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 Penninx, Gerard van Grootheest, Elisabeth Kohls, Ulrich Hegerl, Matthew Owens, Ed Watkins, Ingeborg A. Brouwer, the MooDFOOD Prevention Trial Investigators

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


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.

Original languageEnglish
Pages (from-to)2579-2591
Number of pages13
JournalEuropean Journal of Nutrition
Issue number6
Early online date1 Jan 2019
Publication statusPublished - 1 Sep 2020

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