Dietary Behavior Change Interventions Research Articles

Development and Validation of the Motivation for Healthy Eating Behavior Scale (MHEBS) in the Bengali-Speaking Adults

Purpose: This study aimed to develop and validate a scale to assess the motivation for healthy eating behavior in Bengali-speaking adults. Methodology: The study was cross-sectional in nature and was conducted online via Google Forms. A total of 220 Bengali-speaking adults participated in the study. A literature review was conducted to generate an item pool regarding motivation for healthy eating. The content validity of the items was evaluated by an expert panel from related fields. Based on their responses, the items were modified, and 15 items were assessed for face validity. The scale’s construct validity was assessed by performing an Exploratory Factor Analysis (EFA). The reliability of the scale was examined using the internal consistency reliability coefficient or Cronbach’s alpha. To establish the convergent and divergent validity of the scale, the Satisfaction with Life Scale (SWLS) and Fear of COVID-19 Scale (FCV-19S) scale were used. Major Findings: The MHEBS showed good content and face validity. The internal consistency reliability of the scale was in the acceptable range with Cronbach’s alpha value of 0.820. The EFA suggested a three-factor scale structure, and the factors were “benefits of healthy eating”, “external regulation”, and “affordability”. The scale also showed acceptable convergent and divergent validity with SWLS and FCV-19S respectively. Implications: MHEBS — a 15-item 5-point Likert scale — is the first developed scale to measure the motivation for healthy eating behavior in the Bengali-speaking adult population. The scale would help identify what motivates Bengali adults to for maintaining healthy eating behavior. In addition, it would aid program planners to effectively design health promotion strategies as well as health practitioners and dietitians to counsel patients before applying dietary behavior change interventions. Bioresearch Commu. 10(2): 1557-1564, 2024 (July)

Efficacy of Internet-Based Dietary Behavior Change Interventions in Improving Healthy Eating Across the Life Course: A Systematic Review

ObjectivesTo assess the efficacy of internet-based dietary behavior change interventions in improving healthy eating across the life course. MethodsThis systematic review adhered to the standards set out in the PRISMA 2020 statement: an updated guideline for reporting systematic reviews (BMJ 2021;372: n71). The review protocol was not registered with PROSPERO. PubMed, web of science, Cochrane library and Google scholar databases were searched for randomized control trial studies reported nutrition outcomes associated with the use of internet in interventions for dietary behavior change published from 2013 to 2021. Authors screened, read and extracted data from the articles using eligibility criteria. Authors assessed the risk of bias in each RCT employing the revised Cochrane (2019) risk-of-bias tool for randomized trials (RoB 2). ResultsTwelve studies met inclusion criteria. Sample size was 4,562 participants aged 3 months to over 70 years. Majority 66.7% of studies used websites developed for their interventions. Majority (75%) of included studies communicated with participants through emails. The characteristics of participants at baseline were overweight, obese, consumption of at least 12 oz./day of Sugar Sweetened Beverage (SSB), eating < five servings per day of fruit and vegetables, >1 high-energy, high-fat take-out meal weekly. About 40% of interventions applied the social cognitive theory behavior change techniques to achieve dietary behavior change. Attrition rate ranged from 5.1% to 16.4%. Participants’ level of engagement and completion ranged from 70.1% to 95%. Contents covered in the dietary behavior change interventions varied across studies. As the interventions varied widely, a meta-analysis was not possible, however all studies (100%) reported positive dietary behavior change in intervention participants. ConclusionsThis review shows that internet-based dietary behavior change interventions can be used to target everyone across the life cycle, focus on a wide variety of contents areas in nutrition and behavior change, achieve high retention rate and significant improvements in dietary behavior change. This is significant as face-to-face interventions are not possible with current Covid-19 pandemic restrictions and therefore a good alternative or replacement. Funding SourcesNot funded.

A pilot sequential multiple assignment randomized trial (SMART) protocol for developing an adaptive coaching intervention around a mobile application for athletes to improve carbohydrate periodization behavior

BackgroundIt has recently been identified that manipulating carbohydrate availability around exercise activity can enhance training-induced metabolic adaptations. Despite this approach being accepted in the athletic populations, athletes do not systematically follow the guidelines. Digital environments appear to allow nutritionists to deliver this intervention at scale, reducing expensive human coaching time. Yet, digitally delivered dietary behavior change interventions for athletes and the coaching strategy to support them are still novel concepts within sports nutrition. Methods/designWe aim to recruit 900 athletes across the UK. 500 athletes will be recruited to test the feasibility of a novel menu planner mobile application with coaching for 6 weeks. 250 athletes with pre-existing nutritionist support will also be recruited as control. We will then conduct a 4-week pilot sequential multiple assignment randomized trial (SMART) with an additional 150 athletes. In the SMART, athletes will be given the application and additional coaching according to their engagement responses. The primary outcomes are the mobile application and coach uptake, retention, engagement, and success in attaining carbohydrate periodization behavior. Secondary outcomes are changes in goal, weight, carbohydrate periodization self-efficacy, and beliefs about consequences. Due to the high attrition nature of digital interventions, all quantitative analyses will be carried out based on both the intention-to-treat and per-protocol principles. DiscussionThis study will be the first to investigate improving carbohydrate periodization using a digital approach and tailored coaching strategies under this context. Foundational evidence from this study will provide insights into the feasibility of the digital approach.

Dose and engagement during an extended contact physical activity and dietary behavior change intervention delivered via tailored text messaging: exploring relationships with behavioral outcomes

BackgroundExtended contact interventions delivered via text messaging are a low-cost option for promoting the long-term continuation of behavior change. This secondary analysis of a text message–delivered extended contact intervention (‘Get Healthy, Stay Healthy’ (GHSH)) explores the extent to which changes in physical activity, dietary behaviors and body weight were associated with the frequency of text messages (dose) and contact between the health coach and participant (engagement).MethodsFollowing a telephone coaching program, participants were randomised to receive extended contact via tailored text messages (GHSH, n = 114) or no additional contact (n = 114) over a 6-month period. Message dose, timing, and content were based on participant preferences, ascertained during two tailoring telephone calls. All incoming and outgoing messages were recorded. At baseline and 6 months, participants self-reported body weight and dietary behaviors (fruit and vegetable servings/day). Moderate-vigorous physical activity (MVPA) was assessed via accelerometry.ResultsMedian dose (25th, 75th percentile) was 53 (33, 72) text messages in total across six months. Mean fortnightly dose in weeks 1–2 was 5.5 (95 % CI: 4.3, 6.6) text messages, and remained stable (with the exception of planned decreases in weeks involving additional intervention contacts). Offset against the average fortnightly dose of goal checks (1.6, 95 % CI: 1.3, 2.0 and 1.5, 95 % CI: 1.2, 1.8, for physical activity and diet respectively), mean replies to goal checks were highest in weeks 1–2 (1.4, 95 % CI: 1.4, 1.5 and 1.3, 95 % CI: 1.2, 1.4, respectively) and tended to become lower in most weeks thereafter. Greater weight loss was positively associated with text message dose (P = 0.022), with a difference of 1.9 kg between participants receiving the most and fewest texts. There was no association between engagement and changes in outcome measures.ConclusionsA fixed dose of texts does not seem suitable to meet participants’ individual preferences. Higher self-selected text doses predicted better weight outcomes. However, greater participant engagement through text replies does not predict more favourable outcomes, despite being a suggested facilitator of successful behavior change maintenance.Trial registrationAustralian New Zealand Clinical Trials Registry number: ACTRN12613000949785. Date registered: 27 August 2013. Retrospectively registered. http://www.anzctr.org.au/.

Impact of the Method of Delivering Electronic Health Behavior Change Interventions in Survivors of Cancer on Engagement, Health Behaviors, and Health Outcomes: Systematic Review and Meta-Analysis.

BackgroundIncreased accessibility to the internet and mobile devices has seen a rapid expansion in electronic health (eHealth) behavior change interventions delivered to patients with cancer and survivors using synchronous, asynchronous, and combined delivery methods. Characterizing effective delivery methods of eHealth interventions is required to enable improved design and implementation of evidence-based health behavior change interventions.ObjectiveThis study aims to systematically review the literature and synthesize evidence on the success of eHealth behavior change interventions in patients with cancer and survivors delivered by synchronous, asynchronous, or combined methods compared with a control group. Engagement with the intervention, behavior change, and health outcomes, including quality of life, fatigue, depression, and anxiety, were examined.MethodsA search of Scopus, Ovid MEDLINE, Excerpta Medica dataBASE, Cumulative Index to Nursing and Allied Health Literature Plus, PsycINFO, Cochrane CENTRAL, and PubMed was conducted for studies published between March 2007 and March 2019. We looked for randomized controlled trials (RCTs) examining interventions delivered to adult cancer survivors via eHealth methods with a measure of health behavior change. Random-effects meta-analysis was performed to examine whether the method of eHealth delivery impacted the level of engagement, behavior change, and health outcomes.ResultsA total of 24 RCTs were included predominantly examining dietary and physical activity behavior change interventions. There were 11 studies that used a synchronous approach and 11 studies that used an asynchronous approach, whereas 2 studies used a combined delivery method. Use of eHealth interventions improved exercise behavior (standardized mean difference [SMD] 0.34, 95% CI 0.21-0.48), diet behavior (SMD 0.44, 95% CI 0.18-0.70), fatigue (SMD 0.21, 95% CI −0.08 to 0.50; SMD change 0.22, 95% CI 0.09-0.35), anxiety (SMD 1.21, 95% CI: 0.36-2.07; SMD change 0.15, 95% CI −0.09 to 0.40), depression (SMD 0.15, 95% CI 0.00-0.30), and quality of life (SMD 0.12, 95% CI −0.10 to 0.34; SMD change 0.14, 95% CI 0.04-0.24). The mode of delivery did not influence the amount of dietary and physical activity behavior change observed.ConclusionsPhysical activity and dietary behavior change eHealth interventions delivered to patients with cancer or survivors have a small to moderate impact on behavior change and a small to very small benefit to quality of life, fatigue, depression, and anxiety. There is insufficient evidence to determine whether asynchronous or synchronous delivery modes yield superior results. Three-arm RCTs comparing delivery modes with a control with robust engagement reporting are required to determine the most successful delivery method for promoting behavior change and ultimately favorable health outcomes.

Caregiver involvement in interventions for improving children's dietary intake and physical activity behaviors.

CITATION: Morgan, E. H., et al. 2017. Caregiver involvement in interventions for improving children’s dietary intake and physical activity behaviors. Cochrane Database of Systematic Reviews, 2:1-19, Art. CD012547, doi:10.1002/14651858.CD012547.

You are What You Think Your Social Network Eats: Public Housing, Social Networks, and Fast-Food Consumption.

High-sodium diets (e.g., fast-food intake, FF) may contribute to increased hyper-tension risk among low-income populations. We examined the association between FF intake and perceived social-network member FF intake among Baltimore public housing residents. We analyzed 2014-2015 cross-sectional data. Our dependent variable was FF intake (eating FF weekly versus not), and our independent variable was perceiving one or more network member eating FF weekly. We used multivariable Poisson regression with robust variance, adjusted for individual and network covariates. The 266 public housing residents had mean age 44.5 years: 86.1% women, 95.5% African American, 56.8% hypertension, and 42.8% who ate FF weekly. Residents were significantly more likely to eat FF weekly if they perceived that their network contained one or more members who consumed FF weekly (relative risk 1.50, 95%CI 1.05-2.14, p=.02). Given the association between personal and social network consumption of FF weekly, further investigation may be warranted of novel social network interventions for dietary behavior change.

MS-Diet, a tailored nutrition counselling web-application based on mathematical diet optimization

Abstract Background By definition, messages in tailored approaches are built to reach a given person, based on her/his specific characteristics and needs. Tailored dietary behavior change interventions have a small but significant effect on dietary behavior change. The majority of these interventions target a few food groups or nutrients, without evaluating the overall diet. Diet optimization is a powerful mathematical method to translate nutrient recommendations into individual-specific food choices. This method is increasingly used in nutrition research, in the fields of public health and diet sustainability. Objective: The aim was to combine tailored approaches and diet optimization in a web application of tailored nutrition counselling. Method and results The web application, called MS-Diet, was developed based on behavior changes techniques, such as: self-monitoring, self-regulatory, tailored feedback and engaging communication techniques. In a first feature, based on user’s data collected online (including answers to a food frequency questionnaire), the user can obtain a picture of the nutritional quality of her/his diet, the diet cost and the level of physical activity. In a second feature, MS-Diet suggests to the user a list of tailored dietary advices to get a healthier diet (i.e., a nutritionally adequate diet), adapted to her/his specific needs and food preferences. With the application, the user is actor in her/his own dietary changes: she/he specifies her/his food preferences and; chooses dietary suggestions that she/he considers achievable. Conclusions This prototype could be a future online health promotion tool which could help individuals to improve their diet or serve as a decision-support tool for health professionals. The evaluation of the tool (e.g. whether the use of the tool results in changes of dietary habits) is warranted before use on health promotion. Key messages MS-Diet demonstrates how diet optimization can be used to design dietary advice adapted to user’s needs and food preferences. MS-Diet is a promising tool to help individuals improving their diet but requires qualitative and quantitative evaluation for further improvements.

Mobile-Based Interventions for Dietary Behavior Change and Health Outcomes: Scoping Review.

BackgroundMobile apps are being widely used for delivering health interventions, with their ubiquitous access and sensing capabilities. One such use is the delivery of interventions for healthy eating behavior.ObjectiveThe aim of this study was to provide a comprehensive view of the literature on the use of mobile interventions for eating behavior change. We synthesized the studies with such interventions and mapped out their input methods, interventions, and outcomes.MethodsWe conducted a scoping literature search in PubMed/MEDLINE, Association for Computing Machinery Digital Library, and PsycINFO databases to identify relevant papers published between January 2013 and April 2018. We also hand-searched relevant themes of journals in the Journal of Medical Internet Research and registered protocols. Studies were included if they provided and assessed mobile-based interventions for dietary behavior changes and/or health outcomes.ResultsThe search resulted in 30 studies that we classified by 3 main aspects: input methods, mobile-based interventions, and dietary behavior changes and health outcomes. First, regarding input methods, 5 studies allowed photo/voice/video inputs of diet information, whereas text input methods were used in the remaining studies. Other than diet information, the content of the input data in the mobile apps included user’s demographics, medication, health behaviors, and goals. Second, we identified 6 categories of intervention contents, that is, self-monitoring, feedback, gamification, goal reviews, social support, and educational information. Although all 30 studies included self-monitoring as a key component of their intervention, personalized feedback was a component in 18 studies, gamification was used in 10 studies, goal reviews in 5 studies, social support in 3 studies, and educational information in 2 studies. Finally, we found that 13 studies directly examined the effects of interventions on health outcomes and 12 studies examined the effects on dietary behavior changes, whereas only 5 studies observed the effects both on dietary behavior changes and health outcomes. Regarding the type of studies, although two-thirds of the included studies conducted diverse forms of randomized control trials, the other 10 studies used field studies, surveys, protocols, qualitative interviews, propensity score matching method, and test and reference method.ConclusionsThis scoping review identified and classified studies on mobile-based interventions for dietary behavior change as per the input methods, nature of intervention, and outcomes examined. Our findings indicated that dietary behavior changes, although playing a mediating role in improving health outcomes, have not been adequately examined in the literature. Dietary behavior change as a mechanism for the relationship between mobile-based intervention and health outcomes needs to be further investigated. Our review provides guidance for future research in this promising mobile health area.

Strategies to Engage Adolescents in Digital Health Interventions for Obesity Prevention and Management.

Obesity is one of the greatest health challenges facing today’s adolescents. Dietary interventions are the foundation of obesity prevention and management. As adolescents are digital frontrunners and early adopters of technology, digital health interventions appear the most practical modality for dietary behavior change interventions. Despite the rapid growth in digital health interventions, effective engagement with adolescents remains a pertinent issue. Key strategies for effective engagement include co-designing interventions with adolescents, personalization of interventions, and just-in-time adaptation using data from wearable devices. The aim of this paper is to appraise these strategies, which may be used to improve effective engagement and thereby improve the dietary behaviors of adolescents now and in the future.

Understanding self-reported staging of dietary behavior in low-income women.

This study examined self-reported staging for the goal of eating a low-fat diet and several specific dietary consumption behaviors to understand better readiness for dieting. Self-assessed motivation, food frequency measures, and psychosocial variables were obtained from 2057 low-income women enrolled in the Maryland Food for Life Program. Results indicated that staging of specific dietary consumption behaviors was significantly related to staging for the global goal of eating a low-fat diet. Women evaluate their motivation about eating low-fat diets based on perceived efforts and specific activities related to dietary consumption with important implications for dietary behavior change measurement and interventions.

Cardiometabolic risk factor response to a lifestyle intervention: a randomized trial.

Strategies to increase adherence to national dietary and physical activity (PA) guidelines to improve the health in regions such as the Lower Mississippi Delta (LMD) of the United States are needed. Here we explore the cardiometabolic responses to an education and behavior change intervention among overweight and obese adults that adapted the 2010 Dietary Guidelines (DG), with and without a PA component. White and African American overweight and obese adults were randomized to a DG group (n=61) or a DG+PA group (n=60). Both groups received a 12-week dietary education and behavior change intervention, and the DG+PA group also received a PA education and behavior change intervention with a pedometer. Changes in individual risk factors (blood pressure, fasting glucose, triglycerides, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol) and a continuous cardiometabolic risk score were determined. General linear models compared mean changes between groups, adjusting for covariates. No main effect of intervention group was found in completers (n=99) and those who engaged with ≥80% of the intervention (n=83) for individual risk factors or the continuous risk score. Pooling both groups, those with higher baseline risk factor values realized greater improvements in individual risk factors. Adapting DG did not produce any cardiometabolic benefits, even with a PA component. Although the sample was ostensibly healthy, they were all overweight to mildly obese (body mass index of 25-34.9 kg/m(2)) and participants with higher baseline risk factor values showed more improvements. Adherence to longer-term behavior change may elicit changes in risk profile, so this should be explored.

Steps ahead: a randomized trial to reduce unhealthy weight gain in the Lower Mississippi Delta.

ObjectiveThe Lower Mississippi Delta (LMD) region of the U.S. is characterized by high levels of obesity and physical inactivity. The objective was to test the effectiveness of adapting the 2010 Dietary Guidelines for Americans (DG), with and without a physical activity (PA) component, for attenuating weight gain.Design and MethodsOverall, 121 white and African-American adults (35–64 y; BMI 25–34.9 kg/m2) were randomized to a DG only group (n=61) or a DG+PA group (n=60). Both groups received a 12-week dietary education and behavior change intervention. The DG+PA also received PA education and a pedometer. Changes in weight (kg), %weight and waist circumference (WC; cm) were determined. Analyses considered all completers (n=99) and those who engaged with ≥80% of the intervention (n=83). General linear models compared mean changes between groups after adjustment for baseline values, race and sex.ResultsWeight, %weight and WC significantly decreased from baseline to follow-up in both groups (p<0.05; unadjusted values). Adjusted analysis showed a main effect of group for weight (p=0.041) and %weight (p=0.047) in the completers analysis and WC (p=0.046) in the ≥80% attendance analysis, with the DG+PA group improving weight-related outcomes more.ConclusionsLow-burden behavioral interventions could be effective strategies in attenuating unhealthy weight gain in the LMD.

Acceptability of a text message-delivered physical activity and dietary behavior change intervention in breast cancer survivors

Introduction: A growing body of evidence supports the efficacy of mobile phone text messaging as a broad-reach intervention delivery modality for promoting health behavior change. However, applications among breast cancer survivors, who have much to gain from engaging in physical activity and following a healthy diet, have yet to be evaluated. The aim of this study was to establish the acceptability of text messaging to support physical activity and dietary behavior change in breast cancer survivors.

Physical activity and/or dietary interventions in breast cancer survivors: a systematic review of the maintenance of outcomes

Maintaining physical activity and dietary improvements achieved during an intervention is important for the long-term health outcomes of breast cancer survivors. This review aimed to determine: (a) the proportion of physical activity and/or dietary intervention trials in breast cancer survivors that assessed post-intervention maintenance of outcomes, (b) the proportion of trials that achieved successful post-intervention maintenance of outcomes, and (c) the sample, intervention, and methodological characteristics common among trials that achieved successful post-intervention maintenance of outcomes. A structured search of PubMed, CINAHL, Medline via Ovid, Web of Science, CENTRAL, and PsycInfo was conducted for articles published until March 2012. Included trials had to evaluate a randomized controlled trial of a physical activity and/or dietary behavior change intervention that targeted breast cancer survivors and report on between-group differences of behavioral outcomes at end-of-intervention and at least 3 months post-intervention follow-up. Methodological quality of included trials was also assessed. The search resulted in 1,298 publications. Of 63 identified trials that assessed end-of-intervention outcomes, 10 (16 %) assessed post-intervention maintenance of outcomes; four of these 10 trials achieved successful maintenance. Due to the limited number and heterogeneity of the four trials, few commonalities in sample, intervention, and methodological characteristics were identified. Assessing post-intervention maintenance of physical activity and dietary outcomes in breast cancer survivors is rare. There is a pressing need to direct more attention to this issue to inform the development of interventions to improve the long-term health outcomes for the growing number of breast cancer survivors. For breast cancer survivors, maintaining regular physical activity and a healthy diet are important to enhancing health and well-being over the long-term. More research is needed to identify the best ways of supporting survivors to make and maintain these lifestyle changes.

Translation from Research to Practice: Community Dissemination of a Telephone-Delivered Physical Activity and Dietary Behavior Change Intervention

To describe the process of translating an evidence-based, telephone-delivered physical activity and dietary behavior change intervention from research into practice. Descriptive case study. Nongovernment, primary medical care-based community health organization. Telephone-delivered intervention targeting physical activity and diet in primary medical care patients. Systematic documentation of process outcomes related to intervention adoption and adaptation. Research-community partnerships were critical in facilitating translation, including (1) an initial competitive advantage within a State Health Department-funded preventive health initiative; (2) advocacy to ensure the adoption of the intervention, (3) subsequent support for the adaptation of program elements to ensure fit of the program with the community organization's objectives and capacities, while maintaining feasible elements of fidelity with the original evidence-based program; (4) the integration of program management and evaluation systems within the community organization; and (5) ongoing support for staff members responsible for program delivery and evaluation. Preliminary process evaluation of the Optimal Health Program supports the acceptability and feasibility of the program within community practice. INTERVENTION characteristics central to adoption can be influenced by research-community partnerships. It is likely that evidence-based interventions will need to be adapted for delivery within the real world. Researchers should endeavor to provide training and support to ensure, as much as possible, fidelity with the original program, and that the relevant adaptations are evidence based.

Systematic review of maintenance of behavior change following physical activity and dietary interventions.

In the past decade, there has been no systematic review of the evidence for maintenance of physical activity and/or dietary behavior change following intervention (follow-up). This systematic review addressed three questions: 1) How frequently do trials report on maintenance of behavior change? 2) How frequently do interventions achieve maintenance of behavior change? 3) What sample, methodologic, or intervention characteristics are common to trials achieving maintenance? Systematic review of trials that evaluated a physical activity and/or dietary behavior change intervention among adults, with measurement at preintervention, postintervention, and at least 3 months following intervention completion (follow-up). Maintenance of behavior change was defined as a significant between-groups difference at postintervention and at follow-up, for one or more physical activity and/or dietary outcome. Maintenance outcomes were reported in 35% of the 157 intervention trials initially considered for review. Of the 29 trials that met all inclusion criteria, 21 (72%) achieved maintenance. Characteristics common to trials achieving maintenance included those related to sample characteristics (targeting women), study methods (higher attrition and pretrial behavioral screening), and intervention characteristics (longer duration [>24 weeks], face-to-face contact, use of more intervention strategies [>6], and use of follow-up prompts). Maintenance of physical activity and dietary behavior change is not often reported; when it is, it is often achieved. To advance the evidence, the field needs consensus on reporting of maintenance outcomes, controlled evaluations of intervention strategies to promote maintenance, and more detailed reporting of interventions.

Fruit and Vegetable Express: An Interactive, Stage-Tailored Web Program Designed to Increase Fruit and Vegetable Intake Among 18–24 Year Olds

To describe the development, implementation, and efficacy of a web-based dietary behavior change intervention.

Psychosocial correlates of dietary intake: advancing dietary intervention.

Psychosocial variables that predict dietary behavior become important targets for change in nutrition education programs. Psychosocial variables in models with higher predictability provide more effective levers to promote healthy dietary change. A review of the literature on models with psychosocial variables predicting dietary fat and fruit and vegetable consumption revealed generally low predictiveness, R2 < 0.3 (where R2 is the squared multiple correlation of the statistical model). No single theory provided models that regularly out-predicted others. When models predicted narrower categories of behavior (e.g. milk or salad consumption), predictiveness tended to be higher. Substantial problems were revealed in the psychometrics of both the independent and dependent variables. Little theory-based research has been conducted with adolescents, and the few studies done with children had low predictiveness. In order to increase the predictiveness of models, future research should combine variables from several theories, attend to the psychometrics of all variables, and incorporate variables that moderate the relationship of psychosocial to dietary behavior (e.g. genetics of taste, stage in the life course). Refinements on current research would include longitudinal designs and use of non-self-report methods of dietary behavior to supplement the self-report methods. Improved understanding of dietary behavior should lead to more effective dietary behavior change interventions.