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Kikuchi JLD, Carvalhal MMDL, de Castro MM, Vieira Lourenço-Costa V, dos Santos CAR, Cunha FS, Paracampo CCP, Gomes DL. Factors associated with grazing behavior in candidates for bariatric surgery at a hospital in the Amazon. Front Public Health 2023; 11:1227214. [PMID: 38174082 PMCID: PMC10763686 DOI: 10.3389/fpubh.2023.1227214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 12/04/2023] [Indexed: 01/05/2024] Open
Abstract
Blackground To assess grazing behavior and associated factors in candidates for bariatric surgery monitored at a public hospital that is a reference in the care of people with severe obesity. Methods Cross-sectional analytical study, with candidates for bariatric surgery of both genders, treated in a public hospital in the Amazon. To assess grazing behavior, the Repetitive Eating Questionnaire was used, and to investigate patterns of eating behavior, the Three Factor Eating Questionnaire was used, which assesses: Emotional Eating, Cognitive Restriction and Uncontrolled Eating. Sociodemographic information was obtained through self-report and the description of medication use through the medical record. Body mass index (BMI) was also calculated by measuring weight and height. The SPSS program, v. 21.0 was used. The study was approved by the Research Ethics Committee. Results A total of 205 participants were evaluated, with a mean age of 37.5 ± 8.6 years, the majority (93.7%) being women and the majority (59.5%) was not also using medication to lose weight. About 66.3% of the participants had compulsive grazing. The factor with the highest score was cognitive restriction (p < 0.001). Individuals who used weight loss drugs had higher scores in the cognitive restriction factor (p = 0.015) and lower scores for uncontrolled eating (p = 0.008), compulsive grazing (p = 0.021) and non-compulsive grazing (p = 0.034). Conclusion Linear regression showed that emotional eating and uncontrolled eating were predictors of both compulsive grazing and non-compulsive grazing behavior. It was observed that grazing behavior, cognitive restriction, emotional eating and uncontrolled eating are present and correlated in the studied patients. In addition, the use of weight loss drugs seems to help reduce dysfunctional eating behaviors in patients with severe obesity.
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Affiliation(s)
- Jeane Lorena Dias Kikuchi
- Postgraduate Program in Neurosciences and Behavior, Center for Theory and Research of Behavior, Federal University of Pará, Belém, Brazil
| | | | | | | | | | | | - Carla Cristina Paiva Paracampo
- Postgraduate Program in Neurosciences and Behavior, Center for Theory and Research of Behavior, Federal University of Pará, Belém, Brazil
| | - Daniela Lopes Gomes
- Postgraduate Program in Neurosciences and Behavior, Center for Theory and Research of Behavior, Federal University of Pará, Belém, Brazil
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Smith PJ, Whitson HE, Merwin RM, O’Hayer CV, Strauman TJ. Engineering Virtuous health habits using Emotion and Neurocognition: Flexibility for Lifestyle Optimization and Weight management (EVEN FLOW). Front Aging Neurosci 2023; 15:1256430. [PMID: 38076541 PMCID: PMC10702760 DOI: 10.3389/fnagi.2023.1256430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/20/2023] [Indexed: 02/12/2024] Open
Abstract
Interventions to preserve functional independence in older adults are critically needed to optimize 'successful aging' among the large and increasing population of older adults in the United States. For most aging adults, the management of chronic diseases is the most common and impactful risk factor for loss of functional independence. Chronic disease management inherently involves the learning and adaptation of new behaviors, such as adopting or modifying physical activity habits and managing weight. Despite the importance of chronic disease management in older adults, vanishingly few individuals optimally manage their health behavior in the service of chronic disease stabilization to preserve functional independence. Contemporary conceptual models of chronic disease management and health habit theory suggest that this lack of optimal management may result from an underappreciated distinction within the health behavior literature: the behavioral domains critical for initiation of new behaviors (Initiation Phase) are largely distinct from those that facilitate their maintenance (Maintenance Phase). Psychological factors, particularly experiential acceptance and trait levels of openness are critical to engagement with new health behaviors, willingness to make difficult lifestyle changes, and the ability to tolerate aversive affective responses in the process. Cognitive factors, particularly executive function, are critical to learning new skills, using them effectively across different areas of life and contextual demands, and updating of skills to facilitate behavioral maintenance. Emerging data therefore suggests that individuals with greater executive function are better able to sustain behavior changes, which in turn protects against cognitive decline. In addition, social and structural supports of behavior change serve a critical buffering role across phases of behavior change. The present review attempts to address these gaps by proposing a novel biobehavioral intervention framework that incorporates both individual-level and social support system-level variables for the purpose of treatment tailoring. Our intervention framework triangulates on the central importance of self-regulatory functioning, proposing that both cognitive and psychological mechanisms ultimately influence an individuals' ability to engage in different aspects of self-management (individual level) in the service of maintaining independence. Importantly, the proposed linkages of cognitive and affective functioning align with emerging individual difference frameworks, suggesting that lower levels of cognitive and/or psychological flexibility represent an intermediate phenotype of risk. Individuals exhibiting self-regulatory lapses either due to the inability to regulate their emotional responses or due to the presence of executive functioning impairments are therefore the most likely to require assistance to preserve functional independence. In addition, these vulnerabilities will be more easily observable for individuals requiring greater complexity of self-management behavioral demands (e.g. complexity of medication regimen) and/or with lesser social support. Our proposed framework also intuits several distinct intervention pathways based on the profile of self-regulatory behaviors: we propose that individuals with intact affect regulation and impaired executive function will preferentially respond to 'top-down' training approaches (e.g., strategy and process work). Individuals with intact executive function and impaired affect regulation will respond to 'bottom-up' approaches (e.g., graded exposure). And individuals with impairments in both may require treatments targeting caregiving or structural supports, particularly in the context of elevated behavioral demands.
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Affiliation(s)
- Patrick J. Smith
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Heather E. Whitson
- Department of Medicine, Duke University Medical Center, Durham, NC, United States
- Department of Medicine, Durham Veterans Affairs Medical Center, Durham, NC, United States
| | - Rhonda M. Merwin
- Department of Psychiatry, Duke University Medical Center, Durham, NC, United States
| | - C. Virginia O’Hayer
- Department of Psychiatry and Human Behavior, Thomas Jefferson University, Philadelphia, PA, United States
| | - Timothy J. Strauman
- Department of Psychiatry, Duke University Medical Center, Durham, NC, United States
- Department of Psychology and Neuroscience, Duke University, Durham, NC, United States
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Parent MB, Higgs S, Cheke LG, Kanoski SE. Memory and eating: A bidirectional relationship implicated in obesity. Neurosci Biobehav Rev 2022; 132:110-129. [PMID: 34813827 PMCID: PMC8816841 DOI: 10.1016/j.neubiorev.2021.10.051] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 10/17/2021] [Accepted: 10/28/2021] [Indexed: 01/03/2023]
Abstract
This paper reviews evidence demonstrating a bidirectional relationship between memory and eating in humans and rodents. In humans, amnesia is associated with impaired processing of hunger and satiety cues, disrupted memory of recent meals, and overconsumption. In healthy participants, meal-related memory limits subsequent ingestive behavior and obesity is associated with impaired memory and disturbances in the hippocampus. Evidence from rodents suggests that dorsal hippocampal neural activity contributes to the ability of meal-related memory to control future intake, that endocrine and neuropeptide systems act in the ventral hippocampus to provide cues regarding energy status and regulate learned aspects of eating, and that consumption of hypercaloric diets and obesity disrupt these processes. Collectively, this evidence indicates that diet-induced obesity may be caused and/or maintained, at least in part, by a vicious cycle wherein excess intake disrupts hippocampal functioning, which further increases intake. This perspective may advance our understanding of how the brain controls eating, the neural mechanisms that contribute to eating-related disorders, and identify how to treat diet-induced obesity.
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Affiliation(s)
- Marise B. Parent
- Neuroscience Institute & Department of Psychology, Georgia State University, Box 5030, Atlanta, GA 30303-5030, United States,Corresponding author: Marise B. Parent, , Georgia State University, PO Box 5030, Atlanta, GA 30303-5030, USA. Fax: 404-413-5446
| | - Suzanne Higgs
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, BI5 2TT, United Kingdom
| | - Lucy G. Cheke
- Department of Psychology, University of Cambridge, Downing Street, Cambridge, CB2 3EB United Kingdom
| | - Scott E Kanoski
- Department of Biological Sciences, Human and Evolutionary Biology Section, University of Southern California, Los Angeles, CA, 90089-0371, United States
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Berber LCL, Melendez-Araújo MS, Nakano EY, de Carvalho KMB, Dutra ES. Grazing Behavior Hinders Weight Loss in Long-Term Post Bariatric Surgery: a Cross-Sectional Study. Obes Surg 2021; 31:4076-4082. [PMID: 34215973 DOI: 10.1007/s11695-021-05533-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 06/13/2021] [Accepted: 06/15/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Grazing behavior is common in patients undergoing bariatric surgery (BS); however, little is known about grazing behavior in operated patients in the long term. We aimed to estimate grazing frequency and its association with weight loss and surgery response in patients who had undergone BS. METHODS This cross-sectional study included 109 patients who had undergone Roux-en-Y gastric bypass at least 5 years previously. They answered questions about socioeconomic factors, surgical information, and adherence to treatment/follow-up. The Rep(eat) questionnaire was used for grazing assessment. Student's t-test and Pearson's chi-square test were used to evaluate differences between groups. Analysis of covariance and partial correlation were used to investigate grazing behavior, and weight loss outcomes were controlled for the elapsed time since BS, healthcare service type, current psychologist care status, and the presence of a constriction ring. RESULTS The mean elapsed time since BS was 9.97 ± 2.39 years. Patients with grazing behavior (67%) comprised fewer surgery responders (p = 0.019), had lower total (%TWL, p = 0.005) and excess weight loss (%EWL, p = 0.029), and received less psychological counseling (45.5% vs. 54.5%, p = 0.042). Correlations were found between the presence of grazing and its subtypes and %EWL and %TWL (T = - 0.382, T = - 0.361, p < 0.001; compulsive grazing: T = - 0.358, T = - 0.342, p < 0.001, p = 0.001; non-compulsive grazing: T = - 0.333, T = - 0.311, p = 0.001, p = 0.003). No significant difference between patients with and without grazing behavior was found for previous/current diagnoses of psychological diseases or dietitian counseling. CONCLUSION Grazing behavior is common in the long-term among patients who have undergone BS and is negatively related to weight loss parameters.
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Affiliation(s)
- Larissa Cristina Lins Berber
- Graduate Program of Human Nutrition, Department of Nutrition, Faculty of Health Sciences, University of Brasilia (UnB), Campus Universitário, Darcy Ribeiro. Asa Norte, Brasília, Federal District, 70910-900, Brazil
| | - Mariana Silva Melendez-Araújo
- Graduate Program of Human Nutrition, Department of Nutrition, Faculty of Health Sciences, University of Brasilia (UnB), Campus Universitário, Darcy Ribeiro. Asa Norte, Brasília, Federal District, 70910-900, Brazil.
| | - Eduardo Yoshio Nakano
- Department of Statistics, Institute of Exact Sciences, University of Brasilia (UnB), Campus Universitário, Darcy Ribeiro. Asa Norte, Brasília, DF, 70910-900, Brazil
| | - Kênia Mara Baiocchi de Carvalho
- Graduate Program of Human Nutrition, Department of Nutrition, Faculty of Health Sciences, University of Brasilia (UnB), Campus Universitário, Darcy Ribeiro. Asa Norte, Brasília, Federal District, 70910-900, Brazil
| | - Eliane Said Dutra
- Graduate Program of Human Nutrition, Department of Nutrition, Faculty of Health Sciences, University of Brasilia (UnB), Campus Universitário, Darcy Ribeiro. Asa Norte, Brasília, Federal District, 70910-900, Brazil
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