Eating occasion need states and weight gain prevention in midlife women.

University of Minnesota Ph.D. dissertation. December 2011. Major: Nutrition. Advisor: Marla Reicks, PhD, RD. 1 computer file (PDF); ix, 176 pages, appendices 1-2.Midlife years (age 40-60) are a critical time period for many women because of elevated risk of overweight and obesity. Women often experience age-related weight gain based on both physiological and environmental changes that occur with age. The physiological changes experienced by women can contribute to weight gain, but weight gain can also be due to both environmental and behavioral factors that influence eating behavior. This project was based on a multidisciplinary approach involving nutrition and marketing expertise to address the situational context of eating occasions. The project was conducted in two phases; a descriptive research phase (Phase I) which provided information to inform the development of a controlled intervention phase (Phase II). The objective of the descriptive research phase I was to identify distinct need states based on rational and emotional needs surrounding specific eating occasions experienced by midlife women and determine how eating behavior including energy, food and nutrient intakes, and BMI differed by need state. Data from 5,556 eating occasions experienced by a US national sample of 1,663 women (40-60 years) were used in the segmentation analysis. Six need states were identified: healthy express, comforting interludes, indulgent escapes, nurturing family meals, sensible meals, and fast fueling. Each of the six need states had different energy and food and nutrient intake characteristics. The objective of the controlled-intervention phase II was to implement and evaluate the effectiveness of a nutrition counseling intervention tailored to eating occasion need states to prevent weight gain compared to a control group of midlife women. Participants in the intervention group received ten hours of nutrition counseling over six months based on commonly experienced needs within specific eating occasions. The control group received no counseling. Although not significant, women in the intervention group gained 0.2 kg over the two year period, while women in the control group gained 0.4 kg. Energy intake did not differ significantly between the intervention and control group at any time point, however decreases were observed in total- (p=0.02) and saturated fat intakes (p=0.06), and cholesterol (p=0.01) intake over the two-year period in the intervention compared to control group. Over the two-year period compared to the control group, the intervention group increased intakes of fruit (p=0.02) and low/reduced fat dairy products (p=0.04) and decreased intakes of sugars and candy (p=0.002). Subgroup analyses of women experiencing less-healthy need states (intervention n=71; control n=59) showed results similar to the overall sample regarding weight change. Subgroup analyses of overweight and obese women (Intervention n=116; Control n=103) showed different patterns of change with weight decreasing in the intervention group (86.0 to 85.5 kg) and increasing in the control group (82.8 to 83.4 kg). This study provides evidence that tailoring nutrition education according to most frequently experienced eating occasion need states may, over time, lead to improved weight outcomes in overweight or obese women who often experience less-healthy need states. However, the intervention approach may be less helpful for normal weight women already experiencing healthy need states