Renate Meeusen¹, Karlijn Geurts², Renate Meeusen³, Karlijn Geurts⁴, Kirsten Berk⁵, Elisabeth van Rossum⁶


(1) Erasmus Medical Centre, Rotterdam, Netherlands. (2) Erasmus Medical Centre, Rotterdam, Netherlands. (3) Erasmus Medical Centre, Rotterdam, Netherlands. (4) Erasmus Medical Centre, Rotterdam, Netherlands. (5) Erasmus Medical Centre, Rotterdam, Netherlands. (6) Erasmus Medical Centre, Rotterdam, Netherlands. 

Aim: A higher intake of ultra-processed foods (UPF) is associated with obesity. This study examines the intake of UPF and the associations with body composition and stress in patients with obesity following a 1.5 year combined lifestyle intervention (CLI).

Methods:

Data of 126 adults with obesity participating in a CLI with cognitive behavioral therapy at the academic Obesity Centre CGG, The Netherlands was collected at start, 10 weeks and 1.5 years. Food intake was obtained by a 3-day food diary. To quantify UPF intake, the records were classified into four NOVA categories, based on total consumed energy. BMI, waist circumference, fat- and fat free mass were measured for body composition. Stress was measured both biological (hair cortisol and cortisone) and perceived (Perceived Stress Scale). Eating behavior was determined using the Dutch Eating Behavior Questionnaire. Hospital Anxiety and Depression Scale was used for anxiety and depression. Marginal mixed models were performed to explore associations between UPF intake and the outcomes at all three timepoints, corrected for age and sex.

Results:

UPF intake decreased from 57.5% at baseline to 52.8%, while an increase from 29.0% to 35.9% in unprocessed food intake was observed (both p<0.02).  UPF intake was positively associated with BMI, waist circumference, fat mass, perceived stress, and external eating. Negative associations were found with restrained eating. Associations for changes in UPF intake and body composition were found for BMI, WC and fat mass (all p<0.03). Lastly, UPF intake was affected by positive changes in perceived stress, external eating behavior and anxiety and negative changes in hair cortisone and restrained eating behavior.

Conclusion:

Patients with obesity consumed less ultra processed foods and more unprocessed foods during the CLI. Patients lowering their UPF intake showed improvements in body composition. Their UPF intake decreased after declines in perceived stress, external eating behavior and anxiety and having a more restrained eating behavior and higher hair cortisone.