The association between COVID-19 related income loss and diet quality: The mediating role of distress.

The COVID-19 lockdowns saw many individuals lose income, experience distress and increase intake of foods that would typically be considered less 'healthy' (more processed and less fresh produce). Establishing whether there are direct and indirect links between these variables would be of benefit in preparing for similar future events but also has implications for the current global financial climate, where many are experiencing relative decreases in income. Adults in two locations (UK and Australia) (N = 917) completed online questionnaires to explore the impact of the first COVID-19 lockdown on their change in income, emotional wellbeing (depression, anxiety, stress, loneliness), resilience and diet quality. A structural equation model revealed that income loss was indirectly associated with diet quality via distress. As such, the greater the loss of income experienced, the more distress reported; distress was then directly associated with a less nutritious diet. This pattern of results existed when data from both countries were combined but also when they were modelled individually. Our findings indicate that where individuals experience a sudden reduction of income there are likely to be negative consequences for both mental and physical health. It is plausible that these findings would extend to other circumstances in which sudden loss of income may be experienced such as reductions in state social care, rising inflation and interest rates and sudden increases to the general cost of living.

The development and validation of the food insecurity physical activity concerns scale.

Food insecurity - defined as having limited access to nutritious foods - is linked with obesity. Previous research has also shown that food insecurity is associated with lower levels of leisure-time physical activity (physical activity performed outside of essential activities). This association may occur in part due to concerns about preserving levels of energy during times of food shortage. Currently, no scale exists which measures this construct. Therefore, we aimed to develop and validate such a scale - the food insecurity physical activity concerns scale (FIPACS). Participants (N = 603, individuals with food insecurity = 108) completed an online survey, consisting of the FIPACS, the International Physical Activity Questionnaire short-form (IPAQ), the restraint subscale of the Dutch Eating Behaviour Questionnaire (DEBQ), the amotivation subscale of the Behaviour Regulation In Exercise Questionnaire-2 (BREQ-2), and the Behavioural Inhibition System/Behavioural Approach System Reactivity scale (BIS/BAS) to assess convergent and divergent validity. An exploratory factor analysis revealed a four-factor model of the FIPACS - namely 'Concerns relating to hunger', 'Concerns of replenishment and calories', 'Concerns of physiological effects of exercise' and 'Compensatory behaviours' which was verified through a confirmatory factor analysis. To assess test-retest reliability, 100 participants completed the FIPACS again two weeks later. The FIPACS had good internal, test-retest reliability and divergent validity. However, there was limited evidence of convergent validity. Future studies could incorporate this scale when investigating the association between food insecurity and physical activity.

The association between COVID-19 related food insecurity and weight promoting eating behaviours: The mediating role of distress and eating to cope.

Food insecurity (a lack of stable access to nutritious food) is reliably associated with higher BMI, although the underlying mechanisms are unclear. Past research indicates that this relationship may, in part, be explained by the distress of being food insecure and using food as a coping mechanism. While previous work has focused on long-term food insecurity, the first COVID-19 national lockdown presented a unique opportunity to establish if the same relationships existed for individuals experiencing pandemic related food insecurity. Adults in the United Kingdom (N = 211) were recruited three months after the first UK lockdown via social media. They completed questionnaires on COVID-19 related food insecurity, physical stress, psychological distress, eating to cope, drinking to cope, diet quality, and changes in weight promoting eating behaviours (e.g. consuming larger portions, increased snacking) since the start of the lockdown. A structural equation model revealed that food insecurity was indirectly associated with changes in weight promoting eating behaviours. As predicted, the more instances of pandemic related food insecurity, the more distress individuals reported. Distress was then associated with eating as a way of coping, which in turn was associated with increases in weight promoting eating behaviours. Food insecurity was also indirectly associated with diet quality, but this was via distress only. These results reflect similar pathways observed in individuals reporting chronic food insecurity and strengthens the evidence that distress and eating to cope are generic mediators of food insecurity and eating behaviour.

Household Food Insecurity, Diet Quality, and Obesity: An Explanatory Model.

OBJECTIVE: Food insecurity (a lack of stable access to nutritious food) is reliably associated with poor diet, malnutrition, and obesity; however, the underlying mechanisms are unclear. In this study, the hypothesis that these relations are explained by higher levels of distress, which are due to the experience of food insecurity, and unhealthy coping behaviors (eating high-calorie foods, drinking alcohol) was tested. METHODS: Adults from the United Kingdom (N = 604), who were recruited online and at food banks, completed questionnaire measures of household food insecurity, physical stress, psychological distress, eating to cope, drinking to cope, diet quality, and self-reported height and weight to calculate BMI. RESULTS: Structural equation modeling was used to test the hypothesized relationships, including a multilevel structural model controlling for the effect of income. As predicted, food insecurity was indirectly associated with higher BMI via greater distress and eating to cope. Food insecurity was directly associated with poorer diet quality, but this relationship was not explained by distress and eating to cope CONCLUSIONS: Our data provide novel insight into the psychological experience of being food-insecure and how maladaptive coping mechanisms might play some role in the association between food insecurity, diet, and obesity.

'Eating to survive': A qualitative analysis of factors influencing food choice and eating behaviour in a food-insecure population.

Food insecurity affects approximately 8.4 million people in the UK, one of the worst levels in Europe. Food insecurity is associated with poor diet quality and obesity; however, the drivers of this relationship are unclear. This study used a qualitative approach to explore factors that influence food choice and eating behaviour in a food-insecure population in Liverpool, UK. Face-to-face interviews were conducted with adults (N = 24) who were clients at foodbanks. The interviews were informed by a semi-structured interview schedule, which focussed on access to food, factors influencing food choices, and strategies used to conserve food. Interview transcripts were analysed using inductive thematic analysis. Six themes were developed; 'Income', 'Cost of food', 'Accessibility of shops', 'Health issues', 'Food rationing strategies' and 'Worsened health outcomes'. Income was the most salient factor influencing participants' food choices with all participants reporting a constant struggle to afford food. Food decisions were primarily based on cost; most participants valued eating healthily but could not afford to do so. Strategies to ration food included skipping meals, consuming small portions, cooking in bulk, and prioritising children's food intake. The majority of participants reported pre-existing physical and/or mental health issues, but these were exacerbated by poor access to food leading to a vicious cycle of stress and worsening health issues. In conclusion, participants' food choices and eating behaviour seemed to be most strongly influenced by their level of income. Our findings provide insight into the range of strategies used by participants to conserve food and also highlight the mental health impact of food insecurity. Initiatives addressing income and the cost of healthy food are required.

When a portion becomes a norm: Exposure to a smaller vs. larger portion of food affects later food intake.

BACKGROUND: Portion sizes in the food environment may communicate information about what constitutes a 'normal' amount of food to eat. Here we examined whether mere visual exposure to a smaller vs. larger portion size of snack food affects perceptions of how much a 'normal' sized portion is and how much people choose to eat of that food in future. METHODS: Under the guise of a study on taste preference and personality, 104 female participants were randomly allocated to be exposed to either a smaller or larger portion size of snack food. Twenty-four hours later participants freely selected a portion of the snack food to consume and reported on their perception of what constituted a normal sized portion of the snack food. RESULTS: Participants that were exposed to a smaller, as opposed to larger portion size subsequently believed that a normal portion of the snack food was smaller in size. Exposure to the smaller as opposed to the larger portion size also resulted in participants consuming less snack food the next day. CONCLUSIONS: Environmental exposure to smaller, as opposed to larger portion sizes of food may change perceptions of what constitutes a normal amount of food to eat and affect the amount of food people choose to eat in future.

The portion size effect: Women demonstrate an awareness of eating more than intended when served larger than normal portions.

Large portion sizes lead to increased intake. Some studies suggest that individuals are unaware that they consume more when served larger portions. In a between-subjects design we asked female participants (N = 48) how much pasta and tomato sauce they intended to consume for lunch prior to eating. We then provided a smaller or a larger portion of the same food and invited participants to self-serve a portion into a second bowl (same size in both conditions). After eating until comfortably full, participants were shown an image of the amount they had selected at the beginning of the meal. They were then asked whether they perceived having eaten more or less than this amount, and by how much more or less they had eaten. In total 46 responses were analysed. Of the participants who received the large portion and who ate more than intended, 77% (p = .029) correctly identified eating more. However, when participants were asked to indicate by how much they had eaten above or below their intended amount, those who ate more after receiving a larger portion underestimated their intake by 25% (p = .003). These findings suggest that greater intake from a larger portion is associated with an awareness of having eaten a large quantity combined with a failure to register the actual amount consumed (in the direction of underestimation). The latter might be attributed to an error associated with the visual estimation of volume.

Effects of meal variety on expected satiation: evidence for a 'perceived volume' heuristic.

Meal variety has been shown to increase energy intake in humans by an average of 29%. Historically, research exploring the mechanism underlying this effect has focused on physiological and psychological processes that terminate a meal (e.g., sensory-specific satiety). We sought to explore whether meal variety stimulates intake by influencing pre-meal planning. We know that individuals use prior experience with a food to estimate the extent to which it will deliver fullness. These 'expected satiation' judgments may be straightforward when only one meal component needs to be considered, but it remains unclear how prospective satiation is estimated when a meal comprises multiple items. We hypothesised that people simplify the task by using a heuristic, or 'cognitive shortcut.' Specifically, as within-meal variety increases, expected satiation tends to be based on the perceived volume of food(s) rather than on prior experience. In each trial, participants (N = 68) were shown a plate of food with six buffet food items. Across trials the number of different foods varied in the range one to six. In separate tasks, the participants provided an estimate of their combined expected satiation and volume. When meal variety was high, judgments of perceived volume and expected satiation 'converged.' This is consistent with a common underlying response strategy. By contrast, the low variety meals produced dissociable responses, suggesting that judgments of expected satiation were not governed solely by perceived volume. This evidence for a 'volume heuristic' was especially clear in people who were less familiar with the meal items. Together, these results are important because they expose a novel process by which meal variety might increase food intake in humans.