Effect of food-related behavioral activation therapy on food intake and the environmental impact of the diet: results from the MooDFOOD prevention trial

Alessandra C Grasso, Margreet R Olthof, Corné van Dooren, Miquel Roca, Margalida Gili, Marjolein Visser, Mieke Cabout, Mariska Bot, Brenda W J H Penninx, Gerard van Grootheest, Elisabeth Kohls, Ulrich Hegerl, Matthew Owens, Ed Watkins, Ingeborg A Brouwer, MooDFOOD Prevention Trial Investigators, Marjolein Visser, Ingeborg A Brouwer, Mieke Cabout, Brenda Penninx, Mariska Bot, Nadine Paans, Carisha Thesing, Deborah Gibson-Smith, Melany Horsfall, Lena Weiss, Ed Watkins, Matthew Owens, Amy Romijn, Hannah Bunce, Owain Winfield, Miquel Roca, Margarita Gili, Miquel Tortella, Clara Homar Covas, Margalida Vives Forteza, Adoración Castro Gracia, Maria Angeles Pérez-Ara, José Luis Reig, Ulrich Hegerl, Elisabeth Kohls, Jana Hoesel, Ezgi Dogan, Sabrina Baldofski, Nicole Mauche, Brenda Penninx, Gerard van Grootheest, Bep Verkerk, Alessandra C Grasso, Margreet R Olthof, Corné van Dooren, Miquel Roca, Margalida Gili, Marjolein Visser, Mieke Cabout, Mariska Bot, Brenda W J H Penninx, Gerard van Grootheest, Elisabeth Kohls, Ulrich Hegerl, Matthew Owens, Ed Watkins, Ingeborg A Brouwer, MooDFOOD Prevention Trial Investigators, Marjolein Visser, Ingeborg A Brouwer, Mieke Cabout, Brenda Penninx, Mariska Bot, Nadine Paans, Carisha Thesing, Deborah Gibson-Smith, Melany Horsfall, Lena Weiss, Ed Watkins, Matthew Owens, Amy Romijn, Hannah Bunce, Owain Winfield, Miquel Roca, Margarita Gili, Miquel Tortella, Clara Homar Covas, Margalida Vives Forteza, Adoración Castro Gracia, Maria Angeles Pérez-Ara, José Luis Reig, Ulrich Hegerl, Elisabeth Kohls, Jana Hoesel, Ezgi Dogan, Sabrina Baldofski, Nicole Mauche, Brenda Penninx, Gerard van Grootheest, Bep Verkerk

Abstract

Purpose: Food-based dietary guidelines are proposed to not only improve diet quality, but to also reduce the environmental impact of diets. The aim of our study was to investigate whether food-related behavioral activation therapy (F-BA) applying Mediterranean-style dietary guidelines altered food intake and the environmental impact of the diet in overweight adults with subsyndromal symptoms of depression.

Methods: In total 744 adults who either received the F-BA intervention (F-BA group) or no intervention (control group) for 12 months were included in this analysis. Food intake data were collected through a food frequency questionnaire at baseline and after 6 and 12 months. Greenhouse gas emissions (GHGE), land use (LU), and fossil energy use (FEU) estimates from life-cycle assessments and a weighted score of the three (pReCiPe score) were used to estimate the environmental impact of each individual diet at each timepoint.

Results: The F-BA group reported increased intakes of vegetables (19.7 g/day; 95% CI 7.8-31.6), fruit (23.0 g/day; 9.4-36.6), fish (7.6 g/day; 4.6-10.6), pulses/legumes (4.0 g/day; 1.6-6.5) and whole grains (12.7 g/day; 8.0-17.5), and decreased intake of sweets/extras (- 6.8 g/day; - 10.9 to - 2.8) relative to control group. This effect on food intake resulted in no change in GHGE, LU, and pReCiPe score, but a relative increase in FEU by 1.6 MJ/day (0.8, 2.4).

Conclusions: A shift towards a healthier Mediterranean-style diet does not necessarily result in a diet with reduced environmental impact in a real-life setting.

Trial registration: ClinicalTrials.gov. Number of identification: NCT02529423. August 2015.

Keywords: Depression; Diet; RCT; Sustainability.

Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Effect of the food-related behavioral activation therapy (F-BA) intervention on intake of 18 food groups in overweight adults with subsyndromal symptoms for depression during the 12-month MooDFOOD depression prevention trial (N = 744). The bars represent the difference in change in intake from baseline to 12 months between participants who received F-BA intervention (F-BA group) and participants who did not receive F-BA intervention (control group) when controlling for baseline value of outcome, age, sex and site. The lines represent 95% confidence intervals. *Significant at Holm–Bonferroni-corrected P value

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