Food Insecurity and Affective Determinants of Momentary Adherence in a Randomized Clinical Trial

• Published in: Obesity (Silver Spring, Md.) Md.), 2021-12, Vol.29, p.15-15
• Main Authors: Andersen, Coley, de Baca, Tomas Cabeza, Stinson, Emma, Engel, Scott, Krakoff, Jonathan, Votruba, Susanne, Gluck, Marci
• Format: Article
• Language: English
• Subjects: Food security
• ISSN: 1930-7381; 1930-739X

Background: Weight regain occurs in 1/3 of those achieving successful weight loss, which is often attributed to non-adherence to lifestyle interventions. Psychosocial factors, like negative affect, and food insecurity (FI) through episodic overeating have been proposed to impede long-term weight loss. To date, these variables have not been investigated in conjunction with dietary adherence; given the literature gap we examined the role of affect and FI on dietary adherence. Methods: Fifty participants (19 m; 49 ± 14 y; BMI = 30 ± 8) completed a 6-week outpatient dietary study including BMI measures and the USDA Household Food Security Form. Twice daily ecological momentary assessments captured real-time affect ratings and adherence. Between-person (trait-level; between participant's overall score relative to the mean score across all participants) and lagged within-person (whether each person's current affect ratings impacted future adherence) scores were calculated. Higher adherence scores (range = 0-3) denoted greater adherence. Results: Greater FI and trait-1 evel negative affect was associated with reduced adherence (p = 0.002, p < 0.0001 respectively). Higher levels of trait-level positive affect were associated with greater adherence (p < 0.0001). Negative or positive affect (lagged-within) did not predict subsequent adherence. Significant interactions between affect and FI revealed an association between higher negative affect (lagged-within) and decreased adherence only observed at low levels of FI (p = 0.04), and an association between higher negative affect (between) with decreased adherence, strengthened at greater levels of FI (-1 SD: B = -0.34, p = 0.0483; Mean: B = -0.57, p < 0.0001; +1 SD: B = -0.80, p < 0.0001). Conclusions: Trait-level affect may be more crucial for measures of momentary adherence but FI modified the relationship between negative affect and short-term adherence. Stable traits compared to momentary changes in affect may have disparate longer and shorter-term effects on overall dietary adherence.