Obesity modifies the association between diabetes and iron biomarkers and red cell indices in reproductive-aged women in the United States.

Obesity and diabetes are associated with impaired iron metabolism. We aimed to examine the independent relationship between diabetes and iron after controlling for body weight (or obesity) in women aged 20-49 years. The National Health and Nutrition Examination Survey data from 2015 to 2018 were used in this investigation. Body composition data, HbAc1, iron biomarkers (serum ferritin (SF), soluble transferrin receptor (sTfR), and body iron index (BII)), mean corpuscular volume (MCV), mean hemoglobin concentration (MCH), red cell distribution width (RDW), and hemoglobin were used. Linear regression models were used to examine how and to what extent body mass index (BMI) modified the relationship between diabetes and iron status biomarkers. A total of 1834 women aged 20-49 were included in the analysis with a mean (SD) age of 32 .2 ± 6.1 years and BMI of 29.5 ± 6.9 kg/m2. The mean SF (p = 0.014) and BII (p < 0.001) were lower, while sTfR (p < 0.001) was higher in women with diabetes than those with no diabetes. Mean estimates for MCV and MCH were lower, while RDW (p = 0.001) was higher in diabetes patients (all p < 0.001). Women with diabetes were more likely to have iron deficiency, anemia, and iron deficiency anemia than those without diabetes (18.1% vs 8.6%, p < 0.001), (24.4% vs 8.4%, p < 0.001), and (14.8% vs 5.2%, p < 0.001), respectively. Among women with obesity, those with diabetes had lower predicted ferritin (ß = -0.19, p = 0.016), BII (ß = -0.99, p = 0.016), and hemoglobin (ß = -0.27, p = 0.042) than those without diabetes. The study shows that diabetes is linked to lower iron stores; this is exacerbated in those with obesity.

Decreased salivary alpha-amylase reactivity for excluded young women after a speech task.

Salivary alpha-amylase (sAA) has gained popularity as an easily collected biomarker for sympathetic nervous system activation, and research has shown increases in sAA after completing experimental stress tasks in certain groups. However, recent work suggests that salivary cortisol, another stress biomarker, is suppressed after a speech task among experimentally induced exclusion in young women. The present analysis investigated the sAA response in biologically female undergraduates (n=31) who completed a game of Cyberball and then a speech anticipation task. Results showed that women in the social exclusion experimental group had a greater decrease in sAA compared to young women in the inclusion group after the speech task. Results of this study provide support for stress response suppression in women who have experienced social exclusion. The present findings provide pilot evidence for future, larger studies to advance the tend-and-befriend theory.

Associations between adverse childhood experiences and history of weight cycling.

Background: Adverse childhood experiences (ACEs) predict obesity onset; however, the relationship between ACEs and history of weight cycling has not been adequately explored. This gap is problematic given the difficulty in weight loss maintenance and the impact of ACEs on obesity development, chronicity, and associated weight stigma. The objective of this study was to examine associations between self-reported history of ACEs and weight cycling in a sample of weight loss treatment-seeking adults with overweight/obesity. Methods: The number of participants in the analyzed sample was 78, mostly white educated adult women (80% female, 81% Caucasian, 75% ≥ bachelor's degree) with excess adiposity enrolled in the Cognitive and Self-regulatory Mechanisms of Obesity Study. ACEs were measured at baseline using the ACEs Scale. History of weight cycling was measured using the Weight and Lifestyle Inventory that documented weight loss(es) of 10 or more pounds. Results: Higher ACE scores were associated with a greater likelihood of reporting a history of weight cycling. Participants with four or more ACEs had 8 times higher odds (OR = 8.301, 95% CI = 2.271-54.209, p = 0.027) of reporting weight cycling compared with participants with no ACEs. The association of weight cycling for those who endorsed one to three ACEs was not significant (OR = 2.3, 95% CI = 0.771-6.857, p = 0.135) in this sample. Conclusions: The role of ACEs in health may be related to associations with weight cycling. Results indicated that those who reported four or more ACEs had significantly higher odds of reporting weight cycling compared with those with no ACEs. Further research is needed to further explore how ACEs predict the likelihood of weight cycling, which may be prognostic for sustained weight loss treatment response and weight stigma impacts.

Adverse childhood experiences and obesity linked to indicators of gut permeability and inflammation in adult women.

Gut permeability may increase cardiovascular disease risk by allowing bacterial components (e.g., lipopolysaccharide or LPS) to enter the bloodstream, leading to low-grade inflammation. People with adverse childhood experiences (ACEs) consistently display evidence of chronic inflammation, but the source of this inflammation, and whether gut permeability may contribute, is unknown. Moreover, whether ACE status may further perturb obesity-associated gut permeability and inflammation is unknown. Women (N = 79, aged 18-84y) free of cardiometabolic diseases and inflammatory conditions and not regularly taking anti-inflammatory medications were included in a 2 × 2 factorial design with low or high ACE status (either 0 ACEs or 3+ ACEs) and body mass index (BMI) (either normal-weight [18.5-24.9 kg/m2; NW] or obesity [>30 kg/m2; OB]) as factors (n = 15-27/group). Serum LPS binding protein (LBP), soluble CD14 (sCD14), fatty-acid binding protein-2 (FABP2), LPS core IgM, and the ratio of LBP:sCD14 were used as indicators of gut permeability. Inflammatory markers C-reactive protein (CRP), tumor necrosis factor (TNF)-α, and interleukin (IL)-6 were also measured. Data were analyzed using 2-way ANCOVA (age-adjusted). LBP, LBP:sCD14 and FABP2 were higher in OB versus NW, regardless of ACE status (PBMI < 0.05). Higher ACE status was associated with increased circulating LBP:sCD14 and LPS core IgM (PACE < 0.05). sCD14 was unrelated to BMI or ACEs. CRP was elevated in OB versus NW (PBMI < 0.001) and tended to be higher with 3+ ACEs compared to 0 ACEs (PACE = 0.06). Moreover, TNF-α was greater in 3+ ACEs relative to 0 ACEs (PACE = 0.03). IL-6 was unrelated to BMI or ACE status. No interaction effects were observed for any marker of gut permeability or inflammation. In sum, ACE status and obesity were independently associated with evidence of gut permeability and systemic inflammation but did not interact in relation to indicators of gut permeability.

Hypocortisolemic reactivity to acute social stress among lonely young women.

We examined biopsychosocial stress of acute social pain in relation to chronic loneliness. Hypotheses: 1) Cyberball exclusion (vs. inclusion) would be associated with lower cortisol reactivity to a speech task, and 2) loneliness would moderate the relationship between social exclusion and cortisol reactivity to a speech task, such that higher loneliness would be linked to lower cortisol. Participants (n = 31, women, aged 18-25, 51.6% non-Hispanic white) were randomized to be excluded or included in a game of Cyberball, then completed a speech task. Salivary cortisol was measured at baseline, pre-speech, post-speech, and 15 minutes post-speech. Cortisol reactivity was calculated using area under the curve-increase (AUCi). ANOVA revealed a non-significant, meaningful effect of Cyberball exclusion on cortisol AUCi (p=.103, ηp2=.10), accounting for contraceptive use. Moderation analysis revealed among women with high loneliness, women in the exclusion condition had significantly lower cortisol reactivity than women in the inclusion condition (p=.001). For women with low and medium loneliness, there were no significant differences by Cyberball condition. In sum, lonely young women who are excluded may have hypocortisolemic responses to social stress. Results are consistent with literature suggesting that chronic stress is linked to lower cortisol responses, which is linked to negative physical health outcomes.

Iron Deficiency and Iron Deficiency Anemia in Women with and without Obesity: NHANES 2001-2006.

Obesity has been linked to numerous health and nutritional problems, including impaired iron metabolism, a common cause of anemia. We aimed to determine the prevalence of anemia, iron deficiency (ID), and iron deficiency anemia (IDA) among women aged 20-49 years based on body mass index (BMI) status. We used measures of iron status and body mass index from the 2001-2006 National Health and Nutrition Examination Survey (NHANES). Mean serum ferritin, erythrocyte protoporphyrin, and soluble transferrin receptor were higher, while those of serum iron, percent transferrin saturation, and mean cell volume (MCV) were lower in women with obesity than those with normal weight (all p < 0.016). ID based on the ferritin model was 12.5 ± 1.0% vs. 22.9 ± 1.6% (p < 0.001); 9.0 ± 0.9% vs. 20.0 ± 1.3% (p < 0.001) based on the MCV model; and 8.1 ± 1.0% vs. 10.5 ± 1.2% (p > 0.05) based on the BII model for women with normal weight and women with obesity, respectively. Anemia prevalence was 5.5 ± 0.8% (normal) vs. 9.3 ± 1.0% (obese) (p = 0.005). The IDA estimates based on the ferritin and MCV models were similar but higher than that from the BII model (p < 0.001). Generally, the prevalence rates of ID and anemia (and IDA) were higher for women with obesity, but the method used to define deficiency mattered. The choice of iron indices is important for estimating ID and IDA in populations with obesity.

Parents of Children With High Weight Are Viewed as Responsible for Child Weight and Thus Stigmatized.

Courts in seven U.S. states have removed children with "obesity" from parental custody until children could maintain "healthy weights." These rulings-alongside qualitative reports from parents of children with high weight (PoCHs)-suggest that PoCHs are judged as bad parents. Yet little work has tested whether people genuinely stigmatize PoCHs or what drives this phenomenon. In three experiments with U.S. online community participants (N = 1,011; two preregistered), we tested an attribution theory model: Social perceivers attribute children's weights to parents and thus stigmatize those parents. Experiments 1 and 2 support this model (across parent and child gender). Experiment 3 manipulated attributions of parental responsibility for child weight, revealing attenuated stigma with low attributions of responsibility. Findings are among the first to describe and explain stigma toward a large demographic (parents of children with obesity)-with real-world implications (e.g., for family separation, health care)-and may additionally illuminate the psychology underlying stigma toward parents of children with other potentially stigma-evoking identities.

Does Loneliness Mediate the Relationship Between Adverse Childhood Experiences (ACEs) and Pain Catastrophizing Among Women?

Most adults in the United States report experiencing at least one adverse childhood experience (ACE), with around a quarter of the population reporting three or more. ACEs impact adult biological (e.g., hypothalamic-pituitary-adrenal axis) and psychosocial (e.g., loneliness) functioning, including cognitive patterns in stressful situations. As one example, pain catastrophizing is an emotional and cognitive reaction to pain that is closely related to low distress tolerance. We hypothesized that women with more ACEs would report greater levels of pain catastrophizing in adulthood, an effect potentially mediated via higher levels of loneliness (i.e., perceived lack of social support). Biologically female participants (N=109; 39.8±14.0 years of age; 83.5% white) were recruited through Mechanical Turk and a university online recruitment tool, and completed an online survey including demographics, the 10-item Adverse Childhood Events Scale, the 13-item Pain Catastrophizing Scale, and the 20-item UCLA Loneliness Scale Version 3. A bootstrapped mediation analysis examined the relationships between ACEs and pain catastrophizing via loneliness. Results indicated that loneliness had a significant indirect effect on the relationship between ACEs and pain catastrophizing (indirect effect=0.69; 99% CI=0.15-1.40) such that increased ACEs were related to greater loneliness, which, in turn, was related to greater pain catastrophizing. The present study adds to the literature by suggesting that loneliness is a possible mechanism by which ACEs adversely impact cognitive and emotional well-being in adulthood. Per social cognitive theory, loneliness influences social cognitions, which might make dealing with stressful situations such as pain more difficult and, therefore, increase one's catastrophic thinking patterns.

Does seeking the brawns impact the brain?: An investigation of muscularity-oriented disordered behaviors and cognitive function.

Shifts in body-image ideals over the past 30 years towards leaner, muscular bodies have revealed new health behaviors that may be related to cognitive function. This study objective was to investigate prospective associations between a drive for muscularity and/or muscularity-oriented disordered behaviors (MODBs) with cognition. Data were drawn from Add Health, a nationally representative longitudinal cohort dataset. Drive for muscularity and MODB engagement were assessed in emerging adulthood (ages 18-26). Cognition was measured via immediate word recall, delayed-word recall, and number recall at 7-years later (ages 24-32). Analyzes were conducted in 1976 participants with available data. A one-way ANCOVA revealed that those with a drive for muscularity had lower immediate word recall (F(3, 12,819) = 3.845, p = .009) and delayed word recall (F(3, 12,807) = 5.933, p < .001) scores than other weight goal groups adjusting for covariates. Hierarchical linear regressions between individual MODBs and cognitive outcomes showed that legal performance-enhancing substance use (ßs = 0.06-0.07, p < .05) and exercise (ß = 0.06, p < .05) were positively associated with some cognition scores. Conversely, lifting weights (ß = - 0.06, p < .05) and eating different foods than usual (ß = - 0.05, p < .05) exhibited negative associations with some of the cognitive outcomes. Future research should be conducted to examine other potential outcomes related to the drive for muscularity and associated MODBs.

Associations between Internalized Weight Stigma and Visceral Adipose Tissue Status are Observed in Women but not Men.

Purpose: This study investigated the relationship between internalized weight stigma (IWS) and visceral adipose tissue (VAT), an independent predictor of cardiometabolic disease risk, and how this relationship is moderated by gender. Methods: Participants (N=70, 81% white, 51% women, M age=30.4±7.8 years, M BMI=28.7±5.5 kg/m2, M BF%=32.4±8.9%) completed in-lab measures of demographic factors (age, gender, race/ethnicity), IWS (Weight Bias Internalization Scale-Modified; WBIS-M) and visceral adiposity. VAT mass was measured via DXA. Primary moderation analysis investigated the effect of gender on associations between IWS and VAT mass. Covariates were age, race/ethnicity, and total body fat percent. Results: After adjusting for covariates in the primary moderation analysis, WBIS-M scores displayed a positive association with VAT mass (b=32.58, p=0.033). The relationship between WBIS-M scores and VAT mass was moderated by gender (b=68.63, p=0.020); no relationship between WBIS-M scores and VAT mass was observed in men (b=-2.71, p=0.894), whereas a positive association between WBIS-M scores and VAT mass was observed in women (b=65.92, p=0.003). Conclusions: Internalization of weight stigma was associated with greater visceral adiposity in women across the BMI spectrum, suggesting it as a chronic stressor. Future studies should investigate directionality and causality of this relationship to elucidate mechanisms of stigma-associated CVD risk.

Mindful acceptance, not awareness, associated with lower food susceptibility.

PURPOSE: Food susceptibility refers to an individual's thoughts, feelings, and motivations when highly palatable foods are available. Mindfulness, or the practice of paying attention, non-judgmentally, in the present moment, is a key element in acceptance-based programs, which have been shown to benefit those with high food susceptibility. This study examined the relationship between food susceptibility and (1) trait mindfulness and (2) mindfulness facets (i.e., awareness, acceptance) in daily life. METHODS: Participants were 108 adults with overweight/obesity (45.56 ± 11.41 years old, 75.9% white, 72.2% female) enrolled in a weight loss trial (Clinical Trials.gov Identifier: NCT02786238). Food susceptibility was measured with the Power of Food Scale (PFS). Mindfulness was assessed using the Philadelphia Mindfulness Scale (PHMS) and its two subscales: PHMS-Awareness and PHMS-Acceptance. Two regressions examined the associations of (1) total PHMS on PFS, and (2) simultaneous PHMS subscales on PFS. Covariates were age, sex, race, and education. RESULTS: Regression results revealed, after adjustment for covariates, that Total PHMS was significantly negatively associated with PFS scores (ß = - 0.258, p = 0.001), but only one of the PHMS subscales, Acceptance, was significantly associated with PFS scores (ß = - 0.328, p < 0.001). PHMS-Awareness was not related to PFS scores. CONCLUSION: Greater levels of mindfulness were associated with lower food susceptibility in treatment-seeking adults with overweight/obesity. Mindful acceptance may be the driving factor in this relationship, suggesting that awareness alone is not sufficient for promoting healthier appetite regulation. Interventions aimed to reduce food susceptibility and improve coping with cravings may benefit from an enhanced focus on teaching mindful-acceptance skills. LEVEL OF EVIDENCE: Level III, observational cohort study.

Baseline associations between biomarkers, cognitive function, and self-regulation indices in the Cognitive and Self-regulatory Mechanisms of Obesity Study.

OBJECTIVE: Understanding how biological, cognitive, and self-regulatory factors are related to obesity, and weight regulation is clearly needed to optimize obesity prevention and treatment. The objective of this investigation was to understand how baseline biological, cognitive, and self-regulatory factors are related to adiposity at the initiation of a behavioral weight loss intervention among treatment-seeking adults with overweight/obesity. METHODS: Participants (N = 107) in the Cognitive and Self-regulatory Mechanisms of Obesity Study (Identifier-NCT02786238) completed a baseline assessment with anthropometric, cardiometabolic, inflammatory, cognitive function, and self-regulation measures as part of a larger on-going trial. Data were analyzed with linear regression. RESULTS: At baseline, body mass index, body fat percentage, and waist circumference (WC) were positively associated with fasting insulin and insulin resistance. Higher WC was related to higher fasting glucose and hemoglobin A1c (HbA1c). Higher glucose and insulin resistance levels were related to lower list sorting working memory. Higher glucose and HbA1c levels were negatively associated with reading scores. Cognitive function and self-regulation indices were unrelated. CONCLUSIONS: In adults with overweight/obesity entering a weight loss treatment study: (1) elevated WC and associated glycemic impairment were negatively associated with cognition, (2) poorer executive function and reading abilities were associated with poorer glycemic control, and (3) objectively measured cognitive functions were unrelated to self-reported/behavioral measures of self-regulation. Such findings increase understanding of the relationships between adiposity, biomarkers, cognition, and self-regulation at treatment initiation and may ultimately inform barriers to successful obesity treatment response.

Temporal Relationships Between Pain During Intercourse (PDI), Loneliness, and Depressive Symptoms Among Women.

BACKGROUND: Painful sex can lead to increased psychological distress, including major depressive disorder, and the experience of loneliness may explain this association. AIMS: We aimed to investigate loneliness as a mediator between painful sex and depressive symptoms and hypothesized that women who experienced greater pain during intercourse (ie, more severe and more frequent pain) would endorse higher rates of loneliness and, in turn, higher rates of depressive symptoms at a 6-month follow-up. METHODS: Participants were 148 adults who were assigned female at birth (78.4% white, 77% partnered, 31.14 ± 10.9 years old) and completed an online, anonymous survey including the Female Sexual Function Index (FSFI), UCLA Loneliness Scale-3 (ULS), and demographic information. MAIN OUTCOME MEASURE: Depressive symptoms, measured via the Patient Health Questionnaire-8 (PHQ8) at baseline (T1) and 6-month follow-up (T2) were used as the outcomes of the present study. RESULTS: Painful sex and ULS at T1 were significantly correlated with each other and with PHQ8 at T1 (r = 0.590). However, change in PHQ8 from T1 to T2 was not significantly correlated with ULS (r = 0.024) or any other key study variables, indicating that that ULS was not a significant mediator of the relationship between painful sex at T1 and change in PHQ8 (standardized indirect effect = 0.011; 99% CI = -0.114 to 0.188). CONCLUSION: These findings are consistent with previous studies highlighting that painful sex is related to depressive symptoms through loneliness cross-sectionally, suggesting that future treatments for depressive symptoms among women who experience painful sex might target loneliness. Stout ME, Hawkins MAW. Temporal Relationships Between Pain During Intercourse (PDI), Loneliness, and Depressive Symptoms Among Women. Sex Med 2021;9:100444.

Assessing neuropsychological phenotypes of pediatric brain tumor survivors.

INTRODUCTION: Pediatric brain tumor survivors (PBTS) are at risk for both neurocognitive impairments and psychological difficulties, yet these two domains have historically been discretely examined, with assessment of psychosocial outcomes rarely included in studies of cognitive outcomes. Taking a person-centered approach, the current study aimed to more comprehensively evaluate PBTS late effect profiles, including both neurocognitive and psychological sequelae, and predictors of these profiles. METHOD: PBTS (N = 89) were assessed in a pediatric neuropsychological clinic between May 2009 and May 2018, diagnosed at least 1 year prior, and off-treatment for at least 3 months (Mage  = 6.57 years, SD = 4.53; 46.1% female). Parent- and teacher-report of psychological symptoms, and performance-based measures of neurocognitive functioning were examined using latent profile analysis. The R3STEP procedure identified predictors of class membership. RESULTS: The optimal model identified four classes characterized by: (1) average functioning across all measures ("Average," n = 47), (2) average psychosocial functioning and impaired neurocognitive functioning ("Cognitive Deficit," n = 25), (3) elevated social problems and significant neurocognitive impairments ("Social/Cognitive Deficit," n = 9), and (4) impaired visual planning and problem-solving and elevated parent-reported psychosocial problems, but average processing speed, working memory, and teacher-reported psychosocial outcomes ("Discrepant," n = 8). Ethnicity, race, radiation treatment, and diagnoses of neurofibromatosis 1, hydrocephalus, and cerebellar mutism syndrome were significant predictors of class membership (ps < 0.05). CONCLUSION: The present study identified distinct phenotypes with unique patterns of relations among neurocognitive and psychological domains. These findings are a vital first step toward identifying those at highest risk for poor outcomes and informing interventions that effectively address interrelated treatment targets for specific groups.

Associations between Adverse Childhood Experiences and Performance-Enhancing Substance Use among Young Adults.

BACKGROUND AND OBJECTIVE: Adverse childhood experiences (ACEs) are associated with negative health outcomes, yet their associations with performance-enhancing substance (PES) use are unclear. This study aimed to determine whether ACEs predict greater use of legal and illegal PES in young adults. METHODS: We analyzed data from the National Longitudinal Study of Adolescent to Adult Health (n = 14,322), Waves I (1994-1995) and III (2001-2002). ACEs included childhood sexual abuse, physical abuse, two neglect indicators, and cumulative ACEs. Legal (e.g. creatine monohydrate) and illegal (e.g. non-prescription anabolic-androgenic steroids; AAS) PES use was assessed. RESULTS: Sexual abuse had the greatest effect and predicted higher odds of legal PES use (men: adjusted odds ratio [AOR] 1.66, 95% confidence interval [CI] 1.06-2.59; women: AOR 3.74, 95% CI 1.63-8.59) and AAS use (men: AOR 8.89, 95% CI 5.37-14.72; women: AOR 5.73, 95% CI 2.31-14.18). Among men, a history of physical abuse (AOR 3.04, 95% CI 2.05-4.52), being left alone by a parent/guardian (AOR 2.33, 95% CI 1.50-3.60), and basic needs not being met (AOR 3.47, 95% CI 2.30-5.23) predicted higher odds of AAS use. Among women, basic needs not being met (AOR 2.94, 95% CI 1.43-6.04) predicted higher odds of AAS use. Among both men and women, greater number of cumulative ACEs predicted higher odds of both legal and illegal PES use. CONCLUSIONS: ACEs predict greater PES use among young adults. Clinicians should monitor for PES use among those who have experienced ACEs and provide psychoeducation on the adverse effects associated with PES use.

Adverse childhood events and cognitive function among young adults: Prospective results from the national longitudinal study of adolescent to adult health.

BACKGROUND: Adverse childhood experiences (ACEs) may have lasting impacts on cognition. OBJECTIVE: To determine if ACE exposure is prospectively associated with cognition in young adults. We hypothesized that deprivation- and threat-type ACEs as well as higher cumulative ACE exposure predict poorer cognition. PARTICIPANTS & SETTING: Participants were from the National Longitudinal Study of Adolescent to Adult Health (Add Health), a prospective cohort investigation of U.S. adolescents followed to adulthood. Current study participants were 18-24 years old (Wave III), 24-32 years old (Wave IV), and 31-42 years old (Wave V). The maximum Wave IV sample was 12,288 adults; Wave V was 1277 adults. METHODS: History of ACEs were assessed at Wave III. Three cognitive indicators were assessed at Wave IV and Wave V using the Rey Auditory Verbal Learning Test (immediate and delayed verbal memory) and the Digit-Span Backward Task (working memory). RESULTS: The deprivation ACE of not-having-basic-needs met was associated with poorer working (ß = 0.14, CI95 -0.26, -0.01), immediate (ß=-0.29, CI95 -0.43, -0.15), and delayed memory (ß=-0.27, CI95 -0.43, -0.12) at Wave IV; poorer immediate (ß=-0.47, CI95-0.79, -0.16) and delayed memory (ß=-0.33, CI95 -0.65, -0.01) at Wave V. The threat ACE of sexual abuse was associated with poorer immediate (ß=-0.40, CI95 -0.62, -0.17) and delayed memory (ß=-0.29, CI95 -0.55, -0.03) at Wave IV. Higher cumulative ACEs predicted poorer delayed memory (ß =-0.05, CI95 -0.10, -0.01) at Wave V. CONCLUSIONS: Higher ACEs, especially deprivation-type, were prospectively linked to poorer cognition. Early wide-scale screening/tailored treatments addressing ACEs and cognitive function may be warranted.

Pilot Trial of Acceptance-Based Behavioral Weight Loss and Neurocognition Among American Indians.

Acceptance-based behavioral therapies (ABTs) for obesity may be superior to standard behavioral therapies but have not been adequately tested with American Indians (AIs). Neurocognitive function is also unexamined in relation to behavioral weight loss among AIs despite findings that neurocognition predicts outcomes in general samples, may help explain some of the benefits of ABTs, and may be relevant to marginalized groups. The primary objective of this pilot was to examine the feasibility/acceptability of ABT in an AI sample. Exploratory analyses examined the relationship between neurocognition and weight loss. Forty-eight AI adults with overweight/obesity (ages 43.3 ± 10.3 years, 85% female; baseline body mass index = 36.8 ± 4.4 kg/m2) enrolled in a 6-month open ABT weight loss trial. Feasibility indices, including screening/enrollment, session attendance, retention rates for posttreatment assessments, and program acceptability were examined. Percent weight loss (%WL) was assessed as well as fluid and crystalized neurocognition (National Institutes of Health Toolbox Cognition Battery [NIHTB-CB]). We enrolled 79% of the eligible sample and retained 75% (N = 36) at posttreatment assessments. Program completers lost an average of 5.2 ± 4.9% of initial body weight (dz = 1.14), whereas intent-to-treat analyses show a mean loss of 4.1 ± 4.7%. Participants reported high satisfaction, effectiveness, and cultural appropriateness. Exploratory analyses of neurocognitive domains suggested that crystalized cognition was higher among completers, and higher baseline cognitive flexibility predicted greater %WL (ß = .34, p = .05). ABT resulted in clinically significant weight loss in an AI sample. A controlled trial of ABT in a larger, more diverse sample is warranted to determine whether (a) the findings are robust, generalizable, and/or superior to other treatments and (b) neurocognitive factors moderate outcomes.

Adverse Childhood Experiences Associated with Greater Internalization of Weight Stigma in Women with Excess Weight.

Adverse childhood experiences (ACEs) may be an early life factor associated with adult weight stigma via biological (e.g., stress response), cognitive (e.g., self-criticism/deprecation), and/or emotional (e.g., shame) mechanisms. This pilot study investigated relationships between ACEs and internalized and experienced weight stigma in adult women with overweight/obesity and explored differential relationships between weight stigma and ACE subtypes (i.e., abuse, neglect, household dysfunction). Adult women (68% white, M age = 33 ± 10 years, M BMI = 33.7 ± 7.2 kg/m2) completed measures of ACEs (ACE Questionnaire), internalized weight stigma (IWS; Weight Bias Internalization Scale-Modified; WBIS-M), and lifetime experiences of weight stigma (yes/no). Data were analyzed with linear and logistic regression (n = 46), adjusting for age, race, and body mass index (BMI). Linear regressions revealed a positive association between ACE and WBIS-M scores (ß = 0.40, p = 0.006), which was driven by Abuse-type ACEs (ß = 0.48, p = 0.009). Relationships between WBIS-M scores and Neglect- and Household-Dysfunction-type ACEs did not reach significance (ß = 0.20, p = 0.173; ß = -0.16, p = 0.273). Though descriptive statistics revealed greater rates of experienced weight stigma endorsement by those with high-3+ ACEs (81%) vs. medium-1-2 ACEs (67%) or low/no-0 ACEs (60%), ACE scores were not significantly associated with experienced weight stigma in logistic regression (Wald = 1.36, p = 0.244, OR = 1.324, 95%, CI = 0.825-2.125). ACEs may be an early life factor that increase the risk for internalizing weight stigma in adulthood. Larger studies should confirm this relationship and follow-up on descriptive findings suggesting a potential association between ACEs and experienced weight stigma.

Adverse childhood experiences and cognitive function among adults with excess adiposity.

BACKGROUND: Adverse childhood experiences (ACEs) and obesity are independently associated with brain/neurocognitive health. Despite a growing emphasis on the importance of early life adversity on health, the relationship between ACEs and neurocognition in adults with overweight/obesity is unclear. The objective was to examine associations between self-reported ACEs and measured neurocognitive domains in a sample of adults with overweight/obesity. METHODS: Participants were 95 predominantly white, highly educated adult women (76% female, 81% Caucasian, and 75% ≥ bachelor's degree) with excess adiposity enrolled in the Cognitive and Self-regulatory Mechanisms of Obesity Study. ACEs and fluid/crystallized neurocognitive domains were measured at baseline using the Adverse Childhood Experiences Scale and the NIH Toolbox Cognition Battery and Automated Neuropsychological Assessment Metric, respectively. RESULTS: Higher ACEs scores were negatively correlated with fluid cognition (r = -.34, P < .001) but not crystallized cognition (r = .01, ns). Individuals with 3 and 4+ ACEs displayed significantly lower fluid cognition scores than those with fewer ACEs F 4,89 = 3.24, P < .05. After accounting for body mass index (BMI), age, sex, race, and education, higher ACEs scores were still associated with poorer performance on overall fluid cognition (ß = -.36, P < .01), along with the following subtests: Stroop Colour/Word test (ß = -.23, P < .05), Go/No-Go omissions (ß = .29, P < .01), and Picture Sequence Memory task (ß = -.30, P < .01). CONCLUSIONS: The role of ACEs in health may be related to their associations with executive function and episodic neurocognitive domains essential to cognitive processing and self-regulation. Obesity science should further examine the role of ACEs and neurocognition in obesity prevention, prognosis, and treatment using more rigorous, prospective designs and more diverse samples.

Cognitive dysfunction is a risk factor for overeating and obesity.

This article introduces the rapidly growing literature linking cognitive dysfunction to overeating and obesity. Though neural responses to food and food cues can predispose individuals to overeating, these processes are moderated by a series of cognitive factors. Deficits in attentional bias, delay discounting, and episodic memory have clear connections to overeating in both laboratory and real-world settings. New weight loss interventions target these deficits through strategies designed to either directly improve cognitive function or circumvent them by tailoring weight management strategies to individuals' specific cognitive profile. Future iterations of these interventions should better account for the influence of obesity-related risk factors such as poor sleep, high stress, socioeconomic burden, and prevalent medical risk factors. In so doing, future work may lead to treatment strategies that promote healthy eating and weight for a lifetime. (PsycINFO Database Record (c) 2020 APA, all rights reserved).