No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
The relationship of alcohol use to weight loss in the context of behavioral weight loss treatment
Abstract
Despite common wisdom that reducing alcohol intake will facilitate weight loss, little research has examined whether participants in behavioral weight loss treatments actually decrease their alcohol intake, or whether reduced alcohol intake relates to weight loss outcomes in this context. This study examined the relationship of alcohol use to energy intake excluding alcohol and to weight in 283 overweight and obese adults participating in a 26-session behavioral weight loss treatment. The majority of participants consumed low to moderate levels of alcohol at baseline. Participants who consumed alcohol at baseline meaningfully reduced their alcohol intake by end-of-treatment. Alcohol use did not relate to weight at baseline or end-of-treatment when controlling for relevant demographic variables, and change in alcohol use was unrelated to weight change in the overall sample during treatment. However, end-of-treatment alcohol intake did relate to end-of-treatment energy intake excluding alcohol. In addition, behavioral impulsivity and change in alcohol intake interacted to predict weight loss, such that decreases in alcohol intake were associated with greater percent weight loss at end-of-treatment for participants with higher levels of impulsivity. Alcohol consumption may lead to overeating episodes, and highly impulsive individuals may be at risk for increased energy intake during or after episodes of drinking. Therefore, the recommendation to reduce alcohol intake in the context of behavioral weight loss treatment seems warranted, particularly for individuals with high levels of impulsivity.
... Though the association between alcohol consumption and body weight is unclear, decreasing or eliminating calories from alcohol is typically recommended during weight loss. Despite the potential benefits of reducing alcohol consumption on weight management, few studies have examined whether participants report changes in alcohol intake during weight loss treatment (21)(22)(23) and whether alcohol influences weight loss. One study demonstrated no change in alcohol intake during a lifestyle intervention (23), while another showed decreased intake at the end of treatment (22). ...
... Despite the potential benefits of reducing alcohol consumption on weight management, few studies have examined whether participants report changes in alcohol intake during weight loss treatment (21)(22)(23) and whether alcohol influences weight loss. One study demonstrated no change in alcohol intake during a lifestyle intervention (23), while another showed decreased intake at the end of treatment (22). Alcohol intake was not related to weight change but was associated with change in end-of-treatment energy intake (22). ...
... One study demonstrated no change in alcohol intake during a lifestyle intervention (23), while another showed decreased intake at the end of treatment (22). Alcohol intake was not related to weight change but was associated with change in end-of-treatment energy intake (22). Research is needed to assess changes in alcohol consumption during weight loss and the effect of alcohol on weight management. ...
Objective
This study aimed to assess whether alcohol consumption decreases during an intensive lifestyle intervention (ILI) and whether alcohol consumption is associated with weight loss among participants with overweight or obesity and type 2 diabetes.
Methods
Participants (n = 4,901) were from the Action for Health in Diabetes (Look AHEAD) study, a randomized controlled trial that compared an ILI with a diabetes support and education (DSE) control. Mixed‐effects models were used to estimate the effect of the ILI on alcohol consumption and the influence of alcohol consumption on weight loss at year 4.
Results
ILI and DSE participants did not differ in changes in alcohol consumption. Alcohol intake was not associated with weight loss at year 1 of the ILI. ILI participants who abstained from alcohol lost 5.1% ± 0.3% of initial weight at year 4 compared with a significantly (P = 0.04) smaller 2.4% ± 1.3% for consistent heavy drinkers. ILI participants who abstained from alcohol consumption over the 4 years lost 1.6% ± 0.5% more weight relative to individuals who drank alcohol at any time during the intervention (P = 0.003). DSE participants did not differ in weight loss by alcohol consumption.
Conclusions
Heavy alcohol drinkers are at risk for suboptimal long‐term weight loss. Decreasing alcohol consumption may improve weight management among individuals with diabetes.
... Alcohol's contribution to energy balance, beyond its caloric content, involves inhibiting lipolysis, lipid oxidation and encouraging de-novo lipogenesis [132]. Excessive alcohol consumption can lead to impulsive behavior, unplanned eating events and reduced energy debt [133]. Long-term alcohol consumption, even at low to moderate doses, is associated with insomnia [134], reducing energy expenditure due to sleep deprivation. ...
... • There is no years restricted for selecting the review article • Factors such as gut health and muscle gain were excluded owing to the length of the study. [113] Nedeltcheva et al. [114] Spiegel et al. [115] Klok et al. [116] Buchmann et al. [117] Robertson et al. [118] 2 Circadian misalignment-sleep and meals Johnston [119] Oda [120] Ruddick-Collins et al. [121] Johnston et al. [122] Buxton et al. [123] Scheer et al. [124] Garaulet et al. [125] Jakubowicz et al. [126] 3 Hydration Chang et al. [127] Muckelbauer et al. [128] Dennis et al. [130] Daniels and Popkin [129] Popkin et al. [131] 4 Alcohol Siler et al. [132] Kase et al. [133] Stein and Friedmann, [134] Chao et al. [135] French et al. [136] Levinson and Rodebaugh [137] Page 13 of 20 Dabas et al. Journal of Health, Population and Nutrition (2024) 43:37 • The impact of physical activity has not been covered in this review and should be considered in future studies. ...
Introduction
Approximately four million people worldwide die annually because of obesity. Weight loss is commonly recommended as a first-line therapy in overweight and obese patients. Although many individuals attempt to lose weight, not everyone achieves optimal success. Few studies point out that weight loss eventually slows down, stagnates or reverses in 85% of the cases.
Research question
What could be the reasons for not losing weight even after following a weight loss program?
Methods
A scoping review of the literature was performed using weight loss-related search terms such as ‘Obesity,’ ‘Overweight,’ ‘Lifestyle,’ ‘weight loss,’ ‘Basal Metabolism,’ ‘physical activity,’ ‘adherence,’ ‘energy balance,’ ‘Sleep’ and ‘adaptations. The search involved reference tracking and database and web searches (PUBMED, Science Direct, Elsevier, Web of Science and Google Scholar). Original articles and review papers on weight loss involving human participants and adults aged > 18 years were selected. Approximately 231 articles were reviewed, and 185 were included based on the inclusion criteria.
Design
Scoping review.
Results
In this review, the factors associated with not losing weight have broadly been divided into five categories. Studies highlighting each subfactor were critically reviewed and discussed. A wide degree of interindividual variability in weight loss is common in studies even after controlling for variables such as adherence, sex, physical activity and baseline weight. In addition to these variables, variations in factors such as previous weight loss attempts, sleep habits, meal timings and medications can play a crucial role in upregulating or downregulating the association between energy deficit and weight loss results.
Conclusion
This review identifies and clarifies the role of several factors that may hinder weight loss after the exploration of existing evidence. Judging the effectiveness of respective lifestyle interventions by simply observing the ‘general behavior of the groups’ is not always applicable in clinical practice. Each individual must be monitored and advised as per their requirements and challenges.
... age, sex, location of residence, tobacco use, alcohol consumption and use of hormonal contraception) was made in multiple logistic regression analysis. All tests were two-sided and p < 0.05 was considered statistically significant [24][25][26]. ...
... Copyright: © 2017 Komlavi Yayehd, et.al. [21] b > 80 cm for women and >94 cm for men [22] at risk for increased energy intake during or after episodes of drinking ("binge eating") [24]. Thus, alcohol may contribute to an increase in body weight associated with a certain drinking pattern [33]. ...
Background: The prevalence of obesity is rising in low/middleincome
countries. Better understanding of the epidemiological
characteristics of obesity will benefit the development of prevention
programs in these countries. We sought to determine the prevalence
of obesity and associated factors among adults in Togo, a low-income
country in Western Africa.
Design: This was a secondary analysis from a nationwide crosssectional
survey conducted in September−October 2011.
Methods: The survey involved unselected respondents aged ≥ 18
years living in Lomé (urban population) and in central Togo (semiurban
population). Overweight was defined as Body Mass Index
(BMI) 25−29.9 kg/m2 and obesity as ≥ 30 kg/m2. Central obesity was
classified using National Cholesterol Education Program (NCEP) and
International Diabetes Federation (IDF) definitions.
Results: Data from 2626 respondents were surveyed (1900 in
Lomé, 726 in central Togo). Overall prevalence of obesity was 20.1%
and overweight was 27.7%. Obesity was most prevalent among
subjects aged 35−64 years (Odds Ratio (OR): 2.21 (95% Confidence
Interval (CI): 1.80−2.72)). More women than men were obese (OR:
3.88 (95% CI: 3.08−4.87)), irrespective of whether they lived in an
urban or semi-urban area. Obesity was more prevalent among urban
inhabitants (OR: 2.15 (95% CI: 1.68−2.75)); this difference persisted
after adjustment. The prevalence of central obesity was 33.7% with
the NCEP definition, 48.8% with the IDF definition.
Conclusions: The prevalence of adult obesity in a low-income
Western African population is high. Urban living, female sex and age
35−64 years were associated with obesity, suggesting that prevention
programs should target these classes as a priority.
Keywords: Obesity; Prevalence; Adult; Western Africa
... The majority of quitters gain about 3-9 kg within 8 years of quitting, and between 10% and 13% of quitters gain at least 11 kg [64][65][66][67]. With respect to alcoholic drinks consumption, several studies have reported that alcohol consumption does not necessarily lead to weight gain [68,69], a reduction in the risk of overweight/obesity being reported among moderate alcohol consumers compared to non-drinkers, showing that the beneficial effect of drinking on obesity is present when alcohol is consumed in low-moderate amounts on a regular basis [69,70]. Consistent with these findings, the moderate and low consumption of beer and/or wine were used by the cascade flow model as negative predictors for developing overweight/obesity. ...
(1) Background: Artificial intelligence using machine learning techniques may help us to predict and prevent obesity. The aim was to design an interpretable prediction algorithm for overweight/obesity risk based on a combination of different machine learning techniques. (2) Methods: 38 variables related to sociodemographic, lifestyle, and health aspects from 1179 residents in Madrid were collected and used to train predictive models. Accuracy, precision, and recall metrics were tested and compared between nine classical machine learning techniques and the predictive model based on a combination of those classical machine learning techniques. Statistical validation was performed. The shapely additive explanation technique was used to identify the variables with the greatest impact on weight gain. (3) Results: Cascade classifier model combining gradient boosting, random forest, and logistic regression models showed the best predictive results for overweight/obesity compared to all machine learning techniques tested, reaching an accuracy of 79%, precision of 84%, and recall of 89% for predictions for weight gain. Age, sex, academic level, profession, smoking habits, wine consumption, and Mediterranean diet adherence had the highest impact on predicting obesity. (4) Conclusions: A combination of machine learning techniques showed a significant improvement in accuracy to predict risk of overweight/obesity than machine learning techniques separately.
... During the lockdown, the closure of restaurants, bars and shops could have reduced the availability of alcohol, resulting in reduced alcohol consumption, especially among some older adults who were unable to place online orders 28,45 . Less alcohol consumption has been widely acknowledged as one way to manage weight since alcohol contains energy in a concentrated form and may encourage eating 46 . ...
During COVID-19 lockdown, negative changes in health behaviours have been reported in European older adults. However, less is known about the consequences of these changes on weight gain and obesity, especially in older adults living in England. This study explored the association of health behaviour changes with weight and obesity in English older adults aged 50 years and older, during lockdowns in 2020. We included 4182 participants of the English Longitudinal Study of Ageing COVID-19 sub-study in June/July and Nov/Dec 2020 who also had pre-pandemic data. Perceived changes in health behaviours were regressed on weight and obesity, adjusted for pre-pandemic weight or obesity, and several covariates. Results suggested that less exercise, more sedentariness, eating more and alcohol drinking were associated with a significant increase in weight at both timepoints. Meanwhile, less sedentariness and eating less significantly reduced weight in Nov/Dec 2020. A higher risk of obesity at both timepoints was found in adults sitting, eating, or sleeping more than usual. To conclude, during UK lockdown, older people who engaged in risky health behaviours were at higher risks of weight gain and obesity both in the short run and long term. Considering potential health risks associated with obesity and disruptions in routine lifestyle in the older population even after the pandemic, improved weight management interventions are necessary nationwide.
... As we know, chronic and moderate alcohol consumption (20-40 g/day) could favor a positive energy balance that makes an increase of weight (Devgun et al., 1984). Moreover, alcohol consumption may lead to overeating episodes that increase the risk for increased energy intake during or after episodes of drinking (Kase et al., 2016). However, alcohol inebriation can cause confusion and incoordination in humans, a phenomenon that is paralleled in mice when the righting reflex disappears. ...
To decrease the climbing rate of alcoholic liver disease, the protective effect in subacute alcoholic liver injury of newly isolated Lactiplantibacillus pentosus CQZC01 has been investigated. Lactiplantibacillus pentosus CQZC01 (1 × 109 CFU/kgbw) administered orally could keep weight of mice at 30.54 ± 1.15 g; alleviate alcoholic damage on hepatic morphology; decrease the activities of hyaluronidase (147 ± 19 U/L), procollagen III (4.82 ± 0.54 ng/mL), alanine transaminase (10.66 ± 2.32 U/L), and aspartate aminotransferase (15.18 ± 1.98 U/L); enhance the activities of alcohol dehydrogenase (65.15 ± 3.2 U/mgprot), aldehyde dehydrogenase (16.50 ± 0.96 U/mgprot), superoxide dismutase (623 ± 39 U/mgprot), and glutathione (19.54 ± 2.46 µmol/gprot); and decrease liver total cholesterol (3.59 ± 0.50 mmol/gprot) and triglyceride (0.88 ± 0.24 mmol/gprot) (p < 0.05). Moreover, L. pentosus CQZC01 elevated the level of interleukin‐10 (IL‐10; 807 ± 44 pg/mL) but significantly decreased the levels of IL‐1β (29.75 ± 5.27pg/mL), IL‐6 (58 ± 8 pg/mL), and tumor necrosis factor‐α (TNF‐α, 564 ± 13 pg/mL). Liver malondialdehyde was also significantly decreased by treatment with L. pentosus CQZC01 from 3.61 ± 0.14 to 2.03 ± 0.49 nmol/mgprot. The relative expression of C‐Jun N‐terminal kinase, extracellular regulated protein kinases, and cyclooxygenase‐1 was downregulated, and the SOD1, SOD2, peroxisome proliferator‐activated receptor‐α, glutathione peroxidase, catalase, nuclear factor erythroid‐2‐related factor 2, heme oxygenase‐1 and nicotinamide adenine dinucleotide phosphate were upregulated by L. pentosus CQZC01. The overall protective effect of L. pentosus CQZC01 was comparable to commercial Lactobacillus delbrueckii subsp. Bulgaricus. Lactobacillus pentosus CQZC01 might be a suitable hepatoprotective measure for people who frequently ingest alcoholic drinks.
Practical Application
L. pentosus CQZC01 can alleviate subacute alcoholic liver injury by raising the antioxidant status and upregulating the antioxidant‐related genes.
... The individual variations in consumption during the pandemic are similar to previous research on alcohol consumption, (Rossow et al., 2021) as well as other addictive behaviors (Hodgins & Stevens, 2021;Roberts et al., 2021). The increase in alcohol not only may hinder weight management, (Kase et al., 2016) but could also further exacerbate levels of anxiety and depression (Boden & Fergusson, 2011). Future weight management programs may want to place increased emphasis on healthy ways to cope with stress, boredom, and other emotional triggers, in order to reduce consumption of comfort foods and alcohol during high-risk periods. ...
Purpose
To explore barriers and facilitators to healthy eating during the COVID-19 pandemic among adults enrolled in an internet-based weight loss program.
Methods
Adults in an internet-delivered weight loss program were recruited to participate. Participants completed online study surveys and a semi-structured interview via telephone between June 1, 2020 and June 22, 2020. The interview included questions to explore how the COVID-19 pandemic has influenced dietary behaviors. Constant comparative analysis was used to identify key themes.
Results
Participants (n = 30) were primarily female (83%) and white (87%), 54.6 ± 10.0 years old, and had a mean body mass index of 31.1 ± 4.5 kg/m². Barriers included snacking/ease of access to food, eating as a coping mechanism, and lack of routine/planning. Facilitators included calorie control, regular routine/scheduling, and self-monitoring. General themes with eating were a change in eating out frequency or modality, cooking more, and changes in alcohol consumption.
Conclusion
Eating habits among adults enrolled in a weight loss program changed during the COVID-19 pandemic. Future weight loss programs and public health recommendations should consider modifying recommendations to place increased emphasis on strategies to overcome barriers to healthy eating and promote facilitators that may help with healthy eating, particularly during unexpected circumstances or events.
... However, at Year 4, participants assigned to the Intensive Lifestyle Intervention (ILI) who abstained from alcohol lost 1.6% more weight relative to individuals who drank alcohol at any time during the intervention [46]. Kase and colleagues found that alcohol intake was not associated with weight before or after 26week behavioural weight loss intervention, nor was change in alcohol intake related to change in weight [47]. However, reduction in alcohol was more relevant to weight loss for certain personality traits; specifically, those with higher levels of impulsivity experienced greater weight loss from reducing alcohol consumption. ...
Alcohol is energy-dense, elicits weak satiety responses relative to solid food, inhibits dietary fat oxidation, and may stimulate food intake. It has, therefore, been proposed as a contributor to weight gain and obesity. The aim of this narrative review was to consolidate and critically appraise the evidence on the relationship of alcohol consumption with dietary intake and body weight, within mainstream (non-treatment) populations. Publications were identified from a PubMed keyword search using the terms ‘alcohol’, ‘food’, ‘eating’, ‘weight’, ‘body mass index’, ‘obesity’, ‘food reward’, ‘inhibition’, ‘attentional bias’, ‘appetite’, ‘culture’, ‘social’. A snowball method and citation searches were used to identify additional relevant publications. Reference lists of relevant publications were also consulted. While limited by statistical heterogeneity, pooled results of experimental studies showed a relatively robust association between acute alcohol intake and greater food and total energy intake. This appears to occur via metabolic and psychological mechanisms that have not yet been fully elucidated. Evidence on the relationship between alcohol intake and weight is equivocal. Most evidence was derived from cross-sectional survey data which does not allow for a cause-effect relationship to be established. Observational research evidence was limited by heterogeneity and methodological issues, reducing the certainty of the evidence. We found very little qualitative work regarding the social, cultural, and environmental links between concurrent alcohol intake and eating behaviours. That the evidence of alcohol intake and body weight remains uncertain despite no shortage of research over the years, indicates that more innovative research methodologies and nuanced analyses are needed to capture what is clearly a complex and dynamic relationship. Also, given synergies between ‘Big Food’ and ‘Big Alcohol’ industries, effective policy solutions are likely to overlap and a unified approach to policy change may be more effective than isolated efforts. However, joint action may not occur until stronger evidence on the relationship between alcohol intake, food intake and weight is established.
... Inspection of the means indicates that small shifts in intake patterns occurred between groups to account for this difference. In a large weight-loss study, alcohol intake was not directly related to loss of weight, but played a more complex role interacting with weight changes when the characteristic of impulsivity is considered (Kase, Piers, Schaumberg, Forman, & Butryn, 2016). Thus, reducing alcohol intake may be beneficial to some women seeking to lose weight for whom impulsivity is present. ...
Using a weight resilience framework, health habits of diet and physical activity, social support, and perceived stress were compared in women who lost weight (resilient) and those who did not lose or gained weight (nonresilient) during a weight-loss intervention. Participants were low-income postpartum women participating in a 13-week randomized treatment-control group intervention, with 20 of 50 classified as resilient in losing weight. Measures included the Postpartum Support Scale, the Perceived Stress Scale, and health habit items from the Self Care Inventory. Weight-loss resilient women showed significantly more frequent healthful dietary habits, such as eating a nutritious breakfast, and less frequent unhealthy habits, such as substituting junk food for meals, and less perceived stress than their nonresilient counterparts at both the midpoint and end of the study. Weight-loss resilient women also showed significantly more frequent physical activity habits at the end of the study. No social support differences were found.
This cohort study examines the association of antiobesity medication use and alcohol use among participants enrolled in a weigh loss program.
Objective
Lifestyle intervention can produce clinically significant weight loss and reduced disease risk/severity for many individuals with overweight/obesity. Dietary lapses, instances of non-adherence to the recommended dietary goal(s) in lifestyle intervention, are associated with less weight loss and higher energy intake. There are distinct “types” of dietary lapse (e.g., eating an off-plan food, eating a larger portion), and behavioral, psychosocial, and contextual mechanisms may differ across dietary lapse types. Some lapse types also appear to impact weight more than others. Elucidating clear lapse types thus has potential for understanding and improving adherence to lifestyle intervention.
Methods
This 18-month observational cohort study will use real-time digital assessment tools within a multi-level factor analysis framework to uncover “lapse phenotypes” and understand their impact on clinical outcomes. Adults with overweight/obesity (n = 150) will participate in a 12-month online lifestyle intervention and 6-month weight loss maintenance period. Participants will complete 14-day lapse phenotyping assessment periods at baseline, 3, 6, 12, and 18 months in which smartphone surveys, wearable devices, and geolocation will assess dietary lapses and relevant phenotyping characteristics. Energy intake (via 24-h dietary recall) and weight will be collected at each assessment period.
Results
This trial is ongoing; data collection began on 31 October 2022 and is scheduled to complete by February 2027.
Conclusion
Results will inform novel precision tools to improve dietary adherence in lifestyle intervention, and support updated theoretical models of adherence behavior. Additionally, these phenotyping methods can likely be leveraged to better understand non-adherence to other health behavior interventions.
Trial Registration
This study was prospectively registered https://clinicaltrials.gov/study/NCT05562427
Objectives: Predictors of success among emerging adults (EAs; ages 18-25) within behavioral weight loss (BWL) trials are largely unknown. We examined whether early program engagement predicted overall engagement and weight loss in EAs. Methods: Data were pooled from 2 randomized controlled pilot trials in EAs. Participants (N = 99, 80% female, BMI = 33.7±5.1 kg/m²) received a 3-month BWL intervention. Weight was objectively assessed at 0 and 3 months; engagement was tracked weekly; retention was assessed at 3 months. Results: Greater engagement during the initial 4 weeks of treatment predicted greater weight loss (p = .001). Compared to those who did not engage in all 4 initial weeks, participants meeting this threshold experienced greater overall engagement (9.6 vs 4.2 weeks, p < .001), weight losses (intent-to-treat = -3.8% vs -1.3%, p = .004), and retention (78% vs 53%, p = .012). Conclusions: Early engagement in BWL is associated with better outcomes among EAs. Monitoring engagement in real-time during the initial 4 weeks of treatment may be necessary to intervene effectively. Early engagement did not vary by sex or race; future work should identify characteristics associated with poor early engagement.
In Deutschland gelten derzeit jede zweite Frau und fast zwei von drei Männern als übergewichtig, mindestens jede vierte Person ist adipös. Das wahre Ausmaß dieses Gesundheitsrisikos wurde inzwischen sowohl von der Medizin als auch von der Politik erkannt. Eine wirksame Therapie sollte langfristig angelegt sein und eine Korrektur in der Lebensmittelauswahl, dem Essverhalten und eine Steigerung der körperlichen Aktivität beinhalten.
Alcoholic beverages have long been associated with feasts, celebration and marking special events. Today, it is commonplace to consume alcoholic beverages before, with and/or after a meal. Alcohol provides additional pleasure to the meal and enhances appetite. However, consuming an al-coholic beverage with or before a meal is associated with poor short-term energy compensation; energy from alcohol is addi-tive to total energy intake with the added property of stimu-lating further eating. Limiting alcohol intake is an obvious means to reduce total energy intake for those who wish to lose weight. However, dieters and restrained eaters drink more and report greater binge drinking than unrestrained eaters despite employing cognitive strategies to reduce their intake. In-creased intake may be attributable to greater attentional bias to alcohol related cues as well as to food cues, since these are more salient to those limiting intake. Alcohol increases energy intake in dieters, in part due to abandonment of restraint (disinhibition) and consumption of forbidden items including alcohol exacerbates attempts to resist temptation. Paradoxical-ly, links between binge drinking or increased drinking fre-quency to overweight and obesity may be mediated by dietary restraint. Efforts to limit food and alcohol intake for weight control appear to be unsuccessful and have the net effect of promoting overconsumption. The potential role of restrained eating in the association between alcohol, appetite and obesity has been overlooked by much of the current research and further investigation of this is therefore warranted.
Recreational alcohol intake is a widespread activity globally and alcohol energy (7 kcal/g) can be a contributing factor to weight gain if not compensated for. Given that both excessive alcohol intake and obesity are of public health interest, the present paper provides an update on the association between alcohol consumption and body weight. In general, recent prospective studies show that light-to-moderate alcohol intake is not associated with adiposity gain while heavy drinking is more consistently related to weight gain. Experimental evidence is also mixed and suggests that moderate intake of alcohol does not lead to weight gain over short follow-up periods. However, many factors can explain the conflicting findings and a better characterization of individuals more likely to gain weight as a result of alcohol consumption is needed. In particular, individuals who frequently drink moderate amounts of alcohol may enjoy a healthier lifestyle in general that may protect them from weight gain. In conclusion, despite the important limitations of current studies, it is reasonable to say that alcohol intake may be a risk factor for obesity in some individuals, likely based on a multitude of factors, some of which are discussed herein.
Background:
Few studies have examined racial and educational disparities in recent population-based trends.
Methods:
We analyzed data of a nationally representative sample of 174,228 US-born adults in the National Health Interview Survey from 1997 to 2008. We determined mean BMI trends by educational attainment and race and black-white prevalence ratios (PRs) for overweight/obesity (BMI > 25 kg/m(2)) using adjusted Poisson regression with robust variance.
Results:
From 1997 to 2008, BMI increased by ≥1 kg/m(2) in all race-sex groups, and appeared to increase faster among whites. Blacks with greater than a high school education (GHSE) had a consistently higher BMI over time than whites in both women (28.3 ± 0.14 to 29.7 ± 0.18 kg/m(2) versus 25.8 ± 0.58 to 26.5 ± 0.08 kg/m(2)) and men (28.1 ± 0.17 kg/m(2) to 29.0 ± 0.20 versus 27.1 ± 0.04 kg/m(2) to 28.1 ± 0.06 kg/m(2)). For participants of all educational attainment levels, age-adjusted overweight/obesity was greater by 44% (95% CI: 1.42-1.46) in black versus white women and 2% (1.01-1.04) in men. Among those with GHSE, overweight/obesity prevalence was greater (PR: 1.52; 1.49-1.55) in black versus white women, but greater (1.07; 1.05-1.09) in men.
Conclusions:
BMI increased steadily in all race-sex and education groups from 1997 to 2008, and blacks (particularly women) had a consistently higher BMI than their white counterparts. Overweight/obesity trends and racial disparities were more prominent among individuals with higher education levels, compared to their counterparts with lower education levels.
There are well-established links between impulsivity and alcohol use in humans and other model organisms; however, the etiological nature of these associations remains unclear. This is likely due, in part, to the heterogeneous nature of the construct of impulsivity. Many different measures of impulsivity have been employed in human studies, using both questionnaire and laboratory-based tasks. Animal studies also use multiple tasks to assess the construct of impulsivity. In both human and animal studies, different measures of impulsivity often show little correlation and are differentially related to outcome, suggesting that the impulsivity construct may actually consist of a number of more homogeneous (and potentially more meaningful) subfacets. Here, we provide an overview of the different measures of impulsivity used across human and animal studies, evidence that the construct of impulsivity may be better studied in the context of more meaningful subfacets, and recommendations for how research in this direction may provide for better consilience between human and animal studies of the connection between impulsivity and alcohol use.
The urgency facet of impulsivity, that is, the tendency to act rashly in response to intense emotional contexts [Cyders, M. A., & Smith, G. T. (2008). Emotion-based dispositions to rash action: positive and negative urgency. Psychological Bulletin, 134, 807-828], has been related to a wide range of maladaptive behaviours. The present study further investigates the role of urgency in problematic behaviours by considering distinct psychological mechanisms that may underlie this component of impulsivity. With this aim, 95 volunteer participants were screened with self-reported questionnaires assessing urgency and three problematic behaviours (compulsive buying, excessive mobile phone use, excessive Internet use). They performed two laboratory tasks: a stop-signal task designed to assess the capacity to inhibit prepotent responses in response to both neutral and emotional stimuli; and the Iowa Gambling Task (IGT) measuring the ability to take into account the future consequences of an action. A poor ability to inhibit prepotent responses in the emotional condition of the stop-signal task was found to predict more disadvantageous choices in the IGT, which ultimately results in higher urgency and more problematic behaviours. These findings shed new light on the construct of urgency, its related psychological mechanisms, and its role in problematic behaviours.
To describe dietary changes in men participating in an obesity intervention as part of the Self-Help, Exercise and Diet using Information Technology (SHED-IT) study.
An assessor-blinded randomized controlled trial comparing Internet (n 34) v. information-only groups (n 31) with 6-month follow-up. Dietary intake assessed by FFQ, reporting usual consumption of seventy-four foods and six alcoholic beverages using a 10-point frequency scale. A single portion size (PSF) factor was calculated based on photographs to indicate usual serving sizes.
The campus community of the University of Newcastle, New South Wales, Australia.
Sixty-five overweight/obese men (43 % students, 42 % non-academic general staff, 15 % academic staff; mean age 35.9 (sd 11.1) years, mean BMI 30.6 (sd 2.8) kg/m2).
The average PSF decreased significantly over time (χ2 = 20.9, df = 5, P < 0.001) with no differences between groups. While both groups reduced mean daily energy intake (GLM χ2 = 34.5, df = 3, P < 0.001), there was a trend towards a greater reduction in the Internet group (GLM χ2 = 3.3, P = 0.07). Both groups reduced percentage of energy from fat (P < 0.05), saturated fat (P < 0.001) and energy-dense/nutrient-poor items (P < 0.05), with no change in dietary fibre or alcohol (P > 0.05).
Although men reported some positive dietary changes during weight loss, they did not increase vegetable intakes nor decrease alcohol consumption, while saturated fat, fibre and Na intakes still exceeded national targets. Future interventions for men should promote specific food-based guidelines to target improvements in their diet-related risk factor profile for chronic diseases.
Obesity is a complex condition involving biological, psychological, sociocultural and environmental components. Impulsivity seems to be a particularly important factor. Whiteside and Lynam recently proposed dividing impulsivity into four separate dimensions: Urgency, lack of Premeditation, lack of Perseverance and Sensation Seeking (associated with a tendency to exaggerate the impact of rewards). The objective of this article is to examine how obesity and eating disorder symptoms may be related to the four facets of impulsivity.
Whiteside and Lynam's Impulsive Behavior Scale, the Sensitivity to Punishment and Sensitivity to Reward Questionnaire, the Eating Disorder Examination Questionnaire and the Mizes Anorectic Cognitions Questionnaire were used to explore the association between the cognitive and motivational facets of impulsivity and obesity in 47 overweight or obese persons with eating disorders and 47 normal-weight controls.
Results suggest that overweight and obese persons have higher levels of Urgency, lack of Perseverance and Sensitivity to Reward.
These results suggest that obese and overweight persons have difficulty inhibiting automatic or dominant behavior and intrusive thoughts and a higher sensitivity to reward.
Overweight and obese persons may benefit from psychological interventions targeting self-control problems associated with impulsive eating behaviors.
Ecological momentary assessment (EMA) is particularly suitable for studying substance use, because use is episodic and thought to be related to mood and context. This article reviews EMA methods in substance use research, focusing on tobacco and alcohol use and relapse, where EMA has been most applied. Common EMA designs combine event-based reports of substance use with time-based assessments. Approaches to data organization and analysis have been very diverse, particularly regarding their treatment of time. Compliance with signaled assessments is often high. Compliance with recording of substance use appears good but is harder to validate. Treatment applications of EMA are emerging. EMA captures substance use patterns not measured by questionnaires or retrospective data and holds promise for substance use research.
Background:
Understanding the factors that influence successful weight control is critical for developing interventions.
Purpose:
The purpose of the study was to provide a comprehensive understanding of the role of psychosocial, environmental, and behavioral variables in distinguishing weight-loss maintainers (WLM) from treatment-seeking obese (TSO).
Methods:
WLM (n = 167) had lost > or =10% of their maximum body weight, had kept the weight off for > or =5 years, and were now of normal weight. TSO-1 and TSO-2 had a history of dieting and body mass index > or =25. TSO-1 was predominantly Caucasian; TSO-2 was predominantly African-American. Bayesian model averaging was used to identify the variables that distinguished WLM from TSO-1 and TSO-2.
Results:
The variables that most consistently discriminated WLM from TSO were more physical activity (ORs = 3.95 and 2.85), more dietary restraint (ORs = 1.63 and 1.41), and less dietary disinhibition (ORs = 0.69 and 0.83). Environmental variables, including the availability of physical activity equipment, TVs, and high-fat foods in the home, also distinguished WLM from TSO.
Conclusions:
Obesity treatment should focus on increasing conscious control over eating, engaging in physical activity, and reducing disinhibition. Changes in the home environment may help facilitate these behavioral changes.
Whiteside and Lynam (Whiteside, S. P., & Lynam, D. R. (2001). The Five Factor Model and impulsivity: Using a structural model of personality to understand impulsivity. Personality and Individual Differences, 30, 669-689) clarified the multifaceted nature of impulsivity by identifying four distinct facets of self-reported impulsive behaviors: urgency, (lack of) premeditation, (lack of) perseverance, and sensation seeking. Building on work by Bechara and Van der Linden (Bechara, A., & Van der Linden, M. (2005). Decision-making and impulse control after frontal lobe injuries. Current Opinion in Neurology, 18, 734-739), the main objective of this study was to investigate the hypothesis that perseverance and urgency map onto the two distinct inhibitory functions distinguished by Friedman and Miyake (Friedman, N. P., & Miyake, A. (2004). The relations among inhibition and interference control functions: A latent-variable analysis. Journal of Experimental Psychology: General, 133, 101-135): prepotent response inhibition and resistance to proactive interference. Participants (N=126) completed the UPPS Impulsive Behavior Scale and three tasks: a recent-negatives task to assess proactive interference in working memory, and two Go/No-Go tasks at different paces, the slower of which also assessed task-unrelated thoughts (TUTs). Consistent with the hypothesis, TUTs were positively correlated with lack of perseverance, and multiple regressions revealed that urgency was specifically related to errors in prepotent response inhibition, and lack of perseverance to errors due to difficulties overcoming proactive interference.
Obesity, inactivity and being overweight are leading causes of morbidity and mortality in the United States. The relationship between eating, overeating, and addiction have been discussed, debated and more recently investigated. We have hypothesized that drugs of abuse compete with food for brain reward sites. Overeating and obesity may act as protective factors reducing drug reward and addiction.
In the first part of this study, 374 charts of all active weight management patients in a 12-month period were examined. Demographic information, laboratory testing, psychiatric diagnostic interview, alcohol and drug history were reviewed. A detailed alcohol use, abuse, dependence history was present in 298 charts as part of the pre-bariatric evaluation. The relationship between BMI and alcohol use among female patients (n = 298) was then analyzed.
We found a significant (p <.05) inverse relationship between BMI and alcohol consumption. The more obese the patient was, the less alcohol they consumed. The percentage of women who consumed alcohol in the past year decreased as BMI level increased. These results confirmed our surgeons' perception that it is rare to find a morbidly obese patient excluded for bariatric surgery because of excessive alcohol consumption.
Obese patients have lower rates of alcohol use than found in the general population of women. As BMI increases, lower rates of alcohol consumption are found. Overeating may compete with alcohol for brain reward sites, making alcohol ingestion less reinforcing.
Weight loss is difficult to achieve and maintaining the weight loss is an even greater challenge. The identification of factors associated with weight loss maintenance can enhance our understanding for the behaviours and prerequisites that are crucial in sustaining a lowered body weight. In this paper we have reviewed the literature on factors associated with weight loss maintenance and weight regain. We have used a definition of weight maintenance implying intentional weight loss that has subsequently been maintained for at least 6 months. According to our review, successful weight maintenance is associated with more initial weight loss, reaching a self-determined goal weight, having a physically active lifestyle, a regular meal rhythm including breakfast and healthier eating, control of over-eating and self-monitoring of behaviours. Weight maintenance is further associated with an internal motivation to lose weight, social support, better coping strategies and ability to handle life stress, self-efficacy, autonomy, assuming responsibility in life, and overall more psychological strength and stability. Factors that may pose a risk for weight regain include a history of weight cycling, disinhibited eating, binge eating, more hunger, eating in response to negative emotions and stress, and more passive reactions to problems.
We examined demographic predictors of longitudinal patterns in alcohol consumption.
We used mixed-effects models to describe individual alcohol consumption and change in consumption with age, as well as the associations between consumption and birth year, national alcohol consumption, and demographic factors, among 14 105 adults from the National Health and Nutrition Examination Survey I Epidemiologic Follow-Up Study.
Alcohol consumption declined with increasing age, and individual consumption mirrored national consumption. Higher consumption was associated with male gender, being White, being married, having a higher educational level, having a higher income, being employed, and being a smoker. Faster age-related decline in consumption was associated with earlier cohorts, being male, being married, having a lower educational level, and being a smoker.
Compared with alcohol consumption among earlier cohorts, that among recent cohorts declined more slowly with increasing age, suggesting that negative health effects of alcohol could increase in the future.
Objectives:
To evaluate the reproducibility of, and to compare and calibrate, diet measures by the Northern Sweden 84-item food-frequency questionnaire (FFQ) with measures from 24-hour diet recalls (24-HDR).
Design:
Randomly selected respondents from the EPIC (diet-cancer) and MONICA (diet-cardiovascular disease) study cohort in Northern Sweden were invited to answer the FFQ twice over a one-year interval (FFQ1 and FFQ2), and to complete ten 24-hour recalls (reference method) in the months between. Plasma beta-carotene concentrations were determined from a subset of 47 participants.
Setting:
Västerbotten and Norrbotten, Northern Sweden.
Participants:
Ninety-six men and 99 women, who completed the study.
Results:
The reproducibility of the FFQ was high in terms of both mean energy and nutrient intakes and relative ranking of participants by intake levels (median Pearson correlation of 0.68). Moderately higher food intake frequencies were recorded by FFQ1 compared with 24-hour recalls for dairy products, bread/cereals, vegetables, fruits and potato/rice/pasta, whereas meat, fish, sweet snacks and alcoholic beverage intakes were lower. The median Spearman coefficient of correlation between FFQ1 and the average of ten 24-HDR measurements was 0.50. Daily energy and nutrient intakes were similar for FFQ1 and 24-HDR measurements, except for fibre, vitamin C, beta-carotene and retinol (FFQ1>24-HDR) and sucrose and cholesterol Pearson coefficients of correlation between FFQ1 and 24-HDR corrected for attenuation due to residual day-to-day variation in the 24-HDR measurements ranged from 0.36 to 0.79 (median 0.54). Adjustment for energy had only very moderate effects on the correlation estimates. Calibration coefficients estimated by linear regression of the 24-HDR on the FFQ1 measurements varied between 0.30 and 0.59 for all nutrients except alcohol, which had calibration coefficients close to 1.0. These low calibration coefficients indicate that relative risk estimates corresponding to an absolute difference in dietary intake levels measured by the FFQ will generally be biased towards 1.0. Plasma beta-carotene levels had a Pearson coefficient of correlation of 0.47 with the 24-HDR measurements, and of 0.23 with FFQ1 measurements.
Conclusions:
The Northern Sweden FFQ measurements have good reproducibility and an estimated level of validity similar to that of FFQ measurements in other prospective cohort studies. The results from this study will form the basis for the correction of attenuation and regression dilution biases in relative risk estimates, in future studies relating FFQ measurements to disease outcomes.
In this paper we review recent findings on the disinhibition of dietary restraint Disinhibition induced by preloading depends more upon the perception that the diet has been broken than on actual calorie content of the preload. Disinhibition can also result from emotional distress, with ego-threats more likely than physical fear to disinhibit eating. Low self-esteem dieters are more likely to become disinhibited than are high self-esteem dieters in response to both preloading and distress manipulations. Recent theoretical perspectives on disinhibition are examined and the possible role of self-awareness is highlighted.
Although many studies have linked moderate drinking with a lower risk of death from heart disease, just how alcohol could produce such a benefit has been unclear. Now, new research by investigators at the University of Ulm Medical Center in Germany suggests that alcohol has anti-inflammatory properties that could be at least partly responsible for this heartfelt benefit (Lancet. 2001;357:763-767).Previous studies have suggested that moderate alcohol intake plays a role in lowering the risk of heart disease through a variety of mechanisms, including increasing high-density lipoprotein cholesterol. The mounting evidence that atherosclerosis is an inflammatory disease prompted the German researchers to investigate possible associations between alcohol intake and markers of inflammation, including C-reactive protein (CRP).
Objective:
Impulsive personality traits have been robustly associated with alcohol and drug misuse, but have received little attention in the context of food addiction. The goal of the current study was to examine the interrelationships between impulsive personality traits, food addiction, and Body Mass Index (BMI), including indirect pathways of influence.
Method:
Participants (N = 233) completed the Yale Food Addiction Scale (YFAS) to assess patterns of addictive consumption of food, the upps-p impulsivity scale to assess impulsive personality traits, and provided weight and height to generate BMI.
Results:
Significant positive associations were found between facets of impulsivity, food addiction symptoms, and BMI. Impulsivity was found to be indirectly associated with BMI by way of associations with addictive consumption of food. In particular, an inclination toward behaving irrationally while experiencing negative mood states (Negative Urgency) and low levels of task persistence (lack of Perseverance) were significantly associated with food addiction directly and that relationship was responsible for their relationship to BMI.
Conclusions:
Dispositional impulsivity, routinely associated with high-risk behaviors including addictive consumption of alcohol and drugs, may be an important risk factor when considering tendency to engage in addictive consumption of food. Monitoring food addiction symptoms early may help reduce the likelihood that compulsive food consumption patterns result in weight gain and obesity. Methodological considerations are discussed.
Heightened impulsivity and inefficient inhibitory control are increasingly recognized as risk factors for unhealthy eating and obesity but the underlying processes are not fully understood. We used structural equation modeling to investigate the relationships between impulsivity, inhibitory control, eating behavior, and body mass index (BMI) in 210 undergraduates who ranged from underweight to obese. We demonstrate that impulsivity and inhibitory control deficits are positively associated with several facets of unhealthy eating, including overeating in response to external food cues and in response to negative emotional states, and making food choices based on taste preferences without consideration of health value. We further show that such unhealthy eating is, for the most part, associated with increased BMI, with the exception of Restraint Eating, which is negatively associated with BMI. These results add to our understanding of the impact of individual differences in impulsivity and inhibitory control on key aspects of unhealthy eating and may have implications for the treatment and prevention of obesity.
Human eating behavior can be conceptualized as a self-regulatory activity by which individuals often strive to attain certain self-regulatory goals such as weight control or healthy food intake in the presence of competing impulsive influences triggered by tempting food cues in the environment. The outcome of such a self-regulatory struggle can be strongly influenced by external factors such as alcohol consumption. In the present chapter, we outline a framework for the various acute and chronic effects of alcohol consumption on the self-regulation of eating behavior. Acute effects include (a) the caloric load of alcohol itself which is typically not compensated for, (b) alcohol’s stimulating effect on appetite, and (c) its detrimental effects on self-regulatory capacity. Chronic alcohol abuse also appears to be negatively related to central executive cognitive functioning in the long run. We also discuss the role of alcohol expectancies as modulators of the physiological effects of alcohol. Furthermore, we highlight alcohol’s role in dysfunctional “vicious circles” of self-regulatory failure. Such dysfunctional dynamics may, among other factors, help to account for the observed comorbidity between alcohol abuse and eating disorders. Taken together, alcohol can seriously hamper the self-regulatory pursuit of dieting and other health-related goals, both in the short and in the long run.
Two experiments examined the impact of exposure to social food cues on the spontaneous activation of hedonic thoughts about food in restrained and unrestrained eaters. Consistent with hypotheses, it was found that restrained eaters, but not unrestrained eaters, spontaneously activate hedonic food thoughts upon reading behavior descriptions that involved a palatable food item. Moreover, it was shown that the activation of hedonic food thoughts in restrained eaters occurred on-line. These findings are discussed in the context of a motivational account of eating-regulation and the possible role of the spontaneous activation of hedonic thoughts about food in the self-regulation of restrained eaters.
Based on the fact that energy content in 1 gram of alcohol is 29 kJ or 7.1 kcal, alcohol consumption can lead to weight gain. The present review was conducted to analyze the effects of alcohol consumption on body weight. A search of the Medline database for the period 1984 to March 2010 was conducted to identify cross-sectional, prospective cohort studies and intervention trials investigating the relationship between alcohol consumption and the risk of weight gain. Thirty-one publications were selected on the basis of relevance and quality of design and methods. The findings from large cross-sectional studies as well as from well-powered, prospective, cohort studies with long periods of follow-up were contradictory. Findings from short-term experimental trials also did not show a clear trend. The overall results do not conclusively confirm a positive association between alcohol consumption and weight gain; however, positive findings between alcohol intake and weight gain have been reported, mainly from studies with data on higher levels of drinking. It is, therefore, possible that heavy drinkers may experience such an effect more commonly than light drinkers. Moreover, light-to-moderate alcohol intake, especially wine intake, may be more likely to protect against weight gain, whereas consumption of spirits has been positively associated with weight gain. Further research should be directed towards assessing the specific roles of different types of alcoholic beverages. Studies should also take the effect of consumption patterns into account. In addition, a potential effect modifier that has not been evaluated before but might be important to consider is the subjects' previous tendency to gain weight.
This study used experience sampling to examine within-person associations between positive affect, anxiety, sadness, and hostility and two outcomes: alcohol intoxication and acute dependence symptoms. We examined the role of urgency, premeditation, and perseverance in predicting the alcohol outcomes and tested whether the affective associations varied as a function of urgency. Participants completed baseline assessments and 21 days of experience sampling on PDAs. Hypotheses were partially confirmed. Positive affect was positively, and sadness inversely, associated with intoxication. Hostility was associated with intoxication for men but not women. Negative urgency moderated the association between anxiety and intoxication, making it stronger. However, positive urgency did not moderate the effect of positive affect. Heavier drinkers exhibited the greatest number of symptoms, yet the association between intoxication and acute signs of alcohol disorder was attenuated among these individuals. Results support the use of experience sampling to study acute signs and symptoms of high risk drinking and dependence.
The increased recognition that the worldwide increase in incidence of obesity is due to a positive energy balance has lead to a focus on lifestyle choices that may contribute to excess energy intake, including the widespread belief that alcohol intake is a significant risk factor for development of obesity. This brief review examines this issue by contrasting short-term laboratory-based studies of the effects of alcohol on appetite and energy balance and longer-term epidemiological data exploring the relationship between alcohol intake and body weight. Current research clearly shows that energy consumed as alcohol is additive to that from other dietary sources, leading to short-term passive over-consumption of energy when alcohol is consumed. Indeed, alcohol consumed before or with meals tends to increase food intake, probably through enhancing the short-term rewarding effects of food. However, while these data might suggest that alcohol is a risk factor for obesity, epidemiological data suggests that moderate alcohol intake may protect against obesity, particularly in women. In contrast, higher intakes of alcohol in the absence of alcohol dependence may increase the risk of obesity, as may binge-drinking, however these effects may be secondary to personality and habitual beverage preferences.
Although studies in obese subjects using weight loss medications typically report mean and categorical weight loss, results from diet and exercise intervention trials typically only report mean weight change from baseline along with a level of significance. These data alone do not give clinicians or administrators the data needed to determine the probability that an individual will achieve clinically relevant weight loss. Thus, it is difficult to decide which patients, employees or health plan enrollee would benefit from the type and level of support used in a clinical trial. Our goal was to assess what fraction of subjects enrolled in lifestyle modification interventions achieved clinically significant weight loss. Thus, we requested categorical weight loss data from several investigators who had published results from studies involving either a high- or low-intensity lifestyle modification intervention arm. These categorical data indicate that a substantial fraction of subjects in each lifestyle modification intervention achieved clinically meaningful weight loss, even when the average weight loss is modest.
The theoretical basis for the Johnson-Neyman Technique is here presented for the first time in an American journal. In addition, a simplified working procedure is outlined, step-by-step, for an actual problem. The determination of significance is arrived at early in the analysis; and where no significant difference is found, the problem is complete at this point. The plotting of the region of significance where a significant difference does exist has also been simplified by using the procedure of rotation and translation of axes.
Assessed the effects of alcohol on the eating behavior of normally restrained and unrestrained eaters. The icecream consumption of 55 female college students was measured in a taste rating context following their consumption of alcohol or placebo, the label of which was systematically manipulated. In the absence of a disinhibitory label, alcohol served as a mood elevator (with consumption decreasing for restrained eaters and increasing for unrestrained eaters), replicating the authors' 1976 findings. Alcohol disinhibited the consumption of normally restrained eaters only when supplemented by a disinhibitory label. Results are interpreted as support for a cognitive/pharmacological interaction model of alcohol intoxication. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The authors report the results of a dietary survey of 38,121 Iowa women, 55-69 years of age in 1986, based on a semiquantitative food frequency questionnaire previously tested among Boston-area women aged 34-59 years. The Iowa women, compared with the younger Boston-area women, consumed a similar amount of calories (1,767 vs. 1,844 kcal) and a similar amount of total calories from fat (35 vs. 37%) but had markedly greater intake of the following micronutrients after including supplement use: iron (+18%), calcium (+33%), vitamin A (+43%), riboflavin (+46%), thiamine (+50%), and pyridoxine (+122%). The reproducibility of the questionnaire was examined in two more administrations to 44 of the Iowa women in January and June of 1988. Reproducibility was highest for alcohol (Pearson's r = 0.99), caffeine (r = 0.95), and vitamin E (r = 0.90) and lowest for sucrose (r = 0.53), polyunsaturated fat (r = 0.56), and iron (r = 0.59). Micronutrient intakes were generally more reproducible than macronutrient intakes. The agreement between the June 1988 questionnaire and the average of five 24-hour dietary recalls was also assessed in the 44 subjects. The median correlations of energy-adjusted intake were as follows: for macronutrients, r = 0.45; for micronutrients without supplements, r = 0.33; and for micronutrients with supplements, r = 0.64. This food frequency questionnaire appears to be reasonably reproducible and accurate, so that its use may be extended to epidemiologic studies of older women with a broad range of socioeconomic backgrounds.
Data from the first National Health and Nutrition Examination Survey (HANES I) were analyzed for differences in nutrient intakes based on the amounts of alcohol consumed by US adults, and for relationships between alcohol consumption, calorie intake, and relative body weight. Drinkers had significantly higher intakes of total calories than nondrinkers, but only because of their intakes of alcoholic calories. Among drinkers, the intakes of nonalcoholic calories decreased as alcohol intakes increased, and it was estimated that between 15 and 41% of the alcoholic calories replaced nonalcoholic calories. Despite their higher caloric intakes, drinkers were not more obese than nondrinkers, suggesting that alcoholic calories may be less efficiently utilized than nonalcoholic calories, or may interfere with utilization of nonalcoholic calories. The most salient difference in nutrient intake between drinkers and nondrinkers was the substantially lower carbohydrate intake of drinkers.
Little is known about the role of alcohol in determining change in body weight. In this paper, the authors examine the relation between alcohol intake and body weight in 7,230 US adults aged 25-74 years who participated in the First National Health and Nutrition Examination Survey (1971-1975) and who were reweighed 10 years later (1982-1984). Both cross-sectional and prospective analyses were adjusted for age, race, height, education, health status, smoking status, diet status, physical activity, and total nonalcoholic caloric intake. At baseline, women who reported at least one drink per day weighed 2.3 kg less than nondrinkers (95% confidence interval (CI) -0.4 to -4.2). Little relation was observed between body weight and alcohol intake cross-sectionally among men. Prospectively, both men and women drinkers tended to gain less weight than did nondrinkers (p = 0.006 for trend in women, p = 0.11 for trend in men). Drinkers also had more stable weight over the 10-year follow-up period. Drinkers were less likely to have major weight gain or loss (gaining or losing > or = 10 kg) than were nondrinkers. Compared with nondrinkers, for those who consumed 1-6.9 drinks per week, women had an odds ratio (OR) = 0.7 (95% CI 0.5 to 0.9) for major weight gain and an OR = 0.7 (95% CI 0.5 to 1.1) for major weight loss, while men had an OR = 1.0 (95% CI 0.6 to 1.6) for major weight gain and an OR = 0.7 (95% CI 0.5 to 1.2) for major weight loss. For those who consumed > or = 2 drinks per day, women had an OR = 0.5 (95% CI 0.3 to 1.0) for major weight gain and an OR = 0.8 (95% CI 0.4 to 1.6) for major weight loss, while men had an OR = 0.9 (95% CI 0.5 to 1.6) for major weight gain and an OR = 1.0 (95% CI 0.6 to 1.7) for major weight loss. These data suggest that alcohol intake does not increase the risk of obesity.
To examine the long term (1-2 year), as well as immediate effectiveness of a "waist loss' programme for men.
Two preliminary studies are reported; one following a small group of 42 men over two years after a 6 week "GutBuster' course, the second following men for 1 year after having completed the initial 6 week programme (n = 83), or the initial course plus an additional six fortnightly "advanced' course (n = 37).
Waist, hip and weight measures were reported for the 2 year group; waist and hip only in study 2. Dietary fat, exercise and alcohol intake were also recorded in study 2 through the use of questionnaires. The goal for the initial course was a 1% waist loss per week.
All groups achieved an average waist loss > 1%/week during the initial programme. Waist sizes reported in study 1 were significantly less after 2 years (t = 8.28, p < 0.001) averaging a 6% loss in the group. This equated with an average weight loss of 5.5 kg. A repeated measures ANOVA also showed a significant main effect (F = 85.35; p < 0.0001) for waist losses and an interaction effect (F = 16.53; p < 0.0001) between initial and advanced groups after 1 year in study 2. Average waist losses were 4% and 10% respectively. There were also significant changes in dietary fat intake, exercise and alcohol consumption.
Reductions in waist size in men appear to be more feasible than weight losses in women. "Waist loss' may also be a more valid measure of fat loss in men that body mass measures.
The relationship between alcohol intake and obesity remains uncertain. Evidence suggesting that alcohol-derived energy may be unregulated points to an inability to maintain appetite, energy balance and, hence, body weight when alcohol is introduced to the diet. This study investigated the short-term effects of alcohol on hunger and energy intake in 20 lean women. On 4 occasions, subjects were given a randomised preload drink ('alcohol', 'no alcohol', 'carbohydrate', 'water') followed by visual analogue scales (VAS) rating hunger and an ad lib test meal. There was no difference in hunger ratings (p > 0.05) nor in the amount of energy consumed during the test meal (F = 1.66, p > 0.05) following any of the 4 preloads. Consumption of the 2 high energy preload drinks ('alcohol', 0.91 MJ; 'CHO', 0.72 MJ) did not result in a compensatory decrease in the amount of energy subsequently eaten (ad lib intake: 'alcohol' = 2.62 MJ, 0.32 SEM; 'no alcohol' = 2.98 MJ, 0.28 SEM; 'CHO' = 2.93 MJ, 0.21 SEM; 'water' = 2.82 MJ, 0.25 SEM), suggesting either no physiological recognition or no regulation of energy consumed within a drink in quantities of less than 1 MJ. The addition of either alcoholic or CHO-containing carbonated beverages into the diet will result, in the short-term, to an overall increase in energy intake.
This study was designed to compare the Timeline Follow-Back (TLFB) to daily and real-time assessments of drinking. Our purpose was to evaluate overall correspondence and day-to-day agreement between these two methods among both problem and moderate drinkers.
In Study 1, problem drinkers (n = 20) reported their alcohol consumption daily during 28 days of brief treatment. In Study 2, moderate drinkers (n = 48), recruited from the community, used a palm-top computer to record their drinking for 30 days. In both studies participants completed the TLFB covering the recording period.
Participants in Study 1 reported fewer drinking days, fewer drinks per drinking day and fewer total drinks per day on the TLFB, and those in Study 2 reported fewer drinks per drinking day, fewer ounces per drinking day, fewer total drinks per day and fewer total ounces per day. The magnitude of the difference, however, was modest. There was considerable between-person variation in day-to-day correspondence of TLFB and the daily and real-time reports. Neither person characteristics (gender, education and income) nor the distributional characteristics of drinking (including average consumption, variation) predicted concordance between TLFB and real-time reports.
The Timeline Follow-Back method captured overall levels of drinking quite well compared to a 28-day daily diary and a 30-day electronic interview. Vast individual differences in day-to-day correspondence suggest that the TLFB may be less useful for detecting patterns of consumption.
This review investigates research evaluating the disinhibition hypothesis. This hypothesis postulates that in a sober state behavior is inhibited. When people are influenced by alcohol the inhibitions are supposed to be weakened and the motivating drives are postulated to become disinhibited and potent to influence behavior. This report reviews the effect of alcohol on nerve functions, on human sexuality, aggression, eating behavior, psychological conflicts, fluency in talk, social anxiety, violent crimes and the interaction of alcohol and social norms. It has been shown that individual subjective experiences sometimes indicate disinhibition (reduction of the forces holding back impulses) and objective behavior in some respects was different when the subject was intoxicated, but the mechanism that mediates behavior is not clear. It seems to be difficult to measure independently the forces restraining (inhibiting) the driving forces (uncontrolled impulses) at the same time as measuring these driving forces. The review concludes that there is no unambiguous support of the disinhibition hypothesis. An alternative hypothesis that seems to explain many behaviors in an inebriated individual is the 'time out' hypothesis which states that drunken behavior is influenced more by norms about what it should be than by the pharmacological effect of alcohol.
This study examined the accuracy of a multiple-pass, 24-hour dietary recall method for estimating energy intakes of men and women by comparing it with energy intake required for weight maintenance.
Three-day, multiple-pass, 24-hour recalls were obtained on randomly selected days during a self-selected diet period when subjects were preparing their own meals and during a controlled diet period when all meals were provided by the study. During the dietary intervention, weight was maintained; body weight and dietary intake were monitored closely, thereby allowing estimation of the energy intake required for weight maintenance.
Seventy-eight men and women (22 to 67 years old) from the Dietary Effects on Lipoprotein and Thrombogenic Activity (DELTA) study participated in this study. All 24-hour recalls were collected using a computer-assisted, interactive, multiple-pass telephone interview technique. Energy requirements for each individual were determined by the energy content of the DELTA study foods provided to maintain weight.
Paired and independent t tests were conducted to examine differences among study variables. Agreement between recalled energy intake and weight maintenance energy intake was analyzed using the Bland-Altman technique.
Compared with weight maintenance energy intake, during the self-selected diet period men and women underestimated energy intake by 11% and 13%, respectively. During the controlled diet period, men underestimated energy intake by 13%, whereas women overestimated energy by 1.3%.
Men had a tendency to under-estimate energy intake irrespective of the recording period. The accuracy of the recalled energy intake of women may be influenced by recording circumstances. Researchers should examine the factors influencing underreporting and overreporting by individuals and their impact on macronutrient and micronutrient intakes. Also, strategies need to be developed to minimize underreporting and overreporting.
To investigate the effects of alcohol on appetite and food intake, 26 males attended the laboratory on three occasions. On each occasion, they were given a standard breakfast. Visual analog scale ratings of hunger, desire to eat and fullness (appetite ratings) were recorded from before breakfast until their return to the laboratory for lunch. Thirty minutes before lunch, subjects either rested (baseline), were given 330 ml of a no-alcohol lager (264 kJ: no-alcohol condition) or 330 ml of the same lager spiked with 3 units of alcohol (24 g ethyl alcohol; total energy=969 kJ: alcohol condition). Ratings of appetite were taken before and after the preload or baseline rest period and again before and hourly after lunch. The test meal at lunch consisted of a buffet-style array of foods and chilled water. Ad libitum intake at lunch (excluding energy from alcohol) was significantly higher following alcohol (7301+/-442 kJ) compared to both baseline (6365+/-334 kJ) and the no-alcohol conditions (6479+/-289 kJ). Appetite ratings failed to demonstrate any differences between alcohol and the no-alcohol condition. Total energy intake (including energy from alcohol) was enhanced in the alcohol condition by 30%, suggesting that energy from alcohol is not compensated in the short-term and may even have a stimulatory effect on food intake.
Recent increases in the prevalence of obesity worldwide are suggested to be caused largely by an environment that promotes sedentariness and excessive food intake.
We investigated associations of body mass index (BMI) and obesity with physical activity, food choices, alcohol consumption, and smoking history. In addition, we examined the consistency of these associations over time, with the aim of assessing whether the significance of lifestyle variables as correlates of obesity increased over a 15-y period.
Independent cross-sectional surveys were carried out in 1982, 1987, 1992, and 1997. Altogether, 24604 randomly selected men and women (aged 25-64 y) participated in these surveys. The subjects' weights and heights were measured, and data on lifestyle were collected with self-administered questionnaires.
In men and women, perceived general health, leisure-time physical activity, and daily vegetable consumption were inversely associated with obesity, as were bread consumption in women and activity at work in men. Consumption of sausages, milk, and sour milk and heavy work (in women only) were positively associated with obesity. Obesity was also associated with alcohol consumption and smoking history. Most associations were constant over the 15-y period. However, the inverse associations of BMI with physical activity in women and with perceived health in men seemed to strengthen over time.
A physically active lifestyle with abstention from smoking, moderate alcohol consumption, and consumption of healthy foods maximizes the chances of having a normal weight. The significance of avoiding sedentariness increases over time as a factor associated with normal weight.
Previously, it has been reported that energy consumed as alcohol prior to lunch does not result in subsequent reductions in voluntary food intake, and in some situations alcohol can increase subsequent appetite. The present study extends these findings by examining the effects of beliefs about alcohol content. Eighteen unrestrained men ate lunch 20 min after a preload of either water, an alcoholic beer or a non-alcoholic beer matched for energy content. Food intake was significantly less following the non-alcoholic beer than after alcohol or water, but when preload energy was included subjects had a higher overall energy intake on the day they consumed alcohol compared with both water and no-alcohol conditions. There were no significant differences in hunger or fullness ratings following the three drinks before or after the test meal, but the specific relationship between rated hunger and intake within the test meal was altered by the drink manipulation. The rate at which hunger decreased, and fullness increased, was slower after alcohol than after water or no-alcohol. The drinks did not alter the pleasantness of the test meal or increase hunger at the start of eating. When contrasted with previous work, these data confirm that alcohol consumed before lunch fails to reduce subsequent food intake, but also suggests that changes in rated appetite are influenced by beliefs about alcohol content.
To evaluate the reproducibility of, and to compare and calibrate, diet measures by the Northern Sweden 84-item food-frequency questionnaire (FFQ) with measures from 24-hour diet recalls (24-HDR).
Randomly selected respondents from the EPIC (diet-cancer) and MONICA (diet-cardiovascular disease) study cohort in Northern Sweden were invited to answer the FFQ twice over a one-year interval (FFQ1 and FFQ2), and to complete ten 24-hour recalls (reference method) in the months between. Plasma beta-carotene concentrations were determined from a subset of 47 participants.
Västerbotten and Norrbotten, Northern Sweden.
Ninety-six men and 99 women, who completed the study.
The reproducibility of the FFQ was high in terms of both mean energy and nutrient intakes and relative ranking of participants by intake levels (median Pearson correlation of 0.68). Moderately higher food intake frequencies were recorded by FFQ1 compared with 24-hour recalls for dairy products, bread/cereals, vegetables, fruits and potato/rice/pasta, whereas meat, fish, sweet snacks and alcoholic beverage intakes were lower. The median Spearman coefficient of correlation between FFQ1 and the average of ten 24-HDR measurements was 0.50. Daily energy and nutrient intakes were similar for FFQ1 and 24-HDR measurements, except for fibre, vitamin C, beta-carotene and retinol (FFQ1>24-HDR) and sucrose and cholesterol Pearson coefficients of correlation between FFQ1 and 24-HDR corrected for attenuation due to residual day-to-day variation in the 24-HDR measurements ranged from 0.36 to 0.79 (median 0.54). Adjustment for energy had only very moderate effects on the correlation estimates. Calibration coefficients estimated by linear regression of the 24-HDR on the FFQ1 measurements varied between 0.30 and 0.59 for all nutrients except alcohol, which had calibration coefficients close to 1.0. These low calibration coefficients indicate that relative risk estimates corresponding to an absolute difference in dietary intake levels measured by the FFQ will generally be biased towards 1.0. Plasma beta-carotene levels had a Pearson coefficient of correlation of 0.47 with the 24-HDR measurements, and of 0.23 with FFQ1 measurements.
The Northern Sweden FFQ measurements have good reproducibility and an estimated level of validity similar to that of FFQ measurements in other prospective cohort studies. The results from this study will form the basis for the correction of attenuation and regression dilution biases in relative risk estimates, in future studies relating FFQ measurements to disease outcomes.
Alcohol abusers' and non-abusers' attentional distraction for alcohol-related, concern-related, and neutral stimuli was assessed with the emotional Stroop paradigm. Alcohol abusers (n=14) were tested on admission to inpatient treatment and immediately before discharge, 4 weeks later; non-abusers (n=16) were also tested twice, with a 4-week intervening interval. Alcohol abusers were assessed for alcohol use 3 months after discharge. Unlike control participants and alcohol abusers whose treatment was successful, alcohol abusers whose treatment was unsuccessful (who relapsed or did not maintain post-discharge outpatient contact) had a significant increase in attentional distraction for alcohol stimuli during the 4 weeks of inpatient treatment. Compared to control participants and alcohol abusers who completed the 4 weeks of treatment, those who did not complete treatment (n=9) were highly distracted by concern-related stimuli at treatment admission. The results have implications for understanding the cognitive and motivational processes underlying successful treatment for alcohol abuse.
There is uncertainty as to whether regular alcohol consumption contributes directly to weight gain and the risk of obesity.
We examined the relation between alcohol intake and body weight and the association between changes in alcohol intake and in body weight over 5 y of follow-up.
This was a prospective study of 7608 men aged 40-59 y drawn from general practices in 24 British towns, excluding persons with known diabetes. Five years after screening, 6832 men then aged 45-64 y and without diabetes completed a postal questionnaire on changes in alcohol intake and body weight.
Mean body mass index (BMI; in kg/m(2)) and the prevalence of men with a high BMI (>or= 28; top quintile of the BMI distribution) increased significantly from the light-moderate to the very heavy alcohol intake group even after adjustment for potential confounders. Similar patterns were seen for all types and combinations of alcohol. After 5 y of follow-up, stable and new heavy drinkers (including very heavy drinkers of >or= 30 g/d) showed the greatest weight gain and had the highest prevalence rates of high BMI. Weight change patterns in heavy drinkers at baseline who reduced their intake were not significantly different from those in the stable none-occasional group but showed more weight loss and less weight gain than in the stable or new heavy drinkers.
Heavy alcohol intake (>or= 30 g/d) contributes directly to weight gain and obesity, irrespective of the type of alcohol consumed.
This observational validation study was conducted under controlled conditions to test the accuracy of dietary recall in normal weight, overweight, and obese men using the USDA five-step multiple-pass method for dietary recall.
Cross-sectional analysis of actual and recalled intake of food during 1 day.
Forty-two men ranging in age from 21 to 65 years and in body mass index from 21 to 39 kg/m(2) who lived in the metropolitan Washington DC area were studied.
The subjects selected and consumed all meals and snacks, for 1 day, from a wide variety of foods provided at a human study facility.
Actual and recalled energy, protein, carbohydrate, and fat intakes were determined by direct observation and by a 24-hour dietary recall, respectively. Dietary recall was determined via telephone administration of the USDA five-step multiple-pass method the following day.
Analysis of variance and covariance tested the overall accuracy of recall and the effect of body mass index on dietary recall. Bland-Altman plots were used to assess bias in recall of food intake.
In this population of men, there were no significant differences between actual and recalled intakes of energy (3,294+/-111 and 3,541+/-124 kcal/day), protein (117+/-5 and 126+/-5 g/day), carbohydrate (414+/-16 and 449+/-16 g/day), or fat (136+/-7 and 146+/-8 g/day), respectively. Accuracy of recall was not related to body mass index in that the obese men recalled food intake as accurately as the nonobese men. The energy intake of these men was significantly correlated (r=0.57, P<.05) with their estimated energy requirements. Significant interindividual variation in accuracy of recall was found.
Under controlled conditions, the USDA five-step multiple-pass method can accurately assess intakes of energy, protein, carbohydrate, and fat in a population of men regardless of their body mass index. Researchers and clinical dietitians need to continue to examine factors that influence underreporting and overreporting of food intake by the multiple-pass 24-hour recall method.
To examine the potential dose-response effect of alcohol on appetite and food intake, 12 males attended the laboratory on three occasions. On each occasion, they were given a standard breakfast, then lunch 3 h later, and dinner, 4 h after that. Thirty minutes before lunch, Ss received 330 ml of no-alcohol lager (263 kJ: no-alcohol condition), the same amount of lager spiked with 1 unit (1 UA: 8 g ethyl alcohol, 498.2 kJ) or 4 units of alcohol (4 UA: 32 g ethyl alcohol, 1203.8 kJ). Visual analogue scale (VAS) ratings of appetite and mood were recorded before and after preloads and lunch, then hourly across the day. Intake at lunch (excluding energy from the preload) was significantly higher following 4 UA (5786+/-991 kJ) compared to 1 UA (4928+/-1245 kJ). Participants consumed more high-fat salty food items at lunch following 4 UA compared to the other preloads. Hunger was rated higher following 4 UA across the day in comparison to the other preloads, but fullness ratings failed to reflect any difference by condition. Energy intake at dinner was similar in all conditions and total energy intake across the day was significantly higher after 4 UA (14,615+/-1540 kJ) than after 1 UA (13,204+/-2156 kJ). In conclusion, above a certain threshold, alcohol appears to stimulate appetite in part, due to elevated levels of subjective hunger. When this occurs, energy intake is not reduced at subsequent meals. Thus, alcohol may contribute to positive energy balance via its additive effects to total energy intake and by short-term appetite stimulation.
Impulsivity is now widely viewed as a multidimensional construct consisting of a number of related dimensions. Although many measures of impulsivity are correlated, most recent factor analyses support at least a two-factor model. In the current paper, these two factors have been labelled reward sensitivity, reflecting one of the primary dimensions of Gray's personality theory, and rash-spontaneous impulsiveness. The evidence supporting the existence of two dimensions of impulsivity is reviewed in relation to substance misuse and binge eating.