Kevin Lewis

March 29, 2016

Genetic Differential Susceptibility to Socioeconomic Status and Childhood Obesogenic Behavior: Why Targeted Prevention May Be the Best Societal Investment

Patricia Silveira et al.

JAMA Pediatrics, forthcoming

Objective: To determine whether children carrying the 7-repeat allele of the DRD4 gene living under adverse economic conditions have worse-than-average fat intake compared with those living in a healthy environment.

Design, Setting, and Participants: Data from an established prospective birth cohort (Maternal Adversity, Vulnerability, and Neurodevelopment) were used to study 4-year-old children from Montreal, Quebec, Canada and Hamilton, Ontario, Canada. A total of 190 children (94 girls and 96 boys) had height and weight measured and complete food diaries and were therefore eligible for the study. The study is derived from a birth cohort started in June 2003 and still ongoing. The last age of follow-up was at 6 years.

Results: The 5 steps to distinguish the differential susceptibility from other types of interaction were followed, and the study confirms that differential susceptibility is a relevant model to address the association between the 7-repeat allele of DRD4 and food choices in girls. Of the 190 children, 112 did not have the DRD4 7-repeat allele and 78 did. Baseline characteristics did not differ in these 2 groups. Although not different in several confounders, such as maternal educational level, maternal smoking during gestation, birth weight, and breastfeeding duration, girls carrying the 7-repeat allele of the DRD4 gene and living in adverse socioeconomic conditions have increased fat intake compared with girls who are noncarriers (DRD4 7+ mean, 33.95% of calories derived from fat; 95% CI, 28.76%-39.13%; DRD4 7− mean, 28.76%; 95% CI, 26.77%-30.83%). However, girls carrying the 7-repeat allele of the same gene and living in better socioeconomic conditions have decreased fat intake compared with noncarriers (DRD4 7+ mean, 29.03% of calories derived from fat; 95% CI, 26.69%-31.51%; DRD4 7− mean, 31.88%; 95% CI, 30.28%-33.58%).

Conclusions and Relevance: Alleles previously considered to be obesity risk alleles might in fact function as plasticity alleles, determining openness to environmental modification and/or intervention, as seen in the girls in this study. This finding has important implications for obesity prevention and social pediatrics.


Misclassification of cardiometabolic health when using body mass index categories in NHANES 2005–2012

A.J. Tomiyama et al.

International Journal of Obesity, forthcoming

The United States (US) Equal Employment Opportunity Commission has proposed rules allowing employers to penalize employees up to 30% of health insurance costs if they fail to meet ‘health’ criteria such as reaching a specified Body Mass Index (BMI). Our objective was to examine cardiometabolic health misclassifications given standard BMI categories. Participants (N=40 420) were individuals aged 18+ in the nationally representative 2005–2012 National Health and Nutrition Examination Survey (NHANES). Using blood pressure, triglyceride, cholesterol, glucose, insulin resistance, and C-reactive protein data, population frequencies/percentages of metabolically healthy versus unhealthy individuals were stratified by BMI. Nearly half of overweight individuals, 29% of obese individuals, and even 16% of obesity type II/III individuals were metabolically healthy. Moreover, over 30% of normal weight individuals were cardiometabolically unhealthy. There was no significant race x BMI interaction, but there was a significant gender x BMI interaction, F(4,64)=3.812, P=0.008. Using BMI categories as the main indicator of health, an estimated 74 936 678 US adults are misclassified as cardiometabolically unhealthy or cardiometabolically healthy. Policymakers should consider the unintended consequences of relying solely on BMI, and researchers should seek to improve diagnostic tools related to weight and cardiometabolic health.


Disgust proneness and associated neural substrates in obesity

Tristan Watkins et al.

Social Cognitive and Affective Neuroscience, March 2016, Pages 458-465

Defects in experiencing disgust may contribute to obesity by allowing for the overconsumption of food. However, the relationship of disgust proneness and its associated neural locus has yet to be explored in the context of obesity. Thirty-three participants (17 obese, 16 lean) completed the Disgust Propensity and Sensitivity Scale-Revised and a functional magnetic resonance imaging paradigm where images from 4 categories (food, contaminates, contaminated food or fixation) were randomly presented. Independent two-sample t-tests revealed significantly lower levels of Disgust Sensitivity for the obese group (mean score = 14.7) compared with the lean group (mean score = 17.6, P = 0.026). The obese group had less activation in the right insula than the lean group when viewing contaminated food images. Multiple regression with interaction analysis revealed one left insula region where the association of Disgust Sensitivity scores with activation differed by group when viewing contaminated food images. These interaction effects were driven by the negative correlation of Disgust Sensitivity scores with beta values extracted from the left insula in the obese group (r = −0.59) compared with a positive correlation in the lean group (r = 0.65). Given these body mass index–dependent differences in Disgust Sensitivity and neural responsiveness to disgusting food images, it is likely that altered Disgust Sensitivity may contribute to obesity.


Higher body mass index is associated with episodic memory deficits in young adults

Lucy Cheke, Jon Simons & Nicola Clayton

Quarterly Journal of Experimental Psychology, forthcoming

Obesity has become an international health crisis. There is accumulating evidence that excess bodyweight is associated with changes to the structure and function of the brain and with a number of cognitive deficits. In particular, research suggests that obesity is associated with hippocampal and frontal lobe dysfunction, which would be predicted to impact memory. However, evidence for such memory impairment is currently limited. We hypothesised that higher body mass index (BMI) would be associated with reduced performance on a test of episodic memory that assesses not only content, but also context and feature integration. A total of 50 participants aged 18–35 years, with BMIs ranging from 18 to 51, were tested on a novel what–where–when style episodic memory test: the “Treasure-Hunt Task”. This test requires recollection of object, location, and temporal order information within the same paradigm, as well as testing the ability to integrate these features into a single event recollection. Higher BMI was associated with significantly lower performance on the what–where–when (WWW) memory task and all individual elements: object identification, location memory, and temporal order memory. After controlling for age, sex, and years in education, the effect of BMI on the individual what, where, and when tasks remained, while the WWW dropped below significance. This finding of episodic memory deficits in obesity is of concern given the emerging evidence for a role for episodic cognition in appetite regulation.


Adverse family experiences during childhood and adolescent obesity

William Heerman et al.

Obesity, March 2016, Pages 696–702

Objective: To evaluate the association between adverse family experiences (AFEs) during childhood and adolescent obesity and to determine populations at highest risk for AFEs.

Methods: A cross-sectional analysis was performed of the 2011-2012 National Survey of Children's Health, including children aged 10-17 years. Weighted estimates of 31,258,575 children were based on interviews with 42,239 caregivers. Caregiver reports of nine psychosocial risk factors measured AFEs during childhood. Adolescent overweight and obesity were derived by caregiver-reported child height and weight.

Results: Nearly one-third (30.5%) of children had experienced ≥2 AFEs, with geographic variation by state. The prevalence of obesity among children experiencing ≥2 AFEs was 20.4%, when compared with 12.5% among children with 0 AFEs. Adjusted survey regression models were controlled for child, parent, household, and neighborhood characteristics. Children with ≥2 AFEs in childhood were more likely to have obesity (AOR = 1.8; 95% CI = 1.47-2.17; P < 0.001) than those with no AFEs, with Non-Hispanic, White children most affected.

Conclusions: Adolescents in this national sample who were exposed to greater numbers of AFEs in childhood also had higher rates of overweight and obesity. Geographic variation and differential associations based on race/ethnicity identified children at greatest risk.


Stuck in Unhealthy Places: How Entering, Exiting, and Remaining in Poor and Nonpoor Neighborhoods Is Associated with Obesity during the Transition to Adulthood

Adam Lippert

Journal of Health and Social Behavior, March 2016, Pages 1-21

Adolescents from poor versus nonpoor neighborhoods are more likely to become obese during the transition to adulthood. It is unclear whether this pertains to all adolescents from poor neighborhoods or only those who remain in disadvantaged settings. Further, it is unknown how neighborhood poverty entries and exits are associated with obesity. Using census and interview data from 12,164 National Longitudinal Study of Adolescent Health participants, I find that those who consistently live in poor neighborhoods are more likely to become or remain obese by adulthood than those who never live in poor neighborhoods. Exiting severe neighborhood poverty curtails this risk, while entering and remaining in neighborhood poverty in adulthood increases it. These patterns are more pronounced for young women and robust to adjustments for health behaviors and selection bias. Findings support accumulation of risks and social mobility perspectives and highlight how previous and current neighborhood contexts are relevant for health.


Prejudice Toward Individuals With Obesity: Evidence for a Pro-Effort Bias

Joanne Beames, Melissa Black & Lenny Vartanian

Journal of Experimental Psychology: Applied, forthcoming

Three studies examined the role of causal beliefs in weight stigma in order to better understand people’s evaluations of individuals with obesity. Participants viewed weight-related information about a target individual and evaluated that target on various dimensions. Study 1 showed that offset effort information (i.e., information about effort to lose weight) had a greater impact on participants’ evaluations of individuals with obesity than did other causal information, such as onset control and offset ability. Study 2 extended this finding by demonstrating that the duration of effort invested to lose weight is also important in determining participants’ evaluations of individuals with obesity. Study 3 replicated the effect of effort (albeit in terms of effort to maintain a healthy lifestyle) on evaluations of individuals without obesity. Furthermore, in all 3 studies, disgust mediated the association between perceived effort and desire for social distance from the target. These findings highlight a key role for effort and disgust in weight stigma, and suggest that the negative evaluations of individuals with obesity might in part reflect a pro-effort bias. The present research has important implications for strategies to reduce weight stigma, and may even inform strategies to reduce social stigma beyond obesity, such as drug addiction.


Negative Consequences of Nutrition Information Disclosure on Consumption Behavior in Quick-Casual Restaurants

Satheesh Seenivasan & Dominic Thomas

Journal of Economic Psychology, forthcoming

Do consumers make nutrition informed and healthier choices in all restaurants where nutrition information is disclosed on the menus? In this study, we investigate whether consumers had better product nutrition knowledge, assigned more importance to healthiness when choosing meals, and chose healthier meals in the stores of a quick-casual restaurant chain that displayed nutrition information on their menus, relative to a control group of stores of the same chain that did not display nutrition information. We find robust evidence for the learning effect: consumers estimated the energy content of meals more accurately in restaurants which displayed nutrition information on menus. However, contrary to prior research findings in the context of fast-food restaurants, we find that consumers overestimated the energy content of meals, and chose healthier meals in quick-casual restaurants which did not display nutrition information on menus. Our findings shed a new light on the previous findings by showing that the effect of menu labeling on the healthiness of meals chosen by consumers depends on their prior nutrition beliefs.


Computer Interfaces and the “Direct-Touch” Effect: Can iPads Increase the Choice of Hedonic Food?

Hao Shen, Meng Zhang & Aradhna Krishna

Journal of Marketing Research, forthcoming

People nowadays order food using a variety of computer devices, such as desktops, laptops, and mobile phones. Even in restaurants, patrons can place orders on computer screens. Can the interface a consumer uses affect her choice of food? We focus on the “direct touch” aspect of touch interfaces, whereby users can touch the screen in an interactive manner. In a series of five studies, we show that a touch interface such as that provided by an iPad, compared to a non-touch interface such as that of a desktop computer with a mouse, facilitates the choice of an affect-laden alternative over a cognitively superior one — what we call the “Direct-Touch effect.” Our studies provide some mediational support that the Direct-Touch effect is driven by the enhanced mental simulation of product interaction with the more affective choice alternative on touch interfaces. We also test the moderator of this effect. We obtain consistent results using multiple product pairs as stimuli. Our results have rich theoretical and managerial implications.


The Crunch Effect: Food Sound Salience as a Consumption Monitoring Cue

Ryan Elder & Gina Mohr

Food Quality and Preference, July 2016, Pages 39–46

While a growing body of research explores the impact of normative and environmental extrinsic factors on food consumption quantity, less attention is given to the intrinsic cues, or sensory properties, of the food being consumed. Our research contributes to this growing literature by examining the effect of food sound salience (i.e., the sound that a food makes during mastication) on consumption quantity. Specifically, we show that increased attention to the sound the food makes, or food sound salience, may serve as a consumption monitoring cue leading to reduced consumption. Across three studies, we show a consistent negative relationship between the salience of a food’s sound and food intake. Our research highlights the importance of intrinsic auditory food cues on consumption. Our findings are valuable to both researchers interested in understanding how sensory cues are connected to consumption and marketers utilizing sound in their communications to consumers.


The Effects of Increased Serving Sizes on Consumption

Chris Hydock, Anne Wilson & Karthik Easwar

Appetite, June 2016, Pages 71–79

The US Food and Drug Administration recently revealed that it is considering modifying the Nutrition Facts Panels required on packaged foods. One proposed change is increasing serving sizes included on labels, which has two potential implications. Larger serving sizes could increase consumption if consumers use the serving sizes displayed as a reference point for their own consumption (McFerran et al., 2010). Alternatively, larger serving sizes that depict increased values of negative nutrients (e.g. calories) could lead consumers to perceive foods as less healthy, thereby reducing consumption (Russo, 1996). In study 1 (Online Sample, N = 208, Mage= 32, SDage = 12), participants saw pictures of packaged food items and nutrition labels. The labels, depicted either the existing or larger serving size. Across all foods, larger serving sizes led to lower health perceptions. Labels with larger serving sizes were rated as more representative of typical consumption. Study 2 (Online Sample, N = 347, Mage= 31, SDage = 10) used the same design as Study 1, but required participants to virtually portion foods. While serving sizes did not impact the amount of food consumers portioned, those who saw labels with larger serving sizes estimated that they portioned out more calories. In study 3 (Student Sample, N = 198, Mage= 20, SDage = 1), participants were given M&Ms to eat, paired with a nutritional label depicting either the current or a larger serving size, while participating in unrelated surveys. Participants presented with the larger serving size label consumed less than those presented with the current serving size label. Together, the results suggest that the proposed increase in serving sizes on Nutrition Facts Panels could lower consumption of high-calorie foods.


The effects of pre-ordering and behavioral nudges on national school lunch program participants’ food item selection

Gabrielle Miller et al.

Journal of Economic Psychology, forthcoming

This paper examines the effects of pre-ordering and pre-ordering with behavioral nudges on the selection of fruits, vegetables, and low-fat milk by National School Lunch Program (NSLP) participants in a Florida school. After collecting two weeks of baseline data, students in grades four and five were randomly assigned to one of two treatment groups: the first treatment group pre-ordered their lunches online using a unique software program; the second treatment group received behavioral nudges based on United States Department of Agriculture (USDA) MyPlate recommendations while pre-ordering. Student in grades four and seven served as the control group and continued to obtain their lunches through the normal lunch line. Using difference-in-difference regression analysis, we find that students in the first treatment group selected significantly more fruits, vegetables, and low-fat milk during the pre-ordering intervention phase of the study relative to students in the control group, 27.7%, 15.8%, and 16.3%, respectively, while students in the second treatment group selected significantly more fruits (51.4%), vegetables (29.7%) and low-fat milk (37.3%) than students in the control group. In addition, we find the nudge had a statistically significant positive effect in addition to the effect of pre-ordering; students who received the MyPlate nudge while pre-ordering selected statistically significantly more fruits, vegetables, and low-fat milk than students who pre-ordered without nudging.


Perceived distance and obesity: It's what you weigh, not what you think

Mila Sugovic, Philip Turk & Jessica Witt Acta

Psychologica, March 2016, Pages 1–8

Action abilities are constrained by physical body size and characteristics, which, according to the action-specific account of perception, should influence perceived space. We examined whether physical body size or beliefs about body size affect distance perception by taking advantage of naturally-occurring dissociations typical in people who are obese but believe themselves to weigh less. Normal weight, overweight, and obese individuals made verbal distance estimates. We also collected measures of beliefs about body size and measures of physical body size. Individuals who weighed more than others estimated distances to be farther. Furthermore, physical body weight influenced perceived distance but beliefs about body size did not. The results illustrate that whereas perception is influenced by physical characteristics, it is not influenced by beliefs. The results also have implications for perception as a contributing factor for lifestyle choices: people who weigh more than others may choose to perform less physically demanding actions not as a result of how they perceive their bodies, but as a result of how they perceive the environment.


Diminishing Health, Rising Health Care Costs and Long-Run Growth in Local Government Spending

Mark Skidmore & William Dyar

Michigan State University Working Paper, December 2015

Real local government spending in the United States has increased by 240% between 1972 and 2012, faster than can be explained by population growth (a 48% increase), growth in median household income (a 32% increase), or changes in other economic, demographic, and institutional variables typically used to explain the pattern in local government spending. In this paper we examine the role of other potential drivers of local government growth such as growing income disparity, the increasing number of single female-headed households, increasing number of households living in mobile homes, rising healthcare costs, and diminishing health such as increasing in obesity (and associated physical health problems) as well behavioral problems such as hyperactivity, anxiety, depression, and violence associated with the changing diet of the American people. Since the 1970s, the obesity rate in the United States has increased from 12% to 35%. Using the obesity rate as a proxy for changing health, we find that increasing mental/emotional/physical health problems accounts for a significant portion of increased local government spending growth, particularly in human services such as education that require behavioral management. We also find that local government spending in other spending categories declines with obesity. These findings suggest that deteriorating mental/emotional/physical health resulting from dietary changes and other factors has increased local government spending and shifted spending priorities.


Who Benefits from Calorie Labeling? An Analysis of its Effects on Body Mass

Partha Deb & Carmen Vargas

NBER Working Paper, February 2016

This study uses county-level variation in implementation of calorie labeling laws in the US to identify the effects of such laws on body mass. Using the 2003 to 2012 waves of the Behavioral Risk Factor Surveillance System, we find a statistically insignificant average treatment effect for women and a small, statistically significant and negative average treatment effect for men, indicating a decrease in BMI after implementation of calorie-labeling laws. We estimate finite mixture models and discover that the average treatment effects mask substantial heterogeneity in the effects across three classes of women and men. For both women and men, the three classes, determined within the model, can be described as a subpopulation with normal weight, a second one that is overweight on average and a third one that is obese on average. Estimates from finite mixture models show that the effect is largely concentrated among a class of women with BMI distributions centered on overweight. The effects for men are statistically significant for each of the three classes and large for men in the overweight and obese classes. These results suggest that overweight and obese individuals are especially sensitive to relevant information.


No Spillover Effect of the Foreclosure Crisis on Weight Change: The Diabetes Study of Northern California (DISTANCE)

Janelle Downing et al.

PLoS ONE, March 2016

The emerging body of research suggests the unprecedented increase in housing foreclosures and unemployment between 2007 and 2009 had detrimental effects on health. Using data from electronic health records of 105,919 patients with diabetes in Northern California, this study examined how increases in foreclosure rates from 2006 to 2010 affected weight change. We anticipated that two of the pathways that explain how the spike in foreclosure rates affects weight gain — increasing stress and declining salutary health behaviors — would be acute in a population with diabetes because of metabolic sensitivity to stressors and health behaviors. Controlling for unemployment, housing prices, temporal trends, and time-invariant confounders with individual fixed effects, we found no evidence of an association between the foreclosure rate in each patient's census block of residence and body mass index. Our results suggest, although more than half of the population was exposed to at least one foreclosure within their census block, the foreclosure crisis did not independently impact weight change.


Gain Without Pain: The Extended Effects of a Behavioral Health Intervention

Daniel Mochon et al.

Management Science, forthcoming

We examine the extended effects of an incentive-based behavioral health intervention designed to improve nutrition behavior. Although the intervention successfully improved the target behavior, less is known about any spillovers, positive or negative, that impacted the program’s net benefit. This novel examination presents an opportunity to advance our knowledge of this important question, particularly because many theories predict that balancing behaviors in other domains (e.g., reduced exercise) can occur. Our results show a positive and long-lasting persistence effect for the treatment group, even after the incentive was removed. Moreover, we observe no negative spillover effects into related domains such as exercise, and no negative impact on customer loyalty. These results support the use of incentive-based interventions and highlight the importance, for both theory and practice, of examining their extended effects.


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