Rebecca A. Collins

The 3-arm Targeted Research on Addictive and Compulsive Eating (TRACE) randomised controlled trial, aimed to decrease addictive eating symptoms in adults with the active intervention (dietitian-led telehealth sessions) compared to the passive intervention (self-guided workbook) and control group. The current study evaluated fidelity of the TRACE active intervention delivery to determine if telehealth sessions were delivered according to the intended service parameters: session durations (min), frequency and content. Differences between actual and intended schedules, for participants in the telehealth intervention arm ( n = 39) were analysed. A subgroup of participants’ ( n = 5) sessions were audio recorded ( n = 25 sessions) with n = 24 analysed to determine fidelity of session content against an observer implementation record. Fidelity of telehealth session duration and frequency was classified as ‘good’ and ‘very good’, respectively, with the median duration and days between each session within ±5 min or days, respectively. The dietitian’s fidelity in delivering key components was rated as ‘very good’ by both independent reviewers (82% and 87.2%) respectively. The ‘session summary’ was the least covered topic, followed by ‘determining the client’s main food intake concerns’ . The TRACE programme was delivered as intended based on the session duration and frequency, however observations made during the content analysis identified key content, including the ‘session summary’ , was not always covered. Future trials should monitor fidelity in diverse settings and a range of professionals with variations in training and experience. Australian New Zealand Clinical Trials Registry (ACTRN12621001079831)

Background/Objectives: Fear of missing out (FoMO) describes the concern of missing out on a rewarding experience, a contemporary psychological phenomenon that has yet to be explored in relation to addictive eating. This exploratory study examined the relationship between FoMO and addictive eating, and the effect of reward-related eating and mental health status (anxiety, depression, and stress) on the relationship. Methods: A sample of 227 adults (mean age 49.4 years; 79.3% women) completed an online survey to assess addictive eating (Yale Food Addiction Scale), FoMO (Fear of Missing Out Scale), reward-related eating (Reward-Based Eating Drive Scale), anxiety, depression, and perceived stress (GAD-7, PHQ-8, PSS-4). Mediation and moderated mediation analyses were performed to determine relationships between variables. Results: A direct relationship between FoMO and addictive eating was found. The relationship was partially mediated by reward-related eating after accounting for BMI and gender. Anxiety severity was a significant moderator of the relationship between reward-related eating levels and addictive eating symptoms. Conclusions: This study provides insights that can assist in informing interventions to mitigate the negative effects of FoMO on eating behaviours, particularly among populations vulnerable to anxiety.

Introduction: No Money No Time is a culinary nutrition website focused on diet quality improvement. The aim was to compare participant retention in a 6‐week eHealth challenge, with and without use of financial incentives and to compare demographic characteristic, diet quality and engagement outcomes between them. Methods: The single‐arm, pre‐post studies [Spring Eatz (30 August to 17 September, 2023) and RE$ET (20th February to March, 2024)] recruited adults ≥ 18 years from Australia into a 6‐week nutrition challenge delivered via weekly emails that directed participants to the No Money No Time (NMNT) purpose‐built culinary and nutrition‐related health website from after completing the embedded Healthy Eating Quiz (HEQ) and consenting to data use for research purposes. At the start of each challenge week participants received an email with links to targeted NMNT content, relevant recipes, plus specific time and cost‐efficient advice to help improve dietary patterns. Weeks 2–5 included a prize draw of 4 × AUD$25 eGift cards randomly drawn from participants actively engaging with challenge materials and a week 6 final draw of 4 × AUD$100 eGift cards from participants completing the HEQ and feedback survey post‐challenge. Data was collected on diet quality (HEQ score), demographics (gender, age, vegetarian status, number of people/weekly household grocery expenditure, expenditure on food purchased away from the home, weight and height). NMNT website analytics were collected via Active Campaign software. Results: The incentivised challenge recruited significantly more males (22% vs. 15%) and a younger demographic (mean age 45 y vs. 50 y) compared to unincentivized ( p < 0.01). There was a significantly greater 6‐week retention in the incentivised challenge compared to no incentivisation (21% vs. 16%, z ‐score = 2.14, p < 0.05), with significant increases in diet quality (HEQ score) in adjusted models ( + 4.5 points, p < 0.05), which was not significantly different to the unincentivized challenge p = 0.09. Conclusions: The 6‐week eHealth nutrition challenge using financial incentives improved diet quality and led to significantly greater retention compared to an unincentivized challenge, with overall retention still relatively low. Engagement with weekly emails exceeds global email marketing campaigns. Future iterations should incorporate strategies to increase participant engagement. An email campaign represents a low‐cost approach to achieve short‐term improvement in diet quality.

No Money No Time (NMNT) is a culinary nutrition website designed to optimize diet quality. The primary aim was to evaluate the impact of an online targeted nutrition challenge email campaign that encouraged engagement with NMNT and goal setting to improve diet quality and weekly food expenditure. A secondary aim was to assess NMNT engagement. Australian adults ≥18 years were recruited to the eHealth nutrition challenge delivered via weekly emails. Diet quality was assessed using the Healthy Eating Quiz (HEQ) diet quality tool. Engagement was assessed using email open and click-through rates. Intention-to-treat (ITT) analysis was conducted using mixed effects linear regression. Of 481 adults (49.7 ± 13.9 years, 84% female) who enrolled 79 (16%) completed the challenge. ITT results indicated statistically significant 6-week increases in diet quality score (+3.8 points p ≤ 0.001, d = 0.58) with sub-scale improvements in vegetables (+0.9 points, p = 0.01, d = 0.32), fruit (+1.2 points, p ≤ 0.001, d = 0.55), and dairy (+0.9 points, p ≤ 0.001, d = 0.58). There were significant post-challenge reductions in household spending on takeaway/snacks/coffee of AUD 8.9 per week (p = 0.01, d = 0.29), body weight reduction (−0.6 kg, p = 0.03, d = 0.26), and BMI (−0.2 kg/m²p = 0.02, d = 0.28). The email open rate remained constant at around 67% (56% to 75%), with an average click-through rate of 18% (7.1% to 37.9%). The eHealth nutrition challenge significantly improved diet quality while reducing BMI and money spent on discretionary foods. Strategies to scale the challenge should be tested as an innovative population strategy for improving diet quality, health indicators, and managing household food budgets.

Background: Few interventions for food addiction (FA) report on dietary intake variables. The present study comprised a three‐arm randomised controlled trial in adults with symptoms of FA. The aim was to evaluate dietary intake, sleep and physical activity resulting from a dietitian‐led telehealth intervention at 3 months.Methods: Adults with ≥3 symptoms of FA and a body mass index > 18.5 kg/m² were recruited. Dietary intake including energy, nutrients and diet quality were assessed by a validated food frequency questionnaire in addition to sleep quality and physical activity (total min) and compared between groups and over time. Personalised dietary goals set by participants were examined to determine whether improvements in percent energy from core and non‐core foods were reported.Results: The active intervention group was superior compared to the passive intervention and control groups for improvements in percent energy from core (6.4%/day [95% confidence interval (CI) −0.0 to 12.9], p = 0.049), non‐core foods (−6.4%/day [95% CI −12.9 to 0.0], p = 0.049), sweetened drinks (−1.7%/day [95% CI −2.9 to −0.4], p = 0.013), takeaway foods (−2.3%/day [95% CI −4.5 to −0.1], p = 0.045) and sodium (−478 mg/day [95% CI −765 to −191 mg], p = 0.001).Conclusions: A dietitian‐led telehealth intervention for Australian adults with FA found significant improvements in dietary intake variables. Setting personalised goals around nutrition and eating behaviours was beneficial for lifestyle change.

Background: Interest in addictive eating continues to grow from both a research and clinical perspective. To date, dietary assessment alongside food addiction status is limited, with management options for addictive eating behaviours variable, given the overlap with myriad conditions. The aim of this study was to report the dietary intake and quality‐of‐life outcomes from a personality‐targeted motivational interviewing intervention delivered by dietitians using telehealth.Methods: The study was conducted in adults exceeding their healthy‐weight range with symptoms of addictive eating, as defined by the Yale Food Addiction Scale. The 52 participants were randomised to either intervention or control, with 49 participants commencing the intervention. Individuals participated in the 3‐month, three‐session FoodFix interventions, with dietary outcomes assessed by the Australian Eating Survey and quality of life assessed using the SF‐36 at baseline and 3 months.Results: There were small‐to‐moderate effect sizes, specifically in the intervention group for decreased added sugar intake, increased protein intake, increased meat quality and increased vegetable servings per day. Six out of eight quality‐of‐life domains had small‐to‐moderate effect sizes.Conclusions: This intervention has highlighted the need for further research in larger sample sizes to assess dietary behaviour change by those who self‐report addictive eating.

Research into the complexities of addictive eating behaviours continues to develop, as a deeper understanding of this construct beyond self-report diagnostic tools emerges. In this study, we undertook structured interviews with 40 participants engaged in a personality-based management program for addictive eating, to gain insight into what situations lead people with addictive eating behaviours to overeat, and how they believe their lives would be different if they had control over their eating. A phenomenological analysis to explore compulsion and control in the context of food experiences for participants was used to construct two main themes of the addictive eating paradox and striving to transition from ‘other’ to ‘normal’. The addictive eating paradox identified multiple contradictory experiences of a situation, e.g., ‘loving food’ but ‘hating food’. Striving to transition from ‘other’ to ‘normal’ encompassed the idea that participants envisaged that by gaining control over their eating they could become ‘normal’. This study emphasises the need to provide support and strategies to help people navigate paradoxical thoughts and presents new ideas to increase the effectiveness of interventions for individuals struggling with the complex self-beliefs held by those with addictive eating behaviours.

Background: Disordered eating habits, poor dietary intake and nutritional status, and altered body composition are highly prevalent among individuals with substance use disorders. This systematic review aimed to evaluate the efficacy of dietary interventions in adults with substance use disorders for illicit substances or illicit use of pharmaceutical substances.Methods: Eight scientific databases were searched using predetermined text word and subject heading (MeSH) searches for experimental studies published up to March 2020 that evaluated interventions aiming to improve dietary intake in adults with substance use disorders for illicit substances or illicit use of pharmaceutical substances, which included dietary intake outcomes.Results: Of 9299 articles identified, five studies were included. Three studies (60%) were conducted in outpatient/community clinic settings and two studies (40%) were conducted in inpatient/residential treatment centres. Dietary interventions ranged in duration from 5 weeks to 24 months. These included education and behaviour change advice for nutrition and other lifestyle behaviours (n = 3 studies), nutrition education and provision of healthy food choices within the residential treatment centre (n = 1 study), and polyunsaturated fatty acid supplementation (n = 1 study). Three studies (60%) reported small but significant change in one or more dietary outcome at post‐intervention, including reductions in sweets, fast food or caffeine intake, as well as increases in fruit and vegetable intake.Conclusions: This review has identified a small number of studies, despite the strong evidence that dietary intervention is needed in substance use rehabilitation. More research is needed to determine the most effective intervention approaches for this group, including robust study designs.