to McGill U School of Dietetics & Human Nutrition: 27 Nov 08
Food consumption patterns
to reduce and prevent obesity
David Booth
School of Psychology, College of Life & Environmental Sciences,
University of Birmingham (U.K.)
http://www.psychology-people.bham.ac.uk/people/david.booth
Project with:
Louise Thibault, Nutrition, McGill U, Quebec; Caroline Chesneau, INA Paris France;
Seolhyang Baek, Nursing, Dongguk U, South Korea;
Antonio Laguna-Comacho, Nutrition UAEM, Mexico / Psychology B’ham U, UK.
Slowing the rise of obesity
Obviously,
exercise more and/or eat less!!
Slowing the rise of obesity
Exercise more and/or eat less, as a society (?)
Slowing the rise of obesity
Exercise more and/or eat less, as a society, after big changes (?)
Slowing the rise of obesity
Exercise more and/or eat less, as a society, after big changes (?)
No, obesity is not solely an issue of societal reform, e.g.
public health interventions,
governmental regulations,
responsible businesses.
No doubt, we need all that – but of the right sort.
In the first instance, obesity is not even a societal issue at all.
It’s the individual who is obese or becomes overweight
and has to find ways to exercise more and/or to eat less.
Slowing the rise of obesity
Exercise more and/or eat less:
- each individual within current environment and biology;
- permanently, i.e., maintained across changes in own lifestyle.
Slowing the rise of obesity
Exercise more and/or eat less:
- each individual within current environment and biology;
- permanently, i.e., maintained across changes in lifestyle.
Which feasible exercising or eating patterns are
most effective at keeping weight off?
Slowing the rise of obesity
Exercise more and/or eat less:
- each individual within current environment and biology;
- permanently, i.e., maintained across changes in lifestyle.
Which feasible exercising or eating patterns are
most effective at keeping weight off?
The societal problem is lack of such research
– and for long past (>= 50 yr).
Slowing the rise of obesity
Exercise more and/or eat less:
- each individual within current environment and biology;
- permanently, i.e., maintained across changes in lifestyle.
Which feasible exercising or eating patterns are
most effective at keeping weight off?
After we get some of this evidence,
we can start looking for the further evidence needed
to start reducing obesity in individuals
and preventing overweight even.
- then (NEXT TWO SLIDES)
Slowing the rise of obesity
Exercise more and/or eat less:
- each individual within current environment and biology;
- permanently, i.e., maintained across changes in lifestyle.
Which feasible exercising or eating patterns are
most effective at keeping weight off?
Educate all in such evidence on the behaviour-patterns to change
when unhealthy BMI becomes likely, and
[reduce obesity]
when needing to lose some more weight:
- the same energy-balance affecting habits
for prevention and reduction of obesity.
[avoid overweight]
Slowing the rise of obesity
Exercise more and/or eat less:
- each individual within current environment and biology;
- permanently, i.e., maintained across changes in lifestyle.
Which feasible exercising or eating patterns are
most effective at keeping weight off?
Educate all in this evidence on the patterns to change
when unhealthy BMI becomes likely,
when needing to lose more weight.
or
Environmental reform to prevent lapsing from each change,
also according to evidence on that.
Slowing the rise of obesity
THE ISSUES FOR RESEARCH
Which feasible exercising or eating patterns are
most effective at lowering weight?
What environmental changes would
support avoidance of unhealthy fattening
by preventing lapses from such patterns?
enABLEr/s
evidence-networking
individual diffs.
secure, anonymised
evidence-based & evidence-generating
Application of
databases for
research & services
Better Living
all QoL outcomes e.g. healthy weight, vigour, bodily comfort, ....
Education
validated information
personally tailored
in culture's own terms
research
universities-based
http://wwiyc.org “what-works-in-your-circs”
/
services
to public &
professionals
Research into effective behaviour
(comprehensively across habitual patterns)
The list is rather short still.
1. Alan Blair with Vivien Lewis & DAB (UK AFRC 1987-1991)
Main bivariate analyses: A.J. Blair et alii (1989) Psychology & Health
Supplementary multivariate analyses of same study (all done in 1989-90):Blair, A.J., Lewis, V.J., & Booth, D.A. (1990) Appetite [emotional eating & self-efficacy]
Booth, D.A., Blair, A.J., Conner, M.T., & Lewis, V.J. (1991). In Y. Oomura et al. (Eds.), Progress
in obesity research 1990. Libbey. [sensory preferences (sweetness) & weight control]
Blair, A.J., Lewis, V.J., & Booth, D.A. (1994) Appetite [attitudes, emotional eating & self-efficacy]
Booth, D.A. (1996). In A. Angel et al., Progress in obesity research: 7. Libbey. [‘hunger’/’satiety’]
Booth, D.A., Blair, A.J., Lewis, V.J., & Baek, S.H. (2004) Appetite [PCA on least fattening habits]
2. Simone French with Robert Jeffrey & D. Murray (Pound of Prev’n)
S.A. French et alii (1999) International J. Obesity 23, 320-327.
3. Joachim Westenhoefer & associates (Lean Habits Study, Germany)
J. Westenhoefer et alii (2004) Int J Obesity 28, 334-335.
4. Vicky Drapeau & co. with Angelo Tremblay (Québec Family Study)
V. Drapeau et alii (2004) Am J Clin Nutr 80, 29-37.
No other study that I’ve yet seen covers a full range of specific behaviour.
November 2008: nothing such that cites any of the above.
Research into effective behaviour
(comprehensively across patterns)
(1) A.J. Blair & co (1989) as in Booth et al. (2004)
Most fattening customs of eating
In the English Midlands
F1A: energy in or with drinks between meals
Self-described pattern of
eating and drinking
“Avoid calories between meals,
in drinks and snack foods”
“Avoid sweet ‘extras’ (biscuits,
cakes, sweets, chocolate)”
“Eat fresh fruit & salad instead of
higher-calorie foods”
Score combining the above three
Correlation
with wt. loss
over 1 year
0.31
0.26
0.21
0.28
I.e., cutting out energy intake between meals is
the most important “least fattening habit”
Research into effective behaviour
(comprehensively across patterns)
(1) A.J. Blair & co (1989) as in Booth et al. (2004)
Most fattening customs of eating
in the English Midlands
1A: energy in or with drinks between meals
Full exploitation of such PSYCHOSOCIAL evidence
requires ‘translation’ into the PSYCHOBIOLOGY,
e.g. (in this case – Factor 1A),
timings and sizes of the ‘snack’ and the meal before.
Measure the effects of ‘late mixing’ on gastric emptying
Calculate long-term consequences for body weight
(Booth & Mather 1978; also Booth IJV&N [Swiss Nutrition Society] 1988)
“Snacking” that is fattening:
NOT a snack in the sense of a light meal;
NOT eating a snack-food (if part of a meal).
Energy sources consumed between regular meals,
e.g. in or with drinks an hour or more before a mealtime.
Snacking can be addictive -
NOT because of “palatability” of the food snacked on;
NOT because of “pleasure” or “reward” from sweet (or
salty) taste or from crunchy or succulent texture;
NOT because of “weakness in satiety”.
Ingestive movements on any ‘nibble’ / ’sip’ available
after a meal are associatively conditioned by glucose
from (unsweet, fat-free) starch in that food/drink item.
Research into effective behaviour
(comprehensively across patterns)
(1) A.J. Blair & co (1989) as in Booth et al. (2004)
Most fattening customs of eating
in the English Midlands
1B: high-fat foods/cooking
Self-described pattern of
eating and drinking
“Avoid unnecessary fat in meals”
“Avoid fat in cheese and cream”
Correlation with
wt. loss in 1 yr
0.23
0.20
“Keep fat down when using spreads”
Score combining the above three
0.21
0.22
Full exploitation of this PSYCHOSOCIAL evidence requires
‘translation’ into the PSYCHOBIOLOGY of the mouthful:
Fat does satiate strongly but late after its ingestion,
e.g., through glucose-sparing oxidation of fatty acids in
the triglycerides still in chylomicrons long after the meal.
High-fat foods are fattening NOT because high “palatability” increases volume eaten;
NOT because of a high-fat “behavioural phenotype”.
Deposition of adipose fat requires energy to synthesise
fatty acids from acetate produced from dietary carbohydrate or
protein, unlike deposition from dietary fat.
Eating of high-fat foods is learnt by custom:
NO texture, aroma or taste of “fat” across all high-fat foods;
NO innate preference for fat-based creaminess or crunchiness.
NOT “weakly satiating”: like protein, delayed metabolic satiation.
Traditional or prestigious foods are often high in fat, e.g. (in
UK) foods that store well (because of low water activity), foods
for masculine image of men (‘great British breakfast’; ‘red’ meat).
Research into effective behaviour
(comprehensively across patterns)
(1) A.J. Blair & co (1989) as in Booth et al. (2004)
Most fattening customs of eating
in the English Midlands
Dieting OR Extreme exercise
Self-described habit
Correlation of
1-yr weight loss &
frequency of habit
Predicted to be counterproductive (unsustainable, hence de-motivating -> yo-yo)
“Eat slimmers’ meal replacements
for one or more meals a day” - 0.05
Predicted to spend extra energy but not to be maintained; hence yo-yo dieting
“Do vigorous exercise regularly”
- 0.09
Predicted to spend extra energy and to be a maintainable routine
“Walk or cycle whenever possible”
0.04
Might help identify (=expertise) and/or sustain (=motivation) weight-losing habits
“Go to a slimming club or weight reduction class”
0.11
Research into effective behaviour
(comprehensive of the patterns)
(1) A.J. Blair et alii (1989) Psyc Health; D.A. Booth et alii (2004) Appetite
Strengths
• Practices asked about edited from words by members of public
- edited into smaller number by using examples from public
(AL-C now getting public’s own groupings of new examples)
• Reported weights prospectively at 0 and 12-14 months.
• Bivariate analyses from factor-analytical latent variables.
• Measured behaviour at the end of the study period.
RCTs confound effectiveness of package with adherence to it
cp. Knauper et al. ’05 (McGill Psychology) re ‘self-set rules’.
[Blair et al. also assessed beliefs in efficacy of each practice,
plus psychological barriers, e.g.:low weight-control self-efficacy,
emotional eating, [not eating self-efficacy]
chronic dieting (‘restraint’),
lack of reasons for action (‘attitudes’)]
Research into effective behaviour
(comprehensive of the patterns)
(1) A.J. Blair & co (1989) as in Booth et al. (2004)
Weaknesses
• Only one year tracked
- need longer for obesity-adequate measure of persistence
• Direct questions about frequency of practices:
- unreliable heuristics (e.g., P Slovic; P Sedlmeier & T Betsch, ‘Etc.’)
- need timing of two most recent episodes to calculate real frequency
(over the exact period since the earlier occasion).
• Analysis only of final frequency
- need change in frequency to measure cause of weight change
• Only two points and so no crossed time-lags possible
- needed to measure effect of behavour on weight as distinct from
wt on bhvr, or both from 3rd factor causing both changes
Research into effective behaviour
(comprehensive of the patterns)
(2) S.A. French, R.W. Jeffery, D. Murray (1999) IJO 23, 320-327
Reliable associations (N = 1120)
(only these phrases in the Tables are available)
Strategy
Loss (g/wk)
Reduce calories
27
Eliminate sweets
27
Increase F&V
23
Reduce food amount 20
Decrease fat intake
14
[Less hi-CHO food]
30
[Eliminate snacks]
23
[Increase exercise]
16
while
strategy
in use
P<
0.0001
0.0001
0.0001
0.001
0.001
ns
ns
ns
t2D
x
x
x
Research into effective behaviour
(comprehensive of the patterns)
(2) S.A. French, R.W. Jeffery, D. Murray (1999) IJO 23, 320-327
Strengths
• Large number (23) of so-called “specific weight control behaviors”
• Four successive years of data from N = 1120 (Pounds of Prev’n study)
• The year’s duration of use of each practice recalled
[Prevalences reported (yet again): these may screen for feasibility]
Weaknesses
• Behavioural patterns not specific in analysis, nor defined in report
• Wordings “developed by researchers”: ??recognition by participants
• Orthogonal latent factors not extracted
• Current behaviour not measured at time of weight measurement;
hence an association over the year (or 4y) is fallacious because
weight stays at asymptote only while behaviour persists.
Raynor, Jeffery et al. (2008) did not replicate in N = 5145 over 1 year in t2D
for cutting out sweets, increasing F&V, eating less hi-CHO food.
Research into effective behaviour
(comprehensive of the patterns)
(3) Westenhoefer & co. (2004) IJO
Physicians’ group counselling 4-5 months, initial meal-replacement formula;
follow-up of weight at 3 years.
Odds ratio for reduced weight at 3 years (N = 1247)
practices improved or maintained from 2mth to 12mth / lapsing
Multiple-items score
Avoid fatty or sweet foods; eat F&V
Avoid snacks/nibbles; regular meals
Focus on eating within meals
Active lifestyle; take exercise
Control of emotional eating & stress
WSP’99* “Flexible Control” of eating
OR
P<
1.81
1.71
1.36
1.35
1.31
1.30
0.001
0.001
0.05
0.05
0.05
0.05
1.18
1.17
ns
ns
(?an experimenting approach)
WSP’99* “Rigid Control” of eating
Eat smaller amounts of food
*J Westenhoefer, AJ Stunkard & V Pudel (1999) IJED 26, 53-64.”graduated vs all or nothing”
Research into effective behaviour
(comprehensive of the patterns)
(3) Westenhoefer et al. (2004)
Strengths
• Prospective from 2-12 months of change to 0-3 years outcome
• Dietary and movement practices tracked at 2, 12, 24 and 36 mth
Weaknesses
• Investigators chose the wordings of the behavioural reports.
• Unclear distinction between actual action and intention/attitude.
• Specific behaviour patterns (and motives) combined for analysis.
Opportunity taken
The specific behaviours were counted, even though not quantitated:
- highest success rate (61% with 3y wt loss)
with 7 improvements maintained at 1y;
- 52% success at mode of 5 improvements (quarter of sample).
Research into effective behaviour
(comprehensive of the patterns)
(4) Drapeau et al. & Tremblay (2004) AJCN
Weight & adiposity change in 6 years; at 6y, more/less/same of10 food g’ps
and food portions in 3-day record
Less increase in measures of fatness (weight, body fat %, waistline etc.)
(all 6)
recalled more fruit and fruit products
recorded more whole fruit
recalled less fat and fatty foods
recorded less full-fat milk (not independent of fruit)
(some)
recalled less sugar and sweet foods
effects (above) reduced by allowance for 3-d recorded PA
Strengths
• Assessed intakes of particular foods at final weight measurement
• Measured weight and 5 indices of adiposity at both time-points
• Factored out physical activity and other food habits
Weaknesses
• Recalled changes in consumption were not specific to foods
• No intervening measures between 0 and 6 years
Research into effective behaviour
Behaviourally ‘comprehensive’ studies
Most other work does not track any sorts of behavioural pattern
“Psychobehavioural” associates
merely psychometric scale scores (restraint, depression etc.):
should be treated as supplementary outcomes and/or
motivational moderators (Blair et al., 1989; Lewis, Blair, Booth, 1992a,b)
Important ‘selective’ studies
Coakley et al. & Willett (1998) IJO 22, 89-96: 4y prosp’ve; N=19.5k
snacking fattens, not fat intake (except oldest); TV & no vigorous PA
Knauper et al. (2005) Appetite on self-set rules in wt. control:
persistence (compliance) usually confounds effectiveness
Disconfounding is possible only if change in each behaviour
is tracked during weight loss;
not done by the best RCT so far (DPPRG, 2002 NEJM):
weight still increasing at 2y, while PA relapsing; no ‘dietary’ data
Research into effective behaviour
comprehensive across specific self-described patterns
Follow-up & extend Blair et al. (1989) as in Booth et al. (2004, 2007)
Research trainee’s pilot at McGill with updated methods
- particularly weekly tracking and cross-lagged analyses (Baek)
- ’localised’ (shift culture) to Montreal, French language & students
Concluding part of this talk
using Symposium (2006) slides on http://epapers.bham.ac.uk
Research student’s project at Brum
- nutrition graduate / obesity dietitian for a degree in psychology
First year: strengthen different parts of the methods
e.g. update elicitation & categorisation of descriptions
validate recall of self-described activities
Second year onwards: weekly reporting weight & timings of bhvr
multiple-baseline to asymptotic weight
persistence & antecedents of lapses
More in future at McGill??
Yet more applications for research grants in UK
Theory of ‘enABLE’ research method
1. A subculture’s consensus descriptions of customs
objectify communicable patterns of activity.
Theory
1. A subculture’s consensus descriptions of customs
objectify communicable patterns of activity.
2. Autobiographical memory can time episodes of
an activity as accurately as a diary record can.
Theory
1. A subculture’s consensus descriptions of customs
objectify communicable patterns of activity.
2. Autobiographical memory can time episodes of
an activity as accurately as a diary record can.
3. A sustained change in frequency of a custom of
eating or moving about will change body weight
towards asymptote over a few weeks.
Theory
1. A subculture’s consensus descriptions of customs
objectify communicable patterns of activity.
2. Autobiographical memory can time episodes of
an activity as accurately as a diary record can.
3. A sustained change in frequency of a custom of
eating or moving about will change body weight
towards asymptote over a few weeks.
4. Change to a frequency that is sufficiently prevalent
in a culture will be maintained indefinitely, along
with the asymptotic change in body fat content.
Theory
1. A subculture’s consensus descriptions of customs
objectify communicable patterns of activity.
2. Autobiographical memory can time episodes of
an activity as accurately as a diary record can.
3. A sustained change in frequency of a custom of
eating or moving about will change body weight
towards asymptote over a few weeks.
4. Change to a frequency that is sufficiently prevalent
in a culture will be maintained indefinitely, along
with the asymptotic change in body fat content.
5. Antecedents to lapse from change can be identified in
food supply, transport and built environment, and
evidence found for effective changes in them.
Varieties of intervention
Measurement (tracking) only: “observational”
Multiple-baseline with tracking: quasi-experimental
Multiple baseline tracking in RCT: experimental
versus other wordings of behaviour-changes
The McGill pilot study (observational)
Method (with some short-cuts)
1. Consensus descriptions elicited in one culture (UK)
were ‘localised’ to another culture (Quebec French)
by investigators as participant observers, checked by
back-translation to England’s language and environs.
2. Exact current frequency is given by the reciprocal of
the time difference between the last two occasions.
3. Effect on weight of maintained change in frequency
of a custom after the first week (or 2 weeks) was
measured by correlation between the changes,
4. Effects of initial and changed custom frequencies on
behaviour change maintenance (and weight change
maintenance for an effective custom) were expressed
as ‘dose-response’ slopes.
Design
Convenience sample of French-speakers in Montreal:
21 recruited; 14 completed the planned 6 weeks of the
study: 12 women and 2 men, ages 18-46 years.
At the same time of day on the same day of the week, on
a questionnaire in French, each reported body weight
(weighed that day on the same scales) and recalled the
last two timings of carrying out each of 26 customs of
eating and/or drinking and 6 customs of moving about.
Analysis
Correlations of changes in behaviour and weight (1)
Results are expressed here as r x 100, where r is
Pearson’s product-moment correlation coefficient.
[Where data are seriously skewed, Spearman’s correlation of
ranks, rho, should be used instead.]
If only one pattern of energy intake or expenditure
changes in frequency in a given week, correlation
with weight change can in theory be perfect (r = 1.0).
With such a small sample, the observed r values are
highly unreliable. [When N is adequate for good estimates
of effect size, the 95% confidence limits of r should be given.]
Correlations of changes in behaviour and weight (2)
Positive values indicate that the activity is fattening.
Negative values indicate an effective slimming habit.
Test of the causal hypothesis:
Frequency change correlates with later Weight change.
This is a rather severe test, discounting weight lost in 1st week or two (though 1st week is mainly water).
Cross-lagged control:
Weight change does not correlate in the same direction
with later Frequency change.
Correct the r-value measuring Frequency on Weight by subtracting r-value for Weight on Frequency.
Effect of belief on behaviour:
Weight change correlated in the opposite direction with
later Frequency change indicates action on a correct
belief as to what can produce that change in weight.
Evidence for eating that slims in Francophone Canada
correlation of amount of one change in first week of that change
with amount of the other change in subsequent two weeks
Activity (described
in French = “…”)
r x 100
r x 100
rF,W - rW,F
rW,F/rF,W
Freq 0-1
Wt 1-3
Wt 0-1 Cross-lag Strength
Freq 1-3 corrected of belief
smaller meal a
-63
-50
-13
-
vegetables in meal
-85
54
(-85)
0.6
cheese, dairy cream b
-93
38
(-93)
0.4
food with added sugar
-25
58
(-25)
2.3
“sucreries en ‘surplus’”
-30
45
(-30)
1.5
a
smaller than ‘normal’.
b
“des matières grasses animales [sic] sous forme de ...”
Customs that slim in Montreal (described in French)
Means of correlation values (r x 100) available from up to four lags:
behaviour-Frequency change over one week (F0-1) or two weeks (F0-2)
and Weight change over the next week (W1-2,W2-3) or two (W1-3,W2-4).
Mean
Freq
on Wt
Mean
Wt on
Freq
Mean
cross-lag
corrected
Mean
strength
of belief
smaller meal
-62
-43
[-60]
0.9
vegetables in meal
-28
-9
-14
[3.0]
cheese, dairy cream
-70
17
-48
0.2
food with added sugar
-6
45
[-6]
4.3
“sucreries en ‘surplus’”
-10
16
1
-
take exercise until tired
-34
-28
[-15]
2.4
Pattern of behaviour
[…] = (mean) difference from two of the four (or one of the three) lags available
Customs that fatten in Montreal (described in French)
Frequency change over one week (F0-1) or two weeks (F0-2) and Weight
change over the next week (W1-2,W2-3) or two (W1-3,W2-4) - mean values
Mean
Freq
on Wt
Mean
Wt on
Freq
Mean
cross-lag
corrected
Mean
strength
of belief
use fat in cooking/prep’n
59
20
57
-
drink alcohol
53
-48
(40)
1.1
choose fibre-rich foods
55
11
31
-
eat fruit or salad
73
7
65
-
aerobics/“un club sportiv”
75
18
62
-
Pattern of behaviour
Other ways to test the causal hypothesis
e.g., correlation (unlagged) of a persisting change in
frequency of an activity with the amount of weight lost
Less food than normal in a meal
10.00
12
0.00
Biggest change in Frequency
Each
person’s
biggest
change in
frequency
during a
period of
consistently
up or down
change
Increase in frequency with
greatest decrease in weight
2
1
13
7
-10.00
-20.00
-30.00
14 6
Decrease in frequency
(briefly) with (almost) no
change in body weight
R Sq Linear = 0.396
-40.00
0.00
1.00
2.00
3.00
4.00
5.00
weight change
Change in weight (kg t1 – t2)) over whole period of change
Does maintenance of changed frequency of a practice
depend on how frequent the custom was or is?
Less food than normal in a meal
o
f
6
6
N
u
m
b
e
r
2
12
No.of week
No.of week
N 5.00
u
m
b 4.50
e
r 4.00
3.50
o
f
1
4.50
2
12
4.00
3.50
down
7
7
up
1
3.00
3.00
w
e
e
k
s
5.00
w
e
e
k
s
2.50
13
2.00
0.00
3.00
6.00
9.00
12.00
F0
Starting frequency (times per week)
Change in frequency [increase*] of
eating smaller meals is maintained
for longer if frequency starts higher.
2.50
R Sq Linear = 0.311
R Sq Linear = 0.386
13
2.00
15.00
-6.00
-4.00
-2.00
0.00
2.00
4.00
6.00
8.00
F0-1
Frequency change in first week of change
No sign of effect of size of increase* in frequency.
(Sharp decreases were not well sustained.)
The bigger picture for research (1)
The psychobiological “long haul” (Booth, 1988)
= study of the mechanisms of appetite and its sating,
and of vigour and its fatigue
.
physically energetic
- by itself, such work can’t show how to control weight;
- yet the mechanisms of choice and its satiety/fatigue
must be measured, in order to work out how to
support these psychosocially identified
maintainable least fattening customs,
e.g. through supply of foods, transport, leisure,
etc.
The bigger picture for research (2)
Psychosocial “short-cut” (B ’88)
Generalise and differentiate from
personally tailored locally valid evidence
Track changes in behaviour components
- causal evidence without experiment
- the only way to rescue obesity RCTs
from unusability and invalidity.
The future for enABLEr/s
Provide service through the research
Generate research through services
Begin to educate the public (& professionals) in
personally tailored locally valid evidence
to inform a succession of changes each 1-3 weeks,
- especially of eating habits when
a more sedentary lifestyle begins.
Create demand on commercial and public providers
To change supply in ways that evidence shows to
support effective maintainable patterns of individual
behaviour.
Thank you for your attention
SPARE SLIDES
Bio
‘Bio’
David Booth has research doctorates in
biochemistry and in psychology.
One of his main areas of research since 1964
has been the neural, digestive, metabolic,
sensory and social influences on, and effects of,
choices and intakes of foods and drinks, and
how all these causal processes interact in the
individual’s life.
One major effort has been to characterise and to
measure the least fattening customs of eating
within local environments. This talk will highlight
a pilot study conducted in this School that is now
being extended by a nutrition graduate and
obesity dietitian from Mexico who is studying for
a research degree in Psychology with David and
colleagues at the University of Birmingham.