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Many higher-weight individuals have internalised societal weight stigma, devaluing themselves because of their weight. Rejecting and challenging societal devaluation is generally associated with superior outcomes compared with stigma internalisation or inaction; however, stigma resistance has not been studied in higher-weight individuals, despite ubiquitous weight stigma in daily life. Applying a social identity framework, we utilised decision tree analysis to explore predictors of responses to weight stigma in 931 self-classified higher-weight individuals. While ingroup identification with the group 'Fat' was the major predictor of stigma resistance (versus internalisation), perceived illegitimacy of societal weight stigma defined a subgroup of resisters even in the absence of group identity. Interventions focusing on the illegitimacy of unequal social status and treatment may be effective at reducing internalisation and fostering resistance in a population with characteristically low ingroup identity.

AIMS: The aim of this narrative review was to identify important knowledge gaps in behavioural science relating to type 2 diabetes prevention, to inform future research in the field. METHODS: Seven researchers who have published behaviour science research applied to type 2 diabetes prevention independently identified several important gaps in knowledge. They met to discuss these and to generate recommendations to advance research in behavioural science of type 2 diabetes prevention. RESULTS: A total of 21 overlapping recommendations for a research agenda were identified. These covered issues within the following broad categories: (a) evidencing the impact of whole population approaches to type 2 diabetes prevention, (b) understanding the utility of disease-specific approaches to type 2 diabetes prevention such as Diabetes Prevention Programmes (DPPs) compared to generic weight loss programmes, (c) identifying how best to increase reach and engagement of DPPs, whilst avoiding exacerbating inequalities, (d) the need to understand mechanism of DPPs, (e) the need to understand how to increase maintenance of changes as part of or following DPPs, (f) the need to assess the feasibility and effectiveness of alternative approaches to the typical self-regulation approaches that are most commonly used, and (g) the need to address emotional aspects of DPPs, to promote effectiveness and avoid harms. CONCLUSIONS: There is a clear role for behavioural science in informing interventions to prevent people from developing type 2 diabetes, based on strong evidence of reach, effectiveness and cost-effectiveness. This review identifies key priorities for research needed to improve existing interventions.

Social norms could be a tool in dietary transition toward more sustainable diets, but the results of social norms interventions aimed at encouraging the selection of plant-based foods to date have been inconsistent. One reason for this might be because there are important moderating factors that have yet to be investigated. Here we examine social modeling of vegetarian food choices and test whether modeling is dependent upon individual intentions to follow a vegetarian diet in the future in two different settings. In a laboratory study of 37 women, participants with low intentions to become a vegetarian consumed fewer plant-based foods in the presence of a vegetarian confederate, compared to eating alone. In an observational study of 1,037 patrons of a workplace restaurant, participants with a higher score of on vegetarian intentions had a greater likelihood of taking a vegetarian main course or starter, and a vegetarian social norm was associated with a greater likelihood of a vegetarian choice for the main course but not for the starter. These data suggest that participants with low intentions to follow a vegetarian diet may exhibit reactance against an explicit vegetarian norm in an unfamiliar context (as in Study 1) but that general norm following regardless of dietary intentions be more likely when it is conveyed implicitly in a familiar context (as in Study 2).

Estimates indicate that individuals with coeliac disease are more likely to experience disordered eating and impaired well-being than healthy controls, but less is known about the mechanisms by which these factors are related. The aim of this study was to understand experiences of coeliac disease and influence on subsequent unhelpful eating and lifestyle patterns.An online focus group discussion, hosted through a synchronous chat log, with adults living with coeliac disease was conducted. Seven individuals discussed their condition, lifestyle, and dietary changes post-diagnosis. Discussions were analysed using an interpretative phenomenological approach, a technique that enables new practical or research insight into health conditions based upon participants' experiences of their condition.Three themes were identified: (i) Nobody knew what was happening to my body; (ii) I am so afraid of being 'glutened' that it is central to my thoughts and anxieties; and (iii) I am frightened but I can keep myself safe by being a 'good' coeliac. These appeared to contribute to participant distress or unhelpful eating or lifestyle behaviours. Participants appeared to develop severe anxiety around gluten, and implausible beliefs around diet and lifestyle management that appear to initiate and maintain unhelpful eating behaviours and maladaptive lifestyles changes, that contribute to distress.Extending current knowledge, we propose a novel cognitive perspective on the development and maintenance of disordered eating in coeliac disease. Implications for how health providers can better support individuals with coeliac disease, and the role of dietary management, anxiety, and gastrointestinal symptoms in the development of disordered eating are discussed.

This paper reviews evidence demonstrating a bidirectional relationship between memory and eating in humans and rodents. In humans, amnesia is associated with impaired processing of hunger and satiety cues, disrupted memory of recent meals, and overconsumption. In healthy participants, meal-related memory limits subsequent ingestive behavior and obesity is associated with impaired memory and disturbances in the hippocampus. Evidence from rodents suggests that dorsal hippocampal neural activity contributes to the ability of meal-related memory to control future intake, that endocrine and neuropeptide systems act in the ventral hippocampus to provide cues regarding energy status and regulate learned aspects of eating, and that consumption of hypercaloric diets and obesity disrupt these processes. Collectively, this evidence indicates that diet-induced obesity may be caused and/or maintained, at least in part, by a vicious cycle wherein excess intake disrupts hippocampal functioning, which further increases intake. This perspective may advance our understanding of how the brain controls eating, the neural mechanisms that contribute to eating-related disorders, and identify how to treat diet-induced obesity.

Diets influence our mental health and social wellbeing (MHSW) in multiple ways. A rising community concept, Eco-Regions, has gained interest. The research project “Indicators for assessment of health effects of consumption of sustainable, organic school meals in Ecoregions” (INSUM) aims to develop future-oriented research approaches to measure the potential health effects of more sustainable and healthy diets. This first part of the project focuses on MHSW with the goal to identify suitable study designs and indicators. The methodology is based on a 2-day workshop with an interdisciplinary group of experts. This paper describes commonly applied research methods on the nexus between diet and MHSW as presented by the experts and summarises key points from the discussions. The results show that the dominating tool to investigate MSHW is questionnaires. Questionnaires vary largely depending on the research design, such as participants or distribution channels. Cohort studies addressing families and including in-depth interventional and/or experimental studies may be suitable for an Eco-Region investigation. Those MHSW studies can be conducted and combined with measurements of somatic health effects. We conclude that indicators should be seen as complementary rather than independent. Explorative research designs are required to investigate complex Eco-Regions.

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This study investigated the influence of descriptive norm messages that either communicated that university students eat a sufficient amount of fruit and vegetable (F&V) or that they do not, on F&V consumption, and whether or not any effects are moderated by student identification. An online 2 (Norm: “Sufficient”/“Insufficient”) × 2 (Identification: “Low”/“High”) experimental design was employed. Infographics containing “sufficient”/“insufficient” F&V intake descriptive norms were presented. An identification manipulation was employed to create “high”/“low” student identifiers. F&V intake intentions were assessed after the manipulations; self-reported F&V intake was reported at 2 days post-intervention. Undergraduate students in the United Kingdom (N = 180) reported their intake intentions, of which 112 (62%) completed the behavioral follow-up. Participants were predominantly white female students from Scottish universities, mean age 20.4 (±1.6) years. Baseline mean F&V consumption was high (4.5 ± 2.8). There were no significant main effects of Norm or Identification manipulations on F&V intentions and intake. Significant norm × identification interactions were revealed for fruit intake intentions and vegetable intake at follow-up, indicating half-portion differences (~40 g) between groups. Ironic effects were observed for “high” identifiers, who neither intended to, nor acted in accordance with group norms; “low” student identifiers intended to and followed group norms, whereby the “sufficient”/“low” group intended to consume significantly more fruit portions and consumed more vegetables than the “insufficient”/“low” group. Given the half-portion differences between groups resulting from the norm × identification interactions, future research on a larger sample of young adults with low F&V intake is warranted to further explore the conditions under which moderating effects of identification are observed and the underlying mechanisms.

When eating with strangers, people tend to eat less than they would when eating alone (social inhibition of eating), whereas they tend to eat more with family and friends (social facilitation of eating). To assess awareness of the social inhibition and facilitation of eating we conducted two online studies (Study 1:N = 481; Study 2:N = 485). In Study 1, participants imagined a dining scenario and indicated whether they would eat the same, more, or less when eating with someone who was more or less familiar to them (friend; family member; acquaintance; stranger) compared with when eating alone. Results from Study 1 indicated that participants imagined eating special meals with friends/family and so, in Study 2, another group of participants made the same predictions as for Study 1, but they did so for special and regular meals. In Study 1, a significant majority of participants said that they would “eat less” with a stranger/acquaintance. A similar proportion of participants said that they would “eat the same” or “eat more” when with a friend/family member and significantly fewer participants said that they would “eat less” with a friend/family member. In Study 2, the majority of participants said that they would “eat less” with a stranger across both special and regular meals. For meals with an acquaintance, the majority of participants reported that they would “eat the same” during regular meals, while for special meals, equal numbers said that they would “eat the same” as would “eat less.” The majority of participants indicated that they would “eat more” during a special meal with a friend/family member. However, for regular meals with a friend/family member, a significant majority of participants said that they would “eat the same.” Hence, participants acknowledge the social inhibition of intake and the social facilitation of eating at special meals, but they are either unwilling or unable to acknowledge that they would eat more with a friend/family member at a regular meal compared with eating alone. Raising awareness that eating with friends/family is associated with greater intake at regular meals may be helpful for individuals who are trying to manage their intake.

People eat more when they eat a meal with familiar others than they do when eating alone. However, it is unknown whether eating socially impacts intake over the longer-term. The aim of Study 1 was to examine whether socially facilitated intake is sustained across all meals and across three consecutive days. The aim of Study 2 was to examine whether increased intake during a social meal taken in the laboratory is compensated for under free-living conditions. In Study 1, adult women (n = 26) ate all their meals across three days either with a friend or alone in a counterbalanced cross-over design. In Study 2 adult women (n = 63) consumed a meal in the laboratory either alone or with two friends and then recorded everything they ate and drank for the next three days using electronic food diary software. In Study 1 intake across 3 days was significantly greater in the Social (M = 7310 kcal, SD = 1114) than in the Alone condition (M = 6770 kcal, SD = 974) (F(1,423) = 16.10, p .001, d = 0.51). In Study 2 participants consumed significantly more in the laboratory when eating with their friends (M = 1209 kcal, SD = 340) than when eating alone (M = 962 kcal, SD = 301) (F(1,63) = 13.28, p = .001, d = 0.77). Analysis of food diary data plus laboratory intake showed that intake remained significantly greater in the Social (M = 6396 kcal, SD = 1470) than in the Alone condition after 4 days (M = 5776 kcal, SD = 1182) (F(1,59) = 5.59, p = .021, d = 0.05). These results show that social facilitation of eating is sustained over three days and suggest that people fail to compensate for the social facilitation of eating.

Background/Objectives Intranasal (IN) administration of insulin decreases appetite in humans, but the underlying mechanisms are unclear, and it is unknown whether IN insulin affects the food intake of women with obesity. Subjects/Methods In a double-blind, placebo-controlled, crossover design, participants (35 lean women and 17 women with obesity) were randomized to receive 160 IU/1.6 mL of IN insulin or placebo in a counterbalanced order in the post prandial state. The effects of IN insulin on cookie intake, appetite, mood, food reward, cognition and neural activity were assessed. Results IN insulin in the post prandial state reduced cookie intake, appetite and food reward relative to placebo and these effects were more pronounced for women with obesity compared with lean women. IN insulin also improved mood in women with obesity. In both BMI groups, IN insulin increased neural activity in the insula when viewing food pictures. IN insulin did not affect cognitive function. Conclusions These results suggest that IN insulin decreases palatable food intake when satiated by reducing food reward and that women with obesity may be more sensitive to this effect than lean women. Further investigation of the therapeutic potential of IN insulin for weight management in women with obesity is warranted.

Deficits in interoception have been associated with disordered eating but there has been no systematic review of whether the interoceptive deficits are observed across all types of disordered eating and across interoceptive modalities. There has also been no evaluation of whether deficits in interoception play a causal role in the development of disordered eating. Nor has there been a review of the moderating/mediating factors of the relationship between interoception and disordered eating. To address these gaps we conducted a systematic review using PRISMA guidelines. 104 studies with 32883 participants were included. Deficits in interoception were observed across disordered eating types and interoceptive modalities suggesting that interoception may constitute a transdiagnostic feature of disordered eating. There is currently limited evidence on the causal role of interoception in the development of disordered eating and no studies have formally analysed the moderators/mediators. Future mechanistic research examining particular dimensions of interoception will provide insights into the specific interoceptive deficits associated with disordered eating and could lead to the development of improved therapies.

Previous research suggests that exposure to nature may reduce delay discounting (the tendency to discount larger future gains in favor of smaller immediate rewards) and thereby facilitate healthier dietary intake. This pre-registered study examined the impact of online exposure to images of natural scenes on delay discounting and food preferences. It was predicted that exposure to images of natural scenes (vs. images of urban scenes) would be associated with: (i) lower delay discounting; (ii) higher desirability for fruits and vegetables (and lower desirability for more energy-dense foods); and (iii) delay discounting would mediate the effect of nature-image exposure on food desirability. Adult participants (N = 109) were recruited to an online between-subjects experiment in which they viewed a timed sequence of six images either showing natural landscape scenes or urban scenes. They then completed measures of mood, delay discounting (using a five-trial hypothetical monetary discounting task) and rated their momentary desire to eat four fruits and vegetables (F&V), and four energy-dense foods. There was no statistically significant effect of experimental condition (natural vs. urban image exposure) on delay discounting or food desirability. Bayes factors supported the null hypothesis for discounting (BF01 = 4.89), and energy-dense food desirability (BF01 = 7.21), but provided no strong evidence for either hypothesis for F&V desirability (BF01 = 0.78). These findings indicate that brief online exposure to images of nature does not affect momentary impulsivity or energy-dense food preference, whereas for preference for less-energy dense foods, the evidence was inconclusive.

Background Interoception refers to the processes by which we sense, interpret and integrate signals originating from within the body. Deficits in interoception have been linked to higher BMI and may contribute to weight gain. However, there have been conflicting findings and it is not clear how higher BMI is associated with different facets of interoception, such as interoceptive accuracy (the ability to detect internal signals) and sensibility (the tendency to attend to internal signals). Methods We conducted a systematic review and meta-analysis of studies that measured interoception and BMI. We examined relationships between interoception and BMI in children and adults separately and as a function of interoceptive facet and measure. In sensitivity analyses, we tested for evidence of publication bias and whether the results were consistent when studies with a high risk of bias were excluded. Results A total of 87 articles were eligible for inclusion. In adults (121 effects, 10,425 participants), there was cross-sectional evidence of higher BMI being associated with overall deficits in interoception (r = −0.054, 95% CI: −0.084 to −0.025) and this was consistent across sensitivity analyses. There was no statistically significant evidence of moderation by interoceptive facet or measure, although there was some variability in effect size estimates based on interoceptive facet and measures. A smaller meta-analysis limited to studies that compared participants with normal weight vs. overweight/obesity indicated poorer interoception in participants with overweight/obesity (SMD = −0.39, 95% CI −0.60 to −0.18). Conclusions In cross-sectional studies, deficits in interoception are associated with higher BMI. However, it remains unclear whether deficits in interoception contribute to or are a consequence of weight gain and obesity.

The social facilitation of eating refers to people's tendency to eat more food when dining with others than when dining alone. Recent research suggests that social facilitation may be driven by people's tendency to make more food available even before social meals begin, a phenomenon referred to as social "precilitation." In order to uncover the mechanisms underlying social precilitation, it is helpful to first understand whether people consciously and deliberately make more food available for social meals. Three studies (total N = 792) used an online serving paradigm to investigate this question. Participants were asked to imagine dining alone and dining socially, and indicated how much food they would serve themselves in each scenario. Unexpectedly, participants consistently reported intending to serve themselves smaller portions for social meals than for non-social meals (Study 1). This effect emerged even when they were asked about how someone else would behave (Study 2), and when they were informed that there was plenty of food available at the social meal (Study 3). This research highlights a disconnect between people's intended serving behaviour and the actual serving behaviour observed in laboratory studies, and suggests that people may not be aware of how their behaviour is influenced by the social context. Future research should examine why the disconnect between people's intended and actual serving behaviour occurs, whether it is related to the amount of food provided for social meals, and what implications the disconnect has for people's ability to manage their food intake.

BackgroundPeople with severe mental illnesses (SMI) such as schizophrenia die on average 15 to 20 years earlier than everyone else. Two-thirds of these deaths are from preventable physical illnesses such as hypertension, cardiovascular disease, and diabetes, which are worsened by weight gain. Antipsychotics are associated with significant weight gain. In RESOLVE, a realist synthesis, combining primary and secondary data, will be used to understand and explain how, why, for whom, and in what contexts non-pharmacological interventions can help service users to manage antipsychotic-induced weight gain.MethodsA five-step approach will be used to develop guidance:1. Developing the initial programme theoryAn initial (candidate) programme theory, which sets out how and why outcomes occur within an intervention, will be developed.2. Developing the search The initial programme theory will be refined using academic and grey literature. The proposed initial sampling frame is:Context: people living with SMI, taking antipsychotics, different types of SMI.Intervention: non-pharmacological interventions. Mechanisms: triggered by the intervention.Outcomes e.g. weight, metabolic adverse events, quality of life, adherence, burden, economic. Searching for relevant documents will continue until sufficient data is found to conclude that the refined programme theory is coherent and plausible. Lived Experience (service users) and Stakeholder (practitioners) groups will provide feedback.3. Selection, appraisal, data extractionDocuments will be screened against inclusion and exclusion criteria. Text extracted from these documents will be coded as contexts, mechanisms and their relationships to outcomes.4. Primary Data Collection Realist interviews with up to 30 service users and informal carers, and 20 practitioners will gather data to support, refute or refine the programme theory. 5. Data AnalysisA realist logic of analysis will be used to develop and refine the programme theory from secondary and primary data. The analysis will aim to identify practical intervention strategies to change contexts so that key mechanisms are triggered to produce desired outcomes. Guidance will be produced based on these strategies. DiscussionThis realist synthesis aims to develop guidance for service users and practitioners on the most appropriate interventional strategies to manage and limit antipsychotic weight gain.Systematic review registrationPROSPERO: CRD42021268697

Perceptions of social norms around eating behavior can influence food choices. Communicating information about how others are changing their eating behavior over time (dynamic descriptive social norms) may motivate individuals to change their own food selection and consumption. Following a four-week baseline period, 22 in-store restaurants of a major retail chain across the UK were randomized to display a dynamic descriptive social norm message intended to motivate a shift from meat-to plant-based meals either during the first two, or last two weeks of the four-week study period. A linear regression model showed there was no evidence of an effect of the intervention (β = -0.022, p = .978, 95% CIs: −1.63, 1.58) on the percentage sales of meat-vs plant-based dishes. Fidelity checks indicated that adherence to the intervention procedure was often low, with inconsistencies in the placement and display of the intervention message. In four stores with high fidelity the estimated impact of the intervention was not materially different. The lack of apparent effectiveness of the intervention may reflect poor efficacy of the intervention or limitations in its implementation in a complex food purchasing environment. These challenges highlighted by this study should be considered in future design and evaluation of field trials in real-world environments.

Obesity and Binge-Eating Disorder (BED) are prevalent conditions that are associated with increased risk of morbidity and mortality. There is evidence that the use of pharmacotherapy alongside behavioural treatments can improve quality of life and reduce disease risk for patients with these disorders. However, there are few approved drug therapies for obesity, and these are limited by poor efficacy and/or side effects and only one drug has been approved for the treatment of BED. There is considerable potential to use experimental medicine models to identify new drug treatments for obesity and BED, with greater efficacy and an improved side effect profile, at an early stage of development. Here, we present a model developed in our laboratory that incorporates both behavioural and neuroimaging measures which can be used to facilitate drug development for obesity and BED. The results from validation studies conducted to date using our model suggest that it is sensitive to the effects of agents with behavioural, neurophysiological and neuropharmacological mechanisms of action known to be associated with weight loss and reductions in binge eating. Future studies using the model will be valuable to evaluate the potential efficacy and side-effects of new candidate drugs at an early stage in the development pipeline for both obesity and BED.

Research has shown that seeing positive facial expressions (FEs) towards food increased children's desire to eat foods rated as disliked. However, the effect of adults' positive FEs whilst eating a raw vegetable on children's acceptance and intake of nutritious foods that are less preferred (e.g., vegetables) remains to be established. This study aimed to examine the effect of models' FEs eating raw broccoli on children's acceptance and intake of raw broccoli. 111 children aged 4–6 years (64 male, 47 female) were randomised to watch a video of unfamiliar adult models eating raw broccoli with a positive or neutral facial expression (FE), or a non-food control video. Children's acceptance and intake of raw broccoli was assessed. Data about parent and child characteristics was provided by parents. There was a main effect of FE type on children's frequency of tastes (p = .03) and intake of broccoli (p = .02). Children who were exposed to models eating broccoli with positive FEs had greater frequency of tastes (p = .04) and intake of broccoli (p = .03), than children in the control condition, but not compared to children in the neutral FE condition (p > .05). There was no effect of positive FEs on children's willingness to try broccoli (p > .05). These findings suggest that observing others enjoy a commonly disliked vegetable can encourage children's tastes and intake of the vegetable. Thus, exposing children to others enjoying vegetables could be a useful strategy for encouraging healthier eating in children. Further work is needed to determine whether a single exposure is sufficient and whether these effects are sustained over time.

Lisdexamfetamine dimesylate (LDX) is the only drug currently approved by the FDA for the treatment of Binge-Eating Disorder (BED), but little is known about the behavioural mechanisms that underpin the efficacy of LDX in treating BED. We examined the behavioural and neural effects of an acute dose of LDX (50 mg) in 22 women with binge-eating symptomatology using a randomised, crossover, double-blind, placebo-controlled experimental medicine design. LDX reduced self-reported appetite ratings and intake of both a pasta meal and a palatable cookie snack. LDX also decreased the eating rate of pasta but not of cookies and reduced self-reported liking ratings for pasta at the end of the meal. When viewing food pictures during an fMRI scan, LDX reduced activity bilaterally in the thalamus. LDX enhanced sustained attention and reduced impulsive responding in a continuous performance task but had no effect on emotional bias or working memory. These results suggest the observed effects of LDX on food intake (and by implication the efficacy of LDX in treating BED) may be related to the actions of the drug to enhance satiety, reduce food-related reward responding when full and/or increase cognitive control. Novel pharmacotherapies for BED might be most effective if they have a broad spectrum of effects on appetite, reward and cognition.

The established link between loneliness and poor health outcomes may stem from aberrant inflammatory regulation. The present study tested whether loneliness predicted the inflammatory response to a standardised in vivo immune challenge. Using a within-subjects double blind placebo-controlled design, 40 healthy men (mean age = 25, SD = 5) received a Salmonella Typhi vaccination (0.025 mg; Typhim Vi, Sanofi Pasteur, UK) and placebo (saline) on two separate occasions. Loneliness was assessed using the R-UCLA loneliness scale. Regression analyses showed that those that reported feeling more lonely exhibited an elevated interleukin-6 response (β = 0.564, 95% confidence interval [0.003, 0.042], p

One of the most powerful influences on food intake yet identified is the presence of familiar others at an eating occasion: people eat much more when they eat with friends/family than when they eat alone. But why this is the case is unclear. Across two studies (Study 1: N = 98; Study 2: N = 120), we found that the mere anticipation of social interaction is all that is needed to promote the selection of larger meals, and that this occurs even when a person is alone when they make their decision. Adult women served themselves larger portions when they knew they were going to eat socially versus when they knew they were going to eat alone. These data suggest that how other people influence our food intake reaches beyond the specific eating context to affect pre-meal portion size decisions, suggesting that a fundamental shift is required in our thinking about social influences on eating.

Multi-component food-items are single food products that comprise more than one food class, brought together usually via some form of processing. Importantly, individual components of the food-item remain discernible and sensorially distinguishable from each other (e.g., chocolate chip cookies or ‘choc ice’). Despite a sizable research literature on the formulation of such products, there lacks a concomitant research literature on the effect(s) of multi-component food-items (compared to single component food-items) on eating behaviour. Considerable previous research has investigated the effect of multiple separate food items on food intake, portion size selection and palatability. However, studies rarely use test foods that capture the physical or chemical interactions between components that are characteristic of multi-component foods. Nevertheless, previous research and relevant theory allow us to generate hypotheses about how multi-component foods may affect eating behaviour; consideration of food variety and perceived sensory complexity suggest that consumption of multi-component foods are likely to increase perceived palatability of such foods, self-selected portion size and food intake. Moreover, many (but not all) multi-component foods would be considered ultra-processed, which is a driver of food intake in and of itself. One possibility is that food components brought together as part of a multi-component food-item interact to strongly drive eating behaviour. To explore this idea, researchers will need to work across disciplines to address various practical and methodological barriers including the technical preparation of test foods.

Experimental studies show that inflammation impairs the ability to interpret the mental state of another person, denoted theory of mind (ToM). The current study attempted a conceptual replication in states associated with elevated low-grade inflammation, i.e., high body weight and advanced age. Ninety young (M = 26.3 years, SD = 4.1) or older (M = 70.7 years, SD = 4.0) participants with either a normal body mass index (BMI) (M = 22.4, SD = 2.2) or high BMI (M = 33.1, SD = 3.8) completed the Reading the Mind in the Eyes Test (RMET) to assess emotion recognition. Plasma interleukin-6 (IL-6) level was measured to index low-grade inflammation. As anticipated, elevated IL-6 levels were found with higher BMI, although not with increased age. IL-6 was associated with poorer task performance, independent of potential demographic and health confounders (e.g., sex, education, smoking status, alcohol intake, presence of medical conditions, and medication intake). Analyses also revealed an interaction whereby young individuals with a high BMI showed worse RMET performance compared to their normal BMI counterparts, whereas the opposite pattern was found in older individuals. The present observational study replicated experimental results showing that elevated low-grade inflammation is correlated with a lower ability to infer the mental states of others. These findings suggest that also naturalistic conditions of (protracted) low-grade inflammation may alter emotion recognition.

Binge-Eating Disorder (BED) is the most common eating disorder in the United States. Lisdexamfetamine (LDX) was approved in 2015 by the FDA for treatment of BED and is the only drug approved for treating the disorder. There has been no systematic evaluation of the published clinical and preclinical evidence for efficacy of LDX in treating BED and the mechanisms responsible for the therapeutic action of the drug. To address this gap, we conducted a systematic review and meta-analysis using PRISMA guidelines. Fourteen clinical and seven preclinical articles were included. There is consistent evidence from clinical studies that LDX is an effective treatment for BED and that the drug reduces the BED symptoms and body weight of patients with the disorder. There is also consistent evidence from preclinical studies that LDX reduces food intake but no consistent evidence for a preferential reduction of palatable food consumption by the drug in rodents. The evidence on mechanism of action is more limited and suggests LDX may reduce binge eating by a combination of effects on appetite/satiety, reward, and cognitive processes, including attention and impulsivity/inhibition, that are mediated by catecholamine and serotonin mechanisms in the brain. There is an urgent need for adequately powered, placebo-controlled, behavioural and neuroimaging studies with LDX (recruiting patients and/or individuals with subclinical BED symptoms) to further investigate the mechanism of action of the drug in treating BED. An improved understanding of the behavioural and neurochemical mechanisms of action of LDX could lead to the development of improved drug therapies to treat BED.

BackgroundNegative bias in facial emotion recognition is a well-established concept in mental disorders such as depression. However, existing face sets of emotion recognition tests may be of limited use in international research, which could benefit from more contemporary and diverse alternatives. Here, we developed and provide initial validation for the P1vital® Affective Faces set (PAFs) as a contemporary alternative to the widely-used Pictures of Facial Affect (PoFA).MethodsThe PAFs was constructed of 133 color photographs of facial expressions of ethnically-diverse trained actors and compared with the PoFA, comprised of 110 black and white photographs of facial expressions of generally Caucasian actors. Sixty-one recruits were asked to classify faces from both sets over six emotions (happy, sad, fear, anger, disgust, surprise) varying in intensity in 10% increments from 0 to 100%.ResultsParticipants were significantly more accurate in identifying correct emotions viewing faces from the PAFs. In both sets, participants identified happy faces more accurately than fearful faces, were least likely to misclassify facial expressions as happy and most likely to misclassify all emotions at low intensity as neutral. Accuracy in identifying facial expressions improved with increasing emotion intensity for both sets, reaching peaks at 60 and 80% intensity for the PAFs and PoFA, respectively. The study was limited by small sizes and age-range of participants and ethnic diversity of actors.ConclusionsThe PAFs successfully depicted a range of emotional expressions with improved performance over the PoFA and may be used as a contemporary set in facial expression recognition tests.

International audience; BackgroundInteroception refers to the process of identifying and listening to internal bodily signals, which may be a modifiable determinant of appetite regulation and weight gain. The objective was to examine whether the extent to which self-reported interoception is associated with higher BMI is explained by eating behavior traits.MethodsUK adults (N = 1181, 49% female, 53% with overweight/obesity) completed validated self-report measures of interoception, habitual tendencies to eat in response to satiety signals (intuitive eating), emotional over-eating and other eating traits.ResultsPoorer self-reported ability to detect interoceptive signals (deficits in interoceptive accuracy) was predictive of higher BMI (r = - 0.07 (95% CI -0.13; -0.01), p < .05). In parallel mediation analyses, participants with poorer interoceptive accuracy were significantly less likely to report considering satiety signals when eating and this explained the cross-sectional association between interoceptive accuracy and higher BMI. There was also some evidence that participants with poorer interoceptive accuracy were more likely to report emotional overeating and this also in part explained why interoceptive accuracy was predictive of higher BMI.ConclusionsDeficits in interoception may decrease the likelihood that satiety signals are integrated into eating behaviour related decision making and in doing so contribute to higher BMI.

There is strong evidence that people eat more when eating with friends and family, relative to when eating alone. This is known as the ‘social facilitation of eating’. In this review, we discuss several gaps in the current scientific understanding of this phenomenon, and in doing so, highlight important areas for future research. In particular, we discuss the need for research to establish the longer-term consequences of social eating on energy balance and weight gain, and to examine whether people are aware of social facilitation effects on their own food intake. We also suggest that future research should aim to establish individual and contextual factors that moderate the social facilitation of eating (e.g. sex/gender), and it should clarify how eating socially causes people to eat more. Finally, we propose a novel evolutionary framework in which we suggest that the social facilitation of eating reflects a behavioural strategy that optimises the evolutionary fitness of individuals who share a common food resource.

BackgroundSymptoms of attention deficit hyperactivity disorder (ADHD) and trait impulsivity have been associated with disordered eating but are seldom assessed in community studies, or longitudinally and little is known about the mediating mechanisms.MethodsWe tested associations between ADHD symptoms and disordered eating cross-sectionally and between trait impulsivity and disordered eating longitudinally. We utilised data from a normative cohort of young adults (642 participants: 65% female, Mage = 23 years). Participants were classified as high risk or low risk for disordered eating using the SCOFF instrument. In the first two steps of both cross-sectional and longitudinal hierarchical logistic regression models, demographics and covariates were entered. For the cross-sectional regression, Adult ADHD self-report scale (ASRS) scores, separated into inattentive and hyperactive/impulsive symptoms, were entered in the third step. In a separate longitudinal model, Barratt impulsivity scale subscales (attentional, motor and non-planning impulsivity) were entered in the third step. Depression, as assessed by the moods and feelings questionnaire (MFQ), was examined as a mediator.ResultsCross-sectionally, sex, MFQ score and inattentive symptoms predicted disordered eating risk (model R2 = 20%). Longitudinally, sex, MFQ score and attentional impulsivity predicted disordered eating risk (model R2 = 16%). The relationship between inattentive symptoms and the disordered eating risk was partially mediated by MFQ score, whereas the relationship between attentional impulsivity and the disordered eating risk was fully mediated by MFQ scores.ConclusionsThese data highlight (1) a specific role for inattentive symptoms of ADHD and (2) the importance of both depression and impulsivity in predicting eating disorder risk.

We investigated the neural correlates of working memory guided attentional selection of food versus non-food stimuli in young women. Participants were thirty-two women, aged 20.6y (± 0.5) who were presented with a cue (food or non-food item) to hold in working memory. Subsequently, they had to search for a target in a 2-item display where target and distractor stimuli were each flanked by a picture of a food or a non-food item. The behavioural data showed that attention is particularly efficiently drawn to food stimuli when thinking about food. Using fMRI, we found that holding a non-food versus food stimulus in working memory was associated with increased activity in occipital gyrus, fusiform, inferior and superior frontal gyrus. In the posterior cingulum, retrosplenial cortex, a food item that re-appeared in the search array when it was held in memory led to a reduced response, compared to when it did not re-appear. The reverse effect was found for non-food stimuli. The extent of the reappearance effect correlated with the attentional capture of food as measured behaviourally. In conclusion, these results suggest that holding food in mind may bias attention because thinking of food facilitated neuronal responses to sensory input related to food stimuli and because holding food-related information in mind is less taxing on memory.

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

The social context of eating has a profound effect on consumption choices. Social modeling, that involves using others' behavior as a guide for appropriate consumption, has been well documented for food intake, but less is known about social modeling of food choices. Moreover, social modeling has mainly been studied in laboratory settings. We conducted an observational study in a self-service canteen to examine whether the food choices of an individual were influenced by the choice of the person ahead in the queue. We recorded food choices of 546 individuals (333 men and 211 women) and those of the person in front of them in the queue along a linear buffet. Starters were sub-categorized into salads, mixed starters (e.g. avocado shrimp mayonnaise), and cold meat starters, and desserts were sub-categorized into fruits, dairy products and pastries. There was a significantly higher probability of taking a starter in general (OR = 1.65, IC = 1.06-2.57, p = 0.03), a salad (OR = 1.78, CI = 1.08-2.93, p = 0.02), a mixed starter (OR = 2.98, CI = 1.42-6.05, p 0.01), but not a cold meat, if the person ahead in the queue also took one compared to when the person ahead did not take one. No significant modelling was found for desserts which may be because almost all participants took a dessert. These results highlight that social modeling influences food choices, and that this phenomenon can be observed in a real life setting. These data also suggest that some food categories, such as starters, could be more susceptible to social modeling than are others. Finally, we observed modeling both between familiar and unfamiliar participants, which suggests that social norms could be used to promote healthier eating in a range of settings including friendship groups.

Aims: Using the UK Biobank cohort, a large sample of middle aged and older adults in the UK, the present study aimed to examine the cross-sectional association between type 2 diabetes and cognition and to assess the hypothesised mediating role of common comorbid conditions, whilst controlling for important demographic and lifestyle factors.\ud \ud Methods: Using regression models and general structural equation models, we examined the cross-sectional association between type 2 diabetes status and: fluid intelligence; reaction time; visual memory; digit span and prospective memory; and the hypothesised mediating role of common comorbid conditions: visceral obesity; sleep problems; macrovascular problems; respiratory problems,; cancer and depressive symptoms in 47,468 participants from the UK Biobank cohort, of whom 1,831 have type 2 diabetes. We controlled for ethnicity, sex, age, deprivation, smoking status, alcohol consumption, physical activity levels and use of diabetes medication.\ud \ud Results: Participants with type 2 diabetes had a significantly shorter digit span, b = -0.14, 99.2% CIs [-0.27, -0.11] than those without type 2 diabetes. Those with type 2 diabetes did not differ from those without type 2 diabetes on fluid intelligence, reaction time, visual memory and prospective memory. The associations that do exist between type 2 diabetes and cognition are consistently mediated via macrovascular problems, depressive symptoms, and to a lesser extent visceral obesity. Respiratory problems, sleep disturbances and cancer did not mediate the association between type 2 diabetes status and measures of cognition.\ud \ud Conclusions: Comorbid conditions explain some of the observed association between type 2 diabetes and cognitive deficits. This suggests that prevention, management or treatment of these comorbid conditions may be important to reduce the likelihood of cognitive decline. Treatment studies with long follow-ups are needed to examine this.\ud \ud Tweet: Comorbid conditions explain the association between type 2 diabetes and cognitive deficits. Prevention, management or treatment of these comorbid conditions may prevent or delay the onset of cognitive decline in people with type 2 diabetes.

Contains fulltext : 215289.pdf (Publisher’s version ) (Open Access) Does it matter what we eat for our mental health? Accumulating data suggests that this may indeed be the case and that diet and nutrition are not only critical for human physiology and body composition, but also have significant effects on mood and mental wellbeing. While the determining factors of mental health are complex, increasing evidence indicates a strong association between a poor diet and the exacerbation of mood disorders, including anxiety and depression, as well as other neuropsychiatric conditions. There are common beliefs about the health effects of certain foods that are not supported by solid evidence and the scientific evidence demonstrating the unequivocal link between nutrition and mental health is only beginning to emerge. Current epidemiological data on nutrition and mental health do not provide information about causality or underlying mechanisms. Future studies should focus on elucidating mechanism. Randomized controlled trials should be of high quality, adequately powered and geared towards the advancement of knowledge from population-based observations towards personalized nutrition. Here, we provide an overview of the emerging field of nutritional psychiatry, exploring the scientific evidence exemplifying the importance of a well-balanced diet for mental health. We conclude that an experimental medicine approach and a mechanistic understanding is required to provide solid evidence on which future policies on diet and nutrition for mental health can be based.

AimsWe here present preliminary results from our study to understand better the changes in people’ s experience of food in the months after diagnosis with first episode psychosis (FEP). Weight gain often occurs in the weeks/months after diagnosis and is related to an increase in appetite and food intake. Many drugs that are effective in treating psychosis are associated with changes in the way that people experience reward when they eat.The aim of this project is to increase our understanding of exactly why this happens in terms of an individual's experience of food reward and reduced satiety – and therefore how we can help people with FEP to keep their weight down. At this stage we are looking at the feasibility of applying currently available evaluation tools to people in this situation.MethodA convenience sample was used to recruit 10 service users from RDaSH NHS FT Early Intervention Services. This is a feasibility study which will provide data to underpin a fully powered, larger trial.Rating scales applied were:Power of food questionnaire: measures responsiveness to the food environment.Intuitive Eating Scale: measures an individual's tendency to follow their physical hunger and satiety cues.The loss of control over eating scale (LOCES): measures a global sense of whether individuals experience LOC over eating.Dutch Eating Behaviour Questionnaire (DEBQ): measures restrained eating, emotional eating and external eating.ResultThe ages of the participants ranged from 17-26 years. All were started on Olanzapine at the dose of 5 or 10 mg daily.Baseline total scores for the Power of Food (2.47-3.80)/5 (higher score = more responsiveness) and Intuitive Eating scales (2.10-2.62)/5 (higher score = greater tendency to follow hunger and satiety cues) were in the mid-range, while the LOCES scores varied widely from 1.50-2.38/5.The DEBQ restrained subscale score range was 2.40-2.80/5 (higher indicates greater restraint with food) while the DEBQ external subscale ranged from 2.70—3.00/5 (higher = greater tendency to overeat) and the DEBQ emotional subtotal score was 1.92-1.94/5, in keeping with a relatively low emotional drive to eat.ConclusionOur preliminary results reveal at the beginning of antipsychotic treatment a moderate responsiveness to food and tendency to follow hunger/ satiety cues, with scores for Loss of Control of eating in the low to moderate range and a low emotional drive to eat. The difference between these and the follow-up eating behaviour scores will provide important clues as to the precise changes in eating behaviour with anti-psychotic treatment in FEP.

RATIONALE: Brain 5-HT2C receptors form part of a neural network that controls eating behaviour. 5-HT2C receptor agonists decrease food intake by activating proopiomelanocortin (POMC) neurons in the arcuate nucleus of the hypothalamus, but recent research in rodents has suggested that 5-HT2C receptor agonists may also act via dopaminergic circuitry to reduce the rewarding value of food and other reinforcers. No mechanistic studies on the effects of 5-HT2C agonists on food intake in humans have been conducted to date. OBJECTIVES: The present study examined the effects of the 5-HT2C receptor agonist meta-chlorophenylpiperazine (mCPP) on food consumption, eating microstructure and blood oxygen level-dependent (BOLD) functional magnetic resonance imaging (fMRI) responses to food pictures in healthy female volunteers. METHODS: In a double-blind, placebo-controlled, crossover design, participants were randomized immediately after screening to receive oral mCPP (30mg) in a single morning dose, or placebo, in a counterbalanced order. Test foods were served from a Universal Eating Monitor (UEM) that measured eating rate and fMRI BOLD signals to the sight of food and non-food images were recorded. RESULTS: mCPP decreased rated appetite and intake of a palatable snack eaten in the absence of hunger but had no significant effect on the consumption of a pasta lunch (although pasta eating rate was reduced). mCPP also decreased BOLD fMRI responses to the sight of food pictures in areas of reward-associated circuitry. A post hoc analysis identified individual variability in the response to mCPP (exploratory responder-non-responder analysis). Some participants did not reduce their cookie intake after treatment with mCPP and this lack of response was associated with enhanced ratings of cookie pleasantness and enhanced baseline BOLD responses to food images in key reward and appetite circuitry. CONCLUSIONS: These results suggest that 5-HT2C receptor activation in humans inhibits food reward-related responding and that further investigation of stratification of responding to mCPP and other 5-HT2C receptor agonists is warranted.

Food addiction is controversial within the scientific community. However many lay people consider themselves addicted to certain foods. We assessed the prevalence and characteristics of self-perceived “food addiction” and its relationship to a diagnostic measure of “clinical food addiction” in two samples: (1) 658 university students, and (2) 614 adults from an international online crowdsourcing platform. Participants indicated whether they considered themselves to be addicted to food, and then completed the Yale Food Addiction Scale, measures of eating behavior, body image, and explicit and internalized weight stigma. Participants in the community sample additionally completed measures of impulsivity, food cravings, binge eating, and depressive symptomatology. Follow-up data were collected from a subset of 305 students (mean follow-up 280 ± 30 days). Self-perceived “food addiction” was prevalent, and was associated with elevated levels of problematic eating behavior, body image concerns, and psychopathology compared with “non-addicts”, although individuals who also received a positive “diagnosis” on the Yale Food Addiction Scale experienced the most severe symptoms. A clear continuum was evident for all measures despite no differences in body mass index between the three groups. Multinomial logistic regression analyses indicated that perceived lack of self-control around food was the main factor distinguishing between those who did and did not consider themselves addicted to food, whereas severity of food cravings and depressive symptoms were the main discriminating variables between self-classifiers and those receiving a positive “diagnosis” on the Yale Food Addiction Scale. Self-perceived “food addiction” was moderately stable across time, but did not appear predictive of worsening eating pathology. Self-classification as a “food addict” may be of use in identifying individuals in need of assistance with food misuse, loss-of-control eating, and body image issues.

Objective The need for dietary-management in coeliac disease may lead to the development of disordered eating patterns. A theoretical model of disordered eating has been proposed to explain disordered eating in coeliac disease. The aim of this study was to explore the experiences of typical and disordered eating in coeliac disease to gain a greater understanding of these processes and explore specific pathways within this model. Methods We interviewed 21 individuals with coeliac disease, recruited from a previous database, about their experiences with food and food environments. Information about disordered eating status was assessed via questionnaire. The interviews were analysed qualitatively using Framework analysis, which was underpinned by the theoretical model of disordered eating in coeliac disease. Results Experiences differed between participants scoring high on measures of disordered eating and those who scored low (typical eaters). Participants scoring high on measures of disordered eating were concerned about the consequences of their gluten-free diet on body image and they described eating patterns similar to binge/restrict cycles. Typical eaters reported being able to integrate their dietary self-management into their daily lives; however, general concerns around food and cross-contamination were associated with a restriction in food intake. Conclusions Coeliac disease has a varied impact on eating patterns. The need to follow a gluten-free diet and to be vigilant around food has to be balanced with concerns around food availability and cross-contamination which have the potential to contribute towards disordered eating attitudes and behaviours. The findings suggest that the theoretical model of disordered eating provides an adequate explanation of disordered eating patterns in coeliac disease.

Purpose The need for dietary management in coeliac disease may lead to the development of disordered eating. This study examined the prevalence of disordered eating and factors predicting disordered eating in women with coeliac disease, compared with other dietary-controlled conditions. Methods A cross-sectional, online survey assessing psychological well-being, disordered eating behaviours (Eating Attitudes Test 26 (EAT-26); Binge Eating Scale (BES)) was distributed using online forums, to those with coeliac disease (N = 157), inflammatory bowel disease (N = 116), type two diabetes (N = 88) and healthy controls (N = 142). Hierarchical regressions were conducted to explore and compare the predictors of EAT-26 and BES scores across all groups. Within the coeliac disease group, a cluster analysis was conducted to examine types of disordered eating. Results Higher EAT-26 scores were found in those with coeliac disease and inflammatory bowel disease compared with healthy controls and type two diabetes; participants with a chronic health condition had higher BES than healthy control participants. The factors associated with EAT-26 scores differed across the dietary-controlled health conditions, with dietary management being important for those with coeliac disease. Psychological distress was associated with binge-eating behaviour across all groups. Cluster analyses found two types of disordered eating in coeliac disease; a binge eating type and a restrictive type. Conclusions Disordered eating attitudes and behaviours are more prevalent in participants with chronic health conditions relative to healthy controls. The presence of binge eating behaviours in coeliac disease may be related to non-coeliac disease specific factors such as the distress associated with dietary-controlled illness. EAT-26 scores in coeliac disease are associated with disease specific factors, unique to following the gluten-free diet. These factors are important for identifying and supporting those with coeliac disease and disordered eating.