and examined fifty-nine weight loss intervention studies targeting adults with overweight/obesity that used dietary self-monitoring.Setting:NA.Participants:NA.Results:We identified self-monitoring implementation characteristics, effectiveness of interventions in supporting weight loss and examined weight loss outcomes among higher and lower intensity dietary self-monitoring protocols. Included studies utilised diverse self-monitoring formats (paper, website, mobile app, phone) and intensity levels (recording all intake or only certain aspects of diet). We found the majority of studies using high- and low-intensity self-monitoring strategies demonstrated statistically significant weight loss in intervention groups compared with control groups.Conclusions:Based on our findings, lower and higher intensity dietary self-monitoring may support weight loss, but variability in adherence measures and limited analysis of weight loss relative to self-monitoring usage limits our understanding of how these methods compare with each other.

Continuing to eat even when full leads to excessive calorie consumption and obesity. Thus, understanding brain responses to food cues when satiated has important implications for weight control interventions. We used the late positive potential (LPP, a component of the event-related potentials (ERP) indexing motivational relevance) to determine the extent to which satiety affects brain responses to images of highly palatable foods (high-fat, high-sugar), high and low motivationally relevant (pleasant, unpleasant) and neutral stimuli in a sample of obese (body mass index [BMI] ≥ 30 kg/m2) and lean (BMI < 25 kg/m2) individuals. Satiated individuals (N = 55, 21 with BMI ≥ 30 kg/m2) were fed a nutritional drink prior to the experimental session and were individually matched with 55 unsatiated individuals who saw the same images during a passive viewing task. Satiety did not affect LPP response to food-related or motivationally relevant cues in either BMI < 25 kg/m2 or BMI ≥ 30 kg/m2 individuals (p = .6). Irrespective of satiety, all participants showed larger LPPs as a function of the images' motivational relevance. There were no differences in LPP amplitude between BMI < 25 kg/m2 and BMI ≥ 30 kg/m2 individuals for any picture category, including food. However, within-group comparisons showed that BMI < 25 kg/m2 individuals had larger LPPs to low motivationally relevant pleasant images than to food-related cues (p < .001); this difference was not significant for BMI ≥ 30 kg/m2 individuals. Although satiety does not affect LPP responses to food-related cues, these results highlight the importance of evaluating reactivity to food-related cues in relation to other motivationally relevant stimuli. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Regular physical activity reduces the progression of several cancers and offers physical and mental health benefits for cancer survivors. However, many cancer survivors are not sufficiently active to achieve these health benefits. Possible biological mechanisms through which physical activity could affect cancer progression include reduced systemic inflammation and positive changes in metabolic markers. Chronic and acute hyperglycemia could have downstream effects on cell proliferation and tumorigenesis. One novel strategy to motivate cancer survivors to be more active is to provide personalized biological-based feedback that demonstrates the immediate positive impact of physical activity. Continuous glucose monitors (CGMs) have been used to demonstrate the acute beneficial effects of physical activity on insulin sensitivity and glucose metabolisms in controlled lab settings. Using personal data from CGMs to illustrate the immediate impact of physical activity on glucose patterns could be particularly relevant for cancer survivors because they are at a higher risk for developing type 2 diabetes (T2D). As a pilot project, this study aims to (1) test the preliminary effect of a remotely delivered physical activity intervention that incorporates personalized biological-based feedback on daily physical activity levels, and (2) explore the association between daily glucose patterns and cancer-related insulin pathway and inflammatory biomarkers in cancer survivors who are at high risk for T2D. We will recruit 50 insufficiently active, post-treatment cancer survivors who are at elevated risk for T2D. Participants will be randomly assigned into (1) a group that receives personalized biological feedback related to physical activity behaviors; and (2) a control group that receives standard educational material. The feasibility and preliminary efficacy of this wearable sensor-based, biofeedback-enhanced 12-week physical activity intervention will be evaluated. Data from this study will support the further refinement and enhancement of a more comprehensive remotely delivered physical activity intervention that targets cancer survivors. Trial registration: ClinicalTrials.gov Identifier: NCT05490641.

Weight gain is common among breast cancer patients and may contribute to poorer treatment outcomes. Most programs target breast cancer survivors after the completion of therapy and focus on weight reduction. This study examined the feasibility and preliminary efficacy of an intervention designed to prevent primary weight gain among women receiving neoadjuvant chemotherapy for breast cancer. Thirty-eight newly diagnosed stage II or III breast cancer patients were randomized to the BALANCE intervention or usual care within 3 weeks of starting neoadjuvant chemotherapy. The intervention used a size acceptance-based approach and encouraged home-based resistance and moderate-intensity aerobic exercise as well as a low energy-dense diet to prevent weight gain. Assessments were conducted at baseline, mid-chemotherapy (3 months), and post-chemotherapy (6 months). Intervention feasibility, acceptability, and preliminary effects on anthropometric, quality of life, and circulating biomarker measures were evaluated. Intervention participant retention (100%) and in-person session attendance (80%) were high during the intervention period, although attendance dropped to 43% for telephone-delivered sessions. The majority of participants reported being satisfied with the intervention during chemotherapy (88%). Participants in the intervention group had greater reductions in waist circumference (p = .03) and greater improvements in self-reported vitality scores (p = .03) than the control group at the end of chemotherapy. Significant effects on biomarkers were not observed. A size acceptance weight management program is feasible during neoadjuvant chemotherapy among breast cancer patients and may have beneficial effects on waist circumference and patient vitality. This study was registered as a clinical trial at www.clinicaltrials.gov (NCT00533338).

Background: Regular physical activity (PA) is associated with a lower risk of several types of cancers. However, two-thirds of overweight/obese adults are not sufficiently active; this, in combination with the unfavorable effect of excess body weight, puts them at a greater risk for cancer. One reason that these individuals do not engage in enough PA may be their lack of motivation to change their current behavior due to the perception of putting in effort for possible future gain without obvious short-term benefits. There is a need for innovative ways to help individuals recognize the immediate health benefits of PA and thus increase their motivation. Methods: This pilot intervention tested a PA education module that included a one-on-one counseling session highlighting the acute effects of PA on glucose patterns, followed by a 10-day self-monitoring period with a continuous glucose monitor (CGM) and a Fitbit tracker. Participants rated the acceptability of the education module on a 5-point Likert scale and completed surveys assessing stages of change for motivational readiness. Results: Nineteen overweight/obese adults (84% female) completed the study. Participants gave high ratings to the counseling session for improving their PA-related knowledge (mean = 4.22), increasing motivation (mean = 4.29), and providing personally relevant information (mean = 4.35). The summary acceptability scores for the self-monitoring period were 4.46 for CGM and 4.51 for Fitbit. Participants reported a significant decrease in the precontemplation stage and an increase in the action stage (P < 0.05). Conclusions: CGM is a feasible tool for PA interventions. Impact: Information from CGM could be used as biological-based feedback to motivate PA. See all articles in this CEBP Focus section, “Modernizing Population Science.”

Valid and reliable measures are needed to identify individuals at risk of dietary restraint, emotional and external eating, and to customize weight loss education for more effective weight management. This study aimed to develop and validate a Chinese version of the Weight-Related Eating Behavior Questionnaire (WREQ-C) for assessing dietary restraint, emotional eating, and external eating. In stage one, the linguistic validation of the original English version of the WREQ (WREQ-E) was conducted. In stage two, the psychometric properties of the WREQ-C were first evaluated by item response theory-based (IRT) analyses. The reduced scale was then examined for convergent validity, structural validity (using a confirmatory factor analysis), population invariance, and test–retest reliability. The study included 1007 adults aged between 18 and 71 years. The IRT analysis optimally shortened the original WREQ-E from 16 to 13 items. A convergent validity analysis showed significant correlations between the WREQ-C subscales and the Chinese version of the Dutch Eating Behavior Questionnaire subscales (r = 0.63–0.82). The 13-item WREQ-C demonstrated good reliability (Cronbach’s α = 0.74–0.89) and validity for assessing the psychological aspects of eating behavior, including routine restraint, compensatory restraint, susceptibility to external cues, and emotional eating in Chinese adults.

Human diets in developed countries such as the US have changed dramatically over the past 75 years, leading to increased obesity, inflammation, and cardiometabolic dysfunction. Evidence over the past decade indicates that the interaction of genetic variation with changes in the intake of 18-carbon essential dietary omega-6 (n-6) and omega-3 (n-3) polyunsaturated fatty acids (PUFA), linoleic acid (LA) and α-linolenic acid (ALA), respectively, has impacted numerous molecular and clinical phenotypes. Interactions are particularly relevant with the

Lifestyle factors related to energy balance, such as excess body weight, poor diet, and physical inactivity, are associated with risk of sporadic endometrial cancer (EC) and colorectal cancer (CRC). There are limited data on energy balance-related lifestyle factors and EC or CRC risk among individuals with Lynch syndrome, who are at extraordinarily higher risk of developing EC or CRC. We conducted a systematic review of evidence related to weight status, weight change, dietary habits, and physical activity on EC and CRC risk among individuals with Lynch syndrome. Findings are reported narratively. We searched Medline, EMBASE, CENTRAL, PubMed, and clinicaltrials.gov up to June 14(th), 2018. In total, 1,060 studies were identified and 16 were included. Three studies were related to EC and 13 to CRC. Overall, evidence suggests that weight status/weight change may not be associated with EC risk and multivitamin and folic-acid supplementation may be associated with decreased EC risk. Early-adulthood overweight/obese weight-status and adulthood weight-gain may be associated with increased CRC risk, whereas multivitamin supplementation, tea and high fruit intake, and physical activity may be associated with decreased CRC risk. Current evidence proposes that recommendations related to weight, some dietary habits, and physical activity recommended for the general public are also relevant to individuals with Lynch syndrome. More research is needed, specifically prospective cohorts and randomized controlled trials, to determine if tailored recommendations are needed among individuals with Lynch syndrome.

Background Momentary affect and stress in mothers and their children may be an important predictor of food intake in the natural environment. This study hypothesized that there would be parallel actor and partner effects such that mothers' and children's negative affect (NA), positive affect (PA), and ability to cope with stress would be associated with their own and the other dyad member's unhealthy and healthy food intake in a similar pattern. Method Participants included 202 mother-child dyads (child age range = 8-12 years) who responded to randomly prompted ecological momentary assessment surveys via smartphone up to 7 times per day over 8 days, excluding time at school. At each prompt, mothers and children reported on their current NA, PA, and ability to cope with stress and foods consumed in the past 2 hr. Results Mothers' momentary ability to cope with stress predicted their own and their child's pastries/sweets intake and their own fries/chips intake, and children's momentary ability to cope with stress predicted their own pastries/sweets intake. Mothers and children who reported higher NA on average consumed more pastries/sweets, and children with higher NA on average consumed more fast food. Finally, mothers' momentary PA predicted their own fruit/vegetable consumption. Conclusions Findings provided evidence that the affect and ability to cope with stress of children and mothers predicted subsequent food intake. Given both actor and partner effects, the results show that targeting momentary mothers' and children's ability to cope with stress may have the greatest effect on reducing unhealthy food intake. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Weight losses >10% favorably modulate biomarkers of breast cancer risk but are not typically achieved by comprehensive weight loss programs, including the Diabetes Prevention Program (DPP). Combining the DPP with hunger training (HT), an evidence-based self-regulation strategy that uses self-monitored glucose levels to guide meal timing, has potential to enhance weight losses and cancer-related biomarkers, if proven feasible. This two-arm randomized controlled trial examined the feasibility of adding HT to the DPP and explored effects on weight and metabolic and breast cancer risk biomarkers. Fifty postmenopausal women [body mass index (BMI) >27 kg/m2)] at risk of breast cancer were randomized to the DPP+HT or DPP-only arm. Both arms followed a 16-week version of the DPP delivered weekly by a trained registered dietitian. Those in the DPP+HT also wore a continuous glucose monitor during weeks 4–6 of the program. Feasibility criteria were accrual rates >50%, retention rates >80%, and adherence to the HT protocol >75%. All a priori feasibility criteria were achieved. The accrual rate was 67%, retention rate was 81%, and adherence to HT was 90%. Weight losses and BMI reductions were significant over time as were changes in metabolic and breast cancer risk biomarkers but did not vary by group. This trial demonstrated that HT was feasible to add to comprehensive weight management program targeted toward postmenopausal women at high risk of breast cancer, though upon preliminary examination it does not appear to enhance weight loss or metabolic changes. Prevention Relevance: This study found that it was feasible to add a short glucose-guided eating intervention to a comprehensive weight management program targeting postmenopausal women at high risk of breast cancer. However, further development of this novel intervention as a cancer prevention strategy is needed.

Diet has direct and indirect effects on health through inflammation and the gut microbiome. We investigated total dietary inflammatory potential via the literature-derived index (Dietary Inflammatory Index (DII®)) with gut microbiota diversity, composition and function. In cancer-free patient volunteers initially approached at colonoscopy and healthy volunteers recruited from the medical centre community, we assessed 16S ribosomal DNA in all subjects who provided dietary assessments and stool samples (n 101) and the gut metagenome in a subset of patients with residual fasting blood samples (n 34). Associations of energy-adjusted DII scores with microbial diversity and composition were examined using linear regression, permutational multivariate ANOVA and linear discriminant analysis. Spearman correlation was used to evaluate associations of species and pathways with DII and circulating inflammatory markers. Across DII levels, α- and β-diversity did not significantly differ; however, Ruminococcus torques, Eubacterium nodatum, Acidaminococcus intestini and Clostridium leptum were more abundant in the most pro-inflammatory diet group, while Akkermansia muciniphila was enriched in the most anti-inflammatory diet group. With adjustment for age and BMI, R. torques, E. nodatum and A. intestini remained significantly associated with a more pro-inflammatory diet. In the metagenomic and fasting blood subset, A. intestini was correlated with circulating plasminogen activator inhibitor-1, a pro-inflammatory marker (rho = 0·40), but no associations remained significant upon correction for multiple testing. An index reflecting overall inflammatory potential of the diet was associated with specific microbes, but not overall diversity of the gut microbiome in our study. Findings from this preliminary study warrant further research in larger samples and prospective cohorts.

Introduction Women with pathogenic germline gene variants in BRCA1 and/or BRCA2 are at increased risk of developing ovarian and breast cancer. While surgical and pharmacological approaches are effective for risk-reduction, it is unknown whether lifestyle approaches such as healthful dietary habits, weight management, and physical activity may also contribute to risk-reduction. We conducted a systematic review of evidence related to dietary habits, weight status/change, and physical activity on ovarian and breast cancer risk among women with BRCA1/2 pathogenic variants. Methods We searched Medline, EMBASE, CENTRAL, PubMed, and clinicaltrials.gov up to October 3, 2019. We identified 2775 records and included 21. Results There is limited evidence related to these factors and ovarian cancer risk. For breast cancer risk, evidence suggests higher diet quality, adulthood weight-loss of ≥10 pounds, and activity during adolescence and young-adulthood may be linked with decreased risk. Higher meat intake and higher daily energy intake may be linked with increased risk. Conclusions There is not enough evidence to suggest tailored recommendations for dietary habits or weight management among women with BRCA1/2 pathogenic variants compared to the general population for ovarian and breast cancer risk-reduction, and physical activity recommendations should remain the same.

To examine the associations between high-fat/high-sugar foods (HFHS) and fruit and vegetable (FV) consumption and affective states in women.The researchers used electronic ecological momentary assessment to capture HFHS and FV consumption in the past 2 hours (predictor) and current affective states (outcome) across 1 week among 202 women. Multilevel linear regression was conducted. Weight status was tested as a moderator.Consumption of FV in the past 2 hours was positively associated with feeling happy (P .05). Women who consumed more HFHS or fewer FV than others in the study reported higher average sadness (both P .05). Overweight or obese women who reported more frequent HFHS consumption than others had higher average stress than normal weight women (P .05).The association between HFHS consumption and stress might be stronger in overweight or obese than normal weight women. Future studies could further enhance the electronic ecological momentary assessment method to explore other time-varying moderators and mediators of food consumption and affect.

Postmenopausal breast cancer is the most common obesity-related cancer death among women in the U.S. Insulin resistance, which worsens in the setting of obesity, is associated with higher breast cancer incidence and mortality. Maladaptive eating patterns driving insulin resistance represent a key modifiable risk factor for breast cancer. Emerging evidence suggests that time-restricted feeding paradigms (TRF) improve cancer-related metabolic risk factors; however, more flexible approaches could be more feasible and effective. In this exploratory, secondary analysis, we identified participants following a low-glucose eating pattern (LGEP), defined as consuming energy when glucose levels are at or below average fasting levels, as an alternative to TRF. Results show that following an LGEP regimen for at least 40% of reported eating events improves insulin resistance (HOMA-IR) and other cancer-related serum biomarkers. The magnitude of serum biomarkers changes observed here has previously been shown to favorably modulate benign breast tissue in women with overweight and obesity who are at risk for postmenopausal breast cancer. By comparison, the observed effects of LGEP were similar to results from previously published TRF studies in similar populations. These preliminary findings support further testing of LGEP as an alternative to TRF and a postmenopausal breast cancer prevention strategy. However, results should be interpreted with caution, given the exploratory nature of analyses.

Neurobiological models of addiction posit that drug use can alter reward processes in two ways: (1) by increasing the motivational relevance of drugs and drug-related cues and (2) by reducing the motivational relevance of non-drug-related rewards. Here, we discuss the results from a series of neuroimaging studies in which we assessed the extent to which these hypotheses apply to nicotine dependence. In these studies, we recorded smokers’ and nonsmokers’ brain responses to a wide array of motivationally relevant visual stimuli that included pleasant, unpleasant, cigarette-related, and neutral images. Based on these findings, we highlight the flaws of the traditional cue reactivity paradigm and we conclude that responses to non-drug-related motivationally relevant stimuli should be used to appropriately gauge the motivational relevance of cigarette-related cues and to identify smokers attributing higher motivational relevance to drug-related cues than to non-drug-related rewards. Identifying these individuals is clinically relevant as they achieve lower rates of long-term smoking abstinence when attempting to quit. Finally, we show how this approach may be extended beyond nicotine dependence to inform theoretical and clinical research in the study of obesity. Implications The cue reactivity paradigm (ie, comparing responses evoked by drug-related cues to those evoked by neutral cues) cannot provide conclusive information about the motivational relevance of drug-related cues. Responses to non-drug-related motivationally relevant stimuli should be used to appropriately gauge the level of motivational relevance that substance-dependent individuals attribute to drug-related cues.

Recent advancements in continuous glucose monitoring (CGM) represent a novel and untapped resource to optimize behavior change interventions for the prevention and treatment of type 2 diabetes and obesity. In this chapter, we provide a brief history about CGM and evidence supporting its use, including nontraditional indications (people with type 2 diabetes and nondiabetic populations). We then discuss current applications for CGM as a tool for dietary modification, physical activity behavior change, and weight control as well as insights on the theoretical basis for using CGM as biological feedback to motivate lifestyle behavior change. The chapter concludes with a discussion on the future opportunities for CGM as a wearable lifestyle behavior change tool for the treatment of obesity and diabetes.

Introduction Women with pathogenic germline gene variants in BRCA1 and/or BRCA2 are at increased risk of developing ovarian and breast cancer. While surgical and pharmacological approaches are effective for risk-reduction, it is unknown whether lifestyle approaches such as healthful dietary habits, weight management, and physical activity may also contribute to risk-reduction. We conducted a systematic review of evidence related to dietary habits, weight status/change, and physical activity on ovarian and breast cancer risk among women with BRCA1/2 pathogenic variants. Methods We searched Medline, EMBASE, CENTRAL, PubMed, and clinicaltrials.gov up to October 3, 2019. We identified 2775 records and included 21. Results There is limited evidence related to these factors and ovarian cancer risk. For breast cancer risk, evidence suggests higher diet quality, adulthood weight-loss of ≥10 pounds, and activity during adolescence and young-adulthood may be linked with decreased risk. Higher meat intake and higher daily energy intake may be linked with increased risk. Conclusions There is not enough evidence to suggest tailored recommendations for dietary habits or weight management among women with BRCA1/2 pathogenic variants compared to the general population for ovarian and breast cancer risk-reduction, and physical activity recommendations should remain the same.

Our ability to understand and intervene on eating in the absence of hunger (EAH) as it occurs in peoples' natural environments is hindered by biased methods that lack ecological validity. One promising indicator of EAH that does not rely on self-report and is easily assessed in free-living individuals is glucose. Here, we hypothesize that elevated pre-prandial blood glucose concentrations (PPBG), which reflect a source of readily-available, short-term energy, are a biological indicator of EAH. This was a 7-day observational study of N = 41, 18-24 year old men and women with BMI

Researchers have proposed a variety of behavioral traits that may lead to weight gain and obesity; however, little is known about the neurocognitive mechanisms underlying these weight-related eating behaviors. In this study, we measured activation of reward circuitry during a task requiring response and inhibition to food stimuli. We assessed participants’ emotional eating, external eating, and two subscales of dietary restraint—routine restraint and compensatory restraint—using the Weight-Related Eating Questionnaire. For routine restraint, we found positive associations with activation in the insula, dorsolateral prefrontal cortex, anterior cingulate cortex, orbitofrontal cortex and ventromedial prefrontal cortex in response to high-calorie versus low-calorie foods. For emotional eating, we found positive associations with insula and dorsolateral prefrontal cortex activation in response to high-calorie versus low-calorie foods. We also found positive associations between emotional eating and dorsolateral prefrontal cortex activation in response to approach versus inhibition towards high-calorie foods. Thus, our results demonstrate an increase in activation across brain regions related to self-control and urges in response to high-calorie food associated with both emotional eating and routine restraint. Overall, these results support the construct validity of both emotional eating and routine restraint and provide preliminary evidence that these subscales have similar neural correlates.

The purpose of the current study was to examine affective response to sweet foods and drinks as a function of children's internalizing symptoms using ecological momentary assessment (EMA). A sample of 192 8-12-year-old children completed a self-report measure of internalizing symptoms and EMA prompts of affect and food intake for eight days, excluding time at school. There was an interaction between sweet food intake and internalizing symptoms for positive affect and for sweet drink intake and internalizing symptoms for negative affect. Those low in internalizing symptoms had significantly lower positive affect after consumption of sweet foods compared to when they did not consume sweet foods whereas those higher in internalizing symptoms had slightly, but not significantly, higher positive affect after consumption of sweet foods. Those low in internalizing symptoms had significantly higher negtive affect after consumption of sweet drinks compared to when they did not consume sweet drinks whereas those higher in internalizing symptoms had slightly, but not significantly, lower negative affect after consumption of sweet drinks. Findings highlight the ways in which internalizing symptoms may modulate affective response to sweet foods and drinks.

Introduction: Regular physical activity (PA) lowers the risk of endometrial, breast, and colorectal cancer. However, nearly half of American adults are not sufficiently active. The physical inactivity rate is even higher among the overweight and obese population, which, in combination with the unfavorable effect of excess body weight, puts this population at a greater risk for cancer. Advancements in wearable sensor technology provide opportunities for personalized approaches to increase motivation to be active. The current pilot study used continuous glucose monitors (CGM) to demonstrate the immediate, physiologic benefits of PA. Methods: Insufficiently active (= 25 kg/m2) adults (18-65 years old) without diabetes are being recruited to participate in this pilot intervention. Upon enrollment, participants go through a one-on-one PA education session that includes a discussion about the health benefits of recommended PA levels, demonstration of the acute effect of PA on daily glucose patterns using a web-based glucose simulator, calculation of personal heart rate zones for moderate intensity PA, and development of an exercise plan. After the education session, participants are given a Fitbit Alta HR wristband and are instructed to wear it over the next 10 days. Participants are also given a Freestyle Libre CGM, which consists of a sensor and a reader. The sensor is inserted into the back of the upper arm to collect interstitial glucose data every 15 minutes for 10 days after activation. The reader displays current glucose readings and a graph of the 8 previous hours of glucose data upon scanning the sensor. Participants are instructed to scan the sensor at least 4 times a day and are encouraged to achieve at least 150 minutes of moderate-intensity PA each week. At the end of the self-monitoring period, participants return their Fitbit and have their CGM sensor removed. Results: Thus far, 10 of 20 participants have enrolled in and completed the study. These participants have been 100% female, 70% obese, and 20% Hispanic with a mean age of 41.5 (SD = 8.6) years old. On average, participants scanned their sensor 6 times each day and wore the Fitbit for all 10 days. On average, participants highly rated each component of the education session (on a 5-point scale) for improving their PA knowledge (mean = 4.4), increasing their PA motivation (mean = 4.4), and providing personally relevant information (mean = 4.6). Participants also reported a very positive experience wearing the CGM, with mean ratings (on a 5-point scale) of 4.8 for usability, 4.6 for convenience, 4.9 for value, 4.9 for relevance, and 4.7 for motivating. Conclusion: These preliminary data suggest that using a CGM to motivate PA among nondiabetic adults is feasible and acceptable. Future research will be conducted to examine the effect a CGM-based PA intervention has on changing PA behavior. Citation Format: Yue Liao, Christopher J. Miller, Diana L. Urbauer, Therese B. Bevers, Ernest Hawk, Karen M. Basen-Engquist, Susan M. Schembre. An innovative physical activity intervention in overweight and obese adults using continuous glucose monitor [abstract]. In: Proceedings of the AACR Special Conference on Modernizing Population Sciences in the Digital Age; 2019 Feb 19-22; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(9 Suppl):Abstract nr A17.

Background Few studies have examined the role of maternal stress in relation to their children’s dietary quality and its trajectory over time. Purpose The objective of this longitudinal study was to examine the effect of baseline maternal stress on the change in their 8- to 12-year-old children’s dietary quality over 1 year. Methods Mother–child dyads (N = 189) from the greater Los Angeles area participating in the Mothers’ and their Children’s Health (MATCH) study in 2014–2016 completed assessments at baseline, 6 months, and 12 months. At baseline, mothers (mean age = 41.0 years, standard deviation [SD] = 6.1) completed the 10-item Cohen’s Perceived Stress Scale (PSS). At each time point, children (51% female, mean age = 9.6 years, SD = 0.9) completed up to two 24-hr dietary recalls. Dietary data were used to calculate each child’s Healthy Eating Index 2010 (HEI-2010) score at each time point. Multilevel models examined the effect of time on the patterns of change in children’s HEI-2010 scores over 1 year and the cross-level interaction between baseline maternal PSS score and time on the change in children’s HEI-2010 scores. Results On average, there was no significant linear change in child HEI-2010 across 1 year (b = −0.410, p = .586). Controlling for covariates, the rate of change in HEI-2010 differed depending on mother’s baseline PSS (i.e., significant cross-level interaction effect) (b = −0.235, p = .035). Conclusions Our results showed that higher-than-average maternal stress at baseline was associated with greater decline in children’s dietary quality over 1 year. Family-based dietary interventions that incorporate maternal stress reduction could have positive effects on children’s dietary quality.

While some individuals can defy the lure of temptation, many others find appetizing food irresistible. The goal of this study was to investigate the neuropsychological mechanisms that increase individuals' vulnerability to cue‐induced eating. Using ERPs, a direct measure of brain activity, we showed that individuals with larger late positive potentials in response to food‐related cues than to erotic images are more susceptible to cue‐induced eating and, in the presence of a palatable food option, eat more than twice as much as individuals with the opposite brain reactivity profile. By highlighting the presence of individual brain reactivity profiles associated with susceptibility to cue‐induced eating, these findings contribute to the understanding of the neurobiological basis of vulnerability to obesity., Our findings contribute to the understanding of the biological bases underlying individual differences in vulnerability to cue‐induced eating, and they represent a step toward identifying new targets for personalized weight control interventions.

BackgroundNew methods for assessing diet in research are being developed to address the limitations of traditional dietary assessment methods. Mobile device–assisted ecological momentary diet assessment (mEMDA) is a new dietary assessment method that has not yet been optimized and has the potential to minimize recall biases and participant burden while maximizing ecological validity. There have been limited efforts to characterize the use of mEMDA in behavioral research settings. ObjectiveThe aims of this study were to summarize mEMDA protocols used in research to date, to characterize key aspects of these assessment approaches, and to discuss the advantages and disadvantages of mEMDA compared with the traditional dietary assessment methods as well as implications for future mEMDA research. MethodsStudies that used mobile devices and described mEMDA protocols to assess dietary intake were included. Data were extracted according to Preferred Reporting of Systematic Reviews and Meta-Analyses and Cochrane guidelines and then synthesized narratively. ResultsThe review included 20 studies with unique mEMDA protocols. Of these, 50% (10/20) used participant-initiated reports of intake at eating events (event-contingent mEMDA), and 50% (10/20) used researcher-initiated prompts requesting that participants report recent dietary intake (signal-contingent mEMDA). A majority of the study protocols (60%, 12/20) enabled participants to use mobile phones to report dietary data. Event-contingent mEMDA protocols most commonly assessed diet in real time, used dietary records for data collection (60%, 6/10), and provided estimates of energy and nutrient intake (60%, 6/10). All signal-contingent mEMDA protocols used a near real-time recall approach with unannounced (ie, random) abbreviated diet surveys. Most signal-contingent protocols (70%, 7/10) assessed the frequency with which (targeted) foods or food groups were consumed. Relatively few (30%, 6/20) studies compared mEMDA with the traditional dietary assessment methods. ConclusionsThis review demonstrates that mEMDA has the potential to reduce participant burden and recall bias, thus advancing the field beyond current dietary assessment methods while maximizing ecological validity.

BACKGROUND New methods for assessing diet in research are being developed to address the limitations of traditional dietary assessment methods. Mobile device–assisted ecological momentary diet assessment (mEMDA) is a new dietary assessment method that has not yet been optimized and has the potential to minimize recall biases and participant burden while maximizing ecological validity. There have been limited efforts to characterize the use of mEMDA in behavioral research settings. OBJECTIVE The aims of this study were to summarize mEMDA protocols used in research to date, to characterize key aspects of these assessment approaches, and to discuss the advantages and disadvantages of mEMDA compared with the traditional dietary assessment methods as well as implications for future mEMDA research. METHODS Studies that used mobile devices and described mEMDA protocols to assess dietary intake were included. Data were extracted according to Preferred Reporting of Systematic Reviews and Meta-Analyses and Cochrane guidelines and then synthesized narratively. RESULTS The review included 20 studies with unique mEMDA protocols. Of these, 50% (10/20) used participant-initiated reports of intake at eating events (event-contingent mEMDA), and 50% (10/20) used researcher-initiated prompts requesting that participants report recent dietary intake (signal-contingent mEMDA). A majority of the study protocols (60%, 12/20) enabled participants to use mobile phones to report dietary data. Event-contingent mEMDA protocols most commonly assessed diet in real time, used dietary records for data collection (60%, 6/10), and provided estimates of energy and nutrient intake (60%, 6/10). All signal-contingent mEMDA protocols used a near real-time recall approach with unannounced (ie, random) abbreviated diet surveys. Most signal-contingent protocols (70%, 7/10) assessed the frequency with which (targeted) foods or food groups were consumed. Relatively few (30%, 6/20) studies compared mEMDA with the traditional dietary assessment methods. CONCLUSIONS This review demonstrates that mEMDA has the potential to reduce participant burden and recall bias, thus advancing the field beyond current dietary assessment methods while maximizing ecological validity.

BackgroundWearable sensors have been increasingly used in behavioral research for real-time assessment and intervention purposes. The rapid advancement of biomedical technology typically used in clinical settings has made wearable sensors more accessible to a wider population. Yet the acceptability of this technology for nonclinical purposes has not been examined. ObjectiveThe aim was to assess the acceptability of wearing a continuous glucose monitor (CGM) device among a sample of nondiabetic individuals, and to compare the acceptability of a CGM between a mobile diet tracking app (MyFitnessPal) and an accelerometer. MethodsA total of 30 nondiabetic adults went through a 7-day observational study. They wore a CGM sensor, tracked their diet and physical activity using the CGM receiver and MyFitnessPal, and wore an accelerometer on their waist. After the monitoring period, they completed a 10-item survey regarding acceptability of each of the study tools. Two-tailed paired-sample t tests were conducted to examine whether the summary acceptability scores were comparable between the CGM sensor/receiver and MyFitnessPal/accelerometer. ResultsMore than 90% of the study participants agreed that the CGM sensor and receiver were easy to use (28/30 and 27/30, respectively), useful (28/30 and 29/30, respectively), and provided relevant information that was of interest to them (27/30 and 28/30, respectively). The summary acceptability scores (out of a 5-point Likert scale) were mean 4.06 (SD 0.55) for the CGM sensor, mean 4.05 (SD 0.58) for the CGM receiver, mean 4.10 (SD 0.68) for MyFitnessPal, and mean 3.73 (SD 0.76) for the accelerometer. ConclusionsThe high acceptability of using a CGM from this study suggests a great potential for using CGMs in nondiabetic adults in research settings. Although potential selection bias might contribute to the high acceptability in this study, the continued advancements in wearable sensor technology will make the barriers to tracking and collecting personal physiological data more and more minimal.

Background: Research on the clustering of physical activity, sedentary, and dietary intake behaviors in children has relied on retrospective and parent-report measures, which may obscure true associations. The current study combined objectively-measured moderate-to-vigorous intensity physical activity (MVPA) and sedentary time (ST) data from waist-worn accelerometers, with multiple child-report 24-h dietary recalls to assess specific components of dietary intake (i.e., dietary fat, carbohydrates, protein; glycemic load, fruits and vegetables) in children.Methods: Participants (n = 136, ages 8–12 years) wore an accelerometer for 7 days. On two of those days, children completed 24-h recall phone interviews to assess dietary intake.Results: After adjusting for child age, sex, ethnicity, annual household income, and body mass index (BMI) percentile; ST was positively associated with percent dietary fat intake, and negatively associated with percent dietary carbohydrate intake and glycemic load (p's < 0.01). MVPA was positively associated with percent dietary carbohydrate intake and daily glycemic load, and negatively associated with percent dietary fat intake (p's < 0.05).Conclusion: Despite its direct health benefits, physical activity may be associated with consuming greater proportion of total intake from carbohydrates, especially those with a higher glycemic index. Further research is needed to understand the differential implications of these unique behavioral interrelations for diabetes, cardiovascular, and obesity risk.

Purpose. Develop and demonstrate preliminary validation of a brief questionnaire aimed at assessing social cognitive determinants of physical activity (PA) in a college population. Design. Quantitative and observational. Setting. A midsized northeastern university. Subjects. Convenience sample of 827 male and female college students age 18 to 24 years. Measures. International Physical Activity Questionnaire and a PA stage-of-change algorithm. Analysis. A sequential process of survey development, including item generation and data reduction analyses by factor analysis, was followed with the goal of creating a parsimonious questionnaire. Structural equation modeling was used for confirmatory factor analysis and construct validation was confirmed against self-reported PA and stage of change. Validation analyses were replicated in a second, independent sample of 1032 college students. Results. Fifteen items reflecting PA self-regulation, outcome expectations, and personal barriers explained 65% of the questionnaire data and explained 28.6% and 39.5% of the variance in total PA and moderate-to-vigorous–intensity PA, respectively. Scale scores were distinguishable across the stages of change. Findings were similar when the Cognitive Behavioral Physical Activity Questionnaire (CBPAQ) was tested in a similar and independent sample of college students (40%; R2 moderate-to-vigorous–intensity PA = .40; p < .001). Conclusion. The CBPAQ successfully explains and predicts PA behavior in a college population, warranting its incorporation into future studies aiming at understanding and improving on PA behavior in college students.

Background: Little is known about the relationship between dietary intake and affective and physical feeling states in children. Purpose: The current study used Ecological Momentary Assessment (EMA) to examine how usual dietary intake is cross-sectionally associated with both average affective and physical feeling state ratings and rating variability in children. Methods: Children (N = 110, mean age = 11.0 ± 1.2 years, 52.5% male, 30.1% Hispanic/Latino) completed EMA measures of affective and physical feeling states 3–7 times per day for a full or partial day (weekday evenings and weekend days and evenings) over a 4-day period. Usual intake of pre-selected dietary components was measured prior to the EMA measurement period using the Block Kids Food Screener. Statistical analyses included mixed models and mixed-effects location scale models. Results: Greater usual fiber intake was cross-sectionally associated with higher average positive affect (PA) ratings, lower variability of NA ratings, and higher variability of physical fatigue ratings. Lower usual glycemic load of diet was cross-sectionally associated with lower variability of NA ratings. Lower usual added sugar intake was cross-sectionally associated with higher average physical energy ratings and lower variability of NA ratings. Conclusions: Although temporal precedence was not established by these findings, they indicate that characteristics of children's usual dietary intake are cross-sectionally associated with both the average and variability of affective and physical feeling states. EMA offers a promising avenue through which to explore the associations between affective states and diet and has the potential to provide insight into nuances of this relationship.

ObjectiveTo provide preliminary evidence in support of using ecological momentary assessment (EMA), a real-time data capture method involving repeated assessments, to measure dietary intake in children by examining the concordance of children’s dietary reports through EMA and 24 h recall.DesignChildren completed eight days of EMA surveys, reporting on recent dietary intake of four pre-specified food categories (‘Fruits or Vegetables’, ‘Chips or Fries’, ‘Pastries or Sweets’, ‘Soda or Energy Drinks’), and completed two 24 h recalls during the same period. Concordance of children’s reports of intake during matched two-hour time windows from EMA and 24 h dietary recall was assessed using cross-tabulation. Multilevel logistic regression examined potential person-level (i.e. sex, age, ethnicity and BMI category) predictors of concordance.SettingChildren in Los Angeles County, USA, enrolled in the Mothers’ and Their Children’s Health (MATCH) study.SubjectsOne hundred and forty-four 144 children (53 % female; mean age 9·6 (sd0·9) years; 34·0 % overweight/obese).ResultsTwo-hour concordance varied by food category, ranging from 64·9 % for ‘Fruits/Vegetables’ to 89·9 % for ‘Soda/Energy Drinks’. In multilevel models, overweight/obese (v. lean) was associated with greater odds (OR; 95 % CI) of concordant reporting for ‘Soda/Energy Drinks’ (2·01; 1·06, 4·04) and ‘Pastries/Sweets’ (1·61; 1·03, 2·52). Odds of concordant reporting were higher for Hispanic (v. non-Hispanic) children for ‘Pastries/Sweets’ (1·55; 1·02, 2·36) and for girls (v. boys) for ‘Fruits/Vegetables’ (1·36; 1·01, 1·83).ConclusionsConcordance differed by food category as well as by person-level characteristics. Future research should continue to explore use of EMA to facilitate dietary assessment in children.

Graphical abstract Representative diagram of the experimental setup. The laboratory control computer (A) triggers the dispensing device (B) to dispense either a food (candy) or non-food control item in the delivery receptacle (C). The participant may either eat the candy, or deposit the candy or non-food control item in the appropriate deposit box (D). The display of the master laboratory computer (A) is mirrored in the participant laboratory room (E), and displays pictorial stimuli predicting either the food reward or non-food control item. During the experiment, the electroencephalogram (EEG) is being recorded and is displayed on a computer (F) in the laboratory control room. The master computer (A) sends triggers to the EEG computer (F) to allow subsequent time-locking of events. Blue arrows represent information flow from the participant laboratory room to the laboratory control room. Black arrows represent information flow from the laboratory control room to the participant laboratory room., Neurobiological models of obesity postulate that obese individuals have difficulty regulating food intake partly because they attribute excessive salience to stimuli signaling food availability. Typically, human studies that investigate the relationship between brain responses to food-related stimuli and obesity present food cues without subsequent delivery of food. However, in order to identify the brain correlates of cue reactivity, we must record brain responses to food-related cues signaling food availability. Therefore, we have developed a dispensing apparatus for use in a cued-food delivery task in which event-related potentials (ERPs) to food-related images predicting food delivery and images not predicting food delivery can be recorded. Here, we describe a method where:•The experimental apparatus dispenses an edible item (i.e., a chocolate candy) which may or may not be eaten, or a non-edible control item (e.g., a plastic bead).•Deposit boxes are available to store uneaten candies and the non-edible control items.•The dispensing mechanism is capable of recording the exact timestamp when each delivery event occurs (e.g., release from the dispenser, arrival in the receptacle, storage in the deposit box).

While some individuals can defy the lure of temptation, many others find appetizing food irresistible. The goal of this study was to investigate the neuropsychological mechanisms that increase individuals' vulnerability to cue-induced eating. Using ERPs, a direct measure of brain activity, we showed that individuals with larger late positive potentials in response to food-related cues than to erotic images are more susceptible to cue-induced eating and, in the presence of a palatable food option, eat more than twice as much as individuals with the opposite brain reactivity profile. By highlighting the presence of individual brain reactivity profiles associated with susceptibility to cue-induced eating, these findings contribute to the understanding of the neurobiological basis of vulnerability to obesity.

BACKGROUND The integration of body-worn sensors with mobile devices presents a tremendous opportunity to improve just-in-time behavioral interventions by enhancing bidirectional communication between investigators and their participants. This approach can be used to deliver supportive feedback at critical moments to optimize the attainment of health behavior goals. OBJECTIVE The goals of this systematic review were to summarize data on the content characteristics of feedback messaging used in diet and physical activity (PA) interventions and to develop a practical framework for designing just-in-time feedback for behavioral interventions. METHODS Interventions that included just-in-time feedback on PA, sedentary behavior, or dietary intake were eligible for inclusion. Feedback content and efficacy data were synthesized descriptively. RESULTS The review included 31 studies (15/31, 48%, targeting PA or sedentary behavior only; 13/31, 42%, targeting diet and PA; and 3/31, 10%, targeting diet only). All studies used just-in-time feedback, 30 (97%, 30/31) used personalized feedback, and 24 (78%, 24/31) used goal-oriented feedback, but only 5 (16%, 5/31) used actionable feedback. Of the 9 studies that tested the efficacy of providing feedback to promote behavior change, 4 reported significant improvements in health behavior. In 3 of these 4 studies, feedback was continuously available, goal-oriented, or actionable. CONCLUSIONS Feedback that was continuously available, personalized, and actionable relative to a known behavioral objective was prominent in intervention studies with significant behavior change outcomes. Future research should determine whether all or some of these characteristics are needed to optimize the effect of feedback in just-in-time interventions.

Purpose: Diet modulates gut microbiome composition and systemic inflammation—both intermediary factors in the development of colorectal neoplasia. We investigated the association of total dietary inflammatory potential, as assessed by the literature-derived dietary inflammatory index (DII®), with gut microbiota diversity and composition, microbial gene pathways, and circulating markers. Methods: This epidemiological study was comprised of 36 cancer-free colonoscopy patients (79% positive for precancerous polyps) and 65 healthy volunteers from the medical center community (N=101). Participants completed dietary assessments and provided stool samples for 16S rDNA sequencing >1 month after colonoscopy/polyp removal or antibiotic use. In a subset (n=47), we conducted whole genome shotgun (WGS) sequencing and collected a fasting blood sample. Energy-adjusted (E)-DII score was calculated for each subject and categorized into tertiles. The association between E-DII and fecal microbiota alpha- and beta-diversity was examined. Linear discriminant analysis Effect Size (LEfSe) was used to identify differentially abundant taxa by E-DII level. Multiple linear regression models were used to examine associations controlled for confounders. Results from the least absolute shrinkage and selection operator (LASSO) method and Spearman’s correlation were used to select and evaluate associations of bacterial species with E-DII, their functional pathways, and circulating markers. Results: We observed large between-person variation in Bacteroidaceae and Enterobacteriaceae, two dominant bacteria in the overall sample. Neither alpha- nor beta-diversity significantly differed across E-DII levels. Ruminococcus torques, Acidaminococcus intestine, and Clostridium leptum were most abundant in the most pro-inflammatory diet group, while Akkermansia muciniphila was enriched among subjects with the most anti-inflammatory diet. In the WGS subset, Luteimonas mephitis was inversely associated with E-DII, circulating Lipocalin-2 (r=-0.34; P=0.02), and plasminogen activator inhibitor-1 (r=-0.29; P=0.05). Akkermansia muciniphilaappeared to be inversely correlated with monocyte chemoattractant protein-1 (r=-0.26; P=0.09). Two microbial pathways inversely associated with E-DII, AMP-activated protein kinase (AMPK) and carbon metabolism, were also inversely correlated with C-peptide (AMPK: r=-0.35, P= 0.02; carbon: r=-0.30, P=0.04). Conclusions: Dietary inflammatory potential was associated with differential composition of specific microbes, but not overall diversity of the gut microbiome. Species associated with E-DII were similarly associated with circulating inflammatory biomarkers. Microbial AMPK signaling and carbon metabolism pathways may underlie diet-microbiota interactions that modulate systemic inflammation. Citation Format: Jiali Zheng, Kristi L. Hoffman, Nitin Shivappa, Jonathan Busquets, Jiun-Sheng Chen, Samir Hanash, Susan Schembre, James Hébert, Joseph Petrosino, Peng Wei, Carrie R. Daniel. Dietary inflammatory potential in relation to the gut microbiome among persons at varied risk of colorectal neoplasia [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 3320.

Background: Eating breakfast is believed to promote a healthy body weight. Yet, few studies have examined the contribution of energy balance–related behavioral factors to this relation in minority youth. Objective: We assessed the associations between breakfast consumption and dietary intake, physical activity (PA), and adiposity before and after accounting for energy intake and PA in minority girls. Design: Cross-sectional data were obtained on body mass index (BMI), percentage body fat (measured by BodPod), dietary intake (measured with 3-d dietary records), and PA (measured with 7-d accelerometry) from 87 Latina and African American girls 8–17 y of age (75% Latina, 80% overweight). Dietary records were used to categorize girls as more frequent breakfast eaters (MF; 2 or 3 of 3 d; n = 57) or less frequent breakfast eaters (LF; 0 or 1 of 3 d; n = 30). Chi-square tests, ANCOVA, and multiple regression analyses were conducted. Mediation was assessed with a Sobel test. Results: Compared with the MF group, the LF group spent 30% less time (12.6 min/d) in moderate-to-vigorous-intensity PA (MVPA; P = 0.004) and had a higher percentage body fat (P = 0.029). MVPA accounted for 25% (95% CI: −8.8%, 58.1%; P = 0.139) of the relation between breakfast consumption and percentage body fat. We were unable to show that energy intake or MVPA was a significant mediator of the relation between breakfast consumption and adiposity in this sample. Conclusions: Evidence suggests that among predominantly overweight minority girls, MVPA, but not energy intake, was associated with both breakfast consumption and adiposity; however, a lack of power reduced our ability to detect a significant mediation effect. Other unobserved variables likely contribute to this relation.

Purpose. To determine whether Transtheoretical Model (TTM) constructs differ between individuals making successful versus unsuccessful stage transitions for consumption of five or more servings of fruit and vegetables each day and thus provide a useful basis for designing health promotion interventions. Design. Longitudinal, observational study. A randomly selected, multiethnic cohort of adults assessed at 6-month intervals over 2 years. Setting. General community, Hawaii. Subjects. There were 700 participants (62.6% female; mean = 47 ± 17.1 years; 31.1% Asian, 22.1% Native Hawaiian/Pacific Islander, 35.0% Caucasian; 25.1% participation rate). Measures. Stage of readiness, experiential and behavioral processes of change, pros, cons, self-efficacy, and self-reported fruit and vegetable consumption. Analysis. The study used t-tests to determine which TTM variable scores differed consistently between those making “successful” versus “unsuccessful” stage transitions from precontemplation, preparation, and maintenance. Sample sizes for contemplation and action prohibited similar analyses. Results. Compared to those remaining in precontemplation, individuals successfully progressing from precontemplation showed significantly greater use of behavioral processes (collectively and self-liberation) and consciousness raising (p < .001). However, only self-liberation demonstrated significant differences consistently over time. Conclusion. This longitudinal investigation reveals that TTM behavioral processes, particularly self-liberation, predict successful transition out of precontemplation for adult fruit and vegetable consumption, suggesting that public health messages tailored according to these TTM variables may be effective for this group. However, for adults prepared to adopt or maintain fruit and vegetable consumption, tailoring based on variables from other theories is needed.

The purpose of this study was to test the associations between cognitive and psychological eating behavior traits and detailed measures of adiposity and body fat distribution using imaging-based methods in a cross-sectional study. Eating behavior traits (compensatory and routine restraint, external eating, and emotional eating) were assessed using the validated Weight-Related Eating Questionnaire, and measures of adiposity using anthropometry, dual energy X-ray absorptiometry (DXA), and magnetic resonance imaging (MRI). Each adiposity outcome of interest (total fat, ratio of trunk fat to periphery fat, visceral and subcutaneous fats as % of abdominal area, and % liver fat) was regressed on the four eating behaviors while adjusting for age and race/ethnicity. This study included a total of 60 postmenopausal Japanese American (n = 30) and white (n = 30) women (age: 60–65 years, BMI: 18.8–39.6 kg/m 2 ). Weight-related eating behavior traits did not differ by ethnicity. Higher external eating scores were associated with measures of total adiposity, including higher BMI (β = 0.36, p = 0.02) and DXA total fat mass (β = 0.41, p = 0.001), and with MRI abdominal subcutaneous fat (β = 0.55, p = 0.001). Higher routine restraint scores were associated with visceral adiposity (β = 0.42, p = 0.04). Our findings suggest that different weight-related eating behavior traits might increase not only total adiposity but also abdominal and visceral fat deposition associated with higher metabolic risks. Future research, preferably in a prospective study of men and women and including biomarkers related to psychological stress, will be needed to explore potential underlying biological mechanisms.

To improve our understanding of excess body weight and risk for diabetes type 2, the study examined the influence of weight change in the Hawaii component, including 78,006 Caucasians, Japanese Americans and Native Hawaiians, of the Multiethnic Cohort Study.Participants aged 58.5±9.2 years completed a questionnaire at cohort entry (Qx1), including weight at age 21, and a follow-up questionnaire 5 years later (Qx2). After 14 years of follow-up, 8892 incident diabetes cases were identified through self-reports or linkups with the major health plans in Hawaii. Cox regression analysis was applied, stratified by age and adjusted for confounders, to estimate hazard ratios (HRs).The mean weight gain from age 21 to Qx1 was 10.5±11.0 kg and, between Qx1 and Qx2, 0.8±5.6 kg. Diabetes risk showed a significant dose-response relationship with weight gain from age 21 (P0.0001). The respective HRs for a weight gain of 5-10 kg and greater or equal to 25 kg were 1.8 (95% CI: 1.7-2.0) and 7.7 (95% CI: 7.1-8.4), while weight loss of greater than 5 kg significantly reduced diabetes risk (HR=0.7; 95% CI: 0.6-0.9). The interaction term of weight change since age 21 with ethnicity was also highly significant (P0.0001). Compared with stable-weight Caucasians, the adverse effects of weight gain were more pronounced in those of Japanese and Native Hawaiian descent. Weight change between Qx1 and Qx2 conferred a smaller risk.These findings support the current public-health recommendations for weight control and particularly among ethnic groups at high risk for diabetes.

Weight gain and an increase in overweight and obesity in college students raise serious health concerns. Weight management interventions for college-age men and women might be more effective if they were tailored to subgroups of students with similar behavioral and psychosocial characteristics associated with body weight status. The purpose of this study was to use cluster analysis to identify homogenous subgroups of college-aged men and women enrolled in a weight gain prevention study (Project WebHealth) using baseline data collected in 2008. Project WebHealth was a 15-month nutrition and physical activity intervention designed to decrease the rate of unwanted weight gain in 1,689 college students at eight geographically diverse universities in the United States. Outcome measures included anthropometrics, fruit and vegetable intake, physical activity, cardiorespiratory fitness, and psychosocial variables associated with weight status in college students. Cluster analysis was performed separately by sex using a two-step clustering procedure using weight-related eating and exercise behaviors and psychosocial variables. Cluster groupings were validated against students' measured weight status and waist circumference as indicators of health risk. The study design was cross-sectional. Results showed that three similar clusters were identified for each sex. Validity of the cluster solution was supported by significant group differences in body mass index and waist circumference with the High Risk cluster at elevated health risk compared to the others. For men, variability in eating competence and cognitive restraint scores contributed most to the difference between clusters, whereas for women, emotional eating and uncontrolled eating scores did. These findings could be used to improve effectiveness of messages and interventions by tailoring them to subgroups of college students with similar behavioral and psychosocial characteristics associated with elevated health risk.