title: Eating in moderation and the essential role of awareness. A Dutch longitudinal study identifying psychosocial predictors.
abstract: BACKGROUND
  Eating in moderation, i.e. the attempt to monitor and limit the intake of energy-dense foods, is a promising strategy in the prevention of weight gain. The purpose of this study was to examine which psychosocial factors derived from the I-Change Model (ICM) were associated with eating in moderation, and whether these factors differed between adults with a correct (aware) or incorrect (unaware) perception of their dietary behaviour.
  
  
  METHODS
  This study used a longitudinal design with measurements at baseline (N = 483) and six-month follow-up (N = 379). Eating in moderation was defined as the average daily energy intake from energy-dense food products and was measured by a validated food frequency questionnaire. Linear regression analyses were used to assess the associations between the ICM factors and eating in moderation. The moderating role of awareness was examined by including interactions between awareness and the ICM factors in the regression analyses using the pick-a-point approach to further examine the associations for aware and unaware participants.
  
  
  RESULTS
  Participants who were aware of their dietary behaviour had a significantly lower average daily energy intake compared to those who were unaware. Eating in moderation was predicted by awareness, risk perception, social influence and intention. Among the aware participants, eating in moderation was predicted by risk perception, attitude, social influence and intention. Among the unaware participants, only risk perception and self-efficacy were significantly associated with eating in moderation.
  
  
  CONCLUSIONS
  Our findings show that psychosocial factors may only predict eating in moderation when people are aware of their risk behaviour. Therefore, interventions aimed at promoting complex behaviours, such as eating in moderation, should first focus on improving individuals' awareness of their risk behaviour before targeting motivational factors.
authors.affiliation: School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands; Department of Health Promotion, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands. Electronic address: michel.walthouwer@maastrichtuniversity.nl.
authors.forename: Michel Jean Louis
authors.initials: MJ
authors.lastname: Walthouwer
authors.affiliation: School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands; Department of Health Promotion, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
authors.forename: Anke
authors.initials: A
authors.lastname: Oenema
authors.affiliation: School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands; Department of Methodology and Statistics, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
authors.forename: Math
authors.initials: M
authors.lastname: Candel
authors.affiliation: School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands; Department of Psychology, Open University of the Netherlands, P.O. Box 2960, 6419 AT Heerlen, The Netherlands.
authors.forename: Lilian
authors.initials: L
authors.lastname: Lechner
authors.affiliation: School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands; Department of Health Promotion, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
authors.forename: Hein
authors.initials: H
authors.lastname: de Vries
mesh_terms: D000328:Adult; D001294:Attitude to Health; D001364:Awareness; D015992:Body Mass Index; D004032:Diet / Q000523:psychology; D004435:Eating / Q000523:psychology*; D002149:Energy Intake; D005247:Feeding Behavior / Q000523:psychology*; D005260:Female; D006801:Humans; D006963:Hyperphagia / Q000209:etiology* / Q000523:psychology; D033182:Intention; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D009765:Obesity / Q000209:etiology / Q000517:prevention & control; D012044:Regression Analysis; D012309:Risk-Taking; D012649:Self Concept; D020377:Self Efficacy; D012931:Social Environment; D011795:Surveys and Questionnaires
keywords: Awareness; Determinants; Eating in moderation; I-Change Model; Obesity