abstract: Weight gain and unfavorable body composition are prevalent among midlife and older women; shifts in these characteristics can have detrimental implications on emotional and physical health and longevity. Efforts to attenuate weight-related factors detailing the potential development of obesity are traditionally driven by manipulation of nutrition and/or physical activity; however, sustained results are limited. Novel and integrative approaches are needed to reduce the burden of adverse changes in weight and associated consequences. This dissertation is built around a model of effects of Tai Chi/Qigong in body composition and a pilot test of this intervention and model factors in a group of midlife/older women (N = 36). Three resulting manuscripts include: 1) a proposed biobehavioral model detailing how a Tai Chi/Qigong intervention may improve weight-related outcomes through psychological, behavioral, and physiological pathways, 2) a paper examining pre- to post- intervention differences in the primary outcomes of percent body fat, sleep quality, and emotional eating and the exploratory outcomes of perceived stress, mood state, mindfulness, self-compassion and body awareness; and 3) an exploratory analysis examining correlations between primary (sleep quality, emotional eating), exploratory (perceived stress, mood state, mindfulness, self-compassion and body awareness), and neurophysiological (heart rate variability) outcomes of interest—further, regression models were conducted to explore the predictive value of the independent variables on the dependent variables and associated changes. In manuscript two, dependent t-tests were used to assess pre/post-differences (percent body fat and survey measures); this single group study (8-weeks of Tai Chi/Qigong) did not have a control group. Results of manuscript two demonstrate significant changes in sleep quality (p = .04), perceived stress (p = .05), and body awareness (p = .01). Findings of manuscript three indicate changes in the dependent variable of sleep quality were partially explained by perceived stress (adjusted R2 = 13.4%) and changes in the dependent variable of emotional eating were significantly explained by self-compassion (adjusted R2 = 42.1%). In the context of weight gain and unfavorable body composition in midlife/older women, results of this pilot study, using a standardized Tai Chi/Qigong intervention, indicate that select psycho-emotional factors may be important to explore further. / Dissertation/Thesis / Doctoral Dissertation Nursing and Healthcare Innovation 2019

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This study examined the effect of an 8-week, progressive exercise intervention on neural responses, specifically N2 amplitude as a measure of inhibitory control, to pictures of food. Healthy women ages 18-44 years were randomized to a morning (AM) exercise group or evening (PM) exercise group. The AM group did moderate-to-vigorous intensity exercise on 4 days per week between 6:30 and 9:30 a.m. while the PM group had the identical volume of exercise between 6:30 and 9:30 p.m. Neural responses, eating behaviors, cardiovascular fitness outcomes, and body weight/composition were measured at baseline and after the 8-week intervention. The N2 amplitude in response to pictures of high- and low-calorie foods was assessed using electroencephalography during a go/no-go task. Dietary restraint, emotional eating, and external eating were assessed using the Dutch Eating Behavior Questionnaire. VO2peak, HRmax, and time to completion were measured during a maximal treadmill test. Body weight was measured on a digital scale, and body composition was measured using dual-energy x-ray absorptiometry. There was not a significant task (go, no-go) × group (AM, PM) × period (baseline, 8 weeks) interaction (F = 0.18; p = 0.677), but there was a main effect of exercise over 8 weeks (F = 6.26; p = 0.017) with increased N2 amplitude following the intervention. There was not a significant interaction as a function of picture type (high-calorie, low-calorie), task, group, and period (F = 0.52; p = 0.478). Changes in body weight and neural outcomes were not significantly associated with changes in eating behaviors for either group (ps < 0.05). There was a significant group × period interaction for body weight (F = 4.90; p = 0.032). Body weight increased by 0.79 ± 1.16 kg in the AM group and decreased by 0.21 ± 1.46 kg in the PM group (effect size = 0.77; CI = 0.15-1.35). There was not a significant group × period interaction for body fat percentage, total body fat or fat-free mass (ps < 0.05). When examining the main effect of exercise on cardiovascular fitness outcomes, VO2peak was not different (F = 1.80; p = 0.187), time-to-completion on treadmill increased (F = 6.51; p = 0.014), and HRmax during the treadmill test was significantly lower (F = 5.49; p = 0.025). This study suggests that 8 weeks of exercise training may increase the inhibitory response to pictures of both high- and low-calorie foods. However, time of day of exercise did not influence this response. Eight weeks of exercise training did not change self-reported dietary restraint, external eating, or emotional eating, and there was no correlation between these eating behaviors and inhibitory control. However, evening exercise was more beneficial for body weight than morning exercise. Given the novelty of this study and its results, additional studies on the influence of time of day of exercise on weight management are needed.

L’objectif de ce travail de thèse était d’approfondir la compréhension des liens entre le vécu émotionnel et la prise alimentaire, au travers des deux construits que sont l’alimentation émotionnelle (AE) et l’addiction à l’alimentation (AA). En premier lieu, ce travail a permis de lever un verrou méthodologique relatif à la mesure de l’AE, en réalisant la validation de la version française d’un instrument d’évaluation exhaustif (Emotional Appetite Questionnaire), prenant en compte la variabilité interindividuelle et inter-émotions spécifique à l’AE. La suite de nos travaux, réalisés en population étudiante, ont permis 1) de caractériser différents profils de mangeurs émotionnels; 2) de démontrer que l’AE et l’AA jouent un rôle médiateur entre l’affectivité négative et le surpoids ou l’obésité; 3) de mettre en évidence que le recours à l’AE est un rouage clé dans l’apparition de symptômes cliniques d’AA. La dernière partie de ce travail était consacrée à l’étude de l’impact de l’AE et de l’AA en population clinique, chez des patients souffrant de maladies cardiovasculaires. Les résultats préliminaires de nos travaux mettent en évidence la complexité des liens entre la détresse émotionnelle, les perturbations de la prise alimentaire et la qualité de l’alimentation chez ces patients. Finalement, ce travail de thèse apporte un éclairage sur l’intrication complexe entre les émotions et l’alimentation ainsi qu'une meilleure identification des facteurs pouvant influencer ces liens. De telles connaissances sont cruciales afin d’améliorer les politiques de prévention et favoriser le développement de prises en charge plus ciblées et efficaces. / The objective of this thesis was to deepen the understanding of the links between emotional experience and food intake, by examining the role of two mechanisms: emotional eating (EE) and food addiction (FA). First, this work allowed to overcome a methodological barrier regarding the measurement of EE by validating the French version of the Emotional Appetite Questionnaire. This instrument provides an exhaustive assessment of EE, taking into account the inter-individual and inter-emotional variability specific to this concept. Second, our work, which was carried out in large sample of college students, allowed 1) to characterize different profiles of emotional eaters; 2) to demonstrate that EE and FA mediate the association between negative affectivity and excessive weight or obesity; 3) to demonstrate that EE is a key factor in the severity of clinical symptoms of FA. The last part of this work was devoted to studying the impact of EE and FA in a clinical population of patients with cardiovascular diseases. The preliminary results of this study highlighted the complexity of the links between emotional distress, disordered eating and the quality of food intake in these patients. In conclusion, this thesis sheds light on the complex interplay between emotions and food intake, and provides a better identification of the factors that can influence these links. Such knowledge is crucial in order to improve prevention policies and foster the development of more targeted and effective interventions.

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Weight loss maintenance is essential for the reduction of obesity-related health impairments. However, only a minority of individuals successfully maintain reduced weight in the long term. Research has provided initial evidence for associations between weight-related teasing (WRT) and greater non-normative eating behaviors. Further, first evidence was found for associations between non-normative eating behaviors and weight loss maintenance. Hence, the present study aimed to examine the predictive value of WRT for weight loss maintenance and the role of non-normative eating behaviors as possible mediators of this relationship. The study was part of the German Weight Control Registry that prospectively followed individuals who had intentionally lost at least 10% of their maximum weight and had maintained this reduced weight for at least one year. In N = 381 participants, retrospective WRT during childhood and adolescence, current non-normative eating behaviors (i.e., restrained, external, emotional eating), and change in body mass index (BMI, kg/m2) over two years were examined using self-report assessments. Structural equation modeling was used to analyze the assumed mediational relationship. As a result, a greater effect of retrospective WRT during childhood and adolescence predicted less successful adult weight loss maintenance over two years. Current emotional eating fully mediated this relationship while current restrained and external eating yielded no mediational effects. Hence, a greater effect of WRT predicted greater current emotional eating, which in turn predicted a smaller decrease or a greater increase in BMI. Our findings suggest that suffering from WRT during childhood and adolescence might lead to emotional eating which in turn impairs long-term weight loss maintenance. Thus, our results highlight the need for interventions aiming at reducing weight stigmatization and targeting emotional eating for successful long-term weight loss maintenance.

The concept of self-compassion has been gathering interest for researchers in recent years, as it appears to offer an array of benefits to wellbeing. This study investigated the potential role of self-compassion as a protective factor against disordered eating behaviors. It also examined the mediating roles of three potential variables: body dissatisfaction, perfectionism and contingent self-worth. Given modern representations of the female ideal, failure to achieve or adequately conform to such standards often poses psychological challenges for women and girls. Self-compassion encompasses kind, mindful self-treatment and may be an ideal protective factor against disordered eating. It has also been linked with lower body dissatisfaction, maladaptive perfectionism, and contingent self-worth. The present study found that dissatisfaction with one’s body, as well as a tendency to judge one’s personal worth based on appearance fully mediated the relationship between self-compassion and both restrained and emotional disordered eating respectively. Therefore, a self-compassionate attitude may serve as a protective factor against engaging in disordered eating vis-à-vis strengthening young women’s abilities to look at their bodies in a more compassionate and unconditionally accepting way. / text

Attention deficit hyperactivity disorder (ADHD) is more recently being recognized as a lifetime disorder that continues to affect individuals into their adult lives. Recent research studies have found connections between ADHD and overweight/obesity. The current study was designed to further explore these relationships and better understand the connections between these two constructs among 340 college students. It was hypothesized that the ADHD symptoms (i.e., inattention and impulsivity) would positively predict depressive symptoms, which in turn would predict emotional/binge eating and lead to overweight/obesity. Additionally, it was hypothesized that impulsivity would predict substance use, which would predict emotional/binge eating and also predict overweight/obesity. The model was tested and exhibited excellent fit. ADHD positively predicted depressive symptoms, which in turn positively predicted emotional/binge eating and led to overweight/obesity. Further, ADHD symptoms also positively predicted substance use, which in turn predicted emotional/binge eating and led to overweight/obesity. All paths were statistically significant and findings suggest there are at least two paths that connect ADHD symptoms and overweight/obesity in adults. The current results are of importance to practicing clinicians because they provide increased clarity and depth regarding the connections and relationship between symptoms of ADHD and overweight/obesity.